ACL Rehab

Patient-focused information about ACL rehab stages and exercises

The ACL Rehab app is a relatively comprehensive and detailed resource for patients who may need additional guidance regarding their ACL injury.  Unfortunately the publisher is not named, but this app appears to come from a relatively reliable medical provider.  The home screen includes general information about ACL ruptures and information about surgical treatment and graft options.  It is written from the perspective of a surgeon advising a patient.  Next, the app describes stages of rehabilitation starting from Prehab, and continuing through various weeks of recovery culminating in “Return to Sport” at 6-9 months.  Within in each stage, specific exercises are recommended and described/shown.  These can be added to one’s personalized “My Workout” for quick access and review.

For patients who may be looking for physical therapy guidance, this app has appropriate medical information and recommendations.

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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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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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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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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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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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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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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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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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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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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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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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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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All-Pro Orthopedics

A personal practice app for Dr. Jesse Zisholtz Shaw with patient information, surgery education, appointment booking and a list of services.

This personal practice app is meant to serve as a patient portal for Dr. Jesse Zisholtz Shaw, an orthopaedic sports medicine physician in Tampa, Florida.  The app’s user interface is somewhat unusual, marked by a hidden menu on the right side of the screen.  Users can advance through the menu items, including a welcome screen, the ability to “ask the doctor,” appointment booking information, ability to check in, contact information, and a list of services. The “services listed” includes knee arthroplasty, knee arthroscopy, ligament reconstruction, hip replacement, shoulder replacement, and shoulder arthroscopy.  Each sub-section includes a summary of the pathology and treatment options.  The surgeon includes a few photos of (presumably) his patients as well.  The app even includes a primitive game called PicFlippr to help pass the time.  Overall, this app is a personal practice app that may be useful to current or potential patients of Dr. Zisholtz Shaw

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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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UCSF Center for Joint Replacement

Mobile-based post-operative rehabilitation exercises for UCSF Joint Replacement patients

UCSF has teamed up with CARE to set the standard for the future of mobile rehabilitation.  Currently implemented by the UCSF Joint Replacement program and created by physical therapists, the app provides a personalized website and personalized physical therapy/rehabilitation protocols for patients.   The app is incredibly comprehensive by providing information to patients about their surgery, their surgeon, and lists the exercises they should be performing week-by-week after surgery with complete video demonstrations.

When a patient is enrolled he/she will only see information and post-operative protocols that have been specifically selected by their surgeon.  The app itself consists of the sections described above.  Pre- and post-operative information is available to patients, and the post-operative physical therapy protocol is clearly organized for patients to reference either at home or at the gym.  Overall, the application has been well implemented

*Requires enrollment by the UCSF Joint Replacement program.

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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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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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Gout Channel

An informative patient-education app about gout with advice about treatment and prevention.

This app includes a plethora of information about gout, risk factors, prevention and treatment.  What the app lacks in organization and user interface, it makes up with educational material and price.  The app includes 3 section: What is gout?  Why do I have gout? and What can I do about gout?  Each heading includes multiple sub-headings with useful explanations and information to answer each question.  Unfortunately, the formatting left much to be desired on my iPhone and would not fit to the screen size, requiring finger-scrolling to read every sentence.  There are also some interesting and animated images included in the text.  Specific topics can be bookmarked for easy reference and text could be highlighted and copied, but I could not find a way to email or print the information.  Overall, this is a useful app for patients interested in learning more about gout and includes valuable information about prevention.

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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SG Sports & Ortho

A surprisingly informative general orthopaedic app made by and promoting the practice of Dr. Kevin Yip at Gleneagles Hospital in Singapore.

This app appears to be created by Dr. Kevin Yip and contains a good amount of general orthopaedic patient information.  The app itself is divided into 3 categories: injury, rehab, and videos.  The injury tab uses a tap-forward navigation scheme to selection the area and injury to learn about.  I counted about 30 topics, ranging from sciatica to carpal tunnel syndrome, Achilles tendon rupture, or ingrown toe nail.  Each sub-section includes a paragraph about the condition and information about causes, prevention, and various treatment options supplemented by images of average quality. The rehab section includes information about exercises (passive, active, lower back, and shoulder).  There is also general information about platelet-rich plasma, as well as tips about preparing for your surgery.  Overall, this app seems to be geared for Dr. Yip’s practice, but still offers some generic information for curious patients.

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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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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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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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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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Meniscus Exercises

A patient-focused app that provides information about meniscus tears and phase-oriented exercises for recovery.

