{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T07:08:10Z","timestamp":1784185690892,"version":"3.55.0"},"reference-count":31,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"vor","delay-in-days":65,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Orthop Surg Res"],"DOI":"10.1186\/s13018-026-06951-9","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T23:04:01Z","timestamp":1778540641000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Optimizing treatment strategies for femoral neck fractures using a machine learning model"],"prefix":"10.1186","volume":"21","author":[{"given":"Takashi","family":"Okamoto","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Takeuchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hisami","family":"Hatanaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Shibata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shigeru","family":"Nakagawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masatsugu","family":"Takami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiharu","family":"Kusabiraki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noriaki","family":"Hidaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,12]]},"reference":[{"issue":"1","key":"6951_CR1","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1186\/s12960-022-00752-x","volume":"20","author":"M Honda","year":"2022","unstructured":"Honda M, Inoue N, Liverani M, Nagai M. Lessons learned from the history of postgraduate medical training in Japan: from disease-centred care to patient-centred care in an aging society. Hum Resour Health. 2022;20(1):54.","journal-title":"Hum Resour Health"},{"key":"6951_CR2","doi-asserted-by":"publisher","DOI":"10.7554\/eLife.83888","author":"T Tran","year":"2023","unstructured":"Tran T, Ho-Le T, Bliuc D, Abrahamsen B, Hansen L, Vestergaard P, et al. \u201cSkeletal age\u201d for mapping the impact of fracture on mortality. Elife. 2023. https:\/\/doi.org\/10.7554\/eLife.83888.","journal-title":"Elife"},{"issue":"5","key":"6951_CR3","doi-asserted-by":"publisher","first-page":"e239","DOI":"10.1016\/S2468-2667(17)30046-4","volume":"2","author":"N Papadimitriou","year":"2017","unstructured":"Papadimitriou N, Tsilidis KK, Orfanos P, Benetou V, Ntzani EE, Soerjomataram I, et al. Burden of hip fracture using disability-adjusted life-years: a pooled analysis of prospective cohorts in the CHANCES consortium. Lancet Public Health. 2017;2(5):e239\u201346.","journal-title":"Lancet Public Health"},{"issue":"1","key":"6951_CR4","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1007\/s11657-025-01588-3","volume":"20","author":"CL Gregson","year":"2025","unstructured":"Gregson CL, Armstrong DJ, Avgerinou C, Bowden J, Cooper C, Douglas L, et al. The 2024 UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos. 2025;20(1):119.","journal-title":"Arch Osteoporos"},{"issue":"4","key":"6951_CR5","doi-asserted-by":"publisher","first-page":"446","DOI":"10.3109\/17453674.2010.492763","volume":"81","author":"F Frihagen","year":"2010","unstructured":"Frihagen F, Waaler GM, Madsen JE, Nordsletten L, Aspaas S, Aas E. The cost of hemiarthroplasty compared to that of internal fixation for femoral neck fractures. 2-year results involving 222 patients based on a randomized controlled trial. Acta Orthop. 2010;81(4):446\u201352.","journal-title":"Acta Orthop"},{"issue":"4","key":"6951_CR6","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1302\/0301-620X.43B4.647","volume":"43-B","author":"RS Garden","year":"1961","unstructured":"Garden RS. Low-angle fixation in fractures of the femoral neck. J Bone Joint Surg Br. 1961;43-B(4):647\u201363.","journal-title":"J Bone Joint Surg Br"},{"issue":"2","key":"6951_CR7","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1007\/s11999.0000000000000066","volume":"476","author":"JM Kazley","year":"2018","unstructured":"Kazley JM, Banerjee S, Abousayed MM, Rosenbaum AJ. Classifications in brief: garden classification of femoral neck fractures. Clin Orthop Relat Res. 2018;476(2):441\u20135.","journal-title":"Clin Orthop Relat Res"},{"issue":"1","key":"6951_CR8","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1007\/s11751-010-0099-3","volume":"6","author":"V Nicolaides","year":"2011","unstructured":"Nicolaides V, Galanakos S, Mavrogenis AF, Sakellariou VI, Papakostas I, Nikolopoulos CE, et al. Arthroplasty versus internal fixation for femoral neck fractures in the elderly. Strategies Trauma Limb Reconstr. 