Phenotyping TPF via Self-Supervised Learning: A Label-Agnostic Framework with Expert Validation
This study addresses the substantial inter-observer variability inherent in conventional tibial plateau fracture classification systems—such as Schatzker and AO/OTA—which can cause supervised models to learn human disagreement rather than true morphological patterns. To overcome this limitation, the authors propose the first fully unsupervised self-supervised learning framework that leverages knee radiographs to automatically discover imaging-derived fracture phenotypes. The approach integrates RadImageNet-pretrained ResNet-50, SimCLR contrastive learning, UMAP dimensionality reduction, and k-means clustering. Clinical expert blind review confirmed that the four identified phenotypes exhibit high cohesion (silhouette coefficient: 0.511; bootstrap-adjusted Rand index [ARI]: 0.319) and strong clinical interpretability. Notably, one phenotype was consistently interpreted as comminuted fracture and proved nearly orthogonal to Schatzker classification (ARI = 0.013), revealing a critical morphological dimension overlooked by existing taxonomies.