The Reliability of Measurements Taken from Computer-Stored                     Digitalised X-Rays of Acute Distal Radius Fractures

Sixteen observers measured eight anatomical parameters on digitalised images of six acute distal radial fractures using the Patient Archiving Communication System software and repeated the measurements at least 2 weeks later. Inter- and intraobserver reliability was calculated using intraclass correlation coefficients and tolerance limits. The highest interobserver agreement was demonstrated in the dorsal tilt (intraclass correlation coefficient 0.858; tolerance limit 14.2°). When compared with the results of a study looking at observer reliability in measurement of healed distal radial fractures, the reliability of computerised measurements is not significantly different from those achieved by manual techniques (dorsal tilt interobserver tolerance limits on computer system 16°, compared to 15° using ruler and protractor). These results suggest that the recommended radiological reduction limits for distal radius fractures of <10° change in palmar tilt, <2 mm radial shortening, <5° change in radial angle and a <1 to 2 mm articular step cannot be reliably measured.

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Reliability of Hand Fellows’ Measurements and Classifications from Radiographs of Distal Radius Fractures

Canadian Journal of Plastic Surgery ◽

10.1177/229255030100900204 ◽

2001 ◽

Vol 9 (2) ◽

pp. 51-58 ◽

Cited By ~ 8

Author(s):

Joy C Macdermid ◽

Robert S Richards ◽

Allan Donner ◽

Nick Bellamy ◽

James H Roth ◽

...

Keyword(s):

Distal Radius ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Classification Systems ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Rater Reliability ◽

Intraclass Correlation Coefficients ◽

Direct Measurements ◽

Dorsal Angulation

The inter-rater reliability of classification systems and the direct measurement of fracture displacement was evaluated for two hand fellows in 128 radiographs of distal radius fractures. The fracture classifications rated were the Older, Mayo, AO, McMurtry, Universal and Frykman systems. Measurements of displacement were radial tilt, radial shortening and dorsal angulation on pre- and postreduction films. Intraclass correlation coefficients (ICCs) and kappas, and their associated 95% confidence intervals were calculated. Inter-rater reliability for classification systems was poor, with the exception of the Older system (kappa = 0.73). Prereduction measurement of radial inclination, dorsal angulation and radial shortening had excellent reliability (ICC 0.77). Postreduction films exhibited lower reliability in the same measurements (ICC 0.76). Hand fellows reported inconsistent use of classification systems or radiographical measurements in clinical practice. Further training and/or an increased emphasis on direct measurements, rather than classifications, may be warranted.

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Technique for Intramedullary Stabilization of Ulnar Neck Fractures

Hand ◽

10.1177/1558944717725376 ◽

2017 ◽

Vol 13 (5) ◽

pp. 563-571

Author(s):

Jack Abboudi ◽

Scott M. Sandilands ◽

C. Edward Hoffler ◽

William Kirkpatrick ◽

William Emper

Keyword(s):

Distal Radius ◽

Kirschner Wire ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Distal Radial Fractures ◽

Percutaneous Approach ◽

Intramedullary Stabilization ◽

Ulna Fractures ◽

Neck Fracture ◽

Reproducible Method

Background: Distal ulna fractures at the ulnar neck can be seen in association with distal radius fractures, and multiple techniques have been described to address the ulnar neck component of these injuries. We have found that treatment of ulnar neck fractures can be challenging in terms of anatomy and fracture fixation. We present a new percutaneous fixation technique for ulnar neck fractures commonly seen with distal radius fractures. Technique: Fixation of the ulnar neck fracture is performed after fixation of the distal radius fracture. Our technique uses anterograde intramedullary fixation to stabilize the fracture with a 1.6-mm (0.062 inch) Kirschner wire or a commercially available metacarpal fixation intramedullary nail. The fixation is introduced into the intramedullary space of the ulnar shaft 4 to 6 cm proximal to the fracture at a separate surgical site along the subcutaneous border of the ulna. The fixation is also supported with a sugar-tong splint for the first few weeks after surgery and requires removal of the ulnar implant approximately 10 weeks after implantation. Conclusion: Our technique utilizes a percutaneous approach with minimal fracture exposure. It provides a relatively simple and reproducible method to address ulnar neck fractures commonly seen in association with distal radial fractures.

