Clinical Surgery

Philippa A Rust

Consultant Hand and Wrist Surgeon

Philippa Rust

Consultant Hand and Wrist Surgeon, St John’s Hospital, NHS Lothian & Honorary Clinical Senior Lecturer, University of Edinburgh

Specialist Clinical Interests

Osteoarthritis at base of thumb, Ligament stability of trapeziometacarpal joint, Wrist biomechanics and motion, Anatomical studies of hand and wrist, Tendon injury rehabilitation.

Desired future Projects

Wrist motion, Use of arthoscopy in wrist surgery. Outcomes following wrist surgery.

Current Projects

Anatomical study of wrist, affiliated with Dept of Anatomy, University of Edinburgh.

Previous Projects

Instability of trapeziometacarpal joint, affiliated with Department of Anatomy, University of Edinburgh and Biomechanical Engineering Department and Orthopaedic Department , Royal Infirmary, Edinburgh. Clinical study of trapeziometacarpal joint affiliated with Department of Hand Surgery, St Vincent's Hospital Melbourne.

Qualifications

  • Diploma of Hand Surgery (University of Manchester / British Society Surgery of the Hand), November 2007
  • FRCS(Orth) (Intercollegiate), November 2006
  • MD (University College London / Royal National Orthopaedic Hospital, Stanmore), April 2004
  • MRCS (England), December 1999
  • MBBS (London), June 1996

Awards

  • Best Supervisor Award - nomination, Edinburgh University Students’ Association 2019
  • Orthopaedic Tutor of the Year - awarded 2018 RCSEd / University of Edinburgh
  • MFSTEd, Member of Faculty of Surgical Trainers - RCSEd
  • Lipmann Kessel first prize - Charing Cross Hospital, March 2003
  • St Mary’s Christmas Presentations third prize - December 2003
  • Bone Society Conference prize abstract - Maastricht Netherlands, October 2003
  • Duke of Edinburgh’s Gold Award - awarded at Buckingham Palace, July 1994
  • BMA Medical Book Awards - Highly Commended in Surgical Specialties in the 2019 for Hand Surgery: Therapy and Assessment, 2nd edition David Warwick and Roderick Dunn. Oxford University Press, October 2018. Chapter: Rust P, Birks M, Warwick D. Osteoarthritis of the Hand.

Research Grants

  • Rooney Funding, (12k) awarded 2021 for Post-doctorate to establish a proof of concept for tissue engineering with human discard tissue. Title: 'Establishing an in vitro model using human cells to tissue engineer a flextor tendon to bone construct'. P Rust PI
  • Medical Research Scotland Grant, (75k) awarded 2020 for 4 year for PhD student tissue engineering Project Title: ‘Old Problem, New Trix: Using collagen sponges to engineer bespoke bone-tendon constructs in vitro’. P Rust Co-supervisor.
  • Hand and Wrist Medical Research Foundation (£1700) and Mr Hamilton Skin Fund (£1700) awarded 2020 for 6 month BSc student project title: ‘Examination of the histology of the attachment of the scapholunate ligament to the scaphoid and lunate in the carpal bones of the wrist’. Projecto completed and paper published 2020. P Rust PO
  • Orthopaedic Research UK Grant, (50k) awarded 2019 for PhD student project entitled: ‘Modelling enthesis development in vitro to produce anatomically and clinically relevant bone-tendon constructs for flexor tendon repair’. P Rust Co-supervisor.
  • Orthopaedic Research UK Grantawarded 2016 for 3 year PhD student project entitled: ‘Anatomical design of a tissue engineered in vitro model of the human flexor digitorum profundus enthesis’. PhD submitted 2020. P Rust Co-supervisor.
  • British Association of Hand Therapists Grant, awarded 2015 for project titled: ‘A study to investigate reliability of goniometric measurements of dart throwers motion of asymptomatic wrists’. Project completed and paper published 2016. P Rust PI.
  • Australian Orthopaedic Association Research Trust Grant, awarded March 2009, Assessment of normal trapeziometacarpal joint alignment using CT imaging. Project completed and paper published 2017. Researcher P Rust.
  • Culyer Research Fund, Royal National Orthopaedic Hospital, July 2000. MD awarded 2004 to researcher P Rust.

