gms | German Medical Science

Objectives/Interrogation: Despite growth in hand/upper extremity investigation, truly impactful studies have not been thoroughly identified. While previous studies were limited to a subspecialty-specific scope, this study sought to identify (by citations) and characterize the most impactful papers in hand/upper extremity over the last 25 years.

Methods: The top 1,000 cited studies published between 1992 and 2018 related to the hand/upper extremity were identified with Thomson ISI Web of Science. Studies were organized in descending order by number of citations, and the title and abstract of each study was screened for relevance. Following exclusion of unrelated studies, the top 100 articles by number of citations were identified and reviewed to identify study type, institutional origin, level of evidence, and journal impact factor.

Results and Conclusions: Among the top 100 studies, all were cited ≥ 100 times, and the mean number of authors and citations were 4.51 and 169.4, respectively. The top five study types were case series (n=52), randomized controlled trial (n=17), prospective cohort (n=16), retrospective cohort (n=8), and basic science (n=4). The topics covered were mostly commonly related to shoulder (n=34), wrist/forearm (n=21), hand (n=17), and elbow (n=14). Among shoulder studies, rotator cuff injuries (n=18) were most common, while distal radius fractures (n=12) were most common among wrist/forearm studies and nerve/nerve repair (n=10) among hand studies. Most studies were published from institutions originating in the USA (n=63). The journal that published the most among the top 100 cited was the Journal of Hand Surgery-American Volume (JHS Am, n=33), with 5,092 citations three among the top 10. Mean journal impact factor was 3.29. The majority of studies were of level IV (n=51) and level II (n=16) evidence. However, the number of level I studies has increased since 1992 (3 in 1992-2006 vs. 5 in 2007-2011). The impact of more recent studies is greater, with mean citations per year in 2011 at 82.7/year, compared to 16.1/year in 1992 (R2=0.54). In conclusion, mean citations per year have progressively increased over the past quarter century. The majority of the top 100 articles were published in the JHS Am, were case series, and focused on the shoulder. The majority were level IV or II, retrospective, and non-randomized studies, emphasizing the call for higher-quality, prospective, randomized trials to bolster evidence-based practice.