Fractures are an inevitable part of winter season, for both adults and children. Participating in sports increases the risk, but fractures often happen to non-athletic persons as well.
Different fracture patterns determine the management methods, as well as follow-up strategies during rehabilitation (some fractures require more time than the others).
To ease the things for orthopedic surgeons, as well as sports physicians and physiotherapists, a Swiss-based AO Foundation (which stands for Arbeitsgemeinschaft für Osteosynthesefragen) that focuses on research and education regarding the management of orthopedic injuries, developed AO Surgery Reference website, an evidence-based resource that describes the complete surgical management process from diagnosis to aftercare for different types of fractures, depending on anatomical region.
Furthermore, they made their guide available as a free mobile app for Android and iOS devices.
Upon starting the app you'll notice that it's almost as identical as the website, which isn't necessarily a good thing. The main screen features Overview section that allows users to tap on adult or pediatric skeleton to select a fracture area. But it's not that easy on the small screen, because transferring the web source into the app isn't done in a mobile-friendly way; at least not for all features.
But to healthcare providers, the information should be more important than design and the strength and depth of information provided is where this app excels.
Beside Overview section, the AO Surgery Reference app also includes number of other steps, such as Diagnosis, Decision, Preparation, Approach, Reduction & Fixation, and Aftercare. The users must first choose the area of the fracture before these other steps are populated with the information.
For example, if we have a patient with broken thighbone, in the Overview section we should tap on femur shaft area on skeleton.
Choosing the area will automatically take us to the Diagnosis tab, showing all the major types of femur shaft fractures, including simple, wedge and complex fractures. Each of these types contains sub-types, i.e. spiral, oblique, bending, fragmented, segmented, etc. You can learn more about them by tapping on the 'i' button, which opens a new page with nice illustrations and X-ray images of the fracture.
Since our patient has simple spiral fracture (or 32-A1 according to the AO/OTA Classification of Fractures and Dislocations), tapping on this diagnosis opened the Decision tab, which provides a lot of helpful information about the most appropriate type of treatment for that type fracture (operative or non-operative), as well as general considerations.
You can check how the particular treatments are compared to others in the Evidence section, which provides findings in couple of tables that aren't implemented for a mobile view so well.
Users can also check the Decision Support section with plenty of useful articles and cases from Orthopedic Trauma Directions journal.
For this type of fracture, we got several recommendations. For non-operative treatment, it was temporary Thomas splint. Tapping on information button briefly explains the procedure, along with providing the useful legend about skills and equipment required for the procedure.
If you tap on the procedure itself, you'll get a lot more of information, which is provided in great detail along with the photos.
But, since femoral shaft fractures are usually treated surgically, Thomas splint can only be used temporary (as it names suggest) and we should resort to one of the external or internal fixation methods.
For this review, I've chosen external subtrochanteric fixation, which opened the Preparation tab, providing the information about the key surgical positioning appropriate for the selected procedure. In this case it was abducted contralateral leg or supine position without traction.
Again, procedures are explained briefly when you tap on Info button, while the opening the procedure takes you to the Approach tab, which shows safest anatomical zones as well as hazards to be considered during surgery.
The next step is the Reduction & Fixation section that provides a wealth of information about the procedures, which is supported by high quality illustrations with the impressive level of detail.
The final section is Aftercare, which provides recommendations for the appropriate after-treatment care for a particular injury, with special considerations for the soft-tissue problems.
The navigation within the app is easy, with a bit slower response tho. Users can easily switch between tabs listed at the top of the screen and navigate the content.
I can't help but think that the app would look better if the developers paid more attention to design, particularly regarding porting AO Surgery Reference website to mobile platforms, as well as adding more interactivity. The app looks a bit outdated as is, basically as an old iPhone app, even on Android device.
However, even with these small interface and design quirks, the AO Surgery Reference app works really well. It provides comprehensive, textual and visual evidence-based guidelines for different fracture patterns, various management methods, as well as follow-up strategies during rehabilitation, which all make it a must-have app for orthopedic surgeons.
Benefit: If you're orthopedic surgeon or student you'll find this app an essential reference guide.