Orthopaedics usual and unusual

Orthopaedics, usual
and unusual
Thirty years of experience
Dr L.Prakash M.S., M.Ch (orth) Liverpool
Director. Institute for Special Orthopaedics Chennai 600106
(ISO 9001-2008 certified)

Orthopaedics, usual, and unusual 
Thirty years of experience
Dr L.Prakash M.S., M.Ch (orth) Liverpool

My life as an orthopaedic surgeon
went through three phases
1985 to 2001:
The Surgeon

2002 to 2015 April:
The Learner

May 2015 to present:
The Teacher and Practitioner

First Phase
! Routine beginnings. M.S.,
M.Ch. etc,
! Training under greats like
Freeman, Muller, Goodfellow,
Monk, Wroblowski, Boyle,
Klenerman, Owen, Taylor etc.
! Career as a Trauma and Joint
replacement surgeon.

During this phase, I was:
A prolific surgeon, innovator, and wrote four books and
conducted 80 workshops.

During this phase,
I operated in 106 operation theatres across the country and
abroad, demonstrating surgical techniques and was the
Secretary and Vice President of Indian Orthopaedic
Association.

During this phase,
VERY OCCASIONALLY TREATED A FRACTURE
CONSERVATIVELY

Second Phase:
! Dramatic change in my life.
! From an orthopaedic surgeon, I became a life convict
prisoner in the dreaded Chennai Central Prison.

Life convict in Central prison
Chennai
! 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.

13 YEARS IN PRISON
DESPITE BEING TOTALLY INNOCENT

I spent 13 years as a prisoner, eight as an under
trial and seven as a life convict, under difficult,
desperate and depressing circumstances.

These are my experiences of practicing  
orthopaedics in those times, with limited  
or no facilities, treating desperate patients  
who had nowhere else to go.
My experiences gathered from studying a
few thousand individuals, in a closed atmosphere
with a hundred percent follow up, to tell me if
my methods worked.

You are not allowed to carry X-Rays out of the prison,
and so I have no pictures of fractures, but I maintained
meticulous records, on which this narration is based

I also traced the X-Rays that I could lay
hands on, and the pencil drawings are
shown herewith.

Period spent in the prison 4831 days 
 
Total number of patients seen 11,248 
Conservative treatment
Manipulations
Suturing and minor surgery
Implant removal under LA
Intra-articular injections
Local steroid injection
Referral to other centers

Orthopaedic treatments
! Conservative treatment 2171
! Manipulations under sedation, haematoma block, or
just motivation 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

Surgeries inside the prison:
! Suturing
! Abscess drainage
! Removal of thorns
and foreign bodies
! Skeletal traction
! Implant removal

UNIQUENESS ABOUT PRACTICING
ORTHOPAEDICS IN PRISON
! No X-ray machine in prison hospital
! No POP bandages or traction items
! No Lignocaine or local anaesthesia, without
special permission.
! No anaesthetic drugs
! No sedatives or tranquillisers
! Limited suture material
! No other facilities.

UNIQUENESS ABOUT PRACTICING
ORTHOPAEDICS IN PRISON
! 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

Doing a blood sugar through
prison bars is easy.

Injections are almost a circus or yoga
for both doctor and patient

NOW JUST IMAGINE REDUCING A DISLOCATED SHOULDER
THROUGH THE PRISON BARS!!  
IT IS INDEED UNFORTUNATE THAT I SIMPLY COULD NOT HAVE
TAKEN ANY PICTURES!! 
However, my experiences, led to the
discovery of a new method of reduction
of shoulders; a simple easy method

INTERESTING PROBLEMS
The torn
ear

Shoulder dislocations
! Total 89
! Anterior 83
! Posterior 6
! Associated with
fractures 9
Patients

The Prakash method of reducing
shoulder dislocations
There is no role of traction in shoulder dislocations
because shoulder dislocations are pure rotation,
lateral translation injuries.
Needs no assistant.
Needs no anaesthesia or even analgesia.
Gives consistent, reproducible results; wherever
tried.
Works in dislocations as old as three months.
Simple effective method.

