Medial surface plating of posterior column through the anterior intrapelvic approach in acetabulum fractures with involvement of both columns.

Aims: Posterior column plating through the single anterior approach reduces the morbidity in acetabular fractures that require stabilization of both the columns. The aim of this study is to assess the effectiveness of posterior column plating through the anterior intrapelvic approach (AIP) in the management of acetabular fractures. Methods: We retrospectively reviewed the data from R G Kar Medical College, Kolkata, India, from June 2018 to April 2023. Overall, there were 34 acetabulum fractures involving both columns managed by medial buttress plating of posterior column. The posterior column of the acetabular fracture was fixed through the AIP approach with buttress plate on medial surface of posterior column. Mean follow-up was 25 months (13 to 58). Accuracy of reduction and effectiveness of this technique were measured by assessing the Merle d'Aubigné score and Matta's radiological grading at one year and at latest follow-up. Results: Immediate postoperative radiological Matta's reduction accuracy showed anatomical reduction (0 to 1 mm) in 23 cases (67.6%), satisfactory (2 to 3 mm) in nine (26.4%), and unsatisfactory (> 3 mm) in two (6%). Merle d'Aubigné score at the end of one year was calculated to be excellent in 18 cases (52.9%), good in 11 (32.3%), fair in three (8.8%), and poor in two (5.9%). Matta's radiological grading at the end of one year was calculated to be excellent in 16 cases (47%), good in nine (26.4%), six in fair (17.6%), and three in poor (8.8%). Merle d'Aubigné score at latest follow-up deteriorated by one point in some cases, but the grading remained the same; Matta's radiological grading at latest follow-up also remained unchanged. Conclusion: Stabilization of posterior column through AIP by medial surface plate along the sciatic notch gives good stability to posterior column, and at the same time can avoid morbidity of the additional lateral window.

Open Repair of Posterior Cruciate Ligament Femoral Peel-Off Lesion in Multiligamentous Knee Injuries Results in Good Outcomes.

Purpose: To identify posterior cruciate ligament (PCL) peel-off lesions, to separate these lesions from more common midsubstance tears, and to evaluate patient outcomes after primary open repair. Methods: Patients with acute femoral-side "peel off"-type lesions associated with multiligamentous injuries who underwent PCL repair were identified. Patients with chronic PCL injuries, midsubstance PCL tears, or PCL tibial avulsions were excluded from the study. A total of 11 patients were included in this study. All patients underwent open repair using a suture pullout technique. Results: The mean follow-up period was 18 months. The mean Lysholm score at 12 months was 87. Mean knee range of motion (flexion) achieved at 12 months was 121°. No patient had grade 3 laxity on posterior stress testing at final follow-up. Conclusions: Our study showed good outcomes after primary repair of femoral PCL peel-off lesions. Level of Evidence: Level IV, therapeutic case series.

Rhodium-Catalyzed C4-Selective C-H Alkenylation of 2-Pyridones by Traceless Directing Group Strategy.

A rhodium-catalyzed C4-selective C-H alkenylation of 3-carboxy-2-pyridones with styrenes has been developed. The carboxylic group at the C3 position works as the traceless directing group, and the corresponding C4-alkenylated 2-pyridones are obtained exclusively with concomitant decarboxylation. Unlike the reported procedures, the exclusive C4 selectivity is uniformly observed even in the presence of potentially more reactive C-H bonds at the C5 and C6 positions. By using this strategy, the multiply substituted 2-pyridone can be prepared via sequential C-H functionalization reactions.

Organocatalytic Enantioselective Conjugate Addition of Nitromethane to Benzylidene-2-Benzoyl Acetate: Asymmetric Synthesis of ABT - 627, an Endothelin Receptor Antagonist.

First catalytic and enantioselective conjugate addition of nitromethane to benzylidene-2-benzoyl acetate has been developed using dihydroquinine derived squaramide catalyst with moderate to high selectivities. Asymmetric total synthesis of ABT-627, a potent ETA receptor antagonist is accomplished utilizing the developed method in overall 15.7% yield.

Main-Group-Catalyzed Reductive Alkylation of Multiply Substituted Amines with Aldehydes Using H2.

