Cue Ball Arthroplasty With Humeroradial Total Elbow Arthroplasty (TEA) Revision: An Approach to Managing Infection and Severe Ulnar Bone Loss in TEA.

Total elbow arthroplasties (TEA) have become more prevalent as indications expand. However, TEA complications remain a treatment conundrum. One such complication, periprosthetic joint infections (PJIs) have been reported to occur in up to 12% of all TEA procedures. Irrigation and debridement with retention of hardware and antibiotic suppression has a high failure rate. Two stage revisions of TEA, while more morbid, is an effective approach with previous studies showing a 79% eradication rate. These cases are often associated with periprosthetic bone loss, adding to the surgical complexity. In our case report, we present the case of a 59 year old diabetic male with a primary TEA secondary to a distal humerus fracture who developed a deep infection and was successfully treated with explantation, cue ball antibiotic cement arthroplasty, and humeroradial revision. This case report will discuss the cue ball antibiotic spacer technique and humeroradial revision as a salvage procedure in TEA revisions in the setting of extensive ulnar bone loss.

Stopped-flow NMR: determining the kinetics of [rac-(C2H4(1-indenyl)2)ZrMe][MeB(C6F5)3]-catalyzed polymerization of 1-hexene by direct observation.

Stopped-flow NMR measurements suitable for determination of reaction kinetics on time scales of 100 ms or longer have been achieved by adaptation of a commercial NMR flow probe with a high-efficiency mixer and drive system. Studies of metallocene-catalyzed alkene polymerization at room temperature have been complicated by high rates, imprecise knowledge of the distribution of different catalyst species with time, and the high sensitivity of the catalysts to low concentrations of impurities. Application of the stopped-flow NMR method to the study of the kinetics of 1-hexene polymerization in the presence of (EBI)ZrMe[MeB(C(6)F(5))(3)] demonstrates that NMR spectroscopy provides an efficient method for direct and simultaneous measurement of substrate consumption and catalyst speciation as a function of time. Kinetic modeling of the catalyst and substrate concentration time courses reveal efficient determination of initiation, propagation, and termination rate constants. As first suggested by Collins and co-workers (Polyhedron 2005, 24, 1234-1249), a kinetic model in which Zr-HB(C(6)F(5))(3) forms rapidly upon beta-hydride elimination but reacts relatively slowly with alkene to reinitiate chain growth is supported by these data.

Mechanism of cycloisomerisation of 1,6-heptadienes catalysed by [(tBuCN)2PdCl2]: remarkable influence of exogenous and endogenous 1,6- and 1,5-diene ligands.

The mechanism of the highly regioselective cycloisomerisation of dimethyl hept-1,6-dienyl-4,4-dicarboxylate (1) by a neutral pre-catalyst, [(tBuCN)(2)PdCl(2)] (8), to generate dimethyl 3,4-dimethylcyclopent-2-ene-1,1-dicarboxylate (3) has been investigated by isotopic labelling (reactions involving single and mixed samples of 1,1,2,6,7,7-[(2)H(6)]-1; 3,3,5,5-[(2)H(4)]-1; 1,7-(Z,Z)-[(2)H(2)]-1; [1,3-(13)C(1),5,7-(13)C(1)]-1 and [1,3-(13)C(1),6-(2)H(1)]-1) and by study of the reactions of dimethyl 1-aryl-hept-1,6-dienyl-4,4-dicarboxylates (9 a-e, where aryl is p-C(6)H(4)-X; X=H, OMe, Me, Cl, CF(3)) and dimethyl hept-1,5-dienyl-4,4-dicarboxylate (14), a 1,5-diene isomer of 1. The mechanism proposed involves the generation of a monochloro-bearing palladium hydride which undergoes a simple hydropalladation, carbopalladation, Pd/H dyotropy, beta-H elimination sequence to generate 3. A key point that emerges is that chelation of the 1,6-diene 1 at various stages in the mechanism plays an important role in determining the regioselectivity of the reaction. The selective generation of 3 with pre-catalysts of the form L(2)PdCl(2), as compared to the generation of dimethyl 3-methylene-4-methyl-cyclopentane-1,1-dicarboxylate (2) with pre-catalysts of the form [(MeCN)(2)Pd(allyl)]OTf (5) is ascribed to the absence of chloride ion in the latter, which makes an additional coordination site available throughout turnover. Liberation of the product 3 when [(tBuCN)(2)PdCl(2)] (8) is employed as pre-catalyst, is proposed to proceed via a mono- to bidentate switch in the pi-coordination of diene 1 (eta(2) to bis-eta(2)) displacing pi-coordinated 3 from Pd. When 1-aryl-1,6-dienes 9 are employed as substrates, the electron-donor property of the aryl group is found to influence the regioselectivity of cyclisation. Electron-withdrawing groups favour dimethyl 3-arylmethyl-4-methylcyclopent-2-ene-1,1-dicarboxylates (10), whilst electron-donating aryl groups favour 3-arylidene-4-methyl-cyclopentane-1,1-dicarboxylates (11). The regioselectivity (10/11) correlates with the Hammett sigma(+) values (rho(+)=1.3, r (2)=0.975) indicative of a strong pi-resonance contribution from the aryl ring rather than a simple sigma-inductive effect. Intermolecular modulation of regioselectivity is observed and the net effect proposed to arise through the (pi-->d) donation ability of the vinyl arene in the diene displacing product (10/11) via a mono- to bidentate switch in coordination. The isomerisation process increasingly sequesters Pd as turnover proceeds leading to a powerful inhibition mechanism and ultimately a limitation in turnover number to about 80.