The developers of the meniscus exercises should certainly be applauded for creating an informative and useful app focused on patient care and physical therapy.  The implementation is average, and navigating the app is somewhat clunky at times.  General information about meniscus injuries is provided.  The app then includes exercises based on the phase of injury and level of “protection” required.  Definitive values are provided, for example, restricting the knee from 50-90 degrees of motion during “maximum protection.”  Each exercise is demonstrated with a pseudo-animation composed of a series of images that are reminiscent of early 1990s video games.  Many of the exercises are useful for patients, while others are unnecessary, such as the demonstration for “walking.”  Overall, the app is amusing at worst, and helpful for patients at best.  It does provide ideas for exercises in patients who have already been evaluated by a physician and desire a home exercise program.

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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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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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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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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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Aesculap OrthoPilot USA

This product marketing app demonstrates and educates surgeons about Aesculap’s surgical navigation system.  The app is organized by category: HipSuite, KneeSuite, and SportsMedSuite.  Each section highlights the products available, and a further drill-down menu includes information about special cases, product documents, images, videos, and links.  The app navigation was slow at times, and videos often required extra time to load.  However, the step-by-step guides for using the navigation system could be quite helpful to a surgeon interested in using this device.  Overall, the app includes a few glitches, but is available for free on both iPad and iPhone.

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I.T.S. InfoPoint

This app demonstrates the products made by I.T.S., a medical device company in Austria that develops titanium implants. The app includes many of the features expected from a device company app, including general information, a catalog and description of implants, sub-sections for upper and lower extremities, and a product overview video.  In addition, there is a “fracture classifications” section that assists a surgeon by allowing the user to select a body part from a diagram, then select the fracture pattern – and the app will list the relevant implants.  Selecting on an implant includes typical information such as features, xrays, indications, and a surgical technique PDF.  Overall, many of the features are “empty” and do not include information, and thus the app currently lacks completeness.  Overall, however, this is a great app for surgeons using these devices.

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Septic Hip

This quick-reference app is designed to use a popular clinical algorithm to assist with the diagnostic distinction between transient synovitis and septic arthritis of the hip.  The app is based on 5 clinical predictors: fever, weight-bearing, ESR, WBC (published by Kocher et al. in 1999) and CRP (added by Caird et al. in 2006).  The interface is simple and intuitive by allowing the user to select the predictors that apply to a particular patient.  By touching “next,” the user is then presented with the probability of septic arthritis as calculated by each study individually (validated), and the overall probability of septic arthritis (average of the two).  Overall, this is a simple app that offers a convenient way to utilize an existing and popular clinical diagnostic algorithm.

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BoneTest Miscellaneous 11

Part of an entire suite of BoneTest apps created for test review, the Miscellaneous app includes 50 questions that cover Trauma, Oncology, Basic Science, and Foot & Ankle topics.  The app is simplistically organized as a list of questions, labeled from 1-50.  There is no “test” mode or a way to randomize the question order.  Selecting any given question presents the question and answer options (standard multiple choice, true false, fill-in-the-blank, etc.) with associated images, when appropriate.  Questions and answer choices are clearly presented, but the question format does not reflect OITE or OSAS questions despite many of the questions appearing to be most appropriate for orthopaedic residents and surgeons (too advanced for students, in many cases).  One nice feature is that a brief explanation is provided for every answer choice (incorrect as well correct answers).  References have been provided for every question, but are often vague, and refer only to a book (OKU 9) without chapter or page number.  Lastly, a significant limitation of this app is that once an answer is selected, it can never be “unselected,” implying that this app is “one time use, only.”  Overall, this app is too advanced for students, but is not ideally organized for residents or surgeons by not allowing for question randomization or resetting the questions.

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Knee Pain

Knee Pain is an app “course” created by Dr. Eric Gozna to teach his mnemonic for the 10 most common sources of knee pain: “four thought” on the knee.  The app is actually a narrated slideshow format that auto-advances through 55 slides of informational slides that include descriptions of the anatomy, as well as information about the pathology, the presentation, the diagnosis and treatment.  Some slides include video examples of a clinical exam, and some slides include review questions to reinforce concepts and lessons.  The concept of the app is novel.  Dr. Gozna’s credentials are listed on the site (an orthopaedic surgeon in Canada), however the information presented may be more credible if endorsed by an orthopaedic society.  Overall, the presentation is clear and may be most useful to students, non-orthopaedic providers, or patients interested in learning more about knee pain in a community-based practice.

