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Dababneh et al. Art Int Surg 2024;4:214-32    https://dx.doi.org/10.20517/ais.2024.50                                                                                                                                                    Page 222



                          Tung et al.     Scaphoid                               356                       VGG16, VGG19, RN50, RN101, RN152, DN121, DN169,      RN101: 0.950      RN101: 0.889       RN101: 0.889
                                [44]
                          (2021)                                                                           DN201, Inv, ENB0                                     DN201: 0.910      DN201: 0.944       DN201: 0.861
                          Yang et al.     Scaphoid                               361                       ResNet                                               0.917             0.735              0.920
                                 [45]
                          (2022)
                          Langerhuizen    Scaphoid                               300 (scaphoid series)     Open source pretrained CNN (Visual Geometry Group,   0.77              0.84               0.60
                                     [47]
                          et al. (2020)                                                                    Oxford, United Kingdom)

                          Yoon et al.     Scaphoid                               11,838 (PA, scaphoid view)  DCNN based on the EfficientNetB3 architecture      Fracture detection:  0.87            0.92
                                [48]
                          (2021)                                                                                                                                0.955
                                                                                                                                                                Occult fracture
                                                                                                                                                                detection: 0.81

                          Raisuddin et al.  Distal radius                        4,497 (AP, lat)           DeepWrist                                            General test:     General test: 0.97   General test: 0.87
                                [49]
                          (2021)                                                                                                                                0.990             Occult fractures:   Occult
                                                                                                                                                                Occult fractures:   0.60             fractures:0.92
                                                                                                                                                                0.84
                          Zech et al.     Distal radius                          395 (AP)                  Faster R-CNN model                                   0.92              0.88               0.89
                                 [51]*
                          (2023)
                          Ilie et al.     Finger, hand, wrist, forearm, elbow,   58,846                    Faster R-CNN                                         0.96              0.91               0.89
                                 [53]
                          (2023)          humerus, shoulder, clavicule
                          Watanabe        Distal radius or distal ulna           7,356 (PA, lat)           Inception-ResNet Faster R-CNN                        0.918 (PA)        0.957 (PA)         0.825 (PA)
                                     [54]
                          et al. (2019)                                                                                                                         0.933 (lat)       0.967 (lat)        0.864 (lat)
                          Orji et al.     Finger                                 8,170                     ComDNet-512 (deep neural network-based hybrid model) 0.894             0.94               0.85
                                 [55]
                          (2022)
                          *
                          Pediatric studies. ML: Machine learning; AUC: area under the receiver operator characteristic curve; CNN: convolutional neural network; AP: anterior-posterior radiograph projection; lat: lateral radiograph
                          projection; AI: artificial intelligence; PA: posterior-anterior radiograph projection; WFD-C: wrist fracture detection-combo; DCNN: deep convolutional neural network; R-CNN: region-based convolutional neural
                          network.



                          AI as an adjuvant in ultrasound fracture detection

                          While X-rays remain the gold standard for diagnosing distal radius fractures, the use of ultrasound (US) in emergency departments (ED) has gained popularity
                          due to its accessibility, minimal training requirements, and capacity to assess surrounding soft tissues.



                          Zhang et al. were the first to explore the potential of US for fracture detection, aiming to reduce unnecessary radiation exposure for children without

                          fractures . In their study, they used a three-dimensional ultrasound (3DUS) as a diagnosis tool for patients presenting with wrist tenderness before
                                    [56]
                          undergoing X-rays. The findings demonstrated that 3DUS had a diagnostic accuracy of 96.5% for distal radius fractures, establishing it as a reliable method for

                          fracture detection in a pediatric setting. Moreover, the CNN model trained to interpret US images detected all fractures with 100% sensitivity and 87%
                          specificity, matching the sensitivity of the pediatric MSK radiologist.
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