Recurrent shield ulcer following penetrating keratoplasty for keratoconus associated with vernal keratoconjunctivitis

Though penetrating keratoplasty for keratoconus secondary to vernal keratoconjunctivitis (VKC) invariably carries a good prognosis, the postoperative course may be complicated by recurrent epitheliopathy. Despite good medical control of VKC shield ulcer is still a possibility.     

Use of autologous cultured limbal and conjunctival epithelium in a patient with severe bilateral ocular surface disease induced by acid injury: a case report of unique application

PURPOSE: Reconstruction of the ocular surface in a case of severe bilateral partial limbal stem cell deficiency (LSCD) with extensive symblephara using autologous cultured conjunctival and limbal epithelium. CASE REPORT: A 31-year-old woman presented with severe bilateral ocular surface disease with partial limbal stem cell deficiency, symblephara, lid and facial scarring, with a vision of 20/400 and counting fingers at 1 m in both eyes. Limbal and conjunctival tissue was harvested from the healthy-appearing left eye and used to generate two sheets of composite epithelium consisting of central limbal and peripheral conjunctival cells. The limbal tissues were explanted in the central region while the conjunctival tissues were explanted on the periphery of the deepithelialized human amniotic membrane (HAM) and nurtured using human corneal epithelial cell medium. After successful generation of a monolayer from both tissues had been confirmed, the composite of cultivated limbal and conjunctival epithelium with HAM was transplanted in each eye after excision of fibrous tissue and release of symblephara. One year postoperatively, the patient had a best spectacle-corrected visual acuity of 20/40 in the right eye (preoperative acuity 20/400) and counting fingers at 1 m in the left eye (same as preoperative) with a stable ocular surface. CONCLUSIONS: Autologous cultured epithelial transplantation is as an excellent option in selected patients with bilateral partial LSCD with small area(s) of healthy limbus in either eye and avoids the attendant risk of rejection and cost and potential toxicity of immunosuppression in allogeneic tissue transplantation. This case also highlights the feasibility of generating a composite culture of limbal and conjunctival epithelium using a single amniotic membrane.     

An innovative compression-clamp for open contaminated fractures of patella: a short report of five cases

Five patients with open contaminated fractures of the patella were managed using an indigenously designed external clamp cum compressor. All had an infected lacerated wound at the fracture site, and one had open exposed knee joint (Gustilo grade IIIB open fracture). These patients reported after 3-7 days of injury. The wounds were thoroughly washed and débrided and the clamp cum compressor was applied. They were encouraged to do active knee movements immediately post-operatively. The wounds healed within 3-4 weeks, and the fractures united within 10-16 weeks. Good functional results were achieved in four of the five.     

Congenital polyp of the posterior urethra in a boy

Summary A case of congenital urethral polyp in a boy is reported. The child presented with symptoms of lower urinary tract obstruction, which evaded radiological diagnosis perhaps due to its small size. The polyp showed a squamous metaplasia, one of the rare changes to occur, the usual lining being transitional cell epithelium. From the Department of Surgery, Medical College, Rohtak.     

Locking plate fixation in distal metaphyseal tibial fractures: series of 79 patients

Open reduction and internal fixation in distal tibial fractures jeopardises fracture fragment vascularity and often results in soft tissue complications. Minimally invasive osteosynthesis, if possible, offers the best possible option as it permits adequate fixation in a biological manner. Seventy-nine consecutive adult patients with distal tibial fractures, including one patient with a bilateral fracture of the distal tibia, treated with locking plates, were retrospectively reviewed. The 4.5-mm limited-contact locking compression plate (LC-LCP) was used in 33 fractures, the metaphyseal LCP in 27 fractures and the distal medial tibial LCP in the remaining 20 fractures. Fibula fixation was performed in the majority of comminuted fractures (n = 41) to maintain the second column of the ankle so as to achieve indirect reduction and to prevent collapse of the fracture. There were two cases of delayed wound breakdown in fractures fixed with the 4.5-mm LC-LCP. Five patients required primary bone grafting and three patients required secondary bone grafting. All cases of delayed union (n = 7) and nonunion (n = 3) were observed in cases where plates were used in bridge mode. Minimally invasive plate osteosynthesis (MIPO) with LCP was observed to be a reliable method of stabilisation for these fractures. Peri-operative docking of fracture ends may be a good option in severely impacted fractures with gap. The precontoured distal medial tibial LCP was observed to be a better tolerated implant in comparison to the 4.5-mm LC-LCP or metaphyseal LCP with respect to complications of soft tissues, bone healing and functional outcome, though its contour needs to be modified.     

