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OPEN Fracture detection in pediatric wrist

trauma X‑ray images using YOLOv8
algorithm
Rui‑Yang Ju 1 & Weiming Cai 2*

Hospital emergency departments frequently receive lots of bone fracture cases, with pediatric wrist
trauma fracture accounting for the majority of them. Before pediatric surgeons perform surgery, they
need to ask patients how the fracture occurred and analyze the fracture situation by interpreting
X-ray images. The interpretation of X-ray images often requires a combination of techniques from
radiologists and surgeons, which requires time-consuming specialized training. With the rise of deep
learning in the field of computer vision, network models applying for fracture detection has become an
important research topic. In this paper, we use data augmentation to improve the model performance
of YOLOv8 algorithm (the latest version of You Only Look Once) on a pediatric wrist trauma X-ray
dataset (GRAZPEDWRI-DX), which is a public dataset. The experimental results show that our model
has reached the state-of-the-art (SOTA) mean average precision (mAP 50). Specifically, mAP 50 of our
model is 0.638, which is significantly higher than the 0.634 and 0.636 of the improved YOLOv7 and
original YOLOv8 models. To enable surgeons to use our model for fracture detection on pediatric wrist
trauma X-ray images, we have designed the application “Fracture Detection Using YOLOv8 App” to
assist surgeons in diagnosing fractures, reducing the probability of error analysis, and providing more
useful information for surgery.

In hospital emergency rooms, radiologists are often asked to examine patients with fractures in various parts of
the body, such as the wrist and arm. Fractures can generally be classified as open or closed, with open fractures
occurring when the bone pierces the skin, and closed fractures occurring when the skin remains intact despite
the broken bone. Before performing surgery, the surgeon must inquire about the medical history of the patients
and conduct a thorough examination to diagnose fracture. In recent medical imaging, three types of devices,
including X-ray, Magnetic Resonance Imaging (MRI), and Computed Tomography (CT), are commonly used
to diagnose f­ racture1. And X-ray is the most widely used device due to its cost-effectiveness.
Fractures of the distal radius and ulna account for the majority of wrist trauma in pediatric p ­ atients2,3. In
prestigious hospitals of developed areas, there are many experienced radiologists who are capable of correctly
analyzing X-ray images; while in some small hospitals of underdeveloped regions, there are only young and inex-
perienced surgeons who may be unable to correctly interpret X-ray images. Therefore, a shortage of radiologists
would seriously jeopardize timely patient c­ are4,5. Specifically, some hospitals in Africa have even limited access
to specialist r­ eports6, which badly affects the probaility of the sucess of surgery. According to the s­ urvey7,8, the
percentage of X-ray images misinterpreted have reached 26%.
With the advancement of deep learning, neural network models have been introduced in medical image
­processing9–12. In recent years, researchers have started to apply object detection ­models13–15 to fracture
­detection16–19, which is a popular research topic in computer vision (CV).
Deep learning methods in the field of object detection are divided into two-stage and one-stage algorithms.
Two-stage algorithm models such as R-CNN13 and its improved m ­ odels20–26 generate location and class prob-
abilities in two stages. Whereas one-stage algorithm models directly produce the location and class probabilities
of objects, resulting in the improvement of the model inference speed. In addition to the classical one-stage
algorithm models, such as S­ SD27, ­RetinaNet28, ­CornerNet29, ­CenterNet30, and C ­ entripetalNet31, You Only Look
Once (YOLO) series algorithm m ­ odels32–34 are preferred for real-time a­ pplications35 due to the good balance
between the model accuracy and inference speed.
In this paper, we first use YOLOv8 ­algorithm36 to train models of different sizes on the GRAZPEDWRI-DX37
dataset. After evaluation of the model performances of YOLOv8, we train the models by using data augmentation

1
Graduate Institute of Networking and Multimedia, National Taiwan University, Taipei City 106335,
Taiwan. 2Department of Hand and Foot Surgery, Jingjiang People’s Hospital, Jingjiang City 214500, China. *email:
[email protected]

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to detect wrist fractures in children. We compare YOLOv8 models using our training method with YOLOv7
and its improved models, and the experimental results demonstrate that our models have the highest the mean
average precision (mAP 50) value.
The contributions of this paper are summarized as follows:

• We use data augmentation to improve the model performance of YOLOv8 model. The experimental results
show that the mean average precision of YOLOv8 model using our training method for fracture detection
on the GRAZPEDWRI-DX dataset reaches SOTA value.
• This work develops an application to detect wrist fracture in children, which aims to help pediatric surgeons
interpret X-ray images without the assistance of the radiologist, and reduce the probability of X-ray image
analysis errors.

