Skeletal Radiology

, Volume 48, Issue 2, pp 239–244 | Cite as

Detecting intertrochanteric hip fractures with orthopedist-level accuracy using a deep convolutional neural network

  • Takaaki UrakawaEmail author
  • Yuki Tanaka
  • Shinichi Goto
  • Hitoshi Matsuzawa
  • Kei Watanabe
  • Naoto Endo
Scientific Article



To compare performances in diagnosing intertrochanteric hip fractures from proximal femoral radiographs between a convolutional neural network and orthopedic surgeons.

Materials and methods

In total, 1773 patients were enrolled in this study. Hip plain radiographs from these patients were cropped to display only proximal fractured and non-fractured femurs. Images showing pseudarthrosis after femoral neck fracture and those showing artificial objects were excluded. This yielded a total of 3346 hip images (1773 fractured and 1573 non-fractured hip images) that were used to compare performances between the convolutional neural network and five orthopedic surgeons.


The convolutional neural network and orthopedic surgeons had accuracies of 95.5% (95% CI = 93.1–97.6) and 92.2% (95% CI = 89.2–94.9), sensitivities of 93.9% (95% CI = 90.1–97.1) and 88.3% (95% CI = 83.3–92.8), and specificities of 97.4% (95% CI = 94.5–99.4) and 96.8% (95% CI = 95.1–98.4), respectively.


The performance of the convolutional neural network exceeded that of orthopedic surgeons in detecting intertrochanteric hip fractures from proximal femoral radiographs under limited conditions. The convolutional neural network has a significant potential to be a useful tool for screening for fractures on plain radiographs, especially in the emergency room, where orthopedic surgeons are not readily available.


Fracture Deep learning Orthopedics Convolutional neural network 



The authors express their appreciation to Kamimura K, Fujita Y, and Wakui J for reviewing images and would like to thank Editage ( for English language editing.


The study was conducted without any external funding or grant.

Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Conflict of interest

The authors declare that they have no conflicts of interest.


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Copyright information

© ISS 2018

Authors and Affiliations

  • Takaaki Urakawa
    • 1
    • 2
    Email author
  • Yuki Tanaka
    • 1
  • Shinichi Goto
    • 1
  • Hitoshi Matsuzawa
    • 3
  • Kei Watanabe
    • 2
  • Naoto Endo
    • 2
  1. 1.Department of Orthopedic SurgeryTsuruoka Municipal Shonai HospitalTsuruoka-shiJapan
  2. 2.Division of Orthopedic Surgery, Department of Regenerative and Transplant MedicineNiigata University Graduate School of Medical and Dental SciencesNiigataJapan
  3. 3.Center for Integrated Human Brain Science, Brain Research InstituteUniversity of NiigataNiigataJapan

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