Researcher Supervision Roles

Intercalated BSc, University of Edinburgh student project supervisor: 

  • 2019: ‘Defining the normal range of movement for Dart Thrower’s Motion (DTM) at the wrist in a healthy adult population.’
  • 2020: ‘Examination of the histology of the attachment of the scapholunate ligament to the lunate in the carpal bones of the wrist’
  • 2020: Investigation into range of dart thrower's motion at the wrist in daily activities.’ 
  • MSc student project supervisor for 7 Anatomy MSc dissertations, 2013 - present, University of Edinburgh, resulting in completed dissertation with frequent distinction marks.

PhD student co-supervisor:

  • 2016 – 2019 'Establishing an in vitro model for investigating flexor tendon to bone repair'.
  • 2019 – 2022 Modelling enthesis development in vitro to produce anatomically and clinically relevant bone-tendon constructs for flexor tendon repair’.
  • 2020 – 2024 ‘Old Problem, New Trix: Using collagen sponges to engineer bespoke bone-tendon constructs in vitro.’

Post-Doctorate supervisor:

  • 2021 – 2022 ‘Establishing an in vitro model using human cells to tissue engineer a flexor tendon to bone construct'. 

Medical student and trainee project supervision:

  • St John’s Hospital Plastic Surgery trainee papers for publication and departmental audits supervisor, especially in quality improvement of the hand service in Lothian, 2010 to date.
  • Medical student SSC4 & 5 projects supervisor for University of Edinburgh, each resulting in paper publications:
  • Elective Students from other Scottish Universities have chosen to visit our Hand Unit and I have supervised their projects. These projects mostly result in journal paper publications.

Book Chapters

  • Ahmed I. Rust P. Hand and Wrist. In: Sugand K, Gupte C, eds. ABC of Orthopaedics and Trauma. 1st ed. Oxford: Wiley Blackwell; 2018. p. 47 – 58.
  • Rust P, Birks M, Warwick D. Osteoarthritis of the Hand. In Warwick D, Dunn R, eds. Hand Surgery. 2nd ed. Oxford: Oxford University Press; 2018. P. 269-292.