Given the growing demand for green and sustainable chemical processes, the catalytic reductive alkylation of amines with main-group catalysts of low toxicity and molecular hydrogen as the reductant would be an ideal method to functionalize amines. However, such a process remains challenging. Herein, a novel reductive alkylation system using H2 is presented, which proceeds via a tandem reaction that involves the B(2,6-Cl2C6H3)( p-HC6F4)2-catalyzed formation of an imine and the subsequent hydrogenation of this imine catalyzed by a frustrated Lewis pair (FLP). This reductive alkylation reaction generates H2O as the sole byproduct and directly functionalizes amines that bear a remarkably wide range of substituents including carboxyl, hydroxyl, additional amino, primary amide, and primary sulfonamide groups. The synthesis of isoindolinones and aminophthalic anhydrides has also been achieved by a one-pot process that consists of a combination of the present reductive alkylation with an intramolecular amidation and intramolecular dehydration reactions, respectively. The reaction showed a zeroth-order and a first-order dependence on the concentration of an imine intermediate and B(2,6-Cl2C6H3)( p-HC6F4)2, respectively. In addition, the reaction progress was significantly affected by the concentration of H2. These results suggest a possible mechanism in which the heterolysis of H2 is facilitated by the FLP comprising THF and B(2,6-Cl2C6H3)( p-HC6F4)2.

Catalytic Enantioselective Synthesis of (-)-Podophyllotoxin.

The first catalytic enantioselective total synthesis of (-)-podophyllotoxin is accomplished by a challenging organocatalytic cross-aldol Heck cyclization and distal stereocontrolled transfer hydrogenation in five steps from three aldehydes. Reversal of selectivity in hydrogenation led to the syntheses of other stereoisomers from the common precursor.

N-Phosphine Oxide-Substituted Imidazolylidenes (PoxIms): Multifunctional Multipurpose Carbenes.

This article discusses the concept of N-heterocyclic carbenes (NHCs) equipped with more than one functional moiety, which allows using these NHCs for multiple purposes. A pioneering example for such NHCs is N-phosphine oxide-substituted imidazolylidenes (PoxIms), and their synthesis and strategic use are highlighted. The utility of PoxIms by far exceeds the conventional use as multidentate ligands for metal complexes on account of the synergetic functions of the carbene and the N-phosphine oxide group(s).

Strategic Utilization of Multifunctional Carbene for Direct Synthesis of Carboxylic-Phosphinic Mixed Anhydride from CO2.

Direct synthesis of carboxylic-phosphinic mixed anhydrides has been achieved by treating carbon dioxide with N-phosphine oxide-substituted imidazolylidenes (PoxIms) that contain both nucleophilic carbene and electrophilic phosphorus moieties. This novel mixed anhydride was efficiently derivatized into an ester, an amide, and an unsymmetrical ketone via transformation into its corresponding imidazolium salt followed by a dual substitution reaction. The presented work used well-designed multifunctional carbene reagents to establish a novel utility for carbon dioxide in organic synthesis.

Total Synthesis of Coprinol.

The first synthesis of coprinol has been achieved from 2-methoxy-3,5-dimethylbenzaldehyde via the intermediacy of an indanone derivative where dialkylation, Friedel-Crafts acylation, demethylation, and regioselective formation of a primary -OH group from a chloroacetyl group are the key steps.

Outcome of humeral shaft fractures treated by functional cast brace.