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Tumorpedia Foot and Ankle

This app is the “Foot and Ankle” version in the Tumorpedia series, a collection of apps that serve as an encyclopedia of orthopaedic oncology based on www.bonetumor.org.  This version includes 23 orthopaedic foot and ankle tumors.  Each topic is divided into general information, incidence and demographics, xrays, MRI, CT, pathology, differential diagnosis, and treatment.  The amount of information presented for each topic is variable, but generally a specific and informative overview of the topic is included.  The images are especially useful for demonstrating “typical” appearances on imaging exams and pathologic specimens.   The app also includes an “updated” feature, suggesting that the database may undergo regular updates in the future.  It appears that images are downloaded in real-time from a server, thus the app is of limited use when no WiFi or wireless data signal is available. As a result, some of the images did not load during my testing.  Overall, this series of orthopaedic tumor information is an inexpensive and useful reference for orthopaedic trainees, nurses, and other medical providers who diagnose and treat musculoskeletal tumors.  Because this is a first version, hopefully future versions will be available with improved functionality.

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RealWorld Orthopaedics

Created by physicians and medical students at the Universite de Sherbrooke, this is one of the best musculoskeletal radiology apps available. The app is organized into subheadings: Medical, Technical, and Chapters.  Although not intuitively named, each section contains an abundance of information medical and radiology information.  For example, the Medical section includes a listing of about 150 radiographic fractures and dislocations, with each topic including 1-2 different patient cases.  Selecting a patient includes high-resolution images of the named pathology.  The most valuable and impressive part of the app, however, is the “eye” icon which overlays colorful highlighting directly over the radiograph with associated annotations (“glasses” icon) to explain the important radiographic findings.  This feature, alone, is impressive.  An information icon also links directly to reading material found in the Chapter section.  The Technical and Chapter sections include the same library of patients and images, but organized in a different way.  The most notable feature this app lacks is a “search” function that can quickly search for a fracture or dislocation of choice.  Overall, a very well-made and impressive app that would be useful to any medical student, intern, or junior resident that needs to learn about musculoskeletal radiology.

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CCJR Mobile

Based on the Current Concepts in Joint Review (CCJR) live meetings, this app serves as a mobile version of the conference with information about speakers, topics, and the ability to download full videos.  From the home screen, the user can select a talk from an extensive list of speakers and topics (about 125 lectures) from the 2011 Spring meeting.  Selecting a particular lecture includes an abstract summary of the talk, as well as the option to immediately download the full video (WiFi not required).  Most videos appear to be 6 min in length and download in 1-2 minutes using 3G.  The other modules in the app reorganized the data by Topic, as well as by Speaker.  The app also includes a search feature, which appears to only search the titles of individual lectures, but not the associated abstracts.  Overall, there are few negative remarks that one can make about this well-made, well-organized app that offers over 100 brief lectures on relevant topics by leaders in the field. Currently, this app is offered for free, and would be useful to any surgeons, residents, or fellows who perform total joint arthroplasty.  The App Store summary suggests that future updates will offer premium modules with expanded information at a price.

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iJoints

This app has taken images from the Visible Human Project ™ to recreate axial, coronal, and sagittal slice images of a cadaveric hip, knee, ankle, shoulder, elbow, and wrist.  The app was created by a board certified radiologist, and the functionality is strictly limited to anatomy identification (no added information about anatomical origins, insertion, or inervation).  Navigation is intuitive from the main menu, with joints separated by the types of slices.  Each section includes about 9-12 slices for each joint.  After selecting a slice, options include mirror image (left/right), adding/removing labels, labeling muscles, bones, vessels, or “other,” and advancing a slide. The images are very clear, and all relevant anatomy is labeled. In addition to reviewing by joint, a search function allows for the user to enter any structure and will return every slice that includes the named structure. Lastly, a quiz function also exists that is organized by joint/slice. The quiz shows an image with labelled anatomy and asks you to identify a particular structure (multiple choice). If incorrect, the user is shown the correct answer, as well as the name of the structure that was incorrectly selected. Overall, this app seems most appropriate for students learning anatomy, and especially with regard to radiology-oriented slices for 3D imaging (coronal, axial, and sagittal).  Thus, the app would be greatly beneficial for improving CT and MRI identification, but how this may transfer to surgical anatomy is not as clear.

