Introduction

The last decade has seen an exponential increase in the published scientific literature on hand surgery as demonstrated in Figure 1. However, it is difficult to determine which of these articles have made the most impact and advanced the field of hand surgery. While most academics agree that the goal of research is to produce original, high-quality literature; only a small proportion of published literature is genuinely additive to the established knowledge base.

The relevance of publications in a particular field can be determined by the number of citations received from peers. Citations are acknowledgements given by an author to their peers for previous work undertaken in that field of study. The larger the number of citations an article has received, the more impact it is likely to have had in that field of study. Therefore, we performed a bibliometric analysis to identify the 100 most cited articles in hand surgery in the decade from 2012 to 2022 (Table 1).

Fig 1
Fig 1.The number of articles found on PubMed using the search term ‘hand surgery’, showing an increase from 2012–2022 compared with the previous 40 years

Methods

The comprehensive citation database of the Web of Science (Clarivate, Philadelphia, USA) was used to identify the 100 most cited articles in the field of hand surgery from February 2012 to February 2022. The first and second authors independently searched all publications in English language literature using the key words ‘hand’ and ‘surgery’. The full text of all articles was carefully reviewed and lists were collated of articles deemed relevant to the field. A summative list of articles was created incorporating those that featured in the lists of both authors. A conference was held to determine if articles featured on a single list should be incorporated in the final list of 100 most cited articles and a decision was reached by consensus. Using the method previously described by Joyce and colleagues,1 we further analysed each article not limited to the subject matter, journal of publication, authorship, institution, country and year of publication.

This study was undertaken in accordance with the Declaration of Helsinki and adhered to Good Clinical Practice guidelines.

Results

The 100 most cited articles in hand surgery in the last decade (Table 1) were on average cited 75 times with a standard deviation of 28 citations. The most cited article had 179 citations and the least cited article had 47 citations.

Table 1.List of 100 most cited articles in hand surgery from 2012–2022
Rank Reference Citations Rank Reference Citations
1 Kim and colleagues2 179 51 Huang and colleagues66 65
2 Johnson and colleagues14 161 52 Vujaklija and colleagues68 64
3 Helmerhorst and colleagues34 150 53 Fowler and colleagues70 64
4 Karl and colleagues37 146 54 Williksen and colleagues4 64
5 Shores and colleagues39 145 55 Lin and colleagues74 63
6 Monstrey and colleagues42 139 56 Wall and colleagues76 61
7 Jain and colleagues45 136 57 Koskinen and colleagues79 61
8 Schneeberger and colleagues47 135 58 Cho and colleagues82 61
9 Sabatino and colleagues15 129 59 Dario and colleagues84 60
10 Stanek and colleagues51 120 60 Fufa and colleagues87 60
11 Voskuijl and colleagues52 105 61 Hershman and colleagues90 60
12 Bot and colleagues12 102 62 Lanting and colleagues92 59
13 Naranje and colleagues56 101 63 Goldhahn and colleagues94 59
14 Ayers and colleagues59 100 64 Peimer and colleagues96 58
15 Wilcke and colleagues17 100 65 Shauver and colleagues99 58
16 Karantana and colleagues21 100 66 Saltzman and colleagues102 58
17 Tang24 100 67 Martin-Ferrero32 58
18 Doring and colleagues65 98 68 Alt5 58
19 de Jong and colleagues25 96 69 Vloemans and colleagues36 58
20 Wu and colleagues30 94 70 Moriya and colleagues26 57
21 Hah and colleagues13 94 71 Bawa and colleagues41 57
22 Peimer and colleagues73 93 72 Kloppenburg and colleagues44 56
23 Tyser and colleagues75 92 73 Starr and colleagues27 56
24 Peimer and colleagues78 91 74 Wang and colleagues49 56
25 Sayegh and colleagues81 87 75 Roh and colleagues23 56
26 Dumanian and colleagues83 85 76 Boeckstyns and colleagues3 56
27 Schweizer and colleagues86 85 77 Bentohami and colleagues18 55
28 Osbahr and colleagues89 84 78 Pan and colleagues55 55
29 Tang and colleagues91 84 79 Reith and colleagues58 54
30 Waljee and colleagues16 83 80 del Pinal and colleagues61 54
31 Bauermeister and colleagues7 81 81 Chaudhry and colleagues19 53
32 Lalonde and colleagues98 77 82 Tang and colleagues29 53
33 Lalonde101 74 83 Beckmann and colleagues64 52
34 Ariyan and colleagues6 74 84 Diaz-Siso and colleagues67 52
35 Masquelet33 74 85 Graham and colleagues69 52
36 Hop and colleagues35 72 86 Kirchberger and colleagues71 52
37 Menendez and colleagues38 72 87 Atzei and colleagues72 52
38 Kitay and colleagues40 71 88 Tang28 51
39 Spaans and colleagues43 71 89 Gart and colleagues77 51
40 Lalonde and colleagues46 71 90 Guse and colleagues80 50
41 Kinaci and colleagues48 70 91 Chan and colleagues8 50
42 Lalonde50 70 92 Shibuya and colleagues85 50
43 Lutz and colleagues22 70 93 Grodzinsky and colleagues88 49
44 Walenkamp and colleagues53 69 94 Dwyer and colleagues11 48
45 Butzelaar and colleagues54 69 95 Rinker and colleagues93 48
46 Lalonde and colleagues57 68 96 Bain and colleagues95 48
47 Strazar and colleagues60 68 97 Wijk and colleagues97 48
48 Lalonde and colleagues62 68 98 Boeckstyns and colleagues100 48
49 Filardo and colleagues63 66 99 Roh and colleagues103 47
50 Esenwein and colleagues20 65 100 Van der Avoort and colleagues104 47