BACKGROUND: Functional brace application for isolated humeral shaft fracture persistently yields good results. Nonunion though uncommon involves usually the proximal third shaft fractures. Instead of polyethylene bivalve functional brace four plaster sleeves wrapped and molded with little more proximal extension expected to prevent nonunion of proximal third fractures. Periodic compressibility of the cast is likely to yield a better result. This can be applied on the 1(st) day of the presentation as an outpatient basis. Comprehensive objective scoring system befitting for fracture humeral shaft is a need. MATERIALS AND METHODS: Sixty six (male = 40, female = 26) unilateral humeral shaft fractures of mean age 34.4 years (range 11-75 years) involving 38 left and 28 right hands were included in this study during April 2008 to December 2012. Fractures involved proximal (n = 18), mid (n = 35) and distal (n = 13) of humerus. Transverse, oblique, comminuted and spiral orientations in 18, 35 and 13 patients respectively. One had segmental fracture and three had a pathological fracture with cystic bone lesion. Mechanisms of injuries as identified in this study were road traffic accidents 57.6% (n = 38), fall 37.9% (n = 25). 12.1% (n = 8) had radial nerve palsy 7.6% (n = 5) had Type I open fracture. Four plaster strips of 12 layers and 5-7.5 cm broad depending on the girth of arm were prepared. Arm was then wrapped with single layer compressed cotton. Lateral and medial strips were applied and then after molding anterior and posterior strips were applied in such a way that permits full elbow range of motion and partial abduction of the shoulder. Care was taken to prevent adherence of one strip with other except in the proximal end. Limb was then put in loose collar and cuff sling intermittently allowing active motion of the elbow ROM and pendular movement of the shoulder. Weekly tightening of the cast by fresh layers of bandage over the existing cast brace continued. RESULTS: The results were assessed using 100 point scoring system where union allotted 30 points and 60 points allotted for angulations (10), elbow motion (10), shoulder abduction (10), shortening (5), rotation (5), absence of infection (10), absence of nerve palsy during treatment (10). Remaining 10 points were allotted for five items with two points each. They were the absence of skin sore, absence of vascular problem, absence of reflex sympathetic dystrophy (RSD), recovery of paralyzed nerve during injury and recovery of paralyzed nerve during treatment. Results were considered excellent with 90 and above, good with 80-89, fair with 70-79 and poor below 70 point. Results at 6 months were excellent in 43.94% (n = 29), good in 42.42% (n = 28), fair in 9.1% (n = 6), poor in 4.55% (n = 3). Union took place in 98.48% (n = 65) with an average of 10.3 weeks (range 6-16 weeks). 87.5% (n = 7) paralyzed radial nerve recovered. All wounds healed. Four patients had transient skin problem. One patient with mid shaft fracture had nonunion due to the muscle interposition. CONCLUSION: Modified functional cast brace is one of the options in treatment for humeral shaft fractures as it can be applied on the 1(st) day of the presentation in most of the situations. Simple objective scoring system was useful particularly in uneducated patients.

Differential diagnosis of BPOP arising in relation to patella.

INTRODUCTION: Solitary exostosis is common at the metaphysis of long bones, and rarely may it develop in the lower pole of the patella. Usually it stops growing after skeletal maturity unless complicated. When the growth continues after skeletal maturity, other rare possibilities need to be considered such as bizarre parosteal osteochondromatous proliferation (BPOP). Though solitary exostosis is common at the metaphysis of long bones, very rarely it also develops in lower pole of the patella. Usually they stop growing after skeletal maturity unless complicated. When it starts after skeletal maturity and continues to grow, other rare possibilities like bizarre parostealosteochondromatousproliferation (BPOP) are to be thought of. CASE REPORT: 21 years male student presented with anterior midline painless progressive swelling over right knee joint of one year duration which was hard, non-tender, fixed to patella but mobile with patella. X ray showed midline heterogeneously radio-opaque swelling attached to inferolateral aspect of the anterior surface of patella. Patellar out line is fully maintained except the narrow site of tumour attachment. After exposing through midline incision, the swelling was found to incorporate the patellar tendon completely and an anterior vertical midline cleavage was found. The mass was deliberately detached along the cleavage and from intact patellar tendon. Almost full range of knee movement is obtained in operation table. Immediate post operative 10° quadriceps lag was corrected with quadriceps setting exercises in two weeks time. Histopathological examination demonstrated thin layer of cartilage cover, irregular lamellar bone in deeper zone and spindle cells between them without cytoplasmic atypia. Plenty of cartilage cells in different stages of maturation are seen without column formation. Marrow elements are absent. Periosteum could not be demonstrated and there was no other evidence of malignancy. Features simulate 'bizarre parosteal osteochondromatous proliferation'. There is no recurrence in five years of follow up. CONCLUSION: When exostosis like lesions arise from unusual site and at an unusual age group, other rare conditions need to be investigated. Though the final diagnosis of BPOP is obtained after careful histo-pathological examination, the clinico-radiological findings are also relevant. As literature search indicates, this is possibly second incidence where BPOP arised from sesamoid bone and first from patella.

Asymmetric syntheses of (-)-enterolactone and (7'R)-7'-hydroxyenterolactone via organocatalyzed aldol reaction.

Short syntheses of (-)-enterolactone (1a) and (7'R)-7'-hydroxyenterolactone (1b) have been achieved utilizing organocatalyzed asymmetric cross-aldol reaction of aldehydes 2 and 3 and base-mediated alkylation of lactones 5 and 4.

