Aims: To compare digital imaging sent via email versus conventional radiographs in diagnosing and managing ankle fractures. Methods: Radiographs on a viewing box were photographed using a digital camera with a resolution of 1024 x 768 pixels at 24-bit colour depth. The resultant images were compressed using the JPEG (Joint Photographic Experts Group) format at a medium compression ratio and transmitted as email attachments. The mean size of the resultant files was 165 kByte (range146–209). The study radiographs, including 66 radiographs (33 A-P and 33 Lateral), were viewed by seven orthopaedic surgeons and assessed according to the classification of ankle fracture and the surgeons’ choice of management for that fracture. Over a four month interval, each surgeon was independently shown each set of patients’ radiographs 4 times: twice via JPEG format on a computer screen and twice via a conventional light box. Results: Results were analysed using weight kappa scores, interclass correlation and variance, for interobserver and intraobserver error for both diagnostic classification and for management decision. These results were then used to determine if there was a difference between interpretation of radiographs presented in the two different formats. There were no significant difference in diagnostic accuracy or management decisions between conventional radiographs and telemedicine reading. Conclusions: JPEG compression is suitable for transmission of X-ray