Wrist fractures are the most common type of fractures 1 and typically indicate the fractures in the distal radius or ulna bones. Our findings highlight the importance of a meticulous analysis of DL-based models before clinical use, and unearth the need for more challenging settings for testing medical AI systems. Our results reveal that a typical state-of-the-art approach, such as DeepWrist, while having a near-perfect performance on the general independent test set, has a substantially lower performance on the challenging test set-average precision of 0.99 (0.99–0.99) versus 0.64 (0.46–0.83), respectively. In this study, we have developed and analyzed a state-of-the-art DL-based pipeline for wrist (distal radius) fracture detection-DeepWrist, and evaluated it against one general population test set, and one challenging test set comprising only cases requiring confirmation by CT.
However, previous studies did not pay close attention to the difficult cases which can only be confirmed via CT imaging. Recent advances in the field of Deep Learning (DL), a subfield of Artificial Intelligence (AI), have shown that wrist fracture detection can be automated using Convolutional Neural Networks. X-ray imaging) is used for wrist fracture detection routinely, but occasionally fracture delineation poses issues and an additional confirmation by computed tomography (CT) is needed for diagnosis. >10 degrees dorsal angulation >5 mm shortening significant comminution) 1.Wrist Fracture is the most common type of fracture with a high incidence rate. Open reduction and internal fixation (ORIF) is considered when the fracture is unstable, and/or unsatisfactory closed reduction is achieved (i.e. The cast extends from below the elbow to the metacarpal heads and holds the wrist somewhat flexed and in ulnar deviation 4 - for those of you familiar with Australian rules football this position is reminiscent of the position adopted when holding a ball in preparation for a kick. The vast majority of Colles fractures can be treated with closed reduction and cast immobilization. Location of the medial fracture line: does it involve the radioulnar joint In addition to noting the presence of a fracture a number of features should be sought and commented upon: An associated ulnar styloid fracture is present in up to 50% of cases.Ī pronator quadratus sign is generally seen. If dorsal angulation is severe enough, a dinner fork deformity may be described.There is also usually impaction with resultant shortening of the radius. Dorsal angulation of the distal fracture fragment is present to a variable degree (as opposed to volar angulation of a Smith fracture). The fracture appears extra-articular and usually proximal to the radioulnar joint.
#DISTAL RADIUS FRACTURE CLASSIFICATION SERIES#
The plain radiographic series often comprises an AP and a lateral view however, it is not uncommon for an oblique view to be included. Plain films usually suffice, although if there is a concern of intra-articular extension, then CT may be beneficial. As such, in clinical practice, the use of the term Colles fracture with an appropriate description of any associated injuries is sufficient in most instances. One of the more popular is the Frykman classification system, although it fails to distinguish between Smith and Colles fractures as it is based on AP radiographs 2,3. Radiographic featuresĪ number of classification systems exist for distal forearm fractures. Most fractures are therefore dorsally angulated and impacted. The proximal row of the carpus (particularly the lunate and scaphoid) transfers energy to the distal radius, both in the dorsal direction and along the long axis of the radius.
Most Colles fractures are secondary to a fall on an outstretched hand (FOOSH) with a pronated forearm in wrist extension (the position one adopts when trying to break a forward fall).
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