FracSegmentator: Fracture Instance Segmentation with Trauma-Prior-Guided Contrastive Learning

Fracture injuries often lead to complex bone fragmentations, posing significant challenges for accurate segmentation in surgical planning and trauma assessment. Manual annotation of each fragment is time-consuming and inconsistent, while existing automated methods often fail to separate individual fragments due to the wide variation in fracture types, irregular fracture surface, and close inter-fragment contact. To address these challenges, we introduce FracSegmentator, a deep learning approach for bone fragment instance segmentation. The model takes extracted bone regions in CT as input and isolates individual fragments by identifying fracture surfaces and separating closely contacting structures. Central to our approach is a Trauma-Prior-Guided Contrastive Learning module, which incorporates clinical knowledge through memory-based attention to better distinguish fractured surfaces from healthy regions. We evaluate FracSegmentator on four datasets that cover a range of anatomical sites and fracture patterns. The method achieves state-of-the-art results across all datasets and demonstrates strong generalization capabilities. By delivering accurate and efficient fragment-level segmentation, FracSegmentator supports critical downstream tasks such as automated fracture diagnosis, surgical planning, and preoperative reduction simulation.