Background: The internet has changed the way we access and publish Orthopaedic literature. Traditional subscription journals have been challenged by the open access method of publication which permits the author to make their article available to all readers for free, often at a cost to the author. This has also been adopted in part by traditional subscription journals forming hybrid journals. One of the criticisms of open access publications is that it provides the author with a "pay to publish" opportunity. We aimed to determine if access to the journals impacts their influence.

Methods: We selected the top 40 Trauma and Orthopaedic Journals as ranked by the SCImago Rank. Each journal was reviewed and assessed for the journal quality, defined by reviewing the journal impact factor and SCImago rank; influence, defined by reviewing the top 10 articles provided by the journal for the number of citations; and cost of open access publication.

Results: Of the top 40 journals, 10 were subscription, 10 were open access, and 20 were hybrid journals. Subscription journals had the highest mean impact factor, and SCImago rank with a significant difference in the impact factor (p = 0.001) and SCImago rank (p = 0.021) observed between subscription and open access journals. No significant difference was seen between citation numbers of articles published in subscription and open access journals (p = 0.168). There was a positive correlation between the cost of publishing in an open access journal and the impact factor (r = 0.404) but a negative correlation between cost and the number of citations (r = 0.319).

Conclusion: Open access journals have significantly lower quality measures in comparison to subscription journals. Despite this, we found no difference between the number of citations, suggestive of there being no difference in the influence of these journals in spite of the observed difference in quality.