2011;6(1):7\u201312.","journal-title":"Strategies Trauma Limb Reconstr"},{"key":"6951_CR9","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1016\/j.media.2017.07.005","volume":"42","author":"G Litjens","year":"2017","unstructured":"Litjens G, Kooi T, Bejnordi BE, Setio AAA, Ciompi F, Ghafoorian M, et al. A survey on deep learning in medical image analysis. Med Image Anal. 2017;42:60\u201388.","journal-title":"Med Image Anal"},{"issue":"1","key":"6951_CR10","doi-asserted-by":"publisher","first-page":"520","DOI":"10.1186\/s13018-022-03408-7","volume":"17","author":"Y Cha","year":"2022","unstructured":"Cha Y, Kim JT, Park CH, Kim JW, Lee SY, Yoo JI. Artificial intelligence and machine learning on diagnosis and classification of hip fracture: systematic review. J Orthop Surg Res. 2022;17(1):520.","journal-title":"J Orthop Surg Res"},{"issue":"2","key":"6951_CR11","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1007\/s00256-018-3016-3","volume":"48","author":"T Urakawa","year":"2019","unstructured":"Urakawa T, Tanaka Y, Goto S, Matsuzawa H, Watanabe K, Endo N. Detecting intertrochanteric hip fractures with orthopedist-level accuracy using a deep convolutional neural network. Skeletal Radiol. 2019;48(2):239\u201344.","journal-title":"Skeletal Radiol"},{"issue":"1","key":"6951_CR12","doi-asserted-by":"publisher","first-page":"694","DOI":"10.1186\/s13018-021-02845-0","volume":"16","author":"K Oka","year":"2021","unstructured":"Oka K, Shiode R, Yoshii Y, Tanaka H, Iwahashi T, Murase T. Artificial intelligence to diagnosis distal radius fracture using biplane plain X-rays. J Orthop Surg Res. 2021;16(1):694.","journal-title":"J Orthop Surg Res"},{"issue":"1","key":"6951_CR13","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1111\/1754-9485.12828","volume":"63","author":"M Adams","year":"2019","unstructured":"Adams M, Chen W, Holcdorf D, McCusker MW, Howe PD, Gaillard F. Computer vs human: deep learning versus perceptual training for the detection of neck of femur fractures. J Med Imaging Radiat Oncol. 2019;63(1):27\u201332.","journal-title":"J Med Imaging Radiat Oncol"},{"key":"6951_CR14","doi-asserted-by":"publisher","first-page":"e41137","DOI":"10.2196\/41137","volume":"7","author":"BJ Ferrell","year":"2023","unstructured":"Ferrell BJ. Fine-tuning strategies for classifying community-engaged research studies using transformer-based models: algorithm development and improvement study. JMIR Form Res. 2023;7:e41137.","journal-title":"JMIR Form Res"},{"key":"6951_CR15","unstructured":"Tan M, Le Q: Efficientnetv2: smaller models and faster training. In: International conference on machine learning: 2021: PMLR; 2021; 10096\u201310106."},{"key":"6951_CR16","unstructured":"Simonyan K, Zisserman A. Very deep convolutional networks for large-scale image recognition. arXiv preprint arXiv:14091556 2014."},{"key":"6951_CR17","doi-asserted-by":"crossref","unstructured":"Selvaraju RR, Cogswell M, Das A, Vedantam R, Parikh D, Batra D. Grad-cam: visual explanations from deep networks via gradient-based localization. In: Proceedings of the IEEE international conference on computer vision: 2017; 2017: 618\u2013626.","DOI":"10.1109\/ICCV.2017.74"},{"key":"6951_CR18","doi-asserted-by":"publisher","first-page":"5875","DOI":"10.1109\/TIP.2021.3089943","volume":"30","author":"P-T Jiang","year":"2021","unstructured":"Jiang P-T, Zhang C-B, Hou Q, Cheng M-M, Wei Y. Layercam: exploring hierarchical class activation maps for localization. IEEE Trans Image Process. 2021;30:5875\u201388.","journal-title":"IEEE Trans Image Process"},{"issue":"1","key":"6951_CR19","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1109\/4235.585893","volume":"1","author":"DH Wolpert","year":"2002","unstructured":"Wolpert DH, Macready WG. No free lunch theorems for optimization. IEEE Trans Evol Comput. 2002;1(1):67\u201382.","journal-title":"IEEE Trans Evol Comput"},{"issue":"4","key":"6951_CR20","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1016\/j.otsr.2012.02.003","volume":"98","author":"D Van Embden","year":"2012","unstructured":"Van Embden D, Rhemrev SJ, Genelin F, Meylaerts SA, Roukema GR. The reliability of a simplified Garden classification for intracapsular hip fractures. Orthop Traumatol Surg Res. 2012;98(4):405\u20138.","journal-title":"Orthop Traumatol Surg Res"},{"issue":"1","key":"6951_CR21","doi-asserted-by":"publisher","first-page":"527","DOI":"10.21037\/qims-23-814","volume":"14","author":"LX Wang","year":"2024","unstructured":"Wang LX, Zhu ZH, Chen QC, Jiang WB, Wang YZ, Sun NK, et al. Development and validation of a deep-learning model for the detection of non-displaced femoral neck fractures with anteroposterior and lateral hip radiographs. Quant Imaging Med Surg. 2024;14(1):527\u201339.","journal-title":"Quant Imaging Med Surg"},{"issue":"10","key":"6951_CR22","doi-asserted-by":"publisher","first-page":"5469","DOI":"10.1007\/s00330-019-06167-y","volume":"29","author":"CT Cheng","year":"2019","unstructured":"Cheng CT, Ho TY, Lee TY, Chang CC, Chou CC, Chen CC, et al. Application of a deep learning algorithm for detection and visualization of hip fractures on plain pelvic radiographs. Eur Radiol. 2019;29(10):5469\u201377.","journal-title":"Eur Radiol"},{"issue":"1","key":"6951_CR23","doi-asserted-by":"publisher","first-page":"4314","DOI":"10.1038\/s41467-023-39902-7","volume":"14","author":"A Brown","year":"2023","unstructured":"Brown A, Tomasev N, Freyberg J, Liu Y, Karthikesalingam A, Schrouff J. Detecting shortcut learning for fair medical AI using shortcut testing. Nat Commun. 