Technology Corner: Update on Apps for Residents

The number of high-quality apps available to orthopaedic residents continues to increase at a staggering rate with the current estimate at over 300 apps for iPad, iPhone, and Android. For a complete list with individual reviews, visit www.TopOrthoApps.com.  In this Orrin Franko, MD article I will review a few recent app releases that residents and fellows will find useful for training.

Insights Orthopedics is a free comprehensive and visually stunning news and research aggregator for orthopedics. 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 is essentially a  “flipboard for orthopaedic surgeons.” A simple swipe of the keyboard quickly scrolls through the various information sources permitting continued browsing of abstracts.  All articles include a link to the publisher’s page and, in many instances, full access to the article if open access is available through an institutional subscription. The intuitive user interface includes the ability to bookmark resources for off-line browsing or share links via Twitter, Facebook, LinkedIn, email, and SMS.  The app also includes additional features such as international journal club recommendations and an event calendar for conferences and meetings.

BoneDoc is marketed as “a serious game for surgeons” and functions as an interactive and educational orthopaedic tool for trainees.  The app is organized into 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 table properly.  Xrays are available as the traction is adjusted to ensure that a proper reduction is obtained. Once aligned, the surgeon then moves on to the incision, as well as placement of the hardware (in this case, a sliding hip screw).  Xrays are used throughout the “operation” to ensure the proper alignment and orientation of hardware, including plate position and screw length.  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 to detail that has been placed, as well as the realistic physics and challenges inherent with fixing a hip fracture.  

Throw Like a Pro is not designed for residents, per se, but the quality of the app deserves mention.  In response to the increasing rates of “Tommy John” surgery, Dr. Andrews created this app to help young baseball players prevent injuries and safely participate in sports.  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). The developers estimate a 60% reduction in throwing injuries if used properly.

Orca MD is the newest app by Orca Health for patient education and engagement.  Previously, their apps were called Hand Decide, Spine Decide, Shoulder Decide, etc. This new app centralizes all patient information and integrates a subscription option for annotating and emailing patients information about their condition.  The overall user interface, graphics, and interactive anatomy modules are superb and allow the patient to learn about bones, tendons,  and ligaments while rotating, flexing, and zooming in on the 3D anatomy images.  The conditions covered for each body part are vast, and include 15-20 of the most common diagnoses. After selecting a topic, 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, and often intra-operative videos are included as well.  This app is a clear stand-out that should be kept in mind for any surgeon.

Despite its 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 pre-operative planning for limb lengthening
and alignment surgery.  The appis 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 sagittal plane views of limbs with various angular deformities. The user can also upload any other patient 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.  This is a very powerful teaching tool for residents and surgeons alike.

Residents will notice an increasing trend towards social networking and communication tools for surgeons in the upcoming years.  DocSpera is one 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 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.

* Disclosures: Orrin Franko receives consulting fees or has an ownership interest in www.TopOrthoApps.com, DocSpera, and Insights Orthopedics
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