The Journal of Bone and Joint Surgery has published case reports since its inception as the first scholarly scientific journal dedicated to musculoskeletal medicine and surgery more than 125 years ago. For the last twenty-five years, The Journal’s approach to publishing case reports has been guided by Dr. Henry Cowell’s editorial published in JBJS in June 1987. As the Editor-in-Chief at the time, Cowell stated, “The purpose of a Case Report is to report new information about a rare or unusual condition, a new or improved method of diagnosis of a particular condition, or a new or improved method of treatment of a particular condition.”1 Acceptance rates for the publication of case reports that have been submitted have hovered around 9% to 10% in the recent past.
With the advent of web-based communication and scholarly publication, information has become more easily accessible for use in patient care. Search tools and strategies now allow for the aggregation of case reports on rare and unusual conditions to allow treating physicians and patients alike to combine broader swathes of the peer-reviewed literature to help in decision-making. To date, there has been little attention to the “mining” of case reports of rare or unusual musculoskeletal conditions. We hope that our change in the approach to case reports will meet that need.
Instituted in early 2011, JBJS Case Connector is an electronic publication that allows rare or unusual cases to be grouped for the purposes of decision-making. A linkage system based on concepts and their relationships has been implemented to allow ready access to, and aggregation of, similar cases. These concepts fall into seven major categories: topics, diseases and conditions, treatment and procedures, signs and symptoms, anatomy, devices, and patient demographics. Users can select concepts across these categories to identify cases they seek, or they can search with use of keywords. More than 3000 cases, including all of those from The Journal archives, are now available within JBJS Case Connector for this purpose. While case reports submitted to JBJS Case Connector still undergo peer review, the acceptance rate for publication is currently approximately 30% of submissions.
We invite authors to submit cases to JBJS Case Connector to expand this pool of case reports for two purposes. The first is to add to the database of unusual or rare cases. We suggest for this purpose that a case be one that an individual has seen only once or twice during a career and one that is not common enough for inclusion in a clinical research report of a case series. The definitions outlined by Dr. Cowell are still pertinent, but we will not be applying the strict standard of uniqueness of a case to include it in JBJS Case Connector. In this way, the data set can be expanded to provide physicians with a broader range of case management and outcome information for the purposes of decision-making for a patient who has an uncommon condition.
The second purpose is to aid in the early detection of complications related to a particular device or procedure for which long-term follow-up information has not been published. We particularly invite the submission of unreported or unusual mechanical device complications as has been recently encouraged by the FDA2.
We invite the orthopaedic community at large to support this effort by providing submissions to JBJS Case Connector for the advancement of care for patients with rare or unusual musculoskeletal conditions.