The management of diaphyseal fractures of the long bones in Finland: a nation-wide survey.

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.