The 100 most cited articles in hand surgery from 2012–2022: a bibliometric analysis

Introduction : There has been an increase in the volume of scientific literature over the last decade in the field of hand surgery. The purpose of this bibliometric analysis was to ascertain the articles that have significantly contributed to advancements in hand surgery. Methods : The Web of Science database was used to produce a list of the 100 most cited articles from February 2012 to February 2022. The full text of all articles was carefully examined for further descriptive analysis not limited to subject matter, journal of publication, authorship, institution, country and year of publication. Results : The 100 most cited articles were cited on average 75 times. The most cited article was cited 179 times. Subject matter was not limited to


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).

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.
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'.
Eight authors contributed to 35 per cent of the 100 most cited articles in hand surgery in the last decade (   The most cited (179 citations) article is a prospective evaluation of postoperative opioid consumption in 1416 patients undergoing outpatient upper-extremity procedures over a sixmonth period performed at the Rothman Institute, Thomas Jefferson University, Philadelphia. 2It 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.[5][6][7][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 Australasian Journal of Plastic Surgery | ISSN: 2209-170X The 100 most cited articles in hand surgery from 2012-2022: a bibliometric analysis 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. 9,10t 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.
][13][14][15][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[20][21][22][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. 246][27][28][29][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. 31his 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)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. 1,31Despite these biases, the top 100 most-cited articles in hand surgery are a good representation of substantial work in the last decade.

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

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

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The 100 most cited articles in hand surgery from 2012-2022: a bibliometric analysis

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

Table 2 . Journals that contributed most frequently to the 100 most cited articles in hand surgery from 2012-2022 The 100 most cited articles in hand surgery from 2012-2022: a bibliometric analysis
F = female; M = male

,
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.