We evaluated the top 13 journals in trauma and orthopaedics by impact factor and looked at the longer-term effect regarding citations of their papers. All 4951 papers published in these journals during 2007 and 2008 were reviewed and categorised by their type, subspecialty and super-specialty. All citations indexed through Google Scholar were reviewed to establish the rate of citation per paper at two, four and five years post-publication. The top five journals published a total of 1986 papers. Only three (0.15%) were on operative orthopaedic surgery and none were on trauma. Most (n = 1084, 54.5%) were about experimental basic science. Surgical papers had a lower rate of citation (2.18) at two years than basic science or clinical medical papers (4.68). However, by four years the rates were similar (26.57 for surgery, 30.35 for basic science/medical), which suggests that there is a considerable time lag before clinical surgical research has an impact. We conclude that high impact journals do not address clinical research in surgery and when they do, there is a delay before such papers are cited. We suggest that a rate of citation at five years post-publication might be a more appropriate indicator of importance for papers in our specialty. Cite this article: Bone Joint J 2014;96-B:414–19

The application and interpretation of the impact factor of a journal is fraught with problems, some of which are explored in this editorial

Background: One of the disadvantages of the Impact Factor (IF) is self-citation. The SCImago Journal Rank (SJR) indicator excludes self-citations and incorporates quality of citations that a journal receives by other journals, rather than absolute numbers. This study re-evaluated self-citation influence on the 2007 IF for 17 major orthopaedic journals and the difference in ranking using IF or SJR was investigated. Methods: Divided in a general (n = 8) and specialized (n = 9) group, all journals were analysed for self-citation rate, self-cited rate and citation density. Rankings of the 17 journals for IF and SJR were determined and the difference in ranking was calculated. Results: Specialized journals had higher self-citation rates (p = 0.05), self-cited rates (p = 0.003) and lower citation-densities (p = 0.01). Both groups correlated for self-citation rate and impact factor (general: r = 0.85 ; p = 0.008) (specialized: r = 0.71 ; p = 0.049). When ranked for SJR instead of IF, five journals maintained rank, six improved their rank and six experienced a decline in rank. Biggest differences were seen for BMC MD (+7 places) and CORR (− 4 places). Group-analyses for the IF (general: 7.50 – 95%CI 3.19 to 11.81) (specialized: 10.33 – 95%CI 6.61 to 14.06) (p = 0.26), SJR (general: 6.63 – 95%CI 2.66 to 10.60) (specialized: 11.11 – 95%CI 7.62 to 14.60) (p = 0.07) and the difference between both rankings (general: 0.88 – 95%CI –1.75 to 3.50) (specialized: − 0.78 – 95%CI –2.20 to 0.65) (p = 0.20), showed an enhanced underestimation of sub-specialist journals. Conclusion: Citation analysis shows that general journals tend to use more citations per published article and a larger portion of self-citations constitutes citations of sub-specialist journals compared to more general journals. The SJR excludes the influence of self-citation and awarded prestige by the SJR implies a different quality-evaluation for most orthopaedic journals. A disadvantage using this indicator, is an enhanced effect of underestimation of sub-specialist journals

CAN TKR is aimed to improve accuracy in realignment with balanced knee joint. Variability in the force exerted during tissue tensioning depends on the viscoelastic nature of soft tissues. Aim: To measure gap balance to assess effectiveness of CAN on ligament balance using gap balancing approach with tibia 1st cut. Methods: OrthoPilot system with 4.3 software and Statistical evaluation with Testimate Version 6.0, IDV Gaunting Germany with a two sided Wilcoxon-Pratt test (P< 0.05) used simulating errors in extension and flexion gap balance. P1, control with 16 datasets created and P2-P7 (96 case series) was propagated with ±3mm variants in extension and flexion gap both medial and lateral, only varying 1, keeping others constant. Controls fixed: distal transverse plane cut at 0° to femoral mechanical axis in frontal plane and 3°external rotation in sagittal plane. Tibia cut 90° to mechanical axis. Mechanical axis constant at 0° and gap balance at 0 mm. Deviations in gap errors using trigonometrical calculations based on E-Motion femoral implant, size/thickness; 3/7mm and 4/8.5mm with variation of insert size 10/12mm equal to sum of gap and bone cut. Results: Over tensioning (OT) distal lateral extension gap (DLEG) causes tight distal medial extension gap (DMEG). Under tensioning (UT) DLEG causes loose posterior medial flexion gap (PMFG). UT DLEG causes tight DLEG. Impact factor > 2mm increased PMFG with lateral lift off with only PMFG as variant. Increasing PMFG > 2mm caused lax PMFG. UT even by 1mm PMFG causes error by notching and tight PMFG. A considerable number of errors observed in frontal plane of femur. Relationships between OT/UT analyzed by Spearman rank ratio p< 0.001. Conclusions: Change of tissue spreader tension in EG or FG causes improper registration with mismatch in EG/FG/Bone cut. This study provides a baseline to further assess and develop the concept of optimal soft tissue balance as ligaments function properly only with the desired isometry in gap balancing technique

