Orthopaedic Journal of M. P. Chapter 2021-06-02T12:54:04+0530 Dr Saurabh Jain Open Journal Systems <p>Orthopaedic Journal of Madhya Pradesh Chapter (P-ISSN: <a href="">2320-6993</a> | E-ISSN: <a href="">2582-7243</a>) is official publication of Madhya Pradesh Chapter of Indian Orthopaedic Association. It was started in 1980 with Dr. P. K. Rai as the first editor of the journal. Subsequently Dr. H.K.T. Raza, Dr. Alok C Agrawal (twice), Dr. Sunil Rajan, Dr. A. Mukherjee and Dr. Ashish Gohiya were elected as editors of the journal. Currently Dr. Saurabh Jain is editor of the journal.</p> <p>The journal has both print and online versions and is publishes two issues in a year. It is an open access, free, peer reviewed journal without any article no processing fee for any of its authors. The journal allows free access (Open Access) to its contents to attract more readers and citations to published articles. It permits authors to self-archive final accepted version of the articles on any OAI-compliant institutional / subject-based repository. It is indexed with Index Copernicus with IC value of 71.64. The journal got P-ISSN 2320-6993 in 2013 under the editorship of Dr. Alok C Agrawal and in the year 2020 journal got E-ISSN 2582-7243 under the editorship of Dr. Saurabh Jain. The journal publishes editorial, review articles, original articles and case reports which are published free of charge and journal does not charge for submission, processing or publication of manuscripts and even for colour reproduction of photographs. The journal’s full text is available online at</p> Next Orthopaedic Pandemic Awaiting 2021-06-02T11:18:45+0530 Dr Saurabh Jain <p>Natural history of most of the pandemics which have occurred previously shows regression following the second wave. All these previous pandemics have occurred during the time when the medical and health facilities were not so developed and hence had profound and long lasting effects due to the pandemic itself. But in today’s era of modern medical technologies, the health facilities have been developed and grown to such an extent, that the vaccine and treatment for pandemic which previously took 3 to 4 years to develop, are been developed in just 6 to 8 months time. Hence, post covid era will show sustained and long lasting effects not only due to covid disease alone, but will also show the complications and side effects of covid treatment as well. <br>The ideal treatment of covid-19 is yet to be deduced, but guidelines for mild, moderate and severe form have been designed by AIIMS, New Delhi and approved by ICMR and WHO. The treatment of milder forms (URTI or fever) involves just home isolation and symptomatic treatment by antipyretics and oral Ivermectin. Steroids should not be used in milder form of disease. Treatment of moderate form of covid requires hospital admission, oxygen support, anitiviral therapy with injection Remdesivir, convalescent plasma along with intravenous methyl-presdnisolone and low dose anticoagulants. Severe form of covid additionally requires ICU support and injection Tocilizumab and high end therapies like lung transplant and ECMO.<br>With the kind of scattered health facilities and mixed pathies present in our country, it is quite evident that there is lack of protocol and guideline based management. Multiple types of treatments ayurvedic, homoepathic, herbal, desi kadha etc are used frequently for treatment without evidence based proven effect and without even knowing what the contents are. Further due to, huge population, high ignorance and illiteracy, delayed presentation, treatment by quacks and untrained staffs, it is quite common to have improper treatment with inadvertent, unjustified, long duration of treatment with the drugs other than prescribed. Hence steroid, which should not be given in milder form, are given or advised even in mild or non-symptomatic cases, that too for longer duration's. This irrational, inadvertent and continued use of the treatment especially by use of steroid and remdisivir will cause complications and side effects associated with use of these drugs. This problem probably will be further increased by use of sub-optimal quality and sub-optimal doses of the treatment leading to poor response to treatment and further provocating longer duration of treatment, creating a vicious circle. Thus to summaries, with the quantum of covid infected patients as rampant in our country and use of treatment based on irrational protocol, yet another pandemic due to side effects and complications related to the covid treatment is going to come in near future. Early complications following the treatment like diabetes, cardiac arrest and mucormyosis are already been manifested in society.