ORIF - Bringing Bones Together

Case Style Guide

Case publishing guidelines are here to help get an idea of the minimum set of expectations that we, think are acceptable when uploading a case. Please use these guidelines as a checklist prior to upload.

Do you have permission to publish?

It is important to make sure you have permission to upload a case from your institution. The rules for this can vary a lot from one place to another, and it will depend on your institution's departmental guidelines. In general, uploading a case on Osteosynthesis.org is similar to publishing a case in a journal. Like most journals, you usually don't need written consent from the person in the images as long as the images are anonymized (see below) and patient confidentiality is not compromised. Many hospitals have guidelines that allow the publication of images as long as they are de-identified and in line with the hospital's privacy policies, without needing individual consent. Other hospitals require individual consent, and some have a blanket policy of not allowing publication. It is your responsibility to make sure you are allowed to upload the images. You should also consider if any of your colleagues might have a claim to the images. This can vary from place to place and among individuals. If you want, you can include a note in the case discussion section of the case saying "case courtesy of Dr. X."

Case Categorisation

It is important to properly categorize cases using the AO/OTA classification nomenclature standards. To assist with this process, we have developed a classification menu system. However, it is still crucial to carefully categorize cases to ensure accuracy and facilitate easier retrieval by other users who may be searching for cases using category filters. If your case falls under multiple categories, choose the one that is most relevant to your case.

Case Title

Every Case needs to have a short, relevant title. This not only makes browsing the image library more enjoyable, but helps in the generation of accurate search results.

Clinical History

Cases should have a concise yet comprehensive description. It is not necessary to provide a long report, but the description should include the key features of the case in a short-case format. Please include basic patient demographics, a summary of the mechanism of injury, and a description of the fracture and its unique characteristics. The description should also include a discussion of the reasoning behind the chosen operative strategy, including the techniques and hardware used and the rationale for these decisions.

Surgical Discussion

The operative technique should be discussed in a concise manner. It is important to reflect critically on any issues or concerns that arose during the procedure. Sharing these insights can be valuable for colleagues who may encounter similar situations in the future. With the benefit of hindsight, it may be helpful to suggest any changes or improvements that could have been made. Additionally, it is useful to highlight any particularly successful aspects of the procedure, as well as any challenges that were faced. It may be beneficial to consider whether a different approach might have been more effective in addressing any difficulties that arose. Finally, any limitations of the hardware used should be noted, along with any suggestions for improvement that may enhance future procedures.

Orthopaedic Implants Used

Feel free to name the company and use implant names in the description of your case. If you have any industry conflicts, these should be declared.

Links to Literature and online Resources

Please include relevant published literature at the end of each case, as supplementary reading material. These sources do not need to be formally cited within the case discussion, but can be useful for further understanding of the case. You may also include links to the manufacturer's website or operative technique manuals for details on the implant/system used in the case.

Publication of Case Reports

Together with the Journal of Orthopaedic Surgery and Traumatology (JOST) ISSN: 2603-6398, and in coordination with CrossRef.org, we are offering formal peer reviewed academic publication of selected Case Reports. These will be published as open access on Osteosynthesis.org, archived with JOST and allocated a DOI. DOIs published on Ostesynthesis.org are registered in the Crossref database - the allocation of a DOI indicates that the case report has undergone peer review and has been formally published, making it a citable reference easily discovered and cited by other researchers.

To qualify for JOST publication and allocation of a DOI, we insist on slightly more comprehensive content than would be required to simply upload a regular case to the library. Firstly, upload a new case as you normally would using the link on the home page, or from your user profile - but pay attention to the following prerequisites unique to Case Reports:

  • A concise yet descriptive and interesting title
  • A minimum of 500 words in Clinical History / Surgical Discussion (in total)
  • At least 4 relevant PubMed references serving as supplementary resource material
  • Typically a minimum of 8 images: 2 pre op, 2 intra op, 2 post op, and 2 clinical photos - ideally std orthogonal radiological views (AP/Lat) or as appropriate to facilitate good interpretation of the subject. CT or MRI imaging, and video files may also be considered. Further deviation from imaging standards may be assessed on an individual basis

Payment: Osteosynthesis.org will pay authors of published Case Reports US$25 per publication following peer review once cleared for publication. There is no article processing charge (APC), costs are offset by site sponsorship and advertising. Published case reports will contain promotional links.

