Artificial intelligence in emergency musculoskeletal imaging: A critical review of current applications

• Current artificial intelligence applications support emergency musculoskeletal imaging workflow. • Deep learning models can detect subtle fractures, musculoskeletal infections, and injury acuity. • Current artificial intelligence models support management decisions through fracture classification. • Large language models improve reporting clarity and clinical communication between radiologists and clinicians. Artificial intelligence (AI) is increasingly shaping emergency musculoskeletal imaging, where rapid and accurate diagnosis is often challenged by high imaging volumes and time pressure. These constraints increase the risk of missed injuries and underscore the need for tools that support faster and reliable assessments. AI systems show promise in improving workflow efficiency by prioritizing urgent studies, guiding modality selection, and reducing reporting delays. Deep learning models can enhance abnormality detection by identifying fractures, soft tissue injuries, and infectious processes, and can provide structured classifications that support clinical decision making. Pediatric-focused AI systems address age-specific developmental considerations and offer valuable support for clinicians with varying levels of pediatric musculoskeletal expertise. Large language models further expand the role of AI by improving report clarity, generating structured impressions, and facilitating communication with clinicians, patients, and families. Despite these advances, challenges remain, including limited external validation, dataset bias, and medicolegal considerations. This review summarizes current AI applications across these domains and highlights key strengths, limitations, and future directions for safe and effective integration into emergency musculoskeletal imaging.