<br>The use of inadvertent, irrational, suboptimal and prolonged steroid therapy, along with other complications, is also associated with severe orthopaedic complications, among which the most common are osteoporosis, fragility fractures and avascular necrosis of femoral head. Hence we orthopaedic surgeons in near further will see a pandemic of these post-covid infected cases presenting to us after the treatment with steroids.<br>Hence we should be aware, suspicious, prepared for prompt diagnosis and judicious early treatment of these cases. We should also be aware and prepare ourselves with newer modalities of diagnosis, instruments, equipment and treatment guidelines of these complications so that these entities can be diagnosed earliest and treated successfully, without any severe complications. <br>Post steroid osteoporosis, skeletal fragility fractures and avascular necrosis can lead to rapid deterioration of health status, decreased quality of life, increases dependency and economic burden. Fragility fractures, particularly hip fractures are also associated with high rates of mortality, which is preventable if we could reduce them. Contrary, to the fact that these were the pathologies seen in elderly patients, after the post steroid treatment in covid patients, these pathologies will be at rise in early age groups as well, and if we are not aware, suspicious and prompt enough to diagnose them in even these younger age group, we are likely to miss them or can have delayed diagnosis when they present to us with complications. <br>Screening for osteoporosis and avascular necrosis in these high risk patients of post covid with steroid treatment will help us to diagnose and treat osteoporosis and avascular necrosis, at early stage and minimize the risk of fractures and joint destruction, respectively, associated with these entities. This will involve orthopaedician to do early assessment by complete medical examination with thorough clinical history, look for clinical risk factors, and order for basic laboratory investigations and biomedical markers of bone turnover along with measurement of bone mineral density (BMD) with Dual-energy X-ray absorptiometry (DEXA) scan or high quality digital x rays. Further patients with positive medical history, suggestive clinical suspicions and or presence of additional risk factors should undergo further additional targeted laboratory testing and investigations which will provide useful information to risk stratify patients.<br>Specific additional risk factors which should warn the orthopaedician are, advancing age, history of prior fracture, low body weight, cigarette smoking, excessive alcohol consumption, estrogen deficiency, vitamin D or calcium malabsorption, systemic inflammation, autoimmune disorders and/or high bone turnover states. Measurement of bone mineral density most commonly, precisely and accurately can be done by Dual-energy X-ray absorptiometry (DEXA) or quantitative ultrasound.<br>Evaluation of biochemical markers can predict low bone mass and bone loss, estimate future fracture risk and monitor the treatment. Biochemical markers, which can be used, are the marker of bone formation which are alkaline phosphatase, osteocalcin and Procollagen I Extension Peptides, and markers for bone resorption which are hydroxyproline, Pyridinium Cross-links and Telopeptides and Tartrate-Resistant Acid Phosphatase.<br>In addition to measurement of bone quantity, high-resolution peripheral quantitative computer tomography (HR-pQCT) and magnetic resonance imaging technology can help to measure bone strength and determine qualities of bone such as its geometry, macro, micro, and nanostructure, material composition, volumetric bone density, cortical and trabecular micro-architecture. These non-invasive methods can also help to diagnose avascular necrosis of femoral head early before the signs occur which are evident on x rays.