Skip to main content
Top
Published in: European Journal of Trauma and Emergency Surgery 1/2022

01-02-2022 | Artificial Intelligence | Original Article

Evaluation of an artificial intelligence system for diagnosing scaphoid fracture on direct radiography

Authors: Emre Ozkaya, Fatih Esad Topal, Tugrul Bulut, Merve Gursoy, Mustafa Ozuysal, Zeynep Karakaya

Published in: European Journal of Trauma and Emergency Surgery | Issue 1/2022

Login to get access

Abstract

Purpose

The aim of this study is to determine the diagnostic performance of artificial intelligence with the use of convolutional neural networks (CNN) for detecting scaphoid fractures on anteroposterior wrist radiographs. The performance of the deep learning algorithm was also compared with that of the emergency department (ED) physician and two orthopaedic specialists (less experienced and experienced in the hand surgery).

Methods

A total 390 patients with AP wrist radiographs were included in the study. The presence/absence of the fracture on radiographs was confirmed via CT. The diagnostic performance of the CNN, ED physician and two orthopaedic specialists (less experienced and experienced) as measured by AUC, sensitivity, specificity, F-Score and Youden index, to detect scaphoid fractures was evaluated and compared between the groups.

Results

The CNN had 76% sensitivity and 92% specificity, 0.840 AUC, 0.680 Youden index and 0.826 F score values in identifying scaphoid fractures. The experienced orthopaedic specialist had the best diagnostic performance according to AUC. While CNN's performance was similar to a less experienced orthopaedic specialist, it was better than the ED physician.

