Accused of grave charges and convicted of offences that I would never even imagine committing, I was sentenced to numerous terms of imprisonment including life imprisonment. I spent 13 years as a prisoner, eight as an under trial and seven as a life convict, under difficult, desperate and depressing circumstances.This is my experience of practicing orthopaedics in those times, with limited or no facilities, treating desperate patients who had nowhere else to go. Accused of grave charges and convicted of offences that I would never even imagine committing, I was sentenced to numerous terms of imprisonment including life imprisonment. I spent 13 years as a prisoner, eight as an under trial and seven as a life convict, under difficult, desperate and depressing circumstances.This is my experience of practicing orthopaedics in those times, with limited or no facilities, treating desperate patients who had nowhere else to go.

1. Dr L.Prakash M.S. orth M.Ch, orth

2. DESPITE BEING TOTALLY INNOCENT

3.  Accused of grave charges and convicted of
offences that I would never even imagine
committing, I was sentenced to numerous
terms of imprisonment including life
imprisonment.

9. 0
500
1000
1500
2000
2500
3000
Patients
2171
702 648
3
2670
1121
87
Treatments
Conservative treatment including
skeletal traction
Manipulations with or without
sedation
Suturing and minor surgery
Implant removal under local
anesthesia
Intra-articular injections
Local steroid injection
Referral to other centers

10.  Conservative treatment including
 skeletal traction 2171
 Manipulations with or without sedation 702
 Suturing and minor surgery 648
 Implant removal under local anesthesia 3
 Intra-articular injections 2670
 Local steroid injection 1121
 Referral to other centers 87

11.  Suturing
 Abscess drainage
 Removal of thorns
and foreign bodies
 Skeletal traction
 Implant removal

12.  No X-ray machine in prison hospital
 No POP bandages or traction items
 No Lignocaine or local anesthesia
 No anesthetic drugs
 No sedatives or tranquilizers
 Iimited suture material
 No other facilities.

13.  If I was taken out of my
cell, I had to treat the
patients through the
bars.
 If warders during night
rounds wanted
consultations, I would
be on this side of the
bars

18. The torn ear

20.  Total 89
 Anterior 83
 Posterior 6
 Associated
with
fractures 9 Anterior
dislocations
Posterior
dislocations
Associated with
fractures
83
6
9
Patients
Patients

21.  This my modified Kocher’s method. No huffing and
puffing. Only precise application of biomechanics.
 Patient needs to be relaxed with or without
tranquilizers.

25.  Slow internal
rotation to touch the
hand to the
opposite shoulder.
(most often there
are no clicks or
sounds. Only the
dramatic smile on
the patient’s face
tells you about the
reduction.

26. I had a wonderful
opportunity for a
study.
 Total femoral
fractures treated in
twelve years 70
 Closed fractures
54
 Open fractures 11
 Fractures infected
after fixation who
came to prison
subsequently 5
77%
16%
7%
Closed fractures
Open fractures
Fractures infected after fixation who came to prison
subsequently

27.  Of these; 65 cases
happened inside the
prison.
 Most open fractures
were compound from
within out.
 Most happened after a
fall from tree, building
watch tower etc

28.  In 2002, a patient named
Karuppuswamy
climbed up a tree and
threatened to jump
down.
 He slipped, fell and
broke his right femur.
With a splint, he was
sent to the Government
hospital, where as a
first aid, he was
immobilized in a
Thomas’s splint.
 He was posted for
surgery in a few days.

29.  He was in the general
ward. And on both his sides
were patients with old
fractured femurs.
Discharging sinuses, foul
smell, exposed metal, and
heart wrenching stories of
months or years of misery.
 Karuppuswamy was
petrified. He did not allow
any surgeon to touch him
and was brought back to
the prison in a Thomas’s
splint

31.  I thought about it
for a day and then
asked my assistant
outside to get me
an Ilizarov half
ring, couple of
olive wires, couple
of wire fixation
bolts, and a length
of clothesline.

33.  The prison authorities
allowed me to use traction
on him and I gave an upper
tibial traction somewhat like
a Fisk traction using fan
hooks and locally designed
pullies.
 The prison plumber and
electrician helped.
 Traction was provided by
three concrete bricks each
about four kilos.

35.  Traction was provided
by three concrete
bricks each about four
kilos.
 I would measure the
femoral length daily,
and ensure that there
was no rotation.
 Knee was kept flexed
most of the time over
pillows to traction
level.

