The fifty most cited Latin-American articles in the orthopaedic literature

Purpose

The number of citations of an article is a marker of its academic influence. Several medical specialties, including orthopaedics, have ranked the articles with more citations. We identified the 50 most cited orthopaedic articles from Latin-America and analyzed the characteristics that made them citable.

Methods

Science Citation Index Expanded was searched for citations of articles originated in Latin-America, published in any of the 63 journals in the category “Orthopaedics” from 1988 to 2013. We created a list ranking the 50 most commonly cited articles and determined the citation density (Citations/years since publication). Information noted for each article included authors, year of publication, country of origin, source journal, article type, and field of research.

Results

Latin-American countries were the origin of 1 % of orthopaedic articles. The top 50 most cited articles had between 29 and 150 citations (mean, 44.48); the citation density ranged from 1.43 to 15.5 citations/years (mean, 5.25). The articles were published in 19 of the 63 journals (11 general and eight sub-specialty journals), and all were published in English. Most articles (n = 29) were published in 2000 or later. The majority were clinical articles (n=40), and the most common fields were arthroscopy (n = 15) and hip surgery (n = 13). The top 50 articles originated mainly from Brazil (n = 20) and Argentina (n = 15).

Conclusions

This top 50 list displays articles that have become important references for the orthopaedic scientific community. Researchers may use this work to make their future publications more influential on future investigators.     

Analysis of Orthopaedic Research Produced During the Wars in Iraq and Afghanistan

Background

Military orthopaedic surgeons have published a substantial amount of original research based on our care of combat-wounded service members and related studies during the wars in Iraq and Afghanistan. However, to our knowledge, the influence of this body of work has not been evaluated bibliometrically, and doing so is important to determine the modern impact of combat casualty research in the wider medical community.

Questions/purposes

We sought to identify the 20 most commonly cited works from military surgeons published during the Iraq and Afghanistan conflicts and analyze them to answer the following questions: (1) What were the subject areas of these 20 articles and what was the 2013 Impact Factor of each journal that published them? (2) How many citations did they receive and what were the characteristics of the journals that cited them? (3) Do the citation analysis results obtained from Google Scholar mirror the results obtained from Thompson-Reuters’ Web of Science?

Methods

We searched the Web of Science Citation Index Expanded for relevant original research performed by US military orthopaedic surgeons related to Operation Iraqi Freedom and Operation Enduring Freedom between 2001 and 2014. Articles citing these studies were reviewed using both Web of Science and Google Scholar data. The 20 most cited articles meeting inclusion criteria were identified and analyzed by content domain, frequency of citation, and sources in which they were cited.

Results

Nine of these studies examined the epidemiology and outcome of combat injury. Six studies dealt with wound management, wound dehiscence, and formation of heterotopic ossification. Five studies examined infectious complications of combat trauma. The median number of citations garnered by these 20 articles was 41 (range, 28–264) in Web of Science. Other research citing these studies has appeared in 279 different journals, covering 26 different medical and surgical subspecialties, from authors in 31 different countries. Google Scholar contained 97% of the Web of Science citations, but also had 31 duplicate entries and 29 citations with defective links.

Conclusions

Modern combat casualty research by military orthopaedic surgeons is widely cited by researchers in a diverse range of subspecialties and geographic locales. This suggests that the military continues to be a source of innovation that is broadly applicable to civilian medical and surgical practice and should encourage expansion of military-civilian collaboration to maximize the utility of the knowledge gained in the treatment of war trauma.

Level of Evidence

Level IV, therapeutic study.     

Have Levels of Evidence Improved the Quality of Orthopaedic Research?

Background

Since 2003 many orthopaedic journals have adopted grading systems for levels of evidence (LOE). It is unclear if the quality of orthopaedic literature has changed since LOE was introduced.

Questions/purposes

We asked three questions: (1) Have the overall number and proportion of Level I and II studies increased in the orthopaedic literature since the introduction of LOE? (2) Is a similar pattern seen in individual orthopaedic subspecialty journals? (3) What is the interobserver reliability of grading LOE?

Methods

We assigned LOE to therapeutic studies published in 2000, 2005, and 2010 in eight major orthopaedic subspecialty journals. Number and proportion of Level I and II publications were determined. Data were evaluated using log-linear models. Twenty-six reviewers (13 residents and 13 attendings) graded LOE of 20 blinded therapeutic articles from the Journal of Bone and Joint Surgery for 2009. Interobserver agreement relative to the Journal of Bone and Joint Surgery was assessed using a weighted kappa.

