{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T04:55:33Z","timestamp":1790571333793,"version":"4.1.0"},"reference-count":25,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: To assess the diagnostic performance of Gemini 1.5 Pro, a general-purpose Large Multimodal Model (LMM), as a zero-shot, smartphone-based decision support tool to distinguish pediatric fractures from healthy controls. Methods: A retrospective diagnostic accuracy study was conducted on 182 pediatric radiographs (112 confirmed fractures, 70 healthy controls) using the Gemini 1.5 Pro mobile interface with a 4-question prompt protocol (Detection, Characterization, Skeletal Maturity, Management). Diagnostic metrics were calculated with 95% Confidence Intervals (95% CI). Ground truth was established by a senior musculoskeletal radiologist. Results: The model showed an overall sensitivity of 90.2% (95% CI: 83.1\u201395.0%) and specificity of 87.1% (95% CI: 77.0\u201393.9%). A significant sensitivity gap occurred between displaced (100.0%; 95% CI: 91.4\u2013100.0%) and non-displaced fractures (84.5%; 95% CI: 74.0\u201392.0%; p = 0.007). Qualitative taxonomy revealed a primary physiological bias leading to a 12.8% false-positive rate due to growth plate misinterpretation, alongside minor characterization and localization errors (3.6% of correctly identified fractures). When fractures were correctly identified, proposed management strategies aligned with international standards in 95.0% of cases. Inter-observer reliability was excellent (weighted k = 0.96). Conclusions: Gemini 1.5 Pro displays robust clinical reasoning for obvious trauma. However, its zero-shot performance is limited by subtle morphological disruptions and developmental anatomical nuances such as open growth plates. It shows promise as a mobile clinical decision support system for non-specialists, but expert human supervision remains necessary to ensure safety in the complex radiographic landscape of the immature skeleton.<\/jats:p>","DOI":"10.3390\/diagnostics16193112","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T16:29:53Z","timestamp":1790267393000},"page":"3112","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Benchmarking Gemini 1.5 Pro in Pediatric Emergency Radiology: Sensitivity Gap and Physiological Bias in the Immature Skeleton"],"prefix":"10.3390","volume":"16","author":[{"given":"Cristiano","family":"Benelli","sequence":"first","affiliation":[{"name":"Orthopedic Unit, Sant\u2019Andrea Hospital, University of Rome La Sapienza, Via di Grottarossa 1035, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Labianca","sequence":"additional","affiliation":[{"name":"Orthopedic Unit, Sant\u2019Andrea Hospital, University of Rome La Sapienza, Via di Grottarossa 1035, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vito","family":"Caiolo","sequence":"additional","affiliation":[{"name":"Orthopedic Unit, Sant\u2019Andrea Hospital, University of Rome La Sapienza, Via di Grottarossa 1035, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Altavilla","sequence":"additional","affiliation":[{"name":"Orthopedic Unit, Sant\u2019Andrea Hospital, University of Rome La Sapienza, Via di Grottarossa 1035, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5327-3702","authenticated-orcid":false,"given":"Nicola","family":"Maffulli","sequence":"additional","affiliation":[{"name":"Orthopedic Unit, Sant\u2019Andrea Hospital, University of Rome La Sapienza, Via di Grottarossa 1035, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/j.jisako.2023.10.015","article-title":"Artificial intelligence and the orthopaedic surgeon: A review of the literature and potential applications for future practice: Current concepts","volume":"9","author":"Khoriati","year":"2024","journal-title":"J. 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