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A bibliometric analysis of orthopedic publications originating from Turkey

Objective: The objective of this study was to analyze the research productivity originating in Turkey using articles published in the top 40 orthopedic journals according to the Journal Citation Reports for 2013. Methods: All scientific papers published in English and included in the Science Citation Index Expanded between 1980 and 2013 were analyzed using the “Web of Science”. The number of publications per million (PmP) was calculated. All selected journals were analyzed for the numbers of articles, authorships, institutions and 100 most frequently cited papers. Results: From a total of 130,494 articles published worldwide, the United States ranked first according to output. Turkey ranked 14th in the number of orthopedic publications and 26th out of 30 countries in the PmP index. 2012 produced the greatest number of publications worldwide and 2008 for Turkey. Gunal I., Yazici M. and Ozturk C. were the most frequent contributors. Hacettepe University, Istanbul University and Ankara University were the most frequent intuitions among all Turkish publications. The Archives of Orthopaedic and Trauma Surgery was the most frequently published journal in this period with a rate of 16.3%. There was a total of 9,085 (8,765; excluding self-citations) citations of the 1,398 publications published in Turkey until December 2013, with a citation-to-work ratio of 7.47 and an h-index of 34. Conclusion: With the newly established universities, as well as training and research clinics, the approach of increasing number of orthopedics and traumatology clinics and specialists to scientific activities would be more fruitful in the light of these data.

Bibliometrics is the analysis of books and other media of communication using mathematics and other statistical methods. Bibliometric analyses provide significant advantages for the investigation of publications, journals, authors and publishing institutions and in the demonstration of the scientific productivity of countries. [1] The advances in computer technology and the wider use of the Internet have resulted in an increase in bibliometric analysis since the beginning of the 2000s. In recent years, bibliometric analyses of publications on orthopedics, pediatric orthopedics, hand surgery and knee surgery have been published. [1][2][3][4][5] Using the Web of Science (WoS) database, studies on countries' self-assessment of their scientific productivity have also been reported. [6] In an attempt to determine the contribution of Turkey to global science and the country' s international publication productivity, bibliometric analyses have been conducted under the auspices of ULAKBİM Cahit Arf Information Center. However, no detailed assessment of publications on Orthopedics and Traumatology has been reported.
The purpose of this study was to conduct a bibliometric analysis of Turkish publications in the top 40 orthopedic journals according to the Journal Citation Reports ( JCR) Impact Factor List 2013 by Thomson-Reuters.

Materials and methods
The 68 journals of orthopedics and traumatology listed in the Science Citation Index Expanded (SCI-E) were ranked based on impact factor scores. The top 40 journals were defined as the study group (Table 1). The articles published in these journals between 1980 and 2013 were accessed using the WoS database on 12/31/2013 to identify the total number of publications worldwide between 1980 and 2013. The number of non-article publications (letters to the editor, conference or meeting summaries, chapter of a book, reviews, notes, corrections, and reprints) were removed from the total. The total number of publications from Turkey, and its rank in the world were determined. The number of publications originating from Turkey and other countries per year was also identified. Publications per million (PmP) was calculated by dividing the total number of publications by the population of each country. [6] Articles not originating from Turkey were then excluded from the study. The number of articles from Turkey, the first published article, the year of publication, the journal the article was published in, publishing institutions and the total number of articles of the authors and their total number of articles as the lead author were determined. The differences in the names of educational institutions in the literature were examined one by one. For the correct identification of the number of publications written by authors with identical names (for example, C. Yılmaz), full names of the authors in the top 50 articles were searched.
Using the same software, the total number of cita-tions of publications from Turkey, the distribution of citations according to year and the most cited 100 articles and their authors and institutions were determined. Among the top 100 articles, the institutions with the most publications were determined and the journals the articles were published in and the authors of the oldest and newest articles were also specified.