Results

The total number of Level I and II publications in subspecialty journals increased from 150 in 2000 to 239 in 2010. The proportion of high-quality publications increased with time (p < 0.001). All subspecialty journals other than the Journal of Pediatric Orthopaedics and the Journal of Orthopaedic Trauma showed a similar behavior. Average weighted kappa was 0.791 for residents and 0.842 for faculty (p = 0.209).

Conclusions

The number and proportion of Level I and II publications have increased. LOE can be graded reliably with high interobserver agreement. The number and proportion of high-level studies should continue to increase.     

Impact factors of orthopaedic journals between 2000 and 2010: trends and comparisons with other surgical specialties

Purpose

The impact factors (IF) of orthopaedic journals is an important component in determining the future of orthopaedic research funding. We aim to characterise the trend in journal IF over the last decade and draw comparisons with other surgical specialties.

Methods

We conducted an analysis of impact factors from Journal Citation Reports between 2000 and 2010.

Results

Between 2000 and 2010 the number of orthopaedic journals increased from 24 to 41, more than any other surgical specialty and the mean IF increased from 0.842 to 1.400. Journals printed in the English language had a significantly higher IF in the year 2010 (1.64 vs. 0.33, p = 0.01) than those printed in other languages. English language journals published in the US had significantly higher mean 2010 IF (1.932 vs. 1.243, p = 0.025) than those published in Europe, and this had changed compared with 2000 mean IF (0.978 Vs. 0.704, p = 0.360). Orthopaedics was ranked sixth out of 11 surgical subspecialties in 2000 but dropped to seventh out of 11 in 2010.

Conclusions

The quality of orthopaedic journals has significantly increased over the last decade and this has been accompanied by a rise in mean IF. It is important that orthopaedics continues to improve the quality of research, which may help orthopaedic researchers secure funding in the future.     

The top 100 cited articles in urology

Background

We identified and analyzed the characteristics of the 100 most frequently cited articles published between 1965 and 2007 in journals pertaining to urology and related fields.

Methods

We selected 69 of the highest impact urology and sub-specialty journals and 22 of the highest impact general medical and medical research journals from the 2006 edition of Journal Citation Reports: Science edition. We identified the 100 most frequently cited urological articles published in these 91 journals using the Science Citation Index Expanded (1965–present). We reviewed and analyzed the articles.

Results

The top 100 articles were cited a mean of 629 times (range 418–1435) and published between 1965 and 2003, with 89% published after 1979 and 54% published in the 1990s. Fifteen journals were represented, led by The New England Journal of Medicine (30), The Journal of Urology (22) and Lancet (11). Ninety publications originated from North America (81) or the United Kingdom (9). Johns Hopkins University (13), Harvard University (5), Stanford University (5) and University of California, Los Angeles (5) published the most articles. Five urologists were first authors of 2 or more of the articles. Fifty-six articles reported observational studies. Oncology (51) and transplantation (20) were the most commonly represented urological subfields.

Conclusion

These top-cited articles in urology identify topics and authors that contributed to major advances in urology. Observational studies and randomized controlled trials in oncology published in high-impact urological or medical journals constitute the most common type of highly cited publications.     

Representation of developing countries in orthopaedic journals: a survey of four influential orthopaedic journals

Background

The developing world contains more than ¾ of the world’s population, and has the largest burden of musculoskeletal disease. Published studies provide crucial information that can influence healthcare policies. Presumably much information regarding burden in the developing world would arise from authors from developing countries. However, the extent of participation of authors from the developing world in widely read orthopaedic journals is unclear.

Purpose

We surveyed four influential English-language orthopaedic journals to document the contributions of authors from developing countries.

Methods

We surveyed Clinical Orthopaedics and Related Research, Journal of Orthopaedic Trauma, and the American and British volumes of The Journal of Bone and Joint Surgery, from May 2007 through May 2010. The country of origin of all authors was identified. We used the designations provided by the International Monetary Fund to define countries as either developed or developing.

Results

Two hundred sixty-five of 3964 publications (7%) included authors from developing countries. Ninety percent of these had authors from developing countries with industrialized and emerging-market economies. Publications from Sub-Saharan Africa accounted for only 0.4% of the 3964 articles reviewed and 5.6% of the 265 articles with developing world authorship. Countries with the least robust economies were least represented. Less than 1/3 of articles with authors from the developing world had coauthors from developed or other developing countries.

Conclusion

Additional studies are needed to determine the reasons for the low representation noted and to establish strategies to increase the number of orthopaedic publications from parts of the world where the burden of musculoskeletal disease is the greatest.     