<br>Surgeon should also be familiar with fracture risk assessment tools like FRAX algorithm, which provides estimates of an individual’s 10-year probability of hip fracture or major osteoporotic fractures which incorporates 11 patient factors (i.e., age, sex, height, weight, prior fracture, parental hip fracture, smoking, alcohol, glucocorticoids, rheumatoid arthritis, and either secondary osteoporosis or BMD) to calculate an individual’s fracture risk. <br>Once the diagnosis has been made, we should treat the osteoporosis and avascular necrosis earliest by use of proper nonpharmalogical, medical and surgical therapy, to prevent complications associated with it. Non-pharmacological treatment of these, include life modification to prevent falls and subsequent fragility fractures. This includes correction of refractory errors, use of walking aids, installation of bars, railing and support specially in bathrooms and stairs, using non skid floors, and use of antifracture devices. Light exercises and taking a healthy diet rich in calcium supplements, vitamin D and high proteins along with avoiding risk factors, smoking and alcohol will keep the bone healthy. <br>Medical therapy of osteroporosis and avasular necrosis includes prescribing anti-resorptive therapy in form of biphosphonates, hormone replacement therapy, calcitoin, selective estrogen receptor modulators like raloxifene. Surgeon should also know about dosage, prescription, interaction and contraindication of the recent and evolving therapies like Denusumab and biologics like growth hormone, Teriperatide and Parathyroid hormone etc. <br>Surgical treatment of these patients can be a challenge, owing to their younger age, poor bone quality and lack of ideal fixation method in porotic bones and delayed mobilization. We should be prepared for surgical treatment, if needed at earliest, as early surgery can reduce, hospital stay, mortality and complications. Surgical treatment of osteoporosis involves vertebroplasty, kyphoplasty or prophylactic fixation in certain cases specially hip before the fracture occurs. Further, when bone quality is impaired, surgeon should be prepared for augmented synthesis with use of bone grafts auto as well as allografts, cements, bone substitutes like tricalcium phosphate and biologic and growth factors like BMPs along with armamentarium of specific implants like locking plates, TSP plates, helical blades fixations, multi directional nails and longer implants than normally used etc. Surgical treatment for avascular necrosis in early stages by core decompression and pedicle grafting can prevent the joint replacement surgery.<br>To summarize, we the orthopaedic surgeons should be prepared, aware and cautious enough, to deal with the forthcoming pandemic, which is just about to come after the end of second wave of the covid. This orthopaedic pandemic will be especially in the form of large number of cases presenting to us with osteoporosis, fragility fractures and avascular necrosis of hip, which will be due to complications associated with the steroid treatment of covid patients. If we can diagnosis and treat the patients early before the occurrence of fragility fractures or the need for joint replacement, we could successfully say that we orthopaedic surgeons have dealt with this pandemic successfully. <br>“It is better to prevent and prepare rather than rent and repair”</p> 2021-06-30T00:00:00+0530 Copyright (c) Non-traumatic Osteonecrosis of the femoral head: an overview 2021-06-02T11:18:48+0530 Nikku Mathew Geevarughese Ipe J Chatterji G Vashistha D Haq RU <p>Osteonecrosis of femoral head is a debilitating condition that frequently affects the young. Risk factors primarily include corticosteroid use, alcohol consumption, trauma, blood dyscrasias and coagulation abnormalities. Despite multiple theories, no single mechanism has been successful in fully explaining the pathophysiology, except for one common factor that impairment of circulation to the femoral head leading to subsequent development of necrotic patches. The natural history of the disease is eventual collapse of the hip joint and arthritis; therefore, early diagnosis and intervention are essential. Size and location of the lesion are prognostic factors of progression of the disease process and are best evaluated on magnetic resonance imaging. Management of non-traumatic osteonecrosis remains evolving with better knowledge of the disease process and advances in treatment options. In an early stage, joint-preservation is the primary objective, which offers options of core decompression alone or with adjunctive vascularized bone grafts, avascular grafts, bone morphogenetic proteins, stem cells, or combinations of the above or by transtrochanteric osteotomies. Once collapse has set in, total hip replacement has been the preferred treatment of choice. Nevertheless, careful patient selection and understanding the etiology plays a pivotal role in deciding course of management and choice of implants.