Ankle fracture management using smartphone multimedia messaging service (MMS) imaging - How reliable and to what point?

Reliability of teleconsultation in the diagnosis and treatment of proximal humeral fractures

Purpose

Teleconsultation has become a routine part of clinical practice. The question arises as to whether this is reliable or not. Various studies have assessed the reliability in fractures at other locations in the extremities, but there is no study investigating teleconsultation reliability for proximal humeral fractures, proximal humerus fractures, which are fractures that may cause difficulties in making diagnosis and treatment decisions. Our aim was to evaluate whether proximal humerus fractures could be accurately assessed via teleconsultation.

Methods

Retrospectively, the radiological images of 83 patients were included in the study. Diagnosis and treatment classifications were made by 4 experienced orthopedic specialists. Interobserver and intraobserver analyses were performed on diagnostic and therapeutic decisions based on two forms of evaluation, direct analysis of images in the picture archiving and communication system (PACS) and the analysis of photographs taken from the PACS computer screen that were sent via WhatsApp.

Results

It was observed that there were excellent interobserver and intraobserver compatibility values for Neer and AO classifications and treatment decisions. No significant difference was observed in the evaluation of the images transferred via WhatsApp and the direct evaluation of PACS images.

Conclusion

The reliability of teleconsultation was found to be high in the radiological evaluation of proximal humerus fractures. It is clear that these consultations cannot replace the evaluation of the patient as a whole; however, we think that rapid consultation can enable faster patient management and more accurate diagnosis, especially when under time constraints.