Prospective residents interested in hand surgery must determine whether to apply for fellowships provided by several specialties. For a study, researchers sought to analyze case volumes reported during orthopedic hand surgery and plastic surgery fellowships.

For hand surgery cases, the American Council for Graduate Medical Education case files of authorized hand surgery fellowships were examined (2012 to 2013 to 2020 to 2021). The number of reported cases was compared by specialty. With Student t-tests, temporal patterns were reported, intrapathway variabilities estimated, and interpathway differences calculated.

About 200 cosmetic surgery colleagues (13%) and 1,323 orthopedic hand surgery fellows (87%) were involved. The number of orthopedic hand surgery fellowships rose by 21%, from 58 in 2012 to 2013 to 70 from 2020 to 2021, while the number of plastic surgery fellowships remained unchanged at 16. More hand surgery cases (764+22 against 628+226), arthroscopy cases (53+54 versus 23+38), and miscellaneous hand surgery cases (42+23 versus 31+18) were reported by orthopedic hand surgery fellows than by plastic surgery hand fellows. More instances were reported by plastic surgery hand fellows in wound closure with graft, wound reconstruction with flap, nerve damage, and vascular repair. Overall, orthopedic surgery provided more experience in 15 case categories (58%) than plastic surgery did in five case categories (19%). About 6 case groups (23%) showed no difference in the specialty.

Although orthopedic hand surgery programs provide more cases overall, plastic surgery hand fellowships specialize in wound reconstruction using grafts and flaps, nerve damage, and vascular repair. Finally, the findings of this study establish a baseline for future training opportunities for hand surgery fellows and orthopedic surgery residents.