The peer review process for the evaluation of manuscripts for publication needs to be better understood by the orthopaedic community. Improving the degree of transparency surrounding the review process and educating orthopaedic surgeons on how to improve their manuscripts for submission will help improve both the review procedure and resultant feedback, with an increase in the quality of the subsequent publications. This article seeks to clarify the peer review process and suggest simple ways in which the quality of submissions can be improved to maximise publication success. Cite this article: Bone Joint Res 2013;2:245–7

This talk will initially give a brief overview of the motivations behind open access publishing and explain the practicalities of the different business models from an author's point of view. The talk will then discuss open access policy, particularly in Europe, and how the publishing landscape is constantly changing, with new initiatives and mandates being introduced all the time. Innovation in peer review such as transparent peer review and registered reports will be outlined and evaluated with examples from the BMC journals portfolio. The talk will then explain some of the funding options available to authors for open access publishing, and introduce the Springer Nature funding support service, which is available to anyone wishing to find out their options. Finally, the importance of data sharing will be discussed, as will the relatively new area of open access books

Introduction. The transition from resident to registrar constitutes a steep learning curve in most medical practitioners’ careers, regardless of speciality. We aimed to determine whether a six-week orthopaedic surgical skills course could increase resident skills and confidence prior to transitioning to orthopaedic registrar within the Gold Coast University Hospital, Queensland, Australia. Materials. Unaccredited registrars, orthopaedic trainees, and orthopaedic consultants, through a departmental peer reviewed process and survey, developed a six-session course (“Registrar Academy”) that included basic knowledge and essential practical skills training for residents with an interest in becoming orthopaedic registrars. This course was implemented over a 3-month period and assessed. Mixed method quantitative and qualitative evidence was sought via a 14-item and 18-item Likert scale questionnaire coupled with open-ended questions. Ethical approval was granted by our institutions Human Research and Ethics Comittee, reference no.: HREC/16/QGC336. Results/Discussion. Results were qualitatively synthesised using quantitative and qualitative data. Thirteen residents participated in the course. All residents agreed to statements indicating they felt unprepared to work as an orthopaedic registrar and were not confident in performing various core tasks required. After completing the course, residents indicated greater confidence or comfort in all these areas and felt better prepared for the transition to registrar. There was broad approval of the course among participants. Every participant who completed the final questionnaire agreed or strongly agreed that they enjoyed the course and that it taught usable, reproducible practical skills and increased their orthopaedic knowledge. This group also uniformly agreed or strongly agreed that the course improved their patient care and patient safety. Conclusion. Residents feel unprepared for their transition to orthopaedic registrar and lack confidence in several core competencies. A supplemental “Registrar Academy” within an institution is an effective way to improve knowledge, confidence, and practical skills for residents wishing to transition to a registrar position

You have a great research question or an idea for an innovation that will change your field. You have worked tirelessly to develop the project and are excited with the outcome. Now it is time to disseminate your findings to the world. This talk will give some insight into how to maximise the impact of your writing to reach the largest possible audience. It will discuss what makes a great paper, and provide pointers for navigating the editorial process, from your initial interactions with the editor to handling the sometimes-difficult process of peer review

Summary. Biomechanical studies comparing fixation constructs are predictable and do not relate to the significant clinical problems. We believe there is a need for more careful use of resources in the lab and better collaboration with surgeons to enhance clinical relevance. Introduction. It is our impression that many biomechanical studies invest substantial resources studying the obvious: that open reduction and internal fixation with more and larger metal is stronger. Studies that investigate “which construct is the strongest?” are distracted from the more clinically important question of “how strong is strong enough?”. The aim of this study is to show that specific biomechanical questions do not require formal testing. This study tested our hypothesis that the outcome of a subset of peer reviewed biomechanical studies comparing fracture fixation constructs can be predicted based on common sense with great accuracy and good interobserver reliability. Patients & Methods. Between 2000 and 2012, we found 254 peer reviewed biomechanical studies in prestigious orthopaedic journals comparing construct ‘A’ versus construct ‘B’ to evaluate load to failure in order to determine ‘which construct is the strongest?’. Eleven studies comparing fracture fixation constructs were randomly selected from different journals based on our sense that the answer was obvious prior to performing the study. Three-hundred independent observers; including orthopaedic- and general- surgeons affiliated with the Science of Variation Group (. www.scienceofvariation.org. ), predicted the outcome of these biomechanical studies. Observers were presented the original published illustrations of different treatment modalities and were asked to answer one question: “which construct is the strongest?” Sensitivity, specificity and accuracy were calculated according to standardised formulas. The agreement among the observers was calculated by using a multirater kappa, described by Siegel and Castellan. The kappa values were interpreted as proposed by Landis and Koch. Results. Accuracy was the same or greater than 80% for all studies except for study 1. The level of experience had no influence on the accuracy of predicting outcomes. Sensitivity averaged 84%, ranging from 60% (for study 1) to 99% (for study 7), specificity 86%, ranging from 60% (for study 1) to 99% (for study 7), and accuracy averaged 86% from 60% (for study 1) to 99% (for study 7). The overall categorical rating of inter-observer reliability according to Landis and Koch was moderate (κ = 0,53; SE = 0.01), ranging from κ = 0,03 (SE = 0.01) to κ = 0,95 (SE = 0.01). Analyses of SOVG subgroups identified excellent agreement among Canadian surgeons. Moderate and substantial agreement were found in most of other subgroups: ranging from first year medical students to specialists 20 years or more in practice; and specialists who practice in Australia, Europe and United States. Study 5 was easiest to predict based on common sense (Accuracy 97%, inter-observer reliability 0,88). Study 1 was predicted with least accuracy 61% and the lowest kappa value 0,04. Conclusions. The outcomes of biomechanical studies comparing fracture reduction and fixation constructs are highly predictable with good inter-observer reliability