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Perfil epidemiológico das fraturas radiais distais em hospital de referência em Ribeirão Preto, Brasil

ARCHIVES OF HEALTH INVESTIGATION ◽

10.21270/archi.v9i3.5112 ◽

2020 ◽

Vol 9 (3) ◽

Author(s):

Felipe Azevedo Mendes de Oliveira ◽

Thiago Agostini Pereira Albeny ◽

Luis Guilherme Rosifini Alves Rezende ◽

Filipe Jun Shimaoka ◽

Amanda Favaro Cagnolati ◽

...

Keyword(s):

Distal Radius Fracture ◽

Distal Radius ◽

Case Series ◽

High Energy ◽

Distal Radius Fractures ◽

Radius Fracture ◽

Distal Radial Fracture ◽

Fracture Treatment ◽

Radius Fractures ◽

Distal Radial Fractures

Objetivo: Avaliar o perfil epidemiológico das fraturas do rádio distal em hospitais de referência em Ribeirão Preto(SP), Brasil. Não existem dados suficientes na literatura nacional que corroborem com o perfil epidemiológico das fraturas do rádio distal. Métodos: 245 pacientes apresentaram 254 fraturas do rádio distal, ocorridas entre 2014 a 2017 foram avaliadas retrospectivamente para obtenção do perfil epidemiológico. Os fatores analisados foram idade e sexo, mecanismo do trauma, sazonalidade, tipo de fratura baseada na Classificação AO, presença de exposição óssea, lesões associadas, tipo de tratamento realizado (conservador ou cirúrgico) e o tipo de implante utilizado nos tratamentos cirúrgicos. Resultados: 60,2% dos pacientes participantes eram do sexo masculino e 39,8% do sexo feminino, distribuídos de forma bimodal. A média de idade foi 45,4 anos. Fraturas expostas corresponderam a 92,1% das fraturas e 7,9% representaram as expostas. Pacientes politraumatizados representaram 62,6%. O tempo médio de internação foi 8,09 dias. Conclusão: Apesar do padrão de fraturas mostrar semelhanças com outros estudos, o padrão apresentado pode não traduzir, de forma homogênea, o padrão obtido em outras metrópoles e grandes centros.Descritores: Fraturas do Rádio; Traumatismos do Punho; Epidemiologia; Hospitais Especializados.ReferênciasBruce KK, Merenstein DJ, Narvaez MV, Neufeld SK, Paulus MJ, Tan TP et al. Lack of Agreement on Distal Radius Fracture Treatment. J Am Board Fam Med. 2016;29(2):218-25.MacIntyre NJ, Dewan N. Epidemiology of distal radius fractures and factors predicting risk and prognosis. J Hand Ther. 2016;29(2):136-45.Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006;37(8):691-97.Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clin. 2012;28(2):113-25. Flinkkilä T, Sirniö K, Hippi M, Hartonen S, Ruuhela R, Ohtonen P et al. Epidemiology and seasonal variation of distal radius fractures in Oulu, Finland. Osteoporos Int. 2011;22(8):2307-312.Lindau TR, Aspenberg P, Arner M, Redlundh-Johnell I, Hagberg L. Fractures of the distal forearm in young adults. An epidemiologic description of 341 patients. Acta Orthop Scand. 1999;70(2):124-28.Diamantopoulos AP, Rohde G, Johnsrud I, Skoie IM, Hochberg M, Haugeberg G. The epidemiology of low- and high-energy distal radius fracture in middle-aged and elderly men and women in Southern Norway. PLoS One. 2012;7(8):e43367.Wilcke MK, Hammarberg H, Adolphson PY. Epidemiology and changed surgical treatment methods for fractures of the distal radius: a registry analysis of 42,583 patients in Stockholm County, Sweden, 2004–2010. Acta Orthop. 2013;84(3):292-96.Sigurdardottir K, Halldorsson S, Robertsson J. Epidemiology and treatment of distal radius fractures in Reykjavik, Iceland, in 2004. Comparison with an Icelandic study from 1985. Acta Orthop. 2011;82(4):494-98.Solgaard S, Petersen VS. Epidemiology of distal radius fractures. Acta Orthop Scand. 1985;56(5):391-93.Brogren E, Petranek M, Atroshi I. Incidence and characteristics of distal radius fractures in a southern Swedish region. BMC Musculoskelet Disord. 2007;8:48. Tsai CH, Muo CH, Fong YC, et al. A population-based study on trend in incidence of distal radial fractures in adults in Taiwan in 2000-2007. Osteoporos Int. 2011;22(11):2809-815.Koo OT, Tan DM, Chong AK. Distal radius fractures: an epidemiological review. Orthop Surg. 2013;5(3):209-13. Dóczi J, Renner A. Epidemiology of distal radius fractures in Budapest. A retrospective study of 2,241 cases in 1989. Acta Orthop Scand. 1994;65(4):432-33.Chen NC, Jupiter JB. Management of distal radial fractures. J Bone Joint Surg Am. 2007;89(9):2051-62.Pagano M, Gauvreau K. Princípios de Bioestatística. 2. ed. São Paulo: Pioneira Thompson Learning; 2004. Court-Brown CM. Epidemiologia das fraturas e luxações. In: Court-Brown CM et al. (ed.); Fraturas em adultos de Rockwood Green. 8. ed. Barueri, SP: Manole; 2016.Fanuele J, Koval KJ, Lurie J, Zhou W, Tosteson A, Ring D. Distal radial fracture treatment: what you get may depend on your age and address. J Bone Joint Surg Am. 2009;91(6):1313-19.Jupiter JB, Marent-Huber M; LCP Study Group. Operative management of distal radial fractures with 2.4-millimeter locking plates: a multicenter prospective case series. Surgical technique. J Bone Joint Surg Am. 2010;92(Suppl 1 Pt 1):96-106.

