Böstman O, Rokkanen P
Ann Chir Gynaecol. 1986;75(6):333-6.
A nation-wide survey covering 5 university central hospitals, 16 central hospitals and 29 county or municipal hospitals was directed at the present policy of management in diaphyseal fractures of the humerus, of both bones of the forearm, of the femur and of the tibia. An orthopaedic or general surgeon in charge of the accident services in each of the total of 50 hospitals was asked to estimate for each type of long-bone fracture separately, the relative frequency (as a percentage) of the utilization of certain given methods of treatment in his unit. In adults non-operative treatment predominated in fractures of the humeral shaft (mean percentage from the 50 hospitals 74%) and in fractures of the tibial shaft (76% for the closed and 65% for the open fractures), plate osteosynthesis in fractures of the forearm (72%) and intramedullary nailing in fractures of the femoral shaft (71% versus 22% for plating). In children the highest percentage of internal fixation, 7%, was obtained in forearm fractures. On average no significant differences in the profile of treatment, were found between the university, central and county hospitals, and neither did the relative number of acting orthopaedic surgeons per population in the hospitals of a district influence the frequency of operative versus non-operative management. But despite the observed, on the whole, comparatively uniform and probably judicious policy, a most remarkable variation emerged between individual hospitals in different parts of the country.
一项覆盖5所大学中心医院、16所中心医院以及29所县级或市级医院的全国性调查，针对肱骨骨干、前臂双骨、股骨和胫骨骨干骨折的现行管理政策展开。要求这50所医院中负责事故服务的骨科或普通外科医生，分别针对每种类型的长骨骨折，估算其所在科室采用某些特定治疗方法的相对频率（以百分比表示）。在成人中，肱骨干骨折非手术治疗占主导（50所医院的平均百分比为74%），胫骨干骨折也是如此（闭合性骨折为76%，开放性骨折为65%），前臂骨折采用钢板内固定（72%），股骨干骨折采用髓内钉固定（71%，钢板固定为22%）。在儿童中，前臂骨折的内固定比例最高，为7%。总体而言，在大学医院、中心医院和县级医院之间，治疗方式上未发现显著差异，而且一个地区医院中每人口的在职骨科医生相对数量，也未影响手术治疗与非手术治疗的频率。但是，尽管总体上观察到的政策相对统一且可能较为明智，但该国不同地区的各医院之间仍出现了极为显著的差异。
