ObjectivesTo explore the clinical presentation, diagnosis and treatment of hemophagocytic syndrome (HLH) in children.MethodsThe clinical data from 11 hospitalized pediatric patients with HLH were collected and retrospectively analyzed from 2009 to 2013.ResultsIn 11 pediatric patients with HLH, 6 patients were Epstein-Barr virus associated-HLH, 1 patient was T-cell lymphoma associated-HLH, 2 patients had unknown reason, 2 patients had mutations in the UNC13D gene coding sequence, c.2459C>T/p.A832V (alanine to valine mutation) and c.3067C>T/p.R1023C (arginine to cysteine mutation) respectively. In 11 patients, 6 patients were improved after treatment and 5 patients were died.ConclusionsThe HLH in chil-dren lacks speciifc clinical presentation and progresses rapidly. It should be diagnosed and treated in time.

SUMMARY Anklejointfractureisoneofthemostcommontypesoffracture.Therearemanyresearches on the injury mechanism,treatment principles and surgical techniques.A type of injury which combines posterior dislocation of fibula,known as the Bosworth injury,is relatively rare.In 1947,Bosworth first described this type of injury as an unusual ankle fracture dislocation with fixed posterior fracture disloca-tion of the distal part of the fibula.In this type of fracture,the proximal fibular shaft fragment locks be-hind the tibialis posterior tubercle.This rare ankle fracture variant is often not recognized in initial radio-graphs and requires a computed tomographic (CT)scan for verification.But there are already many re-ports,discussing the injury mechanism,treatment principles and surgical techniques.However,there are few reports of anterior dislocation of the fibula,caused by either injury or surgery.The mechanism of the injury is still not clear.This article reports a case of anterior dislocation of the fibula.We report a patient with left ankle open fracture (Lauge-Hansen pronation-external rotation stage Ⅲ,Gustilo ⅢA).Open reduction and internal fixation was done in the initial surgery,but ended up with poor reduction,resulting in fibula anterior dislocation,anterior dislocation of talus and tibia fibular dislocation.The fibula was dis-located anteriorly of the tibia,which rarely happened.The patient suffered severe ankle joint dysfunc-tion.The second operation took out the original internal fixation,reduced the fracture,and reset the in-ternal fixation.The function of ankle joint was improved obviously after operation.But because of the ini-tial injury and the two operations,the soft tissue around the fracture was greatly damaged.6 months after the second operation,and the fracture still not healed,so the bone graft was carried out in the third sur-gery.Two months after the third surgery,the function of the ankle was significantly better than before, but the fracture healing was poor,which needed further review.Through this case,we understand the rare type of ankle fracture with anterior dislocation of the fibula,and recognize that the timing and quality of initial surgery has a great impact on the patient’s prognosis and rehabilitation period.

In numerous digestive reconstruction techniques after proximal gastrectomy for tumor of the gastroesophageal junction,widely used methods are esophagogastrostomy,esophagogastric tube reconstruction and jejunalinterposition reconstruction.More studies have been focused on jejunalinterposition reconstruction in recent years,from which a variety of modified reconstructions derive.In clinical practice,a flexible choice is needed according to the actual situation of patients.

Surgery alone for the adenocarcinoma of the esophagogastric junction (AEG) often gives unsatisfactory results, with a poor prognosis.At present, there is no unified therapeutic regimen specifically for AEG.Neoadjuvant therapy includes neoadjuvant radiotherapy, chemotherapy and chemoradiotherapy, but the applications and effects of them for AEG are still controversial.

Objective:To investigate the differences between emergency surgery and selective surgery treatment of ankle fractures with dislocation .Methods:In the study , 40 patients with ankle fracture and dislocation were treated and followed up from May 2013 to May 2014, and all the data were collected and analyzed .The subjects involved 29 male patients and 11 female patients .The patients were randomly separated into two groups , and the patients in group A were given surgical intervention within 6 hours af-ter injury , while those in group B were initially given close reduction and given selective operation when the soft tissue condition got better .Group A contained 13 male patients and 7 female patients with average age of 37.10;Group B consisted of 15 male and 5 female, with average age of 37.85.Results:The Baird-Jackson score was applied for assessment of the patients ’ outcomes.According to the score , the outcomes were classified into excellent , good, fair, and poor.In group A (emergency group), the outcomes were 13 (65.0%), 4 (20.0%), 3 (15.0%), and 0, respectively.In group B ( selective group), they were 11 (55.0%), 7 (35.0%), 2 (10.0%), and 0, respectively.The numbers of the patients from excellent to poor were 24 (55.0%), 11 (27.5%), 5 (12.5%), and 0, respectively. Conclusion: There is no significant difference in postoperative function between the two groups , however , early surgical intervention can benefit in accomplishing anatomical reduction much easier and shortening the time of hospitalization , which is cost-saving for the patients .

The Hippocratic oath commands doctors to be the patients supreme advocate. Coupling this command with a well trained physician is the sine qua non of orthopaedic risk management. A favorable doctor and patient relationship is also essential. The occurrence of a malpractice lawsuit is more often the result of the failure to practice the art of medicine by the orthopaedist rather than a failure to apply the science of orthopaedics. The ER (emergency room) is a dangerous area. The risk of litigation in the emergency room is not directly proportional to the severity of injury. In fact, the risk of initiation of legal action is greater in cases of relatively modest disability.

