The Internet has the potential to be an instant access universal medical library: all literature, available anywhere, at any time. In theory, everything which has ever been published could be available - full text and illustrations - on any Internet enabled device. The importance of this is obvious as one tracks the rates at which medical texts go out of print, community medical library budgets dwindle, and new publications arrive. The issue is particularly important in hand surgery, because hand surgery literature continues to be spread across a variety of specialty publications.  This makes it impractical for many hand surgeons to keep abreast of the full spectrum of publications relating to their own specialty without maintaining subscriptions to many journals which have relatively little in common with their practice.

Web site links also allow the promise of turning Web based literature into one giant textbook.  Text on one web site can be linked to related text on others, allowing the user to browse an unlimited number of sources, all within one "cover", and without the need to burden each author with details of cross collaboration. The ability of one document to include live search links which can retrieve related information published after the publication date of that document, the ability of a document to make available all raw data, without size constraint, the ability of a scientific report to be updated live as a study progresses, all provide staggering implications for knowledge storage and retrieval.

Current Reality
The Internet will not replace the hand surgeon's library - at least, not yet.  Copyright law will continue to prevent unlimited access to literature.  Also, reading printed text is still more pleasant and less awkward than reading print on a computer screen.  Most people still choose to print out and read a large electronic document rather than view it entirely on a computer screen. The internet won't replace books until it is as convenient as a book, and should be considered an adjunct to print resources, valuable for quick access, survey of topics, and immediate input while writing papers.  For example, I wrote this article while online using a Web browser editor, and was able to search, browse and confirm online publications as an effortless and integral component of writing.  Internet Web addresses listed in this article can be accessed online at

On-line resources typically have an intrinsically different flavor than print, more often resembling a collection of short stories than a novel.  Literature abstracts, summaries, case presentations and other focused treatments represent the majority of available medical on-line references.  This is an asset for learning, as most people learn and retain more easily from a short illustrated narrative than from an expansive text.

Because hand surgery is such a visual specialty, multimedia available over the Web has utility far beyond print . Page sized illustrations can be linked to much larger high resolution images for further study. Technology for online video on demand is progressing rapidly, and now is satisfactory for instructional or demonstrative videos.  What was that maneuver?  How are the biomechanics affected?  How was that splint fabricated? These sorts of questions are much better served by video than text and static images.  Video clips may be made available for download, but the trend is to use streaming video.  With streaming technology, the viewer or is able to watch the video as it downloads rather than waiting for the download and trying to figure out how to play it later. Examples of streaming hand surgery videos include the fabrication and the use of the Schenck dynamic traction splint for proximal interphalangeal joint fracture dislocations (10), technique of ulnar nerve transposition (35), other clinical videos relating to the hand (22) and hand surgery information for patients (48, 62).

Images and video clips can be annotated or modified and shared through e-mail.  Additionally, graphic data files can be shared on line - not simply pictures, but models which can be modified and incorporated into other  graphic and virtual reality applications (63). It is also now possible to transmit and share raw data from imaging devices such as CT and MRI, allowing the surgeon to view custom cuts and three dimensional reconstructions on their own computer using free programs such as MRIcro (40).