</p> 2021-06-30T00:00:00+0530 Copyright (c) 2021 Orthopaedic Journal of M. P. Chapter Functional outcome of distal end femur fractures treated by minimally invasive plate osteo-synthesis using locking compression plate: a prospective study in 50 adults 2021-06-02T12:53:04+0530 Saket Jati Himanshu Bansal Taha Bohra Mayank Kumar <p>Background: Distal femoral locking compression plate can be done via minimal invasive methods, overcoming the drawbacks of excessive stripping as caused by open methods. Fixed locking construct of the plate also provides stable fixation needed for early mobilization in fractures of distal femur. Hence, we evaluated the results of distal femoral locking compression plate done via minimally invasive technique in fractures of distal end femur.</p> <p>Material and methods: 50 cases of fracture distal end femur were treated by internal fixation with distal femoral locking compression plate via minimal invasive techniques and were evaluated radiologically for union and functionally, using NEER’S Score.</p> <p>Results: 50 distal end femoral fractures (29 males and 21 females) with mean age of 51 years (range 20 to 83 years) were included in study. Mean duration for surgery was 67 minutes (range 60 to 89 minutes), mean blood loss was 119 ml (range 100 to 140 ml) and mean union time was 14.3 weeks (range 11 to 20 weeks). 38 (76 %) patients had excellent results and 8 (16%) had satisfactory results as per NEER’s scoring system with mean NEER’s score of 90.133 (range 74 to 96). Complications seen were knee stiffness as seen in 4 (8%) cases, 4(8%) had superficial infection, 1 (2%) had implant failure, 2 (4%) had malalignment and 1(2%) had nonunion.</p> <p>Conclusion: Pre-contoured distal femoral locking compression plate by virtue of its features, to provide stable fixation and done via minimal invasive technique, provides excellent function, high rate of bone union and fewer complications, even in severely comminuted fractures and osteoporotic bones of distal end femur.</p> 2021-06-30T00:00:00+0530 Copyright (c) 2021 Orthopaedic Journal of M. P. Chapter Comparative Analysis of Functional Outcome of Conventional Midline Parapatellar to Minimally Invasive Subvastus Approach in Total Knee Replacement 2021-06-02T11:18:49+0530 Dr.Rajendraprasad Butala Kedar Parelkar Dr.Akshat Pandey <p><strong>Background</strong>: Minimally invasive subvastus total knee replacement (TKR) has gained popularity over the past few years. Early results of this minimal invasive TKR have shown no clear advantage over conventional longer midline parapatellar approach in relation to the functional outcome and recovery. Hence we analyzed and compared the functional outcome of conventional midline longer parapatellar approach with minimal invasive subvastus approach in TKR surgery.</p> <p><strong>Material and methods</strong>: All cases operated for TKR by two approach minimally invasive subvastus approach or conventional midline parapatellar approach were compared for length of incision, amount of blood loss (drain in first 24-hrs), tourniquet time, visual analogue pain score, range of motion, straight leg raising (SLR), length of hospital stay, knee functional &amp; objective society scores.</p> <p><strong>Results</strong>: 40 patients with mean age 65.3 years (range 59 to 72 years) of osteoarthritis knee who underwent TKR by conventional midline parapatellar approach or minimal invasive subvastus approach were included in the study. 27 were female and 13 were male. The mean incision length, mean tourniquet time and mean total blood loss in conventional midline parapatellar approach group was 18.85 cm (range 17 to 19 cm), 65.5 min (range 60 to 70 min) and 347.6 ml (range 240 to 460 ml) respectively. The mean incision length, mean tourniquet time and mean total blood loss in minimal invasive subvastus approach group was 10.30 cm (range 9 to 11 cm), 85 min (range 80 to 90 ml) and 293.35 ml (range 175 to 409 ml). The mean length of hospital stay was same in both the groups 6.8 days (range 5 to 9).</p> <p><strong>Conclusion</strong>: TKR by conventional midline parapatellar approach demonstrated better functional outcome, reduced operative time, reduced tissue trauma (lesser pressure by retractors), shorter learning curve, easier availability of implant and instrument sets and precise implant placement due to a good visualization of the surgical field in comparison to minimal invasive subvastus approach. Hence conventional midline parapatellar approach method which is tried and time tested, still holds important corner stone in TKR surgery and should be given due consideration.</p> 2021-06-30T00:00:00+0530 Copyright (c) 2021 Orthopaedic Journal of M. P. Chapter Comparison Of Free Hand Versus Offset Guide Technique For Femoral Tunnel Placement In Arthroscopic Anterior Cruciate Ligament Reconstruction 2021-06-02T12:53:31+0530 Dr vivek Singh Singh AK Vyas P Jain P Bhinde S Patidar A Mehta R Sharma SK <p><strong>Background</strong>: Accurate femoral tunnel placement is one of the most crucial steps of ACL reconstruction, and also a predictor of better outcome. This study was done to compare two methods of femoral tunnel drilling, freehand method and offset guide method and to assess them by 3D CT Scan using Bernhard Hertel quadrant to find out which is better method of tunnel placement.