Additionally, to help generate a standard citation reference text, user need to provide an 'Academic Name' in their profile in the user dashboard. There are two username fields: the first is 'Display Name' and refers to how your profile appears on the website to other users. The second name field is 'Academic Name' and should be in the format: Surname, Initial. Initial (eg: Smith, J.H). This won't be visible to other users in general use, it will however, appear on citation references for published cases.

At present, the allocation of DOIs is a manual process. So once you have finished uploading your case to the catalogue, if you believe the case fulfills the above criteria and wish to formalize its academic publication, please just send an email to: admin@osteosynthesis.org requesting that it be allocated for publication.


Please refrain from copying and pasting content from textbooks, articles, or other websites. Copyright laws are in place to protect the work of authors and creators, and any violations could potentially harm the integrity and sustainability of Osteosynthesis.org. It is important to respect these laws and ensure that all content used is properly credited and sourced.

Image quality

To fulfill our goal of establishing the premier orthopedic radiology resource on the internet, it is essential to have high-quality images. Most radiology departments now have Picture Archiving and Communication Systems (PACS) that allow for the export of images to disc. Taking a photograph of a screen is unlikely to produce images that are sufficient for illustrating surgical techniques and outcomes in detail. It is therefore important to obtain images directly from PACS or similar systems to ensure their quality and clarity.


Resolution: There is no set number for the required resolution. The minimum resolution should be the native resolution of the modality, such as 512x512 pixels for CT, 128 to 1024 pixels for MRI (depending on the sequence and scan parameters), and greater than 1024 pixels for plain films. Contrast and brightness: The fracture and osteosynthesis should be clearly visible and the image should be displayed with optimal windowing and levels. Cropping: Images should be appropriately cropped to eliminate any unnecessary blank space around them.

Text overlays and watermarks: Images should not contain any identifying information to protect patient privacy. This includes text overlays, as they may contain patient information or be misinterpreted as such. In addition, the absence of text overlays can improve the aesthetic appearance of the image and facilitate its use in presentations. For clinical images, no watermarks, logos, or other graphics should be present on the image. This includes personal or institutional logos or names, as well as any branding from PACS, viewers, or image processors. There are a couple of exceptions to this rule: manufacturer logos may be present on the images and cannot always be removed, and illustrations may include the creator's signature and a Creative Commons logo.


The image must either be free of copyright restrictions or belong to you. Plagiarism of images or text is absolutely unacceptable and may result in account suspension or deletion.


All cases submitted should be fully de-identified to protect patient privacy. This includes removing all text overlays from images, as they may contain identifying information or be misinterpreted as such. Removing text overlays also helps to eliminate visual clutter and ensures that no information is inadvertently included. Most PACS systems allow for the export of images without text overlays, or screen capture software can be used to crop selected images without text identifiers. It is important to take these steps to protect patient confidentiality and comply with relevant regulations.

Based on HIPAA guidelines, the following types of information should not appear on any patient cases uploaded to any platform:

  • Name
  • Initials
  • Date of birth
  • Address, including full or partial postal code
  • Telephone or fax numbers or contact information
  • E-mail addresses
  • Unique identifying numbers (e.g. UR, MRN, HID, etc.)
  • Vehicle identifiers
  • Medical device identifiers (e.g serial numbers)
  • Web or internet protocol addresses containing any link to the patient
  • Biometric data
  • Facial photograph or comparable image
  • Names of relatives
  • Date of the study

In addition, cases that may be unique enough to potentially identify an individual should not be uploaded. This includes cases that have been featured in the media or any other publicly available source. Protecting patient privacy and confidentiality is of utmost importance and uploading such cases could potentially compromise this.

Please be aware that we take patient privacy and confidentiality very seriously. Any failure to adhere to these guidelines constitutes a violation of our privacy policy and terms of use. If a case with patient information is uploaded, it will be promptly removed, and repeated offenses may result in the suspension of your account. We appreciate your understanding and cooperation in maintaining the privacy of our patients.