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Highlights • Simultaneous bilateral hip fractures in the elderly are rare and usually have a symmetric pattern. • Intracapsular fractures on one side and trochanteric on the other are even rarer. • They are caused by a spontaneous fracture which causes a fall on the contralateral side. • The trochanteric fracture should be operated first to avoid possible complications., Introduction Simultaneous bilateral hip fractures are usually associated with high energy trauma, seizures, metabolic diseases and bisphosphonates use. They are observed rarely in the elderly population after simple trauma and usually have the same fracture pattern (symmetric). We report a rare case of asymmetric fracture and discuss mechanism of injury and treatment, analyzing the literature. Presentation of case We report a case of an 86-year old woman with a simultaneous bilateral asymmetric hip fracture (trochanteric on the right side and subcapital on the left), occurred after a fall at home. The patient was surgically treated by open reduction and internal fixation with an intramedullary nail on the right and by hemiarthroplasty on the left performed during the same surgical session, with good results. Discussion Simultaneous bilateral hip fractures in the elderly are rare and usually are symmetric. In the majority of the cases these fractures are intracapsular and are treated by hemiarthroplasties. On the contrary, simultaneous bilateral hip fractures with a different pattern, as the described case, are extremely rare. The possible mechanism of injury is a spontaneous fracture on one side, which causes a fall the contralateral side. The surgical treatment may be performed bilaterally, treating first the trochanteric fracture. Conclusion Simultaneous bilateral asymmetric hip fracture are extremely rare and may occur in elderly patient with a specific mechanism of injury. We believe that the trochanteric fracture should be operated first to avoid possible complications.

Introduction Acromioclavicular joint cyst (AJC) is a very uncommon condition of the shoulder observed in elderly patients, caused by a degenerative acromioclavicular (AC) joint, frequently associated to a rotator cuff tendon tear. There are two possible cause for the cyst formation. We report two different cases of a AC synovial cyst, with and without rotator cuff tear. Presentation of cases We report two cases, in patients aged respectively 80 and 77 years, with a very large AJC. In one case, the cyst was associated to a rotator cuff tear, while in the other case, the rotator cuff did not present any evident lesion. Both cysts were successfully surgical excised and a distal clavicle resection was performed. Discussion AJC is a rare complication observed in degenerative AC joint and in the majority of cases is associated to a rotator cuff tear. The diagnosis may be made by ultrasound and conventional radiographic examination, although MRI of the shoulder is generally preferred as it allows to better identify the condition of the rotator cuff. Generally, local aspiration of the cyst and corticosteroid injection fails with recurrence of the cyst and surgically treatment is indicated, especially in painful cases. Conclusion Painful AJC should be surgically treated by excision of the cyst associated to a lateral clavicle resection; when a symptomatic massive rotator cuff is present, a reverse total shoulder arthroplasty may be considered. However, in elderly patients, who have no discomfort, watchful waiting may be the treatment of choice.