Review Article

Orthopaedic research in low-income countries: A bibliometric analysis of the current literature

¹ Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
² Orthopaedic Research Unit, Department of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town 7700, South Africa
³ Orthopaedic Trauma Service, Groote Schuur Hospital, University of Cape Town, Cape Town 7700, South Africa
⁴ Director, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
⁵ Alder Hey Hospital, Liverpool L12 2AP, UK
⁶ Oxford Trauma, NDORMS, University of Oxford, OX3 9DU, UK
⁷ University of Malawi College of Medicine, Private Bag 360, Chichiri, Blantyre 3, Malawi
⁸ Countess of Chester Hospital, Chester CH2 1UL, UK
⁹ AO Alliance Foundation, Africa Regional Director, Davos, Switzerland

^* Corresponding author: simonmatthewgraham@doctors.org.uk

Received: 13 May 2019
Accepted: 11 October 2019

Abstract

Background: To perform a bibliometric analysis and quantify the amount of orthopaedic and trauma literature published from low-income countries (LICs).

Methods and methods: The Web of Science database was utilised to identify all indexed orthopaedic journals. All articles published in the 76 orthopaedics journals over the last 10 years were reviewed, to determine their geographic origin.

Results: A total of 131 454 articles were published across 76 orthopaedic journals over the last 10 years. Of these, 132 (0.1%) were published from LICs and 3515 (2.7%) were published from lower middle-income countries (LMICs); 85.7% (n = 112 716) of published orthopaedic research was undertaken in a high-income setting. The majority of the studies (n = 90, 74.4%) presented level IV evidence. Only 7.4% (n = 9) were high-quality evidence (level I or II). Additionally, the majority of research (74 articles, 56%) was published in partnership with high-income countries (HICs).

Conclusions: There is a stark mismatch between the publication of scientific reports on orthopaedic research and the geographical areas of greatest clinical need. We believe there is an urgent need for orthopaedic research to be carried out in low-income settings to guide treatment and improve outcomes, rather than assuming that evidence from high-income settings will translate into this environment.

Level of evidence: IV