Stanford Microsurgery and Resident Training

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

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

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MedTools

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

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

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

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OrthoFlow

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

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

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OrthoGuidelines

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

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

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

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OrthoBullets: Bullets*

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

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

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

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

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

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

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RealWorld Procedures

Video and text tutorials for common procedures

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

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Learning Orthopedics Quiz

A “flashcard” style app for learning orthopedic surgery

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

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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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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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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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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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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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PreOpEval

Preop assessment tool 

PreOpEval is a preop app to help guide how to evaluate patients for non-cardiac surgery. The guidelines are from the American College of Cardiology and American Heart Association and the American College of Chest Physicians most recent recommendations. The app has a cardiac evaluation algorithm to help users decide what a patient’s pre op risk is prior to surgery as well as give guidance regarding key medications, test to order and timing of surgery after cardiac events. While these guidelines are accepted by the ACC/AHA/ACCP it does not mean that is what your local anesthesiologist will follow. Overall a useful tool for residents/students/ancillary staff to help think about what labs need to be ordered, which patients need further workup and how to handle patients on particular medicines.

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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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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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FracturED

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

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

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

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

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DocSpera

HIPAA compliant secure collaboration platform for surgeons

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

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

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

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Current Orthopaedic Practice Journal

Mobile access to the Current Orthopaedic Practice Journal

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

*Requires subscription for full text access

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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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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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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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HAND Journal

A journal app for the Hand Journal.

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

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FRAX

A digital and mobile tool for calculating the FRAX score.

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

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Figure1

Photo sharing app for physicians 

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

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ICJR – International Congress for Joint Reconstruction

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

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

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

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Journal of Pediatric Orthopaedics – British

Mobile access to the Journal of Pediatric Orthopaedics (British)

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

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Journal of Pediatric Orthopaedics – American

Mobile access to the Journal of Pediatric Orthopaedics (American)

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

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AO Spine Principles

A visually impressive description of AO Spine treatment principles.

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

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AAOS Musculoskeletal Exam – Knee

Simple app to learn the knee exam and special tests

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

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CORE – Clinical Orthopedic Exam

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

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OrthoMind

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

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

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Orthopaedics Today Europe

Mobile access to the Orthopaedics Today Europe magazine.

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

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AAOS Musculoskeletal Exam – Shoulder

Simple app to learn shoulder exam and special tests

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

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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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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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Spine Pro III

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

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

Knee Pro III

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

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

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Ankle & Foot Pro III

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

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

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Shoulder Pro III

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

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

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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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AAOS eBooks

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

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

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JBJS ImageQuiz

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

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

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Bone and Joint

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

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

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iShoulder

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

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

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OrthoRef Lite

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

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

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OrthoRef

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

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

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EBSS.live

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

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

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Traumaline

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

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

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OrtoClass

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

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

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TumorOsseo

A Portuguese-language iPhone app for musculoskeletal tumors.

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

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Orthopaedic Surgery Board Review Manual

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

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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 Soft Tissue

This app is the “Soft Tissue” version in the Tumorpedia series, a collection of apps that serve as an encyclopedia of orthopaedic oncology.  This version includes over 14 orthopaedic soft tissue 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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Tumorpedia Lite

This app is the free 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 a selected collection of 28 orthopaedic 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.  Overall, this series of orthopaedic tumor information is a useful reference for orthopaedic trainees, nurses, and other medical providers who diagnose and treat musculoskeletal tumors.