Drooping of apical convex rib-vertebral angle in adolescent idiopathic scoliosis of more than 40 degrees: a prognostic factor for progression.

STUDY DESIGN: It is a retrospective analysis on radiograms of 113 adolescent idiopathic scoliosis (AIS) patients with a curve of 40 degrees or more at the time of presentation. OBJECTIVES: Our aim was to find out the prognostic factor for the curve progression for this group. SUMMARY AND BACKGROUND: There is general consensus in favor of operation when the curve is more than 40 degrees for AIS. There are number of reports on the prognostic and etiologic factors for the progression of scoliosis. Rib-vertebral angle (RVA) became a topic of interest regarding the progression of scoliosis for many researchers since Mehta introduced it in 1972. METHODS: There were 113 AIS patients (95 females and 18 males) who had a curve of more than 40 degrees at the time of presentation, with an average age of 12 years and 10 months. We measured RVA on the convex and concave sides at the apex and 12th vertebrae and measured rib-vertebral angle difference (RVAD) using Mehta's method at each follow-up. We also measured the drooping value of the convex rib after bracing and at final follow-up. RESULTS: Of the 113 patients, 84 responded to bracing and in 29 the curve progressed despite bracing at final follow-up. The average drooping of rib at the apex on the convex side was 11 degrees, which progressed compared with 0.12 degrees in those who responded to treatment. On analyzing the results we could not find any relationship in 12th vertebrae but there was a significant relationship between the drooping value of convex apical rib (RVA Cx) after bracing and curve progression, which is similar to RVAD. There was no relationship between curve progression and initial angle, age, Risser sign, or menarchal status at presentation. CONCLUSIONS: From our study, we conclude that a large number of curves can be treated with bracing; however, when we notice drooping of the convex apical rib along with RVAD, the curve will likely progress.

Transtrochanteric rotational osteotomy for nontraumatic osteonecrosis of the femoral head in young adults.

UNLABELLED: Transtrochanteric rotational osteotomy (TRO) is a controversial procedure with reported inconsistent results. We reviewed 50 patients (60 hips) who underwent this procedure for extensive osteonecrosis of the femoral head, focusing on varization to determine its effectiveness as a head-preserving procedure in young adults. The mean age of the patients was 28 years (range, 18-46 years). Using the Ficat-Arlet classification, 40 hips had Stage II and 20 hips had Stage III involvement. According to the classification system of Shimizu et al., the extent of the lesions were Grade C in 54 hips and Grade B in six hips; the location of the lesions were Grade c in 56 hips and Grade b in four hips. Minimum followup was 18 months (mean, 84 months; range, 18-156 months). The mean preoperative Harris hip score was 44.7 points (range, 32-62 points) which improved to an average postoperative score of 80.1 points (range, 44-100 points) at the latest followup. Forty-four hips showed no radiographic evidence of progression of collapse. Ten hips showed progressive collapse, seven hips showed progressive varus deformity, three hips had stress fractures of the femoral neck, and one hip had infection. We believe TRO with varization is worth attempting for extensive osteonecrosis of the femoral head in young adults, although failures and complications are not uncommon. LEVEL OF EVIDENCE: Level IV, case series. See the Guidelines for Authors for a complete description of levels of evidence.

Deceleration in maturation of bone during adolescent age in achondroplasia--a retrospective study using RUS scoring system.