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Extensor Tendon Entrapment on Computed Tomography Imaging of Distal Radius Fractures

Journal of Wrist Surgery ◽

10.1055/s-0039-3402424 ◽

2019 ◽

Vol 09 (02) ◽

pp. 129-135

Author(s):

Evan D. Nigh ◽

Christopher P. Emerson ◽

David To ◽

Spencer Barnhill ◽

Michael G. Rizzo ◽

...

Keyword(s):

Computed Tomography ◽

Distal Radius ◽

Motor Vehicle ◽

Ct Imaging ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Distal Radial Fractures ◽

Level Of Evidence ◽

Extensor Pollicis Longus ◽

Tendon Entrapment

Abstract Objective To examine the association between distal radius fractures and tendon entrapment identified on computed tomography (CT) imaging. Patients and Methods After Institutional Review Board approval, we retrospectively reviewed distal radius fractures that underwent CT imaging from an electronic database between January 2006 to February 2018 at a single level 1 hospital trauma center. We categorized all distal radial fractures according to the AO-OTA (AO Foundation/Orthopaedic Trauma Association) classification. Distal upper extremity tendons were assessed for entrapment. Fisher's exact test was used for statistical analysis with significance at p < 0.05. Results A total of 183 distal radius fractures were identified in 179 patients. A total of 16 fractures (13 males and 3 females) were associated with tendon entrapment. Mechanism of injury included falls (n = 7), motor vehicle accidents (n = 6), dog bites (n = 2), and gunshot wound (n = 1). Entrapped tendons were limited to the extensor compartment and included the extensor pollicis longus (EPL; n = 11), extensor pollicis brevis (n = 1), extensor carpi ulnaris (n = 1), extensor carpi radialis longus (n = 1), and extensor digitorum communis (n = 2). The most commonly associated AO-OTA fracture pattern with tendon entrapment was complete articular radial fractures (2R3C; 69%), eight of which were simple articular with metaphyseal multifragmentary fractures (2R3C2). Of the distal radius fractures, 81% were associated with additional ulnar fractures of varying severity and displacement. Conclusion Approximately 8.7% of distal radius fractures were retrospectively identified to have tendon entrapment compared with a previously reported incidence of 1.3%. Wrist surgeons and radiologists should have higher suspicion for tendon entrapment and carefully review preoperative CT imaging for tendon entrapment in distal radius fractures especially if there is an intra-articular, multifragmentary injury pattern. Wrist surgeons and radiologists should also have increased suspicion for EPL tendon entrapments given its high incidence in association with distal radius fractures. Level of Evidence This is a Level III, retrospective cross-sectional study.

