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AAOS Now

Published 1/1/2012
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Orrin I. Franko, MD

Keeping Up with Orthopaedic Apps

Apps run the gamut from coding help to patient education

The last few years have witnessed a rapid expansion in clinical information available for use in smart phones and tablets, including new ways to access medical records, read journals, and keep up with product releases. For practicing surgeons, staying abreast of the most relevant and useful software can be a challenge.

The mobile computing sector is currently fragmented by various devices and operating systems. The two leading operating systems or platforms are Apple’s iOS™ operating system and Google’s Android™ operating system; other mobile platforms include Blackberry and Palm.

What are apps?
A strength of both the iOS and Android mobile platforms lies in the availability of third-party software “apps.” Apps are simply small programs that can be downloaded to a device to carry out a specific function. For example, an orthopaedic surgeon may use one app to access orthopaedic journal articles online, and a different app with images and video to teach patients about their condition. Apps can focus on clinical news, drug dosing references, or recording outcomes data.

Apps must be developed separately for the Android and iOS platforms. Therefore, depending on the developer, a given app may be available for Android, iOS, or both. Blackberry and Palm also have a few apps, but neither has been successful in capturing the attention of developers and users.

Apps for iOS-based devices are only available through Apple’s proprietary iTunes App Store. In contrast, apps designed for Google’s Android platform may be available from a variety of sources, including Google’s own Android Market.

To address the increased costs of designing several versions of an app for different devices, some developers have opted to create so-called “web apps,” which are accessed using a standard Internet browser running on the device. Web apps provide easy parity across mobile device platforms, but require Internet access at all times and lack an easy way to save data for off-line retrieval.

An alternative to the pure web app is the “pointer app”—a small app that draws data from an online source. Like web apps, pointer apps require an Internet connection at all times.

Orthopaedic apps
A variety of apps of interest to orthopaedists are available, including those developed for accessing news and education, performing clinical and professional functions, and providing patient information. This article focuses on what I consider to be some of the most relevant and useful apps for orthopaedic surgeons.

Because apps are continuously being created and updated, their availability and the accuracy of the data presented here are constantly evolving. Readers interested in the latest app updates are advised to conduct regular searches of websites that sell or review mobiles apps for physicians. For example, www.TopOrthoApps.com covers apps specifically for orthopaedic surgeons, while other various websites include apps for all medical specialties.

Unless otherwise noted, the apps described in this article are available for both iOS and Android platforms.

News and journal apps
Surgeons who use their mobile devices for keeping up with news and journals can employ a variety of really simple syndication (RSS) feeds and journal apps. The first orthopaedic journal to be available entirely on a mobile device is Acta Orthopaedica. Although the app lacks search functionality, users can browse the entire collection of Acta journals from 1930 to the present and download PDF versions of all articles directly to their mobile phone or tablet pc at no cost.

The Journal of Bone and Joint Surgery (JBJS)—British has released JBJS Br Abstract Manager—a mobile application for searching its abstracts. Users can view only abstracts, not entire manuscripts, and can establish “watch words” to quickly search for relevant topics.

Those who want to browse and read abstracts specific to a particular orthopaedic specialty might be interested in a collection of related apps—BoneFeed, HandFeed, and SportsMed—that provide RSS feeds from selected orthopaedic journals. Although full text reading is not available, abstracts from a variety of relevant journals for each specialty can be quickly reviewed and saved, emailed, or tweeted. Another app, BoneCast, utilizes a similar format, but presents only podcast (audio) and vodcast (video) feeds from popular orthopaedic sources such as JBJS (both American and British editions), the American Orthopaedic Society for Sports Medicine, and the British Journal of Sports Medicine.

AAOS has released a pointer app for this publication. The AAOS Now app allows users to read articles through an Internet browser. The app includes extra features such as podcast interviews and videos.

Clinical and educational apps
Clinical and educational apps include AAOS CodeX Lite, which allows individuals who already subscribe to the AAOS CodeX service to search and select ICD-9 and CPT codes.

The AO Surgery Reference app is a pointer app from the Swiss-based AO Foundation. It serves as a mobile version of the organization’s website (www.aosurgery.org). The interface is organized by body part, allowing the user to navigate through steps to diagnose, classify, and treat musculoskeletal trauma with the assistance of informative text, clear images, and radiographs.

Another AO Foundation app, AO Müller Classification, uses images and drawings to help classify long-bone fractures.

Ortho Traumapedia is an app that can be very useful for managing orthopaedic trauma. Organized by dislocations or fractures of various joints and bones, each section presents facts, images, classification, and treatment in a bullet-type format with radiograph examples and relevant illustrations.

A set of apps (Hallux Angles, Scoliogauge, Knee Goniometer, and Forearm Goniometer) from ockendon.net uses the iPhone and iPad’s internal accelerometer to make goniometric measurements.

General medical
Among general medical applications, the current leader in drug reference guides is the Epocrates Rx® drug reference. The app includes useful features such as drug dosing, side effects, pill identification functionality, and various medical calculators (including electrolytes and body mass index).

A similar app, Medscape from WebMD, also has drug reference and pill identification functionality. In addition, Medscape offers a disease and condition reference library as well as step-by-step instructions for performing various clinical procedures. For example, the musculoskeletal procedure section has in-depth information for nearly 100 procedures, including instructions for performing joint aspirations, tendon injections, and joint reductions.

Orthopaedic surgeons who need to perform specific medical calculations may find MedCalc helpful. This app is available for both the iPhone and the iPad and includes various calculators and reference information, such as an opioid conversion tool, a dermatome distribution map, and an injury severity score calculator.

Patient education
The number and quality of patient-information apps are expanding as quickly as clinical and educational apps. Some individual surgeons and practices have created apps focused on helping patients connect with the appropriate medical provider, including OrthopedicSurgeon.com and ShoulderDoc.co.uk.

One company, Orca Health, has created a comprehensive collection of advanced patient-education apps focused specifically on the most common orthopaedic diseases. Apps such as AgingSpine™, SpineDecide™, FootDecide™, HandDecide™, KneeDecide™, and ShoulderDecide™ include interactive anatomy animations, video clips, audio clips, and text descriptions of common orthopaedic conditions to help patients understand their conditions and possible treatment options. The apps also allow patients to search for nearby medical providers, including orthopaedic surgeons, physical therapists, chiropractors, and others.

Another app, DrawMD Orthopedics, provides surgeons with various background images of bones and joints and allows the user to add stamps in the form of plates, screws, implants, or fractures while drawing on the images to help teach patients about their condition and treatment options.

Manufacturer information
Finally, orthopaedic device companies have recognized the value in providing surgeons, trainees, and patients with information about their products. For patients, this often includes images and descriptions about their available implants, and for surgeons many of the companies have developed technique guides, instructional videos, and other educational materials. Most major implant manufacturers offer apps.

The collection of high-quality apps available to orthopaedic providers and consumers continues to expand. Although this article mentions more than 30 of the most useful applications currently available, the iTunes App Store and the Android Market offered more than 150 orthopaedic apps at the time of writing. The online version of this article includes links to the apps mentioned in this article, as well as to additional information on mobile technology for orthopaedic surgeons.

Orrin I. Franko, MD, is a PGY3 resident at the University of California, San Diego department of orthopaedics and founder of the website, www.TopOrthoApps.com