{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T00:44:46Z","timestamp":1793407486782,"version":"4.5.0"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T00:00:00Z","timestamp":1765843200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T00:00:00Z","timestamp":1765843200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005006","name":"Asan Institute for Life Sciences, Asan Medical Center","doi-asserted-by":"publisher","award":["2024IE0010-1"],"award-info":[{"award-number":["2024IE0010-1"]}],"id":[{"id":"10.13039\/501100005006","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001702","name":"AO Foundation","doi-asserted-by":"publisher","award":["AOTAP24-44"],"award-info":[{"award-number":["AOTAP24-44"]}],"id":[{"id":"10.13039\/501100001702","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    The Garden classification, based on X-ray interpretation and established over 50 years ago, remains the standard clinical classification system for femoral neck fractures (FNFs). Yet, this classification has a high interobserver variability of 70%. We sought to develop a deep-learning algorithm capable of accurately predicting FNF types, using only X-ray images, with performance comparable to that of computed tomography (CT). We retrospectively collected data from 1,588 patients who underwent X-ray and 3D-CT scans and were diagnosed with femoral neck fractures at Asan Medical Center. The input X-ray dataset consisted of paired X-ray images of the hip, with anteroposterior (AP) and lateral views. Using 3D-CT as the reference standard, patients were labeled as Garden types I (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009378, 23.8%), II (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200968, 4.3%), III (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009477, 30.0%), and IV (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009665, 41.9%). Our algorithm consisted of hip-joint detection followed by Garden classification, for which 12 different deep-learning architectures were evaluated. Algorithm performance was externally validated in 100 patients. Our algorithms showed a 90.6% overall accuracy and 88.6% Dice similarity coefficient, indicating excellent FNF type discernment. Our algorithms could serve as a valuable tool for diagnosing FNF based on X-ray data only, with accuracy comparable to that of CT.\n                  <\/jats:p>","DOI":"10.1038\/s41598-025-27766-4","type":"journal-article","created":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T10:43:27Z","timestamp":1765881807000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Garden classification of femoral neck fracture using deep-learning algorithm"],"prefix":"10.1038","volume":"15","author":[{"given":"Jaebeom","family":"Yang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinyong","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keunwoo","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eic Ju","family":"Lim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Wan","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jihoon","family":"Kweon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chul-Ho","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,16]]},"reference":[{"issue":"1","key":"27766_CR1","doi-asserted-by":"publisher","first-page":"5406","DOI":"10.1038\/s41598-024-54932-x","volume":"14","author":"CH Kim","year":"2024","unstructured":"Kim, C. H., Kim, K. P. & Kim, J. W. Comparison of surgical outcomes for hip fracture between older patients with and without cancer: a propensity score matching analysis. Sci. Rep. 14 (1), 5406 (2024).","journal-title":"Sci. Rep."},{"key":"27766_CR2","doi-asserted-by":"crossref","unstructured":"Palm, H. Hip Fracture: The Choice of Surgery. In: Falaschi P, Marsh D, editors. Orthogeriatrics: The Management of Older Patients with Fragility Fractures. 2nd ed. Cham (CH)2021. pp. 125\u2009\u2013\u200941.","DOI":"10.1007\/978-3-030-48126-1_9"},{"issue":"2","key":"27766_CR3","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1016\/j.jemermed.2007.12.039","volume":"37","author":"J Cannon","year":"2009","unstructured":"Cannon, J., Silvestri, S. & Munro, M. Imaging choices in occult hip fracture. J. Emerg. Med. 37 (2), 144\u2013152 (2009).","journal-title":"J. Emerg. Med."