Mini-incision dynamic condylar screw fixation for comminuted subtrochanteric hip fractures

PURPOSE. To review the results of indirect reduction and mini-incision dynamic condylar screw (DCS) fixation for comminuted subtrochanteric femoral fractures. METHODS. 29 men and 14 women aged 25 to 65 (mean, 44) years with comminuted subtrochanteric femoral fractures underwent indirect reduction and mini-incision DCS fixation. Fractures were classified according to the AO classification (10 type 32B and 33 type 32C) and Seinsheimer classification (6 type III, 15 type IV, and 22 type V). Functional outcomes were assessed using the Harris hip score and Merle d'Aubigne score. RESULTS. The mean time to full weight bearing was 11 (range, 8-19) weeks. The mean time to union was 16 (range, 13-22) weeks. There were no cases of non-union or implant failure after a mean follow-up period of 25 (range, 18-30) months. Seven patients had a mean limb length discrepancy of 1.5 (range, 1-2) cm. Two patients had coxa vara and persistent limp. According to the Harris hip score, functional results were excellent in 12 and good in 31 patients. The mean Harris hip score was 88 (range, 80-99) and the mean Merle d'Aubigne score was 17 (range, 14-18). There was no deep infection or avascular necrosis of the femoral head. Restriction of knee flexion beyond 90 degrees was noted in 2 patients. CONCLUSION. Results of indirect reduction and mini-incision DCS fixation for comminuted subtrochanteric femoral fractures are favourable. Proper planning and execution of the technique is required to achieve good functional outcomes and avoid complications. Preservation of vascularity of the medial fragments leads to rapid callus formation and early union and hence avoids implant failure and secondary bone grafting.     

Degenerative lumbar spinal stenosis—results of expansive laminoplasty

Expansive laminoplasty, a procedure used more and more often for cervical myelopathy, was carried out in patients with lumbar spinal stenosis in the Department of Orthopaedics, Paraplegia, Physical Medicine and Rehabilitation of our institute. Twenty-five such clinico-radiologically proven cases were operated upon. For radiological evaluation, computed tomography (CT) was used. Expansive laminoplasty decompresses the nerve roots by osteoplastic enlargement of the lumbar spinal canal, with the maintenance of spinal stability. These advantages were confirmed during the follow-up of 3 to 5 years. Using CT, the spinal canal was found to be enlarged to a nearly rectangular shape and the average enlargement was 124%. The visual analogue scale (VAS) was used for subjective pain assessment before and after the surgery. The ultimate outcome was assessed by the Surin et al. criteria (Spine 17:1-8, 1992).     

Multiple bladder calculi: a rare cause of irreducible uterine prolapse

Background A vesical calculus in a prolapsed cystocele is rare. Objective To highlight bladder calculi as a cause of irreducible uterine prolapse. Case Report A case of irreducible total uterine prolapse caused by multiple vesical calculi is presented. Bladder stones were removed through vaginal cystolithotomy followed by vaginal hysterectomy. Conclusion In cases of acute irreducible pelvic organ prolapse, the possibility of bladder stones should be kept in mind and X-ray pelvis including the prolapsed mass should be done to confirm the diagnosis.