Direct Synthesis of Glycosyl Chlorides from Thioglycosides.

Reported herein is a new method for the direct synthesis of glycosyl chlorides from thioglycosides using sulfuryl chloride at rt. A variety of thioglycosides and thioimidates could be used as substrates. Both acid- and base-sensitive protecting groups were found compatible with these reaction conditions. Preliminary investigation of the reaction mechanism indicates chlorination of the leaving group at the anomeric sulfur as the key step of the reaction.

A Highly Efficient Glycosidation of Glycosyl Chlorides by Using Cooperative Silver(I) Oxide-Triflic Acid Catalysis.

Following our discovery that silver(I) oxide-promoted glycosylation with glycosyl bromides can be greatly accelerated in the presence of catalytic TMSOTf or TfOH, we report herein a new discovery that glycosyl chlorides are even more effective glycosyl donors under these reaction conditions. The developed reaction conditions work well with a variety of glycosyl chlorides. Both benzoylated and benzylated chlorides have been successfully glycosidated, and these reaction conditions proved to be effective in coupling substrates containing nitrogen and sulfur atoms. Another convenient feature of this glycosylation is that the progress of the reaction can be monitored visually; its completion can be judged by the disappearance of the characteristic dark color of Ag2 O.

CT scanogram for limb length discrepancy in comminuted femoral shaft fractures following IM nailing.

INTRODUCTION: Leg length discrepancy (LLD) following intramedullary nailing of femoral fractures is not uncommon. We designed a prospective study to evaluate the efficacy of routine postoperative computed tomography (CT) scanograms for evaluation of limb length discrepancy in patients with comminuted Winquist III or IV femoral shaft fractures treated with intramedullary nailing. METHODS: The study consisted of 15 patients with Winquist III and 13 with a Winquist IV femoral shaft fracture pattern with an average age of 37 years. The mechanisms of injury were motor vehicle collision (13), gunshot wound (12) and falls (three). All patients were treated with a statically locked intramedullary femoral nail (18 antegrade and 10 retrograde). A CT scanogram evaluated limb length in all patients. A discrepancy of greater than 20mm was considered for correction during the same admission. An LLD of 15-20mm was discussed with the patient extensively for correction. RESULTS: In the 28 patients included in our study, the average limb length discrepancy was 9.1mm with a range of -43.5mm short to 10.3mm long. The LLD was less than 10mm in 18 patients (64%), 10-15mm in four patients (14%), 15-20mm in three patients (11%) and more than 20mm in three patients (11%). Measurement of discrepancy as small as 0.5mm showed that 18 patients were fixed with shortening and in 10 patients the operated femur was longer. Tibia lengths were also evaluated separately. Though none of the tibiae had a previous fracture, only three patients (10%) had tibiae of equal length. In 13 patients, an unequal tibia partially corrected the LLD whilst in 12 it added to the discrepancy. Five patients with LLD of greater than 15mm underwent correction. CONCLUSIONS: A postoperative scanogram in patients with comminuted femoral shaft fractures treated with intramedullary nailing is useful to evaluate LLD and allows for early intervention. The ideal length where correction is necessary remains unclear.

Civilian gunshot wounds of the hip and pelvis.

OBJECTIVE: To evaluate orthopaedic injuries associated with civilian hip and pelvic gunshot wounds and their required surgical interventions. DESIGN: Retrospective chart review. SETTING: Level I urban trauma center. PATIENTS: From 1999 to 2008, there were 2808 cases of gunshot wounds that reported to our hospital. Twelve hundred thirty-five patients had an associated fracture that included 42 patients with fractures of the hip and pelvis. The average age of patients was 30.3 years (range, 19-54 years) and 40 of the 42 were male. Eighteen patients (43%) underwent emergency laparotomy for suspected visceral and vascular injuries of which seven patients had a negative laporotomy. There were 18 ilium fractures, 10 hip fractures, nine acetabular fractures, seven pubic rami fractures, six sacral fractures, three sacroiliac joint injuries, and two ischial tuberosity fractures. INTERVENTION: Seven patients required orthopaedic surgical intervention, undergoing a total of 10 operative procedures. RESULTS: All fractures healed and there was no incidence of pelvic ring instability requiring surgical stabilization or chronic osteomyelitis. Nonorthopaedic injuries included 15 small/large bowel perforations (36%), seven vessel lacerations (17%), and two urogenital injuries (5%) that required surgery. Associated injuries included four patients with nerve damage that recovered partially. CONCLUSIONS: Pelvic fractures from civilian gunshot wounds often require emergent surgery for vascular, visceral, and urogenital injuries. Orthopaedic intervention is indicated for intra-articular pathology such as removal of projectiles or bone fragments and reconstruction of the hip and rarely the acetabulum. Pelvic instability and complications of orthopaedic injuries are uncommon. These injuries require a multidisciplinary approach in their management.