Two-Stage Structure-Focused Contrastive Learning for Automatic Identification and Localization of Complex Pelvic Fractures.

Pelvic fracture is a severe trauma with a high rate of morbidity and mortality. Accurate and automatic diagnosis and surgical planning of pelvic fracture require effective identification and localization of the fracture zones. This is a challenging task due to the complexity of pelvic fractures, which often exhibit multiple fragments and sites, large fragment size differences, and irregular morphology. We have developed a novel two-stage method for the automatic identification and localization of complex pelvic fractures. Our method is unique in that it allows to combine the symmetry properties of the pelvic anatomy and capture the symmetric feature differences caused by the fracture on both the left and right sides, thereby overcoming the limitations of existing methods which consider only image or geometric features. It implements supervised contrastive learning with a novel Siamese deep neural network, which consists of two weight-shared branches with a structural attention mechanism, to minimize the confusion of local complex structures of the pelvic bones with the fracture zones. A structure-focused attention (SFA) module is designed to capture the spatial structural features and enhances the recognition ability of fracture zones. Comprehensive experiments on 103 clinical CT scans from the publicly available dataset CTPelvic1K show that our method achieves a mean accuracy and sensitivity of 0.92 and 0.93, which are superior to those reported with three SOTA contrastive learning methods and five advanced classification networks, demonstrating the effectiveness of identifying and localizing various types of complex pelvic fractures from clinical CT images.