This paper is structured as follows: Section "Related work" describes the deep learning methods for detecting frac-
ture, and describes the application of YOLOv5 model in medical image processing. Section "Proposed method"
introduces the whole process of training and the architecture of our model. Section "Experiments" presents the
improved performance of YOLOv8 model using our training method compared with YOLOv7 and its improved
models. Section "Application" describes our proposed application to assist pediatric surgeons in analyzing X-ray
images. Finally, Sect. "Conclusions and future work" discusses the conclusions and future work of this paper.

Related Work
In recent years, neural networks have been widely utilized in image data for fracture detection. Guan et al.38
achieved the average precision of 82.1% on 3,842 thigh fracture X-ray images using the Dilated Convolutional
Feature Pyramid Network (DCFPN). Wang et al.39 employed a novel R-CNN13 network ParalleNet as the back-
bone network for fracture detection on 3842 thigh fracture X-ray images. In addition to thigh fracture detection,
about arm fracture detection, Guan et al.40 used R-CNN for detection on Musculoskeletal-Radiograph (MURA)
­dataset41 and obtained an average precision of 62.04%. Ma and L ­ uo43 used Faster R-CNN21 for fracture detec-
tion on a part of 1052 bone images of the dataset and the proposed CrackNet model for fracture classification
on the whole dataset. Wu et al.42 proposed Feature Ambiguity Mitigate Operator (FAMO) model based on
­ResNeXt10147 and F ­ PN48 for bone fracture detection on 9040 radiographs of various body parts. Qi et al.49 uti-
lized Fast R-CNN20 with ­ResNet5050 as the backbone network to detect nine different types of fractures on 2,333
fracture X-ray images. Xue et al.44 utilized the Faster R-CNN model for hand fracture detection on 3067 hand
trauma X-ray images, achieving an average precision of 70.0%. Sha et al.45,46 used ­YOLOv251 and Faster R-CNN21
models for fracture detection on 5134 CT images of spine fractures respectively. Experiments showed that the
average precision of YOLOv2 reached 75.3%, which was higher than 73.3% of Faster R-CNN, and inference
time of YOLOv2 for each CT image is 27 ms, which is much faster than 381 ms of Faster R-CNN. From Table 1,
it can be seen that even though most of the works using R-CNN series models have shown excellent results, the
inference speed is not satisfactory.
YOLO series ­models32–34 offer a balance of performance in terms of the model accuracy and inference speed,
which is suitable for mobile devices in real-time X-ray images detection. Hržić et al.52 proposed a machine
learning model based on YOLOv4 method to help radiologists diagnose fractures and demonstrated that the
AUC-ROC (area under the receiver operator characteristic curve) value of YOLO 512 Anchor model-AI was
significantly higher than that of radiologists. YOLOv5 m ­ odel53, which was proposed by Ultralytics in 2021, has
been deployed on mobile phones as the “iDetection” application. On this basis, Yuan et al.54 employed external
attention and 3D feature fusion techniques in YOLOv5 model to detect skull fractures in CT images. Warin et al.55
used YOLOv5 model to detect maxillofacial fractures in 3407 maxillofacial bone CT images, and classified the
fracture conditions into frontal, midfacial, mandibular fractures and no fracture. Rib fractures are a precursor
injury to physical abuse in children, and chest X-ray (CXR) images are preferred for effective diagnosis of rib
fracture conditions because of their convenience and low radiation dose. Tsai et al.56 used data augmentation
with YOLOv5 model to detect rib fractures in CXR images. And Burkow et al.57 applied YOLOv5 model to detect