Background The internet is an increasingly utilised resource for accessing information regarding a variety of heath conditions. YouTube is a popular video sharing platform used to both seek and distribute information online. Materials & Methods. A search for ‘scoliosis’ was carried out using YouTube's search engine and data was collected on the first fifty videos returned. A JAMA score (to determine currency, authorship, source and disclosure) and scoliosis specific score (that measures the amount of information on the diagnosis and treatment options as devised by Mathur et al in 2005; scored 0–32) was recorded for each video to measure quality objectively. Additionally the number of views, number of comments and feedback positivity was documented for each. Data analysis was conducted using R 3.1.4/R Studio 0.98 with control for the age of each video in analysis models. Results. The average number of views per video was 71,152 with an average length of 7 minutes 32 seconds. Thirty six percent of the videos fell under the authorship category of personal experience. The average JAMA score was 1.32/4 and average scoliosis specific score was 5.38/32. There was a positive correlation between JAMA score and number of views P=0.003. However in contrast there was a negative correlation between scoliosis specific score and number of views P=0.01. Conclusions. Online health information has historically been poor and our study shows that in an environment like YouTube which lacks a peer review process, the quality of scoliosis information is low. Further work is needed to determine whether accessing information on YouTube can play a role in patient care other than simple education pertaining to the disease and its management. Level of Evidence. Health Services Study Level 3

Summary. The M2a-38. tm. metal on metal total hip arthroplasty showed a high incidence of pseudotumors and an unexpected high revision rate in our thoroughly screened cross sectional cohort. Introduction. After the revival of the metal on metal (MoM) bearing in total hip arthroplasty (THA) at the beginning of this century, there are now serious questions about this type of bearing. The advantage of large head MoM bearing is the increase in range of motion and stability. In our institution the choice was made for 38 mm heads. During the last few years concerns have been raised about the relationship of MoM bearing and elevated serum cobalt and chromium ion levels, their local and systemic toxicological effects and the incidence of local tumorous masses (pseudotumors). Are these findings applicable for all MoM bearings or are there also product specific issues. We present the outcome of a cementless MoM THA using a 38mm head in a unique consecutive series of 377 THA who were performed in our institution. Patients and Methods. All 351 patients (377 THA) with a cementless MoM THA (M2a-38. tm. , Biomet Inc, Warsaw, IN, USA, and Taperloc® stem, Biomet UK, Bridgend) between 2008 and 2011 were evaluated. All patients were analyzed by a physical exam, serum levels of cobalt and chromium and an interview to determine if there were any complaints. An MRI of the hip was made if patients reported pain during physical activity, allergies to metals, serum cobalt or chromium ion levels ≥ 5 ppb or if the inclination of the acetabular component was more than 50 degrees. Nine patients deceased, three were lost to follow up and four already underwent a revision before the screening. We analyzed 361 hips with an average follow up of 30 (range 2–58) months. The average preoperative age was 63 years (41–88). Results. 219 patients with 235 THA (65%) reported no complaints. Median cobalt level in patients with complaints was 6.6 (0.2–173) ppb and in the group without complaints 3.7 (0.2–27.3) ppb. Median chromium level in patients with complaints was 5.0 (0.1–134) ppb and in the group without complaints 3.7 (0.2–27) ppb. On the 226 performed MRI scans, 56 pseudotumors were diagnosed and described using the Anderson classification (9 C1, 41 C2 and 5 C3). 71 hips had been revised after a mean follow of 30 months (range 0.2–50 months). Reasons for revision were because of pain, raised metal ions and a pseudotumor in 28; pain and raised metal ion levels in 15; aseptic loosening of the acetabular or femoral component in 11; raised metal ions and a pseudotumor in 7; combination of luxations, luxation feelings and fractures in 5; infections in 3 and for other reasons in 2. Conclusion. The short-term results of the THA with a 38mm head metal on metal articulation are higher compared with other MoM bearings. They show a revision rate of 7% and 10% in the Australian and England register. In other peer reviewed literature we find a revision rate between 0–13% after five years. We also observed a high incidence of elevated serum levels of metal ions, pseudotumors and an unexpected high early revision rate

Trauma and orthopaedics is the largest of the surgical specialties and yet attracts a disproportionately small fraction of available national and international funding for health research. With the burden of musculoskeletal disease increasing, high-quality research is required to improve the evidence base for orthopaedic practice. Using the current research landscape in the United Kingdom as an example, but also addressing the international perspective, we highlight the issues surrounding poor levels of research funding in trauma and orthopaedics and indicate avenues for improving the impact and success of surgical musculoskeletal research.

Cite this article: Bone Joint J 2014; 96-B:1578–85.

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.