We will be performing site maintenance on AAOS.org on February 8th from 7:00 PM – 9:00 PM CST which may cause sitewide downtime. We apologize for the inconvenience.


Published 1/1/2011

In the Top 100 classic articles, where’s mine?

In October 2010, The Journal of Bone and Joint Surgery—British (JBJS—British) had an article on “The 100 classic papers of ortho-paedic surgery: A bibliometric analysis” and Clinical Orthopaedics and Related Research (CORR) published online “The 100 most cited articles in orthopaedic surgery.”

I looked at both articles. I quickly ran through the lists. There were articles by Harris and Salter and more Harris, but where were my contributions?

I was chagrined and upset and vowed never to read JBJS—British or CORR again (until the next issue). I had to be in the top 100. I am a “legend in my own mind.” I have written extensively on fractures of the neck of the talus and even changed the classification, and I authored a classic article on osteochondrosis of the talus (with two of my former residents). They even call me “Terry Talus” or “Talus Terry.” I also have written several articles on Perthes disease that I considered classic—so much so that my residents call it “Legg-Canale-Perthes” disease. But, nope, I was not in the top 100.

Well, I thought, surely my contemporaries (whom I quoted) will be listed. But, no, I found no mention of Leland Hawkins, MD (fracture of the neck of the talus classification), no Anthony Catterall, MD, PhD (classification of Legg-Calvé-Perthes disease), no Pauwel, no Boyd, no Houston. Hey, what’s going on here?!? Obviously, in my case it’s sour grapes, but what about those other giants in orthopaedics?

So, unlike my normal habit, I decided to read the articles less superficially and more in depth. It finally dawned on me that both lists reflected the number of times an article was cited in specific journals. Both articles picked, with minor exceptions, the same peer-reviewed journals and thus the top 100 listings were roughly the same.

I continued to review the literature in search of the truth (Holy Grail, hidden treasure). I found listings of the top 20 cited articles in trauma and the top 20 in pediatric orthopaedics, but still no listing for “Terry Talus” or “Legg-Canale-Perthes.”

But I did find out what influences the number of times an article is cited. In terms of topics, the evaluation of a surgical or medical therapy; a description of a novel technique; or substantiation of a classification or grading system are important. Citations are also influenced by the time of publication (old versus new), the size and field of the study, and the particular journal in which the article is published.

Realizing that made me feel better. The larger the field, the more is written in that field (specialty) and the more publications in that specialty. Thus, the more times an article in that specialty can be cited. There are lots of total joint articles, lots of sports articles, but not many on the talus or Legg-Canale-Perthes disease. Now I can rationalize why I and some of my predecessors didn’t make the lists.

But shouldn’t “classic” mean more? The dictionary defines “classic” as being an excellent role model of its kind, as in famous, traditional, basic, fundamental, and definitive. Thus, in orthopaedics, classic would mean a model article of its kind, having a great impact on the field, and influencing research, education, tendencies, and opinions.

Measuring classic by the number of times an article is cited is just one approach to meeting this definition. The top 100 or top 20 or top 10 can be picked another way—by subjective, and I mean totally personal, application of the dictionary definition of classic. So, I asked the members of the AAOS Now editorial board and a few others to pick their top 10 articles using any criteria they wanted. (Some picked more, some fewer—orthopaedists have trouble with numbers!)

I did send everyone the definition of a “classic,” and the JBJS—British and CORR lists. I also asked everyone to think broadly about the influence the article had on orthopaedics or the impact on their personal specialty or even on their own practice. So here they are, as subjective as the list may be—the top 20 classics as chosen by the AAOS Now panel, in alphabetical order.

  1. Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW: Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects: A prospective investigation. J Bone Joint Surg Am 1990; 72:403–408.
  2. Denis F: The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine 1983; 8:817–831.
  3. Enneking WF, Spanier SS, Goodman MA: A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res 1980; 153:106–120.
  4. Fairbank TJ: Knee joint changes after meniscectomy. J Bone Joint Surg Br 1948; 30:664–670.
  5. Gustilo RB, Anderson JT: Prevention of infection in treatment of 1,025 open fractures of long bones: Retrospective and prospective analyses. J Bone Joint Surg Am 1976; 58:543–558.
  6. Harrington PR: Treatment of scoliosis: Correction and internal fixation by spine instrumentation. J Bone Joint Surg Am 1962; 44:591-610.
  7. Harris WH: Traumatic arthritis of the hip after dislocation and acetabular fractures: Treatment by mold arthroplasty. J Bone Joint Surg Am 1969; 51:737–755.
  8. Ilizarov GA: The tension-stress effect on the genesis and growth of tissues. Part I: The influence of stability of fixation and soft tissue preservation. Clin Orthop Relat Res 1989; 238:249–281.
  9. Ilizarov GA: The tension-stress effect on the genesis and growth of tissues. Part II: The influence of the rate and frequency of distraction. Clin Orthop Relat Res 1989; 239:263–285.
  10. Neer CS II: Anterior acromioplasty for chronic impingement syndrome in the shoulder: A preliminary report. J Bone Joint Surg Am 1972; 54:41–50.
  11. Neer CS II: Displaced proximal humeral fractures: I. Classification and evaluation. J Bone Joint Surg Am 1970; 52:1077–1089.
  12. Noyes FR, Butler DL, Grood ES, Zernicke RF, Hefzy MS: Biomechanical analysis of human ligament grafts used in knee-ligament repairs and reconstructions. J Bone Joint Surg Am 1984; 66:344–352.
  13. Phalen GS: The carpal tunnel syndrome: Seventeen years’ experience in diagnosis and treatment of 654 hands. J Bone Joint Surg Am 1996; 48:211–228.
  14. Rowe CR, Patel D, Southmayd WW: The Bankart procedure: A long-term end-result study. J Bone Joint Surg Am 1978; 60:1–16.
  15. Salter RB, Simmonds DF, Malcolm BW, Rumble EJ, Macmichael D, Clements ND: The biological effect of continuous passive motion on the healing of full-thickness defects in articular cartilage: An experimental investigation in the rabbit. J Bone Joint Surg Am 1980; 62:1232–1251.
  16. Salter RM, Harris WR: Injuries involving the epiphyseal plate. J Bone Joint Surg Am 1963; 45:587–622.
  17. Schmalzried TP, Jasty M, Harris WH: Periprosthetic bone loss in total hip arthroplasty: Polyethylene wear debris and the concept of the effective joint space. J Bone Joint Surg Am 1992; 74:849–863.
  18. Smith GW, Robinson RA: The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am 1958; 40:607–624.
  19. Trueta J, Harrison MH: The normal vascular anatomy of the femoral head in adult man. J Bone Joint Surg Br 1953; 35:442–461.
  20. Winquist RA, Hansen ST Jr, Clawson DK: Closed intramedullary nailing of femoral fractures: A report of 520 cases. J Bone Joint Surg Am 1984; 66:529–539.

Now that’s an impressive list. I don’t feel bad about not making it, even though I figured they would have to list the “Editor.” But, nope, I still didn’t make it—even in a biased subjective vote!

Oh, well, it was fun, and shows the difference between the top classic articles “cited” and the classic articles that have merit and have meant the most to the small group of orthopaedists surveyed.

Wait a minute! There I am! Number 16 in the 25 top-cited pediatric orthopaedic articles—Beaty JH, Austin SM, Warner WC, et al, on femoral shaft fractures in adolescents. That’s me—old “et al”!