The general public and professionals have adopted the use of mobile devices with Internet access in a range of fields. In 2009, more than two thirds of the world's population owned a mobile phone and about 4.2 trillion text messages were sent. Since then, the popularity of mobile technology has transformed the use of these devices into an almost mandatory part in modern life, with most people taking their phones everywhere they go [1], [2].
In this scenario of rapid technological expansion, many applications have been developed to provide support for professionals involved in healthcare, such as text message (SMS (short message service) and WhatsApp Messenger, for example), e-mails, and access to electronic records and specific literature [1], [2], [3]. New applications are being created at a high rate for specific areas of medicine, which includes viewing of radiological images on mobile phones, called “teleradiology” [1], [2], [4].
Initially, teleradiology was regarded by some with scepticism, not only because it was a relatively new technology, but mainly because of the characteristics of the mobile device – for example the size and resolution of display [1]. Since then both mobile phones (smartphones) and the transmission and reception of data has improved, opening up possibilities for its application both in the medical and dental areas [5].
However, recent studies have shown modest benefits for clinical diagnosis and other health interventions with the use of SMS, especially because of the low quality of the images [1], [6], [7]. Two studies using photos taken with mobile phone demonstrated a reduced accuracy in the diagnosis of fractures compared with the gold standard, the simple X-ray [8], [9]. Low camera resolution and loss of data quality due to the conversion from analogue to digital were the main problems found in these studies.
After reaching a million users by the end of 2009, the WhatsApp downloads increased 10 times by 2010 [10]. Gradually this application has become one of the most popular for mobile smartphones and is currently among the most downloaded in 40 countries of the European Community, Asia, Middle East, and Latin America. In Germany it leads the ranking downloads of 2011 and in Spain has more than six million, according to the Xyologic [11].
The authors’ hypothesis is that using WhatsApp technology does not reduce the quality of the images in their conversion from analogue to digital and therefore provides the ability to identify sufficient details for diagnosis and the classification of fractures. The aim of this study is to evaluate the inter- and intra-observer agreement in the initial diagnosis and classification by means of plain radiographs and CT scan of tibial plateau fractures photographed versus images sent via WhatsApp Messenger.