The patient sits on a chair, with scapula fixed.
The shoulder is externally rotated.
Held in external rotation for two full minutes

Keeping the shoulder in maximum external
rotation for two full minutes, to relax the muscles is
the key to the success of this procedure.
The patient is reassured by engaging him in
conversation.

Adduction followed by internal
rotation; reduces the joint
smoothly.
There are no clicks or clucks.
The head glides in majestically.
The dramatic smile on the patient’s face
is an indication of success.

PROBLEMS TREATED
! Colle’s and Smiths fractures
! Fracture clavicle
! Fracture shaft of humerus
! Fracture neck of femur
! Intertrochanteric fractures
! Fracture shaft of femur
! Calcaneal fractures
! Metacarpals and Meta tarsals

Fractures of humeral shaft
! In the past I operated on all shaft
humerus fractures by AO methods.
! Surgery is not undertaken on prisoners
unless it is a life threatening condition.
! So the burden of conservatively
treating humeral fractures fell on me.
! At that time I was making drawings
for my Anatomy Atlas.

I made some unusual
observations about Humerus
fractures, treated conservatively.
1, Fractures treated with elbow in flexion
always malunited unless undisplaced, and on
occasions went into non union due to plaster
distraction.
2, Those treated with elbow in extension in
full supination, for a short while in long arm
casts, always invariably united soon.

! At that time I was making drawings for my
Anatomy Atlas.
! I had a large pool of a thousand volunteers for
examination and study

Biceps and triceps during flexion and
extension

Displacement in flexion, stability in extension
Disruptive versus protective muscles

56 cases treated in 13 years, all followed up to
three years or longer.
All fractures united, 30 with a little shortening.
Elbow movements full at six months in every case.
Full return to function within an average of two
and a half months.
Average time of clinical union was nine weeks.
Only one complication of acute radial nerve
entrapment and post fracture wrist drop recovered
fully in six months.

Are we over-treating
fractures shaft of humerus?
Conservatively treated humeral shaft
fractures never go into non union if treated
in extension cast.
Full return to function in three months.
Light weight axilla to metacarpal head long
cast in supination and full extension.
Remove cast when patient is pain free; 3 to 4
weeks, and begin elbow movements.
Fracture unites in average eight weeks.

Fractures of the femoral
shaft
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
Closed fractures
Open fractures
Fractures infected after fixation who came to prison subsequently

Typical femoral shaft
fractures seen in prison
! 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

! 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.

! 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

When I was
summoned to see
him, his initial X-Ray
looked something
liked this.

! 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.

I used double olive wires on upper
tibia under local anaesthesia

! 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
pulleys.
! The prison plumber and
electrician helped.
! Traction was provided by three
concrete bricks each about four
kilos.

The Karuppuswamy story
! 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.

! 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

The fourth
month X-ray
was
somewhat
like this

Femoral fractures
! 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 analysed for
publication. It is a real pity that the
circumstances and situations did not
allow me to get or copy the radiographs.

PROBLEMS TREATED
! Low back ache
! Knee arthritis
! Knee injuries
! Frozen shoulders
! Fracture both bones forearm
! Fracture tibia/fibula

THE BACKACHE STUDY
! 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.

Inclusion Criteria 
! Patients with MRI proven single or
more level prolapse with nerve or
root impingement.
! 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

Age distribution
! 20 to 30 16
! 31 to 40 18
! 41 to 50 20
! 51 and above 13
20 to 30 31 to 40 41 to 50 51 & above

Type of treatments 
! Laminectomy/
Discectomy 19
! Epidural injection 14
! Pain killers,
physiotherapy,
exercises 34
Laminectomy/diskectom
Epidural
painkillers, physio

! All operative cases were operated
by orthopaedic or neuro surgeons
outside the prison.

! Six epidural injections were administered
inside the Prison Campus by me, and eight
by other surgeons.
! Conservative group was treated either by me
or have taken no treatment

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.

