Stanford Microsurgery and Resident Training

Essentially microsurgery information, tips, and techniques from Stanford University.

The SMaRT app is a free resource for anyone who performs microsurgery, or for microsurgeons in training.  The app is organized into a simple menu that includes Preparation, Practice Models, Suturing, Intra-Operative Technique, and Study Question headings.  Despite its simplistic appearance, the information is detailed, complex, and valuable.  For example, the Preparation heading includes information about instrumentation, how to set up and adjust the microscope (with associated diagrams), and explanation of sutures.   Many photos and videos are included as well, demonstrating important topics such as adjusting proper posture.  Overall, the app is very easy to navigate, a valuable resource, free, and comes from a reliable source.  I highly recommend this app as a quick reference before any microsurgical case.

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MedTools

A unified repository of surgical implants, technique guides, comparisons, and unpackaging videos.

With so many orthopedic implant companies and device options, I am amazed it has taken so long for someone to create a central educational repository.  MedTools is attempting to do just that in the form of both a website and app.  The app itself is well organized with a side-bar menu organized by body part, and sub-menus organized by implant type.  For a generic implant type (ex: Volar Distal Radius Plates, or Total Knee Arthroplasty), the user can quickly see a collection of all available companies and device offerings.  In some cases (total joint arthroplasty) this can include well over 20 different implants from more than 10 companies.  Users can then select a specific implant to obtain product information such as technique guides, reference charts, and photographs of the surgical tray to help familiarize one’s self with the instrumentation.  The app and website have also started video taping “unboxing” of specific devices to ensure that surgeons and their operative staff are prepared and familiar with devices they plan to use.

Overall, this app seems to have been a long-time coming and reflects a significant investment in work and time.  I anticipate the breadth of implants will grow significantly in the near future, which should greatly increase its value and overall utility to surgeons.

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DASH Outcome Measure

Utility for administering and scoring the DASH Outcome Measure

This app is very simple and does exactly what it is supposed to do: it helps providers (surgeons, therapists, researchers) administer the DASH Outcome Measure (Disabilities of the Arm, Shoulder and Hand).  Objectively, the app has very few flaws or limitations.  The user is provided with various setting options, resources from the website, and the option of either the complete DASH or the QuickDASH. The questionnaire is then provided in its standard form, and appears very similar to the PDF version that is available online.  A patient number can be assigned, and a copy can be emailed to the patient as well as the administrator.

From a clinical perspective, the app does not maintain a database of patient scores and does not provide an easy way to integrate scores into the medical record.  That would take an additional manual step on the part of the medical practice or research group.  However, overall, this is a very useful and easy app for scoring the DASH.

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OrthoFlow

General orthopaedic trauma app for fracture identification, classification, and management

OrthoFlow is the first app created by MediFlow and is designed to be “your orthopaedic specialist in your pocket.”  The app has a familiar user interface which includes a skeleton for selecting a region of injury, followed by a series of lists to select the specific bone and fracture of interest.  Most fractures include a few basic questions such as the location, whether it is intra-articular, and displacement after which the app suggests operative fixation or non-operative treatment.  One of the most useful features is the “What to know for trauma meeting” which includes a high-yield and well-organized description of the anatomy, associated injuries, imaging findings, classification systems, management, surgical approaches, complications, and eponyms for the particular fracture.  The purpose is to help prepare a junior resident or medical student at morning conference.   The information provided on each topic appears to be accurate, if not somewhat generalized, for each fracture.  Classification systems are often accompanied by sketch images which I found very appealing.  Some aspects of the user interface require improvement, such as a “home” button while buried deep within in the “trauma meeting” menus.  Overall, I think the app is a very good start towards a useful trauma handbook for students and junior residents.  Since this is the first version, I anticipate that the app will only improve in functionality over time.

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OrthoGuidelines

App for reviewing the AAOS Guidelines and Appropriate Use Criteria for specific diagnoses.

I applaud the AAOS for creating a very useful and intuitive app for reviewing and consulting the AAOS Guidelines and Appropriate Use Criteria for specific diagnoses.  As most orthopaedic surgeons and trainees are aware, the AAOS has committed a significant effort to developing useful guidelines and tools to help surgeons make the appropriate surgical decisions when treating a number of common conditions.  Until now, the guidelines could only be accessed in their PDF form.  This app allows anyone to review the published guidelines in a very useful format.  The app currently includes 17 guidelines (CPG) and 4 appropriate use criteria (AUC) modules.  The guidelines can be sorted by strength and stage of care.

Overall, the app is well made and a great step forward in improving access to these important tools.  I recommend the app to both trainees (for both education and testing purposes) as well as surgeons (for treatment purposes).

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OrthoBullets: Bullets*

OrthoBullets’ stand-alone and companion app with study material, images, questions, and quizzes

OrthoBullets has scored a home run with their new Bullets* app available from the iTunes store.  This app is can be used as a companion app to the existing OrthoBullets website, but also functions extraordinarily well as a stand-alone resource.  The app consists of 5 sections: Topics, QBank, Cases, Evidence and PASS.  The topics section includes all information on the OrthoBullets site, separated in the same familiar lists and easily searched by keyword.  I found the search and browsing to be very fast and intuitive.  Importantly, each topic includes the same figures, diagrams, and questions associated with the web version to help learn concepts through the VEPTR technique.

The QBank also integrates with your existing online login and automatically transfers over your existing TestMaster scores and personal tests.  It also allows you to create new tests which can be defined by test style, topics, number of questions, etc.  The format will be very familiar to existing OrthoBullets users.

The cases will be familiar to any OrthoBullets user, and includes a presentation, images, and the valuable comments and discussion that ensures.  One of the newest features includes the ability to select “Evidence” to support an answer to a question, greatly enhancing the validity and value of this service.  The evidence can also be searched independently, and by specialty.  All of this is seamlessly integrated into the mobile format.

Lastly, the PASS section is available to residents who already use the PASS system in their residency program.  While I could not test this section entirely, it appears to function similar to the website equivalent.

Overall, the Bullets* app is a full-featured educational tool for any orthopaedic student, resident, fellow, or attending.  With quick and easy access to the entire OrthoBullets database combined with cases, quiz access and a versatile interface – I highly recommend this free app to everyone.

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RealWorld Procedures

Video and text tutorials for common procedures

RealWorld has created another app (in addition to RealWorld Orthopaedics) with tutorials for common procedures.  Those relevant to orthopaedic surgeons include digital blocks, local anesthesia, shoulder reduction, suturing, and upper limb slings. Each tutorial has a short video (1-3 min) with a text description of the background, precautions, equipment, positioning, procedure, and complications.  Overall, the limited orthopaedic procedures are relatively well represented and can assist a junior resident or medical student prepare for a first-time procedure.

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Learning Orthopedics Quiz

A “flashcard” style app for learning orthopedic surgery

This app is designed like a flashcard stack for orthopedic questions and facts. Unfortunately, the app does not tell you how many questions are included, nor can you create quizzes from specific sets such as a particular subject or only “new questions” or “incorrect questions.”  The user selects a quiz length from the options of 25, 50, or 100 questions.  The user then answers the questions and is provided the correct answer if they answered incorrectly while a score is kept and tallied. There exists an option “send” from the quiz.  While I initially suspect this would send a score or questions/answers for review, the button merely takes a screenshot of the current screen.  Overall, not a particularly useful app based on it’s very limited functionality and unknown flashcard stack size.

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AOFAS

Mobile app for the American Orthopedic Food and Ankle Society

AOFAS has published an app for the Foot and Ankle Society.  The app is simple and intuitive.  One limitation is the slow loading time – apparently allowing the app to download content when it opens.  On my review, this significantly limited my ability to review content (took about 3 minutes to load). Once loaded, I had access to annual meeting content (with log-in), information about the foundation, links to web resources, and various publications.  The app is easy to use and provides useful general information from a reliable source.  The biggest limitation is the lack of actual content.  For example, I could not read any publications or view posters without a log in for the annual meeting.  However, for AOFAS members, there is information about various courses and scholarship programs.

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Fractures

Basic app to assist with fracture classification and management

Fractures is published by Inter-Med, a company dedicated to creating educational medical products.  The app does not provide information about whether this was created by orthopaedic surgeons.  The purpose of the app is to provide basic fracture classification and treatment recommendations for a variety of common injuries of the skeleton.  The overall organization is simple, with the option to choose fractures based on a skeleton, list, or search feature.  We like that many fractures are included and that basic information about common classification systems and general treatment principles are provided.  We also really appreciate the abundant references and pubmed links to support the recommendations and information given.  However, fracture classification apps are typically improved with images and diagrams which we could not find in this app.  Adding images would improve the functionality and educational utility dramatically.

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JBS Algorithms Ortho

Educational app 

Joint and Bone algorithm is an orthopedic specific app with step by step guidelines for diagnosis and treatment for a large number of orthopaedic specific issue. It was created by the Joint and Bone Science Master Center in Tehran, Iran. This app is a terrific resource to help students, residents and supporting staff through easy to read algorithms regarding basic orthopaedic problems. The strength of this app is the content and development of almost 100 musculoskeletal algorithms. I applaud the developers for the breadth of their content. While I feel the content could be presented in a more interactive manner, the content and thought that went into the algorithms is impressive. Obviously there are some serious concerns regarding the accuracy and copyright of the algorithms, outside of this major issue the algorithms are well done.