Characteristics and Trends of Orthopedic Publications between 2000 and 2009

Background

This study was undertaken to investigate the trends of orthopedic publications during the last decade, and to document the country of origin, journal, funding source, and language of contribution using PubMed.

Methods

Orthopedic articles published between 2000 and 2009 were retrieved from PubMed using the following search terms: "orthopaedic[Affiliation] AND ("2000/1/1"[PDAT]: "2009/12/31"[PDAT])" and "orthopedic[Affiliation] AND ("2000/1/1"[PDAT]: "2009/12/31"[PDAT])." The articles were downloaded in XML file format, which contained the following information: article title, author names, journal names, publication dates, article types, languages, authors'' affiliations and funding sources. These information was extracted, sorted, and rearranged using the database''s management software. We investigated the annual number of published orthopedic articles worldwide and the annual rate of increase. Furthermore, the country of publication origin, journal, funding source, and language of contribution were also investigated.

Results

A total of 46,322 orthopedic articles were published and registered in PubMed in the last 10 years. The worldwide number of published orthopedic articles increased from 2,889 in 2000 to 6,909 in 2009, showing an annual increase of 384.6 articles, or an annualized compound rate of 10.2%. The United States ranked highest in the number of published orthopedic articles, followed by Japan, the United Kingdom, Germany, and the Republic of Korea. Among the orthopedic articles published worldwide during the last 10 years, 37.9% pertained studies performed in the United States. Fifty-seven point three percent (57.3%) of articles were published in journals established in the United States. Among the published orthopaedic articles, 4,747 articles (10.2%) disclosed financial support by research funds, of which 4,688 (98.8%) articles utilized research funds from the United States. Most articles were published in English (97.2%, 45,030 articles).

Conclusions

The number of published orthopedic articles has been increasing over the last decade. The number of orthopedic articles, journals publication, and funding sources were dominated by research conducted in the United States, while share and growth of Asian countries including Japan, the Republic of Korea, and China were notable.     

The Most Frequently Cited 100 Articles in Liver Transplantation Literature

Introduction

We investigated the liver transplantation literature since 1975 and found the most frequently cited 100 articles and assessed the distribution of authors and journals of these articles.

Evidence-based surgery--evidence from survey and citation analysis in orthopaedic surgery

INTRODUCTION

The results of a survey on evidence-based surgery (EBS) among members of the American Academy of Orthopedic Surgeons (AAOS) and the British Orthopaedic Association (BOA) are presented. The study also analyzes the citations earned by articles with different levels of evidence (LOE) to see if LOE have any bearing on the importance attached to the articles by authors and contributors to the journals.

SUBJECTS AND METHODS

The questionnaire was e-mailed to 1000 randomly chosen consultant orthopaedic surgeons who were members of either the AAOS or the BOA. Participants were provided with the option of responding through web-based entry. For citation analysis, citation data were gathered from the Journal of Bone and Joint Surgery (American volume) between the years 2003 and 2007 (5-year period).

RESULTS

The survey showed that awareness and access to EBS have improved greatly over the years. At the present time, these factors are not important barriers to the implementation of EBS in clinical practice in developed countries. There was a statistically significant difference in those with and without additional qualifications with regard to the approach to EBS. However, an equal percentage of surgeons with and without additional qualifications felt that it was difficult to adhere to EBS guidelines in daily clinical practice. Citation analysis showed that readers of professional journals attach importance to LOE category of the article and tend to cite level-I evidence articles more than other articles.     

Scientific publications in urology and nephrology journals from China: A 10-year analysis

Background:

The scientific research in urology and nephrology of China has developed significantly. The present study was designed to analyze the outputs of publications in urology and nephrology journals from three regions of China: mainland, Taiwan and Hong Kong.

Methods:

The numbers of articles, impact factors, citation reports and other indexes within this category between 2000 and 2009 were extracted for quantity and quality comparisons from PubMed and the ISI (Institute for Scientific Information-currently called the Thomson Reuters Web of Knowledge) database.

Results:

There were 3100 articles from the mainland (36.5%), Taiwan (46.8%) and Hong Kong (16.7%), and the increasing trend in each region was significant (p < 0.001). The accumulated impact factor and total citation of Taiwan exceeded the other two regions, while the average impact factor and citation of Hong Kong was highest. There were differences between the three regions on the most popular journals.

Interpretation:

Although the quantity of articles in urology and nephrology from the mainland has exceeded Taiwan and Hong Kong since 2008, there is a considerable gap in the quality of articles between the mainland and the other two regions.     

High-impact articles in hand surgery

Background

There have been few attempts to identify classic papers within the hand surgery literature. This study used citation analysis to identify and characterize the top 50 highly cited hand surgery articles published in six peer-reviewed journals.