Aims. The evidence base within trauma and orthopaedics has traditionally favoured quantitative research methodologies. Qualitative research can provide unique insights which illuminate patient experiences and perceptions of care. Qualitative methods reveal the subjective narratives of patients that are not captured by quantitative data, providing a more comprehensive understanding of patient-centred care. The aim of this study is to quantify the level of qualitative research within the orthopaedic literature. Methods. A bibliometric search of journals’ online archives and multiple databases was undertaken in March 2024, to identify articles using qualitative research methods in the top 12 trauma and orthopaedic journals based on the 2023 impact factor and SCImago rating. The bibliometric search was conducted and reported in accordance with the preliminary guideline for reporting bibliometric reviews of the biomedical literature (BIBLIO). Results. Of the 7,201 papers reviewed, 136 included qualitative methods (0.1%). There was no significant difference between the journals, apart from Bone & Joint Open, which included 21 studies using qualitative methods, equalling 4% of its published articles. Conclusion. This study demonstrates that there is a very low number of qualitative research papers published within trauma and orthopaedic journals. Given the increasing focus on patient outcomes and improving the patient experience, it may be argued that there is a requirement to support both quantitative and qualitative approaches to orthopaedic research. Combining qualitative and quantitative methods may effectively address the complex and personal aspects of patients’ care, ensuring that outcomes align with patient values and enhance overall care quality

Aims. Systematic reviews of randomized controlled trials (RCTs) are the highest level of evidence used to inform patient care. However, it has been suggested that the quality of randomization in RCTs in orthopaedic surgery may be low. This study aims to describe the quality of randomization in trials included in systematic reviews in orthopaedic surgery. Methods. Systematic reviews of RCTs testing orthopaedic procedures published in 2022 were extracted from PubMed, Embase, and the Cochrane Library. A random sample of 100 systematic reviews was selected, and all included RCTs were retrieved. To be eligible for inclusion, systematic reviews must have tested an orthopaedic procedure as the primary intervention, included at least one study identified as a RCT, been published in 2022 in English, and included human clinical trials. The Cochrane Risk of Bias-2 Tool was used to assess random sequence generation as ‘adequate’, ‘inadequate’, or ‘no information’; we then calculated the proportion of trials in each category. We also collected data to test the association between these categories and characteristics of the RCTs and systematic reviews. Results. We included 917 unique RCTs. We found that 374 RCTs (40.8%) reported adequate sequence generation, 61 (6.7%) were inadequate, 410 (44.7%) lacked information, and 72 (7.9%) were observational studies incorrectly included as RCTs within the systematic review. Publication year, an author with statistical or epidemiological qualifications, and journal impact factor were each associated with adequate randomization. We found that 45 systematic reviews (45%) included at least one inadequately randomized RCT or an observational study incorrectly treated as a RCT. Conclusion. There is evidence of a lack of random allocation in RCTs included in systematic reviews in orthopaedic surgery. The conduct of RCTs and systematic reviews should be improved to minimize the risk of bias from inadequate randomization in RCTs and mislabelling of non-randomized studies as RCTs. Cite this article: Bone Jt Open 2024;5(12):1072–1080

