High-impact articles in hand surgery.

BACKGROUND: There have been few attempts to identify classic papers within the hand surgery literature. This study used citation analysis to identify and characterize the top 50 highly cited hand surgery articles published in six peer-reviewed journals.

METHODS: The 50 most highly cited hand surgery articles were identified in the Journal of Bone and Joint Surgery (JBJS) American, JBJS British, Plastic and Reconstructive Surgery, Journal of Hand Surgery (JHS) American, JHS British/European, and Hand. Articles were evaluated for citations per year, surgical/anatomical topic, and type of study. Clinical studies were further sub-categorized by level of evidence. The distribution of topics was compared with all indexed hand surgery articles. The educational relevance was assessed via comparison with lists of "classic" papers.

RESULTS: The most common subjects were distal radius fracture, carpal tunnel syndrome, and flexor tendon repair. There was moderate correlation between the distribution of these topics and all indexed hand surgery articles (rho = 0.71). There were 31 clinical studies, of which 16 were therapeutic, ten were prognostic, and five were diagnostic. These articles assessed the outcomes of an intervention, described an anatomical/functional observation, introduced an innovation, presented a discovery/classification, or validated a questionnaire. There were only three randomized trials. Using citations per year to control for the influence of time since publication, 36 articles were consistently highly cited. Twenty-three articles were on Stern's Selected Readings in Hand Surgery, considered important in education.

CONCLUSIONS: The top 50 highly cited articles in hand surgery reflect the most common clinical, scientific, and educational efforts of the field.