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DOI: 10.1055/a-2702-5186
A Bibliometric Analysis of the Top 50 Most Cited Articles on Iatrogenic Nerve Injuries of the Upper Limb Following Surgery
Authors
Funding None.

Abstract
Background
Iatrogenic nerve injuries of the upper limb have profound impacts on patients their pain, functionality, and quality of life.
Objectives
This study aims to identify and analyze the most cited publications on those iatrogenic injuries to elicit trends, thematic analysis, and reduce risk.
Methodology
A bibliometric analysis was performed using the Web of Science database. Search terms included “Iatrogenic,” “Upper Limb,” “Nerve,” and “Injury.” The top 50 cited peer-reviewed publications were ranked by citation count and analyzed for publication year, journal, country of origin, institutional affiliations, authorship, and research focus. Trends in diagnostic and management practices were also evaluated.
Results
The most cited articles, published between 1995 and 2022, peaked in publication frequency in 2010 and 2017 (n = 4 each). Citation counts ranged from 7 to 260, with a median of 26.5 (± 15.0, 95% confidence interval: 16–75). These articles were featured in 44 journals. The United States emerged as the leading contributor in both volume and impact (n = 16). Prominent themes included supracondylar humerus fractures (n = 21) and humeral shaft fractures (n = 10), alongside mentions of diaphyseal humeral fractures and shoulder surgery (n = 4 each). Ulnar nerve injuries were the most frequently discussed (n = 23), followed by injuries involving multiple nerves (n = 18) and the radial nerve (n = 14).
Conclusions
This bibliometric analysis highlights key studies on iatrogenic upper limb nerve injuries, identifies trends and gaps, and lays a foundation for evidence-based protocols. It also serves as a guide for future research and collaborative efforts to improve prevention and treatment.
Authors' Contributions
S.S.G.: Conceptualization, searching, methodology, writeup—original draft, writeup—revisions. A.G.K.: searching, methodology, writeup—original draft. H.S.: searching, methodology, writeup—original draft. A.S.: conceptualization, writeup—revisions, supervision. A.P.: conceptualization, writeup—revisions, supervision. M.F.: Conceptualization, writeup—revisions, supervision. M.S.: conceptualization, writeup—revisions, supervision. K.S.: Conceptualization, writeup—revisions, supervision
Publication History
Received: 04 July 2025
Accepted: 16 September 2025
Article published online:
07 October 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
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References
- 1 Luukkonen T. Bibliometrics and evaluation of research performance. Ann Med 1990; 22 (03) 145-150
- 2 Ellegaard O, Wallin JA. The bibliometric analysis of scholarly production: how great is the impact?. Scientometrics 2015; 105 (03) 1809-1831
- 3 Akmal M, Hasnain N, Rehan A. et al. Glioblastome multiforme: a bibliometric analysis. World Neurosurg 2020; 136: 270-282
- 4 Wallin JA. Bibliometric methods: pitfalls and possibilities. Basic Clin Pharmacol Toxicol 2005; 97 (05) 261-275
- 5 Dahlin LB, Wiberg M. Nerve injuries of the upper extremity and hand. EFORT Open Rev 2017; 2 (05) 158-170
- 6 Kretschmer T, Heinen CW, Antoniadis G, Richter HP, König RW. Iatrogenic nerve injuries. Neurosurg Clin N Am 2009; 20 (01) 73-90 , vii
- 7 Crowe CS, Shin AY, Pulos N. Iatrogenic nerve injuries of the upper extremity: a critical analysis review. JBJS Rev 2023;11(1)
- 8 Obert L, Spitael S, Loisel F. et al. Iatrogenic nerve injury during upper limb surgery (excluding the hand). Orthop Traumatol Surg Res 2025; 111 (1S): 104056
- 9 Karabay N, Toros T, Ademoğlu Y, Ada S. Ultrasonographic evaluation of the iatrogenic peripheral nerve injuries in upper extremity. Eur J Radiol 2010; 73 (02) 234-240
- 10 Frostadottir D, Perez R, Dahlin LB. Socioeconomic factors and outcome after repair and reconstruction of digital and major nerve trunk injuries in the upper limb. Sci Rep 2024; 14 (01) 7242