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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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Tumorpedia Espanol

This app is the “Espanol” 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 over 100 orthopaedic tumors with complete information in Spanish.  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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Tumorpedia Bone

This app is the “Bone” 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 over 70 orthopaedic bone 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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Orthopaedics Pro

This app is an attempt at an all-inclusive orthopaedics study tool.  The menu is organized into flashcards, true/fales (500 questions) and single best answer (106 questions).  The flashcards are not merely “factoids” of information, rather they are complete paragraphs of text information for every subject.  The app certainly contains a lot of information, but is also difficult to navigate at times.  The information is inconsistent, and at times impressive.  For example, the subheading “calcaneus fracture” includes reference to normal Bohler’s angle and normal Angle of Gissane.  It also includes Sander’s classification (text only), Zwipp classification, principles of fixation, reports Letournel’s results, and provides Essex-Lopresti’s subtypes.  However, the format is difficult to read and organize in one’s mind.  The true/false section is a sequential series of true/false questions that must be completed in order.  The single best answer section must also be completed in order.  Both of these sections suffer from a poor user interface, however the questions and explanations are good and very complete. Overall, the app is a good first attempt at a review/flashcard app, but would greatly benefit from an interface overhaul which is currently the apps greatest weakness.

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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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Medscape

Medscape is a familiar name among physicians, and their well-designed app extends the functionality of their website into a mobile format.  Using the same login (free), users are provided with headlines based on their selected specialty.  For example, when logged in as “orthopaedics” the headlines include information about metal-on-metal hips, PPI and hip fracture risk, and an article on orthopaedic surgery rates – all headlines link to a full article and include audio or video, if available. The app is then divided into three sections.  The News icon expands upon the headline articles and are specific to your specialty. The Reference icon includes information about drugs, diseases & conditions, procedures, and more. The third icon is Education, includes CME approved articles which can be used to earn CME credit.  The Reference section can be especially useful; articles are incredibly detailed about a broad spectrum of orthopaedic conditions and are written by professionals in the field with references provided.  In addition, the Musculoskeletal Procedures section has an impressive collection of common orthopaedic techniques, such as splinting and joint/tendon injections.  The content of the Medscape app is an expansive collection of free information that would be useful to any provider.  The only challenge is how to find what you’re looking for.  Thankfully, the app has a great search functionality which is both accurate and incredibly fast.  Overall, the app is highly recommended for any provider, and by registering as an orthopaedic surgeon online, the news headlines become even more relevant.

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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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Shoulder Classification

This app is likely to be overlooked and under-rated, but I believe it is a hidden gem.  Someone (no developer or contact information is provided) has compiled an incredibly comprehensive list of injury and disease classification systems about the shoulder with their associated primary literature reference.  The app is organized into list format, and the main list tree includes conditions such as AC joint, Acromion, SLAP, Calcific Tendonitis, etc.  Then, upon selecting a particular condition or injury, you see multiple different classification systems that have been published for that particular topic.  This list is very comprehensive and utilizes the most common classification systems, as well as those less frequently employed.  Each description includes a reference to the primary literature source, a brief description, and typically includes an associated image when appropriate.  Overall, the developers of this small, simple, and free app have done a phenomenal job of compiling classification systems for shoulder pathology.

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OITE Buzzwords

This app, available only for iPhone and Android, is marketed as a “buzzword” study guide for the orthopaedic in-training exam (OITE).  The app is divided into 4 sections: index, about, quiz, and contact.  The index lists 51 buzzwords, such as zebra lines, throckmorton sign, sausage digit, pancake vertebra, etc.  Unfortunately, when testing on an iPhone 4S device the content did not load for all of the content sections resulting in a blank screen.  For screens in which content did load, images required up to 30 seconds to load, and text often required 10 seconds to load.  The information provided for each topic is brief (2-5 sentences).  No references of additional information is provided for any of the  topics.  The quiz section includes a gallery of thumbnail images that can be selected. Once again, the images take up to 30 seconds to load, thereby negating the purpose of the app for quickly reviewing buzzwords.  In addition, the answers to the image pathology would not appear, and in some cases the images did not appear at all. The contact section provides a phone number, email and website: www.bonetumor.org.  Interestingly, the site appears to be an incredibly detailed, expansive, and valuable listing of bone tumors and their presentation, diagnosis, and treatment accompanied by xray and pathologic images.  Overall, this app appears to address a need among residents for OITE studying, however the implementation ranges from painfully slow to entirely non-functional, rendering this app useless at this point.  I do hope that future versions become more stable and useful since this is a great idea for OITE studying.