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Results of the treatment of distal radius fractures with a proprietary implant, the DRONes nail plate – preliminary report

Chirurgia Narządów Ruchu i Ortopedia Polska ◽

10.31139/chnriop.2020.86.2.6 ◽

2020 ◽

Vol 86 (2) ◽

pp. 66-72

Author(s):

Maciej Piotrowski ◽

Keyword(s):

Distal Radius ◽

Soft Tissues ◽

Full Range ◽

Nail Plate ◽

Functional Results ◽

Distal Radius Fractures ◽

Intramedullary Fixation ◽

X Rays ◽

Radius Fractures ◽

Additional Advantage

Introduction. Distal radius fractures are one of the most common bone injuries. Modern treatment methods are needed not only to reduce the time needed to heal, but also allow the wrist the full range of motion as soon as possible. The solution should provide stable bone fixation with the least possible damage to soft tissues, which will allow quick recovery of extremity function. The method meeting these criteria is intramedullary fixation. Aim of the study. To evaluate the treatment results of distal radius fractures with the DRONes® hybrid nail plate. Material and methods. The study group consists of patients with distal radius fracture treated with open reduction and intramedullary fixation. Patients aged 24 to 69 years (average 54 years) were operated on after a failed attempt to adjust the fracture using the closed reduction method. 40 distal fractures of the distal radius qualified for the following 5 types according to AO: 2 fractures -A2, 5 -A3, 8 -C1, 14 -C2, 11 -C3. Two weeks after the surgery, X-rays were performed to check the position of the bone fragments and implant. After a further 6-7 weeks, the union and wrist function were evaluated. Results. Bone union was achieved in all patients within 8-9 weeks, and the range of wrist mobility was only slightly limited. The most common complication was the neurapraxia of the superficial branch of the radial nerve disappearing after 6-8 weeks. Conclusions. Patients treated with the DRONes® hybrid nail plate achieve good functional results after 8-9 weeks and can return to work and their preinjury lifestyle. An additional advantage is the simple surgical technique.

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The reliability of the augmented Lehnert-Schroth and Rigo classification in scoliosis management

South African Journal of Physiotherapy ◽

10.4102/sajp.v77i2.1568 ◽

2021 ◽

Vol 77 (2) ◽

Author(s):

Burçin Akçay ◽

Tuğba Kuru Çolak ◽

Adnan Apti ◽

İlker Çolak ◽

Önder Kızıltaş

Keyword(s):

Treatment Plan ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Error Measurement ◽

X Rays ◽

X Ray ◽

Intraclass Correlation Coefficients ◽

Observer Reliability ◽

The Individual ◽

Curve Patterns

Background: In pattern-specific scoliosis exercises and bracing, the corrective treatment plan differs according to different curve patterns. There are a limited number of studies investigating the reliability of the commonly used classifications systems.Objective: To test the reliability of the augmented Lehnert-Schroth (ALS) classification and the Rigo classification.Methods: X-rays and posterior photographs of 45 patients with scoliosis were sent by the first author to three clinicians twice at 1-week intervals. The clinicians classified images according to the ALS and Rigo classifications, and the data were analysed using SPSS V-16. Intraclass correlation coefficients (ICCs) and standard error measurement (SEM) were calculated to evaluate the inter- and intra-observer reliability.Results: The inter-observer ICC values were 0.552 (ALS), 0.452 (Rigo) for X-ray images and 0.494 (ALS), 0.518 (Rigo) for the photographs. The average intra-observer ICC value was 0.720 (ALS), 0.581 (Rigo) for the X-ray images and 0.726 (ALS) and 0.467 (Rigo) for the photographs.Conclusions: The results of our study indicate moderate inter-observer reliability for X-ray images using the ALS classification and clinical photographs using the Rigo classification. Intra-observer reliability was moderate to good for X-ray images and clinical photographs using the ALS classification and poor to moderate for X-ray and clinical photographs using the Rigo classification.Clinical implications: Pattern classifications assist in creating a plan and indication of correction in specific scoliosis physiotherapy and pattern-specific brace applications and surgical treatment. More sub-types are needed to address the individual patterns of curvature. The optimisation of curve classification will likely reduce failures in diagnosis and treatment.

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Below-elbow or above-elbow cast for conservative treatment of extra-articular distal radius fractures with dorsal displacement: a prospective randomized trial

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1530-1 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 3

Author(s):

Gaetano Caruso ◽

Francesco Tonon ◽

Alessandro Gildone ◽

Mattia Andreotti ◽

Roberto Altavilla ◽

...

