Predicting the stability of distal radius fractures with a small dataset and machine learning

Abstract

Purpose. Distal radius fractures are common fractures of the wrist. These fractures are often displaced and need reduction, after adequate reduction, the patients will have follow-up X-rays to check if the fracture stays stable. This is important because surgery might be required if the fracture becomes unstable. This can lead to delayed surgery which can worsen the treatment outcome.
Therefore, it would be valuable to predict which distal radius fractures are likely to become unstable. Machine learning could help predict the stability of distal radius fractures based on CT. In addition, because there is only a small dataset available, this research also studies the effect of different machine learning methods.
Method. Two different methods were evaluated for the stability prediction of distal radius fractures: traditional machine learning (radiomics method) and a residual network with and without transfer learning (deep learning method). For the radiomics method, a python package called WORC was used, which automatically extracts radiomic features and optimizes machine learning models. For the deep learning method, the backbone of a residual network called Med3D with added layers for classification was used.
Results. The radiomics method combined with augmentation, gave the best results (AUC: 0.64± 0.01). Also, it was found that using an augmented data set in the radiomics method resulted in improved performance. This gives a slight indication that the radiomic method can learn to predict DRF when there would be more data available.
Conclusion. The radiomic method is the most promising method for predicting the stability of distal radius fractures, despite the small difference in performance compared to random guessing and the deep learning method. However, for further research, it is highly recommended to acquire a larger dataset.