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iOrtho+

An-all inclusive physical exam and special test app including images, videos, and artwork to demonstrate the proper execution of each test.

This app is a comprehensive mobile orthopaedic guide that includes physical exam tests and mobilizations.  Although the app can be downloaded for free, only a limited number of exam tests and mobilizations are available until the $14.99 in-app purchase is made.  The app includes over 200 special physical exam tests, separated by body part.  For example, rotator cuff tests are divided by muscle, and subscapularis tests include lift-off (Gerber), internal rotation lag, belly press, belly-off, and bear-hug.  Each test includes a picture demonstrating the test, a brief description of the technique and interpretation, and Stat/Ref which summarizes the clinical evidence supporting the test’s sensitivity, specificity, and +/- liklihood ratios (with references provided).  A great feature is the addition of video for many of the tests.  The mobilizations section includes over 80 techniques images and descriptions.

The app underwent a recent update which now includes medical screening tests to rule out visceral pathology, impressive dermatome artwork, deep tendon reflex testing, C-spine screens such as NEXUS and Canadian spine rules, agility-functional testing for the lower extremity, and enhanced reference list to > 1100 sources, statistical data that includes clustering of ortho tests to enhance evidence-based clinical decision making.  And, if a desired test is not available, the app includes an “add your own test” section.

Overall, the app is best designed for medical students or junior residents who are learning the orthopaedic physical exam and special tests.  The app is very high quality for the extensive information and value it provides.

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eSplint

This app is clearly a must-have guide for any primary care, urgent care, or emergency care provider by providing simple step-by-step instructions for splint application.  In addition, junior residents in musculoskeletal medicine fields, such as orthopaedic surgery or podiatry, may also find this to be a useful refresher for the application of splints.  The app is very simply organized into headings such as Splint Technique, Coaptation, Sugar Tong, etc. and provides a text and image guide for the application of each splint type.  The guide briefly lists a few indications for that particular splints, includes a text description with associated images, provides a very good brief video demonstrating application of the splint, and even includes patient education instructions for splint care!  Overall, this application is very useful to a variety of practitioners.  At such a great price, I cannot think of a reason why anyone who might need to apply a splint would not download this very simple and useful reference tool.

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CARE for Patients

This app and service sets the standard for the future of mobile medicine.  Created by physical therapists, the app is an extension of the CARE subscription service available to surgeons which provides a personalized website and personalized physical therapy/rehabilitation protocols for patients.   The app is incredibly comprehensive by providing information to patients about their surgery, their surgeon, and lists the exercises they should be performing week-by-week after surgery with complete video demonstrations.

The power of this application, however, is a surgeon’s ability to create a fully customizable practice website and personalized app.  Thus, when a patient is enrolled he/she will only see information and post-operative protocols that have been specifically selected by their surgeon.  In essence, the app allows any orthopaedic surgeons to have their own personal app for patients.

The app itself consists of the sections described above.  Pre- and post-operative information is available to patients, and the post-operative physical therapy protocol is clearly organized for patients to reference either at home or at the gym.  Overall, the application has been well implemented and the service is currently being used by various academic and private practices nationwide.

***Special Offer: for surgeons/practices interested in learning more about CARE for Patients™, mention “TopOrthoApps” and receive a 10% discount on any enrollment!***

*Requires enrollment/subscription.  Receive 10% discount by mentioning TopOrthoApps.com!  Find out more here.

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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 nearly 250 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.  In the basic version of the app, the videos are not contained within the app, but rather link to YouTube videos that can be emailed/shared with colleagues. However, for an in-app purchase of $7.99 all videos can be downloaded to the device (about 1GB of data).  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; however, this function is easily improved in a future update.  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.

To learn more about this app, as well as others by the same developers, check out their website at www.clinicallyrelevant.com.

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Paley Growth

This app is a useful utility for any orthopaedic surgeon or physician who treats limb-length discrepencies or needs a limb-length, trunk-height, or total height prediction tool.  Based on the publications and equations developed by Dr. Paley, and produced by Dr. Paley himself, the app is organized into 6 sections: discrepancy, bone length, fetal, height, sitting height, achondroplasia, and “other charts” which includes supporting tables, charts, and diagrams.  Each main section is organized into sub-categories to help a provider identify the appropriate equation.  Once the proper function as been selected, the app is as easy as entering the patients age, gender, and relevant values (limb length, current height, discrepancy, etc.).  Overall, the app provides  a free and invaluable tool for physicians who use the multiplier method in their clinical practice.