- 11 Bergmeister KD, Große-Hartlage L, Daeschler SC. et al. Acute and long-term costs of 268 peripheral nerve injuries in the upper extremity. PLoS One 2020; 15 (04) e0229530
- 12 Lim KJ, Yoon DY, Yun EJ. et al. Characteristics and trends of radiology research: a survey of original articles published in AJR and Radiology between 2001 and 2010. Radiology 2012; 264 (03) 796-802
- 13 Alzobi OZ, Almannai H, Elshoeibi AM. et al. A bibliometric analysis of the top cited articles on anterior cruciate ligament reconstruction with anterolateral ligament reconstruction. J Orthop Res 2025; 4 (04) 100509
- 14 Skaggs DL, Hale JM, Bassett J, Kaminsky C, Kay RM, Tolo VT. Operative treatment of supracondylar fractures of the humerus in children. The consequences of pin placement. J Bone Joint Surg Am 2001; 83 (05) 735-740
- 15 Babal JC, Mehlman CT, Klein G. Nerve injuries associated with pediatric supracondylar humeral fractures: a meta-analysis. J Pediatr Orthop 2010; 30 (03) 253-263
- 16 Piolanti N, Poggetti A, Nucci AM. et al. The 50 most cited articles about wrist surgery. Orthop Rev (Pavia) 2018; 10 (04) 7715
- 17 Samson D, Power DM. Iatrogenic injuries of the palmar branch of the median nerve following volar plate fixation of the distal radius. J Hand Surg Asian Pac Vol 2017; 22 (03) 343-349
- 18 Zhang J, Moore AE, Stringer MD. Iatrogenic upper limb nerve injuries: a systematic review. ANZ J Surg 2011; 81 (04) 227-236
- 19 Zimmermann MS, Abzug JM, Chang J, Stern PJ, Osterman AL. Iatrogenic nerve injuries in common upper extremity procedures. Instr Course Lect 2014; 63: 105-111
- 20 Venneri F, Brown LB, Cammelli F, Haut ER. Safe surgery saves lives. In: Donaldson L, Ricciardi W, Sheridan S, Tartaglia R. editors Textbook of Patient Safety and Clinical Risk Management. Cham: Springer; 2021: 177-188
- 21 Briggs T. A National Review of Adult Elective Orthopaedic Services in England: Getting it Right First Time. 2015
- 22 Barratt H, Hutchings A, Pizzo E. et al. Mixed methods evaluation of the Getting it Right First Time programme in elective orthopaedic surgery in England: an analysis from the National Joint Registry and Hospital Episode Statistics. BMJ Open 2022; 12 (06) e058316
- 23 Burns PB, Rohrich RJ, Chung KC. The levels of evidence and their role in evidence-based medicine. Plast Reconstr Surg 2011; 128 (01) 305-310
- 24 Ajwani SH, Singh J, Ng CY. A review of 100 iatrogenic nerve injuries: delays in referrals remain significant. Ann R Coll Surg Engl 2023; 105 (05) 390-393
- 25 Pucher PH, Park MH, Cromwell DA. et al. Diagnosis and treatment for gastro-oesophageal cancer in England and Wales: analysis of the National Oesophago-Gastric Cancer Audit (NOGCA) database 2012-2020. Br J Surg 2023; 110 (06) 701-709
- 26 Palser TR, Cromwell DA, Hardwick RH. et al. Re-organisation of oesophago-gastric cancer care in England: progress and remaining challenges. BMC Health Serv Res 2009; 9 (01) 204
- 27 Varagunam M, Hardwick R, Riley S, Chadwick G, Cromwell DA, Groene O. Changes in volume, clinical practice and outcome after reorganisation of oesophago-gastric cancer care in England: a longitudinal observational study. Eur J Surg Oncol 2018; 44 (04) 524-531
- 28 Perc M. The Matthew effect in empirical data. J R Soc Interface 2014; 11 (98) 20140378
- 29 Brauer CA, Lee BM, Bae DS, Waters PM, Kocher MS. A systematic review of medial and lateral entry pinning versus lateral entry pinning for supracondylar fractures of the humerus. J Pediatr Orthop 2007; 27 (02) 181-186
- 30 Desai N, Veras L, Gosain A. Using Bradford's law of scattering to identify the core journals of pediatric surgery. J Surg Res 2018; 229: 90-95
- 31 Zhi X, Cui J, Gu Z. et al. Orthopedics research output from China, USA, UK, Japan, Germany and France: a 10-year survey of the literature. Orthop Traumatol Surg Res 2016; 102 (07) 939-945
