Introduction Fractures pose a critical challenge in emergency settings, necessitating rapid and accurate diagnosis to prevent complications. Recent advances in artificial intelligence (AI) have opened new possibilities for fracture detection using X-ray imaging. This study aimed to evaluate the performance of SmartUrgence® by Milvue, an AI tool designed to identify fractures in emergency cases, comparing its results to computed tomography (CT) scans, the gold standard in fracture diagnosis. Methods Patients referred from the Orthopedic Department after clinical suspicion of fractures underwent both AI-assisted X-ray imaging and CT scans. The study compared AI-generated X-ray assessments with CT scan findings to measure the AI tool’s accuracy, sensitivity, and specificity. Results SmartUrgence® demonstrated strong diagnostic metrics: specificity of 95.45%, sensitivity of 91.13%, positive predictive value (PPV) of 93.39%, and negative predictive value (NPV) of 93.85%. Overall accuracy reached 93.67%, with a balanced accuracy of 93.25%. Precision (0.934) and recall (0.911) were also high, reflecting the AI’s ability to minimize false positives and negatives. However, the AI tool’s performance remained significantly different from that of CT scans (P