Author Task Model Dataset mAPval 50

38
Guan et al. Thigh fracture detection DCFPN 3842 thigh fracture X-ray radiographs 0.821
Wang et al.39 Thigh fracture detection R-CNN 3842 thigh fracture X-ray radiographs 0.878
Guan et al.40 Arm fracture detection R-CNN Musculoskeletal-Radiograph (MURA)41 0.620
Wu et al.42 Bone fracture detection FAMO 9040 radiographs of various body parts 0.774
­ uo43
Ma and L Bone fracture detection Faster R-CNN 1052 bone x-ray images 0.884
Xue et al.44 Hand fracture detection Faster R-CNN 3067 hand trauma x-ray images 0.700
Sha et al.45 Spine fracture detection Faster R-CNN 5134 spine fractures CT images 0.733
Sha et al.46 Spine fracture detection YOLOv2 5134 spine fractures CT images 0.753

Table 1.  Experimental results of other studies on fracture detection in various parts of the body based on deep
learning method.

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rib fractures in 704 pediatric CXR images, the model obtained the F2 score value of 0.58. To identify and detect
mandibular fractures in panoramic radiographs, Warin et al.58 used convolutional neural networks (CNNs) and
YOLOv5 model to implement it. Fatima et al.59 used YOLOv5 model to localize vertebrae, which is important
for detecting spinal deformities and fractures, and obtained an average precision of 0.94 at an IoU (Intersection
over Union) threshold of 0.5. Moreover, Mushtaq et al.60 applied YOLOv5 model to localize the lumbar spine
and obtained an average precision value of 0.975. Nevertheless, relatively few researches have been reported on
pediatric wrist fracture detection using YOLOv5 model. While YOLOv8 was proposed by Ultralytics in 2023,
we use this algorithm to train the model for the first time in pediatric wrist fracture detection.

Proposed method
In this section, we introduce the process of the model training, validation and testing on the dataset, the archi-
tecture of YOLOv8 model, and the data augmentation technique employed during training. Figure 1 illustrates
the flowchart depicting the model training process and performance evaluation. We randomly divide the 20,327
X-ray images of the GRAZPEDWRI-DX dataset into the training, validation, and test set, where the training set
is expanded to 28,408 X-ray images by data augmentation from the original 14,204 X-ray images. We design our
model according to YOLOv8 algorithm, and the architecture of YOLOv8 algorithm is shown in Fig. 2.

Data augmentation
During the model training process, data augmentation is employed in this work to extend the dataset. Specifically,
we adjust the contrast and brightness of the original X-ray image to enhance the visibility of bone-anomaly. This
is achieved using the addWeighted function available in OpenCV (Open Source Computer Vision Library). The
equation is presented below:
Output = Input1 × α + Input2 × β + γ , (1)
where Input1 and Input2 are the two input images of the same size respectively, α represents the weight assigned
to the first input image, β denotes the weight assigned to the second input image, and γ represents the scalar
value added to each sum. Since our purpose is to adjust the contrast and brightness of the original input image,
we take the same image as Input1 and Input2 respectively and set β to 0. The value of α and γ represent the pro-
portion of the contrast and the brightness of the image respectively. The image after adjusting the contrast and
brightness is shown in Fig. 3. After comparing different settings, we finally decided to set α to 1.2 and γ to 30 to
avoid the output image being too bright.

Figure 1.  Flowchart of the model training, validation and testing on the dataset. The extended training set is
used to double the number of X-ray images by data augmentation.

Figure 2.  The architecture of YOLOv8 algorithm, which is divided into four parts, including backbone, neck,
head, and loss.

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Figure 3.  Examples of pediatric wrist X-ray images using data augmentation. (a) the original images, (b) the
adjusted images.

Model architecture
Our model architecture consists of backbone, neck, and head, as shown in Fig. 4. In the following subsections,
we introduce the design concepts of each part of the model architecture, and the modules of different parts.

Backbone
The backbone of the model uses Cross Stage Partial (CSP)61 architecture to split the feature map into two parts.
The first part uses convolution operations, and the second part is concatenated with the output of the previous
part. The CSP architecture improves the learning ability of the CNNs and reduces the computational cost of the
model.
YOLOv836 introduces C2f module by combining the C3 module and the concept of ELAN from ­YOLOv732,
which allows the model to obtain richer gradient flow information. The C3 module consists of 3 ConvModule
and n DarknetBottleNeck, and the C2f module consists of 2 ConvModule and n DarknetBottleNeck connected

Figure 4.  Detailed illustration of YOLOv8 model architecture. The Backbone, Neck, and Head are the three
parts of our model, and C2f, ConvModule, DarknetBottleneck, and SPPF are modules.

