Multiple retractions as brazen plagiarist victimizes orthopedics literature

Several journals in the field of orthopedics and related disciplines have been victimized by an apparent serial plagiarist.

The author, Bernardino Saccomanni, of Gabriele D’ Annunzio University, in Chieti Scalo, Italy—across the boot and up a bit from Rome—appears to have lifted significant amounts of text in several articles.

Last January, for example, Current Reviews in Musculoskeletal Medicine, a Springer title, retracted a 2010 article by Saccomanni, “Painful os intermetatarseum in athletes: a literature review of this condition is presented,” after determining that it plagiarized a 2007 article in the Archives of Orthopaedic Trauma Surgery, also from Springer, with a very similar title, “Painful os intermetatarseum in athletes: report of four cases and review of the literature.”

Osteoporosis International, another Springer publication, has retracted a 2011 paper by Saccomanni titled “Vertebroplasty: an international point of view on this “minimally invasive” surgical technique,” after evidently learning that the point of view wasn’t exactly Saccomanni’s to begin with.

Turns out, it wasn’t the first time Saccomanni had expressed that view, either. Clinical Rheumatology, yet another Springer pub, has retracted a 2010 article of his with the remarkably similar title “Vertebroplasty: a point of view on this surgical treatment.”

Whose views were they? That would be Gunnar B.J. Andersson, of Rush University Medical Center in Chicago. Andersson is the author of a 2009 article in Nature Reviews Rheumatology, that seems clearly to be the source of Saccomanni’s words. (Saccomanni also lifted a bit from a 2009 paper in The Spine Journal, “Vertebroplasty and kyphoplasty for the treatment of vertebral compression fractures: an evidenced-based review of the literature.”

Consider:

Saccomanni, in Clinical Rheumatology:

So, what can we deduce from these new results? Certainly, the studies suggest that patients with chronic back pain and a vertebral fracture should not automatically undergo a vertebroplasty, as the cause of a patient’s pain cannot always be attributed to the fracture. Interventional radiologists, although technically superb, are rarely trained to evaluate the source of back pain. Careful selection of patients by physicians with broad expertise in the management of spinal disorders could produce different results. Neither of these two articles mentions the presence of concomitant, potentially painful disorders of the spine, and the exclusion criteria fail to eliminate common spinal disorders such as degenerative changes, stenosis or spondylolisthesis.

Andersson (whose paper is neither cited nor referenced by Saccommani):

So, what can we deduce from these new results? Certainly, the studies suggest that patients with chronic back pain and a vertebral fracture should not automatically undergo a vertebroplasty, as the cause of a patient’s pain cannot always be attributed to the fracture. Interventional radiologists, although technically superb, are rarely trained to evaluate the source of back pain. Careful selection of patients by physicians with broad expertise in the management of spinal disorders could produce different results. Neither of these two articles mentions the presence of concomitant, potentially painful disorders of the spine, and the exclusion criteria fail to eliminate common spinal disorders such as degenerative changes, stenosis or spondylolisthesis.

Saccomanni, in Clinical Rheumatology:

In conclusion, vertebroplasty is likely to be unnecessary for a subgroup of patients with painful osteoporotic fractures. As is true in many areas of spinal care, careful patient selection is paramount to the success of any intervention. We need to better define who will truly benefit from surgery and not use this approach indiscriminately. Comparative effectiveness studies of vertebroplasty and other similar procedures are under way, and should be helpful in this regard.

Andersson, who evidently agrees:

In conclusion, vertebroplasty is likely to be unnecessary for a subgroup of patients with painful osteoporotic fractures. As is true in many areas of spinal care, careful patient selection is paramount to the success of any intervention. We need to better define who will truly benefit from surgery and not use this approach indiscriminately. Comparative effectiveness studies of vertebroplasty and other similar procedures are under way, and should be helpful in this regard.

Andersson said he found out about the copycatting from the editors of Nature Reviews Rheumatology, who wrote him to alert him to the plagiarism—and to apologize.

 I thought literally every word was the same

said Andersson, who added that although he didn’t get worked up about the incident at the time,

I am generally upset about people doing this because it is theft, no matter how you look at it.

