War changes many things. Some changes are destructive and reprehensible. Others are creative and revolutionary. Anyone reading this can easily remark that World War II was a watershed moment in human history, with far-flung changes engulfing the globe. Yet what most do not know is that the field of hand surgery, the ability to treat complex injuries to our body’s most interactive tool, was forged directly by the U.S. Army during World War II. Identifying the need to restore function to the countless upper extremity injuries sustained during the war, President Franklin Delano Roosevelt and Dr. Sterling Bunnell established a network of hand centers across the nation, creating the first generation of true hand surgeons in the world. Initially a uniquely American endeavor, this education and training tradition has spread across the globe, now with countless centers of excellence for hand surgery in over a hundred nations.
With this tradition in mind, it is no surprise that the American Society for Surgery of the Hand (ASSH) is one of the oldest surgical sub-specialty societies in the U.S. This year marked the 75th annual meeting for the ASSH. As many things in 2020 have adapted due to COVID-19, so too has the Hand Society. The stage was originally set for society members to meet in early October 2020 in San Antonio, Texas – the land of the Alamo. However, an audible was called and the meeting was done virtually, organized in near seamless fashion. Interactive sessions, industry seminars, and research presentations were accessible through a virtual lobby, with additional virtual happy hours for socializing. Continuing the theme of education from which it was founded, the ASSH each year presents a guest nation. This year the featured nation was India, allowing a sharing of ideas and forging bonds between surgeons across the sea.
Education and continued self-betterment are ideals common to every physician, and in that sense the ASSH meeting did not disappoint. Master surgical educators presented topics, techniques, pearls, and pitfalls from the fingertips to the shoulder. Experts in the field of nerve surgery, such as Dr. Amy Moore, discussed the revolutionary advances in nerve transfers, a new tool to treat patients with traumatic nerve injury, congenital deficiency, or chronic progressive disease. Symposia were held by respected surgeons such as Dr. Eric Wagner who provided an excellent overview on wrist arthritis, a condition that is common and nuanced with various etiologies, stages of deformity, and a potpourri of treatments. A panel head-to-head discussion was held between arthroscopy masters such as Dr. Michelle Carlson, Dr. Mark Cohen, and Dr. Mark Baratz, providing tricks on scoping everything from the small joints of the fingers, to the elbow, and the shoulder.
Stepping aside from day-to-day diagnoses and treatments, the ASSH meeting offered a glimpse into an area that seems almost like science fiction — that of human-machine interface and myoelectric prostheses. Subject matter experts from the U.S. military, as well as orthopaedic, plastic, and neurosurgeons, discussed groundbreaking research in combining man with machine in the hope of offering amputees the chance to once again touch their surroundings, feel cold and warmth, and hold their loved ones close. The virtual format did not detract from the awe-inspiring nature of witnessing a patient case before and after. A veteran with prior trans-forearm amputation underwent nerve microsurgery to selectively reorient nerve endings to send signals to the receiving end of a myoelectric complete prosthetic hand. This man-machine interface gave the patient the strength to easily grip and lift a gallon of milk, the fine dexterity to pick up an egg without cracking the shell, and to once again experience the emotion of holding his wife’s hand. As a trainee myself, witnessing such amazing feats further confirms my commitment to hand surgery, and the dreams of possibilities that will become reality for my patients as the future unfolds.
The commitment to cultivating younger learners, including residents, fellows, and fresh attendings, is a hallmark of the ASSH. Few societies focus such immense time and resources on fostering bonds, mentorship, education, and career advice for junior members. An entire day of each annual meeting is dedicated to resident and fellow education, and the ASSH did not allow the virtual distance imposed by COVID-19 to affect this. Named in honor of the late Dr. Adrian E. Flatt, himself a lifelong devotee to teaching, this special session focuses on the essential bread and butter knowledge to succeed as an upper extremity surgeon. Panels composed of experienced academic surgeons discuss the appropriate diagnosis, treatments, and surgical techniques for upper extremity fracture care, arthroplasty, tendon and nerve injuries, and both local and free tissue flap transfers. During non-COVID-19 years, a hands-on cadaver lab is an additional key element for learners to directly practice these skills under faculty guidance. Finally, specific talks are geared towards those on the cusp of starting practice, with words of wisdom and warning on the foreign landscape of medical billing and coding, job contract negotiation, and various practice settings. This commitment to its junior members fosters friendship, instills a true sense of community, and maintains involvement in the society for years to come.
It has been exactly 75 years since the end of World War II, coinciding precisely with the 75th annual meeting of the American Society for Surgery of the Hand. The ravages of that war birthed a completely new field of medicine and surgery, a field that continues to push the boundaries of science and promulgate education in person and digitally. COVID-19 is yet another challenge facing the global community, and like many obstacles before it, if we put our heads and hands together there is nothing that we cannot endure and overcome.
Adil Shahzad Ahmed is an Orthopaedic Surgery resident physician at the University of South Florida in Tampa, FL. Next year he will be a Hand & Upper Extremity Surgery Fellow at Emory University in Atlanta, GA. He is interested in offering a lens into the life of a doctor and surgeon, and the growth throughout the stages of education and training. He also runs a website providing advice and personal anecdotes to college and medical students on the journey to becoming physicians (www.medschooldeclassified.com).
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