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OrthoMeter

OrthoMeter joins a number of apps that utilize the iPhone’s internal accelerometer to conveniently measure clinically relevant angular measurements.  In this case, the app is beautifully designed to assist with the measurements of an angle between two lines, an angle measured from the horizontal, and an angle measured off the vertical.  For the three functions, the images provided suggests arthroplasty functions, such as the distal femoral angle, the alpha angle of the hip, and acetabular cup version, respectively.  The user interface is very simple and intuitive and includes the ability to save and email data for specific patients.  One thing that sets this app apart from other goniometric devices is the elegant interface, as well as the ability to receive the angular results via either a male or female voice.  Unfortunately, at a price of $11.99, this app is somewhat expensive given its limited function and less expensive competitors.  However, for providers that intend to use this app regularly and appreciate the nice design, this may be a good investment.

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KneeDecide

KneeDecide is part of the Orca Health collection of apps that provides information for patients about various orthopaedic conditions.  Like the entire “decide” series, the user interface, graphics, and interactive anatomy modules are superb and allow the user to learn about knee bone, tendon, meniscus, and ligament anatomy while rotating, flexing, and zooming in on the images.  The conditions covered in this app include meniscal tear, ACL tear, MCL injuries, PCL tear, patellofemoral chondrosis, tibiofemoral chondrosis, chondral lesions, advanced arthritis, lateral patellar compression syndrome, patellar dislocation, patellar tendonitis, Osgood-Schlatter disease, iliotibial band syndrome, mechanical disorders, and fractures.  Consistent with the entire line of apps, each disease includes a plethora of xray, MRI, and CT imaging with appropriate annotations demonstrating normal and pathologic conditions.  Audio recordings are also included to narrate the text as well. Like the other apps in this series, users can search for medical providers that treat these conditions.  Overall, KneeDecide is a very impressive addition to the Orca Health “decide” series and has the potential to greatly improve patient education and comprehension about orthopaedic conditions.

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Knee Goniometer

Part of the goniometer series developed by Ockendon.net, knee goniometer expands upon the functionality of simple goniometer to do exactly what it says: it uses the iPhone’s internal accelerometer to mimic a goniometer for clinical measurements.  The app includes prompting the user to select which side is being tested and the side that the examiner is standing on.  The app only has three functions: set, hold, and reset.  Although accuracy depends on the calibration of your devices internal electronics, the app does what it says and allows for precise and objective measurements when a standard goniometer is unavailable.

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IOS Fixator

IOS Fixator blends the iPhone/iPad’s touch screen with patient imaging to create a very impressive tool for pre-operative templating using the IOS fixation device.  The app consists of 2 sections.  First, the PDF user guides are available for the IOS fixation device and the STORM (Saffordshire orthopaedic reduction machine).  The second part of the app includes a templating program to use with the external fixator.  First, the user acquires an xray of the patient’s fracture (a sample is provided in the app).  Next, a sizing template is calibrated, and the user then outlines the fracture corners.  Once the fracture is contained, the fragment becomes “free” for the user to realign with the distal or proximal fracture fragment.  The final step provides template guides for the user to align with the newly reduced fracture image. Overall, the concept is impressive and well-execute.  Unfortunately, this app is only useful for providers who currently use the IOS fixator device.  An expansion to other types of external fixator or internal fixation devices would be impressive and very useful.  Nevertheless, the ability to manipulate a fracture from your iPhone or iPad is likely a taste of future emerging technologies.

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FootDecide

FootDecide is part of the Orca Health collection of apps that provides information for patients about various orthopaedic conditions.  Like the entire “decide” series, the user interface, graphics, and interactive anatomy modules are superb and allow the user to learn about foot anatomy in different regions of the foot and ankle while rotating, flexing, and zooming in on the images.  The conditions covered in this app include Achilles tendonitis/Haglund’s deformity, ankle and subtalar arthritis, peroneal tendonitis/tear, bunionette (taylor’s bunion), Morton’s neuroma, hammer toe, interdigital callus, metatarsalgia, tarsometatarsal arthritis, stress fracture/reaction, ankle sprain, second MTP instability, bunion (hallux valgus), plantar fasciitis, and posterior tibial tendinosis.  Consistent with the entire line of apps, each disease includes a plethora of xray, MRI, and CT imaging with appropriate annotations demonstrating normal and pathologic conditions.  Audio recordings are also included to narrate the text as well. Like the other apps in this series, users can search for medical providers that treat these conditions and this particular app expands the selection to include an orthotist, cobbler, and pedicurist.  Overall, FootDecide is a very impressive addition to the Orca Health “decide” series and has the potential to greatly improve patient education and comprehension about orthopaedic foot conditions.

