A Review of the Orthopod Family of Mailing Lists

Discussion with a colleague is one of the great safety valves in medicine. Stopping someone in a corridor, waving some radiographs and bouncing an idea off him or her is such a time-honoured activity that it is affectionately known as a "corridor consult" or a "curbside consult." No one has ever suggested that these informal meetings are a substitute for careful and skilful medical practice, nor, on the other hand,  that advice so gained should be monitored, controlled and exposed to "quality control". Yet there must be few people in orthopaedics who have not had recourse to a corridor consult or who have not offered one, and most of us would acknowledge their value.

 

Since the internet could connect anyone in orthopaedics to anyone, it is not surprising that seeking advice across the internet in the form of a corridor consult through cyberspace was one of the earliest and remains one of the most vibrant activities on the medical internet. In theory one should be able to ask the advice of the foremost authorities of the field in which one's problem lies. This review examines this process in practice as found in the Orthopod family of mailing lists.

 

A mailing list is essentially a list of email addresses held by a server. If your address is on that list you have the privilege of receiving all the messages that are sent to the list and the privilege of sending messages yourself. As with any email message the communication has a subject, and if you reply, the same "subject" is retained. Sometimes during the course of the exchanges the subject gets altered but if there is clear continuity with one messages obviously being in response to another, the whole collection of messages is called a "thread". Threads are probably a more valid subdivision of the messages that get sent to a mailing list because the subject can be changed arbitrarily while still adhering to the thread. However, it is also true that some very different topics can get discussed while still ostensibly on the same "thread". Thus a typical recent exchange started with a question about the use of intramedullary rod fixation in femoral fractures in the paediatric age group. The experience and techniques of a number of surgeons using this technique was presented complete with geographical notes about the French city of Nancy where some strong proponents work. The discussion then centred on the flexiblility and metallurgical make-up and design of such devices. This provoked questions from third world orthopaedic surgeons about whether cheaper and longer established devices such as Kirschner wires or Rush rods could be used. This in turn produced a discussion of the use of intramedullary rod fixation in forearm fractures in children and the devices and techniques available for use in that problem. Along the way several Xrays were sent to the group, several references were cited and the addresses of commercial suppliers of the equipment being discussed was publicised. This example is described in some detail to give the flavour of exchanges on the mailing list, the free association of ideas, the international nature of the audience and the overall helpfulness of the participants.

 

The original Orthopaedic Mailing List (OML) was started in 1993 and continued until December 1997. It was strongly represented in the USA and fostered such an intense sense of community that several of the subscribers decided to meet at the 1996 American Academy of Orthopaedic Surgeons (AAOS) meeting. This first "Geek Meet" was such a success that several friendships initiated on the mailing list were cemented at the meeting and have resulted in fruitful international collaboration since. It also became clear to the small group of orthopaedic surgeons working on posting web page information to the internet that the mailing list was the best way to publicise their work and seek colleagues. In July 1997 the Orthopod List was founded. It was initially seen as complementary rather than competitive with OML. Orthopod is based in the UK and is part of Mailbase, a collection of more than 2000 academic mailing lists supported by funds from the United Kingdom Joint Information Systems Committee of the Higher Education Funding Councils for England, Scotland and Wales and the Department of Education of Education for Northern Ireland. Its aim was more academic in the beginning and, in fact, case discussions were discouraged unless part of a research topic. However, in December 1997 the server for OML withdrew support for the mailing list and the two lists merged. While retaining its academic basis and its cosmopolitan membership, Orthopod was strengthened by many new members from OML and by vigorous case discussion. As the time came around for the 1998 AAOS meeting, it was clear that another "Geek Meet" was eagerly anticipated. At the same time another movement in the internet was fostering the formation of a co-operative Gateway to Orthopaedics on the Internet. Orthogate - a name coined on one of the orthopaedic mailing lists by Gobinder Singh - was intensely discussed and publicly planned on Orthopod for months before the inaugural meeting in March 1998. The next development was the foundation, in April 1998, of the speciality lists Arthroplasty, Hand, Limb Reconstruction, Spine and Orthopaedic Sports Medicine. This was in response to a perception by some members that they were receiving too many messages per day, many about areas of orthopaedics they were not interested in.

Although it is up to each participant to store messages as they come in, the mailbase organisation does also store the messages and archive them at the mailbase site. For each list these is a separate collection indexed from a page at (i.e.) http://www.mailbase.ac.uk/lists/orthopod/archive.html
for the orthopod list, and

http://www.mailbase.ac.uk/lists/arthroplasty/archive.html for the arthroplasty list etc. From this page you can find out how to join the list, the names and addresses of the list owners, and members, a description of the purpose of the list and the groundrules. Every message sent to the list in the last two years has been stored and archived by the month organised by date, sender, subject and thread. Thus it would be a simple matter to find the message sent by a particular indvidual in a particular time frame; and not too difficult to answer more open questions like "what has been said about forearm fractures?" Mailbase archiving system does store some illustrations but a number of other orthopaedic sites do collect cases from the mailing list and post them with the original question. BoneHome has done this from the days of the OML and Belgian Orthoweb has a fine collection as well. It has often been said that between cases, discussion, illustration and references the raw material for a textbook is being rapidly written.

Fig 1. Messages per month in the Orthopod family of mailing lists


Click to enlarge...

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