Conclusion

The deep learning algorithm has the potential to be used for diagnosing scaphoid fractures on radiographs. Artificial intelligence can be useful for scaphoid fracture diagnosis particularly in the absence of an experienced orthopedist or hand surgeon.
Literature
1.
go back to reference Angermann P, Lohmann M. Injuries to the hand and wrist. A study of 50.272 injuries. J Hand Surg Br. 1993;18:642–4.CrossRef Angermann P, Lohmann M. Injuries to the hand and wrist. A study of 50.272 injuries. J Hand Surg Br. 1993;18:642–4.CrossRef
2.
go back to reference Gaebler C, McQueen MM. Carpus fractures and dislocations. In: Bucholz RW, Heckman JD, Court-Brown CM, Tornetta P, editors. Fractures in adults. Philadelphia: Lippincott WW; 2009. p. 782–828. Gaebler C, McQueen MM. Carpus fractures and dislocations. In: Bucholz RW, Heckman JD, Court-Brown CM, Tornetta P, editors. Fractures in adults. Philadelphia: Lippincott WW; 2009. p. 782–828.
3.
go back to reference Carpenter CR, Pines JM, Schuur JD, et al. Adult scaphoid fracture. Acad Emerg Med. 2014;21:101–21.CrossRef Carpenter CR, Pines JM, Schuur JD, et al. Adult scaphoid fracture. Acad Emerg Med. 2014;21:101–21.CrossRef
4.
go back to reference Gäbler C, Kukla C, Breitenseher MJ, et al. Diagnosis of occult scaphoid fractures and other wrist injuries. Are repeated clinical examinations and plain radiographs still state of the art? Langenbecks Arch Surg. 2001;386:150–4.CrossRef Gäbler C, Kukla C, Breitenseher MJ, et al. Diagnosis of occult scaphoid fractures and other wrist injuries. Are repeated clinical examinations and plain radiographs still state of the art? Langenbecks Arch Surg. 2001;386:150–4.CrossRef
5.
go back to reference Sabbagh MD, Morsy M, Moran SL. Diagnosis and management of acute scaphoid fractures. Hand Clin. 2019;35:259–69.CrossRef Sabbagh MD, Morsy M, Moran SL. Diagnosis and management of acute scaphoid fractures. Hand Clin. 2019;35:259–69.CrossRef
6.
go back to reference Shetty S, Sidharthan S, Jacob J, et al. Clinical scaphoid fracture: is it time to abolish this phrase? Ann R Coll Surg Engl. 2011;93:146–8.CrossRef Shetty S, Sidharthan S, Jacob J, et al. Clinical scaphoid fracture: is it time to abolish this phrase? Ann R Coll Surg Engl. 2011;93:146–8.CrossRef
7.
go back to reference Cheng CT, Ho TY, Lee TY, et al. Application of a deep learning algorithm for detection and visualization of hip fractures on plain pelvic radiographs. Eur Radiol. 2019;29:5469–77.CrossRef Cheng CT, Ho TY, Lee TY, et al. Application of a deep learning algorithm for detection and visualization of hip fractures on plain pelvic radiographs. Eur Radiol. 2019;29:5469–77.CrossRef
8.
go back to reference Chung SW, Han SS, Lee JW, et al. Automated detection and classification of the proximal humerus fracture by using deep learning algorithm. Acta Orthop. 2018;89:468–73.CrossRef Chung SW, Han SS, Lee JW, et al. Automated detection and classification of the proximal humerus fracture by using deep learning algorithm. Acta Orthop. 2018;89:468–73.CrossRef
9.
go back to reference Olczak J, Fahlberg N, Maki A, et al. Artificial intelligence for analyzing orthopedic trauma radiographs. Acta Orthop. 2017;88:581–6.CrossRef Olczak J, Fahlberg N, Maki A, et al. Artificial intelligence for analyzing orthopedic trauma radiographs. Acta Orthop. 2017;88:581–6.CrossRef
10.
go back to reference Cooney WP, Dobyns JH, Linscheid RL. Fractures of the scaphoid: a rational approach to management. Clin Orthop Relat Res. 1980;149:90–7.CrossRef Cooney WP, Dobyns JH, Linscheid RL. Fractures of the scaphoid: a rational approach to management. Clin Orthop Relat Res. 1980;149:90–7.CrossRef
11.
go back to reference Bhat M, McCarthy M, Davis TR, et al. MRI and plain radiography in the assessment of displaced fractures of the waist of the carpal scaphoid. J Bone Jt Surg Br. 2004;86:705–13.CrossRef Bhat M, McCarthy M, Davis TR, et al. MRI and plain radiography in the assessment of displaced fractures of the waist of the carpal scaphoid. J Bone Jt Surg Br. 2004;86:705–13.CrossRef
12.
go back to reference Clementson M, Björkman A, Thomsen NOB. Acute scaphoid fractures: guidelines for diagnosis and treatment. EFORT Open Rev. 2020;5:96–103.CrossRef Clementson M, Björkman A, Thomsen NOB. Acute scaphoid fractures: guidelines for diagnosis and treatment. EFORT Open Rev. 2020;5:96–103.CrossRef
13.
go back to reference Tang JB, Giddins G. Why and how to report surgeons’ levels of expertise. J Hand Surg Eur. 2016;41:365–6.CrossRef Tang JB, Giddins G. Why and how to report surgeons’ levels of expertise. J Hand Surg Eur. 2016;41:365–6.CrossRef
14.