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OITE Tumor

This app, available only for iPhone and Android, is marketed as a “buzzword” study guide for the orthopaedic in-training exam (OITE) tumor topics.  The app is divided into 5 sections: about, index, flashcards, quiz, and contact.  The index lists 78 tumor buzzwords, such as zebra lines, PNET, Batson’s Plexus, Codman triangle, etc.  Unfortunately, when testing on an iPhone 4S device the app ran very slow and crashed at times, despite its very limited content (text and images).  For screens in which content did load, images were presented with a text description that include spelling errors at times.  The information provided for each topic is brief (2-5 sentences).  No references of additional information is provided for any of the topics.  The flashcards present a gallery of thumbnail images for selection. Once again, the images take up to 30 seconds to load, and some do not load at all, thereby negating the purpose of the app for quickly reviewing buzzwords.  In addition, the answers to the image pathology would not appear, and thus there is no way to check one’s knowledge against the real answer. The quiz section includes a listing of topics with a complete question stem and multiple choice answers and explanations.  Only 10 questions are included.  The contact section provides a phone number, email and website: www.bonetumor.org.  Interestingly, the site appears to be an incredibly detailed, expansive, and valuable listing of bone tumors and their presentation, diagnosis, and treatment accompanied by xray and pathologic images.  Overall, this app appears to address a need among residents for OITE studying, however the implementation ranges from painfully slow to entirely non-functional, rendering this app useless at this point.  I do hope that future versions become more stable and useful since this is a great idea for OITE studying.

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OITE Strategy

This app, available only for iPhone and Android, provides free advice for orthopaedic residents taking the orthopaedic in-training exam (OITE).  The app is divided into 4 sections: topics, resources, method, and contact.  The topics include valuable information regarding the prevalence of particular types of questions based on published data. For example, the Tumor sub-heading provides the user with the most commonly tested orthopaedic tumors for the past 10 years. Other sub-headings estimate the number of questions expected to be on a given test. The resources section provides a useful list of peer-reviewed publications that address OITE-related topics, such as analyses of the most commonly tested topics, as well as the average scores for the 2009 exam. The Methods section reviews general multiple-choice techniques, and the contact section provides a phone number, email and website: www.bonetumor.org.  Interestingly, the site appears to be an incredibly detailed, expansive, and valuable listing of bone tumors and their presentation, diagnosis, and treatment accompanied by xray and pathologic images.  Overall, this app provides interesting and useful information for orthopaedic residents and provides additional resources for more information.  When testing on an iPhone, the app ran surprisingly slow and required nearly 15 seconds to initiate.  The app appears to be a “teaser” app encouraging residents to purchase other apps by the same developer, OITE Tumor and OITE Buzzwords.

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Campbell’s Operative Orthopaedics

Campbell’s is the first orthopaedic text book that has transitioned to the digital age!  The app is not the complete 4-volume text, rather this is “core techniques,” which includes brief summaries of 242 common surgical and bedside procedures accompanied by images and videos.   The app is divided into the four volumes of the full book with their corresponding subheadings.  For example, the app includes 26 surgical approaches, such as removal of iliac bone graft, anterolateral approach to the humerus, and z-plasty.  Most descriptions are brief with 2-5 images, and would serve as a “refresher” for a senior resident or surgeon familiar with a procedure, or as an introduction for a medical student or junior resident who needs a quick orientation before a case.  However, in addition to the many brief entries, some topics are reviewed completely with 20-30 images and videos up to 15-20 minutes in length.  These videos are incredibly detailed and review how to perform full surgical procedures.  Examples of “complete” entries with videos and images include femoral nailing, ACL reconstruction, SLAP repair, rotator cuff repair, chevron osteotomy, compartment syndrome fasciotomy, shoulder hemiarthroplasty, and carpal tunnel release – I counted a total of 23 videos within the app.  Unlike many other apps that offer videos, all media is completely contained within this app and downloaded to the device, which explains the download size of over 800mb, but also has the great benefit of full access 100% of the time (i.e. review surgical techniques on an airplane).  Lastly, the app has a very good search feature that scans all topic titles and text within the app.
Overall, Campbell’s Operative Orthopaedics is the first orthopaedic text to “go digital” with an incredibly useful reference app that is ideal for junior orthopaedic surgery residents.  Although considered an expensive app at $100, compare this to list price of nearly $800 for the 4-volume print version. Of course, the app is not the complete text, but is most useful to trainees who may frequently use the app as a “refresher” between operative cases.  The interface is well designed, the images and text are clear, and the search function is invaluable.  In addition, consider that the purchase price includes ownership for life with all associated updates.  Campbell’s is a very highly recommended app for those who can afford it.