Peer Review Publications: Papers

  • Liew M Y, Dingle L, Semple A, Rust P. A symptomatic review of return to work and activities after scapholunate ligament injury and treatment. In process.
  • Patera E, Rust P. Creation of 3D anatomical models illustrating an intact and centrally torn Triangular Fibrocartilage Complex for patient education prior treatment. Submitted to Anatomical Sciences Education Journal
  • Semple A, Clarke G, Rust P. Delayed failure of a two-stage secondary tendon reconstruction of flexor digitorum profundus tendon. Submitted to Hand NY.
  • Robb L, Buick T, Rust P. Skin abnormality of the hand. Submitted to BMJ. 
  • Brennan C, Mapara R, Chauhan V, Rust P. Women in Surgery Scotland: Addressing inequality in the surgical workforce and improving training for all. Submitted to BJS
  • Brennan C, Rust P, Yong L, Foley J, McKie S. The value of the distal radioulnar joint effusion in diagnosing triangular fibrocartilage complex tears on magnetic resonance imaging. In press: Archives of Bone and Joint Surgery.
  • Scutt F, Hughes D, Rust P. Maintaining surgical training during Covid 19 and redeployment: Experiences from a group of Core Surgical Trainees. In Press Postgrad Med Journal.
  • Liew M Y, Rust P, Mortimer J, Paxton J, Tham S. Examination of the histology of the attachment of the scapholunate ligament to the scaphoid and lunate in the carpal bones of the wrist. In press: Journal Wrist Surgery.
  • Stirling P, Chan C, Rust P. A reference range of Dart-Thrower’s Motion at the wrist in a healthy adult population. In press: J Hand Surg Am. 
  • Ammari T, Dores C, Ferreira F, Jordan D, Macdonald N, Rust P. Establishing local diagnostic reference levels for mini C-arm use in upper limb surgery - A step towards national audit. The Surgeon. 2020 Sept 26;S1479-666X(20)30120-7. doi: 10.1016/j.surge.2020.08.007. Online ahead of print
  • Brown MT, Rust PA. Fractures of the thumb metacarpal base. Injury. 2020 Jul 25:S0020-1383(20)30634-3. doi: 10.1016/j.injury.2020.07.053. Epub ahead of print. PMID: 32741606.
  • Lambert R, Yeoman T, Wang C, Grant J, Rust PA The effect of ring finger distal interphalangeal joint stiffness on grip strength: a simulated study in normal participants. . J Hand Surg Asian Pac. 2020 Sep;25(3):296-300. doi: 10.1142/S2424835520500319
  • Elajnaf M, Rust P, Wallace R. The Effect of Surgery for Base of Thumb Osteoarthritis on Range of Dart Thrower’s Motion at the Wrist in Cadavers. J Hand Surg Eur. 2020 Jun;45(5):495-500
  • McCann M, Rust P, Brown K, Lawrie D. Radiation exposure of patients during mini C-arm use: an audit in 2032 procedures. J Hand Surg Eur.  2019 August; 44(7): 737 – 737.
  • Robertson GA, Kiong AK, Maffulli N, Simpson CK, Rust PA. Return to sport following surgical management of triangular fibrocartilage tears: a systematic review. British Medical Bulletin. 2019 Jun 19;130(1):89-103.
  • Bond S, Rust P, Boland M. The accommodation of bone anchors within the distal phalanx for repair of flexor digitorum profundus avulsions. J Hand Surgery Am. 2019 Nov; 44(11):986. Feb 15. pii: S0363-5023(18)30234-X. doi: 10.1016/j.jhsa.2018.12.012.
  • Rust PA, Manojlovich LM, Wallace R. A comparison of dart thrower's range of motion following radioscapholunate fusion, four-corner fusion and proximal row carpectomy. J Hand Surg Eur 2018 Sept; 43(7): 718 – 722.
  • McCann MR, Rust PA, Wallace R. The Stabilising Effect of the Anterior Oblique Ligament to Prevent Directional Subluxation at the Trapeziometacarpal Joint of the Thumb: A Biomechanical Cadaveric Study. Arch Bone Jt Surg. 2018 March;6(2):105-111