Results
Out of the 167,072 publications listed in the SCI-E, 1,877 (1.12%) scientific publications were written by Turkish authors. When the non-article publications were excluded, a total of 130,494 publications were identified and the number of total and publications per million were calculated for each country ( Table 2). The United States of America (USA) ranked first with 60,016 publications and Turkey 14th with 1,594 publications in the mentioned journals. Among the top 30 publishing countries based on the number of publications per million, Switzerland ranked first with 407.5 (*10 6 ) and Turkey 26 th with 21(*10 6 ) ( Table 3). The highest number of articles (n=7,656) worldwide was published in 2012 and in 2008 from Turkey (n=149) ( Fig. 1). While the number of publications from Turkey increased dramatically since the 2000s, there has been a considerable decrease since 2010 ( Fig. 1 and Table 2). After the exclusion of 196 articles of non-Turkish origin or published with authors from different countries (152 from USA, 11 from Canada, 10 from Britain, 10 from the Netherlands, and 13 from other countries), a total of 1,398 articles from Turkey remained. In the top 40 journals as ranked by impact factor, the first article published was "Treatment of open fractures with external fixation" by Aslanoğlu O. et al. in the Orthopedics journal in 1984. [7] Of the publishing institutions, Hacettepe University ranked first with 141 publications, followed by Istanbul University (including Çapa and Cerrahpaşa) with 135 and Ankara University with 94. On the other hand, between 2010 and 2014 Istanbul University ranked first with 30 publications, followed by Hacettepe University   Table 1).
The 1,398 published articles were cited 9,085 (8,765; excluding self-citations) times, for an average of 7.47 ( Fig. 2 and Table 6). Table 6 presents the most frequently cited 10 publications. The most cited publication was "Short-segment pedicle instrumentation of thoracolumbar burst fractures: does transpedicular intracorporeal grafting prevent early failure?" by Alanay A. et al. published in the Spine journal in 2001 and was referenced 85 times. [8] In recent years, the number of citations to publications   10.1097/00007632-199302000-00020 Publishing date: Feb 1993 [13] Title: Gabapentin is a first line drug for the treatment of neuropathic pain in spinal cord injury. 1.

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from Turkey has been increasing. In addition, 2012 saw the highest number of citations to publications from Turkey (Fig. 2). Publications from Turkey were most frequently cited by American authors (n=2.586).  Publishing date: Aug 2005 [20] 8.

9.
10. Table 7. Distribution of authors among the most cited 100 articles. 6 Alanay The increased number of publications worldwide was attributed to a number of factors, in particular increased gross national product and scientific support, [6] However, the decreased number of scientific publications in Turkey despite an increased gross national product is not supportive of this hypothesis. This decrease might have resulted from an unstable healthcare policy and the according temporary or permanent separation of the majority of faculty members from universities due to the implementation of the 'full day law' . One of the parameters used in the measurement of scientific productivity of a community is the PmP index, which is the ratio of the number of publications to the population of a country. When the top 30 countries according to the publication ranking were ordered based on the PmP, Turkey ranked 26 th with 21 PmPs (Table  2). Scandinavian countries such as Switzerland, Sweden and Norway ranked high. Among the G8 countries; China, France, Germany and Italy ranked below 100. It is evident that global productivity associated with industrialization and economic growth does not trigger scientific productivity. Therefore, it can be concluded that economic growth is not the only way to increase scientific productivity.