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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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OrthoClass

A fracture classification reference, this app has an intuitively simple interface with the potential for great utility when describing/classifying fractures.  The apps is divided into 2 main sections: adult and pediatric trauma.  Sub-classifications include various joints and bones with matching thumbnail images to orient the user.  Once selecting a specific region (i.e. distal radius), the app then presents multiple classification systems for that region (i.e. Frykman, AO, Fernandez, Melone, Universal, etc.) as well as their accompanying images (typically taken directly from the primary source), and references.  Having such a well-organized reference list is worth the download in itself.  It is worth noting that the summaries for each fracture are brief, and presented only in table format.  Thus, this app is clearly designed for physicians/trainees who already have a basic knowledge of the fracture pattern and involved structures. Lastly, the app has a useful “search” function which worked very well.  Overall, a good reference app for trainees and surgeons needing to classify many fracture patterns.

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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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CobbMeter

CobbMeter 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 scoliosis, kyphosis, and sacral slope.  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 $19.99, 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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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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Orthopedics Hyperguide

The Orthopedics Hyperguide app is a CME app with a variety of orthopaedic educational resources.  The app includes modules for learning, testing, and review.   The home screen allows the user to search and view videos, podcasts, tutorials, and lectures on various topics. The user can then create quizzes from a large Q-bank of questions. According to the app, there are nearly 4,000 unique questions available.  The module section suggests there are over 300 different educational resources available.  Overall, this app has the potential to be very useful for learning, reviewing, and testing and can potentially provide CME credit as well.

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Scoligauge

Part of the goniometer series developed by Ockendon.net, scoligauge uses the iPhone’s internal accelerometer to mimic a scoliometer.  The user first calibrates the device on a level surface, and then chooses to measure the angle based on the device’s position on an object or based on the camera image. The app shows a very realistic scoliometer model during the measurement.   Overall, the app relies on the accuracy of your iPhone’s internal accelerometer, but the app does what it says and allows for precise and objective measurements when a standard scoliometer is unavailable.

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Simple Goniometer

Part of the goniometer series developed by Ockendon.net, simple goniometer does exactly what it says: it uses the iPhone’s internal accelerometer to mimic a goniometer for clinical measurements.  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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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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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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SugarSync

Overall: 4+
Functionality: 5
Coolness: 5

SugarSync is actually a cloud-based data back-up service that includes the use of their free apps.  But, because most surgeons are probably under-protected with regard to the security of their digital data, I strongly advocate the use of some type of auto-backup service, such as SugarSync or one of its competitors.  After paying for a subscription and installing the program onto as many computers as you would like, SugarSync will automatically back up your data in real-time both to the cloud, as well as between computers.  For example, in my home I sync my two laptops so that the data between my “home” computer and my “work” computer are always matched.  Then, I also sync specific folders (such as photos) between my computers and my wife’s computer.  Copying/transferring files with flash drives and emailing document versions have become obsolete.  Lastly, because I have the app installed on my phone and my iPad, I can access any file from anywhere, any time.  That includes photos, documents, or reading material and includes the ability to email the files directly to a colleague.  The price is competitive, and the functionality has redefined the way I manage my data.  For more information, see my FAQ section.

 Cost: Free app with subscription service.
Download Here

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