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Orthopedics Patient Education by CoherentRX

Orthopedics Patient Education by CoherentRX   

Anatomy and Educational tool 

CoherentRX  has created an app to help orthopaedic surgeons and their workforce improve patient education and comprehension. CoherentRX Orthopedics has multiple features: 3-D anatomy visuals, drawing tools to mark visuals, photo and screenshot uploads as well as text and email info that is HIPAA compliant. While all of these features are powerful tools the app lacks ease to use. CoherentRX Orthopedics is very well priced $2.99/year (one of the cheaper patient educational options) however it is not the best patient educational tool on the market. While it has multiple features that are useful, the lack of disease specifics educational modules makes it difficult to actually use in practice. I applaud CoherentRX on making an Orthopedic app that has the potential to improve patient comprehension and education, however the app is still behind other players in the market.

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https://itunes.apple.com/us/app/medibabble/id355398880?mt=8

Ortho10 Pro

Simple ICD-10 look-up for orthopaedic surgeons

Ortho10 is the first and only ICD-10 code look-up app specifically for orthopaedic surgeons.  The app has a very simple and intuitive interface which makes finding the proper code, and saving common codes, very easy to do.  Any user can easily find the proper code within less than 6 taps, regardless of any pre-existing knowledge of ICD-10. The app first opens to a list of body parts each on separate tiles.  Once a body part is selected, you have specific options relevant to that region, such as osteoarthritis, fracture, joint pain, sprain, etc.  As the user continues to drill down in choices they are prompted to select a more specific diagnosis, laterality of the injury or pathology, and the type of encounter (initial or subsequent, as required by ICD-10).  The user is then clearly presented with the diagnostic code and a description of the code.  At every level, there is the opportunity to move back up the selection tree and change a response.  And, once a code is selected, it can be saved in favorites for quick reference at a later time.  Overall, the app is easy to use and will be very important and useful as the mandatory transition to ICD-10 takes effect.  The app has already undergone revisions and improvements since its initial release, and we anticipate additional improvements and expansions.  There is currently a free version with all codes but limited additional features, as well as a paid version with enhancements such as “favorites” and “recently used” codes.

Free version:

Pro Version:

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MedTunnel

HIPAA-Compliant secure healthcare communication

This app is meant to remove fax and paper from cluttering your life. MedTunnel is trying to revolutionize the way the healthcare providers share and send information. This company has provided a service that protects patient privacy, but improves communication and makes your phone easy to use. Many apps already offer HIPAA compliant text or email tools via your phone. However, MedTunnel has given users the tools to make sharing information between physicians and patients more robust by giving users the ability to email or send documents. MedTunnel is one of the only HIPAA compliant messaging services that allow a user to take a photo with their phone and turn it into a pdf file and allow pdfs to be viewed and annotated, all on a phone. These two features make the app one of the best HIPAA compliant communication tools on the market. In addition the app is only a small portion of the larger desktop platform that has been created by MedTunnel. The desktop version allows users to have more control of their content and allow all files on any desktop running MedTunnel to securely be saved to the cloud. One concern about the app is you need the desktop version to set up some of the features and without setting these features the app is not the easiest to use.  For the app to be useful to you and your practice you would need the staff and other providers in your practice to adopt the app for the best use of these features. Overall an excellent HIPAA compliant communication app for healthcare professionals.

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AAOS Access

Complete video content from the AAOS

The American Association of Orthopaedic Surgeons (AAOS) has now created a mobile app portal for access to an entire library of AAOS video content.  The AAOS Access app includes the ability to view, download, and save videos from the Orthopaedic Video Theater, previously only found on the AAOS website.  The user interface is easy to navigate, with a navigation tab on the left providing shortcuts to featured videos, special collections, or specific topics.  Videos can be downloaded for viewing, or streamed directly on the device.  Video and audio content is very good, and can be watched in full screen mode.   The current collection (March 2015) includes 414 videos, an impressive collection, and certainly more will be added in the future.  Additional features include a search function as well as a bookmark tool for easily accessing favorites.

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ASSH HandCare

Patient handouts for upper extremity conditions made by the ASSH.

The American Society for Surgery of the Hand (ASSH) is one of the first orthopaedic specialty societies to take a pro-active role in tablet-based patient education with release of HandCare.  The app is free, simple to understand, and easy to use.  The library of documents covers 60 of the most popular topics treated by upper extremity surgeons.  Each hand out is 1 page and includes a combination of images and text explaining cause, diagnosis, and treatment for each pathology or procedure.  The handouts are very clear and well written.  In addition, basic annotation tools including highlighting, underlining, strike-out, comments, and free-writing are provided allowing the surgeon to modify or customize these as needed, and then save a custom version as a bookmark for future access.  Once a document is selected, it can be easily shared via email as a PDF.  The app even includes 5 “anatomy templates” for sketching/teaching from a model of a hand or upper extremity muscles or bones.  Overall, a very useful app that should be duplicated by other orthopaedic specialty societies.

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ICUC

High-quality case-based teaching tool for orthopedic trauma.

The ICUC app represents the future of surgical education.  Founded by orthopaedic surgeons and launched in 2014, the purpose of this app is to improve orthopaedic surgical education by sharing expert opinion on common cases through open and transparent commentary (www.ICUC.net).  The app itself is very high quality and has an intuitive user interface.

The user begins by selecting a body region, divided by bones/joints of the upper or lower extremity.  At the time of this review, about half of the bones/joints had associated teaching files. Once an area is selected, the user is presented with a library of cases, reference cases, and expert opinions.

The ICUC Library includes continuous and complete registration of every surgical procedure performed by a group of selected surgeons during a registration period, with no possibility of changes of any type to the original data for different fracture patterns.  For this reason, there exist cases with and without errors. An overview page for each case includes the AO fracture classification, assessment of outcome, approach, and highlights.  The entire case can then be downloaded and reviewed.  The case is of very high quality and includes pre-operative imaging (XR and CT), intra-operative photographs, intra-operative fluoroscopy images, post-operative XR, and post-operative clinical function.  As an example of the level of detail, the proximal humerus case I reviewed had over 170 included images and commentary.  Of note, the comments are quite honest, and appropriately critical about imperfect techniques or non-ideal outcomes.  The amount of information here is extraordinary, with just the proximal humerus having 49 detailed cases.

The Reference Cases section includes animations representing approaches and treatment techniques.  These are usually in the form of an animation and clearly represent the theory behind treatment.

The Expert Opinion section includes recommendations for various parts of the procedure.  For example, in the proximal humerus they include X-ray tips, advice for retraction of the cephalic vein, recommendations to avoid drill-tip screws, drilling tips, etc.  These reflect the opinions of experienced leaders in the field.

The interface is easy to navigate.  When cases are selected and downloaded, they are stored in the “briefcase” for easy access and reference.  Cases can then be removed as well, if additional storage space is required.

Overall, this app represents an extraordinary advancement in surgical education and transparency.  The inclusion of a high volume of cases, combined with honest expert opinion, provides the opportunity for enhanced resident and surgeon education that is not limited by geographic barriers.  I recommend this app highly for all trainees and surgeons.

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OrthoEvidence

Mobile access to OrthoEvidence, including a reading list and full ACE reports

OrthoEvidence is a new app that complements existing subscriptions to the OrthoEvidence product.  For more information, please see www.MyOrthoEvidence.com.  The premise of the platform is to provide “ACE” reports (Advanced Clinical Evidence Report) and improve evidence-based practice.  The app is an extension of the website and is very well designed and easy to use.

After logging in, the app has a home screen where recently added articles are populated in chronological order.  However, the menu allows for easy sorting by specialty as well.  When an article looks interesting to the reader, a quick “left swipe” allows for the option to add to reading list or add to favorites.  In this way, the user can easily scan new articles and select which ones should be saved for future review.  When ready to read, the reading and favorite lists are easy to access and list the selected articles. Impressively, the iPhone and iPad version sync with each other and selected readings on one device become available on the other (ie: select articles while “on the go” with your iPhone, but read them at a later time on your iPad). With one tap the ACE reports becomes immediately available.  For those who use OE, the ACE report has the same familiar appearance and includes links to the full text article (if available), a PubMed link, graphical representations of the Risk of Bias and Reporting score, and the synopsis and summary.  Added features include the ability to comment, rate the paper, and share via Facebook, Twitter, or Email.  The app also includes a robust search feature which includes a simple search (keyword) and advanced options (filter by date, score, bias, verification, or selected journals).  It is clear that the developers have taken every effort to create and intuitive, easy, and efficient app to complement their existing website.

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JBJS Journals

Tablet access to all four JBJS titles.

One of the leading orthopaedic journals, JBJS, has released a fully-functional app for searching and reading content from their four journals: The Journal of Bone & Joint Surgery, JBJS Reviews, JBJS Case Connector, and JBJS Essential Surgical Techniques. The app includes the functionality that would be expected of any comparable journal app: the ability to select articles, view full-text or PDF versions, search for articles or search within articles for terms, select favorites, and share articles with colleagues.  A nice feature includes the option to “Open in…” another program, allowing for easy download and transfer of PDFs into a personal archiving system or into an annotation app for future review.  The app is simple and easy to navigate without many bells and whistles.  The version I reviewed only has the current journal editions available, but hopefully archive data will be available in future.

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AOTrauma Orthogeriatrics

Educational tools for the care of older adults with fractures.

AOTrauma releases another high-quality app to assist in the management of fracture patients, this time with a focus on geriatric patients.  Not surprisingly, the app’s interface is smooth and intuitive, separated into 4 categories: osteoporosis, delirium, anticoagulation, and pain management.  Each section is organized as a drill-down series of questions to help guide the treatment for these patients based on current literature. At every step, “background information” can be selected to see the evidence guiding each decision.  The app is simple, useful, and achieves the stated goals of helping surgeons manage common co-morbidities in elderly fracture patients.

