Learning any new technique or skill can be challenging or overwhelming at times. This is especially true when learning something with multiple steps that must be performed in a fixed sequence, as is the case with many surgical techniques. Many surgical textbooks and technique guides focus on a step-by-step educational model in an attempt to simplify this learning process.

The ICUC app is an exciting new app that takes learning the step-by-step process of surgical procedures to a new level. The program uses real clinical multimedia and high resolution images to teach the management of common orthopaedic fractures. This advanced app focuses on multiple established techniques and approaches in orthopaedic trauma care.

The ICUC app is free which is very impressive considering the expert participation and high quality information in the app. The program is relatively new and still adding content, but has the potential to be a commonly used reference for surgeons. The following is a review of the current 1.1 app design for iPads.

User Interface:

The app requires a quick and free registration process to gain access to the app content. All of the surgeons, patients and patients’ information are anonymized throughout the entire app.

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The home screen consists of a body with either an upper extremity or lower extremity section.

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Selecting a section takes you to a more detailed map of extremity regions and joints.

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If, for example, you selected the proximal humerus, the app opens to three subsections: ICUC Library, Reference Cases, and Expert Opinions. These sections are listed across the top of the app.

The content in most sections needs to be downloaded before loading that topic. Downloaded content is saved in the briefcase tab on the right side of the program. The downloaded content can consist of very large files. The files can be deleted, but it does not appear that there is an option of sorting or searching your downloaded content. This becomes an issue if you are downloading content across multiple joints and techniques at the same time.

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The ICUC Library contains hundreds of cases focused on teaching the principles of injury and surgical techniques. The library presents many injury examples and treatment techniques, but the user should note that some of the techniques presented are “not recommended.”

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The user should closely observe whether the presented technique is “Recommended” or “Not Recommended.” The first time I used the app, I went through a few cases and was surprised how I did not agree with the treatment method — then on closer review, I noticed at the beginning of the case it was listed as “Not Recommended”. It would be helpful to place these cases in a separate section or have text on each slide to remind the user this is not the ideal treatment method. It is beneficial to see these techniques and learn from them, but this presentation method could be misleading,

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Reference Cases give examples of surgical approaches and positioning in a step-by-step design. The images in this section are very high quality. Sometimes, however, you can scroll through multiple images and it is unclear what the surgeon is trying to accomplish or what the next step is going to be in the procedure. Some of the slides have text that is very beneficial for understanding that part of the technique, but I wish more slides had short descriptions of the presented technique.

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The Expert Opinions section includes some great multimedia. There are several videos and 3-D images demonstrating specific techniques. This is a great section for learning tips and tricks.

The app reminds me of teaching applications that use Cognitive Load Theory which works on the idea that the human brain can only process and interpret a certain amount of information at a single point in time. Therefore, it breaks down each step of a surgical procedure with one image and a short amount of text explaining that image. Once that concept is learned, the user can advance to the next topic. The app could apply this technique more consistently to enhance the learning opportunities.

Healthcare workers that would benefit from the app

  • Practicing surgeons and resident surgeons-in-training.

Ed. Note: This post was updated after publication to reflect the fact that the ICUC app was developed independently of the AO Foundation; the app first came to our attention at an AO Foundation event where it was recommended/promoted.

  • Price
    • Free
    • High quality images
    • Multiple examples of techniques and approaches
    • Ability to download content for offline review
    • Animations enhance the clinical images
  • Dislikes
    • An app tutorial to explain utilizing different sections of the app (these are present online but not in the app).
    • Some case examples are listed as “not recommended” but if the user does not see this first slide, they may study an inappropriate technique.
    • Briefcase of downloaded content does not allow for searching or sorting after downloading content.
  • Overall

    This is a very well-designed app with high-quality images and a growing number of case examples. The information could be very useful for case review or case preparation.

  • Overall Score
  • User Interface

    The information is presented well, but the subsections can take time to navigate. Downloaded content is also not organized with any sort function.

  • Multimedia Usage

    Excellent high-quality images. It would be helpful to have more explanations on each image to more clearly explain what is happening in the image.

  • Price

    The app is free.

  • Real World Applicability

    This app can be very useful for review and case preparation.

  • Device Used For Review

    iPad 2

  • Available for DownloadiPad