  We demonstrate the feasibility of a fully automatic computer-aided diagnosis
(CAD) tool, based on deep learning, that localizes and classifies proximal
femur fractures on X-ray images according to the AO classification. The
proposed framework aims to improve patient treatment planning and provide
support for the training of trauma surgeon residents. A database of 1347
clinical radiographic studies was collected. Radiologists and trauma surgeons
annotated all fractures with bounding boxes, and provided a classification
according to the AO standard. The proposed CAD tool for the classification of
radiographs into types "A", "B" and "not-fractured", reaches a F1-score of 87%
and AUC of 0.95, when classifying fractures versus not-fractured cases it
improves up to 94% and 0.98. Prior localization of the fracture results in an
improvement with respect to full image classification. 100% of the predicted
centers of the region of interest are contained in the manually provided
bounding boxes. The system retrieves on average 9 relevant images (from the
same class) out of 10 cases. Our CAD scheme localizes, detects and further
classifies proximal femur fractures achieving results comparable to
expert-level and state-of-the-art performance. Our auxiliary localization model
was highly accurate predicting the region of interest in the radiograph. We
further investigated several strategies of verification for its adoption into
the daily clinical routine. A sensitivity analysis of the size of the ROI and
image retrieval as a clinical use case were presented.
