Searching the Internet or the Literature for an orthopaedic subject is made more difficult by the large number of synonyms acronyms and eponyms which are employed. Distal radius fracture may be the preferred term for the subject but there is a profusion of terms that might be employed – even in English – DRF, wrist fracture, Colles’ Fracture, Barton, Die-Punch, Smith’s etc. This matters greatly when undertaking an electronic search. At present one must try to include all equivalent names in order to obtain a comprehensive collection of citations. It would simplify the situation if there was a commonly agreed term for each subject but too much emotion is invested in nomenclature for this to happen. Instead, it would be both possible and desirable to use a unique code for each subject. Using the code for electronic searching would then be accurate and comprehensive as long as everyone agrees and uses the same code. The coding systems currently in use internationally are the Medical Subject Heading (MeSH) code used by the US National Library of Medicine (NLM), Unified Medical Language System (UMLS), the International Classification of Diseases (ICD) and Systematized Nomenclature of Medicine (SNOMED). Each of these presents problems such as lack of granularity, redundancy, poor choice of term or limited access. None of them are used as an aid to finding information outside the NLM. For example the MeSH term Osteosarcoma includes Ewings Sarcoma as a subcategory; most orthopaedic surgeons would find that inappropriate; the subject appears twice (under neoplasms of bone tissue with code C04.557.450.565.575.650 and under sarcoma with code C04.557.450.795.620), so there would be some question as to which code to use. If you search for either code, no orthopaedic resources are found on the Internet. The only websites where the codes are mentioned are descriptions of library coding systems! We have not yet got the message that inserting unique codes in the text or meta-data of a website is a way to improve accessibility and readership on the Internet.

The Orthopaedic Web Links (OWL) directory website(1) is facing the problem of classifying and categorizing orthopaedic subjects so that links to resources on similar subjects are found together. The Orthogate Classification of Orthopaedic Subject Headings (OCOSH)(2) has been devised as a framework for a coding and categorization system on this site. The OCOSH code is based on and incorporates the MeSH code but it would be easy to include other coding systems. A code for use by electronic systems does not have to be ‘elegant’ in human terms. The (unique) code for Osteosarcoma is C04.557.450.565.575.650_BD_BN_CTS_CT_B_OSC. Each part of this code is separately searchable and it would be a simple matter to add on the ICD-10 code (M9180/3). Creating the code system may not be as difficult a task as securing universal agreement to use it.

  1.   Orthopedics, Orthopedic Surgery & Orthopedic Web Links (2008) [Website] Available at
  2.   OCOSH Classification System – Orthopaedic Web Links 2008 [Website] Available at\