Introduction: Telemedicine is a valuable but underused resource for the delivery of health care to patients in areas that are underserved. The purpose of this study was to determine whether Hand Surgery teleconsultation for upper extremity injuries can be used to accurately diagnose and formulate treatment plans.

Methods: 100 patients with acute upper extremity injuries were prospectively evaluated by one orthopaedic resident. The evaluations involved a history and physical examination, digital images of the patient, and digital radiographs. This patient information was presented electronically to two hand surgeons six weeks after these surgeons directly evaluated the patients in the outpatient clinic. The physicians formulated a diagnosis and treatment plan for the patients based on the blinded electronic information, and these findings were then compared to the treatment plans made by the physicians directly at the earlier time point. Kappa coefficients (kappa) of intraobserver and interobserver reliability for diagnosis and treatment were generated.

Results: Telemedicine consultation did not alter proposed treatment plans within observers (intraobserver agreement: kappa =. 89, high) or between observers (kappa =. 86, high). The actual number of diagnoses and treatments which changed within observers was four and five, respectively.

Discussion and Conclusion: Telemedicine consultation resulted in no significant change in the proposed management of upper extremity injuries, and appears to provide an accurate and powerful method for delivery of orthopaedic care.