Final evaluation was done by 
! Visual Rating
Scale
! Visual analogue
scale
! Oswestry
disability index
Visual Rating Scale
Visual analogue scale
Oswestry disability index

Conclusions:
! No difference between Epidural injection and No
treatment

Conclusions:
! Surgery gave the worst results with
permanent complications in 19% of the
patients

Moral of the story:
! Never operate on any prolapsed
disc.
! Even those with neurological
deficit or bladder problems get well
after some time.

Evidentiary value and
scientific validation.
Conservatively treated massive prolapsed discs: a 7-year follow-up
RT Benson1, SP Tavares1, SC Robertson2, R Sharp1, and RW Marshall1
RCS Annals: Volume: 92 Issue: 2, March 2010, pp. 147-153
A massive disc herniation can pursue a favourable clinical
course. The long-term prognosis is very good and even
massive disc herniations can be treated conservatively

Evidentiary value and
scientific validation.
The Cochrane Review of Surgery for Lumbar Disc Prolapse and
Degenerative Lumbar Spondylosis
Gibson, J. N. Alastair MD, FRCS; Grant, Inga C. MSc; Waddell,
Gordon DSc, MD, FRCS
! There is no scientific evidence on the effectiveness of any
form of surgical decompression or fusion for degenerative
lumbar disc prolapse, compared with natural history,
placebo, or conservative management.

Lumbar Disc Herniation: A
Controlled, Prospective Study
with Ten Years of Observation. 
WEBER, HENRIK MD
The controlled trial showed a statistically significant better result in
the surgically treated group at the one-year follow-up
examination. After four years the operated patients still showed
better results, but the difference was no longer statistically
significant. Only minor changes took place during the last six
years of observation.

Results of Surgery Compared With
Conservative Management for Lumbar
Disc Herniations 
Postacchini, Franco MD 
! Conservative management gives satisfactory results in a high proportion
of patients with disc herniation in the course of a few months of treatment
onset.
! Surgical treatment is significantly faster in yielding a satisfactory
resolution of symptoms, but the results of surgery often deteriorate in
the long and very long term because of recurrence of radicular, and
especially low back, pain.
! Microdiscetomy appears to give slightly better results than standard
operation in the first few weeks or months after surgery, but not
successively

The Efficacy of Systematic Active
Conservative Treatment for Patients With
Severe Sciatica A Single-Blind, Randomized,
Clinical, Controlled Trial 
ARTICLE in SPINE 37(7):531-42 · APRIL 2011
Active conservative treatment was
extremely effective for patients who
had symptoms and clinical findings
that would normally qualify them for
surgery.

Principal indications for disc
surgery:
! 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!!

Dr Prakash’s SC index or B/B
Ratio
! 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

INVALUABLE LESSONS LEARNT
! 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

I had a large pool of subjects in a
closed environment, enabling me
to conduct numerous studies.
Amongst other studies, I also performed physical
and anthropometric measurements of over ten
thousand inmates and prison officials.
One of the studies enabled me to understand knee
sizes, and plan the ideal dimensions for a TKR
implant for the Indian population spread and
also device a new operation for medial
compartment arthritis, the PFO or Prakash
Fibular Osteotomy.

But before that
But why Varus scenario in Indian knees?
Are our knees different?
Is there a racial variation in coronal deviation
of the knee joint?

Apparently yes. Apart from my studies I have found two
references. One for adults and one for children.
Varus and valgus deformities in knee osteoarthritis among different ethnic
groups (Indian, Portuguese and Canadians) within an urban Canadian
rheumatology practice
Raman Joshi1, Nimu Ganguli2, Christopher Carvalho3, Faye de Leon4, Janet
Pope5
Significantly more varus deformity was noted in the Indian-born group than
the Canadian-born group (P = 0.002), and more valgus deformity was noted in
the Portuguese-born than Canadian-born group (P = 0.009).
Conclusions: Patient populations differed significantly in terms of varus and
valgus deformities at the knee.

