Publication Name	World Journal of Orthopedics
Manuscript ID	113710
Country	United Kingdom

Category	Orthopedics
Manuscript Type	Retrospective Cohort Study
Article Title	From subtle breaks to missed diagnoses: Real-world evaluation of an artificial intelligence fracture detection tool
Manuscript Source	Invited Manuscript
All Author List	Sari Wathiq Al Hajaj, Khaled Soliman, Mahira Zafar, Callum Garnham, Dawod Al Hajaj, Omar Elshafie, Ahmad Alsswah and Mohammed H Elwan
Funding Agency and Grant Number
Corresponding Author	Sari Wathiq Al Hajaj, MD, Department of Trauma and Orthopaedics, Kettering General Hospital, NHS Foundation Trust, Kettering NN16 8UZ, Northamptonshire, United Kingdom. sarialhajaj95@gmail.com
Key Words	Artificial intelligence; Fractures; Bone/diagnostic imaging; Radiography; Emergency service; Hospital; Diagnostic errors; Sensitivity and specificity; Retrospective studies; Humans
Core Tip	Artificial intelligence (AI) is increasingly utilised in musculoskeletal imaging; however, its clinical utility in fracture detection remains a subject of debate. In this retrospective study aimed at assessing diagnostic accuracy, we evaluated an AI-based fracture detection system in comparison with radiologist reports across over 2000 limb radiographs. The AI demonstrated high accuracy but failed to identify approximately 10% of fractures, primarily subtle or minimally displaced injuries, and frequently overdiagnosed old or degenerative changes. False negatives posed a greater clinical risk than false positives, underscoring the importance of implementing AI as a triage and decision-support tool rather than a substitute for radiologists.
Citation	Al Hajaj SW, Soliman K, Zafar M, Garnham C, Al Hajaj D, Elshafie O, Alsswah A, Elwan MH. From subtle breaks to missed diagnoses: Real-world evaluation of an artificial intelligence fracture detection tool. World J Orthop 2025; In press

Received	2025-09-01 05:27
Peer-Review Started	2025-09-01 05:27
First Decision by Editorial Office Director	2025-09-17 08:30
Return for Revision	2025-09-17 08:30
Revised	2025-10-02 00:09
Publication Fee Transferred
Second Decision by Editor	2026-01-14 02:35
Second Decision by Editor-in-Chief
Final Decision by Editorial Office Director	2026-01-14 09:59
Articles in Press	2026-01-14 09:59
Edit the Manuscript by Language Editor
Typeset the Manuscript

ISSN	2218-5836 (online)
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