The Implementation of Artificial Intelligence in Upper Extremity Surgery: A Systematic

Dylan Parry¹Brennon Henderson¹Paul Gaschen²Diane Ghanem³Evan J Hernandez^2,4,5Anceslo Idicula^2,5Tammam Hanna^2,5Brendan J MacKay^2,5*

• ¹Texas Tech University Health Sciences Center School of Medicine, Lubbock, United States
• ²Texas Tech University Health Sciences Center Department of Orthopedic Surgery, Lubbock, United States
• ³Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, United States
• ⁴Department of Health Sciences, College of Health Sciences, Rush University, Chicago, United States
• ⁵Hand and Microvascular Surgery, University Medical Center, Lubbock, United States

The rapid expansion of artificial intelligence (AI) in medicine has led to its increasing integration into upper extremity (UE) orthopedics. The purpose of this systematic review is to investigate the current landscape and impact of AI in the field of UE surgery.Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic search of PubMed was conducted to identify studies incorporating AI in UE surgery. Review articles, letters to the editor, and studies unrelated to AI applications in UE surgery were excluded.Results: After applying inclusion/exclusion criteria, 118 articles were included. The publication years ranged from 2009 to 2024, with a median and mode of 2022 and 2023, respectively. The studies were categorized into six main applications: automated image analysis (36%), surgical outcome prediction (20%), measurement tools (14%), prosthetic limb applications (14%), intraoperative aid (10%), and clinical decision support tools (6%). Discussion: AI is predominantly utilized in image analysis, including radiograph and MRI interpretation, often matching or surpassing clinician accuracy and efficiency. Additionally, AIpowered tools enhance the measurement of range of motion, critical shoulder angles, grip strength, and hand posture, aiding in patient assessment and treatment planning. Surgeons are increasingly leveraging AI for predictive analytics to estimate surgical outcomes, such as infection risk, postoperative function, and procedural costs. As AI continues to evolve, its role in UE surgery is expected to expand, improving decision-making, precision, and patient care.