AI in hand surgery: hype or helpful? A comprehensive survey of emerging technologies

Abstract

Artificial intelligence (AI) is beginning to reshape the landscape of hand surgery, but most clinical evidence still originates from radiology and other surgical specialties. This literature survey provides a comprehensive overview of current and near-term AI applications in the field. Presently, AI enhances diagnostic accuracy by identifying subtle fractures, nerve compressions, and vascular anomalies on imaging that may elude human detection. Presently, AI contributes mainly to diagnosis/imaging (fracture detection; adjuncts for nerve/perfusion studies) and planning (AI-assisted 3D reconstructions), with intraoperative platforms such as augmented reality (AR) microscopes and robotics largely adapted from neurosurgery/spine and only emerging in hand surgery. While many of these visualization platforms themselves are not AI, they increasingly integrate AI-based modules for image processing and real-time data overlay. Early postoperative risk-stratification models (e.g., stiffness, infection, complex regional pain syndrome) and digital rehabilitation are promising but require prospective, multi-center validation. Additionally, AI-driven tools streamline operative documentation and empower patient education through conversational agents. Looking ahead, developments such as implantable micro-sensors for real-time anastomosis monitoring, AI-guided perforator mapping, and miniaturized AR-assisted visualization promise to further transform practice. However, challenges persist - from limited datasets and the need for external validation, to high costs, regulatory hurdles, and ethical concerns surrounding data privacy and algorithm transparency. Achieving the sub-millimeter precision required for safe surgical implementation remains one of the most critical technical challenges. Emphasizing explainable AI and maintaining the surgeon’s central role in decision-making will be crucial to safe implementation. Ultimately, the convergence of AI, advanced imaging, robotics, and microsurgical techniques holds significant promise to elevate precision, outcomes, and patient-centered care in hand surgery.

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