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Insights Orthopedics

Orthopaedic journal and news aggregator with personalized information.

Insights Orthopedics is a comprehensive and visually stunning news and research aggregator for orthopedics.  With a recent redesign in October 2014, their interface has become even more streamlined and visually appealing. Using their specialized search engine, the app collects orthopaedic journals, videos, full-text articles, news, podcasts, images, clinical trials, and association information and presents it in a clear and functional format.  The app looks and feels like the “flipboard for orthopaedic surgery.” The initial landing page presents the various modules, including journal clubs from various institutions, leading journal articles, videos, upcoming events, bookmarks, and industry.  A simple swipe of the keyboard quickly scrolls through the various articles and videos permitting continued browsing of abstracts.  With the new features, thousands of institutional library subscriptions have been adding, permitting full access to the article for users.  The intuitive user interface includes the ability to bookmark resources for off-line browsing or share links via Twitter, Facebook, LinkedIn, email, and SMS.  One of the apps most versatile features is the Aggregator function, which works as a search and includes many pre-populated key terms as well as the ability to type in your own words.

Overall, this app has the look and feel of a “top app” with a number of useful features for any orthopaedic surgeon or trainee.

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Touch Surgery

3-D Surgical Simulation App        

Touch Surgery is a 3-D surgical simulation app to help surgeons/assistants/students become more familiar with particular surgical procedures in their respective field. The app has recently been updated and now offers an even larger library of fundamental orthopaedic procedures that you can download onto your device. The visual clarity and upgrades have drastically improved over the last year. Once you have downloaded the procedure there is a simulation demo that takes you through a step by step demo. The simulation reviews patient set-up, incisions and which neurovascular structures to avoid as well as retractor placement using gestures you make on your device. Once you have completed the demo you can then test yourself through the procedure and see if you are improving your scores. Overall, the best surgical simulation app still out there. It has a clean interface and practical demos for learning orthopaedic residents and students. Some of the apps are 3-D modules which are better made for an iPAD. Hopefully more of the orthopaedics demo’s will be converted to a 3-D format.

In the news

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Throw Like a Pro

Baseball throwing injury prevention app released by Dr. James Andrews and Dr. Kevin Wilk

In response to the increasing rates of “Tommy John” surgery as a result of throwing injuries, this app has been released to help young baseball players prevent injuries and safely participate in sports.  The purpose of this app is to provide information about safe participation that keeps players out of the operating room.

The app includes an overview of baseball throwing injuries, statistics, and general guidelines for prevention.  The app then divides recommendations into Pre-Season and In-Season sections.  In Pre-Season, videos are included that demonstrate how to perform 5 different stretching exercises, with instructions to complete them daily.  Next, the player performs the “Throwers Ten” which includes videos of 20 more exercises that should be performed with 10 repetitions, 3-4 times/week.  Lastly, there is advice for a throwing progression with a module that talks the player through the distance and number of throws to build up.

The In-Season module includes a warm up with stretching (same videos), a thrower’s ten band workout (more videos), a throwing warm up and a pitching warm up.  The app includes a pitch-count tool which can be modified for the patient’s age, rest days, and maximum pitches desired (and advised).

Overall, the app has a very high production quality and includes important information from leading surgeons in the field of throwing injuries. They estimate a 60% reduction in throwing injuries if used properly.

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Sports Fellow Self Assessment Exam

Self Assessment exam from the AOSSM for Sports Fellows

This app is designed for fellows in sports medicine. The app is designed for the user to take a quiz and then review the responses.  Quizzes can be selected, downloaded, and then reviewed, and includes answers, explanations, and images.  It has a similar format to AOSSM Self Assessment Exam app.

*Requires registration

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Radiopaedia MSK

App version of Radiopaedia.org, radiology teaching files for musculoskeletal education.

This app presents musculoskeletal imaging in a case-based format and is designed to teach students and residents about musculoskeletal injuries.  The app is very intuitive, and currently includes 68 case presentations.  Each case has unknowns with various imaging modalities and views, questions, and then answers to those questions. It also includes a radiology report, as well as additional online cases with the same (or similar) diagnoses.  The app is very simple, yet intuitive, and can be very useful for reviewing images.

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PhysioMD

Physical Therapy app created by orthopaedic surgeons for specific injuries.

This app is designed to be “Rehab where you want it, when you want it.”  The app organizes therapy into different phases for different injuries, and specific therapy packages can be purchased individually for each injury.  To get started, the user selects their gender, injured area, and mechanism of injury – which presumably influences the injuries that are presented on the following page. Once an injury is selected, the exercise package can be purchased and installed for about $7.99. For shoulder instability, for example, there are 4 phases: Acute, Mobility/Strengthening, Strengthening/Limited, and Return to Sport. The app developers require the user to confirm that he/she has completed the previous objectives before advancing.  Once into each module, an extensive list of exercises are shown with images, description, and links to high-quality videos demonstrating the exercise.

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FracturED

App for learning skills needed to treat fractures in the emergency department.

Created by an emergency medicine resident, this app is organized into modules for educating residents about how to care for fractures in the emergency department. The app begins with basic information, including annotated images for demonstrating surface anatomy, bones, and nerve distributions.  The app is then organized into cases which include a brief story of the patient, appropriate xray imaging with various views, and a discussion of the pathology and treatment options.  The discussion also has an extensive list of references for additional reading.

As of this review, the app includes 20 cases for the “Hand and Wrist” including a demonstration of how to apply various splints.  However, the general “upper extremity,” “lower extremity” and “foot” sections are all marked as “coming soon.”

This app is a useful learning tool for ED residents, but is currently only limited to the upper extremity.

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DocSpera

HIPAA compliant secure collaboration platform for surgeons

DocSpera is a company and app developed specifically for collaboration and case sharing among medical professionals.  With an orthopaedic surgeon co-founder, it has been tailored for the proceduralist, and functions well as a networking and case-sharing tool for surgeons.

The app requires registration as a verified physician. Once complete, all functionality is available for free, including access to the contact list, invitations to join specific networks, the ability to upload documents and images to a personal filing cabinet, and messaging features.  Some of the most useful features include the ability to create a personal network for a practice, society, or specialty interest group.  Discussion threads can be initiated by any group member and are visible only to those within the group.  In addition, because of its HIPAA compliant standards, specific patient information is secure through the platform and protected for public view.

Overall, DocSpera is a great solution for practices or providers looking to collaborate and share information about patients and cases.

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Current Orthopaedic Practice Journal

Mobile access to the Current Orthopaedic Practice Journal

This simple, intuitive, and sleek app allows users to download complete issues of the journal and browse full articles.  The app is organized into the “library” – which shows all journal issues – and the “viewer” – where journals can be read.  The journal is presented in entirety, including the table of contents and advertisements.  Currently, the app and journals are offered for free, however a subscription will likely be required in the future. For now, though, download the app and benefit from this fantastic resource.

*Requires subscription for full text access

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Corin Resource Hub

Information about Corin orthopaedic implants for surgeons

This device company app is a resource and educational tool for surgeons who want to use or learn more about Corin products. The app is divided into solutions for the hip, knee, and “technology.”  As expected, the app includes general information about the products and marketing information.

*Requires subscription for full text access

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California Orthopaedic Association

Conference app for the 2014 California Orthopaedic Association and QME Course

This app is created for attending the COA 2014 Annual Meeting in Monterey, CA.  Presumably, future meetings will have similar apps that will support equivalent functionality, including an agenda, speakers/evaluations, list of attendees, social events, QR reader, map, photo feed, etc

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BoneDoc

A serious game for simulating orthopaedic surgery.

The BoneDoc app is marketed as “a serious game” and functions as an interactive and educational orthopaedic surgery tool.  The game was created by Dr. Phil Blyth from New Zealand and represents many accuracies of hip surgery.

The app layout is a list of patients that need surgery.  The first case, for example, is a hip fracture that requires fixation. The surgeon must walk through every step of the operation, beginning with setting up the traction properly.  Xrays are available as the traction is adjusted to ensure that a proper reduction is obtained. Once complete the surgeon then moves on to the incision, as well as placement of the hardware.  Xrays are used throughout the “operation” to ensure the proper alignment and orientation of hardware.  Once finished, the surgeon receives a score for every aspect of the case, and is reimbursed appropriately.

The game is very impressive due to the attention of detail that has been placed, as well as the realistic physics and challenges inherent with fixing a hip fracture.  I applaud the developers for creating a challenging and educational app for surgeon education.  I look forward to future releases with additional fracture options.

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Bone Ninja

Sophisticated app for pre-operative planning of osteotomies and limb correction.

Although it has a catchy name and cute icon, Bone Ninja is neither a toy nor a game. This is a sophisticated and serious app created by the International Center for Limb Lengthening to teach planning for limb lengthening and alignment surgery. The app was primarily used as a tool for the deformity course that they host, and I advise that anyone interested in the app either take the course or watch one of the introductory lectures.

The app itself includes a library of images for practicing and learning. This includes both frontal and saggital plane views of limbs with various angular deformities. The user can also upload their own image. Once an image is selected, you enter the editing mode. The features are impressive, and include calibration and enhanced editing tools such as various select functions, linking options, the ability to free-cut the image, angular and length measurement tools and rulers, and more. It even has “hardware” icons that can be added to the images.

As stated above, this app is not for amateurs and includes lessons and resources for learning, including links to YouTube videos (Part 1, Part 2, Demo).