Methods

The 50 most highly cited hand surgery articles were identified in the Journal of Bone and Joint Surgery (JBJS) American, JBJS British, Plastic and Reconstructive Surgery, Journal of Hand Surgery (JHS) American, JHS British/European, and Hand. Articles were evaluated for citations per year, surgical/anatomical topic, and type of study. Clinical studies were further sub-categorized by level of evidence. The distribution of topics was compared with all indexed hand surgery articles. The educational relevance was assessed via comparison with lists of “classic” papers.

Results

The most common subjects were distal radius fracture, carpal tunnel syndrome, and flexor tendon repair. There was moderate correlation between the distribution of these topics and all indexed hand surgery articles (rho = 0.71). There were 31 clinical studies, of which 16 were therapeutic, ten were prognostic, and five were diagnostic. These articles assessed the outcomes of an intervention, described an anatomical/functional observation, introduced an innovation, presented a discovery/classification, or validated a questionnaire. There were only three randomized trials. Using citations per year to control for the influence of time since publication, 36 articles were consistently highly cited. Twenty-three articles were on Stern’s Selected Readings in Hand Surgery, considered important in education.

Conclusions

The top 50 highly cited articles in hand surgery reflect the most common clinical, scientific, and educational efforts of the field.     

Are the claims made in orthopaedic print advertisements valid?

Purpose

Advertisements are commonplace in orthopaedic journals and may influence the readership with claims of clinical and scientific fact. Since the last assessment of the claims made in orthopaedic print advertisements ten years ago, there have been legislative changes and media scrutiny which have shaped this practice. The purpose of this study is to re-evaluate these claims.

Methods

Fifty claims from 50 advertisements were chosen randomly from six highly respected peer-reviewed orthopaedic journals (published July–December 2011). The evidence supporting each claim was assessed and validated by three orthopaedic surgeons. The assessors, blinded to product and company, rated the evidence and answered the following questions: Does the evidence as presented support the claim made in the advertisement and what is the quality of that evidence? Is the claim supported by enough evidence to influence your own clinical practice?

Results

Twenty-eight claims cited evidence from published literature, four from public presentations, 11 from manufacturer "data held on file" and seven had no supporting evidence. Only 12 claims were considered to have high-quality evidence and only 11 were considered well supported. A strong correlation was seen between the quality of evidence and strength of support (Spearman r = 0.945, p < 0.0001). The average ICC between the assessors’ ratings was strong (r = 0.85) giving validity to the results.

Conclusion

Orthopaedic surgeons must remain sceptical about the claims made in print advertisements. High-quality evidence is required by orthopaedic surgeons to influence clinical practice and this evidence should be sought by manufacturers wishing to market a successful product.     

An Analysis of References Used for the Orthopaedic In-Training Examination: What are Their Levels of Evidence and Journal Impact Factors?

Background

Although the references recommended for the Orthopaedic In-Training Examination (OITE) have been evaluated in certain subspecialty domains, suggested reference level of evidence (LOE), impact factor, and citation age have not been evaluated comprehensively to our knowledge.

Questions/purposes

We present an analysis of all references cited in the OITE recommended readings for each test question including the duration of time between their initial publication and their use in the OITE, which we defined as citation age, LOE, and the impact factor of the journals referenced.

Methods

We evaluated all references for the 2010 to 2012 OITE administrations (three examinations; 825 questions total). Publication characteristics, including citation age, were noted. The LOE for each journal article and the impact factor of each journal were determined; differences in LOE and impact factor were compared between test sections. A total of 1817 references were cited in the 825 questions we evaluated; this denominator was used in all calculations that follow.

Results

The recommended reading references included 1337 journal article references (74%), 469 text references (26%), and 11 multimedia sources (0.6%; eg, websites, instructional DVDs). The three most commonly recommended journals were general orthopaedic journals, TheJournal of Bone and Joint Surgery (American Volume), Journal of American Academy of Orthopaedic Surgeons, and Clinical Orthopaedics and Related Research^®. The majority (72.2%) of the cited journal references were published within 10 years of the test date, with a mean ± SD citation age of 8.3 ± 7.4 years. The majority of the cited journal articles were Levels IV and V evidence (mean, 4.16 ± 1.1). The Spine section had higher LOE (3.74; p < 0.001), although the practical relevance of such a difference is questionable, as all but two sections’ LOE rounded to Level IV evidence. The Spine and Basic Science sections were published in journals with a larger mean impact factor (Basic Science, 7.16 ± 12.67; Spine, 5.73 ± 12.08; p < 0.001).

