Conjugate Addition of Grignard Reagents to Thiochromones Catalyzed by Copper Salts: A Unified Approach to Both 2-Alkylthiochroman-4-One and Thioflavanone.

Grignard reagents undergo conjugate addition to thiochromones catalyzed by copper salts to afford 2-substituted-thiochroman-4-ones, both 2-alkylthiochroman-4-ones and thioflavanones (2-arylthiochroman-4-ones), in good yields with trimethylsilyl chloride (TMSCl) as an additive. The best yields of 1,4-adducts can be attained with CuCN∙2LiCl as the copper source. Excellent yields of 2-alkyl-substituted thiochroman-4-ones and thioflavanones (2-aryl substituted) are attained with a broad range of Grignard reagents. This approach works well with both alkyl and aromatic Grignard reagents, thus providing a unified synthetic approach to privileged 2-substituted thiochroman-4-ones and a potential valuable precursor for further synthetic applications towards many pharmaceutically active molecules. The use of commercially available and/or readily prepared Grignard reagents will expedite the synthesis of a large library of both 2-alkyl substituted thiochroman-4-ones and thioflavanones for additional synthetic applications.

Stratifying the mechanical performance of a decellularized xenogeneic tendon graft for anterior cruciate ligament reconstruction as a function of graft diameter: An animal study.

OBJECTIVES: This study investigated the biomechanical performance of decellularized porcine superflexor tendon (pSFT) grafts of varying diameters when utilized in conjunction with contemporary ACL graft fixation systems. This aimed to produce a range of 'off-the-shelf' products with predictable mechanical performance, depending on the individual requirements of the patient. METHODS: Decellularized pSFTs were prepared to create double-bundle grafts of 7 mm, 8 mm, and 9 mm diameter. Femoral and tibial fixation systems were simulated utilizing Arthrex suspension devices and interference screws in bovine bone, respectively. Dynamic stiffness and creep were measured, followed by ramp to failure from which linear stiffness and load at failure were measured. The mechanisms of failure were also recorded. RESULTS: Dynamic stiffness was found to increase with greater graft diameter, with significant differences between all groups. Conversely, dynamic creep reduced with increasing graft diameter with significant differences between the 7 mm and 9 mm groups and the 8 mm and 9 mm groups. Significant differences were also found between the 7 mm, 8 mm, and 9 mm groups for linear stiffness, but no significant differences were found between groups for load at failure. The distribution of failure mechanisms was found to change with graft diameter. CONCLUSION: This study showed that decellularized pSFTs demonstrate comparable biomechanical properties to other ACL graft options and are a potentially viable option for ACL reconstruction. Although grafts can be stratified by their diameter to provide varying biomechanical properties, it may be more appropriate to alter the fixation technique to stratify for a greater diversity of biomechanical requirements.Cite this article: Bone Joint Res 2019;8:518-525.

Does achieving the 'Best Practice Tariff' criteria for fractured neck of femur patients improve one year outcomes?

INTRODUCTION: 'Best Practice Tariff' (BPT) criteria have been developed to improve peri-operative care for hip fracture patients. This paper aims to explore the impact of BPT criteria on 1-year outcomes. PATIENTS AND METHODS: Anonymised data were acquired from the National Hip Fracture Database (NHFD) for patients presenting to Bradford Royal Infirmary with a fractured neck of femur during the period April 2011 to December 2015. Two study groups were defined: those that achieved the BPT uplift criteria, and those that did not. Three primary outcome measures were identified: one year survival, mobility status and residential status. Further analysis was performed to ascertain whether achieving any individual BPT criterion significantly affected 1-year outcomes. RESULTS: 1414 cases were included, 784 (55%) of whom met the BPT criteria. The 1-year survival rate of the BPT-achieved group was 67.7%, compared with 61.4% in the non-BPT group (relative risk reduction 10.3%, p = 0.014). Mobility status declined by at least one grade in 50.8% of the BPT-achieved group, compared with 60.8% of the non-BPT group (risk reduction 16.4%, p = 0.003). BPT achievement had no significant effect on residential status at one year. Multivariate analysis identified that post-operative Abbreviated Mental Test Score (AMTS) and falls assessment were significantly associated with reduced 1-year mortality. Similarly, both pre- and post-operative AMTS assessments resulted in greater potential to return to pre-morbid mobility level. When controlling for potential confounders (age, gender, ASA grade, pre-morbid mobility and residential status) logistic regression modelling showed that achieving the BPT criteria was associated with a 30% increase in the odds of survival at one year (p = 0.046). DISCUSSION: Achieving the BPT requirements has a significant impact on 1-year mortality and return to pre-morbid mobility level. The effect of AMTS and falls assessments on these outcomes may be due to their properties as surrogate markers for more thorough and considered peri-operative assessment. CONCLUSIONS: Few studies describe the effect of BPT criteria on 1-year outcomes; therefore the results presented here help to vindicate the investments made in the scheme. Furthermore, these results may help steer subsequent revisions to BPT requirements by encouraging greater focus on peri-operative assessment and interventions.

Late presentation of a subiliacus haematoma after an apophyseal injury of the anterior inferior iliac spine.

Apophyseal injuries are particularly common in adolescents when the growth spurt that accompanies puberty places increased strain on developing bones and muscles. Bone growth in particular exceeds that of soft tissues resulting in relatively tight musculature and subsequent excessive strain at these sites of tendon insertion into bone. We describe a case of a young athlete who presented with chronic hip pain after an anterior inferior iliac spine apophyseal injury with subsequent haematoma formation under the iliacus muscle. There was no evidence of a bleeding disorder. In view of the late presentation, he was managed non-operatively. This injury requires a low threshold for early cross-sectional imaging. The delay in management in this case did not lead to any long-term sequelae.