Hypermobility Spectrum Disorder (HSD or hEDS) is attributed to a collagen abnormality associated with excessive joint flexibility. Approximately 90% of females with hip dysplasia have hypermobility. Manifestations of hypermobility in various body systems are unique to every patient, affecting different tissues of the body with varying degrees of severity. Our purposes were to identify the manifestations of hypermobility across multiple body systems and to study the recognition of hypermobility in the medical literature of multiple specialties over multiple decades. A literature search of the major medical disciplines for key words associated with HSD was performed. These specialties included gastroenterology, gynecology, neurology, psychiatry, oral-maxillofacial surgery, cardiology, and orthopaedic surgery. A specialty-specific impact factor (IF) score was calculated as the percentage of research articles that referenced hypermobility as a comorbidity over all articles within that specialty. Statistical differences were identified using single factor ANOVA with significance determined at p<0.05. We reviewed many published, specialty-specific manifestations of hypermobility, and describe them. All six non-orthopaedic specialties demonstrated a continually increasing relative IF ratio throughout the study period with a peak impact average of 0.22 (p<0.05 compared with other time ranges). There was a 93.3% overall increase in IF scores from the 1992–1998 period to the most recent period examined (p<0.05). Hypermobility is increasingly recognized as a significant health issue in multiple disciplines. Since dysplasia is associated with approximately 40% of all primary total hip arthroplasty cases, understanding the multi-system manifestations, and broad impact of hypermobility on patients, is relevant for every hip surgeon. We are expanding our research into other medical disciplines, including urology, ophthalmology, dermatology, clinical psychology, and others

Objectives. Despite the fact that research fraud and misconduct are under scrutiny in the field of orthopaedic research, little systematic work has been done to uncover and characterise the underlying reasons for academic retractions in this field. The purpose of this study was to determine the rate of retractions and identify the reasons for retracted publications in the orthopaedic literature. Methods. Two reviewers independently searched MEDLINE, EMBASE, and the Cochrane Library (1995 to current) using MeSH keyword headings and the ‘retracted’ filter. We also searched an independent website that reports and archives retracted scientific publications (. www.retractionwatch.com. ). Two reviewers independently extracted data including reason for retraction, study type, journal impact factor, and country of origin. Results. One hundred and ten retracted studies were included for data extraction. The retracted studies were published in journals with impact factors ranging from 0.000 (discontinued journals) to 13.262. In the 20-year search window, only 25 papers were retracted in the first ten years, with the remaining 85 papers retracted in the most recent decade. The most common reasons for retraction were fraudulent data (29), plagiarism (25) and duplicate publication (20). Retracted articles have been cited up to 165 times (median 6; interquartile range 2 to 19). Conclusion. The rate of retractions in the orthopaedic literature is increasing, with the majority of retractions attributed to academic misconduct and fraud. Orthopaedic retractions originate from numerous journals and countries, indicating that misconduct issues are widespread. The results of this study highlight the need to address academic integrity when training the next generation of orthopaedic investigators. Cite this article: J. Yan, A. MacDonald, L-P. Baisi, N. Evaniew, M. Bhandari, M. Ghert. Retractions in orthopaedic research: A systematic review. Bone Joint Res 2016;5:263–268. DOI: 10.1302/2046-3758.56.BJR-2016-0047