Conclusions

Our data show that the majority of the recommended readings for the OITE stem from higher impact general orthopaedic and major subspecialty journals. Furthermore the observed mean LOE of the recommended readings shows a preponderance of Levels IV and V research. These data may suggest that test-takers may find benefit in the review of high-level general orthopaedic journals, and review articles in particular while preparing for the OITE, although further study is necessary to determine optimal test preparation strategies. Finally, our study provides a baseline analysis of the study designs of OITE recommended references, and may provide insight for educators designing resident educational curricula.

Electronic supplementary material

The online version of this article (doi:10.1007/s11999-014-3895-0) contains supplementary material, which is available to authorized users.     

The misuse of 'no significant difference' in British orthopaedic literature

INTRODUCTION

Many studies published in medical journals do not consider the statistical power required to detect a meaningful difference between study groups. As a result, these studies are often underpowered: the sample size may not be large enough to pick up a statistically significant difference (or other effect of interest) of a given size between the study groups. Therefore, the conclusion that there is no statistically significant difference between groups cannot be made unless a study has been shown to have sufficient power. The aim of this study was to establish the prevalence of negative studies with inadequate statistical power in British journals to which orthopaedic surgeons regularly submit.

MATERIALS AND METHODS

We assessed all papers in the last consecutive six issues prior to the start of the study (April 2005) in The Journal of Bone and Joint Surgery (British), Injury, and Annals of the Royal College of Surgeons of England. We sought published evidence that a power analysis had been performed in association with the main hypothesis of the paper.

RESULTS

There were a total of 170 papers in which a statistical comparison of two or more groups was undertaken. Of these 170 papers, 49 (28.8%) stated as their primary conclusion that there was no statistically significant difference between the groups studied. Of these 49 papers, only 3 (6.1%) had performed a power analysis demonstrating adequate sample size.

CONCLUSIONS

These results demonstrate that the majority of negative studies in the British orthopaedic literature that we have looked at have not performed the statistical analysis necessary to reach their stated conclusions. In order to remedy this, we recommend that the journals sampled include the following guidance in their instructions to authors: the statement ‘no statistically significant difference was found between study groups’ should be accompanied by the results of a power analysis.     

The use and abuse of abbreviations in orthopaedic literature

INTRODUCTION

Abbreviations are commonly used in medical literature. Their use has been associated with medical errors and they can be a source of irritation and misunderstanding. There are strict guidelines for their use. This study analysed the use of abbreviations in orthopaedic literature and compared adherence with guidelines in a general orthopaedic and spinal journal. It also examined orthopaedic professionals& understanding of abbreviations.

SUBJECTS AND METHODS

The use of abbreviations in articles over a 3-month period in a general orthopaedic and spinal journal was analysed. The number of abbreviations and adherence with guidelines was recorded. A group of orthopaedic healthcare professionals were tested for their understanding of abbreviations.

RESULTS

Almost half of all abbreviations were not properly used and 30% of abbreviations were never defined. Abbreviations were used significantly more often in the spinal journal. Only 40% of abbreviations were correctly defined by the orthopaedic professionals tested.

CONCLUSIONS

Guidelines regarding the use of abbreviations are not being adhered to by authors or editors. The poor understanding of abbreviations underlines the importance of minimising their use and defining abbreviations when they are used.     

A pioneer of urologic surgery from a small town in Ontario,Canada: A tribute to Abraham Groves (1847–1935)

Background:

Abraham Groves worked as a general practitioner and surgeon in the small town of Fergus, Ontario, Canada. Several priority claims have been attributed to Groves’ life in surgery, including aseptic surgery (1874), appendectomy (1883) and the use of surgical gloves (1885). He was also an early practitioner of urological surgery.

Objective:

The purpose of this paper is to describe and objectively assess his contributions as a pioneer in urological surgery.

Methods:

A systematic search of contemporary journals was made for articles by or about Groves. These articles and his 1934 autobiography were reviewed. The information was assessed not only for priority, but also for the development of organized surgical principles and thought.

Results:

Groves published frequently throughout his career; up to this point, 36 papers have been identified. Groves’ claims are verifiable for aseptic surgery, which were the result of logical surgical thought and was practiced throughout his career. Contemporary publications support his early use of suprapubic lithotomy (1875), prostatotomy (1887), bladder repair (1892), urethral repair (1903), renal decapsulation (1905) and prostatectomy (1911).

Conclusions:

Despite his isolation, Abraham Groves independently developed a full range of surgical techniques and principles relevant to modern-day urology. His impact was reduced by the nature of the environment in which he worked and by the limited circulation of the journals in which he chose to publish.