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. 2024 Dec;50(6):2819-2831.
doi: 10.1007/s00068-024-02557-0. Epub 2024 Jul 9.

AI for detection, classification and prediction of loss of alignment of distal radius fractures; a systematic review

Koen D Oude Nijhuis #  1   2 , Lente H M Dankelman #  3   4 , Jort P Wiersma  5   6 , Britt Barvelink  7 , Frank F A IJpma  8 , Michael H J Verhofstad  9 , Job N Doornberg  5   8   10 , Joost W Colaris  7 , Mathieu M E Wijffels  9 ; Machine Learning Consortium
Affiliations

AI for detection, classification and prediction of loss of alignment of distal radius fractures; a systematic review

Koen D Oude Nijhuis et al. Eur J Trauma Emerg Surg. 2024 Dec.

Abstract

Purpose: Early and accurate assessment of distal radius fractures (DRFs) is crucial for optimal prognosis. Identifying fractures likely to lose threshold alignment (instability) in a cast is vital for treatment decisions, yet prediction tools' accuracy and reliability remain challenging. Artificial intelligence (AI), particularly Convolutional Neural Networks (CNNs), can evaluate radiographic images with high performance. This systematic review aims to summarize studies utilizing CNNs to detect, classify, or predict loss of threshold alignment of DRFs.

Methods: A literature search was performed according to the PRISMA. Studies were eligible when the use of AI for the detection, classification, or prediction of loss of threshold alignment was analyzed. Quality assessment was done with a modified version of the methodologic index for non-randomized studies (MINORS).

Results: Of the 576 identified studies, 15 were included. On fracture detection, studies reported sensitivity and specificity ranging from 80 to 99% and 73-100%, respectively; the AUC ranged from 0.87 to 0.99; the accuracy varied from 82 to 99%. The accuracy of fracture classification ranged from 60 to 81% and the AUC from 0.59 to 0.84. No studies focused on predicting loss of thresholds alignement of DRFs.

Conclusion: AI models for DRF detection show promising performance, indicating the potential of algorithms to assist clinicians in the assessment of radiographs. In addition, AI models showed similar performance compared to clinicians. No algorithms for predicting the loss of threshold alignment were identified in our literature search despite the clinical relevance of such algorithms.

Keywords: Artificial intelligencess; Distal radius fractures; Trauma; Wrist.

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Conflict of interest statement

Declarations. Ethical approval: This study was performed at the Trauma Research Unit Department of Surgery, Erasmus University Medical Center Rotterdam, the Netherlands and at the Orthopedic Department, the University of Groningen, University Medical Center Groningen, the Netherlands. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Inclusion and exclusion flowchart
Fig. 2
Fig. 2
Different visualization of localization of fractures on PA radiographs. From left to right: a heatmap, a polygon and a bounding box
See this image and copyright information in PMC

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