2023;14(1):4314.","journal-title":"Nat Commun"},{"issue":"6","key":"6951_CR24","doi-asserted-by":"publisher","first-page":"1711","DOI":"10.1007\/s00198-011-1772-1","volume":"23","author":"GM Waaler Bjornelv","year":"2012","unstructured":"Waaler Bjornelv GM, Frihagen F, Madsen JE, Nordsletten L, Aas E. Hemiarthroplasty compared to internal fixation with percutaneous cannulated screws as treatment of displaced femoral neck fractures in the elderly: cost-utility analysis performed alongside a randomized, controlled trial. Osteoporos Int. 2012;23(6):1711\u20139.","journal-title":"Osteoporos Int"},{"issue":"1","key":"6951_CR25","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/j.jos.2016.08.015","volume":"22","author":"H Liu","year":"2017","unstructured":"Liu H, He L, Zhang G, Gong X, Li N. Comparison of total costs between internal fixation and hemiarthroplasty for displaced femoral neck fractures. J Orthop Sci. 2017;22(1):75\u201380.","journal-title":"J Orthop Sci"},{"issue":"3","key":"6951_CR26","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1007\/BF03016088","volume":"55","author":"T Shiga","year":"2008","unstructured":"Shiga T, Wajima Z, Ohe Y. Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression. Can J Anaesth. 2008;55(3):146\u201354.","journal-title":"Can J Anaesth"},{"issue":"15","key":"6951_CR27","doi-asserted-by":"publisher","first-page":"1609","DOI":"10.1503\/cmaj.092220","volume":"182","author":"N Simunovic","year":"2010","unstructured":"Simunovic N, Devereaux PJ, Sprague S, Guyatt GH, Schemitsch E, Debeer J, Bhandari M. Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ. 2010;182(15):1609\u201316.","journal-title":"CMAJ"},{"issue":"10","key":"6951_CR28","doi-asserted-by":"publisher","first-page":"e46175","DOI":"10.1371\/journal.pone.0046175","volume":"7","author":"L Moja","year":"2012","unstructured":"Moja L, Piatti A, Pecoraro V, Ricci C, Virgili G, Salanti G, Germagnoli L, Liberati A, Banfi G. Timing matters in hip fracture surgery: patients operated within 48 hours have better outcomes. A meta-analysis and meta-regression of over 190,000 patients. PLoS ONE. 2012;7(10):e46175.","journal-title":"PLoS ONE"},{"issue":"6","key":"6951_CR29","doi-asserted-by":"publisher","first-page":"1612","DOI":"10.1097\/JS9.0000000000000385","volume":"109","author":"Q Cai","year":"2023","unstructured":"Cai Q, Fu K, Jia W, Li X, He H, Yao Z, Chen X, Dong Y, Wang Q, Kang B, et al. In-hospital waiting time to surgery and functional outcomes in geriatric hip fractures: a directed acyclic graph-based preplanned analysis from a prospective multicenter cohort study. Int J Surg. 2023;109(6):1612\u20139.","journal-title":"Int J Surg"},{"key":"6951_CR30","doi-asserted-by":"publisher","DOI":"10.1007\/s00774-025-01650-7","author":"Y Kokubu","year":"2025","unstructured":"Kokubu Y, Obi A, Kimura Y, Hattori A, Nemoto H, Matsuda Y, et al. Three-year trends in early hip fracture surgery surrounding a national reimbursement policy in Japan. J Bone Miner Metab. 2025. https:\/\/doi.org\/10.1007\/s00774-025-01650-7.","journal-title":"J Bone Miner Metab"},{"key":"6951_CR31","doi-asserted-by":"publisher","DOI":"10.1145\/2939672.2939785","volume-title":"XGBoost: a scalable tree boosting system","author":"T Chen","year":"2016","unstructured":"Chen T. XGBoost: a scalable tree boosting system. Cornell University; 2016."}],"container-title":["Journal of Orthopaedic Surgery and Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13018-026-06951-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13018-026-06951-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13018-026-06951-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T07:02:47Z","timestamp":1784185367000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s13018-026-06951-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,12]]},"references-count":31,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["6951"],"URL":"https:\/\/doi.org\/10.1186\/s13018-026-06951-9","relation":{},"ISSN":["1749-799X"],"issn-type":[{"value":"1749-799X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,12]]},"assertion":[{"value":"7 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was approved by the Kinshukai Group Institutional Review Board (approval 2025-17) on November 13, 2025. All procedures were conducted in accordance with institutional guidelines and the Helsinki Declaration of 1975, as revised in 2024. All patient data were anonymized and handled in accordance with data protection laws and institutional guidelines to protect patient confidentiality. Informed consent was not obtained due to the retrospective nature of the study; however, an opt-out procedure was implemented to ensure that patients had the opportunity to decline participation.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"411"}}