App website: http://www.lifebridgehealth.org/RIAO/BoneNinjaAppforiPad.aspx

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Biomet Orthosize

Image templating viewer for Biomet implants

This app is designed for pre-operative templating of Biomet implants and works in conjunction with their web platform at www.Orthosize.com. The purpose is not to template on the mobile device, but rather to review or modify images created with the desktop software.  To use the app, contact your Biomet representative.

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ASSH 2013

Conference app for the 2013 Annual Meeting of the American Society of Surgery for the Hand

This app is created for attending the ASSH 2013 conference in San Francisco.  Presumably, future meetings will have similar apps that will support equivalent functionality, including a schedule, personal calendar, full program, speaker search, handout information, maps, exhibitor details, and more.

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Arthrex Synergy

Image and Video app that works in conjunction with Arthrex’s arthroscopy tower

This app works with Arthrex’s arthroscopy tower and allows for each transfer of images and videos to an iPad for editing, patient education, and sharing.  Use of the app and login information can be obtained from your device representative.

The app is organized into a list of patients with their corresponding images. Once a patient is selected, the images can be viewed individually, with a few editing features for enhancement. For example, this includes saturation adjustment, contrast adjustment, and the ability to annotate with text, lines, and circles/arrows. The benefit of annotation is that images can then be selected for sharing with the patient, via email.  In addition to the images, links can be provided for documentation on related implants, or documents uploaded by the surgeon.  The surgeon can also record a video message or narration of the diagnosis and treatment.

Arthrex has gone to appropriate lengths to ensure that all transmissions are HIPAA compliant, and sharing the images generates 2 emails, the second with a secure password that allows the patient to unlock the attachment in the first email.

Overall, this is a very high quality app that complements their associated medical devices.

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AOSSM Self Assessment Exam

Self Assessment exam from the AOSSM

This app is designed for surgeons preparing to take the subspecialty orthopaedic surgery exam in sports medicine. The app is designed for the user to take a quiz and then review the responses.  Quizzes can be selected, downloaded, and then reviewed, and includes answers, explanations, and images.

*Requires purchase of exam

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AAOS Musculoskeletal Exam – Spine

Simple app made by the AAOS to learn the spine exam

I commend the AAOS’ effort to create mobile educational material for students and trainees, which includes this simple app for learning the spine exam.  This app has a very simple structural layout in list form that presents the spine exam: standing/seated/supine/prone examination, Waddel signs, cervical spine muscle testing and cervical spine range of motion testing.  Each part of the exam includes a description, instructions and video.  In addition, references are provided for further reading. However, despite the useful information presented here, the app is bare and lacks much depth.  The user interface is unfortunately too simple and somewhat uninviting.  Overall, the content includes 46 total exam maneuvers.  At a cost of $9, this is quite a high price considering other apps that include more information and detail at a better value.  I hope that this app will be expanded upon and improved in future versions.

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Orthokeys

Orthokeys is an innovative orthopaedic app with a variety of tools ranging from  a thorough library of fracture classifications, a templating program based on known  classification patterns and a note section that allows you to share cases with others. The most impressive feature of the app is a clever photo tool that allows you to template fracture patterns using the injury classification library and layer it on top of the xray all on your iPhone or iPad. I applaud the developer for including both pediatric and adult fracture patterns making this one of the few apps to include pediatric fracture classification. However once you have templated the fracture pattern you are not able to template implants to help assess which size hardware you may need. Additional tools include an online Orthopaedic browser that does not have strong search capability and a surgical implant directory that lacks much needed information. Overall, this app has many useful features which could be more thorough and integrated better with the rest of the app.

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MediBabble

Medical Translator App

MediBabble is a powerful translation tool to help providers communicate with non-English speaking patients. There are many apps that provide translation tools to providers, but I have to say MediBabble is the best one on the market (and its free!). MediBabble differentiates itself with a robust database of pertinent medical phrases (including orthopaedic ones) organized in a standardized history-taking format. It does not require the user to be connected to the internet and it actually has medical phrases that are spoken to the patient from your phone. This app is probably best for intermediate language speakers who do not have the medical vocabulary to perform a complete history. Having tried the app myself I found it extremely useful as many of the phrases allow me to ask the patient close ended questions that I didn’t know ask with my mediocre spanish. Currently the app is available in Chinese, French, German Haitian Creole and Russian. Overall, a fantastic app that will help mediocre language speakers with history taking. I just wish the app would translate all that the patient was saying for me……..  but I guess that is called using translator services.

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Orthopaedics 365

Clinical daily pearls regarding the most recent and evidence-based tips for orthopaedic surgeons.

This app is a creative way to stay fresh with some of the most pertinent and evidence-based topics in orthopaedic surgery. Created by a current orthopaedic chief resident, the app has a very simple interface.  It presents itself as a calendar with “365 clinical pearls” that are delivered to the user daily via a push-notification at a designated time.  Each pearl can be shared with colleagues via text, email, or twitter and includes a reference to a relevant journal article. In addition to daily push notifications, the user can also browse through the calendar to read additional pearls.  Thus, this serves as a primitive collection of study facts or flashcards. Unfortunately, the functionality is limited since they are not sorted by topic. Overall, the app does a good job of its stated purpose, which is to deliver a new orthopaedic fact every day.

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HS/KS/AAHKS Specialty Day

A meeting app for the Hip Society/Knee Societ 2013

This app is a meeting app for the Hip Society and Knee Society. Unfortunately, the app requires a personal login for access. Thus, a detail review cannot be provided at this time.

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HAND Journal

A journal app for the Hand Journal.

This is a journal app for Hand. Unfortunately, the app requires a personal login for access. Thus, a detail review cannot be provided at this time.

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FRAX

A digital and mobile tool for calculating the FRAX score.

This app is a very useful and free tool for calculating the WHO Fracture Risk Assessment Tool (FRAX).   Created by the International Osteoporosis Foundation and Doctot, the app is intuitive and simple to use.   The app includes a detailed section about FRAX and its purpose: to calculate a patient’s 10-year probably of fracture based on BMD – and references have been provided.  To use the actual assessment tool, select “start the test.”  The app then walks you through a series of 14 questions on the FRAX, such as age, gender, ethnicity, weight, height, history of fractures, co-morbidities (smoking, steroids, RA, osteoporosis, alcohol), type of fracture, and T-score.  The final result is a FRAX score that estimates the risk of fracture based on the validated tool.  Users can then save the score with a patient’s name. Overall, this very simple app is both validated and effective and should be highly considered for anyone who already uses FRAX in their office.

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JBJS Reviews

The Journal of Bone & Joint Surgery has added a new publication to their portfolio. JBJS Reviews is a dedicated online journal meant to publish clinical information in a mobile/web based format. As a result JBJS has created a new app meant to serve as the platform through which JBJS Reviews will be presented to mobile readers. JBJS’s  app has an easy to use interface that allows readers to search, create favorites and follow recent articles they have looked up. In addition, while I commonly give Journals a difficult time for using an inferior pdf viewer to read articles. JBJS Reviews allows the reader to download the pdf and read the article in any pdf viewer of their choosing. The interface to read the articles is a little buggy as buttons overlap one another. Hopefully with the next version of this app they will improve the article viewing options. Overall, a well made app that will definitely be used by the readership of the JBJS.

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https://itunes.apple.com/us/app/jbjs-reviews/id787553942?mt=8

PingMD (updated)

HIPAA compliant messaging

PingMD is a creative app to help providers securely and efficiently communicate with patients and other providers. This app creates HIPAA compliant text-messaging. If you did not know, text messaging through your phone provider does not meet HIPAA compliance guidelines. As a result, PingMD was created to fill this void. Overall the app is very user friendly and has a clean interface. Patients and other coworkers can send messages, photos and videos to help communicate with one another. The main criticism with PingMD in my prior review was that it was cumbersome to find other coworkers and patients. *PingMD has just released an update that allows users to easily find coworkers through their current phone contact list.* This update is a powerful move by PingMD. This network based app depends on other providers and patients using the app for it to be successful. Over time as more hospital systems adapt and integrate mobile health solutions this app will likely becoming an everyday part of patient and physician interactions. 

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OTA Annual Meeting 2012

Mobile App to guide OTA attendees

The OTA Annual Meeting 2012 app was created to help attendees navigate the OTA 2012 conference in Minneapolis, Minnesota. The app is thorough and impressive with the resources it gives users which include: a search feature to find a topic of interest and where it will be discussed/presented, a list of exhibitors and their locations, and a thorough schedule that users are able to add to favorite and create their own schedule.  I am impressed the OTA is using social media to help communicate with attendees (twitter and QR code reader) at the conference. While the app is thorough and a great resource for conference attendees I hope the next iteration of the app for future conferences includes more detail about presentation topics with downloadable handouts and information on the posters with that would be useful for attendees. Overall a great resource to navigate the OTA conference

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https://itunes.apple.com/us/app/ota-annual-meeting-2012/id563263168?mt=8

My Knee Guide

Patient resource for those considering knee replacement

My Knee Guide is a complete resource for patients considering knee replacement surgery. I am extremely impressed with how this app personalizes the experience of knee replacement surgery to the patient. The app has creative stories of real-world patients and their experiences of undergoing total knee arthroplasty. The in-app features include: calendar with reminders of surgery specific details and checklists, email alerts to remind patients what to do and when, location based resources of local hospitals and surgeons with SCIP protocol compliance rates and many more resources. Personally my favorite part of the app is “my surgery guide” which informs patients day by day exactly what to expect before and after their surgery. This app will assist the orthopaedic surgeon to set patient expectations and help patients stay informed throughout their treatment process. My only criticize with all the resources in the app is that patients may become overwhelmed. This is an app I plan to use with my patients to help them learn more about total knee replacement.