</p> <p><strong>Material and methods</strong>: 30 patients, who underwent arthroscopic ACL reconstruction from June 2018 to April 2020, were compared for the femoral tunnel placement by freehand and offset methods and were assessed by postoperative 3D CT Scan. Height and length of femoral tunnel and the percentage of femoral height (h) and length (t) to the total height and length respectively were calculated on the Bernhard Hertel quadrant and compared.</p> <p><strong>Results</strong>: The mean ‘h’ was 28.62 ± 7.68 (range 15.5 to 42), while mean of ‘t’ was 34.86 ± 9 (range 21.5 to 55.5) in free hand method. The mean ‘h’ was 28.65 ± 10.19 (range 11.6 to 58), while mean of ‘t’ was 31.6 ± 5.02 (range 21.8 to 44.4) in femoral offset guide method. On comparing mean of “h” of freehand method with the mean of “h” of offset guide method, the p value was 0.984 (p value &gt; 0.05), which was not significant. Similarly, on comparing mean of “t” of freehand method with the mean of “t” of offset guide method, the p value was 0.230 (p value &gt; 0.05), which was not significant.</p> <p><strong>Conclusion</strong>: Femoral tunnel preparation leads to almost similar tunnel position by both freehand and offset guide method. Both methods are associated with surgeon’s learning curve. 3D CT-Scan and Bernhard Hertel grid is reliable and reproducible method for evaluating femoral tunnel.</p> 2021-06-30T00:00:00+0530 Copyright (c) 2021 Orthopaedic Journal of M. P. Chapter To Evaluate the Functional Outcome of Platelet Rich Plasma Therapy in Osteoarthritis of Knee 2021-06-02T11:18:51+0530 Saket Jati Himanshu Bansal Garg A Shubham Jain <p><strong>Background</strong>: Osteoarthritis of knee is a chronic, degenerative condition associated with pain, deformity, disability, difficulty in movements and reduction in the quality of life. This study aims to assess the efficacy of intra-articular injection of autologous platelet rich plasma (PRP) therapy in the management of osteoarthritis of knee.</p> <p><strong>Material and methods</strong>: 50 patients with symptomatic knee osteoarthritis were treated by 5 ml autologous intra-articular PRP injection and were assessed for pain, quality of life and rate of satisfaction by WOMAC score.</p> <p><strong>Results</strong>: 50 cases (KL grade II 18 and grade III 22) were included in the study. In KL grade II, the mean WOMAC score, pretreatment was 57.11 ± 6.36, which improved to 53.76 <u>+</u> 7.6 (p=0.000) at 2 weeks, to 31.97 ± 4.51 (p=0.001) at one month, to 26.97 ± 3.47(p=0.001) at 3 months and to 22.11 ± 2.99 (p=0.001) at final follow-up of 6 months. In KL grade III, the mean WOMAC score pretreatment was 59.21 ± 5.63, which improved to 55.76 ± 7.6 (p=0.000) at 2 weeks, to 48.79 ± 5.42 (p=0.001) at one month, to 36.46 ± 4.36 (p=0.001) at 3 months, and to 32.12 ± 2.66 (p=0.001) at final follow-up of 6 months.</p> <p><strong>Conclusion</strong>: Use of single PRP intra-articular injection in the management of osteoarthritis knee provides excellent pain relief, improvement in quality of life and high rate of satisfaction, which is more effective in the early stages of osteoarthritis than the advanced stage. Relief starts immediately and it increases gradually with time. PRP is a safe, easy, minimally invasive and cheap alternative in the management of knee osteoarthritis.</p> 2021-06-30T00:00:00+0530 Copyright (c) 2021 Orthopaedic Journal of M. P. Chapter Evaluation of percutaneous fixation of intra articular fractures of calcaneum using Essex Lopresti manoeuvre 2021-06-02T11:18:52+0530 Mantri D Jain S Kothari Nilesh <p><strong>Background</strong>: Debate continues regarding the ideal management of calcaneal fractures, between open reduction and internal fixation and closed methods. Open plating has failed to prove its superiority over closed methods owing to poor soft tissue coverage, severe soft tissue swelling, lack of availability of sturdy implants and complications associated with plating. Hence we evaluated the outcome of percutaneous fixation of tongue type intra-articular fracture of calcaneum by Essex Loprestimanoeuvre.</p> <p><strong>Material and methods</strong>: 30 tongue type intra-articular fractures of calcaneum in 23 patients operated by Essex Loprestimanoeuvre by closed reduction and percutaneous pin fixation were assessed functionally by Maryland foot score and radiologically by Bohler’s angle and Gissane’s angle.