In total, 36 journals contributed to the 100 most cited articles in hand surgery from 2012 to 2022. Table 2 highlights the six prominent journals (impact factor ranging from 1.907 to 5.284) that published 60 per cent of these articles. Further analysis revealed that 20 per cent of these were ‘review articles’.

Table 2.Journals that contributed most frequently to the 100 most cited articles in hand surgery from 2012–2022
Journal Impact factor Number of articles
Journal of Hand Surgery (American Volume) 2.230 21
Journal of Bone and Joint Surgery (American Volume) 5.284 10
Journal of Hand Surgery (European Volume) 2.648 9
Plastic and Reconstructive Surgery 4.763 8
Clinical Orthopaedics and Related Research 4.176 6
Hand Clinics 1.907 5

Eight authors contributed to 35 per cent of the 100 most cited articles in hand surgery in the last decade (Table 3). Authorship demonstrated a gender predilection with only 17 per cent contributed by female authors. North American authors contributed to 70 per cent of these articles as demonstrated in Figure 2. Authors from countries in the Asia-Pacific region contributed to 12 per cent of these articles with most contributions from the People’s Republic of China. Plastic and reconstructive surgeons and orthopaedic surgeons contributed equally to this literature on hand surgery. Additional contributors were not limited to trauma surgeons, neurosurgeons, rehabilitation physicians and academics in the field of basic science and physical therapy.

Table 3.Authors who contributed most frequently to the 100 most cited articles in hand surgery from 2012–2022
Author Gender Department Institution Country Number of articles
Lalonde D M Plastic and reconstructive surgery Saint John Regional Hospital; Dalhousie University Canada 7
Ring DC M Orthopaedic surgery Massachusetts General Hospital USA 7
Tang JB M Orthopaedic surgery Affiliated Hospital of Nantong University China 5
Chung KC M Plastic and reconstructive surgery University of Michigan USA 4
Middelkoop E F Plastic, reconstructive and hand surgery Vrije Universiteit Amsterdam Netherlands 3
MacDermid JC F Physical therapy University of Western Ontario Canada 3
Goslings J M Trauma surgery Academic Medical Centre; University of Amsterdam Netherlands 3
Peimer CA M Orthopaedic surgery UP Health System—Marquette; Michigan State University USA 3

F = female; M = male

Fig 2
Fig 2.Distribution by continent of authors contributing to the 100 most cited articles in hand surgery from 2012–2022

The most cited (179 citations) article is a prospective evaluation of postoperative opioid consumption in 1416 patients undergoing outpatient upper-extremity procedures over a six-month period performed at the Rothman Institute, Thomas Jefferson University, Philadelphia.2 It demonstrated that patients are being prescribed three times greater opioid medications than required and therefore proposed prescribing guidelines based on anatomical locations and procedure types to customise opioid prescription.