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AJSM (American Journal of Sports Medicine)

Mobile Access to the American Journal of Sports Medicine

The American Orthopaedic Society for Sports Medicine (AOSSM) has done an excellent job producing another of its reputable journals onto a mobile platform. The American Journal of Sports Medicine app has allowed journal subscribers with easy- to-use access of the magazine in app form. The app has many advanced features such as searching for relevant topics within all issues of the publication, allowing users to save favorite articles and sharing journal articles easily through email. These up-to-date app features makes this app an excellent tool on the iPhone and iPad. In addition, the AJSM has started to build video and audio content which can become an important educational tool for viewers in the future. My only criticism that I made with other apps from the AOSSM is the reader software used to view the journal articles is slightly clunk and doesn’t allow you to make notes or easily manipulate the journal articles. However, once the developers build more video and audio content into the app it will quickly become a must have for anyone in the field.

Overall a very useful Journal application with advanced app features.

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Sookasa

Cloud based file storage that is secure and encrypted

Sookasa is a great HIPPA compliant solution to file sharing through the cloud. The seamless integration with Dropbox (the most popular free data cloud service) makes Sookasa very user-friendly and easy to use. Sookasa is valuable to medical professionals because it finally offers an easy to use cloud platform that is not exposed to security and compliance risks. You can encrypts files, create an audit trail, track files and allow administrators to easily delete and retrieve files.  The app allows users to securely view encrypted documents on your iPhone or iPad device. This service is a must have for all medical professionals who use dropbox/googledrive/box or any other cloud device where patient information is stored. If you are not using cloud based file storage in your practice due to concerns for security there is now finally a solution. Sookasa is a revolutionary new product that can change the way you manage your practice.

*The Fees are subscription based and can be pricey based on usage, but likely a worthwhile investment*

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OrtoEscores

Easy app to calculate outcomes scores for patients

This is a great app to help staff calculate relevant outcome scores for patients. The app includes 30 different outcome measures that surgeons can use to help establish measures for how patients are progressing through their care. The app has the functionality to email this information to the patient and to the surgeon. However, a significant portion of the app is in Portuguese as it was originally made for use in Brazil. Also, the formatting of some of the surveys on the iPhone are not the best Overall a great app to calculate outcomes scores that will be more useful once fully translated and more functional on the iPhone.

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Figure1

Photo sharing app for physicians 

A brilliant app that allows healthcare professions to share photos and discuss cases without violating HIPPA regulations. This company should be commended with the effort and detail they used to make sure they protect patient privacy. The issue with sending photos and sharing patient information to other healthcare professionals through a phone messaging has potential regulatory consequences. Figure 1 has solved this problem by creating intuitive in-app tools that easily allow the user to remove identifying information. There is an automatic face-blocker feature that detects faces in photos. In addition, the app has a quick consent form you can have the patient complete if your institution does not have a photo sharing policy in place. The app also has the functionality to allow users to search for topics of their particular interest. Figure 1 is a great photo sharing app with some clever features for health professionals that will improve once the user base increases. The app is a must have.

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ICJR – International Congress for Joint Reconstruction

This comprehensive app includes joint reconstruction lectures, procedures, and technologies.

This free app is published by the International Congress for Joint Reconstruction (ICJR), a nonprofit organization focused on improving the quality of orthopaedic care. The app is very well made and includes video presentations from past ICJR meetings. The current version can be accessed in guest mode which permits 3 video downloads.  As of August 2013, there were 35 conferences with videos to access and 9 more upcoming in the next 2 years.  The app also includes the ability to save videos for watching later, search by faculty, and search for particular topics.  The app includes other common features such as video sharing via email and full screen video review.  The video I downloaded was very high quality.

*Requires login for full access. Guest access limited to 3 videos.

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Sports Health-HD

Mobile access to Sports Health publication

This simple, intuitive, and sleek app allows users to download complete issues of the journal and browse full articles.  The app is organized into the “library” – which shows all journal issues – and the “viewer” – where journals can be read.  The journal is presented in entirety, including the table of contents and advertisements.  The key feature, however, is the integration of links among the table of contents, emailing links, posting to twitter and facebook, and hopefully the future integration of digital media.  Currently, the app and journals are offered for free, however a subscription will likely be required in the future. For now, though, download the app and benefit from this fantastic resource.

*Requires subscription for full text access

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Journal of Pediatric Orthopaedics – British

Mobile access to the Journal of Pediatric Orthopaedics (British)

The Journal of Pediatric Orthopaedics (British) is part of a series of digital journal conversions by Wolters Kluwer.  This simple, intuitive, and sleek app allows users to download complete issues of the journal and browse full articles.  The app is organized into the “library” – which shows all journal issues – and the “viewer” – where journals can be read.  The journal is presented in entirety, including the table of contents and advertisements.  The key feature, however, is the integration of links among the table of contents, emailing links, posting to twitter and facebook, and hopefully the future integration of digital media.  Currently, the app and journals are offered for free, however a subscription will likely be required in the future. For now, though, download the app and benefit from this fantastic resource.

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Journal of Pediatric Orthopaedics – American

Mobile access to the Journal of Pediatric Orthopaedics (American)

The Journal of Pediatric Orthopaedics (American) is part of a series of digital journal conversions by Wolters Kluwer.  This simple, intuitive, and sleek app allows users to download complete issues of the journal and browse full articles.  The app is organized into the “library” – which shows all journal issues – and the “viewer” – where journals can be read.  The journal is presented in entirety, including the table of contents and advertisements.  The key feature, however, is the integration of links among the table of contents, emailing links, posting to twitter and facebook, and hopefully the future integration of digital media.  Currently, the app and journals are offered for free, however a subscription will likely be required in the future. For now, though, download the app and benefit from this fantastic resource.

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AO Spine Principles

A visually impressive description of AO Spine treatment principles.

This simple and lightweight app includes basic information about the AO Spine principles.  The app is divided into 3 main sections: the home screen, principles, and details. There are 6 different classifications: trauma, tumor, deformity, degeneration, infection, and metabolic/inflammatory/genetic.  Selecting each section then includes a rotating wheel describing each of the 4 principles: stability, alignment, biology, and function.  The information provided is general and broad, and does not serve as a useful resource.  However, as a single download and review, this is somewhat interesting.

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AAOS Musculoskeletal Exam – Knee

Simple app to learn the knee exam and special tests

I commend the AAOS’ effort to create mobile educational material for students and trainees, which includes this simple app for learning the knee exam and special tests.  This app has a very simple structural layout in list form that presents the knee exam: inspection, muscles, range of motion, and special tests.  Each part of the exam includes a description, instructions and video.  The special tests include information about specificity and sensitivity and include a short reference list.  However, despite the useful information presented here, the app is bare and lacks much depth.  The user interface is unfortunately too simple, and the overall content includes only 20 total exam maneuvers.  At a cost of $9, this is quite a high price considering other apps that include more information and detail at a better value.  I hope that this app will be expanded upon and improved in future versions.

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Orthopaedic Nursing Journal

Mobile access to the orthopaedic nursing journal.

The Journal of Orthopaedic Nursing is part of a series of digital journal conversions.  This simple, intuitive, and sleek app allows users to download complete issues of the journal and browse full articles.  The app is organized into the “library” – which shows all journal issues – and the “viewer” – where journals can be read.  The journal is presented in entirety, including the table of contents and advertisements.  The key feature, however, is the integration of links among the table of contents, emailing links, posting to twitter and facebook, and hopefully the future integration of digital media.  Currently, the app and journals are offered for free, however a subscription will likely be required in the future. For now, though, download the app and benefit from this fantastic resource.

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Orthopedics Today Healio

Mobile Access to the Orthopaedics Today Magazine

This is a good mobile version of the Orthopaedics Today. The app updates with the latest and most recent articles within different topics of orthopaedics daily. While this app lacks a search option and the ability to find to find old articles, it does allows you to star favorite articles and is trying to build a video library of expert talks in the field.

Overall a good app for a useful magazine.

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Orthopaedic Journal of Sports Medicine

Mobile Access to Orthopaedic Journal of Sports Medicine

The American Orthopaedic Society for Sports Medicine has done an excellent job in advancing it’s journals into mobile platforms. With the Orthopaedic Journal of Sports Medicine they have provided unrestricted open access to full text in an easy-to-use format. The articles are available for download and can be viewed through the mobile app.  This app does an excellent job giving the reader up-to-date app features: search function to find journal articles, share articles to peers via email, and easily save articles to a favorite’s folder. My only criticism reading the journal articles is slightly clunk and doesn’t allow you to make notes or easily manipulate the journal articles.

Overall a very useful Journal application with advanced app features.

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Canadian Orthopaedic Association

Mobile Access to the Canadian Orthopaedic Association

This is a weak mobile version of the Canadian Orthopaedic Association website. The app is meant to allow members to have easy access to up to date news and event information. However the lack seems to fall short of providing more than three articles in its news column and does not organize its events calendar well on the iphone. I acknowledge the innovation of using push notifications to remind members of upcoming events, but outside of this one good feature the app itself is lacking the information and thoroughness that the website clearly provides.

Overall a weak app for an important association.

