Background: Rapid and accurate fracture detection is critical in emergency departments (EDs), where high patient volume and time pressure increase the risk of diagnostic error, particularly in radiographic interpretation. Multimodal large language models (LLMs) with image-recognition capability have recently emerged as general-purpose tools for clinical decision support, but their diagnostic performance within routine emergency department imaging workflows in orthopedic trauma remains unclear. Methods: In this retrospective diagnostic accuracy study, we included 1136 consecutive patients referred from the ED to orthopedics between 1 January and 1 June 2025 at a single tertiary center. Given the single-center, retrospective design, the findings should be interpreted as hypothesis-generating and may not be fully generalizable to other institutions. Emergency radiographs and clinical data were processed by a multimodal LLM (2025 version) via an official API using a standardized, deterministic prompt. The model’s outputs (“Fracture present”, “No fracture”, or “Uncertain”) were compared with final diagnoses established by blinded orthopedic specialists, which served as the reference standard. Diagnostic agreement was analyzed using Cohen’s kappa (κ), sensitivity, specificity, accuracy, and 95% confidence intervals (CIs). False-negative (FN) cases were defined as instances where the LLM reported “no acute fracture” but the specialist identified a fracture. The evaluated system is a general-purpose multimodal LLM and was not trained specifically on orthopedic radiographs. Results: Overall, the LLM showed good diagnostic agreement with orthopedic specialists, with concordant results in 808 of 1136 patients (71.1%; κ = 0.634; 95% CI: 68.4–73.7). The model achieved balanced performance with sensitivity of 76.9% and specificity of 66.8%. The highest agreement was observed in knee trauma (91.7%), followed by wrist (78.8%) and hand (69.6%). False-negative cases accounted for 184 patients (16.2% of the total cohort), representing 32.4% of all LLM-negative assessments. Most FN fractures were non-displaced (82.6%), and 17.4% of FN cases required surgical treatment. Ankle and foot regions showed the highest FN rates (30.4% and 17.4%, respectively), reflecting the anatomical and radiographic complexity of these areas. Positive predictive value (PPV) and negative predictive value (NPV) were 69.4% and 74.5%, respectively, with likelihood ratios indicating moderate shifts in post-test probability. Conclusions: In an emergency department-to-orthopedics consultation cohort reflecting routine clinical workflow, a multimodal LLM demonstrated moderate-to-good diagnostic agreement with orthopedic specialists, broadly within the range reported in prior fracture-detection AI studies; however, these comparisons are indirect because model architectures, training strategies, datasets, and endpoints differ across studies. However, its limited ability to detect non-displaced fractures—especially in anatomically complex regions like the ankle and foot—carries direct patient safety implications and confirms that specialist review remains indispensable. At present, such models may be explored as hypothesis-generating triage or decision-support tools, with mandatory specialist confirmation, rather than as standalone diagnostic systems. Prospective, multi-center studies using high-resolution imaging and anatomically optimized algorithms are needed before routine clinical adoption in emergency care.

Club foot (CF) is characterized by multiple deformities such as varus, adductus and internal rotation of the forefoot. It is well-known and a frequent congenital disorder. CF can concurrently be seen with several diseases but it can rarely manifest as a component of any other syndrome. Ritscher-Schinzel syndrome, or cranio-cerebello-cardiac syndrome, is rarely seen and has autosomal recessive inheritance. It is characterized by cranio-facial, cerebellar and cardiac abnormalities. We report a case diagnosed as Ritscher-Schinzel syndrome concurrent with persistent CF. A two-year-old boy with persistent CF and concurrent congenital hip dysplasia. Despite successful serial casting and subsequent achilloplasty a clinical relapse was observed in our patient. After a detailed phenotypic evaluation, genetical tests and imaging technique the patient was diagnosed 3C Ritscher-Schinzel syndrome. A comprehensive literature review did not show any reports about concurrent hip dysplasia and clubfoot in Ritscher-Schinzel syndrome. We report that CF may be associated with rare genetical abnormalities. With this report we would like to raise awareness about the possible association of persistent CF with this rare genetical disorder, Ritscher-Schinzel syndrome. It should be included in differential diagnosis of patients with persistent CF.

Osteochondral lesions of the talus (OLTs) are a significant cause of chronic ankle pain and functional impairment. However, the relationship between lesion

Background/Objectives: Pediatric upper extremity fracture patterns may differ across age groups, anatomical sites, sex, and seasons. This study aimed to describe hospital presentation patterns over 15 years, emphasizing age-specific fracture-site distributions and sex ratios. Methods: We retrospectively reviewed children aged 0–18 years presenting with upper extremity fractures between January 2010 and December 2024. Fractures were identified using International Classification of Diseases, 10th Revision codes and classified by site, age group (0–3, 4–7, 8–13, and 14–18 years), sex, season, and weekday. Analyses included chi-square tests with Cramer’s V, seasonal age comparisons with effect-size measures, and negative binomial regression of daily presentation counts adjusted for season and calendar year. Results: Among 30,526 fracture-diagnosis records, distal radius fractures were most common. The strongest overall categorical association was between fracture site and age group (Cramer’s V = 0.286), followed by age group and sex (V = 0.252). Male predominance increased with age, reaching a male/female ratio of 7.24 at 14–18 years and 19.03 for adolescent metacarpal fractures. Distal humerus fractures clustered at 4–7 years, whereas metacarpal fractures clustered in adolescence. Seasonal differences in demographic and anatomical distributions were statistically significant but small. Mean age was lowest in summer and highest in winter. Adjusted weekend presentation volume was lower than weekday volume. Conclusions: Detailed subgroup analysis reveals substantial age-, sex-, and fracture-site-specific variation. Without trauma-mechanism or population-denominator data, these findings describe hospital presentation patterns rather than causal risk estimates.