</p> <p><strong>Results</strong>: 30 calcaneal fractures with mean age 31.6 years and mean follow up of 8.3 months were included in the study. The mean pre-operative Bohler’s angle improved from 8.300 ± 3.84, to 24.470 ± 8.31 immediate postoperatively and to 24.330 ± 8.46 at final follow up of 6 months, respectively. The mean pre-operative Gissane’s angle improved from 134.130 ± 7.03, to 123.150 ± 8.79 immediate postoperatively and to 123.550 ± 8.82 at final follow up of 6 months, respectively. Mean union time was 9 weeks. The mean Maryland Foot Score was 83.43 ± 7.53 (range 61 to 92) and 86 % cases had excellent to good results.</p> <p><strong>Conclusion</strong>: Essex-Lopresti’s method for treatment of tongue-type fractures of calcaneum is easy, cost effective, day care procedure provides stable fixation, early mobilization and excellent results, with low complication rates.</p> 2021-06-30T00:00:00+0530 Copyright (c) 2021 Orthopaedic Journal of M. P. Chapter Management of Sub-trochanteric Fractures by Long Proximal Femoral Nail in Young Adults 2021-06-02T11:18:52+0530 Shukla R divyanshu Patel divya <p><strong>Background</strong>: Sub-trochanteric fractures are difficult to manage and are frequently associated with complications, owing to high stresses in this region. We evaluated the outcome of long proximal femoral nailing in management of these sub-trochanteric fractures.</p> <p><strong>Material and methods</strong>: 32 patients of closed sub-trochanteric fractures of femur in patients more than 18 years’ age were treated with long proximal femoral nail and were assessed functionally by Harris Hip Score and radiologically to assess union.</p> <p><strong>Results</strong>: 32 patients of sub-trochanteric fractures with mean age 50.09 years treated with long proximal femoral nailing were included in the study. 24 were male and 8 were female. Right side was affected in 18 cases and left in 14 cases. Mean operative blood loss was 122.6 ± 27.6 ml (range 110 to 143 ml).&nbsp; The mean union time was 14.37 weeks (range 12 to 24 weeks). The mean Harris Hip score was 85.9. Only one patient had complication in form of proximal screw back out.</p> <p><strong>Conclusion</strong>: Long proximal femoral nailing provides reliable and excellent to good results in the management of difficult sub-trochanteric fractures, with minimal complications, but the surgery is technically demanding and requires learning curve.</p> 2021-06-30T00:00:00+0530 Copyright (c) 2021 Orthopaedic Journal of M. P. Chapter Functional Outcome of Proximal Tibial Sagittal Fractures Treated with Minimally Invasive Plate Osteosynthesis 2021-06-02T12:54:04+0530 Dr.Saket Jati Dr. Himanshu Bansal DR.TAHA BOHRA Kumar M Dr. Morin Joy Daya <p><strong>Background</strong>: Tibial plateau fractures are common intra-articular fractures, representing 1-2% of all fractures. Modern locking plate systems provide increased angular stability, have a low implant profile, improved design matching the peri-articular bone surface and are compatible with minimally invasive techniques. We evaluated the functional outcome of tibial plateau sagittal fractures using a locking compression plate done via a minimally invasive technique.</p> <p><strong>Material and methods</strong>: 60 cases of sagittal plane proximal tibial fractures of Schatzker type I, IV, V, and VI fractures were treated using locking compression plate via minimally invasive techniques and were assessed for functional outcome by Modified Rasmussen’s score.</p> <p><strong>Results</strong>: A total of 52 patients with a mean age of 43.71 years were included in the study (8 patients were lost in follow-up). 39 were male and 13 were female. 30 patients (58%) had excellent, 19 patients (36%) had good, 3 patients (6%) had fair functional outcome and none of the patients had a poor outcome. The mean Rasmussen score in the series was 25.85.</p> <p><strong>Conclusion</strong>:&nbsp;Internal fixation of proximal tibial sagittal fractures with locking plates, following the principles of MIPO (Minimally invasive percutaneous osteosynthesis) provides, satisfactory fracture reduction, less damage to soft tissues, allows early mobilization and excellent to good functional outcome even in these complex tibial plateau sagittal fractures.