Discussion

This bibliometric analysis lists the 100 most cited articles in hand surgery over the last decade in English language literature to provide junior hand surgeons and academics with valuable sight into profound advancements. This list features some landmark trials, review papers and consensus guidelines that should form part of the armamentarium of knowledge of the hand surgeon.3–8

The number of times an article was cited by peers was used as a surrogate to determine the articles that have most significantly impacted this field and therefore its scientific merit. Each citation reflects an assessment by the author as to which article is interesting and relevant to their study. The average number of citations per article was 75 (range 47–179). In comparison, the average number of citations per article was 274 (range 165–1007) in plastic and reconstructive surgery and 405 (range 278–1013) in general surgery.9,10 It should be noted that articles published from 2020 to 2022 did not feature in this list, because of the inherent flaw of bibliometric analysis using citations, as these articles did not have enough time to accumulate adequate citations.

This study is a continuation of the initial work by Joyce and colleagues that examined the 100 most cited classic papers in hand surgery from 1945 to 2013.1 While historically, the prominent publications were limited to three source journals namely the Journal of Hand Surgery (American Volume), Journal of Hand Surgery (European Volume) and Hand Clinics; in the decade from 2012–2022 source journals also included but were not limited to the Journal of Bone and Joint Surgery (American Volume), Plastic and Reconstructive Surgery and Clinical Orthopaedics and Related Research.1 This spread of prominent articles across more source journals might be due to the increase in the number of journals, digitalisation of content, ease of access and the open-source movement.

Pain management was a central theme that featured in 18 of these 100 articles, particularly focused on reduction of opioid prescription.11–16 This demonstrates a paradigm shift in research focus from anatomical or cadaveric studies and examination of reliability of clinical and radiological investigations that featured prior to 2012.1

Distal radius fractures and management was another major area of focus. The most cited (100 citations) article in this theme examined the Swedish (Stockholm) registry data of 42,583 patients to perform a descriptive analysis of the incidence and demographics of distal radius fractures and described the shift in surgical management from external fixation to open reduction and fixation with plating.17 Other articles in this theme examined various modalities of management (non-surgical, external fixators, percutaneous Kirschner-wires, palmar and volar plates) of distal radius fractures and described their respective complications.18–23

Another major area of research was tendon injuries and repair. The most cited (100 citations) article in this theme was a review article that examined reports of outcomes of flexor tendon repair and elaborated on the problems associated with such surgeries.24 Other articles in this theme investigated the incidence of tendon injuries, various surgical techniques for repair and rehabilitation protocols.25–30 The interest in these areas of research appears similar to that in the period prior to 2012.1

The impact factor of the source journals does not appear to predict the number of articles they contributed to the 100 most cited list. The impact factor helps gauge the quality of academic journals and is calculated by dividing the number of article citations from a journal by the number of articles in that journal over a two-year period.31 This metric has a significant limitation in that it ascribes undue significance to work in fields with a larger readership. The Journal of Bone and Joint Surgery (American Volume) (5.284), Plastic and Reconstructive Surgery (4.763) and Clinical Orthopaedics and Related Research (4.176) appeal to the wider population of orthopaedic and plastic and reconstructive surgeons, while the Journal of Hand Surgery (American Volume) (2.230), Journal of Hand Surgery (European Volume) (2.648) and Hand Clinics (1.907) have a smaller audience of hand surgeons.

The purpose of bibliometric analysis is to transform something intangible, scientific quality, into a tangible entity. Patent analysis is another method to assess scientific merit as it quantifies materialisation of technologies. However, this is limited by undue emphasis on industry-funded research. Alternative metrics such as altmetrics focus on online activity to examine exchange and discussion both within the academic community and beyond. Altmetrics is a more recent tool and attention can be positive or negative. Scientific merit can also be assessed by research accolades and conference presentations. Due to the inherent biases in these techniques, they were not incorporated in this study.

This study has limitations inherent to all bibliometric analyses. The use of citations to gauge the significance and impact of articles is subject to citation bias. Some authors preferentially cite their own work or that of their colleagues to improve their bibliometrics. Moreover, non-English language publications have a smaller audience, limiting their exposure and ability to acquire more citations. The phenomenon of ‘incomplete citing’ refers to the practice of referencing in order to persuade the reader rather than to acknowledge substantial pre-existing work in the field.1,31 Despite these biases, the top 100 most-cited articles in hand surgery are a good representation of substantial work in the last decade.

Conflict of interest

The authors have no conflicts of interest to disclose.

Funding declaration

The authors received no financial support for the research, authorship, and/or publication of this article.

Revised: November 11, 2023 AEST