I could locate one study, in children
Normal development of the
knee angle in healthy Indian
children: a clinical study of 215
children
Uttam Chand Saini, Kamal
Bali, Binoti Sheth, Nitesh
Gahlot, andArushi Gahlot

Normal development of the knee angle in healthy
Indian children: a clinical study of 215 children
The overall pattern of development might be slightly
different in Indian children, especially in Indian girls, with
early reversal of physiological varus (<2 years of age) and a
late peak of maximal valgus at the knee (6 years of age).
Varus after 3 years seems atypical for Indian
children. We provide an elaborate set of data for the mean
TFA of different age groups and believe that this data
could be of potential benefit to the physicians while
evaluating lower limb alignment in Indian children aged 2–
15 years.

Knee varus in Indian population
There have been few demographic or
anthropometric studies of the Indian
knees in adult population.
No study has been done on long term
measurements of knee saggital
deviation with an increase in age.

My anthropological study of Indian
knee saggital and coronal positions
Study conducted in prison
Conducted over 12 years
Fourteen thousand Indian
Males were studied

Methods
Instruments used were a Galton
calliper, Long scale, Wall, Pencil
and long sheets of paper.

Methods
Patient stood with back to the
wall.
Second toe faced straight towards
the observer
Line drawn from hip centre to
knee centre was allowed to bisect
the line from centre of ankle to
centre of knee.

Material
All subjects were male
Convict and under-trial prisoners.
Age from 18 to 91
Only 9% complained of any
problems
Except for Sex, they represented the
average Indian population

Results Saggital plane
Total Knees
studied
14,321
Varus
alignment
7642
Valgus
alignment
1387
Neutral
alignment
5292

Varus knees
Total knees
Neutral knees
Valgus knees

Relationship between age and Varus

Correlation between symptoms of medial
compartment OA and knee varus

Progression of varus with age
1640 subjects over 40 years
of age were progressively
followed up for ten years or
longer.
Average rate of progression
of varus was two degrees per
year and increased
exponentially with age.

Varus progresses with age and the progress is
more rapid in obese individuals
While less than 15% of those in twenties had varus
knees, over 60% of those above 70 had varus knees.
Varus progressed most rapidly between the ages of
60 to 80.
Once a knee gets into varus disposition, it continues
to progress till the patient’s death.

Important observation
More than 50% Indian knees had a varus disposition, though
not all varus knees had symptoms of medial compartment
OA.
Severity of symptoms had a direct correlation to the degree
of varus, and after 30 degrees, all knees were symptomatic.
Varus of the knee gradually and progressively increases with
age.

Limitations of the study
No facilities for radiographic co-relation
It was only a clinico-anthropometric study.
Large numbers give the findings credibility
Study will be published soon.

What would you do in this case?
56 year old gyaenacologist
Advised TKR by six
surgeons.
Severe pain on walking, no
rest pain.

PFO, something new
Accidental discovery in 2004
Based on my experiences in prison
An out of the box method which produces remarkable and
startling results both functionally and radiologically.

How??
Prison riots happen infrequently.
Wardens are instructed to hit
rioting prisoners with a Lathi,
Below the knees, to avoid
grievous injuries.
Fracture proximal fibula is an
usual consequence.

Unique aspects of practicing
orthopaedics in the prison
Every single inmate has to come to you if he breaks a bone.
Most orthopaedic problems come to you.
There are absolutely no facilities available.
But for a pure scientist, this is a wonderful opportunity for
study.
And these are my studies that lead to PFO

OA knee is very common in India.
About 6% of above 70yrs old are
considered essential candidates for
TKR, due to the bad state of their
knees.
Its natural that a prison too would have its
share of ideal TKR candidates on
their waiting list.
Unfortunately a convict prisoner seldom gets any surgery except for
life threatening conditions

It is only natural that a few of these
ripe candidates for TKR would indulge
in riots and break their fibula.
Miraculously, in all these patients, the symptoms of OA
disappeared immediately after fractured fibula.
Those waiting for surgery refused a knee replacement as
their symptoms had disappeared!

Fractures below fibular neck cured pain
from severe medial compartment OA
How does it work?
The single versus triple cortex
theory.
Whatever be the theory, it really
works well in most patients.