Research is the quest for information. It is not an excuse for attending meetings in exotic places, nor is it an escape from clinical work that has become uninteresting. The early orthopaedic joumals contained reports of patients who have been treated by individual surgeons in specific, often novel, ways. There was little scientific structure, but nevertheless these papers were valuable as they disseminated knowledge to other Surgeons and also stimulated enquiry. Orthopaedic research has developed dramatically over the last two or three decades. Patient related research has been advanced as a result of the availability of new techniques for example electron microscopy, DNA sequencing and the Genome, together with the discovery of the fine details of the cytokine control of cellular processes. This has gone hand in hand with the development of surgical sophistication allowing more adventurous interventions. Joint replacement and internal fixation have led to close associations between orthopaedic surgeons and scientists from other disciplines, notably engineers and material scientists. This multi-disciplinary involvement is typical of orthopaedic surgeons and results in each discipline benefiting from the specialist knowledge of the others. The natural tendeney for orthopaedic surgeons to be interested in mechanical items is clear from a study of the distribution of interesting cars in the hospital car park!. The efficacy of different treatment methods should be challenged and this has resulted in the need for careful audit and epidemiological review. In some instances this has resulted in the conclusion that often used treatments are not effective. The assiduous application of the Cochrane principles is often very revealing, not least in that it indicates the lack of properly conducted orthopaedic trials. Academic orthopaedics is in danger. In many countries the speciality is under pressure, normally as a result of economic measures that restrict the avallability of salarles and grants. In spite of these restrictions, it is surprising that there is a steady supply of excellent papers. How much better it could be with more funding. The purpose of publícation is to share information. It should be the aim of every research worker to make a contribution to the understanding of the subject and to share his findings with his colleagues. Curiously many researchers feeI that their commitment to their project is complete as soon as they finish the trial and have the results. The preparafion of their work for dissemination through publication is often a very weak link and in some instances is absent. This is a dangerous tendency as their information may not be broadcast, wasting the scientific endeavour and endangering the status of the fundíng organisation, whose charitable status often depends on sharing the fruitg of research. The incentive to publish is very variable. In some institutions the very existenee of a research department depends on a ‘paper score’ which is normally calculated from the product of the number of papers and the impact factor of the j ournal in which they are published. The calculation used to determine the impact factor of ajournal does not favour orthopaedic journals, as most orthopaedic papers are not quoted prolifically within the first year of publication. In contrast orthopaedic papers tend to have a much longer and more valuable lifetime and to some this is the more important and relevant feature. Unfortunately, the long-term value of the papers is not part of the calculation of impact factor. In order to achieve a high impact factor the publication must be in a rapidly changing field and contain at least a tiny element of special originality, which leads to it being quoted by most of the workers in that field. In the publishing world there is an ongoing discussion conceming an index that is more relevant than the impact factor. For some, the competition for publication is so intense that there is ‘salami slicing’. Salami slicing is a process of publishing very small morsels of information in short papers instead of producing the complete study. It is done intentionally to increase the number of papers published and is frowned upon by scientific editors. Even worse there are cases of plagiarism and fraud, sadly occurring more commonly in surgical publication, than in other disciplines. It may be time to ask fundamental questions about the need for research, articularly the need for every doctor in training to improve or embellish his or her Curriculum Vitae by decorating it with published works. There ís a tendeney for the more wealthy and better respected grant awarding bodies to fund successful rescarch teams, rather than to risk their limited resources on a spectacular project from an unknown team. Funding is avallable from commercial sources. The role of this type of rescarch may require special assessment. There are issues of intellectual property rights and instances of commercial organisations delaymg or preventing publication if the findings of the study are not favourable. Many cynical readers give no weight to papers that are sponsored by commercial sources. It is essential that rescarch in orthopaedics continues and that every possible step is taken in order to facilitate high quality research. There may be strength in numbers and it could be that the newly revitalised European Orthopaedic Research Society could help in supporting the endeavours of rescarch workers, particularly when it comes to European funding

Aims. Our purpose was to determine the quality of current randomised controlled trials (RCTs) in hand surgery using standardised metrics. Materials and Methods. Based on five-year mean impact factors, we selected the six journals that routinely publish studies of upper extremity surgery. Using a journal-specific search query, 62 RCTs met our inclusion criteria. Then three blinded reviewers used the Jadad and revised Coleman Methodology Score (RCMS) to assess the quality of the manuscripts. Results. Based on the Jadad scale, 28 studies were of high quality and 34 were of low quality. Methodological deficiencies in poorly scoring trials included the absence of rate of enrolment, no power analysis, no description of withdrawal or dropout, and a failure to use validated outcomes assessments with an independent investigator. Conclusion. A large number of RCTs in hand, wrist, and elbow surgery were of suboptimal quality when judged against the RCMS and Jadad scales. Even with a high level of evidence, study design and execution of RCTs should be critically assessed. Methodological deficiencies may introduce bias and lead to statistically underpowered studies. Cite this article: Bone Joint J 2017;99-B:94–9

Introduction. The productivity of trainees, consultants and institutions is frequently judged by the quantity of articles published in medical journals. While personnel may change, an institution should pride itself on its publication record. The aim of the study was to assess the publication history of Irish orthopaedic units over the last 5 years, and to identify patterns of publication. Methods. Using the same criteria used to differentiate candidates applying for the specialist registrar posts, we performed an extensive Pub Med search of each consultant affiliated with each orthopaedic unit in the country for the last 5 years (2004-2008) to assess the number of publications by each respective consultant and unit. Only the most senior publishing orthopaedic consultant, and the specific institution cited received credit for each paper. Publications were classified by individuals, institutions, publication type and impact factor. Results. 239 papers were published from 22 orthopaedic units over the 5 years, in 69 different journals. 56 consultants had at least one senior author publication, 7 consultants had more than ten publications. Teaching hospitals and units affiliated with research laboratories performed well. Some smaller units perform well when the average papers-per-consultant ratio is applied. Impact factors of the journals targeted varied considerably and reveals in interesting duality among authors when opting for profile or prestige. Conclusions. This audit provides an insight into the volume, quantity and quality of publications produced by Irish orthopaedic units over the last 5 years. With the current difficulties with regards to funding research, both consultants and orthopaedic units need to be more brand-conscious when submitting papers for publication

