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Withdrawal of a paper

¹ Journal of Bone and Joint Surgery, 22 Buckingham Street, London WC2N 6ET, UK.

Correspondence should be sent to Mr J. Scott; e-mail: j.scott{at}jbjs.org.uk

A paper entitled "Recombinant human morphogenetic protein-2 for type grade III open segmental tibial fractures from combat injuries in Iraq" was submitted to the JBJS[Br] with a covering letter dated 9 October 2007 which was signed by the authors. The corresponding author was Dr. T. Kukla. The letter of transmittal included the statement that each of the authors had read and approved the final manuscript. It also said that the authors were employees of the United States Government and that the submitted work was performed as part of their official duties.

The paper described the management of 138 Gustillo Type IIIB and C tibial fractures in soldiers injured in Iraq. It was a retrospective study with some randomisation of these patients into two groups, one of which received bone morphogenetic protein-2 (rhBMP-2) as part of the management and the other did not. The authors reported a significantly higher union rate in the group treated with rhBMP-2 (92% vs 76%). There was also a higher rate of further surgery required in the patients who did not receive BMP. This seemed to our reviewers to be an excellent study involving a large number of severe open tibial fractures investigated with appropriate methodology and reported satisfactorily. It was stated in the paper that appropriate ethical approval had been obtained and that each patient had provided informed consent. The reviewers suggested relatively minor modifications with some clarification, including further details with regard to those patients who were lost to follow-up and the technique used for bone grafting. It was also requested that some details of those patients who had undergone amputation be included along with further details about the management of the associated injuries of the soft tissue. The corresponding author then sent a revised manuscript with a covering letter indicating, for instance, that several hundred soldiers had sustained a traumatic amputation during the period of study, but that this was not the purpose of the manuscript and that none of the patients described in this paper had required an amputation. Some further information was also provided indicating that there were 51 pedicle muscle flaps and five fasciocutaneous flaps in this series which were all successful.

The paper was Accepted on the 18th April 2008. It was extensively rewritten by an associate editor and further corrected by me. Subsequently, as is routine practice, galleys were returned to the corresponding author and further minor corrections made during June 2008. The paper was published in the August edition of the Journal. It clearly seemed to represent a major contribution to the treatment of these severe complicated fractures which are difficult to manage and usually require several surgical procedures, careful wound management and extensive rehabilitation.

Shortly after the paper was published we received correspondence from one of the persons identified as a co-author indicating that the alleged co-authors had not seen the manuscript prior to publication and that they had not signed the letter of transmittal. It was further disclosed that much of the paper was essentially false.

Appropriate representations were made to the Walter Reed Army Medical Center in Washington DC, the alleged source of the paper, even though Dr Kuklo had retired from the US Army and left Walter Reed well before his paper was submitted for publication. A local investigation was instigated and we received further correspondence dated 6 November 2008 including the following paragraph:

"The results of the investigation establish that Dr Timothy R Kuklo did not submit the article through the Office of Clinical Investigations or the Public Affairs office, as required by Army regulations, before he submitted the article to your publication; that the signatures of the supposed co-authors of the article were, in fact, forged; that Dr Kuklo acted without any involvement of personnel at the Walter Reed Army Medical Center; and that the article was in no way vetted through Walter Reed’s Publication process before publication. As you are aware, once the article was reviewed by the purported co-authors of the article, a number of serious questions were raised regarding the validity of the information and the conclusions made in the article".

Under these circumstances the paper published by this Journal has been formally withdrawn from the scientific literature and Dr Kuklo banned from submitting further papers to this Journal.

James Scott, MA, FRCS, Editor

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