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Dababneh et al. Art Int Surg 2024;4:214-32 https://dx.doi.org/10.20517/ais.2024.50 Page 228

SIMILAR WORK
We would like to highlight previous studies conducted on the usefulness of AI in the field of hand and wrist
surgery. Firstly, a 2023 article published by Miller et al. aimed to educate hand surgeons on AI, its current
applications, and its potential integration into their practice . This paper explored various roles of AI,
[90]
including fracture detection, decision-making processes, and outcome prediction. The authors described
AI’s potential to enhance diagnostic accuracy, facilitate orthopedic surgery referrals, and aid in scan
assessments. Similarly, our review offers a more comprehensive analysis of AI’s potential in detecting a
wider range of hand and wrist fractures including distal radius and ulna fractures using various imaging
techniques such as US and CT scans. In addition, AI applications in pediatric settings were also described in
our review.

Keller et al.’s literature review is the only one, to our knowledge, that specifically explored the application of
[91]
AI in hand surgery . Their primary search identified 435 articles, with 235 ultimately included in their final
analysis. Their findings were categorized based on the roles of AI, which included automated image analysis
of anatomic structures, fracture detection, various other applications, and those loosely related to hand
surgery. This paper was essentially intended for hand surgeons and therapists, as it also explored aspects of
hand rehabilitation. Considering the rapid evolution of AI and the fact that Keller et al.’s review was
conducted in July 2021, our review aims to update surgeons on the innovations and advancements made
since then. Moreover, our review was conducted from an academic plastic surgery perspective, which
justifies the inclusion of AI’s role in education and patient communication, microsurgery, and a deep dive
into CTS. Therefore, our work builds on Keller et al.’s foundation but also expands the scope.

In addition, the literature includes other systematic reviews solely focused on the evaluation of AI in
fracture detection. For instance, Kraus et al., in 2023, identified ten studies on AI’s performance in detecting
[92]
scaphoid fractures using X-rays . Our review identified and analyzed nine of these ten studies, using
performance metrics such as AUCs. Similarly, reviews by Oeding et al. and Singh et al. focused on AI’s
effectiveness in scaphoid fracture detection, yielding results consistent with our findings [93,94] .

Nevertheless, this study faced some limitations. First, determining what type of articles to include was
challenging due to how vast the field of hand surgery is and the rapid pace of AI advancements. This was
addressed by exclusively including articles of clinical relevance to hand surgeons, which justifies the
exclusions of certain articles such as those related to rehabilitation and prosthetics for arms and hands.
Various combinations of keywords were used in searches on databases before identifying the most effective
keywords to identify the largest number of pertinent articles.

Second, the decision to only include articles published in the last decade narrows the scope of this review
regarding earlier contributions. Most articles covered in this review were published in 2023 and 2024, with
the inclusion of only one article each from 2017 and 2018. Nevertheless, the objective of this study was to
highlight the latest innovations in AI within hand and wrist surgery. Therefore, this limitation may impact
readers’ understanding of AI’s full evolution, as earlier milestones are shallowly addressed.

Third, to cover as many aspects of AI applications in hand surgery as possible, a lot of topics were included
in this paper. However, we recognize that conducting systematic reviews on each subject separately would
result in more extensive coverage. This is a potential avenue for future work, where more focused reviews
could be conducted.