Keyword(s):

Conservative Treatment ◽

Clinical Outcomes ◽

Distal Radius ◽

Randomised Trial ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Distal Radial Fractures ◽

Radiological Parameters ◽

Cast Group

Abstract Background Distal radial fractures are common traumatic injuries, but their management remains controversial also in case of conservative treatment regarding the type of immobilisation. Hence, we conducted a two-arm, parallel-group, prospective randomised trial to compare the capacity of long casts (above-elbow) and short casts (below-elbow) to maintain the reduction of extra-articular distal radius fractures with dorsal displacement (AO/OTA classification: 2R3A2.2). Methods Seventy-four eligible patients with AO/OTA 2R3A2.2 fractures treated with closed reduction and cast immobilisation were randomised to the long cast group (n°= 37) or to the short cast group (n°= 37). Baseline radiological parameters, radial inclination (RI), radial height (RH), ulnar variance (UV) and palmar tilt (PT) were taken, and compared with clinical (DASH, Mayo Wrist and Mayo Elbow) and radiological scores taken at 7–10 days, 4 weeks and 12 weeks. Furthermore, to evaluate correlations between radiological parameters and functional outcomes, patients were divided into two groups according to whether or not their radiological parameters at Follow-ups 2 and 3 were acceptable, i.e. within the range 11–12 mm for RH, 16°–28° for RI, − 4–+ 2 mm for UV and 0°–22° for PT. Results Patient demographic and baseline radiological parameters were similar between groups. At follow-up, there were no statistically significant differences between the two types of cast in terms of RI, RH, UV or PT, or Mayo wrist or DASH scores. Short cast group patients displayed better Mayo elbow score at follow-up 2 (4 weeks), but this difference was no longer statistically significant at follow-up 3 (12 weeks). No statistically significant differences in clinical outcomes were found between patients who presented acceptable radiographic parameters at follow-up and those who did not. Conclusion As there were no significant differences between short casts and long casts in terms of fracture reduction maintenance or clinical outcomes, short casts are an effective method of post-reduction immobilisation in AO/OTA 2R3A2.2 fracture of the radius. Radiological parameters outside the range conventionally considered acceptable do not preclude a satisfactory clinical outcome. Trial registration ClinicalTrials.gov PRS, NCT04062110. Registred 20 August 2019.

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Radiographic Outcomes and Complications of Delayed Fixation of Distal Radius Fractures

Hand ◽

10.1177/1558944720930301 ◽

2020 ◽

pp. 155894472093030

Author(s):

Stella J. Lee ◽

Derek S. Stenquist ◽

Jamie E. Collins ◽

Ariana N. Mora ◽

Brett A. Teplitz ◽

...

Keyword(s):

Cohort Study ◽

Surgical Treatment ◽

Distal Radius ◽

Distal Radius Fractures ◽

X Rays ◽

Matched Cohort ◽

Radius Fractures ◽

Radiographic Outcomes ◽

Radiographic Parameters ◽

Surgical Fixation

Background: Surgeons are sometimes presented with patients with distal radius fractures who present in a delayed fashion or lose reduction after several weeks of attempted closed management. There are limited studies on delayed surgical treatment of distal radius fractures to assist providers in decision-making. Methods: We conducted a matched cohort study to compare radiographic outcomes and complications for patients with a distal radius fracture treated with delayed (3-5 weeks) or early (0-2 weeks) surgical fixation. Patients ages 18+ who underwent open reduction and internal fixation of distal radius fractures by a volar approach at 2 Level I trauma centers between 2003 and 2015 were eligible. We measured radiographic outcomes and reviewed medical records to determine operative approach and complications. Results: There were 25 cases and 50 controls matched for age (18-87), sex, and AO fracture type. The delayed group had surgery at a mean of 24.8 days from injury and the early group at 5.6 days. There was no statistically significant difference between the delayed and early cohorts in radiographic parameters on injury x-rays, in improvement in radiographic parameters on first postoperative x-rays, or in maintenance of radiographic parameters at union. Conclusion: We did not find significant differences in radiographic outcomes or complication rates between patients with delayed versus early surgical treatment for distal radius fracture. Providers treating patients with late presentation or late displacement have the option of surgical fixation beyond the first few weeks after injury. Level of Evidence: III (Retrospective matched cohort study)

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Arthroscopic Management of Intra-articular Ligament Lesions on Distal Radius Fractures

Revista Iberoamericana de Cirugía de la Mano ◽

10.1055/s-0041-1730393 ◽

2021 ◽

Vol 49 (01) ◽

pp. 024-036

Author(s):

Marcio Aurelio Aita ◽

Ricardo Kaempf ◽

Bruno Gianordoli Biondi ◽

Gary Alan Montano ◽

Fernando Towata ◽

...