  • Alanazi G, Langschmidt J, Rust PA. Investigation into the function Anatomy of the Flexor Tendon Pulley System of the Hand, International Journal of Surgery. November 2017, 47:S68
  • Rust PA, Ek ETH, Tham SKY. Assessment of normal trapeziometacarpal joint alignment. J Hand Surg Eur. 2017 July;42(6):605-609
  • Golay SK, Rust P, Ring D. The Radiological Prevalence of Incidental Kienbock Disease.  Arch Bone Jt Surg. 2016 Jun;4(3):220-3.
  • Yeoman TF, Rust PA. A rugby player's finger injury. BMJ. 2016 Apr 13;353:i1911.
  • Cliff N, Rust P. A study to investigate intra-rater and inter-rater reliability of goniometric measurements of dart throwers motion of asymptomatic wrists. Hand Therapy MArch 2016; 22(2): 58 – 64.
  • J Grant, T Reekie, P.A Rust. The effect of Flexor Digitorum Profundus on Grip Strength: A Study Examining the Functional Effect of a Single Digit Flexor Digitorum Profundus Avulsion.   Orthopaedic Proceedings 2016 June 98-B/SUPP_12/4.
  • Yong, Li Yenn, Rust, Philippa Use of a cancellous screw to allow single-piece carpal bone excision in proximal row carpectomy. Current Orthopaedic Practice March/April 2015; 26: 199–200.
  • Rust PA, Philips SA. An unusual case of triangular fibrocartilage complex tear after a wrist-lock restraint. Ann Orthop Rheumatol. 2015; 3(4): 1059.
  • Goldie S, Sargeant H, Rust P, Anderson W. A footballer’s finger injury. BMJ. 2013; 15: 347.
  • Rust P, Tham S. Ligament Reconstruction of the Trapezial-metacarpal Joint for Early Arthritis: A Preliminary Report. J Hand Surg Am. 2011; 36(11):1748-52.
  • Rust PA, Bennett T. An uncommon cause of a common problem. Hand Surgery. 2009; 14(2-3): 131-134.
  • Rust PA, Eckersley R. Twenty questions on tendon injuries in the hand. Review article. Current Orthopaedics. 2008; 22(1): 17-24.
  • Rust PA, Tanna N, Spicer DDM. Repair of ruptured quadriceps tendon with Leeds-Keio ligament. Knee Surgery, Sports Traumatology, Arthroscopy. 2008;16(4):370-372.
  • Rust PA, Kalsi P, Cannon SR, Briggs TW, Blunn GW. Will mesenchymal stem cells differentiate into osteoblasts on allograft? Clin Orthop Relat Res. 2007;457:220-6.
  • Rust PA. The day I was involved in a major incident (St Mary’s Hospital, London bombings, 7 July 2006). British Orthopaedic Association Yearbook. 2006;53.
  • Rust PA, Tingerides C, Cannon SR, Briggs TWR, Blunn GW. The effect of cryopreservation on the osteogenic potential of human mesenchymal stem cells. Cryoletters. 2006;27(1):17-28.
  • Korda M, Blunn GW, Phipps K, Rust PA, Di Silvio L, Coathup MJ, Goodship AE, Hua J. Can mesenchymal stem cells survive under normal impaction force in revision total hip replacements? Tissue Engineering. 2006;12(3):625-630.
  • O’Neil J, Rust P, Knight D, Ricketts D. Greens could be bad for you: A study of the inappropriate use of theatre greens. Southern Medical Journal. 2005;98(10):1053-4.
  • Rust P, Gill K. Dr Foster and the league tables. Fact or fiction? The Newsletter of Orthopaedic Association. 2004;30:55.
  • Keong N, Ricketts D, Alakeson N, Rust P. Pressure sores following elective total hip arthoplasty: pitfalls of misinterpretation. Annals of the Royal College of Surgeons. 2004;84:174-176.
  • Rust P, Dewar D, Shenton K, Cummins R. Breast infection with Dirofilaria repens – first reported UK case. The Breast. 2002;11(2):203-204.
  • Rust P, Hunt I, Jowett A, Rottenberg G, Wallis D. Alcohol        and X-rays in emergency department. Emergency Medicine Journal. 2001;18:460-461.
  • Rust P, Ashkan A, Ball C, Stapleton S, Marsh H. Two cases of Gliomatosis Cerebri. Journal of Clinical Neuroscience. 2001;8(4):361-3.
  • Hunt I, Rust P. Toxicology screening in Trauma. Journal of Accident & Emergency Medicine. 2001;18:147.

