Hand Surgery
Introduction
Surgical treatment includes
open or endoscopic release of the carpal tunnel. Carpal tunnel release (CTR)
surgical procedure is the most common hand and wrist surgery in the USA, with
over 400,000 procedures per year and relatively high social and economic costs
that exceed USD 2 billion, annually.
The development of hand
surgery and the education of hand surgeons in America in the twentieth century
are commonly attributed to Sterling Bunnell, a general surgeon who developed a
keen interest in surgery of the hand. His seminal article describing tendon
repair in 1918 initiated focused interest in this field. Bunnell’s involvement
in hand surgery greatly increased as a result of the Second World War, when US
Army Surgeon General Norman Kirk recognized the need for specialized surgeons
and coordinated care to treat the various extremity injuries seen in combat. As
a result, a formal system of treating hand injuries was begun. Hand surgery
became a more specific specialty in the 1940s with the development of regional
hand centers, the formation of hand societies, and publication of the
monograph: Surgery of the Hand.
Since that time clinical
interest in surgery of the hand has increased dramatically. The body of
literature germane to hand surgery blossomed between 1950 and 1990, when hand
surgery moved from the exclusive treatment of extremity trauma to include more
diverse care such as reconstruction for arthritis and microsurgical tissue
transfer. The formation of hand societies, including the American Society for
Surgery of the Hand (ASSH) in 1946 and the American Association for Hand
Surgery (AAHS) in 1970 has led to the development of more formal practice
guidelines, a rigorous training system, and focused research with dedicated
scientific journals as well as added certification in hand surgery by the
American Board of Orthopedic Surgery, American Board of Surgery, and American
Board of Plastic Surgery. The literature has broadened in scope to include all
facets of adult and pediatric hand surgery.
Few authors have endeavored
to describe the “classic” papers in the hand surgery literature. In one
article, 26 papers and chapters were identified within 13 clinical categories
and selected based on the author’s opinion and experience. Another grouping of
seminal articles within the field is Stern’s “Selected Readings in Hand
Surgery,” where approximately 500 articles were identified based on their
educational value for residents and fellows.
Despite the large volume of
publications and the aforementioned grouping of classic papers, there have been
no studies identifying in an objective, scientific manner the manuscripts with
the most impact from the dedicated hand, orthopedic, and plastic surgery
journals. The goal of this study was to identify the 50 most cited articles in
hand surgery and to identify and categorize the subject matter described within
A literature search was
performed to identify highly cited articles from the following six scientific,
peer-reviewed journals from their inception to the present: Journal of Bone and Joint Surgery (JBJS)
American Volume, Journal of Bone and
Joint Surgery (JBJS) British Volume,
Plastic and Reconstructive Surgery (PRS), Journal of Hand Surgery (JHS)
American Volume, Journal of Hand Surgery
(JHS) British and European Volume, and
Hand.
A literature search was
performed on January 1, 2010, via Thomson/Reuters Web of Knowledge to identify
the most cited articles in each of the aforementioned journals, and the top
articles were then cross-checked for accuracy of content with the Medline
database. Along with basic information about an article (such as author, title,
date of publication), the Thomson/Reuters search engine provides information
about the number of times that a particular article has been cited by other
articles.
To obtain this citation
information, we entered the Thomson/Reuters Web of Knowledge search engine
online. This allows for search by “publication name,” and we independently and
serially input each of the six journals used for this manuscript. All published
articles for a given journal were then identified; the list was then sorted by
“times cited.” For the purpose of this study, we sorted articles from each
journal by times cited, from highest to lowest.
The top 1,000 highly cited
articles for each of the six journals were identified in the above manner and
collected into a spreadsheet. For the journals that have a more broad focus
than just hand surgery (Plastic and Reconstructive Surgery, JBJS American, JBJS
British), the senior author reviewed each article, starting with the most
highly cited, and then separated the top 50 that explicitly reported about hand
surgery. For the hand surgery specific journals (JHS American, JHS British and
European, Hand), the top 50 cited articles were chosen.
The top 50 highly cited
articles for each of the six journals were then combined into one spreadsheet
(total of 50 × 6 = 300
articles) and sorted by times cited. The top 50 of the combined articles were
selected to be the subject of this study. Each of these articles was then
cross-checked against the Medline database to check accuracy of content and
applicability to hand surgery. If there were any discrepancies, the original
article was checked and kept in the study if accurate or discarded from the
study if inaccurate.
The top 50 highly cited
articles were then sorted by number of citations, both in absolute number and
also stratified by citations per year. This was done to eliminate the bias
associated with publication year as older articles have had more time for
citation. These 50 articles were further classified by surgical/anatomic topic
(distal radius fracture, carpal tunnel syndrome, flexor tendon repair, wrist
kinematics, triangular fibrocartilage complex (TFCC), scaphoid fracture and
management, wrist instability, and nerve repair/grafting), type of study
(clinical or experimental—defined as human vs. non-human subjects), and study
sub-type: anatomical/functional, discovery/classification, innovation,
validation, or outcomes. Anatomical/functional refers to a study that
investigated the structural or mechanical components of the hand (an example of
this would be a study of the ligaments surrounding the carpometacarpal joint of
the thumb). Discovery refers to a study that led to the identification of a
physiologic or clinical principle (an example would be the discovery that
pressures in the carpal tunnel are elevated in carpal tunnel syndrome).
Innovation refers to studies in which a novel technique or idea is presented;
i.e., a new drug or surgical technique. Validation refers to a study that
validated a questionnaire or survey (i.e., validation of the DASH survey). All
clinical studies were further sub-categorized by level of evidence and whether
they were therapeutic, prognostic, diagnostic, or economic in nature.
The distribution, by topic,
of the 50 most highly cited hand surgery articles was compared to the
distribution of all indexed publications (Medline search) of these same topics.
To obtain a thematic
distribution for the 50 most highly cited articles, the number of articles
identified per category was divided by 50 and a percentage obtained, i.e.,
(scaphoid articles/50) %. To obtain a comparative thematic distribution from
all hand-surgery-related topics, a search was done for the term “hand surgery”
and the total number of articles identified, followed by a search for each of
the aforementioned categories (i.e., “scaphoid fracture” or “distal radius
fracture”). Next, the number of articles in each of these specific categories
was divided by the total number of indexed “hand surgery” articles to result in
a percentage of the total articles per category (i.e., scaphoid articles/total
hand surgery articles %). The 50 most highly cited articles and all articles
related to hand surgery were compared; analysis was performed using a Pearson
correlation.
Lastly, the educational
relevance of these papers was assessed by comparing these articles to published
lists of “classic” papers in hand surgery and to Stern’s Selected Readings in
Hand Surgery used for educational purposes.
Statistical Analysis
Statistical analysis was
performed using a Pearson correlation between groups, with an absolute value
closer to 1 indicating greater correlation.
Results
Fifty articles were
identified as the most highly cited within the hand surgery literature (see
Table 1). The number of total citations per article ranged from 133 to 553
(mean 210), and the number of citations per year ranged from 5.79 to 30.6 (mean
8.50). Thirty-six of these articles were found to be consistently highly cited
since publication, defined as more than seven citations per year. These highly
cited articles were published in five of the six searched journals.
Jan Ricks Jennings, MHA, LFACHE
Senior Consultant
Senior Management
Services
412.913.0636 Cell
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JanJenningsBlog.Blogspot.com
November 21, 2021
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