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CORE – Clinical Orthopedic Exam

CORE has set the standard for a clinical exam app.  Divided by body part, body region, alphabetical, favorites, or search – the app contains a database of over 400 clinical tests which includes a purpose, instructions, video demo, and test properties.   The most striking feature of this app, in addition to the vast collection of tests and videos, is actually the “properties” tab.  For every test, data is presented regarding the sensitivity, specificity, likelihood ratio, accuracy and other relevant statistical tests based on primary literature references.  These lists are incredibly complete.  For example, the hip impingement test lists 10 primary sources with their respective sensitivities and specificities using the impingement test to detect labral tears.  In addition, by selecting the primary references the user is directed to the full literature source with the abstract text.  This is a feature that I have not seen replicated by any other orthopaedic reference.  The videos can either be downloaded to the app or a link to YouTube can be emailed/shared with colleagues.  Tests can be marked as a “favorite” and quickly reviewed at a later time.  Unfortunately, the search feature was not ideal.  When I searched “grind” there were “no results” but when I searched “Apley” I was provided with Apley’s Grind Test.  This app seems ideal for a medical student with an interest in musculoskeletal medicine (PM&R, sports medicine, or orthopaedic surgery) or a junior resident in any of these fields.  Overall, a very complete and useful app for trainees.

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OrthoMind

Mobile access to OrthoMind.com, professional management for orthopaedic surgeons.

The orthopaedic practice management site www.OrthoMind.com has released an app for mobile access to posts and messages.  The app replicates many of the most popular features of the website: Clinical Posts, Business Posts, and Messages.  This includes the ability to post new messages with photos included.  The posts are viewed in the standard fashion, and I experienced no delays accessing content or viewing comments.  This is a perfect adjunct to the website for registered users.

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Orthopaedics Today Europe

Mobile access to the Orthopaedics Today Europe magazine.

This app is a very good mobile version of the Orthopaedics Today Europe magazine.  The app includes full access to new and old issues, including options to download the document to the device or view online.  There are nice features such as a robust search option, as well as ways to share the content via email.  Overall, a very good mobile adaptation of a useful magazine.

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AAOS Musculoskeletal Exam – Shoulder

Simple app to learn shoulder exam and special tests

I commend the AAOS’ effort to create mobile educational material for students and trainees, the first of which is this simple app for learning the shoulder exam and special tests.  This app has a very simple structural layout in list form that presents the shoulder exam: inspection, muscles, range of motion, and special tests.  Each part of the exam includes a description, instructions and video.  The special tests include information about specificity and sensitivity and include a short reference list.  However, despite the useful information presented here, the app is bare and lacks much depth.  The user interface is unfortunately too simple, and the overall content includes only 30 total exam maneuvers.  At a cost of $9, this is quite a high price considering other apps that include more information and detail at a better value.  I hope that this app will be expanded upon and improved in future versions.

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British Orthopaedic Association

Simple app to learn shoulder exam and special tests

I commend the British Orthopaedic Association (BOA) for creating a mobile app for patient and surgeon education.  The app includes modules such as news, multimedia, membership information, publications, events, etc. The app is easy to navigate and includes a somewhat eclectic collection of resources for surgeons.  This app may be moderately useful for members of the BOA.

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Nerve Whiz

Extraordinary app with detailed and complete information about the brachial and lumbar plexes, including innervation, sensory distribution, and sites of compression.

Developed by Zach London, MD from University of Michigan, Nerve Whiz is one of the most useful and intuitive nerve reference resources I have come across.  The app includes complete information about the course, branches, innervation, sensory distribution, and sites of compression of the brachial plexus (C5-T1) and lumbar plexus (L2-S2).  The app has multiple sections with hidden gems.  “Chart” includes a complete listing of all data, organized by either upper or lower extremity and sorted by muscle, nerve, roots, action, trunk, or cord.  The next feature is an incredible “muscle localizer” and uses an intuitive algorithm to provide the site of injury after the user selects muscles that are injured.  For example, selecting a weak “deltoid” returns localization to either C5, C6, upper trunk, posterior cord, or axillary nerve.  The diagram section utilizes a brachial plexus diagram and highlights the selected area of interest – the diagram is both intuitive and complete.  The final section, “sensory,” allows the user to point to an area of sensory loss and returns a list of potential roots and nerves that may be injured, with associated dermatome diagrams.  Overall, this extraordinary reference app should be in the pocket of every medical student and orthopaedic, neurologic, or neurosurgical trainee.

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Heel Thy Tendon

Lightweight informational app for patients with foot tendinopathy including information about the disease and treatments.

Heel Thy Tendon (creative name) was developed by an orthopaedic surgeon from Lewisburg, PA and includes general information about 4 common types of foot tendinopathy.  The app begins by asking the patient to select the area of pain and isolates either Achilles tendinopathy, posterior tibial tendinopathy, peroneal tendinopathy, or plantar fasciitis. Each section includes a powerpoint with generic information and treatment options (surgery, platelet rich plasma, shockwave therapy, and non-operative treatment).  There is also a text-based summary of each condition.  Overall, the app provides general information about four common causes of foot pain and may be useful for patients looking to learn more about chronic foot pain and to help guide them to an appropriate specialist.

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HandMD

A personal practice app for the hand surgery practice of Dr. Jeffrey Wint in Springfield, MA.

This app is a personal practice app for Dr. Jeffrey Wint.  The app includes information about Dr. Wint, including office information, location, hours, Twitter feed, and various podcasts.  A tab also includes various academic and professional achievements, including education/training information and recent awards.  Users can send a private message to Dr. Wint via the app.

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iSplint

A light-weight splinting reference designed for emergency department physicians.

iSplint has features not present in other splinting apps, including fully native videos demonstrating splint application.  The app was created by an emergency medicine physician at George Washington University, giving it credibility.  Unfortunately, the selection of splints is limited to thumb spica, triple S, radial gutter, dorsal hand, sugar tong (upper extremity), posterior ankle, and sugar tong (lower extremity).  Aside from non-traditional orthopaedic terminology for some of these splints, the application of splints are all demonstrated using fiberglass with minimal padding.  This is somewhat of a deviation from traditional orthopaedic splint application.  In addition to the video demonstration, there is a “discussion” for each splint which links to a table that offers an image of the applied splint, application tips, and provides very brief indications.  Overall, this app is focused more towards emergency department staff, as advertised.  However, orthopaedic providers should be aware of this application and consider recommending it to colleague for simple splint applications.

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Top Ortho “App”

Download the www.TopOrthoApps.com iPhone app!  You’re already on the website, why not have on-the-go access direct from your iPhone?  This app has all of the best Top Ortho App lists that you’re used to: Top Apps, Free Apps, iPad Apps, Journals, Sports Apps, and much more!  Full reviews and screenshots are all available for free.

This app has all of the best Top Ortho App lists that you’re used to: Top Apps, Free Apps, iPad Apps, Journals, Sports Apps, and much more!  Full reviews and screenshots are all available for free.

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Orthopaedic Patient Information

Very high-quality 3D anatomical models with video demonstrations of common anatomy, pathology, and treatments.

Orthopaedic Patient Information is part of the 3D4Medical’s suite of full-featured anatomy apps.  All of their apps follow a similar and intuitive format, but this one differs slightly. The relevant body part is presented with a video demonstrating the most common anatomy, conditions, and treatments.  These demonstrations are very high quality.   The level of detail and anatomical accuracy of all muscles, tendons, vessels, nerves, ligaments and bones is impressive.  Overall, the entire suite of 3D4Medical anatomy apps are the best anatomy models we have seen yet, and this patient information app is fantastic.

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Skeleton System Pro III

Full-featured 3D anatomy models with support for 3D rotation, various anatomy layers, cross-sectional slices, annotations, and video demonstrations.

Skeleton System Pro III is part of the 3D4Medical’s suite of full-featured anatomy apps.  All of their apps follow a similar and intuitive format. In the skeletal system, any region of the body is selected for a more focused view. The relevant body part is presented with skin covering, and different anatomical layers can then be “unwrapped” sequentially through the body.  The level of detail and anatomical accuracy of all muscles, tendons, vessels, nerves, ligaments and bones is impressive.  In addition to the different layers, the view can be manipulated freely.  All body parts can be rotated in the horizontal plan through 360 degrees rotation.  In addition, axial, coronal, and sagittal slices can be taken through various levels of each joint or body part.  The app includes “pins” which already identify every possible structure of every layer.  In addition, most of the apps in the series include videos demonstrating relevant surgical procedures or common pathologies.  These demonstrations are very high quality.  The app includes a “pen” feature for drawing on the screen, however doodles are not saved and disappear once the pen is turned off.  There is even a separate button to turn vessels on and off.  Overall, the entire suite of 3D4Medical anatomy apps are the best anatomy models we have seen yet, based on their accuracy, level of control, and video demonstrations.  Ideal for health care students and possibly even for surgical preparation.

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Spine Pro III

Full-featured 3D anatomy models with support for 3D rotation, various anatomy layers, cross-sectional slices, annotations, and video demonstrations.

Spine Pro III is part of the 3D4Medical’s suite of full-featured anatomy apps.  All of their apps follow a similar and intuitive format. The relevant body part is presented with skin covering, and different anatomical layers can then be “unwrapped” sequentially through the body.  The level of detail and anatomical accuracy of all muscles, tendons, vessels, nerves, ligaments and bones is impressive.  In addition to the different layers, the view can be manipulated freely.  All body parts can be rotated in the horizontal plan through 360 degrees rotation.  In addition, axial, coronal, and sagittal slices can be taken through various levels of each joint or body part.  The app includes “pins” which already identify every possible structure of every layer.  In addition, most of the apps in the series include videos demonstrating relevant surgical procedures or common pathologies.  These demonstrations are very high quality.  The app includes a “pen” feature for drawing on the screen, however doodles are not saved and disappear once the pen is turned off.  There is even a separate button to turn vessels on and off.  Overall, the entire suite of 3D4Medical anatomy apps are the best anatomy models we have seen yet, based on their accuracy, level of control, and video demonstrations.  Ideal for health care students and possibly even for surgical preparation.

