Sterling Bunnell, MD, founded the American Society for Surgery of the Hand in 1946.
As swarms of injured soldiers returned from World War II
with complex hand injuries, a need arose for a specialized society that could
organize and educate surgeons in hand surgery, according to Daniel J. Nagle,
MD, current president of the
American Society for Surgery of the Hand.
Before World War II, care for hand injuries was
fragmented, as neurosurgeons, generalists, orthopedists and plastic surgeons
all participated in operations on the hand. This fragmented care led to a
special interest in the hand as a distinct entity. This meant that one surgeon
could care for all of the hand tissues: nerves, tendons, vessels, skin and
bones, David Tate, MD, FACS, current head of the history committee of the
American Society for Surgery of the Hand (ASSH), told Orthopedics
General surgeon Sterling Bunnell, MD, was a pioneer of
hand surgery and trained surgeons in the subspecialty in San Francisco,
according to Nagle. In 1944, U.S. Army Surgeon General Norman T. Kirk asked
Bunnell to lead the establishment of nine hand surgery centers in the United
States. Bunnell traveled to each center, teaching and performing hand
surgeries, Nagle said. These centers became the basis for the formation of
In 1916, a forerunner of Bunnell, Allen B. Kanavel, MD,
who served in the Naval Reserves, “got the ball rolling with rational
anatomically-based comprehensive hand care,” Tate said. Kanavel published
the first book on hand surgery, Infections of the Hand, and
started the Chicago School of Hand Surgery.
H. Boyes, MD, an ASSH founder, is shown educating would-be hand surgeons at an
early meeting of the society. He was tapped as the first editor of the
Journal of Hand Surgery.
Images: American Society for Surgery
of the Hand.
“Dr. Bunnell took it to the next level in terms of
a standardized mode of care that encompassed all these different
disciplines,” Tate said.
Bunnell’s 1944 book, Surgery of the
Hand, became the standard hand surgery text at the time, according to
“Bunnell had suffered a hip fracture in 1927 during
the crash of a small airplane,” Tate said. “In spite of this
non-united hip fracture, Bunnell displayed great energy and drive, traveling
around the country on a private airplane helping coordinate care for all the
injured soldiers and sailors [at the different centers].”
Bunnell and colleague, Joseph Boyes, MD, wanted to
sustain communication between all of the hand centers through a professional
society, according to Nagle and Tate. This desire led to the mission of ASSH,
which is “to offer a forum to perpetuate the camaraderie and support an
exchange of ideas between the hand surgeons who had manned the hand surgery
services in the nine Army general hospitals,” Nagle said.
Bunnell, Boyes and a group of other interested surgeons
from the nine centers met at the Blackstone Hotel in Chicago on January 20,
1946 to discuss this mission. What emerged was the first hand surgery
At first, obtaining membership to ASSH was exclusive.
Perspective ASSH members had to submit a lecture and have it accepted by a
committee to be a part of the association. There were 35 members at the start,
In the early 1970s, the society began discussing the
definition of hand surgery and making membership more inclusive. This resulted
in the dramatic increase in the growth of membership of the society.
left to right are about half the original 35 ASSH founding members: Darrel T.
Shaw, Joseph H. Boyes, Lot D. Howard, S. Benjamin Fowler, Sterling Bunnell,
Arthur Barsky, Donald D. Slocum, Walter C. Graham, J. William Littler, William
Metcalf, Richard H. Mellen, Gilbert Hyroop, Donald R. Pratt, William F.
Frackelton, Robert L. Payne, Jr.
In the early 1980s, because of the increased
sophistication of hand surgery, an effort was made to create of the Certificate
of Added Qualifications in Surgery of the Hand (CAQSH). Its inception and
creation, largely by the efforts of past ASSH president George E. Omer, MD,
resulted in the first examination of the CAQSH given in 1989.
To become an active member of ASSH, members must now
complete their residency in orthopedics, general surgery or plastic surgery, do
a hand surgery fellowship, obtain their specialty board certification, go into
practice, pass the CAQSH and submit a case list, application and letters of
recommendation to ASSH. Today there are 1,866 active ASSH members, and the
group has a total membership of 3,223.
Hand surgery advances
Before World War II, hand injuries often resulted in
stiff, unusable hands, amputations or even death if the hand became infected,
There was no replantation or microsurgery, according to
Robert Szabo, MD, MPH, president of ASSH from 2009 to 2010. He recalled meeting
a patient of Bunnell at “a little bed and breakfast in Napa Valley.”
Bunnell performed Dupuytren’s surgery on the patient.
“Bunnell did all surgeries standing up without any
magnification and big knives,” Szabo noted. “He used a 22 blade as
opposed to now; the biggest blade is a 15.”