go back to reference England JR, Cheng PM. Artificial intelligence for medical image analysis: a guide for authors and reviewers. Am J Roentgenol. 2019;212:513–9.CrossRef England JR, Cheng PM. Artificial intelligence for medical image analysis: a guide for authors and reviewers. Am J Roentgenol. 2019;212:513–9.CrossRef
15.
go back to reference Li DL, Shen F, Yin Y, et al. Weighted youden index and its two-independent-sample comparison based on weighted sensitivity and specificity. Chin Med J (Engl). 2013;126:1150–4. Li DL, Shen F, Yin Y, et al. Weighted youden index and its two-independent-sample comparison based on weighted sensitivity and specificity. Chin Med J (Engl). 2013;126:1150–4.
16.
go back to reference Wijetunga AR, Tsang VH, Giuffre B. The utility of cross-sectional imaging in the management of suspected scaphoid fractures. J Med Radiat Sci. 2019;66:30–7.CrossRef Wijetunga AR, Tsang VH, Giuffre B. The utility of cross-sectional imaging in the management of suspected scaphoid fractures. J Med Radiat Sci. 2019;66:30–7.CrossRef
17.
go back to reference Smith M, Bain GI, Turner PC, et al. Review of imaging of scaphoid fractures. Aust N Z J Surg. 2010;80:82–90.CrossRef Smith M, Bain GI, Turner PC, et al. Review of imaging of scaphoid fractures. Aust N Z J Surg. 2010;80:82–90.CrossRef
18.
go back to reference De Zwart AD, Beeres FJ, Ring D, et al. MRI as a reference standard for suspected scaphoid fractures. Br J Radiol. 2012;85:1098–101.CrossRef De Zwart AD, Beeres FJ, Ring D, et al. MRI as a reference standard for suspected scaphoid fractures. Br J Radiol. 2012;85:1098–101.CrossRef
19.
go back to reference Platon A, Poletti PA, Van Aaken J, et al. Occult fractures of the scaphoid: the role of ultrasonography in the emergency department. Skelet Radiol. 2011;40:869–75.CrossRef Platon A, Poletti PA, Van Aaken J, et al. Occult fractures of the scaphoid: the role of ultrasonography in the emergency department. Skelet Radiol. 2011;40:869–75.CrossRef
20.
go back to reference Yin ZG, Zhang JB, Gong KT. Cost-effectiveness of diagnostic strategies for suspected scaphoid fractures. J Orthop Trauma. 2015;29:e245–e252252.CrossRef Yin ZG, Zhang JB, Gong KT. Cost-effectiveness of diagnostic strategies for suspected scaphoid fractures. J Orthop Trauma. 2015;29:e245–e252252.CrossRef
21.
go back to reference Ndow J, Ndow K, Maffulli N, et al. The suspected scaphoid fracture. How useful is a unit policy? Bull Hosp J Dis. 1998;57:93–5. Ndow J, Ndow K, Maffulli N, et al. The suspected scaphoid fracture. How useful is a unit policy? Bull Hosp J Dis. 1998;57:93–5.
22.
go back to reference Harrison W, Newton AW, Cheung G. The litigation cost of negligent scaphoid fracture management. Eur J Emerg Med. 2015;22:142–3.CrossRef Harrison W, Newton AW, Cheung G. The litigation cost of negligent scaphoid fracture management. Eur J Emerg Med. 2015;22:142–3.CrossRef
23.
go back to reference Jamjoom BA, Davis TRC. Why scaphoid fractures are missed. A review of 52 medical negligence cases. Injury. 2019;50:1306–8.CrossRef Jamjoom BA, Davis TRC. Why scaphoid fractures are missed. A review of 52 medical negligence cases. Injury. 2019;50:1306–8.CrossRef
24.
go back to reference Ring J, Talbot C, Price J, et al. Wrist and scaphoid fractures: a 17 year review of NHSLA litigation data. Injury. 2015;46:682–6.CrossRef Ring J, Talbot C, Price J, et al. Wrist and scaphoid fractures: a 17 year review of NHSLA litigation data. Injury. 2015;46:682–6.CrossRef
25.
go back to reference Tibrewal S, Jayakumar P, Vaidya S, et al. Role of MRI in the diagnosis and management of patients with clinical scaphoid fracture. Int Orthop. 2012;36:107–10.CrossRef Tibrewal S, Jayakumar P, Vaidya S, et al. Role of MRI in the diagnosis and management of patients with clinical scaphoid fracture. Int Orthop. 2012;36:107–10.CrossRef
26.
go back to reference Bethel J. Scaphoid fracture: diagnosis and management. Emerg Nurse. 2009;17:24–9.CrossRef Bethel J. Scaphoid fracture: diagnosis and management. Emerg Nurse. 2009;17:24–9.CrossRef
27.
go back to reference Amrami KK, Frick MA, Matsumoto JM. Imaging for acute and chronic scaphoid fractures. Hand Clin. 2019;35:241–57.CrossRef Amrami KK, Frick MA, Matsumoto JM. Imaging for acute and chronic scaphoid fractures. Hand Clin. 2019;35:241–57.CrossRef
Metadata
Title
Evaluation of an artificial intelligence system for diagnosing scaphoid fracture on direct radiography
Authors
Emre Ozkaya
Fatih Esad Topal
Tugrul Bulut
Merve Gursoy
Mustafa Ozuysal
Zeynep Karakaya
Publication date
01-02-2022
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 1/2022
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-020-01468-0

Other articles of this Issue 1/2022

European Journal of Trauma and Emergency Surgery 1/2022 Go to the issue