Abstract
PurposeThere are over 500 medically related applications (apps) for mobile devices. Very few of these applications undergo testing and peer-review for accuracy. The purpose of this study is to assess the accuracy of limb deformity measurements on the Bone Ninja app compared to PACS and to determine the intra- and inter-observer variability among different orthopaedic practitioners.MethodsFour participants (attending, senior and junior resident, and physician assistant) measured the leg length (LL), the lateral distal femoral angle (LDFA), and the medial proximal tibial angle (MPTA) of 48 limbs (24 patients), twice with both Bone Ninja and PACS. The difference between the measurements obtained with the Bone Ninja app and PACS were measured. We determined the consistency of the intra-observer intra-class correlation coefficient (ICC) for both systems.ResultsThere were no statistical differences in leg length discrepancy (LLD), MPTA, or LDFA measurements between Bone Ninja and PACS (p = 0.96, 0.87, and 0.97, respectively). The intra-observer ICC for the LL, LDFA, and MPTA was similar between Bone Ninja and PACS (0.83, 0.89, and 0.96 vs. 0.96, 0.93, and 0.95, respectively). The inter-observer ICC was similar between Bone Ninja and PACS (0.95, 0.96, and 0.99 vs. 0.99, 0.98, and 0.98, respectively).ConclusionsThis study demonstrates that Bone Ninja is an accurate educational tool for measuring LLD, LDFA, and MPTA. Both systems are reliable instruments for evaluating limb length differences and angles on standing radiographs for pre-operative deformity planning and education. This is the first study to evaluate the accuracy of Bone Ninja compared to the gold standard of PACS.
Highlights
The reliability of proper pre-operative planning and measurement of lower extremity deformity is important in the treatment of growth disturbances, malalignment, malunions, and unicompartmental arthritis in the young person [1]
There were no statistical differences in leg length discrepancy (LLD), medial proximal tibial angle (MPTA), or lateral distal femoral angle (LDFA) measurements between Bone Ninja and Picture Archiving and Communication Systems (PACS) (p = 0.96, 0.87, and 0.97, respectively)
The intra-observer intra-class correlation coefficient (ICC) for the LL, LDFA, and MPTA was similar between Bone Ninja and PACS (0.83, 0.89, and 0.96 vs. 0.96, 0.93, and 0.95, respectively)
Summary
The reliability of proper pre-operative planning and measurement of lower extremity deformity is important in the treatment of growth disturbances, malalignment, malunions, and unicompartmental arthritis in the young person [1]. Preoperative planning is typically done with various Picture Archiving and Communication Systems (PACS) and software programs. Bone Ninja, a mobile application, was developed for patient/physician education and is available for the iPad platform (Apple Inc., Cupertino, CA, USA). This application allows for measurements and deformity correction planning without the need for scissors, paper, or expensive computer software programs. Some of these applications assist with medical diagnosis, treatment suggestions, or function as tools using the in-device
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