Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. MethodsWe did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. FindingsWe included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58•0%) were male. Median gestational age at birth was 38 weeks (IQR 36-39) and median bodyweight at presentation was 2•8 kg (2•3-3•3). Mortality among all patients was 37 (39•8%) of 93 in low-income countries, 583 (20•4%) of 2860 in middle-income countries, and 50 (5•6%) of 896 in high-income countries (p<0•0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90•0%] of ten in lowincome countries, 97 [31•9%] of 304 in middle-income countries, and two [1•4%] of 139 in high-income countries; p≤0•0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2•78 [95% CI 1•88-4•11], p<0•0001; middle-income vs high-income countries, 2•11 [1•59-2•79], p<0•0001), sepsis at presentation (1•20 [1•04-1•40], p=0•016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4-5 vs ASA 1-2, 1•82 [1•40-2•35], p<0•0001; ASA 3 vs ASA 1-2, 1•58, [1•30-1•92], p<0•0001]), surgical safety checklist not used (1•39 [1•02-1•90], p=0•035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1•96, [1•4...

PURPOSE OF THE STUDYOlecranon fractures in skeletally immature patients are rather rare and represent up to 7% of elbow skeletal injuries. Although the majority of olecranon fractures is constituted by undisplaced fractures treated conservatively with good outcomes, a few of them require surgery. The aim of the study was to compare two different approaches of surgical treatment -the open reduction with tension band wiring -cerclage (ORCe) and the closed reduction and percutaneous pinning (CRPP). MATERIAL AND METHODS37 patients (28 boys, 9 girls) were included in the retrospective multicentric study. The patients were treated at two different institutions (the

Background: A Jones fracture is a transverse fracture of the V. metatarsal bone, without significant dislocation in the diaphysis junction and metaphyseal metaphysis. This type of fracture is usually associated with a minimal injury mechanism, and is characterized with minimal swelling, absence of hematoma and prolonged healing. The aim of the presented study was to compare the surgical and conservative therapy of Jones fracture. The study was registered in the www.clinicaltrials.gov database, under the ClinicalTrials.gov ID: NCT04037540 on 27th July 2019. Methods: A total of 27 study subjects were randomized into two groups – Conservative (K): 12, and Operational (O): 15. The study subjects were followed after 6 and 12 weeks using X-ray and the American Orthopedic Foot and Ankle Score (AOFAS). In the absence of X-ray signs of healing and low AOFAS score in Group K, treatment was considered unsuccessful and the patient was indicated for surgical treatment. Results: Five patients in Group K showed no signs of healing on X-ray after 12 to 6 weeks. These patients also manifested poor AOFAS scores and were indicated for surgical treatment and excluded from the study. Fracture failure was observed in seven patients. Their AOFAS scores were at the least satisfactory and, the patients continued in conservative therapy. After 12 weeks, 6 patients manifested fracture healing on X-ray and the AOFAS score of 100. In one patient who refused surgery, the fracture was not healed after 12 weeks. In Group O, seven patients achieved fracture healing on X-ray after 6 weeks, 8 patients did not show fracture healing. The average AOFAS score after 6 weeks was 97 (excellent). After 12 months, 13 patients showed findings of fracture healing on X-ray. The average AOFAS score was 100 points (maximum). Conclusions: The results of the study show that 1) Surgical treatment leads to significantly faster signs of healing on X-ray than the conservative one 2) After six weeks of surgery, 93% (14 out of 15) of patients are able to fully load the limb. Keywords: Jones - Fracture - AOFAS - Herbert screw Unique protocol ID: FNO-KUCH-01-Jones

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