Surgical treatment of the radial head is critical to the outcome of Monteggia-like lesions.

AIMS: The aim of this study was to evaluate the outcome of Monteggia-like lesions at midterm follow-up and to determine whether the surgical treatment of the radial head influences the clinical and radiological results. PATIENTS AND METHODS: A total of 78 patients with a Monteggia-like lesion, including 44 women and 34 men with a mean age of 54.7 years (19 to 80), were available for assessment after a mean 4.6 years (2 to 9.2). The outcome was assessed using the Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), Mayo Modified Wrist Score (MMWS), and The Disabilities of the Arm, Shoulder and Hand (DASH) score. Radiographs were analyzed for all patients. A total of 12 Mason type I, 16 type II, and 36 type III fractures were included. Surgical treatment consisted of screw fixation for all type II and reconstructable type III fractures, while radial head arthroplasty (RHA) or excision was performed if reconstruction was not possible. RESULTS: The mean MEPS was 88.9 (40 to 100), mean OES was 40.1 (25 to 48), mean MMWS was 88.1 (50 to 100), mean DASH score was 14.7 (0 to 60.2), and mean movement was 114° (sd 27) in extension/flexion and 155° (sd 37) in pronation/supination. Mason III fractures, particularly those with an associated coronoid fracture treated with RHA, had a significantly poorer outcome. Suboptimal results were also identified in patients who had degenerative changes or heterotopic ossification on their latest radiograph. In contrast, all patients with successful radial head reconstruction or excision had a good outcome. CONCLUSION: Good outcomes can be achieved in Monteggia-like lesions with Mason II and III fractures, when reconstruction is possible. Otherwise, RHA is a reliable option with satisfactory outcomes, especially in patients with ligamenteous instability. Whether the radial head should be excised remains debatable, although good results were achieved in patients with ligamentous stability and in those with complications after RHA. Cite this article: Bone Joint J 2019;101-B:1512-1519.

Bis(oxazolinylmethyl)pyrrole derivatives and their coordination as chiral "pincer" ligands to rhodium.

Bis(oxazolinylmethyl)pyrrole derivatives (R)L(N)H (4a-e), which were designed as protioligands for meridionally coordinating "pincer" ligands, were synthesized by cyclization of pyrrole-2,5-diethylacetate with a series of chiral amino alcohols. Deprotonation of (R)L(N)H (4a-d) with tBuLi and subsequent reaction with [RhCl(CO)(2)](2) gave the corresponding rhodium(I) complexes [Rh((R)L(N))(CO)] (R = iPr: 5a, Ph: 5b, Bn: 5c, Ind: 5d), which were also prepared by reaction of (R)L(N)H with one molar equivalent of [Rh(acac)(CO)(2)]. Upon heating the compounds at 100 degrees C in toluene over a period of 2-5 h, complete rearrangement via a 1,3-H shift between the pyrrole ring and the bridging methylene groups took place to yield the corresponding isomeric complexes [Rh(iso-(R)L(N))(CO)] (6a-d). The transformation induced a planarization of the tridentate ligand system, resulting from the formation of a series of conjugated double bonds. Stirring the rhodium(I) complex 5a with an excess of CH(3)I in dichloromethane at ambient temperature(14) gave the octahedrally coordinated product of an oxidative addition [Rh((iPr)L(N))(CH(3))I(CO)] (7), while reaction of complex 5a with one molar equiv of CsBr(3) as a mild brominating reagent in toluene at 80 degrees C led to complete conversion of the rhodium(I) species to the dibromorhodium(III) complex [Rh(iso-(iPr)L(N))Br(2)(CO)] (8).