Summary Background Risk of mortality following surgery in patients across Africa is twice as high as the global average. Most of these deaths occur on hospital wards after the surgery itself. We aimed to assess whether enhanced postoperative surveillance of adult surgical patients at high risk of postoperative morbidity or mortality in Africa could reduce 30-day in-hospital mortality. Methods We did a two-arm, open-label, cluster-randomised trial of hospitals (clusters) across Africa. Hospitals were eligible if they provided surgery with an overnight postoperative admission. Hospitals were randomly assigned through minimisation in recruitment blocks (1:1) to provide patients with either a package of enhanced postoperative surveillance interventions (admitting the patient to higher care ward, increasing the frequency of postoperative nursing observations, assigning the patient to a bed in view of the nursing station, allowing family members to stay in the ward, and placing a postoperative surveillance guide at the bedside) for those at high risk (ie, with African Surgical Outcomes Study Surgical Risk Calculator scores ≥10) and usual care for those at low risk (intervention group), or for all patients to receive usual postoperative care (control group). Health-care providers and participants were not masked, but data assessors were. The primary outcome was 30-day in-hospital mortality of patients at low and high risk, measured at the participant level. All analyses were done as allocated (by cluster) in all patients with available data. This trial is registered with ClinicalTrials.gov , NCT03853824 . Findings Between May 3, 2019, and July 27, 2020, 594 eligible hospitals indicated a desire to participate across 33 African countries; 332 (56%) were able to recruit participants and were included in analyses. We allocated 160 hospitals (13 275 patients) to provide enhanced postoperative surveillance and 172 hospitals (15 617 patients) to provide standard care. The mean age of participants was 37·1 years (SD 15·5) and 20 039 (69·4%) of 28 892 patients were women. 30-day in-hospital mortality occurred in 169 (1·3%) of 12 970 patients with mortality data in the intervention group and in 193 (1·3%) of 15 242 patients with mortality data in the control group (relative risk 0·96, 95% CI 0·69–1·33; p=0·79). 45 (0·2%) of 22 031 patients at low risk and 309 (5·6%) of 5500 patients at high risk died. No harms associated with either intervention were reported. Interpretation This intervention package did not decrease 30-day in-hospital mortality among surgical patients in Africa at high risk of postoperative morbidity or mortality. Further research is needed to develop interventions that prevent death from surgical complications in resource-limited hospitals across Africa. Funding Bill & Melinda Gates Foundation and the World Federati...

Introduction: Since the times of our ancestors, traditional medicine has existed to cure all diseases [1]. The objective of this study was to assess the complications of traditional fracture treatment. Patients and Methods: This was a prospective study extending from January 01, 2018 to June 30, 2018, duration of six months. It concerned patients who had traditionally been treated beforehand for traumas with bone lesion in a traditional therapist and who had developed a complication, the definitive management of which was made in the department. Results: This study involved 102 patients, including 71 men (69.6%), with a sex ratio of 2.2. 33 patients or 32.4% were under 15 years old. The average of our patients' age was 29.61 years with extremes of 2 and 89 years. Pupils/students (44 pupils and 5 students) were the most represented with 49 cases or 48.1% of the cases. The majority of patients (59.8% of cases) were educated or had a basic level. The majority of patients (36.3%) came as motif for a painful swelling. Gangrene was the most common complication with 37 cases or 36.3% of cases. Conclusion: At the end of our study, we have noticed that the traditional preliminary treatment of fractures was based mainly on trial and error. Practicing with inadequate means and measures without respecting the anatomical structures, is a real source of disabling handicaps. We have recorded 38, among the 102 patients who came for a complication of traditional treatment: that is 45.2% amputation, which is deplorable.

Introduction: Subtalar or peritalian dislocation is rare; it represents 15% of peritalian injuries. The aim of this study was to describe the radioclinical and therapeutic characteristics and to assess the functional result. Patients and Methods: This study is about a continuous descriptive and prospective study over a period of 5 years. It has been conducted from March 2013 to February 2018 at the Ségou Hospital, a second referral hospital in Mali. The functional results were evaluated by the score of the American Orthopedic Foot and Ankle Society (AOFAS). Results: Seven cases of subtalar dislocation fractures were diagnosed in six male patients with an average age of 38 years (36 to 47 years old). In five cases the etiology of the trauma was a motorcycle accident and a fall from height. The lesion was bilateral in one case. The average time to care was 3 hours (1 to 9 hours). There was one case of open dislocation fracture with talus enucleation. The dislocation was medial in 6 cases and lateral in one case. It was pure in three cases. The treatment was orthopedic in 2 cases and surgical in 5 cases. The post-operative complications were complicated by an infection of the operative site in one case. The average length of hospital stay was 4 days. The functional result was excellent in 2 cases; good in 2 cases, fair in 2 cases and poor for 1 case. Conclusion: Subtalar dislocation is a rare and serious lesion of the posterior tarsus. The long-term prognosis depends on the earliness of treatment and the severity of the associated injuries.

The authors report a rare case of Monteggia bilateral fracture combining bifocal fracture of the left ulna to a mid-shaft fracture of the radius with dislocation of the radial head and on the right; a fractured ulna with dislocation of the radial head occurring in a patient of 31 years after an accident of the public highway. In emergency, the treatment consisted of a fixation with radius special plates and a left pin ulnar upper radio. The evolution was marked by a good consolidation and after six months the patient had resumed operations.

We report an unusual case of basic bilateral fracture of fifth metatarsals in a 48 years old post-menopausal woman. She had previously been treated for arterial high blood pressure, parathyroidectomy and rheumatoid arthritis by a long corticotherapy treatment. The lesion was caused by an indirect mechanism in an overweight context. The diagnosis of a pseudarthrosis of the base of the fifth metatarsals was maintained after 7-month treatment. The patient received a treatment of both pseudarthrosis. The post-operative periods were simple. After a 9-month follow-up, the treatment allowed consolidation with painless feet allowing her to resume work.