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Hand (N Y). 2011 Dec;6(4):384-9. doi: 10.1007/s11552-011-9362-4. Epub 2011 Sep 23.

Analysis of the inter- and intra-observer agreement in radiographic evaluation of wrist fractures using the multimedia messaging service.

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Department of Traumatology and Orthopaedics, James Paget University Hospital, Gorleston on Sea, UK.



Orthopaedic surgeons are often asked to evaluate X-rays of patients admitted to the Accident and Emergency Department with the suspicion of a wrist fracture or, in the case of an evident fracture, to decide the correct treatment. The aim of this study was to evaluate the feasibility of a correct interpretation of the images of injured wrists on the screen of a last generation mobile phone, in order to evaluate if the specialist could make the right diagnosis and choose the correct treatment.


Five orthopaedic and one hand surgeons have evaluate the X-rays of 67 patients who sustained an injury to their wrist. In the case of fracture, they were asked to classify it according to the AO and Mayo classification systems. The evaluation of the images was accomplished through the PACS and using a mobile phone, at a different time. In order to check the inter- and intra-observer reliability, the same pattern was followed after a few months.


The mobile phone showed basically the same agreement between the observers highlighting the worsening of the inter- and intra-observer reliability with the increment of the variables considered by a classification system.


The present paper confirms that a last generation mobile phone can already be used in the clinical practise of orthopaedic surgeons on call who could use it as a useful device in remote or poorly served areas for a rapid and economic consultation


The level of evidence of this case is economic and decision analysis, level 2.


Inter-observer agreement; Intra-observer agreement; Telemedicine; Wrist fracture

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