Knee Pro III

Full-featured 3D anatomy models with support for 3D rotation, various anatomy layers, cross-sectional slices, annotations, and video demonstrations.

Knee Pro III is part of the 3D4Medical’s suite of full-featured anatomy apps.  All of their apps follow a similar and intuitive format.  The relevant body part is presented with skin covering, and different anatomical layers can then be “unwrapped” sequentially through the body.  The level of detail and anatomical accuracy of all muscles, tendons, vessels, nerves, ligaments and bones is impressive.  In addition to the different layers, the view can be manipulated freely.  All body parts can be rotated in the horizontal plan through 360 degrees rotation.  In addition, axial, coronal, and sagittal slices can be taken through various levels of each joint or body part.  The app includes “pins” which already identify every possible structure of every layer.  In addition, most of the apps in the series include videos demonstrating relevant surgical procedures or common pathologies.  These demonstrations are very high quality.  The app includes a “pen” feature for drawing on the screen, however doodles are not saved and disappear once the pen is turned off.  There is even a separate button to turn vessels on and off.  Overall, the entire suite of 3D4Medical anatomy apps are the best anatomy models we have seen yet, based on their accuracy, level of control, and video demonstrations.  Ideal for health care students and possibly even for surgical preparation.

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Ankle & Foot Pro III

Full-featured 3D anatomy models with support for 3D rotation, various anatomy layers, cross-sectional slices, annotations, and video demonstrations.

Ankle & Foot Pro III is part of the 3D4Medical’s suite of full-featured anatomy apps.  All of their apps follow a similar and intuitive format.  The relevant body part is presented with skin covering, and different anatomical layers can then be “unwrapped” sequentially through the body.  The level of detail and anatomical accuracy of all muscles, tendons, vessels, nerves, ligaments and bones is impressive.  In addition to the different layers, the view can be manipulated freely.  All body parts can be rotated in the horizontal plan through 360 degrees rotation.  In addition, axial, coronal, and sagittal slices can be taken through various levels of each joint or body part.  The app includes “pins” which already identify every possible structure of every layer.  In addition, most of the apps in the series include videos demonstrating relevant surgical procedures or common pathologies.  These demonstrations are very high quality.  The app includes a “pen” feature for drawing on the screen, however doodles are not saved and disappear once the pen is turned off.  There is even a separate button to turn vessels on and off.  Overall, the entire suite of 3D4Medical anatomy apps are the best anatomy models we have seen yet, based on their accuracy, level of control, and video demonstrations.  Ideal for health care students and possibly even for surgical preparation.

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Shoulder Pro III

Full-featured 3D anatomy models with support for 3D rotation, various anatomy layers, cross-sectional slices, annotations, and video demonstrations.

Shoulder Pro III is part of the 3D4Medical’s suite of full-featured anatomy apps.  All of their apps follow a similar and intuitive format.  The relevant body part is presented with skin covering, and different anatomical layers can then be “unwrapped” sequentially through the body.  The level of detail and anatomical accuracy of all muscles, tendons, vessels, nerves, ligaments and bones is impressive.  In addition to the different layers, the view can be manipulated freely.  All body parts can be rotated in the horizontal plan through 360 degrees rotation.  In addition, axial, coronal, and sagittal slices can be taken through various levels of each joint or body part.  The app includes “pins” which already identify every possible structure of every layer.  In addition, most of the apps in the series include videos demonstrating relevant surgical procedures or common pathologies.  These demonstrations are very high quality.  The app includes a “pen” feature for drawing on the screen, however doodles are not saved and disappear once the pen is turned off.  There is even a separate button to turn vessels on and off.  Overall, the entire suite of 3D4Medical anatomy apps are the best anatomy models we have seen yet, based on their accuracy, level of control, and video demonstrations.  Ideal for health care students and possibly even for surgical preparation.

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Arthrosurface

3D virtual knee models promoting Arthrosurface products.

Arthrosurface has released this app presumably for patient education and demonstration of normal and abnormal knee kinematics.  The app is very simple and opens directly to the 3D image of their knee model.  Finger swipes allow for either 360 degree rotational manipulation or range of motion.  There are 3 views: normal, disease, and surgery.  You can also elect to view the implant alone.  Overall, the app is limited in functionality and as a demonstration of knee motion and implants, there are other apps with a much greater feature set.

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Biomet Bone Model

3D virtual bone models of Biomet’s knee, hip, and shoulder solutions.

Biomet enters the world of device apps with “Bone Model” as a way to educate patients and demonstrate their knee, hip, and shoulder implants.  Each module has a 3D model that can be spun 360 degrees in real time with a finger swipe.  A slider bar along the bottom of the screen manipulates joint motion, and pins over the model identify specific structures. Each module has different demonstrations of normal anatomy, damaged anatomy (osteoarthritis), and implants.  There are options to turn on/off bones, ligaments, cartilage, and annotations.

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Stryker ARIA Spine

Animated and 3D models of the Stryker ARIA Spine system.

Stryker has expanded their diverse collection of apps with an animated technique guide for their ARIA spine system.  The app, based on Visible Body technology, offers a walk-through of their equipment and procedure with the ability to change the camera orientation, zoom, show/remove anatomical parts or surgical equipment, and provides audio and text guidance to the user.  Overall, the use of interactive 3D models makes for a pleasant user interface that is very impressive.  The app would be most appropriate for trainees preparing for a case, an operating room tech familiarizing themselves with a procedure, or a patient who wants to better understand their operation.

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AAOS eBooks

Full-featured app for downloading and reading books in your AAOS bookshelf library. Text and images are all very clean and apps runs smoothly.

AAOS eBooks, that provides mobile access to titles purchased from their web-based store. As of writing, the store includes 8 popular titles, but is expected to increase to over 30 titles within the next few months.  Unfortunately purchases cannot be made directly through the app, but rather must be paid for on the website.  In addition, although the app asks users to log in via their AAOS username and password, this is an error and rather users must register at the AAOS eBookstore website (www.ebooks.aaos.org) to gain login information. After logging in, users can view the books they have purchased and can download them selectively, ranging in size from about 10-80 Mb.  Once downloaded, the text viewer has typical options, including the ability to change the font, change text size, adjust brightness, highlight text, make notes, and place bookmarks.  The annotation functions are primitive, at best, and even the instructions for highlighting require 4 separate steps each time.  The books themselves are of high quality, text is crisp, and images are clear, however the user cannot increase the image size, which often prevents fully appreciating many of the detailed illustrations.  Because books are downloaded to the device, they are accessible even without internet access, which is a valuable feature.  The app is still primitive in its feature set and title selection.  In addition, some books, such as OKU 10, already ship with a CD that includes a digital PDF version of the book, which is much easier to read and annotate using any of the popular PDF readers for mobile devices.

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VCF Mobile

Free information about vertebral compression fractures from Medtronic, including a description of balloon kyphoplasty and the Medtronic VCF product line.

The app provides general information and images about vertebral compression fractures while simultaneously promoting Medtronic’s line of VCF products.  The app runs well, and is divided into various sections, such as VCF, Product Info, Literature, Requests, and Dr. Look-up.  The general VCF information is basic level information appropriate for patients and includes drawings and videos, as well as “risks of VCF.”  In addition, there is an expended information module about balloon kyphoplasty.  The product information section includes the ability to request waiting room brochures and study abtracts.  The literature section is actually quite useful, and has 5 selected studies (obviously supporting balloon kyphoplasty) with summaries of the findings and results. Overall, the app provides some information for patients and may help surgeons reference a small subset of the available literature and request patient information material.

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JBJS ImageQuiz

Full-featured app including JBJS Image Quiz case reports, questions, images, and discussion about the case, the pathology, and appropriate treatment.

This app provides access to JBJS’s bi-monthly “Image Quizzes” that appear in the printed journal.  The app is well-designed and easy to navigate. All cases are presented in thumbnail format and, as of writing, the current version includes 54 cases.  Each case includes 3 sections: Question, Answer, and Discussion.  The question section includes a detailed case history as well as a number of relevant images which load quickly and clearly on the iPad.  The “quiz” appears to the left of the screen with a single question and multiple-choice options.  Interestingly, the user has the option of choosing “how others chose” to see the answers selected by other quiz takers.  This can be done either before or after making your own selection.  Once an answer is submitted, the user automatically advances to the “answer” section if correct, and is presented with a brief explanation.  Selecting “learn more in the discussion,” provides a more thorough explanation of the disease process and relevant clinical pearls.    Overall, the app is very clear and runs smoothly on the device.  At a price of $0.99, the app is somewhat of an enigma.  To those who already subscribe to JBJS, it seems odd that the journal would charge for access to these cases. While, for those who do not currently have a subscription, $0.99 for unlimited clinical cases and explanations is a phenomenal value.

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Bone and Joint

Full-featured app for reviewing and sharing JBJS (British), Bone & Joint Research, and Bone & Joint 360.