Summary Statement. The mechanism of spinal cord injury varies across the human population and this may be important for the development of effective therapies. Therefore, detailed understanding of how variables such as impact velocity and depth affect cord tissue damage is important. Introduction. Studies have shown an independent effect of impact velocity and depth on injury severity, thereby suggesting importance of the interaction between the two for spinal cord injury. This work examines both the individual and interactive effects of impact velocity and impact depth on demyelination, tissue sparing, and behavioural outcomes in the rat cervical spinal cord. It also aims to understand the contribution of the energy applied during impact, not only the impact factors. Decoupling the effects of these two impact parameters will help to describe the injury mechanism. Maximum principal strain has also been shown to be useful as a predictor for neural tissue damage in vivo and in finite element (FE) models. A better understanding of this relationship with experimental results may help to elucidate the mechanics of spinal cord injury. Methods. In this study, 54 male Sprague-Dawley rats were given a contusion spinal cord injury at impact speeds of 8 mm/s, 80 mm/s, or 800 mm/s with depths of 0.9 mm or 1.5 mm. Animals recovered for 7 days followed by behavioural assessment and examination of the spinal cord tissue for demyelination and tissue sparing at 1 mm intervals, ±3 mm rostrocaudally to the epicentre. In parallel, a previously developed finite element model of the rat spinal cord was used to examine the resulting maximum principal strains in the spinal cord for correlations with histological and mechanical impact data. Results and discussion. Impact depth was a consistent factor in predicting axonal damage, tissue sparing, and the resulting behavioural deficit. Increased impact velocity resulted in significantly higher impact energies and measureable tissue damage at the 1.5 mm impact depth, but not at the 0.9 mm impact depth and is best displayed by the percentage of axon damage at the injury epicentre. Linear correlation analysis with FEA strain showed significant (p≪0.001) correlations with axonal damage in the ventral (R2=0.86) and lateral (R2=0.74) regions of the spinal cord and with white matter (R2=0.90) and grey matter (R2=0.76) sparing. Discussion and Conclusion. The difference in injury severity to velocity at different impact depths identifies the existence of threshold interactions between the two impact factors. Beyond this point incremental increases in either velocity or depth are more likely to result in significantly increased impact energy and thus tissue damage and functional impairment. The relationship between the impact depth and velocity of injury demonstrated a more rate sensitive response to spinal cord tissue damage at the deep (1.5 mm) impact depth than at the shallow (0.9 mm) impact depth. Impact velocity also became quickly less significant than impact depth in determining tissue damage further from the epicentre. Furthermore, the results shown by this work extend the research identifying significant correlations between maximum principal strain and neurological tissue damage

The February 2024 Wrist & Hand Roundup³⁶⁰ looks at: Occupational therapy for thumb carpometacarpal osteoarthritis?; Age and patient-reported benefits from operative management of intra-articular distal radius fractures: a meta-regression analysis; Long-term outcomes of nonsurgical treatment of thumb carpometacarpal osteoarthritis: a cohort study; Semi-occlusive dressing versus surgery in fingertip injuries: a randomized controlled trial; Re-fracture in partial union of the scaphoid waist?; The WALANT distal radius fracture: a systematic review; Endoscopic carpal tunnel release with or without hand therapy?; Ten-year trends in the level of evidence in hand surgery.

Aims

Several artificial bone grafts have been developed but fail to achieve anticipated osteogenesis due to their insufficient neovascularization capacity and periosteum support. This study aimed to develop a vascularized bone-periosteum construct (VBPC) to provide better angiogenesis and osteogenesis for bone regeneration.

Using inaccurate quotations can propagate misleading information, which might affect the management of patients. The aim of this study was to determine the predictors of quotation inaccuracy in the peer-reviewed orthopaedic literature related to the scaphoid. We randomly selected 100 papers from ten orthopaedic journals. All references were retrieved in full text when available or otherwise excluded. Two observers independently rated all quotations from the selected papers by comparing the claims made by the authors with the data and expressed opinions of the reference source. A statistical analysis determined which article-related factors were predictors of quotation inaccuracy. The mean total inaccuracy rate of the 3840 verified quotes was 7.6%. There was no correlation between the rate of inaccuracy and the impact factor of the journal. Multivariable analysis identified the journal and the type of study (clinical, biomechanical, methodological, case report or review) as important predictors of the total quotation inaccuracy rate. We concluded that inaccurate quotations in the peer-reviewed orthopaedic literature related to the scaphoid were common and slightly more so for certain journals and certain study types. Authors, reviewers and editorial staff play an important role in reducing this inaccuracy