PFO, Surgical steps
Small 2cm incision, 6 to 8
cm below fibular head.
1.5 cm fibula is excised.
Patient walks and climbs
stairs the same day.
Can be well done as an
outpatient procedure

PFO, observations so far
Effective in all patients, even those with
patellofemoral OA
Patient remains pain free for three years or longer.
My first patient operated in 2004, is still happy and
refuses knee replacement.
A multi-centre trial is being conducted presently
and about 1800 surgeries have been done in the last
one year.

PFO, the first case, nine years follow up

PFO, other references
Zong-You Yang, MD; Wei Chen, MD; Cun-Xiang Li, MD; Juan Wang, MD; De-Cheng Shao, MD; Zhi-Yong hou, MD; Shi-
Jun gao, MD; Fei Wang, MD; Ji-Dong Li, MD; Jian-Dong hao, MD; Bai-Cheng Chen, MD; Ying-Ze Zhang, MD
It is a safe, simple, and effective procedure that is an alternative to total knee
arthroplasty for medial compartment OA of the knee joint. Care must be taken to
avoid potential nerve injuries.
Proximal fibular osteotomy may reduce knee pain significantly in the varus
osteoarthritic knee and improve the radiographic appearance and functional recovery
of the knee joint.

How I tackled the
knee design of an
Indian Knee??
Many questions
had intrigued me
for a long time.
Now was the time
to search for
answers.

Question? 
Are Indian knees Narrower front to back,
than their Caucasian counterparts?

Question? 
Does Squatting since childhood alter
the condylar shape?

Question? 
What is the normal orientation of the femoral condyles
in relation to the femoral head? What is the Varus/
valgus spread in average population?

Question? 
Is there a normal Tibial Varus?

Question? 
Are Indian upper tibias wider from side
to side, but narrower from front to back?

Question? 
 
What is the tilt
of the tibial
articular surface
vis a vis the
ankle joint in the
anterio-posterior
direction?

Question? 
Can anthropometric or Radiological
measurements predict the age of onset of
OA knees?

Question? 
Relation between the severity of OA and the state of
ligaments in and around the knee?

Methodology
employed
! Measurement of actual
bones 640
! Anthropometric
measurements 8400 knees
(4200 patients)
! Radiological measurement
of 1300 Radiographs
! Total knee joints measured
10340
Osteology
Radiography
Clinical

At one stage my bedroom had more
bones than the Anatomy department

Measurements taken
FEMORAL CONDYLE
! Mediolateral dimensions
! Anterioposterior dimension of medial condyle
! Anterioposterior dimension of lateral condyle
! Femoral valgus/varus

Measurements taken
UPPER TIBIA
! Mediolateral dimension
! Medial anterioposterior dimension
! Lateral Anterioposterior dimension
! Tibial varus/valgus

Achieving consistency in radiographic
measurements, and ensuring that they
correspond to actual knee measurements.
Each X-ray was scanned and digitized.
The patients knee girth, mid thigh girth and upper calf girth were
measured.
The AP and Side to side dimensions of the limb were thus calculated.
Using computer software, the X-rays were resized so that the outer
soft tissue shadow measured the exact dimensions of the limb in
each case.
Consistency in measurements was thus ensured.

Dr Prakash’s modified Galton
anthropometric calliper

Conclusions of the above study
LOWER FEMORAL
DIMENSIONS WITH SPREAD
! Mediolateral 64.5 to 91.2
! So Femoral component should be available in 53mm, 56mm
59mm 62mm 64mm 67mm 70mm and 75mm medio-lateral
dimensions.
Mediolateral
Numbers

LOWER FEMORAL DIMENSIONS WITH SPREAD 
Anterioposterior 63.1mm to 86.4mm 
! So Femoral component should be available in 50mm, 53mm,
56mm 58mm 59mm 63mm 66mm and 70mm AP dimensions.
Femur AP
inmm
0
22.5
45
67.5
90
1 51 101151201251
Anterioposterio
Numbers

Conclusions of the above study
UPPER TIBIAL DIMENSIONS WITH SPREAD
! Mediolateral 55.2 to 81.3mm, and thus the tibial trays should
be available in 55mm, 60mm, 63mm, 66mm, 71mm, 75mm
and 81mm
Tibial dimensions
M-Ldimension
0
22.5
45
67.5
90
1 20 39 58 77 96 115134153172191210229248267

UPPER TIBIAL DIMENSIONS WITH SPREAD 
 
Anterioposterior 38.1 to 55.4 
So tibial trays should come in AP dimensions of 38,
40, 43, 45, 47, 51 and 55mm 
 
Anterioposterior
Numbers

These dimensional studies helped
me to design my knee joint

Soon to be launched TKR and THR
prosthesis in the price range of 15,000 to
20,000,

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

Latex rubber pouring, hand casting,
painting

This helped me to make models for this
conference.
The worlds first silicone flexible
workshop models.