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Hallux Angles

Overall: 3+
Functionality: 3
Coolness: 4

This app is a great idea and a novel integration of technology that uses the camera, touch screen, and computational power to help surgeons measure hallux valgus angles based on an xray.  The app first presents the user with a drawing of a foot and identifies the intermetatarsal angle, the distal metatarsal angle, and the hallux valgus angle.  The user selects which angle to measure, and the app pulls up the camera and prompts the user to align the screen with the metatarsal or phalangeal shafts.  It then calculates the angle and presents them on the initial drawing with the option to save and email the image, if desired.  Overall, the app is a great idea and smooth mixing of technologies.  Unfortunately, making the angle measurement dependent on the user’s ability to hold still and keep the camera a constant distance from the image, which has the potential to introduce “noise” into the calculation.  Because most PACS systems are now well-equipped to measure angles, this app is not useful to individuals who use electronic imaging. However, for someone with printed xrays and without a protractor, this app can provide an objective measurement for an otherwise subjective assessment.

Cost: Free
Download Hallux Angles Here

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Synthes

Overall: 4+
Functionality: 4+
Coolness: 4

Like many other device company apps, the Synthes app can serve as a library and educational resource for surgeons and trainees with regards to Synthes products.  The app is not exclusively for orthopaedic surgeons, and also includes CMF and Vet products, in addition to their Trauma and Spine product lines.  The app comes in both iPad and iPhone versions, which each have navigation interfaces designed specifically for the size of each device. On the iPhone, navigation is simple and consistent with other Synthes product websites by allowing the user to view Key Technologies, Browse by Anatomy, Synthes Solutions, Clinical Resources, and General Resources.  As the user advances through the drill-down navigation screens, more information and more options are provided including images, AO classification systems for the relevant body part, and case studies demonstrating use of their products.  The app is clearly designed for providers, not patients, and hosts a wealth of information that ranges from general tips and techniques to useful images and guides for specific products.  Useful features include in-app links to the Synthes Resident program, Synthes Surgeon.com, and the ability to search the app for a particular product. One limitation of the app is that it requires updates on a weekly basis, which can be frustrating when trying to access information quickly.  Otherwise, the app is well-made, complete, and provides useful information to any surgeon who uses Synthes products.

Cost: Free
Download Synthes Here

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Leg.Fractures

Overall: 2+
Functionality: 3
Coolness: 2

This app was designed by physicians for providers treating lower limb injuries in the UK.  The app has 7 sections: patients, standards-1, standards-2, arterial supply, surface markings, fasciotomies, and pinning of tibia.  The first three sections describe which patients these guidelines apply to, and the “standards” section essentially lists the guidelines that should be performed for these types of patients.  The next 4 sections provide visual aids to inform the reader of the relevant anatomy in regards to the arterial supply, surface landmarks of the leg, cross-section of the leg for fasciotomies, and safe locations for ex-fix pin placement using cross-sectional slices.  Overall, the information presented is very brief yet can serve as a quick refresher for a trainee or surgeon already familiar with the procedure(s).  However, this app does not provide enough information for a student to learn much about the treatment of acute leg trauma.  This small app has valuable information but only at a superficial level and is therefore ideal as a quick reference in only very specific situations.

Cost: Free
Download Leg.Fractures Here

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Sigma Knee Replacement

Overall: 5
Functionality: 4
Coolness: 5+

With this app, DePuy has set the new standard in device-sponsored surgeon and patient education apps.  The app quickly earns high marks for a smooth and interactive user interface that utilizes rotating platforms to showcase their five headings: early intervention, primary TKA, revision TKA, high performance instrumentation, and professional education.  Each section is filled with information about different products, and each product is supplemented with information about design features, technique overview and guides, specific and unique advantages of the product, surgical technique guides with videos, and more.   There are some especially cool features, such as the “explore” function in the patellofemoral solutions which uses an animated knee that allows the user to flex/extend the knee at will.  This app is currently the “coolest” app available and for a surgeon who uses DePuy joint replacement products, can be especially useful as well. One limitation is that the app is nearly 700 mb in size, which can take a healthy bite out of your iPad storage.  However, after 20 seconds of playing with this app it becomes obvious why so much memory is required.