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through Split and Concat, as illustrated in Figure 4, where the ConvModule consists of Conv-BN-SiLU, and n is
the number of the bottleneck. Unlike ­YOLOv553, we use the C2f module instead of the C3 module.
Furthermore, we reduce the number of blocks in each stage compared to YOLOv5 to further reduce the com-
putational cost. Specifically, our model reduces the number of blocks to 3,6,6,3 in Stage 1 to Stage 4, respectively.
Additionally, we adopt the Spatial Pyramid Pooling - Fast (SPPF) module in Stage 4, which is an improvement
from Spatial Pyramid Pooling (SPP)62 to improve the inference speed of the model. These modifications lead to
our model with a better learning ability and shorter inference time.

Neck
Generally, deeper networks obtain more feature information, resulting in better dense prediction. However,
excessively deep networks reduce the location information of the object, and too many convolution operations
will lead to information loss for small objects. Therefore, it is necessary to use Feature Pyramid Network (FPN)48
and Path Aggregation Network (PAN)63 architectures for multi-scale feature fusion. As illustrated in Fig. 4, the
Neck part of our model architecture uses multi-scale feature fusion to combine features from different layers of
the network. The upper layers acquire more information due to the additional network layers, whereas the lower
layers preserve location information due to fewer convolution layers.
Inspired by YOLOv5, where FPN upsamples from top to bottom to increase the amount of feature informa-
tion in the bottom feature map; and PAN downsamples from bottom to top to obtain more the top feature map
information. These two feature outputs are merged to ensure precise predictions for images of various sizes. We
adopt FP-PAN (Feature Pyramid-Path Aggregation Network) in our model, and delete convolution operations
in upsampling to reduce the computational cost.

Head
Different from YOLOv5 model utilizing a coupled head, we use a decoupled ­head33, where the classification and
detection heads are separated. Figure 4 illustrates that our model deletes the objectness branch and only retains
the classification and regression branches. Anchor-Base employes a large number of anchors in the image to
determine the four offsets of the regression object from the anchors. It adjusts the precise object location using
the corresponding anchors and offsets. In contrast, we adopt Anchor-Free64, which identifies the center of the
object and estimates the distance between the center and the bounding box.

Loss
For positive and negative sample assignment, the Task Aligned Assigner of Task-aligned One-stage Object
Detection (TOOD)65 is used in our model training to select positive samples based on the weighted scores of
classification and regression, as shown in Eq. 2 below:

t = s α × uβ , (2)
where s is the predicted score corresponding to the labeled class, and u is the IoU of the prediction and the
ground truth bounding box.
In addition, our model has classification and regression branches, where the classification branch uses Binary
Cross-Entropy (BCE) Loss, and the equation is shown below:

(3)
   
Lossn = −w yn log xn + 1 − yn log (1 − xn ) ,

where w is the weight, yn is the labeled value, and xn is the predicted value of the model.
The regression branch uses Distribute Focal Loss (DFL)66 and Complete IoU (CIoU) L ­ oss67, where DFL is
used to expand the probability of the value around the object y. Its equation is shown as follows:
DFL(Sn , Sn+1 ) = −((yn+1 − y) log(Sn ) + (y − yn ) log(Sn+1 )), (4)
where the equations of Sn and Sn+1 are shown below:
yn+1 − y y − yn
Sn =
yn+1 − yn
, Sn+1 =
yn+1 − yn
. (5)

CIoU Loss adds an influence factor to Distance IoU (DIoU) ­Loss68 by considering the aspect ratio of the predic-
tion and the ground truth bounding box. The equation is shown below:
Distance22 v2
CIoULoss = 1 − IoU + + , (6)
DistanceC2 (1 − IoU) + ν

where ν is the parameter that measures the consistency of the aspect ratio, defined as follows:
4 w gt wp 2
ν= (arctan − arctan ) , (7)
π2 hgt hp
where w is the weight of the bounding box, and h is the height of the bounding box.

