ReviewJournal of experimental orthopaedics2025
Recurring low statistical robustness in orthopaedic surgery: A systematic review of 84 fragility index studies.
Review in Journal of experimental orthopaedics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
1 citing paper in PubMed.
- Recurring low statistical robustness in orthopaedic surgery: A systematic review of 84 fragility index studies.Journal of experimental orthopaedics · 2025Review
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Purpose: Increasing attention has been directed towards the fragility index (FI) and reverse fragility index (RFI) in orthopaedic surgery. The purpose of this study was to amalgamate the FI and RFI literature in orthopaedic surgery, and critically appraise its clinical impact. Methods: Three databases were searched from inception to 22 March 2025, for articles evaluating either the FI or RFI across orthopaedic surgery. Median and mean FI and RFI were presented as ranges with median values. Findings from correlation analyses assessing the impact of study characteristics on FI were consolidated. Citation analysis was performed to assess the uptake of FI/RFI literature. Results: Eighty-four studies were included in the final analysis. Sports medicine was the most represented subspeciality (25.0%). Median FI of subspeciality-specific studies ranged from 1 to 6, and RFI from 3 to 7. Median FI of pathology-specific studies ranged from 0 to 12, and RFI from 2 to 10. The RFI exceeded the FI in most pathology-specific studies (93.3%). Decreasing p-value (88%), increasing sample size (50%) and increasing study power (50%) were commonly found to be associated with increasing fragility index. The median number of citations was 11.5 (interquartile range [IQR], 3.0-27.0) with a median citation density of 3.1 (IQR, 1.2-6.2). Sports medicine publications had the highest collective median citation density of 4.3 (IQR, 1.0-6.6). The h-index for all included studies was 25, indicating 25 studies had at least 25 citations. Earlier publication year ( Conclusion: The majority of fragility index research is concentrated across a few orthopaedic subspecialties with redundant findings indicating low statistical robustness. Recurring methodologic recommendations based on correlation analyses include increasing patient sample size to increase study power. Methodological recommendations from this body of research should be integrated into future original studies to strengthen statistical robustness. Level of Evidence: Level III.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.