Cost:Free
Download Sigma Knee Replacement Here

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FlipChart

Overall: 3+
Functionality: 3
Coolness: 4

This app is created by Stryker as a patient education tool for surgeons using Stryker total hip, total shoulder, and total knee replacement systems.  The app is organized into charts, my charts, and “create a chart.”  The create a chart feature allows the user to add “pins” to the educational image-based slide show to add commentary within the chart.  A pen is also available to mark the background or highlight particular areas of the image.  Once complete, the chart appears in the “my charts” tab for later reference.  Thus, a surgeon could spend some time creating a personalized chart for his/her surgeries and then use that chart to education patients in clinic about what the procedure will entail.  Overall, the user interface is very simple and easy to navigate and the app is well-made.  As a patient education tool, this may be useful for surgeons who have time to explain the details of surgery to patients accompanied by images.

Cost:Free
Download FlipChart Here

inMotion

Overall: 4+
Functionality: 4
Coolness: 5

This app is created by Stryker and is an impressive patient education tool with regard to the two advertised devices: a total knee and a total hip arthroplasty.  What makes this app unique, however, is the integration of computer animation, video, and audio that includes a highly realistic anatomical model with the options to select anatomic structures and make them transparent or hide them during the demonstration.  This is truly the future of medicine.  For example, you might show a patient hip motion after a total hip arthroplasty procedure, and during the video the user can “hide” any overlying muscles or bones to reveal the implant, or you can add them back one-by-one to demonstrate the relative anatomy.  Overall, this app should be downloaded for the coolness factor alone.  It would make a great resource for a waiting room, but of course this is probably most useful to surgeons using Stryker’s products.

Cost:Free
Download inMotion Here

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OpTech Live

Overall: 4
Functionality: 4
Coolness: 2+

This app is part of Stryker’s library of applications and, like other device company apps, provides the user with a library of device and implant user guides.  The interface is well-organized by topic and lists PDF guides according to specialty or body part.  Selecting an item quickly downloads the PDF surgical technique guide which can then be saved in a library on the device (for referencing later) or a link to the document can be emailed.  Browsing for topics is very easy with essentially no delay.  For access to Stryker’s line of technique guides, this app does everything it should.

Cost: Free
Download OpTech Live Here

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DrawMD Orthopedics

Overall: 4+
Functionality: 4
Coolness: 4+

Part of the DrawMD line of apps, these developers have created a novel platform for teaching patients about their medical conditions.  The app is essentially a “scratch pad” for showing patients their disease, demonstrating surgical techniques, and explaining anatomy.  The advantage of the Orthopedics version is that in addition to being able to use a patient’s xrays as your background, the app comes pre-loaded with orthopaedic body parts and orthopaedic “stamps.”  For example, the current version includes images of the knee, shoulder, hip, hands, feet, ankles, forearm, etc.,  as well as stamps that demonstrate cartilage, fractures, plates, screws, and arthroplasty implants (and many more).  The user can mark the image with a pen and make text comments as well.  Once complete, the image can be saved or emailed to a patient with your office information.  This app is a free and novel way to teach patients about their pathology and treatment options in a visual format.

Cost: Free
Download Here

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OrthoFind

Overall: 3
Functionality: 3
Coolness: 3

This app is essentially a very clear and well-designed product guide for Breg, Inc.; maker of orthopedic braces.  The interface is visual and can be helpful to both physicians and patients looking to explore their catalog and purchase their products.  The user is first prompted to select a body region and is then presented with images and descriptions of their available products with additional information and high-resolutions available to read and view.  Each page provides the opportunity for “more information” which connects you with a Breg representative, provides a brochure, or directs you to a product page.  The app has additional resources including links to various orthopaedic websites and an FAQ section with questions, answers, and explanations about common orthopaedic conditions.  For a surgeon or a patient who is looking to have more information at their fingertips about Breg products, this app is very well made and can be quite useful.

 Cost: Free
Download Here

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Ortho Scores

Overall: 3-
Functionality: 2
Coolness: 3

This app is ideal for orthopaedic surgeons who routinely keep track of patient outcomes using assessment scores.  The app allows the user to organize a list of patients, contacts, and surgeons – but the “patients” function is clearly the emphasis.  Once entering a patient, the user can then walk through many of the most popular outcomes assessments for the hip, knee, shoulder, elbow, wrist, foot, ankle, and spine.  These include, but are not limited to, Harris Hip Score, Oxford Hip Score, WOMAC, SF-12, Knee Society Score, Constant Score, DASH, Quick-DASH, and the Oswestry Low Back Pain assessment.  The free version limits the number of patients that can be scored, and the full version allows for unlimited patients, unlimited contacts, and the ability to email the scores. Overall, this can be a very useful tool for both surgeons and patients to monitor outcomes.  Unfortunately, during testing the app was quite “buggy” and frequently crashed when running from my device.  Hopefully future updates will be more stable.