Number of Authors citations
A total of 130,494 articles were published in journals included in our study. The highest number of articles was published by authors from the USA (60,016 articles; 46%) ( Table 2). With regard to the number of publications, Turkey ranked first among countries of the Middle East and Eastern Europe. It is of interest that G8 countries such as Germany, France and Russia did not rank among the top 10. For instance, the number of publications from Russia was 44. This decrease can be explained by the fact that these countries refuse to adopt English as the scientific lingua franca and continue to publish in their own language and region.
Inter-university communication and joint scientific publication is common in Turkey, as in other countries. A total of 196 articles published when Turkish academicians were observers in foreign universities or conducted by interinstitutional cooperation were detected. The institutions with the highest number of articles published in cooperation with authors from foreign universities were Hacettepe University (45 publications), Ankara University (14 publications) and Istanbul University (9 publications), respectively. On the other hand, Turkish authors had the highest number of joint scientific publications with Alfred I. duPont Hospital for Children (USA) and Children' s Hospital Philadelphia (USA). The authors with the highest number of joint publica-tions with foreign institutions and academics were Muharrem Yazıcı (15 publications), Mahmut Nedim Doral (14 publications) and Muharrem İnan (13 publications), respectively. The continuation and increase of this cooperation is of great importance for the globalization of Turkish orthopedic science.
Publishing institutions are also as important as countries. Ensuring the continuity of articles and their successful publication are important indicators of institutional scientificity. Hacettepe University had 141 Turkish articles, Istanbul University 135 and Ankara University 94 published in the study group journals ( Table 5). Between 2010 and 2013, a period when the number of publications from Turkey decreased, Istanbul University (30 publications) and Hacettepe University (29 publications) ranked first and second, respectively. During this period, Acıbadem University and Hospitals published 18 articles, Başkent University and Ankara Numune Hospital 14 each, and Kırıkkale University 13.
The continuity of name is important for the recognition of an educational institution and follow-up of its scientific activities. A literature review demonstrated a mean difference of 4.1 [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]  The increased scientific scholarship amount was associated with the increased number of publications in foreign countries. [6] A scientific citation to a publication indicates its validity and scientific value. Thus, 2012 saw the highest number of citations of publications from Turkey (Fig.  2). There has been an increase in citations over years. An analysis of citations to Turkish publications in the literature revealed that the most frequently cited 100 publications were written by 390 different authors. The most frequently cited authors were Alanay A, Surat A and Yazıcı M with 6 publications each. Five authors received 5 citations and 3 authors received 4 ( Table 7). Fourteen publications from Ankara University, 13 from Istanbul University and 11 from Hacettepe University received the highest number of citations. Spine published most of the most cited 100 publications (22 publications). The oldest publication among the top 100 was "Congenital dislocation of the hip and its relation to swaddling used in Turkey" by Kutlu et al., which was published in the Journal of Pediatric Orthopedics in 1992 and was referenced 35 citations. [9] The newest paper is "The Microfracture Technique for the Treatment of Full-Thickness Articular Cartilage Lesions of the Knee: Midterm Results" by Aşık et al., which was published in Arthroscopy: The Journal of Arthroscopic and Related Surgery in 2008 and received 28 citations. [10] There was a total of 9,085 citations to publications from Turkey (self-citation: 320). The highest number of citations to publications from Turkey was made by the USA, China, England, and India. Furthermore, publications from Turkey were second most commonly cited by Turkish authors.
In this study, as in all WoS-based bibliometric analyses, articles published before 1980, those not included in the top 40 and journals which terminated publishing activities before 2013 could not be assessed. Furthermore, this study might be unable to reflect the actual scientific activities of authors and institutions. An analysis based on SciVerse, Scopus or PubMed or other databases also including the assessment of articles published in the journals excluded from the study and in domestic journals can provide more satisfactory information. The number of publications of an institution may vary depending on an author' s failure to use standard names and abbreviations during the course of submission. To avoid this, all institution names in the literature were examined individually. Authors' names and legal changes in the surnames could not be documented. The impact factor of the journals is another matter of debate. A high impact factor is not always linked to scientific quality of a journal. [11] However, bibliometric analyses provide objective data reflecting one scientific activities of a country in a specific field of science or in any research field and enables comparison with scientific activities of other countries.
In conclusion, of 122 countries, Turkey ranked 14th in the number of orthopedic publications and 26th out of 30 countries in the PmP index. We believe that, with the newly established universities, as well as training and research clinics, the approach of increasing number of orthopedics and traumatology clinics and specialists to scientific activities would be more fruitful in the light of these data.

Conflicts of Interest: No conflicts declared.
Most bibliometric analyses use data originating from one or more of the three citation indices supplied by Thomson Reuters. (ISI â€" the Institute for Scientific Information â€" founded by Eugene Garfield in 1958 is now a part of Thomson Reuters.) The most important Thomson Reuters citation index for medicine, life science and the natural sciences is the Science Citation Index Expanded (SCIE).Â The starting point in a bibliometric analysis is to select a group of publications. This selection of publications forms the unit of analysis. The publications may for example be selected on the basis of the authorsâ€™ organizational affiliation, such as For that purpose, a bibliometric analysis was conducted over the 33560 medicine-related articles published by Turkish universities during the years 2010 to 2012 in journals indexed by the Web of Science. In order to conduct in depth subject-based analaysis of publication patterns, the publications are classified under three medical divisions by aggregating medical subject categories provided by Web of Science.Â Even though there are in depth studies of medical publications originated from Turkey in the literature, existing studies either focus on identifying the performance of a particular medical school in Turkey or comparing the performance of all Turkish institutions to another country in a specific medical subject.