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IntroductionNonunion of femoral neck fractures frequently occurs in elderly patients. In patients with rheumatoid arthritis, reoperation rates after internal fixation of a displaced femoral neck fracture increase by up to 60 %. Revision surgery with arthroplasty is often preferred for nonunion of femoral neck fractures because there are few effective options for conservative treatment. Teriparatide (TPTD) is a human parathyroid hormone analog and the only anabolic drug for the treatment of severe osteoporosis.DiscussionThere are two types of treatment regimens using TPTD: a once-daily administration of recombinant type TPTD and a once-weekly administration of a chemically synthesized type. Although there have been some reports showing that the once-daily recombinant type TPTD was effective for nonunion treatment, the effect of a once-weekly administration of the chemically synthesized type of TPTD is unknown. This report shows the efficacy of the chemically synthesized TPTD for the treatment of femoral neck fracture nonunion in a patient with risk factors that include rheumatoid arthritis and steroid intake.

The possibility to enhance the effect of a modest chiral element in a metal ligand by the use of a second ligand possessing a concave cavity has been examined for the examples of 1,3- and 1,4-chirality transfer within the metal coordination sphere. Complexation of Ru(C60Me5)Cl(CO)2 with (R)-prophos [(R)-1,2-bis(diphenylphosphino)propane] took place with excellent diastereoselectivity to give a configurationally stable chiral-at-metal complex, Ru(C60Me5)Cl((R)-prophos). This complex was converted, with good to perfect diastereoselectivity, into a variety of cationic complexes, [Ru(C60Me5)((R)-prophos)L][SbF6] (L = MeCN, t BuCN, methacrolein, acetone, CO, BnNC, 2,6-Me2C6H3NC), and a vinylidene complex, [Ru(C60Me5)(CCPhH)((R)-prophos)][SbF6]. The chirality transfer to the reactants reacting in the outer sphere of the coordination resulted in an asymmetric Diels−Alder reaction, albeit with modest selectivity.