Overview
 Hand Surgery has a very strong and deep-rooted foundation in the history of
orthopaedic development in Hong Kong coincided with the era of industrial
blooming in the 70s and 80s. Since the inception of the department in 1983
under the leadership of Professor PC Leung and Jack CY Cheng, there had been
extensive service development, researches and publications in microsurgery,
congenital hand anomalies, tendon and nerve surgeries, as well as innovative
flaps and grafts for complex reconstructions. The establishment of the replantation
service since 1984, the setting up of the “Special Hand Clinic” and the “Congenital
Upper Limb Anomaly (CULA) Clinic” in 1985 accelerated to the formation of a
dedicated “Hand Team” in 1987 headed by
Professor LK Hung, when all hand conditions
were put under the sole responsibility of the
team. In 1994, Dr. PC Ho joined the team as
a senior medical officer and later succeeded
Professor Hung as the team head in 2007
till now. Over the past 20 years, Professor
Hung and Dr. Ho successfully introduced
endoscopic and arthroscopic surgeries in
the upper limb and became pioneers and
leaders in the field internationally. Update,
the scope of service and research extends
to elbow surgery, small joint arthroscopies,
upper limb arthroplasties including elbow,
wrist and finger joints, percutaneous and
minimal invasive surgeries, as well as supermicrosurgeries.
Clinical Service
The whole clinical team is composed of multidisciplinary professionals including surgeons,
dedicated nurses, occupational therapists and physiotherapists. The urge for resource optimization
and expertize enhancement catalyzed the formation of the cluster hand service within the New
Territories East Cluster (NTEC) of the Hospital Authority of Hong Kong in 2002. Since then, there
had been close collaboration among the hand surgeons and therapists in the Prince of Wales
Hospital (PWH), the Alice Ho Miu Ling Nethersole Hospital (AHNH) as well as the North District
Hospital (NDH), as exemplified by sharing of operating facilities and the launching of the NTEC
Cluster Replantation Team Service in June 2002, the first of its kind in Hong Kong. In 2009, the
hand surgery services in PWH and AHNH were further aligned and administered under a single
cluster hand team concept as led by Dr. PC Ho, consultant and director of the cluster hand
service. The current surgical team composed of two associate consultants, one resident specialist,
two to three trainees, with Professor LK Hung being the advisor. The annual admission is around 800 cases, with more than 530 operations (emergency and
elective) performed in PWH and about 450 elective cases operated at AHNH each year.
Besides general orthopaedic services, the Hand Team runs two special clinics in PWH: the
Special Hand Clinic which takes care of patients with complicated hand and wrist problems
requiring intensive monitoring and tailor made rehabilitation, and the CULA clinic which takes care
of children with congenital differences in the hand and upper limb as well as those complicated
pediatric hand and upper limb injuries. Both clinics are attended by dedicated therapists to
enhance communication and fine tuning of the rehabilitation protocol to meet the special need and
progress of individual patient. With similar concepts, a HARP (Hand Ambulatory Rehabilitation
Program)clinic was established in AHNH since March 2010 by Dr. Sally Cheng. Supported by a
sophisticated Pre-Operative Anaesthetic Clinic (POAC) service, most of the hand cases (including
infants and children) operated in AHNH under general anaesthesia can be discharged on the
same day of admission.
The scope of service includes managing patients of all ages suffering from hand and wrist bony
and soft tissue injuries, brachial plexus injuries, problematic wounds in upper limbs, amputations,
infection, tumour, tendinopathies, entrapment neuropathies, post-traumatic, inflammatory and
degenerative arthritis and disorders of the elbow, wrist and hand, tetraplegic and spastic upper
limb functional reconstruction, post-burn reconstruction and congenital differences of upper limb.
The scope of expertise includes microsurgical repair of limbs, digits and fingertips, various types
of local, distant and free flaps in wound coverage and functional reconstructions, nerve repair and
brachial plexus reconstructions and joint replacement in small joints of the upper limb. Around
20 to 30 replantation cases are performed by the cluster replantation service team annually
involving surgeons of PWH and AHNH (Dr. WL Tse, Clara Wong, Sally Cheng, Esther Chow, PC
Ho) and NDH (Dr. HW Yiu). In particular, in the past 16 years, a major emphasis and intensive
effort had been put on the advancement and the extended clinical application of arthroscopy and
minimal invasive surgery in the wrist and hand, and lately in the elbow joint. The evolving concept
and sophistication in skill enabled most if not all articular problems of the wrist to be managed
arthroscopically. More than 150 wrist, elbow and finger joints arthroscopies and more than 100
endoscopic carpal tunnel release are performed by the cluster hand team each year.
Future direction
Over the past three years Dr. Clara Wong has made considerable breakthroughs and established
a solid foundation in elbow surgery especially on arthroscopic surgery and arthroplasty, and
has streamlined the rehabilitation and research protocol. Dr. Esther Chow succeeded the noble
tradition and continued to develop a more mature service and registry for congenital upper limb
differences. Certainly these are other important foci that our team is committed to develop and
advance. Besides, we have launched into the field of navigation and computer aided surgeries in
tumour resection, osteotomy and fracture fixation, super-microsurgery of free perforator flaps and
lymphatic surgery, endoscopic flap harvest, innovative arthroscopy and reconstructive surgery of
the wrist and elbow including new implant designs and materials.
