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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My Knee Injury

A patient-focused app on knee pain and exercises

MyKneeInjury appears to be focused towards patients with knee pain, and includes an aspect of product sales suggesting it may be commercially motivated.  The app is organized in 12 icon tiles with titles such as “identify injury,” “treatment,” and “flexibility.”  When selecting on injury identification, for example, the user is given the option to select the area of pain (front, inside, outside, back) with each topic describing a generic clinical vignette suggestive of a specific diagnosis.  As all medical providers know, diagnosing knee complaints is certainly not as easy as “picking from a list,” questioning the apps intention.  Once a diagnosis is selected, general information is presented about the injury, general treatment and healing time information, and a link to useful products for sale from a medical distributor.  I suspect this may reflect the app’s true objective.  Overall, I believe the app’s utility is minimal and is unlikely to significantly assist patients who need any more than the description for a few stretches and exercises.

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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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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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Biolox Inside

Company information about biolox ceramic implants

Biolox has produced this information app to give providers detailed product information regarding their ceramic implant component and designs. The app is well-made and include very technical information regarding the shape, size, and cautions with using their ceramic products for hip, knee, and shoulder arthroplasty.  The app includes numerous videos, 3D animations, and booklet handouts on the topics of wear, fretting corrosion, implants, and results.  Overall an informative app for medical providers who want to learn more about these implants.

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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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SS Carpal Tunnel

Explanation and information about limited open carpal tunnel syndrome

This app, created by Surgery Squad, is a cute and useful educational tool for educating patients about carpal tunnel syndrome.  Unfortunately, the information in the app is not all entirely accurate as it draws a very strong link between computer use and carpal tunnel syndrome and suggests that release of transverse carpal ligament alleviates all “inflammation” of the median nerve.  Using cartoon-like graphics and user interaction, the app asks you to “perform” the procedure through the various steps of a standard carpal tunnel utilizing a carpal tunnel-tome.  The steps are overall reasonable, but obviously reflect the specific preferences of the design surgeons, such as use of non-absorbable sutures and a post-operative splint with return to activity in 4-6 weeks.   Overall, this may be a useful app to recommend to patients considering a carpal tunnel release, especially if the technique closely matches your own.

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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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My Academy

AAOS Academy Meeting 2015 

My Academy is the AAOS 2015 official academy meeting app. My Academy is meant to help academy members and vendors navigate the Academy meeting. This app is a dramatic upgrade from prior academy meeting apps. I can honestly say the AAOS did it right this time. The app has features that allow you to easily search lectures and vendors, find out when and where they are and point you in the right direction with a map. The interface is friendly and easy to use. The messaging features and auto-reminders help you manage your time. The app is free with registration and will be a must have at the next Academy meeting.

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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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Xrays in MPS

Information about xray findings in patients with mucopolysaccharidosis

This app is developed by BioMarin and includes basic information about skeletal dysplasia in mucopolysaccharidosis (MPS).   The information tabs include general disease information, basic science, and images of hips, spine, shoulders, hand, and other bone deformities in the disease.

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Hand.MD

A personal practice app for Dr. Orrin Franko with patient information, videos, and peri-operative as well as post-operative rehabilitation education.

This personal practice app is a full-featured patient portal for Dr. Orrin Franko. Powered by CARE, 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.  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.  The user interface is intuitive and visually appealing. Overall, the application has been well implemented and would be a great benefit to any patients of Dr. Franko.

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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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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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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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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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Muller AO Classification of fractures-Long Bones

AO/OTA Classification app    

AO trauma has developed an app that reviews the Muller classification of long bone fractures. This app is a thorough review of the Muller classification that is traditionally used by the AO and OTA. The app has a nice feature that allows takes the user through a step-by-step guide with photos to help you identify and classify the fracture pattern you may be dealing with. Once you have identified the fracture classification you then get to see the x-ray of the particular fracture pattern. While this tool may be used to help residents/ancillary staff and Emergency Room physicians to communicate with orthopaedic surgeons this tool is not practical to the everyday orthopaedic surgeon. Overall, an easy to use app that is not that useful for everyday practice.

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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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Spine MD

A personal practice app for Dr. Todd Lanman with patient information, videos, and peri-operative as well as post-operative rehabilitation education.

This personal practice app is a full-featured patient portal for Dr. Todd Lanman, a spine surgeon in Beverly Hills. Powered by CARE, 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.  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.  The user interface is intuitive and visually appealing. Overall, the application has been well implemented and would be a great benefit to any patients of Dr. Lanman.

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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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Orlando Orthopaedic

A personal practice app for the Orlando Orthopaedic Center with offices, physicians, and appointment information.

This is a personal practice app for the Orlando Orthopaedic Center.  The format is unique in that the landing page asks patients to point to “what hurts” on a silhouette of a body.  Once selecting a region, however, you still have to select the area that hurts and are then provided with a very brief synopsis of pain in that region.  The apps more useful feature includes address information for the Center’s  5 office locations, biographic information for the 17 physicians, and contact information to make an appointment.  This app is only useful for patients of this group needing an address or wanting to get in touch with their physician

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KOC – Knoxville Orthopedic Clinic

A personal practice app for the Knoxville Orthopaedic Clinic.

This is a personal practice app for the Knoxville Orthopaedic Clinic.  The user interface is refined and intuitive, and the current features include requesting an appointment, calling the office, linking to the KOC website,  a patient portal, and inbox/message functionality.  The features all appear to work as expected without any significant issues.

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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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Cervical Spondylosis

Stretching, activity, and strengthening exercises focused on reducing symptoms of cervical spondylosis.

This interesting app provides information and demonstrations of exercises to assist with cervical spondylosis. What makes the app “unique” is the graphical presentation which, for lack of a better description, reminds me of the graphics one would find on Super Nintendo.  Nevertheless, the app includes 3 stretching exercises, 7 active exercises, and 8 strengthening exercises for the cervical spine. These includes things like trapezius stretch, isometric lateral neck flexion, or chin tucks.  Each exercise has a “video” demonstration that consists of captions while the Super Nintendo-esque graphics demonstration the motion through a series of static images.  The app has no information about the author or developer, but all exercises seem relatively common and safe. Thus, the app may be useful for individuals searching for a quick reference to cervical spine exercises.

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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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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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PhotoGoniometer

Photo app for goniometer measurements

Photogoniometer is another goniometer app that uses photos to help practitioners measure limb angle. The app uses an innovative method of measuring angles where you first take a photo with the limb extended and then take a second photo with the limb flexed. The images are then superimposed and the limb angle is calculated. While this is a creative way to measure range of motion this app is much more difficult to use than having to actually take a goniometer out of your pocket to measure range of motion angles. Taking photos and then still having to measure the range of motion takes more steps than quickly measuring it in your office. I like how the app developers attempted to be creative with goniometer measurements, but it is not very easy to use. There is a light version that is free for users with advertising, but the paid version is only $0.99 and allows you to save photos. Maybe something researchers would use to save information? A creative goniometer app that is not very useful.

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