Cost: Free for Lite version, $99.99 for full version.  Spine Scores only for $19.99.
Download the Full Version Here
Download the Lite Version Here
Download Spine Scores Here

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Ortho Traumapedia

Quick reference for on-call trauma related to fractures and dislocations
 

This app is the ideal complement to any student, resident, fellow, or attending taking general orthopaedic trauma call.  The app has a simple and intuitive user interface separated into either dislocations or fractures and organized by bone, joint, or region.  Each topic is then divided into the same four sub-topics: facts, image, classify, and treat.  With an easy-to-read bullet format, the user can quickly glean the most critical facts about a particular fracture, answer common “pimp” questions, understand how to interpret the radiology, and review various classification systems for a particular injury.  One of the most useful features are the images which include very clear lines, arrows, and circles overlying normal and injury radiographs to teach the user how to evaluate and interpret injury films.  Overall, the material appears to be consistent with most other orthopaedic trauma texts, although no references are provided.

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Multiplier

Calculator for predicting height and bone length in children.

Designed to help surgeons predict leg-length discrepancies at maturity, this app has expanded the use of Paley’s Multiplier tables to allow for the prediction of height, upper extremity length, and timing of epiphysiodesis.  The app itself is published by Sinai Hospital of Baltimore and includes a variety of references from their institution.  In addition to an intuitive user interface, there are useful resources including a complete multiplier table as well as the Elbow Scoring System to determine skeletal age.  The app also includes additional information such as AP and lateral foot measurements, as well as diagrams for measuring limb alignment. Overall, the app is certainly a requirement for any medical student, resident, fellow, or attending working with pediatric orthopaedic patients.

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OrthoEvent

Overall: 3+
Functionality: 4
Coolness: 3+

This free app is useful for any orthopaedic practitioner who attends or is planning to attend any orthopaedic-related conference. The app is designed to compile information regarding nearly all professional orthopaedic conferences worldwide, as well as organize conferences according to specialty. Once a conference is selected, the app provides dates, locations, abstract deadlines, and links to meeting websites. The app is limited by the fact that information is inconsistent, and that the majority of the app text is in French with no other languages available. Overall, the application is a creative and very helpful way to search for conferences that you might not otherwise be aware of.

Cost: Free
Download Here

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AO Muller Classification

Overall: 3
Functionality: 3-
Coolness: 3

Created by the AO Foundation, this classification app allows a user to determine the Muller classification of long-bone fractures by selecting the bone, the segment, and the fracture morphology. In addition, radiographs are included to demonstrate true images of fracture patterns as a supplement to the figures provided. Once a particular fracture is selected, the user can save cases as “favorites” with a memo, a tool that could be valuable for a resident needing to keep track of fracture types while seen on call. The app also includes a “glossary” section that offers supplemental notes such as classification terminology and instructions for identifying fractures. Lastly, all data lives on the device thereby allowing for rapid access and use even without a data access signal.

Cost: Free
Download Here

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AO Surgery Reference

Overall: 4+
Functionality: 4
Coolness: 3+

Created by AO and released in No­vember 2010, the AO Surgery Refer­ence app has set the bar for orthopae­dic reference apps. The data mirrors information which has been previ­ously existed at www.aosurgery.org but is formatted specifically for the smartphone. The app has an intuitive interface that walks the user through the diagnosis, decision process, prepa­ration, surgical approach, reduction, fixation, and aftercare of fractures. Additional information can be found by selecting the “info” icon next to an option, and reference articles are provided on every page. Some of the most valuable aspects, in addition to the text, are the abundance of images demonstrating fracture patterns, pa­tient positioning, and anatomy/surgi­cal approaches. Ideally, this app can serve as a quick reference while treat­ing a patient or prior to a surgery when no other references are available for review. The greatest limitation to this app is that all data is pulled from the internet in real-time, and thus a data connection (3G or WiFi) is required for the app to function. In addition, some fractures are still not available, but the app suggests that future updates will be included.

Cost: Free
Download Here

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