Orthopaedic Internet Education

Orthopaedic Education on the Internet

As presented by Lennard Funk to the Asia Pacific Orthopaedic Association, Kuala Lumpur, 2004


The Internet has developed from a University toy to a global information resource in less than 20 years. Since it’s inception the academic benefits were realized. It is the ideal tool for the sharing of information and much quicker and cheaper to publish than any book. I have been involved in Orthopaedic online education for 12 years and have watched it expand from small fanatical groups of enthusiastic nerds to a key part of Orthopaedic learning. There now exists a large number of Orthopaedic resources of varying professionalism and use, with a wide range of target audiences. These include patient information sites, professional education sites, commercial services, organizations, online journals, government bodies and media sites. These all have a role to play in our current and future education. They are becoming more sophisticated and easier to use. In this lecture I will outline the various categories and their role, direct the audience to key websites and define the future of intelligent online education.


People have dreamt of a universal information database since the invention of the first data storage computers in the nineteen forties. The data would be accessible to people around the world, shared and comprehensive information.

Thanks to the efforts of pioneers at the US Advanced Research Project Agency (ARPA) in the nineteen sixties and seventees the internet was developed. The internet was founded on the premise of providing and sharing information by these and other pioneers of the period. The world wide web was developed around the ‘hypertext’ concept of quick links, as an easy way of accessing and viewing the internet. The Web has become completely global and comprises billions of pages of information. It can be accessed from even the most remote areas of the world and has millions of users. It is the preferred source of information for most people.

Information is the knowledge derived from study, experience, or instruction. Education is the knowledge or skill obtained or developed by a learning process The search for information on the internet and collating of this information becomes Education, thus the Internet is a massive provider of Education – through numerous methods – direct or indirectly. Orthopaedic surgery has been very mush a part of this information expansion, with over two million orthopaedic websites on the internet


With so many Orthopaedic websites available, how do you know which ones are any good?

Silberg et al. published a useful list of criteria in the Journal of the American Medical Association in 1997 (Silberg WM, Lundberg GD, Musacchio RA. JAMA 1997; Vol 277(15): 1244-1245). Based on these criteria, we should ask the following of any website:

  1. Who wrote the information? (what are the author(s) experiences / qualifications?)
  2. When was it last updated? (is the information out of date?)
  3. How is it funded? (are there any conflicts of interest?)
  4. What type of information is it? (descriptive or prescriptive)
  5. Does the site have an editorial board that includes independent medical experts?
  6. How reliable is the evidence that findings are based on?

The Health on the Net Foundation (HON) at www.hon.ch  applies these criteria (and others) to medical websites and then allows them HON accreditation. Websites belonging to HON should be free from commercialism and of an acceptable informaton quality. They all need to be written by medically tained and qualified persons and apply transparency of authorship and sponsorship, amongst other criteria. HON applies a code of conduct for medical websites. HON state their mission as to guide lay persons or non-medical users and medical practitioners to useful and reliable online medical and health information.

Orthopaedic Websites>

Orthopaedic websites can be broadly categorised as follows:

  1. Search Engines – search the Web in specific ways, depending on the search engine. Google is probably the most effective. It is worthwhile using the Advanced Searches
  2. Portals – these are sites established to allow an access to selected Orthopaedic websites on the Net. They may provide tools to search the web and sub-categorise the websites, making it easier for users to find sites of relevance. These may be established by individuals or organisations and may have an element of bias. They are a useful aid to browsing for information. The best and biggest is Orthogate and OWLS.
  3. Educational Resources –are individual sites, which provide a selection of educational and informative material; such as articles, CME sessions, discussion groups, surveys, images, quizzes etc.
  4. Online Textbooks – online books; but more effective as hyperlinks aid quick and easy navigation
  5. Online Journals – Almost all paper journals now have an online version. This may enhance the paper journal by providing video, additional information etc.
  6. Distance Learning Sites – comprising formal educational programmes
  7. Organisations – e.g. AAOS, APOA etc. Members information, news articles, policies etc.
  8. Commercial – Almost all product companies have websites providing educational information on their products.

Search Engines

One of the most common starting points for any information is search engines. These vary in accuracy in finding the most appropriate information for you. Google (www.google.com ) has become the most popular, as it has a unique way of assimilating the internet and searching. It uses two systems called PageRank and Anchor Texts. PageRank is the probability that a random surfer visits a page. Anchor Text works by associating text with not only the page that a link is on, but also with the page a link is linking to. (more details see http://www-db.stanford.edu/pub/papers/google.pdf ) Google also offers lots of other useful services, such as translation, image searches, spell checking etc.