36.  He was sitting up in a
week and moving in the
bed in two. He was out of
the bed by the fifth week,
walking with a six feet
bamboo cane.
 In three months he was
walking and by fourth
month back to playing
football.
 No locking plates, no
flexible nails, no rigid
locking nails, no
protruding stubs, no
scars, full function, three
degree valgus and half
an inch shortening

38.  From that time on no convict would get his
femur operated.
 I managed eleven open (punctured wounds
from inside) and 54 closed femoral fractures all
with excellent results.
 The scientific data is being analyzed for
publication. It is a real pity that the
circumstances and situations did not allow me
to get or copy the radiographs.

39.  11 cases in thirteen years.
 Three associated with
acetabular fractures.
 All treated by closed reduction
 Excellent results in all but one
who developed OA after four
years. He is coming to me
shortly for a hip replacement.

40.  Low back ache
 Knee arthritis
 Knee injuries
 Frozen shoulders
 Fracture both bones
forearm
 Fracture tibia/fibula

41.  Colle’s and Smiths fractures
 Fracture clavicle
 Fracture neck of humerus
 Fracture neck of femur
 Intertrochanteric fractures
 Fracture shaft of femur
 Calcaneal fractures
 Metacarpals and Meta tarsals

42.  By luck, I had an
opportunity to
monitor and study
a group of 67
patients with CT or
MRI proven
Prolapsed
intervertebral discs
treated by various
means and could
study them for
periods up to 13
years, with a mean
follow-up of 10
years.

43.  Patients with persistent
symptoms, pain and some
neurological deficit
 SLR below 40 degrees
 Patients who were convict
prisoners and could be
closely followed up for at
least 7 years or more

44.  20 to 30 16
 31 to 40 18
 41 to 50 20
 51 and above 13
0
5
10
15
20
No Of Patients
16
18
20
13
20 to 30 31 to 40 41 to 50 51 & above

45.  Laminectomy/
Discectomy 19
 Epidural
injection 14
 Pain killers,
physio,
excersices 34
28%
21%
51%
Patients
Laminectomy
/diskectomy
Epidural
painkillers,
physio

46.  All operative cases were operated by
orthopods or neuro surgeons outside the
prison.

47.  All epidural injections were administered
inside the Prison Campus by me
 Conservative group treated either by me or
have taken no treatment

48.  Though this is a prospective study, it is
neither double blind nor controlled. I
had no control over patients falling into
a particular group. Situations
determined the group into which the
patient fell.

49.  Visual Rating
Scale
 Visual
analogue
scale
 Oswestry
disability
index
0
5
10
15
20
25
30
35
40
No Treatment Injection Operation
1 1.3
3.8
1.4 2.1
4.6
11
18
40
Visual Rating Scale Visual analogue scale
Oswestry disability index

50.  No difference between Epidural injection and
No treatment

51.  Surgery gave the worst results with permanent
complications in 19% of the patients

52.  Never operate on any prolapsed disc.
 Even those with neurological deficit or bladder
problems get well after some time.

53.  Holiday for the surgeon and spouse
 College admission for surgeon’s son
 A new car or holiday home
 Or possibly even a speed boat if he operates
every back!!

54.  Scrotum/cerebrum×100
 Balls over brains ratio
 While our testosterone urges us to rush into
surgery, cerebral serotonin urges caution
 We must make our choices wisely

55.  Don’t operate in
 1, Fracture clavicles
 2, Fracture calcaneum
 3, Fractures in
Children below ten
 4, Prolapsed
intervertebral disc
 There are a few
exceptions however

56.  I used my learnings in the fields of
sculpting and rubber mouding to make
hand prosthesis ( cosmetic) for two below
elbow amputee convict prisoners. I also
developed a method of silicon rubber feet

60.  106 books, 25 million hand written words.
 Fiction, non fiction, mythological, adventure
stories, legal thrillers, sensuous, and
detective novels.

66.  When the selfie bug hit the world, I was in
a small cell without even proper electricity

88.  I was acquitted in all cases that were
foisted on me

90.  The newspapers
and televisions
had buggered up
my reputation
 But these
patients cared a
dam
 The next day of
my release, I had
begun operating

91.  Nature was
kind on me,
my
experiences
in art and
sculpting had
probably
made my
fingers more
accurate

92.  To my luck, I
attracted only
complex and
unusual cases.
 And nature has
helped me so far as
I have now learnt to
respect nature

94.  I also received
a wholehearted
welcome from
my orthopaedic
colleagues and
the Indian
Orthopaedic
Association

95.  It is not where
you are that
matters.
 What matters is
what you do!!

96.  They can take
away your
liberty, only you
can take away
your freedom.
 They can
imprison your
body, only you
can imprison
your mind

97.  A physician is
never off duty.
He is there
24/7/365
 A scientist finds
research
material
wherever he is;
even in a prison

98.  Keep meticulous
records, you
don’t know when
they will be
useful
 Keep smiling, for
no trouble lasts
for ever. The
rainbow is out
there.