Hand surgery training in the United States of America

Abstract

Hand surgery was first recognized as a distinct speciality when Dr Sterling Bunnell was commissioned by the United States of America (USA) Armed Forces to teach hand surgery across military units. Under his tutelage, a number of his students became Founders of the Hand Surgery speciality in America. In January 1946, Dr Bunnell and a group of other surgeons returning from World War II met in Chicago to fulfil their vision of establishing hand surgery as a unique speciality; here, the American Society for Surgery of the Hand (ASSH) was born. These founders came from three separate surgical specialities: general surgery, plastic surgery and orthopaedic surgery. Today, hand surgery training is embedded within these specialities in the USA as a fellowship pathway after receiving fundamental exposure in one of these core disciplines. In the ensuing years, a number of novel techniques were developed, such as rigid fixation of fractures, joint replacement surgery, microsurgery in promoting replantation and flap surgery, wrist surgery and arthroscopy. These advancements come with the challenge of training a comprehensive hand surgeon who is capable of complex trauma care, able to perform complicated microsurgery procedures for mangled hand injuries, as well as advanced bone fixation procedures. Additionally, the growth of nerve surgery requires the hand surgeon to understand peripheral nerve anatomy and physiology to tackle intriguing problems extending from the brachial plexus to the digital nerves.