Skeletal Plan is a pre-operative planning and record tool for spinal instrumentation. Plan a construct level by level, scan implant barcodes to capture the manufacturer, system, size, lot number and expiry, and finish with a clean operative record: a grouped implant inventory, a PDF for the notes, and a shareable link or QR code. More than 93,000 implant references across 152 systems are built in. It works fully offline in 22 languages, and nothing you enter leaves your device. NEW IN THIS VERSION The same buttons in every implant dialog. The screw, cage, disc, corpectomy cage, plate, rod, osteotomy and note dialogs now end in Close, Remove, and Add or Update. The button names the implant and where it goes, for example Add cage with L4/5 underneath, and says so for a pair: Add screws, Add cages for a PLIF, Add rods. Each title bar shows the level, side or span you are working on. Remove keeps the dialog open with the details still filled in, so you can correct a placement by removing it and adding it again. If you change something and then close, the dialog asks before discarding the change. In the screw dialog, recording a screw and moving between levels are now separate. Add screw records it and keeps the dialog open; the arrow buttons move up a level, down a level, or to the other side, and place nothing. Confirm & Next and Skip have gone: to work down the spine, tap Add screw, then the down arrow. Moving to a level that already has a screw shows it, with Update and Remove. Vertebral column resection over several levels. Choose the lowest vertebra resected: one vertebra is recorded as a VCR, two or more as a multi-level VCR, and the chart shows every resected body. The VCR and its reconstruction cage share their levels, and changing them in either dialog changes both. A saved corpectomy now reopens at the vertebra resected. It reopened one level higher, and tapping Update then saved it there; please check the levels of any corpectomy you reopened and updated. Confirming a VCR a second time no longer adds a second cage. When scanning, the button on the scan card names where the scan goes, and in the screw dialog it is Add screw, so one tap records the scanned screw at its scanned size. In the scanner, the arrow buttons move on with the camera still open. The case scan pool fills the screen, keeps a scan still on its card when you turn the camera off, and shows how many implants you have scanned. The rod and Quick Add dialogs also fill the screen, so their buttons are always in reach.

Skeletal Plan is a pre-operative planning and record tool for spinal instrumentation. Plan a construct level by level, scan implant barcodes to capture the manufacturer, system, size, lot number and expiry, and finish with a clean operative record: a grouped implant inventory, a PDF for the notes, and a shareable link or QR code. More than 93,000 implant references across 152 systems are built in. It works fully offline in 22 languages, and nothing you enter leaves your device. NEW IN THIS VERSION One side at a time. The screw dialog has a Workflow switch: Bilateral places left and right together, Unilateral places one side at a time. In Unilateral, Next goes to the opposite pedicle at the same level first, then down a level, so each side can take its own size at the apex. The buttons name where they go, for example Next: T8 Right. A Skip button moves on without placing anything, to the opposite pedicle or down a level. Scanning is one screw at a time. Starting a scan puts the dialog on the side you opened it for, which you can still change. Each screw starts unscanned; the previous screw's barcode, lot and expiry are offered as "Same implant as T8 Left" and copied only if you tap it. Confirm now waits while a scan is on its card, in every implant dialog, until you tap Use this scan or discard it. Previously the implant could be saved at the size shown in the form rather than the scanned size. Please check the sizes of scanned implants in cases saved with earlier versions. The Confirm & Next as Default preference has been removed. Next is now always the highlighted button. Confirm & Next now keeps the head type and shank of modular screws, as Confirm does. Every spinal level is offered in the screw dialog, in order. Placing a screw outside the chart's current view widens the view to show it. On iPhone, the scanner shows in large type where the scan will be recorded, such as T8 Left or L4/5, in every implant dialog. In the screw dialog, Next and Skip are in the scanner itself, so the camera stays open from screw to screw; Next appears once you use the scan and shows the size being recorded. On iPhone and iPad, tapping a pedicle opens the screw dialog ready to use, instead of opening the level list, and the dialog's buttons sit in tidy rows with Skip outlined in amber. Messages now stand out from the title bars, and on iPhone they appear at the top of the screen.

A PDF now carries the whole case. Choose Open, pick a PDF, and the entire plan comes back, patient details included — there is no longer a project file to keep alongside it. Treat an exported PDF as you would any patient record: the attached case stays with it even if the printed page is redacted. PDFs from earlier versions still open, rebuilt from the link inside them, which carries the construct without the patient details. The link inside the PDF now opens in Acrobat and PDF Expert as well as Preview and Files. Opening a shared link or a scanned QR code now asks before it replaces the case you have open, and a link tapped while the app is closed opens the case once. Screw heads sit in the same place on the pedicle whatever length you choose. Only the shank changes.

The app no longer asks whether to save the case on this device. That question belongs to a shared computer in an office, not to your own phone or iPad, and no other app on your device asks it. The case is now saved as you would expect, and you can still switch saving off at any time from the privacy dot on the toolbar. Nothing was given up to remove the question. The case is stored encrypted, it is deleted automatically after 24 hours, and turning saving off still clears everything immediately — useful on a shared departmental iPad. The screw type you choose now stays chosen. When you used Confirm & Next to work down a construct, the type you had just selected was not carried to the next level: choosing a uniplanar screw at one level opened the next on polyaxial, and the two then alternated down the spine. Each level looked reasonable on its own, so it was easy to miss. Constructs built this way are worth re-checking. Nothing was recorded incorrectly, but the dialog may not have shown what you intended. Exports made with the phone held upright are now complete. Exporting a PDF or image in portrait left out the panel carrying the patient details, the bone graft record and the implant inventory, and left any corpectomy reconstruction cage or spinal plate off the chart. Exports now carry identical content whichever way the device is held. The Plan and Final choice on the Inventory tab now decides which inventory is exported, and that tab opens on Plan, matching iPad and desktop.

Two-part barcodes now scan in either order. Many implant pouches carry the product on one barcode and the lot number and expiry on a second one. The lot and expiry used to be captured only if the product barcode happened to be read first, so the same pouch could scan completely one time and arrive with the lot missing the next. Either barcode can now be read first, and one read on its own is held and matched to the pouch it came from. If you have recorded cases recently, it is worth checking they carry a lot number. The app opens on the Plan tab, instead of reopening wherever you last left it. Fixation system names type normally in the patient panel. Letters were being read as keyboard shortcuts, so a name containing an "e" could open the Export panel mid-word. Interbody cages are recorded more accurately. Stryker Tritanium PL cages 27 mm and longer now come up as a single TLIF cage by default, matching how a straight cage of that length is usually placed, while the shorter 23 mm cages still default to PLIF. A scanned cage can be switched between TLIF and PLIF with its scanned size locked, a PLIF can be recorded as two separate cages each with its own barcode and lot, and Tritanium PL cages fill in their built-in lordosis angle automatically.