By: Nathan Skelley, M.D.
Is your surgeon a gamer?
Bonedoc by Otago Innovation Limited tries to make all orthopedic surgeons gamers before stepping into the operating room. Instead of a first person shooter, this app is making a first person surgeon.
As mobile technology continues to advance, more applications are focusing on simulating virtual surgical and medical techniques before performing them on real patients.
Bonedoc breaks away from step-by-step instructional apps such as Touch Surgery by Kinosis and gives the user/surgeon greater ability to interact with the surgical procedure. In Bonedoc, the user is graded on their ability to reduce the fracture and properly place instrumentation.
Your actions at one step of the case will directly affect how you do at a later step of the case. Furthermore, Bonedoc allows users to share case scores creating competition that further drives the learning process.
The app opens with a disclaimer and then a list of upcoming OR cases. The first case is a sliding hip screw for an intertrochanteric fracture. The app is designed so the user cannot choose other cases until they pass or prove proficiency in the given case. They should also not scroll through the whole OR list as that removes the names and in the version tested would lock the app requiring a rebooting of the program.
Once the first case is selected, the surgeon/user is taken to the operating room where the patient is already positioned. The graphics are great and resemble an operating room.
The first task is using fluoroscopy to position the left hip for the operation. The user needs to delicately adjust the position of the leg checking the reduction on fluoroscopy. A pull-out menu from the right helps to direct the objectives and maneuvers.
Even with this pull out menu, it takes a few attempts at the surgery to become familiar with the apps positioning gestures and tools. The app is scoring the user on attempts at reduction and fluoroscopy shots used. This is challenging considering the internal and external rotation function on the foot was difficult to control for minor adjustments.
Once the fracture is appropriately reduced on AP and Lateral views, the user taps the operate button to begin the surgery. The incision motion is a little challenging to master. The user is essentially creating a single line incision and then spreading the incision to make four points to view the fracture.
Getting the pin appropriately placed can require a few fluoroscopy shots before the surgeon is satisfied with the placement, similar to an actual operation. The drill feature is great and provides for partially drilling the guide pin. Similarly, drilling screws for fixation has a unique way of telling when the second cortex is about to be breached. There is no function for depth gauging screw length, moving fluoro to check screw alignment, or removing screws if unsatisfied with placement.
The cases end once fixation is complete. The app then removes other tissues and allows the surgeon to view their fixation construct in isolation with the bone. They can fly around and zoom in and out viewing the errors or successes with their construct.
Once the user clicks finish, they are presented with their scores across several elements of the surgery. If they score high enough to pass, they can progress to the next surgery on the operating room list.
- Great graphics and user interface–the OR is very impressive.
- Provides an overview for key steps involved in surgery.
- Removes many of the smaller steps involved in the surgery to focus on skills that create a game environment.
- The guide for judging drill depth is very creative.
- Some controls are difficult to use and take some practice.
- Inability to move fluoroscopy during the surgery.
- Limited cases and similar operation each time.
- Minor bugs with the operating room list page.
- No discussion of anatomy or retractor placement.
Healthcare workers that would benefit from the app
- Orthopedic physicians-in-training and practicing surgeons wanting to review or learn a new technique.
- This application has great potential to influence the training of future surgeons. The game concept is great and makes the app much more engaging. Surgery is extremely complicated and trying to cover all aspects of an operation in a single app is a significant challenge.
- Similarly, there are many different ways and techniques for performing an operation that adds to the complexity of creating an all inclusive app. This app does a nice job of covering the major concepts but should expand on the features, instruction and cases.
- Anyone interested in orthopedic virtual surgery simulation should definitely check out this app.
Type of device used to review app–iPhone 5
Version of App: 1.1
Rating: (1 to 5 stars): 4.5/5
- User Interface: 5/5 – The app has beautiful graphics and creates the operating room setting very well. Some of the gestures and the OR tools take a few attempts to become accustomed to using them.
- Multimedia usage: 4/5 – The app uses great multimedia features and creates the operating room environment well making the user feel like a first person surgeon.
- Price: 5/5 – The price is fair for the amount of content and media in the app.
- Real world applicability: 4/5 – The application needs some easier controls and diversity in cases, but has the potential to be a great training tool for physicians-in-training.
This post does not establish, nor is it intended to establish, a patient physician relationship with anyone. It does not substitute for professional advice, and does not substitute for an in-person evaluation with your health care provider. It does not provide the definitive statement on the subject addressed. Before using these apps please consult with your own physician or health care provider as to the app’s validity and accuracy as this post is not intended to affirm the validity or accuracy of the apps in question. The app(s) mentioned in this post should not be used without discussing the app first with your health care provider.