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Procedures Consult Superbly Demonstrates Common Bedside Orthopedic Techniques

10/21/2009 by Dr. Wodajo,

If one wanted to get an idea of the potential of the iPhone as a tool for bedside medical and surgical education, this application by Modality and Elsevier would be a good starting place to get inspired. While it seems obvious that a portable device with a great user interface, a sophisticated operating system and great multimedia features should be a shoe-in for portable medical education, what is equally true is that the critical ingredient remains great instructional content.

"Procedures Consult: Internal Medicine - Musculoskeletal" brings together a highly detailed review of orthopedic bedside procedures, such as aspiration of small and large joints, splint application and reduction of joint dislocations, with a well crafted user interface to create an application that will genuinely be useful for emergency room physicians and junior orthopedic residents.

The content is derived from Elsevier's Procedures Consult website, which is a curated video site describing over 270 procedures spanning several disciplines. (Please see the recent review of the companion application "Procedures Consult: Internal Medicine - General" on this website. The content for this application is derived mostly from the emergency medicine/musculoskeletal section. The information for each procedure consists of pre-procedure and post-procedure check lists as well as step-by-step instructions of the procedure itself, accompanied by references. In addition, one or more videos for each procedure is embedded into the app, available for immediate viewing. Surface landmarks are shown graphically as is a simplified 3 cut-away dimensional graphic of the relevant deep anatomy. Some procedures, such as shoulder reductions, are also accompanied by a representative radiographs of the problem.

What I liked about this app:

  • the attention to the relevant surface and deep anatomy, as well as the indications for each procedure is very helpful
  • videos are of high quality and are embedded directly in the application. (refer to other review for more details)
  • the techniques themselves are well-described and, I believe, few practitioners will find much cause to quibble with the instructions

What I did not like about the app:

  • not much really, perhaps the post procedure care is unrealistically detailed for the typical bedside interaction

What I'd like to see in future versions:

  • the content for this application is aimed mostly at ED procedures, which is surely a good market, however a future application with a more orthopedic focus, including closed fracture management and even surgical procedures would certainly be appreciated


While there has been a proliferation of medical instructional websites over the last five years, bringing that information to the bedside is more than just a convenience, it is a critical next step. Websites and mobile applications will not replace peer-reviewed scientific literature nor the principle of apprenticeship in medical training. However, I can easily imagine when all post-graduate trainees are routinely expected to refer to mobile applications such as this one before undertaking unfamiliar procedures. This will undoubtedly reduce errors and enhance the care of our patients.