Ethics approval
This research does not involve human participants and/or animals.

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Experiments
Dataset
Medical University of Graz provides a public dataset named GRAZPEDWRI-DX37, which consists of 20,327
X-ray images of wrist trauma in children. These images were collected from 6,091 patients between 2008 and
2018 by multiple pediatric radiologists at the Department of Pediatric Surgery of the University Hospital Graz.
The images are annotated in 9 different classes by placing bounding boxes on them.
To perform the experiments shown in Table 5 and Table 6, we divide the GRAZPEDWRI-DX dataset ran-
domly into three sets: training set, validation set, and test set. The sizes of these sets are approximately 70%, 20%,
and 10% of the original dataset, respectively. Specifically, our training set consists of 14,204 images (69.88%), our
validation set consists of 4,094 images (20.14%), and our test set consists of 2029 images (9.98%). The code for
splitting the dataset can be found on our GitHub. We also provide csv files of training, validation and test data
on our GitHub, but it should be noted that each split is random and therefore not reproducible.

Evaluation metric
Intersection over Union (IoU)
Intersection over Union (IoU) is a classical metric for evaluating the performance of the model for object detec-
tion. It calculates the ratio of the overlap and union between the generated candidate bounding box and the
ground truth bounding box, which measures the intersection of these two bounding boxes. The IoU is repre-
sented by the following equation:
area(C) ∩ area(G)
IoU = , (8)
area(C) ∪ area(G)
where C represents the generated candidate bounding box, and G represents the ground truth bounding box
containing the object. The performance of the model improves as the IoU value increases, with higher IoU values
indicating less difference between the generated candidate and ground truth bounding boxes.

Precision‑recall curve
Precision-Recall Curve (P-R Curve)69 is a curve with recall as the x-axis and precision as the y-axis. Each point
represents a different threshold value, and all points are connected as a curve. The recall (R) and precision (P)
are calculated according to the following equations:
TP TP
Recall = , Precision = , (9)
TP + FN TP + FP
where True Positive (TP ) denotes the prediction result as a positive class and is judged to be true; False Positive
( FP ) denotes the prediction result as a positive class but is judged to be false, and False Negative ( FN ) denotes
the prediction result as a negative class but is judged to be false.

F1‑score
The F-score is a commonly used metric to evaluate the model accuracy, providing a balanced measure of per-
formance by incorporating both precision and recall. The F-score equation is as follows:
1 + β 2 × Precision × Recall
 
F-score = (10)
β 2 × Precision + Recall
When β = 1, the F1-score is determined by the harmonic mean of precision and recall, and its equation is as
follows:
2 × Precision × Recall 2TP
F1 = = (11)
Precision + Recall 2TP + FP + FN

Experiment setup
During the model training process, we utilize pre-trained YOLOv8 model from the MS COCO (Microsoft Com-
mon Objects in Context) val2017 d ­ ataset72. The research reports provided by U
­ ltralytics36,53 suggests that YOLOv5
training requires 300 epochs, while training YOLOv8 requires 500 epochs. Since we use pre-trained model, we
initially set the total number of epochs to 200 with a patience of 50, which indicate that the training would end
early if no observable improvement is noticed after waiting for 50 epochs. In the experiment comparing the
effect of the optimizer on the model performance, we notice that the best epcoh of all the models is within 100,
as shown in Table 4, mostly concentrated between 50 and 70 epochs. Therefore, to save computing resources,
we adjust the number of epochs for our model training to 100.
As the ­suggestion36 of Glenn, for model training hyperparameters, the ­Adam73 optimizer is more suitable for
small custom datasets, while the ­SGD74 optimizer perform better on larger datasets. To prove the above conclu-
sion, we train YOLOv8 algorithm models using the Adam and SGD optimizers, respectively, and compare the
effects on the model performance. The comparison results are shown in Table 4.
For the experiments, we choose the SGD optimizer with an initial learning rate of 1×10−2, a weight decay of
5×10−4 , and a momentum of 0.937 during our model training. We set the input image size to 640 and 1024 for
training on a single GPU GeForce RTX 3080Ti 12GB with a batch size of 16. We train the model using Python 3.8

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and PyTorch 1.8.2, and recommend readers to use Python 3.7 or higher and PyTorch 1.7 or higher for training.
It is noteworthy that due to GPU memory limitations, we choose 3 worker threads to load data on GPU GeForce
RTX 3080Ti 12GB when training our model. Therefore, using GPUs with larger memory and more computing
power can effectively increase the speed of model training.