- 32 Zhu E, Shemesh S, Iatridis J, Moucha C. The association between scholarly impact and National Institutes of Health funding in orthopaedic surgery. Bull Hosp Jt Dis 2017; 75 (04) 257-263
- 33 Physicians WU. . Orthopaedic Achievements through Patient Care, Education and Research; 2023 . Accessed at: https://www.ortho.wustl.edu/content/Research/7040/Achieving-Excellence—Research-at-Washington-University-Orthopedics/Orthopaedic-Achievements.aspx?utm_source=chatgpt.com
- 34 Mayo A. . Clinic Research; 2023 . Accessed at: https://www.mayo.edu/research/about/research-facts-funding
- 35 Lin J, Chen L, Dou D. Progress of orthopaedic research in China over the last decade. J Orthop Translat 2020; 24: 131-137
- 36 Nyman E, Dahlin LB. The unpredictable ulnar nerve-ulnar nerve entrapment from anatomical, pathophysiological, and biopsychosocial aspects. Diagnostics (Basel) 2024; 14 (05) 489
- 37 Andrews K, Rowland A, Pranjal A, Ebraheim N. Cubital tunnel syndrome: anatomy, clinical presentation, and management. J Orthop 2018; 15 (03) 832-836
- 38 Morrey ME, Morrey BF, Sanchez-Sotelo J, Barlow JD, O'Driscoll S. A review of the surgical management of distal humerus fractures and nonunions: from fixation to arthroplasty. J Clin Orthop Trauma 2021; 20: 101477
- 39 Davlin LB, Bergfield TG, Aulicino PL. Variations of the ulnar nerve. A surgical perspective. Orthop Rev 1993; 22 (01) 33-39
- 40 König PS, Hage JJ, Bloem JJ, Prosé LP. Variations of the ulnar nerve and ulnar artery in Guyon's canal: a cadaveric study. J Hand Surg Am 1994; 19 (04) 617-622
- 41 Rogers MR, Bergfield TG, Aulicino PL. The failed ulnar nerve transposition. Etiology and treatment. Clin Orthop Relat Res 1991; (269) 193-200
- 42 Mirzayan R, Syed SP, Shean CJ. Dissection of an ulnar nerve previously transposed and wrapped with human amniotic membrane: a report of 3 cases. JBJS Case Connect 2021;11(3)
- 43 Posner MA. Compressive neuropathies of the ulnar nerve at the elbow and wrist. Instr Course Lect 2000; 49: 305-317
- 44 Krkovic M, Bosnjak R. Subperiosteal elevation of the ulnar nerve-anatomical considerations and preliminary results. Injury 2008; 39 (07) 761-767
- 45 Ogata K, Manske PR, Lesker PA. The effect of surgical dissection on regional blood flow to the ulnar nerve in the cubital tunnel. Clin Orthop Relat Res 1985; (193) 195-198
- 46 Bouyer-Ferullo S. Preventing perioperative peripheral nerve injuries. AORN J 2013; 97 (01) 110-124.e9
- 47 Cheng H, Clymer JW, Po-Han Chen B. et al. Prolonged operative duration is associated with complications: a systematic review and meta-analysis. J Surg Res 2018; 229: 134-144
- 48 Okwumabua E, Black AC, Thompson JH. Anatomy, Shoulder and Upper Limb, Nerves. Treasure Island (FL): StatPearls; 2024
- 49 Majeed H. Litigations in trauma and orthopaedic surgery: analysis and outcomes of medicolegal claims during the last 10 years in the United Kingdom National Health Service. EFORT Open Rev 2021; 6 (03) 152-159
- 50 Liang Z, Mao J, Lu K, Li G. Finding citations for PubMed: a large-scale comparison between five freely available bibliographic data sources. Scientometrics 2021; 126 (12) 9519-9542
- 51 Rupp M, Schäfer C, Heiss C, Alt V. Pinning of supracondylar fractures in children - strategies to avoid complications. Injury 2019; 50 (Suppl. 01) S2-S9
- 52 Skaggs DL, Cluck MW, Mostofi A, Flynn JM, Kay RM. Lateral-entry pin fixation in the management of supracondylar fractures in children. J Bone Joint Surg Am 2004; 86 (04) 702-707
- 53 Brown IC, Zinar DM. Traumatic and iatrogenic neurological complications after supracondylar humerus fractures in children. J Pediatr Orthop 1995; 15 (04) 440-443
- 54 Rasool MN. Ulnar nerve injury after K-wire fixation of supracondylar humerus fractures in children. J Pediatr Orthop 1998; 18 (05) 686-690
- 55 An Z, Zeng B, He X, Chen Q, Hu S. Plating osteosynthesis of mid-distal humeral shaft fractures: minimally invasive versus conventional open reduction technique. Int Orthop 2010; 34 (01) 131-135