},{"issue":"2","key":"27766_CR4","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1007\/s11999.0000000000000066","volume":"476","author":"JM Kazley","year":"2018","unstructured":"Kazley, J. M., Banerjee, S., Abousayed, M. M. & Rosenbaum, A. J. Classifications in brief: garden classification of femoral neck fractures. Clin. Orthop. Relat. Res. 476 (2), 441\u2013445 (2018).","journal-title":"Clin. Orthop. Relat. Res."},{"issue":"7","key":"27766_CR5","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1007\/s00402-005-0022-4","volume":"125","author":"M Zlowodzki","year":"2005","unstructured":"Zlowodzki, M., Bhandari, M., Keel, M., Hanson, B. P. & Schemitsch, E. Perception of garden\u2019s classification for femoral neck fractures: an international survey of 298 orthopaedic trauma surgeons. Arch. Orthop. Trauma. Surg. 125 (7), 503\u2013505 (2005).","journal-title":"Arch. Orthop. Trauma. Surg."},{"issue":"6","key":"27766_CR6","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1016\/j.aott.2015.11.004","volume":"50","author":"A Turgut","year":"2016","unstructured":"Turgut, A. et al. Is surgeons\u2019 experience important on intra- and inter-observer reliability of classifications used for adult femoral neck fracture? Acta Orthop. Traumatol. Turc. 50 (6), 601\u2013605 (2016).","journal-title":"Acta Orthop. Traumatol. Turc."},{"issue":"1","key":"27766_CR7","doi-asserted-by":"publisher","first-page":"520","DOI":"10.1186\/s13018-022-03408-7","volume":"17","author":"Y Cha","year":"2022","unstructured":"Cha, Y. et al. Artificial intelligence and machine learning on diagnosis and classification of hip fracture: systematic review. J. Orthop. Surg. Res. 17 (1), 520 (2022).","journal-title":"J. Orthop. Surg. Res."},{"key":"27766_CR8","unstructured":"Ren, S. Q., He, K. M., Girshick, R., Sun, J. & Faster, R-C-N-N. Towards Real-Time object detection with region proposal networks. Adv. Neur in ;28. (2015)."},{"issue":"6","key":"27766_CR9","first-page":"411","volume":"45","author":"L Beimers","year":"2002","unstructured":"Beimers, L. et al. Subcapital hip fractures: the garden classification should be replaced, not collapsed. Can. J. Surg. 45 (6), 411\u2013414 (2002).","journal-title":"Can. J. Surg."},{"issue":"4","key":"27766_CR10","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1016\/0020-1383(93)90177-8","volume":"24","author":"MJ Parker","year":"1993","unstructured":"Parker, M. J. Garden grading of intracapsular fractures: meaningful or misleading? Injury 24 (4), 241\u2013242 (1993).","journal-title":"Injury"},{"key":"27766_CR11","doi-asserted-by":"crossref","unstructured":"Handoll, H. H. & Parker, M. J. Conservative versus operative treatment for hip fractures in adults. Cochrane Database Syst. 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Insights Imaging. 16 (1), 86 (2025).","journal-title":"Insights Imaging"},{"issue":"3","key":"27766_CR18","doi-asserted-by":"publisher","first-page":"303","DOI":"10.3109\/17453670902967281","volume":"80","author":"H Palm","year":"2009","unstructured":"Palm, H., Gosvig, K., Krasheninnikoff, M., Jacobsen, S. & Gebuhr, P. A new measurement for posterior Tilt predicts reoperation in undisplaced femoral neck fractures: 113 consecutive patients treated by internal fixation and followed for 1 year. Acta Orthop. 80 (3), 303\u2013307 (2009).","journal-title":"Acta Orthop."},{"key":"27766_CR19","doi-asserted-by":"publisher","first-page":"102497","DOI":"10.1016\/j.jcot.2024.102497","volume":"54","author":"CH Kim","year":"2024","unstructured":"Kim, C. H. & Kim, J. W. A recent update on the fixation techniques for femoral neck fractures: A narrative review. J. Clin. Orthop. Trauma. 54, 102497 (2024).","journal-title":"J. Clin. Orthop. 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Data collection was performed in accordance with the relevant guidelines and regulations of the committee.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval\u00a0<!--Emphasis Type='Bold' removed-->and Informed Consent."}}],"article-number":"43926"}}