The British Editorial Society of Bone and Joint Surgery has also leapt into the mobile world with Bone and Joint, an iPad and iPhone app for viewing their collection of publications: The Journal of Bone & Joint Surgery (British), Bone & Joint Research, and Bone & Joint³⁶⁰. The app is available for free, however the full text version requires either a personal subscription or institutional access.  The reading pane includes a sidebar for browsing the current or previous issue organized by table of contents.  When an article is selected, the user can either view “abstract” or “full text.”  The full-text version appears in a condensed format, with tables and figures accessible via direct links.  In addition, all references can be directly tapped to link directly to the abstract.  The user can also choose to “download PDF” which opens the document with options for full screen viewing as well as sharing.  The share feature is surprisingly functional: the app generates an email that attaches the full-text PDF article.  Other features contained within the app include the ability to view only images and figures, select articles as favorites, full-text search capabilities, and history browsing.  All three journals named above are viewed in the same format, however users only have access to journals that are specifically included in their personal or institutional access.  Overall, very smooth integration of multiple journals and institutional access.  The ability to directly attach PDF articles to emails is a very useful feature.

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Biolox

CeramTec’s product information app about their line of ceramic hip arthroplasty products with useful animated videos.

For surgeons who already use CeramTec products, or who are interested in learning more about ceramic technology, this app includes a lot of useful information.  Four products are highlighted: the ball, insert, DUO, and OPTION.  Each section includes product information, as well as tips, handling recommendations, brochures, and news.   A number of high quality animations are included and fun to watch.   The app also includes news articles and brochures from the company, which might be useful to some surgeons, but difficult to read on an iPhone.

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iShoulder

A full featured app with fantastic images and information for providers and patients, as well as a drawing utility and notes/calendar sections.

This full-featured app contains a vast library of valuable images, text, and features that would be useful to surgeons, trainees, and patients.  The unassuming format includes sections for doctors, patients, and utilities.  Doctors have a number of choices, including anatomy, operative approaches, examination, tests, outcomes scores, and more.  Each category includes subsections with concise and relevant text and images.  For example, the operative approach section is very good, and includes detailed images useful for a quick review before a case; it even includes “dangers” to watch out for.  The Scores section includes a quick reference for the Constant, UCLA Shoulder, Rowe, ISIS, QuickDASH, and Oxford questionnaires.  Every section I explored included more and more useful information.  The “Patients” section is equally expansive with 10 of the most common categories of shoulder pathology presented with images and text.  Lastly, the utilities include a drawing board to demonstrate rotator cuff pathology, a voice notes recorder, personal text notes, and a calendar.  The practical utility of these functions is unclear, but I was impressed that the developer went through the effort to include these added features.  Overall, the app could benefit from a redesign, but the information hidden within the clunky navigation system is very good.

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OrthoRef Lite

A free version of a list-based reference of orthopaedic classification systems from the creator of NeuroMind, one of the top Neurosurgery apps.  This version only includes 60 scores for free.

From the creator of top-app NeuroMind, this app attempts to provide a comprehensive list of orthopaedic classification systems and decision support for orthopaedic surgeons and trainees.  The lite version only includes 60 scores for free, but the remaining 40 require the full version.  The app is organized into 3 sections: scores, decision support, and “other.”  Currently the app is in its infancy and is limited by the number of scores available, as well as a lack of images.  In total, this app currently contains over 100 scoring and classification systems.  The list is organized by body part, and for the most part, many of the most common systems are included.  Unfortunately, the app is limited by the fact that there are no images provided to assist with fracture descriptions, which are relatively succinct and difficult to understand if not already familiar with a particular injury scoring system.  The decision support tab provides assistive scoring tools for 9 different injuries, including SLIC, TLICS, and stroke risk in AF.  These are definitely helpful.  The “other” section includes links to a safe surgery checklist as well as the TEDx talk given by the app’s creator, Pieter Kubben.  Overall, this app is most appropriate for surgeons already familiar with a particular classification system and who need a reminder about the details.

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OrthoRef

A list-based reference of orthopaedic classification systems from the creator of NeuroMind, one of the top Neurosurgery apps.

From the creator of top-app NeuroMind, this app attempts to provide a comprehensive list of orthopaedic classification systems and decision support for orthopaedic surgeons and trainees.  The app is organized into 3 sections: scores, decision support, and “other.”  Currently the app is in its infancy and is limited by the number of scores available, as well as a lack of images.  In total, this app currently contains over 100 scoring and classification systems.  The list is organized by body part, and for the most part, many of the most common systems are included.  Unfortunately, the app is limited by the fact that there are no images provided to assist with fracture descriptions, which are relatively succinct and difficult to understand if not already familiar with a particular injury scoring system.  The decision support tab provides assistive scoring tools for 9 different injuries, including SLIC, TLICS, and stroke risk in AF.  These are definitely helpful.  The “other” section includes links to a safe surgery checklist as well as the TEDx talk given by the app’s creator, Pieter Kubben.  Overall, this app is most appropriate for surgeons already familiar with a particular classification system and who need a reminder about the details.

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EBSS.live

An orthopaedic spine trauma literature search tool for finding articles about spine surgery, full abstracts, and levels of evidence.

AO Foundation has created a unique and useful tool that is a great resource for residents, students,  and orthopaedic surgeons alike who perform spine surgery.  The app is organized by subtopic: Trauma, Tumor, Deformity, Degeneration, Infection, and Metabolic/Inflammatory/Genetic spine diseases.  In total, the app includes over 3800 peer-reviewed clinical articles applicable to spine surgery.  The user can also search by key word, and can presumably find relevant articles related to very specific topics.  The search algorithm appears to apply to the title, as well as the abstract.  In addition, the app easily identifies the level of evidence for each article, provides the full abstract, and links to the Pubmed abstract.  Overall, while smart phones are typically not the platform of choice to browse the literature, this app is certainly worth a look.

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Traumaline

An orthopaedic trauma literature search tool organized by body part and published by the AO foundation to organize peer-review articles and evaluate levels of evidence.

AO Foundation has created a unique and useful tool that is a great resource for residents, students,  and orthopaedic surgeons alike.  Organized by body part (with a familiar appearance to those who use the AO Surgery app), this app has classified over 5500 peer-reviewed articles applicable to the treatment of orthopaedic fractures.  The user can search by body part as well as key word, and can presumably find relevant articles related to specific trauma topics.  The search algorithm appears to apply to the title, as well as the abstract.  In addition, the app easily identifies the level of evidence for each article, provides the full abstract, and links to the Pubmed abstract.  Overall, while smart phones are typically not the platform of choice to browse the literature, this app is certainly worth a look.

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Ombro e Cotovelo

A Portuguese-language iPhone app for orthopaedic shoulder and elbow pathology.

Unfortunately, I do not speak Portuguese and cannot evaluate this app based on its merits.  However, from playing around with the menus, this app appears to offer a significant amount of general information about shoulder and elbow pathology… in Portuguese.

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OrtoClass

A Portuguese-language iPhone app for orthopaedic trauma classification systems.

Unfortunately, I do not speak Portuguese and cannot evaluate this app based on its merits.  However, from playing around with the menus, this app appears to closely mimic the English-language “OrthoClass” app that received very high reviews.  The only difference is that this one is in Portuguese.

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TumorOsseo

A Portuguese-language iPhone app for musculoskeletal tumors.

Unfortunately, I do not speak Portuguese and cannot evaluate this app based on its merits.  However, from playing around with the menus, this appears to be a very functional tool that includes a plethora of information about musculoskeletal tumors.  …and it’s in Portuguese.

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Mobile Coder Foot and Ankle

This is a useful coding app designed specifically for surgeons who perform foot and ankle surgery.  The app download is free and allows the user to view all sections, however the complete 12-section download require an in-app purchase of $49.99. The taskbar is organized into four sections.  The “patients” tab allows the user to add patient records and includes information such as facility, date/time, patient info, assistant, and comments.  That record can then be associated with the second section: CPT.  CPT codes are organized by body region and separated by the usual CPT categories.  A search function is available, and the user can identify favorite codes to save time during future entries.  The codes themselves include options to include modifiers and the interface is easy to navigate.  The third tab is a patient history section, and the fourth tab is a configuration tab where the user can enter facilities and surgical assistants.  The program includes help alerts for every screen that are initially informative, but must be turned off in the configuration tab because they quickly become bothersome.  Overall, the app is one of many coding apps available and will appeal to many surgeons, however there does not appear to be support for ICD-9 codes if that is an important feature to you.

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Zimmer 411

Zimmer’s product application has beautifully integrated both patient and surgeon information is a user-friendly and aesthetically pleasing design that has quickly become one of the lead orthopaedic apps on the market.  Clearly designed to promote information about Zimmer products, the app focuses on Patient Stories, Causes of Pain, Treatment Options, Know When You’re Ready, and Joint Replacement.  The integration of videos, teaching diagrams and illustrations, interactive animations, and peri-operative guidance is unmatched by other orthopaedic implant companies.  One of the strongest features of the app is the combination of patient information as well as “surgeon tools.”  By selecting the surgeon tools drop-down tab, a entirely new library of information becomes available including 3D animations, diagrams, procedure videos, product listings, and x-rays.  Overall, this app is a powerful supplement to any physician performing hip and knee arthroplasty, and especially to those who utilize or want to learn more about Zimmer products.

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Orthopaedic Surgery Board Review Manual

This app is a journal reader for issues of the Orthopaedic Surgery Board Review Manual by Hospital Physician. At the time of review (March 2012), the app includes 6 issues: Patellofemoral Pain, Thermal Injuries in the Extremities, Osteonecrosis of the Femoral Head, etc.  Each “issue” reads like a regular journal with advertisements, a table of contents, and full journal contents.  However, because each issue is on a single topic, the contents include an introduction, anatomy, pathogenesis, presentation, diagnosis, treatment, etc.  The app is clear, quick, and easy to navigate.  The articles are easy to read and include a plethora of useful information.  Although it is not clear whether this will remain free in the future – it is currently available at no cost and supported by advertising.