</p> 2021-06-30T00:00:00+0530 Copyright (c) 2021 Orthopaedic Journal of M. P. Chapter A case of congenital pseudoarthrosis tibia treated by four in one procedure and review of literature 2021-06-02T11:18:53+0530 Jain S Ajmera A Dr. Mitul Jain <p>Standard methods of treatment for congenital pseudoarthrosis of tibia (CPT) including internal fixation with intramedullary rodding, external fixation or ilizarov fixation, vascularized fibula transfer or combinations have varied results with high rates of recurrence. We report such a rare case of congenital pseudoarthrosis tibia which failed to unite with primary surgery of ilizarov and then was successfully treated and united with four in one procedure which involves creating a synostosis between proximal and distal ends of both tibia and fibula. The procedure is reliable and effective in preventing re-fractures.</p> 2021-06-30T00:00:00+0530 Copyright (c) 2021 Orthopaedic Journal of M. P. Chapter Prof. D. K. Sonkar (1965-2021) 2021-06-02T11:18:53+0530 Dr Deepak Mantri <p>Our community sadly lost a pillar on 15th January 2021, when Prof. Dinesh K Sonkar left for his heavenly abode at the age of 55 years after a valiant battle with Neck Cancer.<br>Prof Dinesh Sonkar was born on 15th September 1965 at Bina (District Sagar), Madhya Pradesh. After completing his basic schooling from Bina, he joined as an MBBS student at MGM Medical College, Indore where he completed his graduation and post-graduation (M.S Orthopaedics) in the year 1989 and 1992 respectively. During his graduation, owing to his commitment to physical fitness, competitive sports and great singing and oratory skills, he was awarded with the reputed Mr MGM Award.<br>After completing his post-graduation in Orthopaedics, he served his alma mater as Senior Registrar from 1994 till 1996. He was selected as Assistant Professor, Orthopaedics at MGM Medical College, Indore through MPPSC in September 1997. During his tenure as Assistant Professor his paper on the innovative “Indore shoe” for maintenance of clubfoot was shortlisted for the prestigious A.A Mehta Gold Medal Paper competition at IOACON, Jaipur 2000. This innovation got appreciation all over the country bringing recognition to the department and Indore. <br>He held the post of Associate Professor at MGMMC, Indore from 2003 to 2007 when his discipline towards work, incredible surgical skills, his ability to execute a variety of complex surgical procedures in a perceptibly simple way and his dedication to undergraduate and postgraduate teaching got admiration amongst his colleagues and students.<br>He served as Professor and Head of the Department at SRS Medical College, Rewa from 2007 to 2010. It was under his able leadership that the Post Graduate Degree Course got recognised by M.C.I at SS Medical College, Rewa. His tenure at Bundelkhand Medical College, Sagar from 2010 till 2013, laid the keystone for building from scratch, the Orthopaedic department at Bundelkhand Medical College. He led the department from the front and expanded its horizon by demonstrating various novel orthopaedic procedures like arthroplasty and spine surgery.<br>He joined as Professor, Orthopaedics at MGM Medical College, Indore in 2013, where he was promoted as the head of department after the retirement of his predecessor Dr Pradip Bhargava in 2014. Under his headship the department organized the National Postgraduate Teaching Course during IOACON 2017 at MGM Medical College, Indore. He was also the Organizing chairman for the 1st Alumni meet organized by Department of Orthopaedics in December 2017.<br>He was also the Principal of School of Physiotherapy till it became a part of MGM Allied Health Sciences Institute (MAHSI) in 2018. It was under his able supervision that Artificial Limb Fitting Centre (ALFC) got unparalleled reputation amongst the fraternity for offering good quality rehab aids for specially abled in Indore and its vicinity. <br>He has also been the President of Indore Orthopaedics association from 2015-16, which was a landmark year in the history of the association. <br>He has to his credit, presenting many research papers; countless faculty lectures and publishing several research papers in international, national and state level journals of repute. He chaired sessions in various national and state level conferences educating presenters from all parts of the country. <br>He was a problem solver and often took the difficult projects willingly and completed them with much ease. He has been a great teacher, enlightening the path for most of us.<br>Prof Dinesh Sonkar is survived by his wife Smt Tara Sonkar and two sons, Harsh vardhan and Yash vardhan Sonkar. Yashvardhan is pursuing MBBS from MGM Medical College, Indore and carrying forward his father’s dream.<br>His legacy will live in the hearts and minds of everyone he interacted with as well as those he reached as a teacher.</p> 2021-06-30T00:00:00+0530 Copyright (c)