International and National Presentations in the last 5 years

 

  • Chan C, Stirling P, Nicola Cliff N, Rust P. The normative range of Dart Thrower's Motion at the wrist in a healthy and adult population. 75th ASSH meeting, October 2020. 
  • Rust P. Lecture: Osteoarthritis of the Base of Thumb. BSSH / BOTA Conference, RCSEd, November 2019. 
  • Elajnaf M, Rust P, Wallace R. The effect of surgery for base of thumb osteoarthritis on range of dart thrower's motion at the wrist in cadavers. 14th IFSSH, Berlin, June 2019.
  • Mortimer J, Paxton J, Rust P. Designing an anatomical and clinically relevant bone anchor for tissue engineering the enthesis at the human flexor digitorum profundus insertion. World Congress of Biomechanics. Dublin, July 2018.
  • Mortimer J, Paxton J, Rust P. Characterising the anatomy of the flexor digitorum profundus insertion to guide avulsion repair. BSSH Meeting, Edinburgh 2017
  • Yong L, Mckie S, Simpson C, Rust P. The value of a distal radial ulna joint effusion in diagnosing TFCC tears on MRI scan. BSSH meeting Edinburgh. November 2017.
  • Reid J, Winstanley J, Bucknall V, MacSween K, Rust P Don’t let the bugs bite: our experience of the management of bite injuries causing hand infection in a regional hand surgery unit. BSSH meeting, Edinburgh. November 2017.
  • G. Alanazi, J. Langschmidt, Rust PA. Investigation into the Functional Anatomy of the Flexor Tendon Pulley System of the Hand, International Conference of Surgery, London, November 2017.
  • Yeoman T, Wang C, Grant J, Rust P. The effect of ring finger DIP joint stiffness on grip strength. BSSH meeting 2017.
  • Bond S, Rust P. The use of bone anchors in the surgical repair of repair of flexor digitorium profundus avulsions: is the distal phalanx too small? BSSH Meeting, Cardiff, October 2016. 
  • Golay SK, Rust P, Ring D. The radiological prevalence of incidental Kienbock disease. BSSH meeting, Cardiff. October 2016.
  • Manojlovich LM, Wallace R. Rust PA, A comparison of dart thrower's range of motion following radioscapholunate fusion, four-corner fusion and proximal row carpectomy. BSSH Meeting, London, October 2015.
  • Cliff N, Rust P. A study to investigate intra-rater and inter-rater reliability of goniometric measurements of dart throwers motion of asymptomatic wrists. BSSH meeting, October London. 2015.

Publications: Other

  • Twelve abstracts published in peer review journals.
  • Audits: Regularly departmental audits done including: The use of a mini-c-arm and IRMER regulation compliance paper, antibiotic guidelines in Hand Surgery and Hand Trauma Service.

Teaching

I enjoy teaching, appreciating the importance of not only to meeting the need for and training surgeons of the future, but also as teaching stimulates and furthers one’s own knowledge.

Course innovation:

  • Founder of the Edinburgh Advanced Cadaveric Wrist Course in 2019.

I delivered this sell out course with a for senior trainees a subspecialty interest in Hand Surgery. It provided a fresh cadaveric limb to each delegate and all instrumentation to practice a series of more complex hand and wrist operations, with a national faculty teaching the surgical procedures and advising on technical aspects of the challenges of the surgery. The course receives excellent candidate feedback.

  • Co-founder and lead faculty of The Imperial FRCS(Orth) Clinical and Viva Revision Course. Having set up this course, as a trainee, I successfully delivered the course (October 2007/ 2008/ 2009) over 4 days in three hospitals (Charing Cross, Chelsea & Westminster, St Mary’s Hospitals) with a full faculty of 38 and student complement of 16. The course still runs annually and is now in its 12th year.
  • Course Director of Edinburgh Hand Surgery Course, which runs annually at RCSEd in Spring.

Current teaching roles:

  • St Thomas’ Hand Trauma Course, Faculty for this annual Course
  • Cardiff Cadaveric Advanced Hand & Wrist Fracture Fixation Course, Faculty
  • Edinburgh International Trauma Course, Faculty. 
  • Trauma and Orthopaedics Surgical ChM online Course RCSEd/ University of Edinburgh, Lead for Hand Surgery module.
  • Awarded Trainer of the Year for Teaching, 2018. 
  • Orthopaedic Training Committee, South East Scotland Committee Member
  • East of Scotland Core Trainee ARCP and Training Committee Member
  • Educational Supervisor for Core Trainees at St John’s Hospital, since 2014.
  • Clinical Supervisor for ST and CT trainees in Plastic Surgery at St John’s Hospital

Invited lectures include:

  • Rust P. Lecture: Osteoarthritis of the Base of Thumb. BSSH / BOTA Conference, RCSEd, November 2019. 
  • Rust P. Lecture: Being the best you can be. Women in Surgery Scotland. RCSEd 2019

Training in teaching course completed:

  • TOES training, BOA 2021
  • IST training, RSCEd 2018
  • PhD supervisor training, including training in Bias, University of Edinburgh 2016
  • Training the Trainers Course, RCSEd 2014
  • Teacher Educational Scheme, Guy’s Hospital Medical School, 1998