fellowship 培训的骨科创伤医生在肱骨干和锁骨骨干骨折处理中的差异。
Variation in management of humeral and clavicular shaft fractures amongst fellowship trained orthopedic traumatologists.
机构信息
Department of Orthopedic Surgery, Baylor College of Medicine, 7200 Cambridge St. Suite 10A, Houston, TX, 77030, USA.
出版信息
BMC Musculoskelet Disord. 2020 Sep 18;21(1):618. doi: 10.1186/s12891-020-03639-x.
BACKGROUND
There exists a wide variety of opinions on the appropriate management of diaphyseal humeral and clavicular fractures amongst orthopedic surgeons. The purpose of this study is to determine if there is a preference amongst orthopedic traumatologists on treatment of diaphyseal humerus and clavicle fractures with respect to various patient populations.
METHODS
A 6-question survey was created using Surveymonkey.com and distributed via the Orthopedic Trauma Association (OTA) website to fellowship trained orthopedic surgery traumatologists to survey the preferred management of a simple oblique middle 1/3rd diaphyseal humerus fracture and a middle 1/3rd displaced diaphyseal clavicle fracture in the following 3 clinical settings: a healthy laborer, an older patient with co-morbidities, and if the surgeon themselves sustained the injury. The ratio of operative to non-operative management was calculated for all 6 questions. A chi-square value was performed to determine if the results are clinically significant based on the clinical scenario.
RESULTS
There was 56 responses to the survey that were included in the analysis. Overall, there was a statistically significant trend towards surgical management of the surgeon's own diaphyseal humerus fractures (55%) compared to that of healthy patients (41%) and those with medical comorbidities (21%) (p = 0.02) A similar trend was noted for operative management for diaphyseal clavicle fractures by the surgeon on their own fractures (43%) compared to that of healthy patients (38%) and those with medical comorbidities (18%) (p = 0.02).
CONCLUSION
While there are an increasing number of relative indications for treatment of diaphyseal humerus shaft and clavicle fractures, the results of this survey indicate that fellow-ship-trained orthopedic trauma surgeons prefer surgical management of simple humerus and clavicular fractures in young, healthy patients as well as in themselves.
背景
骨科医生对骨干肱骨和锁骨骨折的适当处理方法存在广泛的意见。本研究旨在确定在各种患者群体中，骨科创伤医生在治疗骨干肱骨和锁骨骨折方面是否存在偏好。
方法
使用 Surveymonkey.com 创建了一个包含 6 个问题的调查，并通过骨科创伤协会（OTA）网站分发给接受过 fellowship 培训的骨科创伤外科医生，以调查以下 3 种临床情况下治疗简单的中段 1/3 骨干斜形肱骨骨折和中段 1/3 移位骨干锁骨骨折的首选方法：健康劳动者、患有合并症的老年患者以及如果外科医生自己受伤。对于所有 6 个问题，计算了手术与非手术治疗的比例。进行卡方检验以确定结果是否根据临床情况具有临床意义。
结果
共有 56 份对调查的回复被纳入分析。总体而言，与健康患者（41%）和合并症患者（21%）相比，外科医生自己的骨干肱骨骨折更倾向于手术治疗（55%），这具有统计学显著趋势（p=0.02）。对于外科医生自己的骨干锁骨骨折的手术治疗，也观察到类似的趋势，与健康患者（38%）和合并症患者（18%）相比，倾向于手术治疗（43%）（p=0.02）。
结论
虽然治疗骨干肱骨和锁骨骨折的相对适应证越来越多，但这项调查的结果表明，接受过 fellowship 培训的骨科创伤外科医生更喜欢对年轻、健康的患者以及自己进行简单的肱骨和锁骨骨折的手术治疗。
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