title: WhatsApp Messenger is useful and reproducible in the assessment of tibial plateau fractures: inter- and intra-observer agreement study.
abstract: OBJECTIVE
  The aim of this study was to evaluate the inter- and intra-observer agreement in the initial diagnosis and classification by means of plain radiographs and CT scans of tibial plateau fractures photographed and sent via WhatsApp Messenger.
  
  
  BACKGROUND
  The increasing popularity of smartphones has driven the development of technology for data transmission and imaging and generated a growing interest in the use of these devices as diagnostic tools. The emergence of WhatsApp Messenger technology, which is available for various platforms used by smartphones, has led to an improvement in the quality and resolution of images sent and received.
  
  
  METHODS
  The images (plain radiographs and CT scans) were obtained from 13 cases of tibial plateau fractures using the iPhone 5 (Apple Inc., Cupertino, CA, USA) and were sent to six observers via the WhatsApp Messenger application. The observers were asked to determine the standard deviation and type of injury, the classification according to the Schatzker and the Luo classifications schemes, and whether the CT scan changed the classification. The six observers independently assessed the images on two separate occasions, 15 days apart.
  
  
  RESULTS
  The inter- and intra-observer agreement for both periods of the study ranged from excellent to perfect (0.75<κ<1.0) across all survey questions. When asked if the inclusion of the CT images would change their final X-ray classification (Schatzker or Luo), the inter- and intra-observer agreement was perfect (k=1) on both assessment occasions.
  
  
  CONCLUSIONS
  We found an excellent inter- and intra-observer agreement in the imaging assessment of tibial plateau fractures sent via WhatsApp Messenger. The authors now propose the systematic use of the application to facilitate faster documentation and obtaining the opinion of an experienced consultant when not on call. Finally, we think the use of the WhatsApp Messenger as an adjuvant tool could be broadened to other clinical centres to assess its viability in other skeletal and non-skeletal trauma situations.
authors.affiliation: Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, RJ 22440-040, Brazil. Electronic address: v_giordano@me.com.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Giordano
authors.affiliation: Departamento de Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ 21941-590, Brazil.
authors.forename: Hilton Augusto
authors.initials: HA
authors.lastname: Koch
authors.affiliation: Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, RJ 22440-040, Brazil.
authors.forename: Carlos Henrique
authors.initials: CH
authors.lastname: Mendes
authors.affiliation: Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, RJ 22440-040, Brazil.
authors.forename: André
authors.initials: A
authors.lastname: Bergamin
authors.affiliation: Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, RJ 22440-040, Brazil.
authors.forename: Felipe Serrão
authors.initials: FS
authors.lastname: de Souza
authors.affiliation: Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, RJ 22440-040, Brazil.
authors.forename: Ney Pecegueiro
authors.initials: NP
authors.lastname: do Amaral
mesh_terms: D000328:Adult; D000368:Aged; D040421:Cell Phone / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D063731:Mobile Applications / Q000706:statistics & numerical data*; D015588:Observer Variation; D015203:Reproducibility of Results; D013978:Tibial Fractures / Q000145:classification* / Q000000981:diagnostic imaging / Q000453:epidemiology*; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Health information technology; Tibial plateau fracture; WhatsApp Messenger