OBJECTIVES: Knowledge of bone age in achondroplasia is required for the prediction of adult height, timings of limb lengthening, and epiphysiodesis procedures. The purpose of this investigation was to determine the differences in skeletal age in achondroplasia and a control population with the Tanner-Whitehouse 3 method using the RUS score and to determine the right age for the interventional procedure for limb lengthening procedure or deformity correction in these patients. MATERIALS AND METHODS: Left hand radiographs of 34 patients (age range, 5-18 years) with achondroplasia were evaluated for skeletal age using the RUS scoring system, which were compared with the left hand radiographs of 41 patients (age range, 5-18 years) without achondroplasia measuring skeletal age. The difference in chronological age and RUS bone age were evaluated statistically according to gender and age group. RESULTS: In the achondroplasia group, chronological age were 10.5 +/- 4.3 years for males and 10.1 +/- 3.6 years for females and RUS bone age were 9.2 +/- 4.0 years for males and 8.9 +/- 3.4 years for females, which showed statistically significantly difference (males p = 0.0003 and females p < 0.0001), while in the control group, chronological age were 11.1 +/- 2.9 years for males and 10.7 +/- 3.4 years for females and RUS bone age were 11.2 +/- 3.4 years for males and 10.7 +/- 3.3 years for females, which did not show statistically significantly difference (males p = 0.54 and females p = 0.76). Our finding suggested a delay of 1.4 years for males and 1.2 years for females in the maturation of bone in achondroplasia patients. Difference between chronological age and RUS bone age was 0.9 +/- 1.1 for <10 years and 1.6 +/- 0.9 for >10 years in the study group, while 0.1 +/- 1.1 for <10 years and -0.2 +/- 0.6 for >10 years in the control group, which also showed >statistically significant difference (<10 years p = 0.04 and >10 years p < 0.0001). These differences indicate that there was a delay in the maturation of bones by 1 year in the group <10 years and 1.8 years in the group >10 years in achondroplasia patients compared to nonachondroplasia patients. CONCLUSION: We recommend the use of the Tanner-Whitehouse 3 method especially the radius, ulna, short bone score to measure the skeletal age and to wait for a longer time before interventional procedures in achondroplasia patients.

Redislocation after treatment of traumatic dislocation of hip in children: a report of two cases and literature review.

From August 1998 to June 2005, we treated five children (age range 2-9 years) with traumatic dislocation of hip. The mean follow-up period was 4.1 years (range 1-8 years). There was acceptable reduction in all cases by single attempt at closed reduction. Two patients aged 2 and 3 years, respectively, had redislocation. Other complications like nerve injuries, avascular necrosis, growth disturbance, ectopic ossification and post-traumatic arthritis were not seen till the last follow-up (mean 4.1; range 1-8 years). Closed reduction is an effective treatment method for traumatic dislocation of hip in children, but adequate immobilization and protection from weight bearing is needed in children aged less than 10 years to prevent redislocation.

Hip and knee dislocation during femoral lengthening in congenital short femur: a rare case report.

Congenital short femur is a rare and complex deformity that is often associated with other anomalies. There are few reports of either hip or knee dislocations during femoral lengthening in congenital short femur predisposed by associated anomaly. However, there are probably no case reports of both hip and knee joint dislocation occurring in same case during femoral lengthening in congenital short femur. We have this case of congenital short femur, where both hip and knee dislocation occurs during femoral lengthening. We reviewed different article to understand the cause and avoid such unwanted complications in future.

Pelvic fracture after scoliosis surgery in osteogenesis imperfecta: a case report.

Literature, describing scoliosis in patients of osteogenesis imperfecta (OI), favors operative treatment as soon as possible in the form of fixation with instrumentation and fusion to prevent curve progress and pulmonary function deterioration. There are various complications associated with the treatment of scoliosis in OI before, during, and after surgery because of poor bone quality in such patients. We presented a case report of stress-induced transverse fracture of both iliac wings after scoliosis surgery in a 16-year-old girl with OI, who was treated conservatively. Owing to unusual symptoms and continuous dull pain in her back, the diagnosis was delayed during which the conditions made her life miserable. This report also suggests that a stress fracture should be on high suspicion in OI patients when they present with minor difference in the nature of pain.

Quantitative assessment of mineralization in distraction osteogenesis.

OBJECTIVES: The most important decision in distraction osteogenesis is the timing of fixator removal. Various methods have been tried, such as radiographic appearance of callus and bone mineral density (BMD) assessment, but none has acquired gold standard status. The purpose of this study was to develop another objective method of assessment of callus stiffness to help clinicians in taking the most important decision of when to remove the fixator. MATERIALS AND METHODS: We made a retrospective study of 70 patients to compare the BMD ratio and pixel value ratio. These ratios were calculated at the time of fixator removal, and Pearson's coefficient of correlation was used to show the comparability. Inter- and intra-observer variability of the new method was also tested. RESULTS: Good correlation was found between BMD ratio and pixel value ratio, with a Pearson's coefficient of correlation of 0.79. The interobserver variability was also low, with high intra-observer reproducibility, suggesting that this test was simple to perform. CONCLUSION: Pixel value ratio is a good method for assessing callus stiffness, and it can be used to judge the timing of fixator removal.