# Reliability- and Anatomy-Consistency-Aware Multimodal Learning for Robust Fracture Classification from Bangladeshi Radiographs

arXiv: https://arxiv.org/abs/2608.21482 · HTML: https://mlsanity.com/paper/2608.21482/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 5 of its 22 references that are in the map.
- First posted on arXiv 21 Aug 2026.

## Builds on (most cited first, 5 of 5)

- [Grad-CAM: Visual Explanations from Deep Networks via Gradient-based Localization](https://mlsanity.com/paper/1610.02391/) (2016)
- [On Calibration of Modern Neural Networks](https://mlsanity.com/paper/1706.04599/) (2017)
- [A ConvNet for the 2020s](https://mlsanity.com/paper/2201.03545/) (2022)
- [MedFuse: Multi-modal fusion with clinical time-series data and chest X-ray images](https://mlsanity.com/paper/2207.07027/) (2022)
- [Missing-modality Enabled Multi-modal Fusion Architecture for Medical Data](https://mlsanity.com/paper/2309.15529/) (2023)

## Abstract (arXiv)

Background: Multimodal fracture classifiers may benefit from patient and anatomical metadata, but they can also become brittle when contextual information is missing or mismatched. Methods: We studied 1493 radiographs from the Bangladeshi OrthoFrac-XR dataset using leakage-safe age, sex, bone type, and laterality. A ConvNeXt image encoder was combined with a clinical multilayer perceptron through concatenation, late fusion, reliability-gated residual fusion, and a hierarchical state-location formulation. We additionally introduced an anatomy-consistency gate that attenuates metadata corrections when an image-side anatomical prediction disagrees with the reported bone type. Results: Across five folds and three seeds, hierarchical residual fusion achieved a macro-F1 of 0.6046 +/- 0.0279, compared with 0.5727 +/- 0.0270 for image-only learning, while improving the Brier score from 0.5239 to 0.4948. In a five-fold robustness experiment, anatomy-consistency fusion reduced the macro-F1 loss under shuffled metadata from 0.0567 to 0.0203 relative to ordinary residual fusion, although its clean-data macro-F1 was lower. Without bone type at inference, auxiliary anatomy supervision improved macro-F1 from 0.5620 +/- 0.0330 to 0.5899 +/- 0.0289. Conclusions: Structured context improves fracture classification, and consistency-aware gating limits harm from mismatched metadata. The observed clean-performance-robustness trade-off and the absence of patient-level identifiers motivate external and prospective validation.