Open Access, Keyword Quantity and Quality Are Associated With Citation Impact in Orthopaedic Research

Citation counts are widely used as indicators of scientific visibility and academic impact. We hypothesized that open access (OA) status, the number of author-defined keywords, and keyword quality would be associated with higher citation rates. Few data is available regarding this issue, therefore we did a retrospective investigation aiming to: 1) Evaluate the impact of OA on citation counts of articles published in Orthopaedics & Traumatology: Surgery & Research (OTSR), 2) Evaluate the impact author-defined keyword characteristics (number and quality) on citation counts.

We hypothesised that these parameters would be associated with higher citation rates.

This retrospective bibliometric study included all PubMed-indexed articles published in Orthopaedics & Traumatology: Surgery & Research between 2016 and 2026 (n = 2,760 articles). Publication year, article type, OA status, and author-defined keywords were extracted. Citation outcomes were obtained from OpenAlex and Crossref. The primary outcome was OpenAlex citations counted from the publication year through the two following calendar years. Keyword assessment included keyword number, a frequentist score based on top n-grams from comparable PubMed articles, and a clinical relevance score based on a semi-automated orthopaedic lexicon.

Median two-year OpenAlex citations were 3.0 (Q1-Q3:1.0-7.0). In the 2016-2024 analysis, OA was associated with higher two-year citation counts in both univariable (β = 1.29,95%CI[0.67-1.90] (p < 0.0001)) and multivariable analyses(β = 0.93,95%CI[0.34-1.50] (p = 0.002)). In the multivariable model, the number of author keywords (β = 0.22,95%CI[0.03-0.40] (p = 0.024)) and keyword top n-gram matches (β = 0.09,95%CI[0.07-0.11] (p < 0.001)) were independently associated with higher citation counts. The clinical keyword relevance score showed a positive trend that did not reach statistical significance (β = 1.50,95%CI[-I[-0.04-3] (p = 0.056)). Yet, the clinical keyword relevance score was significantly associated with higher citation counts in univariable analysis (β = 0.13,95%CI[0.09-0.17] (p < 0.0001)).

OA status and keyword quality were associated with higher citation rates after accounting for citation maturation. Article accessibility and keyword discoverability may represent modifiable levers to improve orthopaedic research visibility.

IV; retrospective observational study.