White Book

A Major Milestone for Hand Surgery in Europe

The European Competency and Training Framework for Hand Surgery was endorsed by UEMS on 25 april 2026.

This represents an important milestone for Hand Surgery in Europe. It recognises Hand Surgery as a distinct field of advanced competence within surgery and provides, for the first time, a common European framework describing the knowledge, skills and professional standards expected for structured Hand Surgery training.

This achievement has not been realised overnight. It is the result of many years of dedication, vision and commitment by numerous colleagues across Europe who have worked tirelessly to advance Hand Surgery as a specialty area and to promote high standards of patient care, education and collaboration. Everyone who has contributed to the growth and development of Hand Surgery over the years has, in one way or another, helped lay the foundations for this moment. For that, I would like to express my sincere gratitude.

I would also especially like to thank the members of the Working Group who worked intensively together with me on the development of this document. Their expertise, constructive discussions, perseverance and willingness to seek balanced solutions across different European training systems were essential in bringing this framework to completion.

Equally important is the spirit in which this document should be interpreted. The Framework is intended as a guideline and educational reference for your organisation and harmonisation of Hand Surgery training across Europe. It is not legislation, nor is it intended to replace national regulations or existing training structures. Europe is characterised by diversity in healthcare systems, surgical traditions and educational pathways, and this document was specifically designed to respect that diversity while defining common principles and standards.

Finally, this should be seen as a living document. As Hand Surgery continues to evolve, so too will education, surgical techniques, competency-based training and multidisciplinary collaboration. The Framework will therefore continue to be refined and optimised in the future through ongoing dialogue, experience and collaboration between the many professionals and organisations involved in Hand Surgery training across Europe.

This endorsement is not an endpoint, but rather an important beginning for the future of Hand Surgery training in Europe.

Sincerely yours,

Brigitte van der Heijden
President FESSH

On behalf of the Working Group:

Maurizio Calcagni (Switzerland)
Xavier Gueffier (France)
Carlos Heras-Palou (UK)
Gerald Kraan (The Netherlands)
Hayat Lamou (Germany)
Gürsel Leblebicioglu (Türkiye)
Jorma Ryhanen (Finland)
Pierluigi Tos (Italy)

Produced by the European Board of Hand Surgery – EBHS

WHAT IS HAND SURGERY?

Hand surgery is the field of medicine that deals with problems of the hand and wrist, whether of congenital, traumatic, degenerative, inflammatory or tumoral origin. The aim is to restore the function of the hand, which should be regarded as the key organ of prehension and sensibility. In this context, hand surgeons are also involved with complex problems of the whole upper extremity, including lesions of the peripheral nerves and the brachial plexus. Hand surgeons are also involved in the restoration of prehension in cases of tetraplegia and spasticity. Because of their special expertise, hand surgeons are also frequently involved in the repair of lower extremity nerve lesions.

THE SCOPE OF HAND SURGERY

The scope of hand surgery is broad and requires a wide range of diverse operative skills necessary to diagnose and treat, conservatively or surgically, hand and pertinent upper extremity and peripheral nerves affections.

The hand surgeon masters microsurgery as well as orthopaedic and plastic surgery techniques, as applied to the complex and delicate anatomy of the hand and upper limb. Hand Surgery considers also the cosmetic aspects of the reconstruction of the hand. A close cooperation with other specialists is required, including orthopaedic and trauma surgeons, plastic surgeons, radiologists, paediatric surgeons, rheumatologists, anaesthetists, specialized physiotherapists, occupational therapists and other paramedics for rehabilitation, orthotics and prosthetics. The treatment of a lesion of the hand/upper extremity in the earliest phase by a surgeon trained in hand surgery offers the patient the best chances of early and best recovery, and also reduces the costs related to the disability and time-off work for society. This is particularly true for the hand traumas, which are particularly frequent.

This book is made by cooperation of the specialist sections of UEMS, which deal with the education and qualification in hand surgery in EU countries, and FESSH in order to set the minimal requirements for a surgeon, who treats the complex problems of the hand. The UEMS Council has endorsed it in Prague, October 9, 2010.

To read the book please click on the DOWNLOAD button on the upper right.