Reliability of WhatsApp images of plain radiographs to diagnose fractures of the hand and wrist

Abstract

We assessed the reliability of plain radiographs interpreted through WhatsApp messaging system in orthopaedic hand trauma consultation in a large teaching hospital. Plain radiographs of 25 hand fractures and five normal radiographs were captured from a picture archiving and communication system using iPhone XS smartphone, anonymized and sent to 53 orthopaedic residents’ and consultants’ personal smartphones. The participants independently assessed the images and answered questions on fracture identification and characteristics, diagnostic confidence, further imaging and surgical inclination. The study was repeated after a 1-month washout period using the picture archiving and communication system on the hospital desktop. The results showed good (0.60 < ƙ < 0.80) intraobserver agreement on fracture identification and characteristics. The overall diagnostic accuracy for hand fractures was 95% on WhatsApp and 99% on the desktop. In conclusion, images of plain radiographs transmitted via WhatsApp were reliable for interpretation in orthopaedic hand trauma consultation. Level of evidence: IV

Re: Giddins G. The distal radioulnar joint after distal radial fractures: when and how do we need to treat pain, stiffness or instability? J Hand Surg Eur. 2023, 48: 230–45

“…The Hand to Elbow Clinic Bath, UK Email: greygiddins@handtoelbow.com We read the article by Khoo et al (2023) with interest. Although we agree that radiographs sent from a smartphone via WhatsApp are sufficiently reliable to diagnose hand fractures in many cases, two issues must be addressed.…”

The Role of Telemedicine in Prehospital Traumatic Hand Injury Evaluation

“…Several studies have already evaluated mobile communication in trauma settings with positive results. For example, some messaging systems have already proven effective for radiograph interpretation in orthopedic trauma consultations, with good intraobserver agreement between phone pictures and desktop images [ 20 ]. In some cases, specialized apps to evaluate specific traumatic injuries by patients at home have been developed, with positive feedback [ 21 ].…”

Emerging technologies in hand surgery

“…These articles are further explored with an insightful Further Knowledge article commentary from (Shrikant, 2023), sharing his experience with the challenges of measuring ROM remotely, especially in certain hand conditions. On a slightly different note, but also on the same theme of remote technology, Khoo et al (2023) fractures with 95% accuracy. Already widely used, this simple App could be employed as a useful adjunct for first-line interpretation of images for emergency consultation with the emergency room or when seeking senior advice, as long as information governance is adhered to.…”

“…These articles are further explored with an insightful Further Knowledge article commentary from (Shrikant, 2023), sharing his experience with the challenges of measuring ROM remotely, especially in certain hand conditions. On a slightly different note, but also on the same theme of remote technology, Khoo et al. (2023) demonstrated the reliability of using WhatsApp images to diagnose fractures with 95% accuracy.…”