The 100 Most Impactful Papers in Hand and Upper Extremity Surgery over the Last 25 Years: A Bibliometric Analysis of the Orthopaedic Literature.

Introduction  Despite growth in hand/upper extremity investigation, impactful studies have not been thoroughly identified. Previous studies have been limited in scope. This study sought to identify and characterize the most impactful orthopaedic papers in hand/upper extremity over the past 25 years. Materials and Methods  The top 1,000 hand/upper extremity orthopaedic studies published from 1992 to 2017 were identified with Web of Science. After screening for relevance in order of decreasing citation number, the top 100 articles were identified for bibliometric analysis. Results  The mean number of authors and citations were 4.51 (range, 1-21) and 169.4 (range, 105-863). Common study types included, case series ( n = 52), randomized controlled trial ( n = 17), and prospective cohort ( n = 16), which predominantly covered topics related to shoulder ( n = 34), wrist/forearm ( n = 21), and hand ( n = 17). Among wrist/forearm and hand studies, distal radius fractures ( n = 12) and nerve-related topics ( n = 10) were most frequently analyzed. Most studies were of level IV ( n = 51) and level II ( n = 16) evidence. Recent studies had greater impact (mean citations/year: 2011, 82.7/year vs. 1992, 16.1/year). Conclusion  Most of the 100 top orthopaedic articles in hand/upper extremity were of level IV or II evidence, retrospective, and nonrandomized. Despite an observed recent increase in level I studies, a lack of prospective, randomized trials is apparent.