Clinical Rheumatology also has retracted Saccomanni’s 2010 paper, “Total elbow arthroplasty: history, current concepts, and future,” the abstract of which is virtually identical to a 2006 article by Stephen Trigg, a Mayo Clinic orthopedic surgeon, in Northeast Florida Medicine.

That’s not all. A Medline search of Saccomanni’s name came up with about a dozen citations (including the retraction from Current Reviews in Musculoskeletal Medicine). One of those publications was a 2008 letter in the Archives of Orthopaedic and Trauma Surgery Including Arthroscopy and Sports Medicine (a Springer-Verlag title) in response to a 2003 article in the Hong Kong Journal of Orthopaedic Surgery.

We Googled the text of Saccomanni’s letter:

It was interesting to read the article by Ng et al. in a issue of the Hong Kong Journal of Orthopaedic Surgery [1]. The authors have described a review of five patients with anterior dislocation of the hip after having undergone a total hip replacement by the posterior approach.

While it is accurately mentioned in the article that it is rare to find anterior dislocation after using the posterior approach for total hip arthroplasty, I fail to understand why the article is titled ‘aetiology and treatment’ because the described aetiology is nothing but a complication of excessive anteversion, which is well known. The cause of three of the reported five cases was established by fluoroscopy. It would be of interest to other readers also to know why such a definitive aetiological factor was not investigated for the two other patients, especially when such cases are reported. Also, I would like to highlight that, in all these reported cases, the approach had nothing to do with the type of dislocation (anterior). Rather, as the authors themselves mention, the anterior dislocations were only because of the high angle of anteversion, which was wrongly done during the surgery. I appreciate the fact that authors have reported their avoidable complications as a scientific paper. The rehabilitation and treatment protocol after any such adversity is nicely described in this article and is quite informative.

And found this [note–pdf]:

Dear Sir,

It was interesting to read the article by Ng et al in a recent issue of the Hong Kong Journal of Orthopaedic Surgery.1 The authors have described a review of 5 patients with anterior dislocation of the hip after having undergone a total hip replacement by the posterior approach.

While it is accurately mentioned in the article that it is rare to find anterior dislocation after using the posterior approach for total hip arthroplasty, I fail to understand why the article is titled ‘aetiology and treatment’ because the described aetiology is nothing but a complication of excessive anteversion, which is well known. The cause of 3 of the reported 5 cases was established by fluoroscopy. It would be of interest to other readers also to know why such a definitive aetiological factor was not investigated for the 2 other patients, especially when such cases are reported.

Also, I would like to highlight that, in all these reported cases, the approach had nothing to do with the type of dislocation (anterior). Rather, as the authors themselves mention, the anterior dislocations were only because of the high angle of anteversion, which was wrongly done during the surgery.

I appreciate the fact that authors have reported their avoidable complications as a scientific paper. The rehabilitation and treatment protocol after any such adversity is nicely described in this article and is quite informative.

That letter appeared in 2003, and was signed by a Dr. KM Marya, of SSR Medical College, in Belle Rive, Mauritius.

Somehow, we get the sense that we could do this all day with his papers and produce similar results.

We emailed Saccomanni for comment and received this reply:

WHICH ARTICLES?

When we specified, he responded:

my papers are original.

My papers have been published after three revisions!!!

Now, Saccomanni’s first point speaks for itself, but we do have a few thoughts about his second statement.

Clearly, the screening process at Clinical Rheumatology and Osteoporosis International (which has given Saccomanni a lifetime publishing ban) failed. We’ve argued before that if reporters can find plagiarized text with Google, major publishers ought to be able to do it in their sleep using internal databases (let alone services like CrossCheck, etc.). For Saccomanni to have been able to slip two, virtually identical papers into journals belonging to the same publishing company is bad enough. For both of them to have plagiarized so obviously is even worse.

We hope that, if Springer doesn’t already mandate that every one of its titles use a third-party plagiarism-detection service, in addition to whatever internal controls are already in place (please say there are some!), it starts doing so now.