The balance between artificial and human intelligence in clinical practice.

INTRODUCTION: Artificial intelligence (AI) is becoming increasingly integrated into clinical care in hand surgery. Its applications extend across diagnosis, planning, intraoperative assistance, postoperative monitoring, rehabilitation, prosthetics and education.

APPLICATIONS: In diagnostic imaging, AI improves the detection of distal radius and scaphoid fractures, estimates osteoporosis from hand radiographs, identifies triangular fibrocartilage complex injuries on magnetic resonance imaging, segments bones and cartilage, and supports dynamic wrist analysis; ultrasound- and neurophysiological-based models aid carpal tunnel syndrome diagnosis. Prognostic models predict outcomes after carpal tunnel release and thumb carpometacarpal osteoarthritis with mixed performance. Pre- and intraoperative applications include large language model-based triage and coding, navigation and phase/gesture recognition from surgical video, autonomous microsurgical prototypes and telemanipulator platforms for supermicrosurgery. Artificial intelligence-enabled telemonitoring (e.g. remote photoplethysmography) and video-based mobility tracking support postoperative care and rehabilitation. Vision-guided and multimodal sensing enhance myoelectric prosthesis control.

RISKS: Risks include data privacy and security, algorithmic bias (data, transposition, normative, annotation) and opacity, overreliance with automation bias and skill erosion, and unresolved legal and ethical questions (liability, conflicts of interest, compassion in care).

CONCLUSION: Balanced adoption requires diversified datasets, privacy-preserving strategies (pseudonymization, differential privacy, federated learning), transparent reporting, AI literacy and ethics in medical education and interfaces that expose uncertainty and employ cognitive forcing functions. Post-deployment surveillance should track data drift, out-of-distribution inputs and performance using automated alerts and multidisciplinary review. Artificial intelligence should augment, never replace, clinical judgment, with explicit role delineation and continuous monitoring to safeguard equity and patient-centred outcomes.