Keyword(s):

Return To Work ◽

Distal Radius ◽

Patient Reported Outcomes ◽

Distal Radius Fractures ◽

Joint Surface ◽

Wrist Arthroscopy ◽

X Rays ◽

Radius Fractures ◽

Patient Reported ◽

The Mean

AbstractArticular distal radius fractures (DRFs) have increased in incidence in recent years, especially among the economically active population. Most of the treatment approaches are based on plain X- rays, and do not give us any information on how to treat these fractures. In the search for solutions with greater precision in diagnosis, in reducing the joint surface of the fracture, and envolving minimally-invasive techniques, we found arthroscopy as the main tool for these patients. Therefore, an enhanced understanding of the biomechanics of the different types of fracture associated with ligamentous lesions should facilitate the right decision regarding the treatment. The present paper aims at providing a management-oriented concept to diagnose and treat ligamentous lesions associated with intra-articular DRFs based on a arthroscopy-assisted procedure, and showing the objective and patient-reported outcomes and a new classification. The objective and patient-reported outcomes were: the mean range of motion (ROM) was of 94.80% on the non-affected side; the mean score on the abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) was of 3.6 (range: 1 to 12). The score on the Visual Analog Scale (VAS) was of 1.66 (range: 1 to 3). Complications were observed in 2 (13.33%) patients: extensor tendon synovitis in 1 patient, and a limitation (stiffness) in ROM in 1 patient, both treated with wrist arthroscopy release. The mean time until the return to work was of 6.4 weeks. In patients with unstable intra-articular DRFs associated with ligamentous lesions, the fixation of specific osseous-ligamentous fragments and ligamentous repair/reconstruction by wrist arthroscopy prove to be a safe and reliable treatment. The clinical and functional results predict that the patients can return to work more quickly.

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Artificial intelligence to diagnosis distal radius fracture using biplane plain X-rays

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02845-0 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Kunihiro Oka ◽

Ryoya Shiode ◽

Yuichi Yoshii ◽

Hiroyuki Tanaka ◽

Toru Iwahashi ◽

...

Keyword(s):

Artificial Intelligence ◽

Diagnostic Accuracy ◽

Distal Radius ◽

Diagnostic Tests ◽

Styloid Process ◽

Final Diagnosis ◽

Distal Radius Fractures ◽

X Rays ◽

Radius Fractures ◽

X Ray

Abstract Background Although the automatic diagnosis of fractures using artificial intelligence (AI) has recently been reported to be more accurate than those by orthopedics specialists, big data with at least 1000 images or more are required for deep learning of the convolutional neural network (CNN) to improve diagnostic accuracy. The aim of this study was to develop an AI system capable of diagnosing distal radius fractures with high accuracy even when learning with relatively small data by learning to use bi-planar X-rays images. Methods VGG16, a learned image recognition model, was used as the CNN. It was modified into a network with two output layers to identify the fractures in plain X-ray images. We augmented 369 plain X-ray anteroposterior images and 360 lateral images of distal radius fractures, as well as 129 anteroposterior images and 125 lateral images of normal wrists to conduct training and diagnostic tests. Similarly, diagnostic tests for fractures of the styloid process of the ulna were conducted using 189 plain X-ray anteroposterior images of fractures and 302 images of the normal styloid process. The distal radius fracture is determined by entering an anteroposterior image of the wrist for testing into the trained AI. If it identifies a fracture, it is diagnosed as the same. However, if the anteroposterior image is determined as normal, the lateral image of the same patient is entered. If a fracture is identified, the final diagnosis is fracture; if the lateral image is identified as normal, the final diagnosis is normal. Results The diagnostic accuracy of distal radius fractures and fractures of the styloid process of the ulna were 98.0 ± 1.6% and 91.1 ± 2.5%, respectively. The areas under the receiver operating characteristic curve were 0.991 {n = 540; 95% confidence interval (CI), 0.984–0.999} and 0.956 (n = 450; 95% CI 0.938–0.973). Conclusions Our method resulted in a good diagnostic rate, even when using a relatively small amount of data.

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