The study aims to compare the long-term functional and radiographic outcomes of two devices for the treatment of primary intertrochanteric fractures (IFs, OTA 3.1A2.1–A2.3) in elderly patients with osteoporosis. Between December 2010 and August 2014, 332 elderly osteoporosis patients with IFs (OTA 3.1A2.1–A2.3) fixed by an InterTAN nail (IT) or a proximal femoral nail anti-rotation (PFNA) device were retrospectively evaluated. Follow-up occurred 1, 3, 6, and 12 months postoperatively and every year thereafter. Mortality was recorded. Patient-related functional and radiographic outcomes were compared. The primary endpoint was the long-term radiographic outcomes. The secondary endpoint was the long-term functional outcomes. A total of 283 patients (283 hips) with osteoporosis (IT, n = 144; PFNA, n = 139) were evaluated with a mean follow-up period of 38.8 months (range, 36–43 months). No between-group significant differences were noted in the patient demographics, operation variables, and postoperative Harris Hip Score. More radiographic complications were noted in terms of screw cut-out, femoral shaft fracture distal or around the tip of the main nail, and varus collapse of the femoral head in the PFNA group compared with that in the IT group (P < 0.05). For osteoporotic IFs (OTA 3.1A2.1–A2.3) in elderly patients, the use of IT aids in decreasing radiographic complications, but the between-group functional outcomes showed no significant difference.

Avascular necrosis of the femoral head (AVNFH) occurs infrequently following femoral neck fracture. The association between AVNFH and dyslipidaemia remains controversial. Although major risk factors for AVNFH have been proposed, most of them remain under discussion. Our purpose herein was to evaluate the association between dyslipidaemia and AVNFH following low-energy femoral neck fractures treated with cancellous screws in elderly patients in our tertiary care centre. Four hundred and seventy-two consecutive patients (472 hips) with low-energy femoral neck fractures were identified and treated with cancellous screws from July 2007 to April 2013. Patients underwent evaluations preoperatively and each subsequent postoperative visit (months 1, 6, 12, 18, 24, 30, and 36). Clinical and radiographic evaluations were documented at each visit. The risk factors of AVNFH were assessed by multivariate binary logistic analysis. Follow-up was available for 277 patients, which included 135 patients diagnosed with AVNFH (AVNFH group) and 142 patients without AVNFH (control group). The median follow-up for patients alive at the time of analysis was 40 months (range, 37 to 46 months). The mean total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), and apolipoprotein B (Apo-B) values were considerably higher in the AVNFH group compared with those in the control group. The mean high density lipoprotein cholesterol (HDL-C) and apolipoprotein A1(Apo-A1) values were significantly lower in the AVNFH group compared with those in the control group. A multivariate logistic backward regression model showed that HDL-C and LDL-C were the only variables associated with the development of postoperative AVNFH in patients with a femoral neck fracture (Odds ratio[OR] 33.09, 95% Confidence Interval[CI]: 2.65–19.42, p < 0.001 and OR 45.94, 95% CI: 0.47–27.75, p < 0.001, respectively). Our results suggest that both low HDL-C and high LDL-C have a tendency to result in the occurrence of AVNFH in elderly patients with low-energy femoral neck fractures treated with cancellous screws.

Branchial fistulas are uncommon in the clinical setting. The coexistence of first and second branchial fistulas has not been previously reported. We herein describe a 12-year-old girl who presented with a 2-year history of repeated swelling and purulence behind the right earlobe and neck. According to the patient’s physical and auxiliary examination findings, she was diagnosed with coexisting first and second branchial fistulas, both of which were completely removed by surgery. No clinical signs of fistula recurrence were present at the patient’s 20-month postoperative follow-up. Ipsilateral coexisting first and second branchial fistulas are very rare; thus, a false-positive diagnosis can easily occur if the doctor does not carefully perform specialized physical examinations. Surgery is an effective method for treating this condition. Adequate preoperative imaging preparation is imperative to ensure the most effective course of treatment. The purpose of this article is to improve clinicians’ awareness of this disease, thereby effectively reducing the rates of missed diagnosis and recurrence.