title: Teleconsultation using multimedia messaging service for management plan in pediatric orthopaedics: a pilot study.
abstract: BACKGROUND
  Application and assessment of the usefulness of image transfer through a mobile telephone in pediatric orthopaedic practice was investigated.
  
  
  METHODS
  Twenty patients with traumatic lesions requiring urgent consultation were included. Relevant x-rays were photographed and transferred using Multimedia Messaging Service to the orthopaedic surgeon at our department. The discussion on the need to transfer the patient for treatment and the final treatment was retrospectively scrutinized by 10 independent orthopaedic surgeons. The agreement on the diagnosis and the management plan proposed after image transfer were assessed.
  
  
  RESULTS
  The lesion concerned the lower limb in 6 cases, upper limbs in 13 cases, and the spine in 1 case in patients aged 2 to 16 years. The transmitted images were 160 x 120-pixel jpeg files in 1 case, 240 x 180-pixel jpeg files in 8 cases, 320 x 240-pixel jpeg files in 1 case, and 640 x 480-pixel jpeg files in 10 cases. In all the cases studied, all the investigators agreed that the images were good enough for doing the diagnosis even in cases of minor or nondisplaced fractures. The same decisions of transfer or management were taken in all the cases by all the investigators. Review of the transferred images versus the original full-scale images did not change the final diagnosis and management plan.
  
  
  CONCLUSIONS
  In this study, even in case of low-resolution images (160 x 120-pixel jpeg), images were of sufficiently high quality for interpretation. This enables rational management decisions to be made using this costless and widely available technology. In patients requiring surgical treatment, a final operative decision is mandatory after transfer, bedside examination, and review of other data in addition to images. Teleconsultation using Multimedia Messaging Service is especially useful to improve remote management of orthopaedic patients in local hospitals or for decisions of transfer when surgical treatment is needed.
  
  
  CONCLUSIONS
  Level IV (case series).
authors.affiliation: Department of Pediatric Orthopaedics, Armand Trousseau Hospital, Pierre and Marie Curie Paris 6 University, Paris, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Elkaim
authors.forename: Amélie
authors.initials: A
authors.lastname: Rogier
authors.forename: Jean
authors.initials: J
authors.lastname: Langlois
authors.forename: Camille
authors.initials: C
authors.lastname: Thevenin-Lemoine
authors.forename: Kariman
authors.initials: K
authors.lastname: Abelin-Genevois
authors.forename: Raphaël
authors.initials: R
authors.lastname: Vialle
mesh_terms: D000293:Adolescent; D040421:Cell Phone; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D050723:Fractures, Bone / Q000628:therapy; D006801:Humans; D008297:Male; D019212:Multimedia; D019637:Orthopedic Procedures / Q000379:methods*; D010360:Patient Transfer; D010865:Pilot Projects; D019114:Remote Consultation / Q000379:methods*; D012189:Retrospective Studies