Misquotation of a commonly referenced hand surgery study

Purpose Novel clinical studies often define how we practice hand surgery. Proper referencing of these articles is therefore critical. Since the publication of Knirk and Jupiter's 1986 study analyzing intra-articular distal radius fractures in young adults, citations of this article have appeared to be inconsistent in the biomedical literature. We believe that analysis of studies referencing the Knirk and Jupiter article will reveal notable discrepancies with respect to the original data. Methods We carefully reviewed Knirk and Jupiter's original article, Intra-articular Fractures of the Distal End of the Radius in Young Adults (J Bone Joint Sung 1986;68A:647-659) and formulated a comprehensive tabular outline of results and conclusions made in the article for reference. An electronic search was performed using the Institute for Scientific Information Scientific Citation Index for all articles written in English referencing the Knirk and Jupiter article from 1986 through 2002. Of the 159 articles found in the ISI database, 154 were retrieved and reviewed by 2 hand surgeons. Each article referencing the work was classified into I or more of 12 separate categories and rated as accurate, inaccurate, or equivocal with respect to Knirk and Jupiter's original data. Results Of the 154 articles examined, 63 have at least I inaccurate reference of the Knirk and Jupiter article. In general, articles referencing Knirk and Jupiter's classification system, protocol, or tables are accurate (59 of 63), whereas a majority of the articles addressing the value of 2 mm of articular incongruity after a distal radius fracture are inaccurate (43 of 57). Conclusions Conclusions drawn from the Knirk and Jupiter article, especially regarding the value of 2 mm of articular incongruity of the radiocarpal joint at the time of fracture union, vary from one author to the next. Care must be taken in referencing biomedical literature, particularly articles that have a potentially profound impact on clinical patient management.