Patients with osteogenesis imperfecta (OI) usually also show osteoporosis and bone fragility. Because these defects may also be combined with an airway that is difficult to manage, abnormal platelet function, and other problems, the perioperative management of anesthesia represents a substantial challenge. Therefore, it is important to be able to predict the risks during the perioperative period and to formulate and implement specific high-quality anesthesia management plans for such patients when they experience trauma. We report the case of a 59-year-old female patient with OI who experienced trauma resulting in fractures of the left proximal humerus and right hip. She required open reduction and internal fixation of her humerus and total hip arthroplasty. However, she also had obstructive sleep apnea syndrome, and an airway assessment indicated that her airway would be difficult to maintain. General anesthesia combined with a nerve block was administered. An ultrasound-guided bilateral superior laryngeal nerve block and cricothyroid membrane puncture were used to facilitate endotracheal intubation. An ultrasound-guided “hourglass-pattern” fascia iliaca block was performed for perioperative analgesia. The use of a regional block and preparation for the difficult airway access represented important and successful aspects of the management of anesthesia in this patient.

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Background: To evaluate the feasibility of "hourglass-sign" fascia iliac block and sacral plexus block for elderly femoral neck fractured patients with multiple complications.Methods: A total of 32 patients with femoral neck fracture undergoing closed reduction and internal fixation for femoral neck fractures were included. Ultrasound-guided "hourglass-sign" fascia iliac block and sacral plexus block anesthesia were applied to all patients. The success rate of anesthesia, the hemodynamic parameters, VAS scores, general clinical data and perioperative information would be collected.Results: 30 patients were included and analyzed into the study finally, all patients were diagnosed with different systemic diseases before surgery. The successful rate of "hourglass-sign" fascia iliac block combined with sacral plexus block guided by ultrasound and nerve stimulator was 93.8%. The change of MAP at different time points was about 5% of the baseline values, and the heart rate was about 7%. VAS scores decreased significantly after anesthesia and continued at least 1 hour after surgery. The anesthesia evaluation degree of most patients was satisfactory. There were no complications or adverse reactions associated with anesthesia. Conclusion:This combined nerve block provided effective anesthesia for closed reduction and internal fixation for femoral neck fractures of elderly patients, rarely caused instability in the circulatory system, had fewer adverse reactions and could be widely used in clinical practice.Trial Registry: This trial was registered at Chinese clinical trial (ChiCTR2000034114)

Background: Rosai-Dorfman disease (RDD) is a rare benign proliferative disease whose etiology is not clear and may be related to infection or unexplained immune dysfunction. The authors present a case of RDD with lung involvement in a 10-year-old patient.\\ Case description: a 10-year-old female found that the left lymph node was enlarged for more than 7 months, the larger range was about 6.5-5.9-8.1cm, and the cervical MR was considered as: malignant tumor, the possibility of lymph node metastasis was high. At the same time, lung CT conclusion: multiple nodules in both lungs, it is possible to consider metastatic tumor. Finally, RDD was diagnosed by pathology and immunohistochemistry.\\ Discussion: RDD involving the lung is very rare in clinic, and lung RDD clinical symptoms and imaging have no obvious specific manifestations, clinically easy to be misdiagnosed as malignant tumor, the final need for pathological diagnosis. The pathological manifestation of this case is typical, CD68, CD163 and Smur100 are all positive, and no other lesions are found in clinical and laboratory examination, so it is considered as the possibility of RDD involving the lung.\\ Conclusion: The simple use of imaging methods for diagnosis RDD is easy to lead to misdiagnosis, we need to comprehensively consider the use of different diagnostic methods; and according to the epidemiological characteristics of RDD, long-term follow-up of cases is necessary.

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