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The Changing Paradigm of the Hand Surgery Technique Article

Shin, Alexander Y. MD

Techniques in Hand & Upper Extremity Surgery: September 2013 - Volume 17 - Issue 3 - p 123
doi: 10.1097/BTH.0b013e3182a2aef6

Mayo Clinic, Rochester, MN

Conflicts of Interest and Source of Funding: The author reports no conflicts of interest and no source of funding.

Address correspondence and reprint requests to Alexander Y. Shin, MD, Mayo Clinic, Rochester, MN 55906. E-mail:

During my Orthopedic Residency in the 1990s, journal articles in hand surgery were typically scientific reports, reviews of specific topics, and case reports. The primary source of the technique-related literature were textbooks—Green’s Hand Surgery, Rockwood and Green’s Operative Orthopedics, and various Atlas’s of Hand Surgery Techniques. Textbooks were my primary source for learning surgical techniques, surgical anatomy, rehabilitation protocols, complications, and expected outcomes. The downside to textbooks were the long turnover times to the next edition, with many chapters being “recycled” and little being reported new in surgical techniques.

During my residency and fellowship training, the VHS video surgical techniques produced by various societies were the best supplement to the textbook descriptions of surgery. These technique videos were expensive, and often not quickly accessible to trainees preparing for surgery the night before.

In 1997, the paradigm shifted when the Techniques in Hand and Upper Extremity was introduced. I was finishing my hand surgery fellowship and received an introductory copy of the first article in the first issue. My first thought was: another journal—how am I to keep up with all this information. At a time when the number of journals was exploding, this journal happened to be unique—it would be a journal dedicated to presenting the latest surgical techniques, updates on the newest equipment, and progress in therapies of the upper extremity. Reluctantly, I read the first article in the first edition, “A fiber splitting capsulotomy technique for dorsal exposure of the wrist” by Drs Berger and Bishop.1 I soon adopted this technique and it became my standard dorsal approach to the wrist. Each issue contained a technique that soon found its way into my practice. Unlike the textbook description of a technique, I was able to read about new and evolving techniques.

Over the next decade, internet access exploded and online access to journals and textbooks became the next paradigm shift for learning surgical techniques. No longer did one have to wait for a next journal article or request reprints from libraries; instead, one could have nearly instantaneous access to not one technique article but to any technique article that was in a pdf format.

In 2008, a concept of placing video content on a Web site dedicated to surgical techniques was introduced by VuMedi. Over the next 5 years, this concept brought about the most rapid paradigm transition from the technique article to the technique video. Residents and fellows no longer read the classic descriptions of surgical techniques in the textbooks but viewed streaming videos online. With instant access, these videos can be viewed immediately before a case. Unfortunately, a majority of these videos are not peer reviewed and represent the unbiased opinion of the producer of the video.

With these paradigm shifts, the question that we must answer is where will the technique article evolve to in the next decade? There is a distinct change in the manner in which our younger generation of upper extremity surgeons gather information and learn. No longer is it enough to read a textbook description of a technique, nor is it enough to have step-by-step images or illustrations detailing a surgical technique in a quarterly journal. The next generation of hand surgeons learns by streaming videos, summary pdf, and interactive chat/facebook/twitter communications on hand-held devices.

Our challenge is to engage this generation while pushing the current generation to adopt these new methods of learning to evolve the hand surgery technique article.

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1. Berger RA, Bishop AT.A fiber-splitting capsulotomy technique for dorsal exposure of the wrist.Tech Hand Up Extrem Surg.1997;1:2–10.
© 2013 by Lippincott Williams & Wilkins