MEDLINE is NLM's database of indexed journal citations and abstracts now covering nearly 4,500 journals published in the United States and more than 70 other countries. Available for online searching since 1971, MEDLINE includes references to articles indexed from 1966 to the present. New citations are added weekly. All citations in MEDLINE are assigned MeSH® Terms and Publication Types from NLM's controlled vocabulary. MEDLINE citations and abstracts are available as the primary component of NLM's PubMed database, which is searchable via the Internet.

In addition to providing access to MEDLINE, PubMed provides access to:

  1. The out-of-scope citations (e.g., articles on plate tectonics or astrophysics) from certain MEDLINE journals, primarily general science and chemistry journals, for which the life sciences articles are indexed for MEDLINE.
  2. Citations that precede the date that a journal was selected for MEDLINE indexing.
  3. Some additional life science journals that submit full text to PubMedCentral™ and receive a qualitative review by NLM.

my.PubMed is a full-featured search interface to PubMed - www.mypubmed.com  . my.PubMed can be tailored by the user to suit individual interests and provides the following features:

  1. Forms based query formulation.
  2. Automatic display of summaries when viewing search results.
  3. Display of similar documents when viewing documents.
  4. Display of recommended documents when viewing documents.
  5. Automatic mark-up of retrieved documents with search links.
  6. Search history listing searches made and documents retrieved.
  7. Saving searches for later re-use (with an SDI option).
  8. Saving documents in folders.
  9. Emailing documents to others.

Orthopaedic Portals

A Web Portal is a site featuring a suite of commonly used services, serving as a starting point Web portal services often include a search engine or directory, news, email, forums, chat, and options for customization. Large portals often include dozens or hundreds of bundled services.

The two most popular Orthopaedic Portals are Orthogate & Orthopaedic Wed Links (OWLS). Orthogate has been developed to incorporate OWLS and provides tools for a complete online Orthopaedic community. It is the official portal for ISOST (the Internet Society of Orthopaedic Surgery and Trauma). It does have a strong Canadian influence.

OWLS is an extremely comprehensive collection of Orthopaedic links. It is kept updated by enthusiastic contributors, who are all practising Orthopaedic surgeons. Unlike HON, there is no strict quality process for inclusion, although all websites are assessed by the contributors before uploading and Silberg criteria are generally applied.



Orthopaedic resources

Due to the easy availability of Content Management Systems and PHP, there are lots of Orthopaedic resource sites on the Internet. Some are run by individuals and are out of date, some are commercial and of limited educational value. However there are a few excellent sites, such as Medscape and MDConsult.

Medscape is free to use, but has a lot of commercial input. MDConsult is subscription based and has no commercialism. MDConsult also provides access to the full text from a large number of journals Both have a strong USA influence.



Online textbooks

The top five Orthopaedic textbooks on the internet are:

  1. Orthoteers - www.orthoteers.co.uk  
  2. Wheeless Textbook of Orthopaedics - www.wheelessonline.com  
  3. WorldOrtho - www.worldortho.com  
  4. Maitrise Orthopedique - www.maitrise-orthop.com  
  5. South Australian Orthopaedic Registrar Notes - www.som.flinders.edu.au/FUSA/ORTHOWEB/notebook  

Journal Website

Most journals have a website with access to full articles (usually only the period since starting electronic journals). Access is usuually by subscription only. Some journals have excellent supplementary information and leading the way is the American Journal of Bone and Joint Surgery - www.ejbjs.com  .

Distance Learning

The International Center for Orthopaedic Education (ICOE) - www.icoe.aoassn.org  - is an excellent service for international clinical visits and fellowships in Orthopaedics. It is supported by a number of organisations and hopefully will continue to grow.


Orthopaedic organisations, such as the American Academy of Orthopaedic Surgeons (AAOS), are now providing online education for patients and surgeons. The AAOS has indicated that their goal is to be the dominant Internet publisher in orthopaedics and they are developing an impressive resource at www.aaos.org .


Most Orthopaedic product companies are providing educational information on their products from their websites. The quality and content is variable. An example of a company that seem to have got it right are www.arthrex.com  .


The Orthopaedic internet has grown tremendously along with the expansion of the internet. There is a lot of information and education on the internet, but finding the most relevant can be difficult. Hopefully this presentation has clarified and helped the process for you. The future is exciting as the internet gets faster and multimedia becomes more commonplace.

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