Ablation study
In order to demonstrate the positive effect of our training method on the performance of YOLOv8 model, we
conduct an ablation study on YOLOv8s model by calculating each evaluation metric for each class, as shown in
Table 2. Among all classes, YOLOv8s model has good accuracy in detecting fracture, metal and text, with mAP 50
of each above 0.9. On the opposite, the detection ability of bone-anomaly is poor, with mAP 50 of 0.11. Therefore,
we increase the contrast and brightness of X-ray images to make bone-anomaly easier to detect. Table 3 presents
the predictions of YOLOv8s model using our training method for each class. Compared with YOLOv8s model,
the mAP value predicted by the model using our training method for bone-anomaly increased from 0.11 to 0.169,

mAPval mAPval
Class Boxes Instances Precision Recall 50 50-95
All 47435 9613 0.674 0.605 0.623 0.395
Boneanomaly 276 53 0.505 0.094 0.110 0.035
Bonelesion 45 8 0.629 0.250 0.416 0.212
Fracture 18090 3740 0.885 0.903 0.947 0.572
Metal 818 168 0.878 0.899 0.920 0.768
Periostealreaction 3453 697 0.645 0.684 0.689 0.357
Pronatorsign 567 104 0.561 0.713 0.611 0.338
Softtissue 464 89 0.324 0.315 0.251 0.125
text 23722 4754 0.961 0.984 0.991 0.750

Table 2.  Validation results of YOLOv8 for each class on the GRAZPEDWRI-DX dataset when the input image
size is 1024.

mAPval mAPval
Class Boxes Instances Precision Recall 50 50-95
All 47435 9613 0.694 0.592 0.631 0.402
Boneanomaly 276 53 0.510 0.151 0.169 0.076
Bonelesion 45 8 0.658 0.243 0.414 0.213
Fracture 18090 3740 0.899 0.896 0.947 0.569
Metal 818 168 0.898 0.890 0.924 0.780
Periostealreaction 3453 697 0.721 0.654 0.700 0.359
Pronatorsign 567 104 0.534 0.683 0.611 0.342
Softtissue 464 89 0.367 0.236 0.241 0.120
text 23722 4754 0.961 0.981 0.991 0.754

Table 3.  Validation results of our model for each class on the GRAZPEDWRI-DX dataset when the input
image size is 1024.

mAPval mAPval Speed GPU

Model Size Optimizer Best Epoch 50 50-95 RTX 3080Ti (ms)
YOLOv8s 640 SGD 56 0.611 0.389 4.4
YOLOv8s 640 Adam 57 0.604 0.383 4.3
YOLOv8s 1024 SGD 36 0.623 0.395 5.4
YOLOv8s 1024 Adam 47 0.625 0.399 4.9
YOLOv8m 640 SGD 52 0.621 0.396 4.9
YOLOv8m 640 Adam 62 0.621 0.403 5.5
YOLOv8m 1024 SGD 35 0.624 0.402 9.9
YOLOv8m 1024 Adam 70 0.626 0.401 10.0

Table 4.  Model performance comparison of YOLOv8 models using SGD and Adam optimizers. For training
with the SGD optimizer, the initial learning rate is 1×10−2; for training with the Adam optimizer, the initial
learning rate is 1×10−3.