We review the literature about Heterotopic Ossification (HO) and introduce its pathophysiology, classification, incidence, clinical presentation, diagnosis, prophylaxis and treatment in this article. HO is the presence of bone in soft tissue where bone normally does not exist. Mature HO has the same morphology as callus. It is considered that 3 conditions are necessary for HO: osteogenic precursor cells, inducing agents, and a permissive environment. Fever, swelling, erythema, and occasional joint tenderness appear in the early stage of HO. The most sensitive imaging modality for early detection of HO is three-phase bone scintigraphy which can also monitor the metabolic activity and degree of maturity of HO. Non-steroidal antiinflammatory drugs (NSAIDs) are the most effective for the prophylaxis of HO after the operation of hip replacement or acetabulum fracture. Surgical resection is the only treatment for patients with severe joint tenderness following HO.

Objective:To investigate the management of pelvic injury associated with complete anterior sacroiliac joint dislocation.Methods:In the study, 6 cases of pelvic injury associated with complete an-terior sacroiliac joint dislocation treated in Beijing Jishuitan Hospital from February 2008 to June 2014 were analyzed.We described the history and severity of injury, emergency treatment, and fracture radio-logy.In all the cases, the surgical treatment and postoperative functional exercise were performed.We followed up all the cases on an average of 1.6 years, assessed the postoperative recovery and summed up the treatment experience.Results:All the 6 patients with fractures recovered without infection and nerve symptoms after surgery.Their X-rays showed good reduction of sacroiliac joints.All the cases were followed up on an average of 1.6 years.Six months after surgery, the Majeed scores were perfect in 2 cases, good in 2, fair in 1, and poor in 1.The patients with poor scores suffered persistent pain, and decreased physical activity, and when walking long distances, they needed a walking stick.The 2 patients with low scores could not resume the original work.Conclusion:Pelvic injury associated with complete anterior sacroiliac joint dislocation is a special type of the pelvic injury since the managements during the emergency phase are difficult.The surgery should be done as early as possible, and the anterior approach is available for the reduction and fixation.

Objective:To study the risk factors for contralateral hip fracture within 2 years after primary hip fracture surgery in elderly patients.Methods:A retrospective study was conducted of the 1,962 elderly patients who had been surgically treated for hip fractures at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from May 2015 to April 2018. They were 573 males and 1,389 females; the median age of primary hip fracture was 81 (75, 86) years. They were divided into 2 groups according to whether a contralateral hip fracture occurred or not within 2 years after primary hip surgery: 134 patients in the contralateral fracture group and 1,828 ones in the contralateral fracture-free group. The duration from primary hip fracture to secondary contralateral fracture was recorded. The χ2 test and Mann-Whitney U test were used to compare between the 2 groups their gender, age, walking ability, laboratory indexes upon admission, concomitant internal diseases, Charlson comorbidity index (CCI), duration from admission to surgery, duration from admission to discharge and complications during follow-up. The risk factors for contralateral hip fracture within 2 years after primary hip surgery were determined by the Cox's proportional hazard regression model. Results:In the elderly patients with hip fracture, the 2-year cumulative incidence of secondary contralateral hip fracture was 6.83%(134/1,962) and the median duration from primary surgery to secondary contralateral hip fracture was 365 (189, 611) d. The risk factors for contralateral hip fracture were female ( RR=2.081, 95% CI: 1.351 to 3.207, P=0.001), concomitant peripheral vascular disease ( RR=5.876, 95% CI: 2.922 to 11.818, P< 0.001), concomitant chronic obstructive pulmonary disease ( RR=3.750, 95% CI: 1.897 to 7.413, P< 0.001), progressively higher CCI ( RR=1.363, 95% CI: 1.223 to 1.519, P<0.001), complicated pneumonia ( RR=3.606, 95% CI: 2.054 to 6.332, P<0.001), complicated urinary infection ( RR=7.670, 95% CI: 4.441 to 13.248, P<0.001), and complicated deep venous thrombosis (DVT) ( RR=7.389, 95% CI: 3.992 to 13.677, P<0.001). Conclusions:The risk factors for contralateral hip fracture within 2 years after primary hip fracture surgery in elderly patients may be female, concomitant peripheral vascular disease and chronic obstructive pulmonary disease, progressively higher CCI, and complicated pneumonia, urinary infection and DVT.

Objective To evaluate the secondary internal fixation plus bone grafting for salvage of failed internal fixation for intertrochanteric hip fractures. Methods Between January 2001 and March 2008, 25 patients with intertrochanteric fractures who had suffered from failed initial internal fixation were treated with secondary open reduction and internal fixation and bone auto grafting. They were 15 men and 10 women, with a mean age of 50 (17 to 72) years. The mean interval between the initial operation and the revision was 12 (4 to 27) months. The failure of original internal implants involved the dynamic hip screw (DHS) in 12 patients, the dynamic condylar screw (DCS) in 3, the angular blade plate (ABP) in 1, the cephalomedullary nail in 3 and the cannulated screw in 6. The replacement of internal implants included PFN in 12 eases, DCS in 7, DHS in 4 and ABP (95°) in 2. Results The mean follow-up was 24 (6 to 84) months. The revisions were uneventful. Of the 25 nonunions, 24 healed (96.0%). The postoperative mean hip rating (Harris score) for the hip joint was 87(35 to 100) points. The X-ray films at the last follow-up revealed the coLlodiaphyseal angle averaged 120° ( 110° to 140°). No avascular necrosis of the femoral head or hip degeneration was found. Conclusion In properly selected patients, secondary internal fixation with bone grafting for failed open reduction and internal fixation of intertrochanteric hip fractures can provide a high rate of union and good clinical results with a low rate of complications.