- 56 Haapaniemi T, Berggren M, Adolfsson L. Complete transection of the median and radial nerves during arthroscopic release of post-traumatic elbow contracture. Arthroscopy 1999; 15 (07) 784-787
- 57 Mulpuri K, Tritt BL. Low incidence of ulnar nerve injury with crossed pin placement for pediatric supracondylar humerus fractures using a mini-open technique. J Orthop Trauma 2006; 20 (03) 234 , author reply 234
- 58 Wang JP, Shen WJ, Chen WM, Huang CK, Shen YS, Chen TH. Iatrogenic radial nerve palsy after operative management of humeral shaft fractures. J Trauma 2009; 66 (03) 800-803
- 59 Claessen FM, Peters RM, Verbeek DO, Helfet DL, Ring D. Factors associated with radial nerve palsy after operative treatment of diaphyseal humeral shaft fractures. J Shoulder Elbow Surg 2015; 24 (11) e307-e311
- 60 Slobogean BL, Jackman H, Tennant S, Slobogean GP, Mulpuri K. Iatrogenic ulnar nerve injury after the surgical treatment of displaced supracondylar fractures of the humerus: number needed to harm, a systematic review. J Pediatr Orthop 2010; 30 (05) 430-436
- 61 Carofino BC, Brogan DM, Kircher MF. et al. Iatrogenic nerve injuries during shoulder surgery. J Bone Joint Surg Am 2013; 95 (18) 1667-1674
- 62 Dekker AE, Krijnen P, Schipper IB. Results of crossed versus lateral entry K-wire fixation of displaced pediatric supracondylar humeral fractures: a systematic review and meta-analysis. Injury 2016; 47 (11) 2391-2398
- 63 Lee YH, Lee SK, Kim BS. et al. Three lateral divergent or parallel pin fixations for the treatment of displaced supracondylar humerus fractures in children. J Pediatr Orthop 2008; 28 (04) 417-422
- 64 Zhao JG, Wang J, Meng XH, Zeng XT, Kan SL. Surgical interventions to treat humerus shaft fractures: a network meta-analysis of randomized controlled trials. PLoS One 2017; 12 (03) e0173634
- 65 Rhee PC, Spinner RJ, Bishop AT, Shin AY. Iatrogenic brachial plexus injuries associated with open subpectoral biceps tenodesis: a report of 4 cases. Am J Sports Med 2013; 41 (09) 2048-2053
- 66 Hochwald NL, Levine R, Tornetta III P. The risks of Kirschner wire placement in the distal radius: a comparison of techniques. J Hand Surg Am 1997; 22 (04) 580-584
- 67 Esmailiejah AA, Abbasian MR, Safdari F, Ashoori K. Treatment of humeral shaft fractures: minimally invasive plate osteosynthesis versus open reduction and internal fixation. Trauma Mon 2015; 20 (03) e26271
- 68 Ladenhauf HN, Schaffert M, Bauer J. The displaced supracondylar humerus fracture: indications for surgery and surgical options: a 2014 update. Curr Opin Pediatr 2014; 26 (01) 64-69
- 69 Hu X, Xu S, Lu H. et al. Minimally invasive plate osteosynthesis vs conventional fixation techniques for surgically treated humeral shaft fractures: a meta-analysis. J Orthop Surg Res 2016; 11 (01) 59
- 70 Eberl R, Eder C, Smolle E, Weinberg AM, Hoellwarth ME, Singer G. Iatrogenic ulnar nerve injury after pin fixation and after antegrade nailing of supracondylar humeral fractures in children. Acta Orthop 2011; 82 (05) 606-609
- 71 Na Y, Bai R, Zhao Z. et al. Comparison of lateral entry with crossed entry pinning for pediatric supracondylar humeral fractures: a meta-analysis. J Orthop Surg Res 2018; 13 (01) 68
- 72 Longo UG, Forriol F, Loppini M. et al. The safe zone for avoiding suprascapular nerve injury in bone block procedures for shoulder instability. A cadaveric study. Knee Surg Sports Traumatol Arthrosc 2015; 23 (05) 1506-1510
- 73 Singh AK, Arun GR, Narsaria N, Srivastava A. Treatment of non-union of humerus diaphyseal fractures: a prospective study comparing interlocking nail and locking compression plate. Arch Orthop Trauma Surg 2014; 134 (07) 947-953
- 74 Streufert BD, Eaford I, Sellers TR. et al. Iatrogenic nerve palsy occurs with anterior and posterior approaches for humeral shaft fixation. J Orthop Trauma 2020; 34 (03) 163-168
- 75 Rose RE, Phillips W. Iatrogenic ulnar neuropathies post-pinning of displaced supracondylar humerus fractures in children. West Indian Med J 2002; 51 (01) 17-20
