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BACKGROUND Intercondylar humerus fractures and low transcondylar type fractures of distal humeral often require surgical exposure and anatomical reduction of the articular surface as well as stabilization of the medial and lateral columns of the distal humerus. Traditionally, these injuries have been treated surgically with various extensor mechanism-disrupting surgical approaches. These approaches have often led to delayed union or non-union of the olecranon, triceps weakness, and osteotomy-related prominent implants. To avoid these problems, various extensor mechanism-sparing approaches that provide bicolumnar exposure of the distal part of the humerus have been described, including triceps-splitting and reflecting techniques. The paratricipital approach was developed to avoid the problems of olecranon osteotomy approach for non comminuted distal humerus fractures. The purpose of this study was to compare the paratricipital approach with olecranon osteotomy and evaluate their effects on the functional outcomes of intercondylar fractures of the distal humerus managed with open reduction and internal fixation (ORIF) by reviewing 38 cases of intercondylar distal humerus fractures surgically managed with either of the approaches during 2015 - 2017. METHODS The retrospective study was conducted at our institution, R.G. Kar Medical College, Kolkata from May 2015 to May 2017. OA type C1 and C2 fractures were included in the study. Type C3 fractures were excluded from the study. Distal humeral open reduction and internal fixation (ORIF) was performed with either orthogonal or parallel plate constructs in 38 patients, where paratricipital approach was used in 21 patients and olecranon osteotomy was done for 17 patients. RESULTS Patients in the paratricipital approach group seems to have better range of motion in terms of flexion and extension. Moreover, mayo elbow performance score (MEPS) of the paratricipital group is better than that of olecranon osteotomy group, even more so in younger age groups. CONCLUSIONS We found that ORIF via the paratricipital approach would confer better functional outcomes for simple intra-articular distal humerus fractures in patients of all age groups. KEYWORDS Distal Humerus Fracture, Paratricipital, Olecranon Osteotomy

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.

Butyrolactones, chemically the five-membered saturated cyclic ester class of compounds, have wide occurrence as the key structural units in many natural products, which show significant biological activities, particularly in their pure nonracemic form. Moreover, the structural diversity and biological importance of these chiral butyrolactone–derived natural products have inspired the development of various new drug molecules. Consequently, many attractive routes have been developed by synthetic organic chemists exploiting different synthetic approaches for the asymmetric synthesis of butyrolactones. The asymmetric aldol reaction, because of its advantage of creating up to two chiral centers in one sequence, has also served as a key reaction for the synthesis of chiral butyrolactones. In this chapter, we will give an overview of the aldol reaction–based synthetic strategies used for the synthesis of butyrolactones in asymmetric form.

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 a...

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).

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.

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.

The direct syntheses of imidic-phosphinic mixed anhydrides and phosphinates were accomplished via phosphorylation of isocyanates or aldehydes with N-phosphine oxide-substituted imidazolylidenes (PoxIms) that are equipped with both nucleophilic carbene and electrophilic phosphorus moieties. In addition, the catalytic cyclotrimerization of phenyl isocyanate took place by employing a PoxIm having bis-N-phosphine oxide groups. The results presented in the current study demonstrate that judiciously designed multifunctional carbenes represent a promising potential for the phosphorylation of heterocumulenes and carbonyl compounds.

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 H

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.

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.

INTRODUCTION: Bizarre parosteal osteochondral proliferation (BPOP) is a rare variety tumour like bone lesion usually of small bones of hands and feet which has a strong tendency for recurrence. Clinico-radiologically solitary exostosis like lesion in those areas which continue growing after skeletal maturity without any pre-existing lesion one should think of BPOP. CASE REPORT: 46 years male patient presented in 2009 with progressive painless, hard, nontender swelling arising from distal half of the left second metatarsal bone of one year duration. X ray showed multi-horned heterogeneously radio-opaque swelling attached to 2 nd metatarsal where one of the horns was pressing over 3 rd metatarsal making its divergent appearance. Open biopsy showed lamellar bone with inter-trabecular spindle cells without any evidence of malignancy. Irregular shaped cartilage cells of different size in bluish tint cartilage are found in the bone cartilage interface. Through dorsal incision wide margin resection of the second metatarsal was done and reconstructed with autologus tricortical bone graft from ipsilateral iliac crest. Further histopathological examination demonstrated similar picture and absence of periosteum in addition. Significant cartilaginous cap could not be identified. Features simulate BPOP. It took 6 months - time for incorporation of graft. Movements of foot joints regained except 50% restriction of targeted metatarsophalangeal joint. There is no recurrence in 4 years follow up. CONCLUSION: Exostosis like lesions when arising from unusual site and at unusual age group other rare conditions is to be thought of. As they have tendency for recurrence adequate resection is essential. Though the final diagnosis of BPOP is obtained after histopathological examination, the clinico-radiological findings are also important for treatment planning.

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.

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.Our aim was to find out the prognostic factor for the curve progression for this group.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.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.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.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.

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.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.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.Pixel value ratio is a good method for assessing callus stiffness, and it can be used to judge the timing of fixator removal.

A competent and general asymmetric synthesis of 7′-hydroxydibenzylbutyrolactone lignans such as (7′S)-hydroxymatairesinol and (7′S)-hydroxyarctigenin has been reported from N-succinyl-2-oxazolidinone in six steps where diastereoselective aldol reaction and stereoselective alkylation serve as the key steps.

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.

Herein, a novel and viable strategy to fabricate fully solution processable nanostructured n-type organic semiconducting material through block copolymer supramolecular assembly consisting of polystyrene-b-poly(4-vinyl pyridine) (PS-b-P4VP) and an asymmetric perylenebisimide (PBI) has been demonstrated. The block copolymer supramolecular assemblies show hierarchical structure formation in two length scales (lamella within lamella) from synergistic phase separation of block copolymer and PBI molecule inside the comb block. The optical and luminescent studies clearly evidence that the nature of aggregation of the PBI molecules inside the P4VP domain through facial π–π stacking is modified with tailored luminescent properties compared to its pure state. The block copolymer supramolecular assembly with 1:1 mole ratio (4-vinyl pyridine:PBI) shows almost three-order enhancement of charge carrier mobility compared to pristine PBI though it has only (0.571) of PBI weight fraction. It is believed that the organic semiconductor polymeric system described here will be useful for preparing luminescent materials, organic electronic and optoelectronic devices.

(+)- and (−)-Methylenolactocins and phaseolinic acids are synthesized in four steps via asymmetric syn- and anti- aldol reactions of chiral N -succinyl-2-oxazolidinones using the same set of reagents.

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.

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.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.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 p0.0001), 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 for10 years and 1.6 +/- 0.9 for10 years in the study group, while 0.1 +/- 1.1 for10 years and -0.2 +/- 0.6 for10 years in the control group, which also showedstatistically significant difference (10 years p = 0.04 and10 years p0.0001). These differences indicate that there was a delay in the maturation of bones by 1 year in the group10 years and 1.8 years in the group10 years in achondroplasia patients compared to nonachondroplasia patients.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.

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.

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.

An efficient and protection free asymmetric synthesis has been reported for all-trans variant 2,5-diaryl-3,4-disubstituted tetrahydrofuran lignans in seven steps from N-succinyl-2-oxazolidinone. (+)-Galbelgin and (+)-galbacin were synthesized in very good overall yields by this route where diastereoselective aldol reaction, stereoselective C-alkylation over O-alkylation and Friedel–Crafts reaction serve as key steps.