Sezai Ozkan - Hand and Upper Extremity Service, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA, Yawkey Center, USA
Jos J. Mellema - Hand and Upper Extremity Service, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA, Yawkey Center, USA
David Ring - Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
Neal C. Chen - Hand and Upper Extremity Service, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA, Yawkey Center, USA

Background: To examine whether interobserver reliability, decision-making, and confidence in decision-making in thetreatment of distal radius fractures changes if radiographs are viewed on a messenger application on a mobile phonecompared to a standard DICOM viewer.Methods: Radiographs of distal radius fractures were presented to surgeons on either a smart phone using a mobilemessenger application or a laptop using a DICOM viewer application. Twenty observers participated: 10 (50%) wererandomly assigned to the DICOM viewer group and 10 (50%) to the mobile messenger group. Each observer was askedto evaluate the cases and (1) classify the fracture type according to the AO classification, (2) recommend operative orconservative treatment and (3) rate their confidence about this decision.Results: There was no significant difference in interobserver reliability for AO classification and recommendation forsurgery for distal radius fractures in both groups. The percentage of recommendation for surgery was significantlyhigher in the messenger application group compared to the DICOM viewer group (89% versus 78%, P=0.019) and theconfidence for treatment decision was significantly higher in the mobile messenger group compared to the DICOM viewergroup (8.9 versus 7.9, P=0.026).Conclusion: Messenger applications on mobile phones could facilitate remote decision-making for patients with distalradius fractures, but should be used with caution.

Decision-making, Distal radius, Interobserver agreement, Messaging application, Teleconsultation