- 76 Noger M, Berli MC, Fasel JH, Hoffmeyer PJ. The risk of injury to neurovascular structures from distal locking screws of the unreamed humeral nail (UHN): a cadaveric study. Injury 2007; 38 (08) 954-957
- 77 Davies G, Yeo G, Meta M, Miller D, Hohmann E, Tetsworth K. Case-match controlled comparison of minimally invasive plate osteosynthesis and intramedullary nailing for the stabilization of humeral shaft fractures. J Orthop Trauma 2016; 30 (11) 612-617
- 78 Tabor Jr OB, Bosse MJ, Sims SH, Kellam JF. Iatrogenic posterior interosseous nerve injury: is transosseous static locked nailing of the radius feasible?. J Orthop Trauma 1995; 9 (05) 427-429
- 79 Taniguchi Y, Matsuzaki K, Tamaki T. Iatrogenic ulnar nerve injury after percutaneous cross-pinning of supracondylar fracture in a child. J Shoulder Elbow Surg 2000; 9 (02) 160-162
- 80 She Y, Xu Y. Treatment of fifth metacarpal neck fractures with antegrade single elastic intramedullary nailing. BMC Musculoskelet Disord 2017; 18 (01) 238
- 81 Kakazu R, Dailey SK, Schroeder AJ, Wyrick JD, Archdeacon MT. Iatrogenic radial nerve palsy after humeral shaft nonunion repair: more common than you think. J Orthop Trauma 2016; 30 (05) 256-261
- 82 Shoji K, Heng M, Harris MB, Appleton PT, Vrahas MS, Weaver MJ. Time from injury to surgical fixation of diaphyseal humerus fractures is not associated with an increased risk of iatrogenic radial nerve palsy. J Orthop Trauma 2017; 31 (09) 491-496
- 83 Lim R, Tay SC, Yam A. Radial nerve injury during double plating of a displaced intercondylar fracture. J Hand Surg Am 2012; 37 (04) 669-672
- 84 Marcu DM, Balts J, McCarthy JJ, Kozin SH, Noonan KJ. Iatrogenic radial nerve injury with cannulated fixation of medial epicondyle fractures in the pediatric humerus: a report of 2 cases. J Pediatr Orthop 2011; 31 (02) e13-e16
- 85 Lee KM, Chung CY, Gwon DK. et al. Medial and lateral crossed pinning versus lateral pinning for supracondylar fractures of the humerus in children: decision analysis. J Pediatr Orthop 2012; 32 (02) 131-138
- 86 Da Silva T, Rummel F, Knop C, Merkle T. Comparing iatrogenic radial nerve lesions in humeral shaft fractures treated with helical or straight PHILOS plates: a 10-year retrospective cohort study of 62 cases. Arch Orthop Trauma Surg 2020; 140 (12) 1931-1937
- 87 Koh J, Tornetta III P, Walker B. et al. What is the real rate of radial nerve injury after humeral nonunion surgery?. J Orthop Trauma 2020; 34 (08) 441-446
- 88 Rees AB, Schultz JD, Wollenman LC. et al. A mini-open approach to medial pinning in pediatric supracondylar humeral fractures may be safer than previously thought. J Bone Joint Surg Am 2022; 104 (01) 33-40
- 89 Zhao H, Xu S, Liu G, Zhao J, Wu S, Peng L. Comparison of lateral entry and crossed entry pinning for pediatric supracondylar humeral fractures: a meta-analysis of randomized controlled trials. J Orthop Surg Res 2021; 16 (01) 366
- 90 Carrazzone OL, Barbachan Mansur NS, Matsunaga FT. et al. Crossed versus lateral K-wire fixation of supracondylar fractures of the humerus in children: a meta-analysis of randomized controlled trials. J Shoulder Elbow Surg 2021; 30 (02) 439-448
- 91 Woo CY, Ho HL, Ashik MBZ, Lim KB. Paediatric supracondylar humeral fractures: a technique for safe medial pin passage with zero incidence of iatrogenic ulnar nerve injury. Singapore Med J 2018; 59 (02) 94-97
- 92 Kwok SM, Clayworth C, Nara N. Lateral versus cross pinning in paediatric supracondylar humerus fractures: a meta-analysis of randomized control trials. ANZ J Surg 2021; 91 (05) 980-985
- 93 Hara T, Tatebe M, Kurahashi T, Hirata H. Iatrogenic peripheral nerve injuries - Common causes and treatment: a retrospective single-center cohort study. J Orthop Sci 2021; 26 (06) 1119-1123
- 94 Billmann FG, Bokor-Billmann TT, Burnett CA, Lapshyn H, Hopt UT, Kiffner E. Postoperative ulnar neuropathy is not necessarily iatrogenic: a prospective study on dynamic ulnar nerve dislocation at the elbow. World J Surg 2014; 38 (08) 1978-1983