Research
Clinical research has been an integral part of the team development and core value since its
establishment. Extensive output has been produced by Professor PC Leung in microsurgeries,
including the report of the first hand replantation in Hong Kong in 1975, and numerous publications
in the application of toe to hand transfer and burn hand reconstructions. Publications and
researches in congenital differences included epidemiology, classification and management
strategy on extra-thumb, innovative surgeries such as free hemi-metatarsal bone graft for
hypoplastic thumb reconstruction, pulp island flap augmentation of extra-thumb, syndactyly
correction without need for skin graft, preservation of a 5 fingers hand in Apert’s syndrome etc.
Nerve surgeries included outcome study on various minimal invasive carpal tunnel releases,
medial epicondylectomy for cubital tunnel syndrome, as well as an anatomical study in
musculocutaneous nerve and application in functional muscle transfer, to name a few.
Publications on wrist surgery included wrist arthroscopy under portal site local anaesthesia,
novel technique of arthroscopic resection of volar wrist ganglion, new classification system for
scaphoid fractures, percutaneous scaphoid screw fixation and management of ulnar wrist pain
following distal radius fractures. A significant breakthrough was the arthroscopic bone grafting for
scaphoid nonunion developed by Dr. PC Ho and Professor LK Hung in 1997 and is now being
popularized internationally. Other innovations and original ideas included arthroscopic assisted
TFCC reconstruction with tendon graft, arthroscopic carpectomy and limited carpal fusion, as
well as arthroscopic osteochondral bone grafting for cartilage defects. Our outstanding research
works won multiple awards at major meetings, including the Hodgson Award for 4 times and the
Arthur Yau Award for 3 times at the Annual Congresses of the Hong Kong Orthopaedic Association
between 1995 and 2010. Team members also won the Best Paper Awards at the Annual
Congresses of the Hong Kong Society for Surgery of the Hand 8 times between 1998 and 2009.
In 2012, Dr. PC Ho was granted with the Terry Whipple Prize at the Congress of the Federation
of European Societies for Surgery of the Hand in Antwerp, Belgium to honour his achievement in
wrist arthroscopic surgery.
On the collaboration side, we worked with the stem cell research team under direction of Professor
Li Gang on the possibility of delivering mesenchymal stem cells for wrist cartilage regeneration in
minimally invasive surgical manner. Besides, there were extensive input from the Department of
Diagnostic Radiology and Organ Imaging, leaded by Professor James Griffith, Alex Ng and Ryan
Lee, enabling valuable study such as assessment of the blood flow of scaphoid nonunion with
MRI and the correlation of MRI with arthroscopic findings to be on print. More clinical –radiological
studies will be conducted through our close collaboration and eagerness to explore and discover
from different perspectives.
Teaching and Training
Our team provides undergraduate teaching for medical students of the Chinese University of
Hong Kong in Year 1, 4 and 6 and also trainees from various orthopaedic and surgical units over
Hong Kong. We established the first basic microsurgery training course in Hong Kong in 1986 with
annual intake of 20 surgeons, followed by the advanced course in 1993. Currently we conducted
two courses each year providing microsurgical training for trainees and specialists of different
disciplines, local and overseas, including orthopaedics, general surgery, ENT and plastic surgery
etc.
Since 2000, with the support of HKSSH and the Orthopaedic Learning Center, we have conducted
numerous cadaveric workshops led by world experts on elbow arthroscopy, upper limb arthroplasty
on elbow, wrist and hand, scaphoid fracture fixation, flap dissection and tendon repair etc.
The most well known workshop is the Annual Wrist Arthroscopy Workshop founded in 1997 by
Professor LK Hung as part of an advanced training course for orthopaedic surgeons from the
Mainland China. Dr. PC Ho succeeded the directorship in 2008 and transformed the event into
an international one with teaching faculty and participants from worldwide. Over the past 5 years,
participant number raised from 58 to over 120, and participating countries or areas from 16 to
22, covering most of the Asia-Pacific countries and many in Europe and America. To date over
700 surgeons worldwide have benefitted from the workshops and many have commenced wrist
arthroscopic surgery in their clinical practices. Our training programme had drawn numerous
hand surgeons from China, Taiwan, Asian-Pacific countries and Europe to become our clinical
fellows for varied duration. Our reputation also gained the visit of a number of Bunnell’s Travelling
Fellows of the American Society for Surgery of the Hand since 1992. In addition, we have inspired
many centers in the region including Taiwan, Singapore, Wenzhou, Shanghai and lately in Ningbo
China to set up wrist arthroscopy courses on a regular basis. Since 2009, we have been playing
instrumental roles in the wrist arthroscopy workshops in conjunction with the European Wrist
Arthroscopy Society (EWAS) twice every year at both Lukang, Taiwan and Strasbourg, France.
The establishment of these international interactions and fraternity has certainly enhanced the
transfer of knowledge and skill, exchange of new ideas and concepts, research collaboration, and
promotion of arthroscopic surgery of the hand and wrist in a worldwide scene.
Highlights
 Arthroscopic Reconstructive Wrist Surgery
 Congenital Hand Surgery
 Small Joint Replacement
 Microsurgery
Finale
Hand surgery represents one of the most challenging fields in surgery: fascinating surgical
technique; precise handling of bone, joint and soft tissue; application of different amours including
microsurgery, arthroscopy, arthroplasty, navigation and even robotic surgery.
In the Future, our team will continue to face all the new challenges and continue to strive for the
best in clinical service, research, training and teaching in the field of hand surgery.
 Team Gathering with our Singapore Fellow, 2012
 1st Wrist arthroscopy course in 1997  1st International wrist arthroscopy workshop in 2008
 Prof. Berger visit in 1997 |