Szabo said the patient told him, “Look, he did a
great job. He only cut one of my nerves.” Szabo added that at the time, if
a surgeon cut just one nerve in Dupuytren’s surgery, “you did
“Hand surgery has changed dramatically,”
Andrew Weiland, MD, ASSH president from 1995 to 1996, said. “In 1975,
there was a birth of microsurgery where we were able to sew back traumatically
amputated fingers and limbs. There have been tremendous advances in the repair
of nerve injuries and in different types of fixation devices, plates and
screws, for fractures of the hand and wrist.”
Focus on education
The society’s mission continues to be the education
of its members, according to Szabo. Annual meetings are a forum for hand
surgeons to meet and present their scientific findings. Nagle also noted that
the mission of the society also includes the education of its members regarding
the business aspects of hand surgery and advocacy in regards to changes in the
health care environment.
“Research is also one of its core missions,”
the oldest medical specialty society in the United States, has a museum and
library in San Francisco, where William L. Newmeyer III, MD, FACS, and Hal
Gibson are shown studying part of the historic collection there.
ASSH held its first meeting in 1947 at the Palmer House
in Chicago, according to Nagle. The Palmer House continued to remain the place
for ASSH members to meet and share innovative hand surgery studies until the
16th meeting was held in Florida.
Until the 1970s, Nagle said, ASSH members published
their studies in the Journal of Bone and Joint Surgery.
Eventually, the publication ran out of space to accommodate the large influx of
hand surgery papers. Adrian Flatt, MD, president of ASSH from 1975 to 1976,
founded the Journal of Hand Surgery, with Boyes as its first
Between 1974 and 1978, the Hand Society Council formed
committees to evaluate postgraduate educational training because there were no
formal hand surgery training programs, Szabo said.
ASSH helped develop hand surgery fellowships. George E.
Omer, MD, head of the Continuing Education Committee, developed quality
controls for fellowship, according to Szabo. ASSH used to make onsite reviews
for accreditation; however accreditation is now obtained through the
Accreditation Council for Graduate Medical Education.
The American Foundation for Surgery of the Hand, the
fundraising arm of ASSH formed 25 years ago, provides public patient
information, funds for fellows to attend meeting, financial backing for
innovative research and fellowships for young residents, according to Weiland,
the foundation’s committee chairman. He estimated the endowment at about
Collaboration exists not only between ASSH members, but
also between ASSH and other societies. ASSH participates in many of the
American Academy of Orthopaedic Surgeons advocacy activities and joint
education projects, Nagle said. ASSH also works with the American Society for
Plastic Surgery, the American College of Surgeons, the American Medical
Association and the American Association for Hand Surgery.
ASSH also fosters education among nations, Szabo said.
ASSH combines meetings with international societies each year such as the
Japanese or British hand surgery societies. ASSH also accepts members from
other countries. The only fellowship officially sanctioned by ASSH, the
Sterling Bunnell fellowship, allows a young member of the society to
“travel around the world to observe how hand surgery is being performed in
various offshore hand surgery centers,” Nagle said.
Because the definition of hand surgery continues to
evolve and now includes upper extremity surgery, ASSH foresaw the need to
increase training “to match the scope of what our practices are and to
redefine our identity,” Szabo said. He has created a new education
initiative to move toward 2-year fellowships, which would add an extra year of
training to existing fellowships and include upper extremity education. This
move is a work in progress, Szabo said, who hopes to see its inception by
Other goals of the society include task forces to focus
on hand replantation and increased member involvement, such as using social
media to engage members, and developing an online archive of historical
material and apps for smart phones. Each president has their own platform for
the future, Szabo said, noting the platform for upcoming president W.P. Andrew
Lee, MD, will address membership benefits. Edward Akelman, MD, slated for
presidency after Lee, is concerned about electronic advancement of the society,
“We must continue to maintain ASSH’s position
as the premier provider of hand surgery education,” Nagle said. –
by Renee Blisard
- Daniel J. Nagle, MD, can be reached at Northwestern University
Feinberg School of Medicine, 737 N. Michigan Ave., Suite 700, Chicago, IL
60611; 312-337-6960; email: email@example.com.
- Robert Szabo, MD, MPH, can be reach at Department of Orthopaedic
Surgery, University of California, Davis, 4860 Y Street, Sacramento, CA 95817;
916-734-3678; email: firstname.lastname@example.org.
- David Tate, MD, FACS, can be reached at Louisville Arm and Hand,
315 E. Broadway, Suite 195, Louisville, KY 40202; 502-629-4263; email:
- Andrew Weiland, MD, can be reached at 535 E. 70th St., New York, NY
10021; 212-606-1575; email: email@example.com.