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mAPval mAPval Speed CPU Speed GPU

Model 50 50–95 Intel Core i5 (ms) RTX 3080Ti (ms) PARAMS (M) FLOPs (B)
YOLOv5n 0.589 0.339 \ 2.8 1.77 4.2
YOLOv8n 0.601 0.374 67.4 2.9 3.01 8.1
Ours 0.605 0.379 111.3 3.4 3.01 8.2
YOLOv5s 0.601 0.357 \ 3.3 7.03 15.8
YOLOv8s 0.604 0.383 191.5 4.3 11.13 28.5
Ours 0.612 0.392 285.1 4.9 11.13 28.7
YOLOv5m 0.613 0.371 \ 4.0 20.89 48.0
YOLOv8m 0.621 0.403 536.4 5.5 25.84 78.7
Ours 0.629 0.404 685.9 5.1 25.84 78.7
YOLOv5l 0.620 0.379 \ 5.6 46.15 107.8
YOLOv8l 0.624 0.403 1006.3 7.4 43.61 164.9
Ours 0.637 0.406 1370.8 7.2 43.61 164.9

Table 5.  Quantitative comparison of fracture detection when the input image size is 640. Speed means the
total time of validate per image, and the total time includes the preprocessing, inference, and post-processing
time.

mAPval mAPval Speed CPU Speed GPU

Model 50 50–95 Intel Core i5 (ms) RTX 3080Ti (ms) PARAMS (M) FLOPs (B)
YOLOv5n 0.600 0.347 \ 3.2 1.77 4.2
YOLOv8n 0.605 0.387 212.1 3.3 3.01 8.1
Ours 0.608 0.391 260.4 4.4 3.01 8.1
YOLOv5s 0.622 0.371 \ 4.4 7.03 15.8
YOLOv8s 0.625 0.399 519.5 4.9 11.13 28.5
Ours 0.631 0.402 717.1 6.2 11.13 28.5
YOLOv5m 0.624 0.380 \ 7.1 20.89 48.0
YOLOv8m 0.626 0.401 1521.5 10.0 25.84 78.7
Ours 0.635 0.411 1724.4 9.4 25.85 78.7
YOLOv5l 0.626 0.378 \ 11.3 46.15 107.8
YOLOv8l 0.636 0.404 2671.1 15.1 43.61 164.9
Ours 0.638 0.415 3864.5 13.6 43.61 164.9

Table 6.  Quantitative comparison of fracture detection when the input image size is 1024. Speed means the
total time of validate per image, and the total time includes the preprocessing, inference, and post-processing
time.

an increase of 53.6%. Figure 5 also shows that our model has a better performance in detecting bone-anomaly,
which enables the improvement of the overall model performance. From the ablation study presented above, we
demonstrate that the model performance can be improved by using our training method (data augmentation).
In addition to the data enhancement, researchers can also improve model performance by adding modules such
as the Convolutional Block Attention Module (CBAM)70.

Experimental results
Before training our model, in order to choose an optimizer that has a more positive effect on the model perfor-
mance, we compare the performance of models trained with the S­ GD74 optimizer and the A ­ dam73 optimizer. As
shown in Table 4, using the SGD optimizer to train the model requires less epochs of weight updates. Specifically,
for YOLOv8m model with an input image size of 1024, the model trained with the SGD optimizer achieves the
best performance at the 35th epoch, while the best performance of the model trained with the Adam optimizer
is at the 70th epoch. In terms of mAP and inference time, there is not much difference in the performance of
the models trained with the two optimizers. Specifically, when the input image size is 640, the mAP value of
YOLOv8s model trained with the SGD optimizer is 0.007 higher than that of the model trained with the Adam
optimizer, while the inference time is 0.1ms slower. Therefore, according to the above experimental results and
the suggestion by G­ lenn36,53, for YOLOv8 model training on a training set of 14,204 X-ray images, we choose
the Adam optimizer. However, after using data augmentation, the number of X-ray images in the training set
extend to 28,408, so we switch to the SGD optimizer to train our model.
After using data augmentation, our models have a better mAP value than that of YOLOv8 model, as shown
in Table 5 and Table 6. Specifically, when the input image size is 640, compared with YOLOv8m model and

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Figure 5.  Detailed illustration of the validation at the input image size of 1024, (a) is our model, and (b) is
YOLOv8 model.

