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The Bone & Joint Journal
Vol. 107-B, Issue 2 | Pages 213 - 220
1 Feb 2025
Zheng Z Ryu BY Kim SE Song DS Kim SH Park J Ro DH

Aims. The aim of this study was to develop and evaluate a deep learning-based model for classification of hip fractures to enhance diagnostic accuracy. Methods. A retrospective study used 5,168 hip anteroposterior radiographs, with 4,493 radiographs from two institutes (internal dataset) for training and 675 radiographs from another institute for validation. A convolutional neural network (CNN)-based classification model was trained on four types of hip fractures (Displaced, Valgus-impacted, Stable, and Unstable), using DAMO-YOLO for data processing and augmentation. The model’s accuracy, sensitivity, specificity, Intersection over Union (IoU), and Dice coefficient were evaluated. Orthopaedic surgeons’ diagnoses served as the reference standard, with comparisons made before and after artificial intelligence assistance. Results. The accuracy, sensitivity, specificity, IoU, and Dice coefficients of the model for the four fracture categories in the internal dataset were as follows: Displaced (1.0, 0.79, 1.0, 0.70, 0.82), Valgus-impacted (1.0, 0.80, 1.0, 0.70, 0.82), Stable (0.99, 0.95, 0.99, 0.83, 0.89), and Unstable (1.0, 0.98, 0.99, 0.86, 0.92), respectively. For the external validation dataset, the sensitivity and specificity were as follows: Displaced (0.83, 0.94), Valgus-impacted (0.89, 0.90), Stable (0.88, 0.95), and Unstable (0.85, 0.99), respectively. The overall means (Micro AVG and Macro AVG) for the external dataset were Micro AVG (0.83 (SD 0.05), 0.96 (SD 0.01)) and Macro AVG (0.69 (SD 0.02), 0.95 (SD 0.02)), respectively. Conclusion. Compared to human diagnosis alone, our study demonstrates that the developed model significantly improves the accuracy of detecting and classifying hip fractures. Our model has shown great potential in assisting clinicians with the accurate diagnosis and classification of hip fractures. Cite this article: Bone Joint J 2025;107-B(2):213–220


The Bone & Joint Journal
Vol. 106-B, Issue 11 | Pages 1348 - 1360
1 Nov 2024
Spek RWA Smith WJ Sverdlov M Broos S Zhao Y Liao Z Verjans JW Prijs J To M Åberg H Chiri W IJpma FFA Jadav B White J Bain GI Jutte PC van den Bekerom MPJ Jaarsma RL Doornberg JN

Aims

The purpose of this study was to develop a convolutional neural network (CNN) for fracture detection, classification, and identification of greater tuberosity displacement ≥ 1 cm, neck-shaft angle (NSA) ≤ 100°, shaft translation, and articular fracture involvement, on plain radiographs.

Methods

The CNN was trained and tested on radiographs sourced from 11 hospitals in Australia and externally validated on radiographs from the Netherlands. Each radiograph was paired with corresponding CT scans to serve as the reference standard based on dual independent evaluation by trained researchers and attending orthopaedic surgeons. Presence of a fracture, classification (non- to minimally displaced; two-part, multipart, and glenohumeral dislocation), and four characteristics were determined on 2D and 3D CT scans and subsequently allocated to each series of radiographs. Fracture characteristics included greater tuberosity displacement ≥ 1 cm, NSA ≤ 100°, shaft translation (0% to < 75%, 75% to 95%, > 95%), and the extent of articular involvement (0% to < 15%, 15% to 35%, or > 35%).