Other things besides
orthopaedics
! 106 books, 25 million hand written words.
! Fiction, non fiction, mythological, adventure stories, legal
thrillers, sensuous, and detective novels.

Twenty five million words look
like this

Twenty five million words
look like this as books

I was then bit by the art bug and
started doing water colours

Water colors
! When the selfie bug hit the world, I was in
a small cell without even proper electricity

I progressed in art to acrylic
colours

Dr L.Prakash’s
Hundred sculpture
project
Clay, Plaster of  
Paris, Resins, Acrylic, Marble,
Granite, Epoxy, PMMA, Bronze
Aluminium, Dental cement,
Gypsum.
I experimented with all materials.

My experience in metallurgy helped
me to cast my TKR prototypes.

I also did a lot of Material
research

Invented PRAKLAY, an air drying
polymer clay with numerous
applications

Latex and silicone masks and cinema
special effects

My experiments in non
surgical reversal of heart
disease and diabetes
Knowledge under duress

And then at last I won!! 
! I was acquitted in all cases that were foisted on me

When I reached home I was really surprised 
Five patients were waiting for me!!

Patients were awaiting my return
! 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

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

The surgery went off
brilliantly
! 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

My Colleagues
! I also received a
wholehearted
welcome from my
orthopaedic
colleagues and the
Indian Orthopaedic
Association

In The last nine months
! I began my practice again and now specialise in complex and
referral cases only. Presently I do revision joints and Ilizarov
surgeries.

Since then, I have designed
Ultralite Rings

Designed a Total knee for
Indian patient

Wrote five books and more are
coming

Got an ISO 9001-2008 for my
clinic

Began an ambitious painting project: 
 
PRAKASH’S ATLAS OF ORTHOPAEDIC EXPOSURES
the test marketing of which has just begun

This is a simplified surgical exposures
text book.

Future plans
Orthopaedic teaching and education
Workshops and conferences.
Design and development of instruments to make your life easy.
World Class made in India knees for below 20,0000 Rs
Museum of orthopaedic implants
IOA orthopaedic history museum
Streamlining orthopaedic teaching and fellowships
Sculpting the future of IOA

Orthopaedic teaching and education

Surgical DVDs, and technique
videos

Workshops and conferences.
Delhi - November
2016 - Ilizarov
Workshop
Chennai -
December 2016 -
Ilizarov Workshop
Chennai - Feb 2017
- TKR Workshop
I am planning to organise 4 to 5
workshops, nationally and internationally
every year for the next five years.

Design and development of
instruments to make your life easy.

Developments in pipeline
! Ultralite rings
! Polyaxial telescope
hinges
! Prakash Cement
Removal set
! Generic TKR
implant
! Prakash Knee
instruments
! Prakash Gap
balancer

Developments in pipeline
! 3 D printed implants
and jigs
! Silicone limb models
! Special chisels
! Silicone die for
PMMA spacer
! Low cost bone
cement
! Bangle fixator

World Class made in India knees for below
20,0000 Rs

Museum of orthopaedic implants
A travelling museum to be donated to IOA

IOA orthopaedic history museum

Streamlining orthopaedic teaching and
fellowships, in India

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

Conclusions
! They can take away
your liberty, only you
can take away your
freedom.
! They can imprison
your body, only you
can imprison your
mind

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

Conclusions
! Keep meticulous records, you don’t know
when they will be useful

Conclusions
! Keep smiling, for no trouble lasts for
ever. The rainbow is out there.

Orthopaedics usual and unusual

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