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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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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AAOS Access

Complete video content from the AAOS

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

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ICUC

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

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

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

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

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

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

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

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

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AOTrauma Orthogeriatrics

Educational tools for the care of older adults with fractures.

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

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Insights Orthopedics

Orthopaedic journal and news aggregator with personalized information.

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

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

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Radiopaedia MSK

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

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

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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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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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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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OTA Annual Meeting 2012

Mobile App to guide OTA attendees

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

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

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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AO Davos Courses 2012

A basic information about the AO Davos Courses in 2012

This simple and lightweight app includes basic information about the AO courses in Davos for 2012.  It includes an overview of the courses, information about clinical divisions, and general information about the AO.

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iSplint

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

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

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Top Ortho “App”

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

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

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Orthopaedic Patient Information

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

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

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AAOS eBooks

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

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

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VCF Mobile

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

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

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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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I.T.S. InfoPoint

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

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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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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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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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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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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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ShoulderDecide

ShoulderDecide is part of the Orca Health collection of apps that provides information for patients about various orthopaedic conditions.  Like the entire “decide” series, the user interface, graphics, and interactive anatomy modules are superb and allow the user to learn about shoulder anatomy while rotating, flexing, and zooming in on the images.  The conditions covered in this app include rotator cuff tear, bursitis, impingement, calcific tendinitis, glenohumeral arthritis, acromioclavicular arthritis, instability, proximal humeral fractures, clavicle fractures, AC separation, frozen shoulder, and biceps tendon tears & tendinitis.  Consistent with the entire line of apps, each disease includes a plethora of xray, MRI, and CT imaging with appropriate annotations demonstrating normal and pathologic conditions.  Audio recordings are also included to narrate the text as well. Like the other apps in this series, users can search for medical providers that treat these conditions.  Overall, ShoulderDecide is a very impressive addition to the Orca Health “decide” series and has the potential to greatly improve patient education and comprehension about orthopaedic conditions.

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KneeDecide

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

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IOS Fixator

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

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HandDecide

HandDecide is part of the Orca Health collection of apps that provides information for patients about various orthopaedic conditions.  Like the entire “decide” series, the user interface, graphics, and interactive anatomy modules are superb and allow the user to learn about hand anatomy in different regions of the hand and wrist while rotating, flexing, and zooming in on the images.  The conditions covered in this app include carpal tunnel syndrome, wrist injury, TFCC, thumb base arthritis, de Quervain’s tendonitis, skier’s thumb, ganglion cyst, mallet finger, dupuytren’s contracture, trigger finger, and flexor tendon injury.  Consistent with the entire line of apps, each disease includes a plethora of xray, MRI, and CT imaging with appropriate annotations demonstrating normal and pathologic conditions.  Video and audio recordings are also included to narrate the text and demonstrate surgical procedures. Like the other apps in this series, users can search for medical providers that treat these conditions and this particular app expands the selection to include a physical therapist, plastic surgeon, and manicurist.  Overall, HandDecide is a very impressive addition to the Orca Health “decide” series and has the potential to greatly improve patient education and comprehension about orthopaedic hand conditions.  At only $1.99 this application is a great value for the amount of information included.

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FootDecide

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

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SpineDecide

SpineDecide is part of the Orca Health collection of apps that provides information for patients about various orthopaedic conditions.  Like the entire “decide” series, the user interface, graphics, and interactive anatomy modules are superb and allow the user to learn about spine anatomy while rotating, flexing, and zooming in on the images.  The conditions covered in this app include cervical bulge, cervical herniation, cervical stenosis, spondylolisthesis, lumbar bulge, lumber herniation, lumbar stenosis, degenerative disc disease, kyphosis, and scoliosis.  Consistent with the entire line of apps, each disease includes a plethora of xray, MRI, and CT imaging with appropriate annotations demonstrating normal and pathologic conditions.  Audio recordings are also included to narrate the text as well. Like the other apps in this series, users can search for medical providers that treat these conditions.  Overall, SpineDecide is a very impressive addition to the Orca Health “decide” series and has the potential to greatly improve patient education and comprehension about orthopaedic conditions.

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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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NeuroMind

Overall: 2+
Functionality: 3
Coolness: 1

This app was designed for neurosurgeons, however the content includes spine and spine trauma information that would also be valuable to orthopaedic trainees and spine surgeons.  The interface is nothing more than a listing of classification systems roughly organized by specialty such as general, motor, spine, spine trauma, tumor, and vascular.  For spine and spine trauma there are about 18 classification systems listed and selecting a topic provides the user with a text description of the classification table and a reference. There is no fancy interface design, no graphics, and no ability to save “favorites” for quick reference.  But, for someone who needs access to a list of spine classification tables, this is a free and light app to keep in your pocket.  Overall, this is probably useful to only a select group of individuals.

Cost: Free
Download Here

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Ortho Scores

Overall: 3-
Functionality: 2
Coolness: 3

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

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

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Ortho Traumapedia

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

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

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SLIC

Overall: 3+
Functionality: 4
Coolness: 2

This app uses decision-tree diagrams to assist surgeons with the treatment of various trauma-related spine pathology including burst fractures, central cord syndrome, facet fracture dislocation, facet subluxation, and hyperextension injury.  Each topic provides a flowchart as well as a decision-support interface to walk the user through the treatment algorithm.  The data appears to be peer-reviewed and closely mirrors charts from published articles on the topic, however no references are provided.  Overall, this may be useful to individuals taking spine-trauma call.

Cost: Free
Download Here

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Multiplier

Calculator for predicting height and bone length in children.

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

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OrthoEvent

Overall: 3+
Functionality: 4
Coolness: 3+

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

Cost: Free
Download Here

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AO Muller Classification

Overall: 3
Functionality: 3-
Coolness: 3

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

Cost: Free
Download Here

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AO Surgery Reference

Overall: 4+
Functionality: 4
Coolness: 3+

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

Cost: Free
Download Here

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