YOLOv8l model, the mAP 50 of our model improves from 0.621 to 0.629, and from 0.623 to 0.637, respectively.
Although the inference time on the CPU is increased from 536.4 ms and 1006.3 ms to 685.9 ms and 1370.8 ms,
respectively, the number of parameters and FLOPs are the same, which means that our model can be deployed
on the same computing power platform. In addition, we compare the performance of our model with that of
YOLOv7 and its improved models. As shown in Table 7, the mAP value of our model is higher than those of
­YOLOv732, YOLOv7 with Convolutional Block Attention Module (CBAM)70 and YOLOv7 model with Global
Attention Mechanism (GAM)71, which demonstrates that our model has obtained SOTA performance.
This paper aims to design a pediatric wrist fracture detection application, so we use our model for fracture
detection. Figure 6 shows the results of manual annotation by the radiologist and the results predicted using our
model. These results demonstrate that our model has a good ability to detect fractures in single fracture cases,
but metal puncture and dense multiple fracture situations badly affects the accuracy of prediction.

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Figure 6.  Examples of pediatric wrist fracture detection on X-ray images. (a) manually labeled images, (b)
predicted images.

mAPval
Model Precision Recall F1 50
YOLOv553 0.682 0.581 0.607 0.626
YOLOv732 0.556 0.582 0.569 0.628
YOLOv732 + ­CBAM70 0.709 0.593 0.646 0.633
YOLOv732 + ­GAM71 0.745 0.574 0.646 0.634
YOLOv836 0.694 0.679 0.623 0.636
Ours 0.734 0.592 0.635 0.638

Table 7.  Evaluation of wrist fracture detection with other state-of-the-art (SOTA) models on the
GRAZPEDWRI-DX dataset.

Application
After completing model training, we utilize a Python library that includes the Qt toolkit, PySide6, to develop
a Graphical User Interface (GUI) application. Specifically, PySide6 is the Qt6-based version of the PySide GUI
library from the Qt Company.
According to the model performance evaluation results in Tables 5 and 6, we choose our model with YOLOv8s
algorithm and the input image size of 1024, to perform fracture detection. Our model is exported to onnx format,
and is applied to the GUI application. Figure 7 depicts the flowchart of the GUI application operation on macOS.
As can be seen from the illustration, our application is named “Fracture Detection Using YOLOv8 App”. Users
can open and predict the images, and save the predictions in this application. In summary, our application is
designed to assist pediatric surgeons in analyzing fractures on pediatric wrist trauma X-ray images.

Conclusions and future work

Ultralytics proposed the latest version of YOLO series (YOLOv8) in 2023. Although there are relatively few
research works on YOLOv8 model for medical image processing, we apply it to fracture detection and use data
augmentation to improve the model performance. We randomly divide the dataset, consisting of 20,327 pediatric
wrist trauma X-ray images from 6091 patients, into training, test, and validation sets to train the model and
evaluate the performance.
Furthermore, we develop an application named “Fracture Detection Using YOLOv8 App” to analyze pediatric
wrist trauma X-ray images for fracture detection. Our application aims to assist pediatric surgeons in interpreting
X-ray images, reduce the probability of misclassification, and provide a better information base for surgery. The
application is currently available for macOS, and in the future, we plan to deploy different sizes of our model in
the application, and extend the application to iOS and Android. This will enable inexperienced pediatric surgeons
in hospitals located in underdeveloped areas to use their mobile devices to analyze pediatric wrist X-ray images.
In addition, we provide the specific steps for training the model and the trained model in our GitHub. If
readers wish to use YOLOv8 model to detect fracture in other parts of the body except the pediatric wrist, they
can use our trained model as the pre-training model, which can greatly improve the performance of the model.

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Figure 7.  Example of using the application “Fracture Detection with YOLOv8 Application” on macOS
operating system .

Data availability
The datasets analysed during the current study are available at Figshare under https://​doi.​org/​10.​6084/​m9.​figsh​
are.​14825​193.​v2. The implementation code and the trained model for this study can be found on GitHub at
https://​github.​com/​Ruiya​ngJu/​Bone_​Fract​ure_​Detec​tion_​YOLOv8.

Received: 16 May 2023; Accepted: 14 November 2023

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Author contributions
R.J. conceived and conducted the experiments, and W.C. provided knowledge about the fracture and analyzed
the results. All authors reviewed the manuscript.

Funding
The authors did not receive support from any organization for the submitted work.

Competing interests
The authors declare no competing interests.

Additional information
Correspondence and requests for materials should be addressed to W.C.
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