• Koen D Oude Nijhuis, Britt Barvelink, Jasper Prijs, Yang Zhao, Zhibin Liao, Ruurd L Jaarsma, IJpmaFrank F AFFADepartment of Trauma Surgery, University Medical Centre Groningen and Groningen University, Hanzeplein 1, 9713PZ, Groningen, the Netherlands., Joost W Colaris, Job N Doornberg, WijffelsMathieu M EMMETrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands., and Machine Learning Consortium.
• Department of Orthopaedic Surgery, University Medical Centre Groningen and Groningen University, Hanzeplein 1, 9713PZ, Groningen, the Netherlands. k.d.oude.nijhuis@umcg.nl.
• Eur J Trauma Emerg Surg. 2025 Jan 17; 51 (1): 2626.

PurposeDistal radius fractures (DRFs) are often initially assessed by junior doctors under time constraints, with limited supervision, risking significant consequences if missed. Convolutional Neural Networks (CNNs) can aid in diagnosing fractures. This study aims to internally and externally validate an open source algorithm for the detection and localization of DRFs.MethodsPatients from a level 1 trauma center from Adelaide, Australia that presented between 2016 and 2020 with wrist trauma were retrospectively included. Radiographs were reviewed confirming the presence or absence of a fracture, as well as annotating radius, ulna, and fracture location. An internal validation dataset from the same hospital was created. An external validation set was created with two other level 1 trauma centers, from Groningen and Rotterdam, the Netherlands. Three surgeons reviewed both sets for DRFs.ResultsThe algorithm was trained on 659 radiographs. The internal validation set included 190 patients, showing an accuracy of 87% and an AUC of 0.93 for DRF detection. The external validation set consisted of 188 patients, with an accuracy and AUC were 82% and 0.88 respectively. Radial and ulnar bone segmentation on the internal validation was excellent with an AP50 of 99 and 98, but moderate for fracture segmentation with an AP50 of 29. For external validation the AP50 was 92, 89 and 25 for radius, ulna, and fracture respectively.ConclusionThis open-source algorithm effectively detects DRFs with high accuracy and localizes them with moderate accuracy. It can assist clinicians in diagnosing suspected DRFs and is the first radiograph-based CNN externally validated on patients from multiple hospitals.© 2025. The Author(s).

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