13 years in prison, orthopaedics and a little more by dr l.prakash m.s. orth m.ch, orth
TRANSCRIPT
Dr L.Prakash M.S. orth M.Ch, orth
13 YEARS IN PRISON ORTHOPAEDICS AND A LITTLE MORE
13 YEARS IN PRISON
DESPITE BEING TOTALLY INNOCENT
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.
Life convict in Central prison Chennai
Life convict in Central prison Chennai
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.
You are not allowed to carry X-Rays out of the prison, and so no pictures of
fractures, but I maintained meticulous records, on which this paper 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
Patients0
500
1000
1500
2000
2500
3000
2171
702 648
3
2670
1121
87
Treatments
Conservative treatment including skeletal tractionManipulations with or without seda-tionSuturing and minor surgeryImplant removal under local anes-thesiaIntra-articular injectionsLocal steroid injectionReferral to other centers
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
Suturing
Abscess drainage
Removal of thorns and foreign bodies
Skeletal traction
Implant removal
Surgeries inside the prison:
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.
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
UNIQUENESS ABOUT PRACTICING ORTHOPAEDICS IN PRISON
Doing a blood sugar through prison bars is easy.
Taking BP a little tricky.
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!!
The torn ear
INTERESTING PROBLEMS
Using thin nylon sutures, he was operated under local anesthesia on the jailor’s office table
Total 89 Anterior 83 Posterior 6 Associated with fractures
9
Shoulder dislocations
Anter
ior dis
locati
ons
Poster
ior dis
locati
ons
Associ
ated w
ith fra
ctures
83
6 9
PatientsPatients
This my modified Kocher’s method. No huffing and puffing. Only precise application of biomechanics.
Patient needs to be relaxed with or without tranquilizers.
External rotation, slow and sustained to the maximum extent.
Wait for three minutes by the clock (this is the most important step)
Adduction slowly and gently.
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.
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
Fractures of the femoral shaft
77%
16% 7%
Closed fractures
Open fractures
Fractures infected after fixation who came to prison subsequently
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
And then 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 anesthesia
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.
Fisk Traction
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.
The Karuppuswamy story
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
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.
Femoral fractures
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.
Dislocated hips
Low back ache Knee arthritis Knee injuries Frozen shoulders Fracture both bones
forearm Fracture tibia/fibula
PROBLEMS TREATED
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
PROBLEMS TREATED
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.
THE BACKACHE STUDY
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
Inclusion Criteria
20 to 30 16 31 to 40 18 41 to 50 20 51 and above 13
Age distribution
No Of Patients02468
101214161820
1618
20
13
20 to 30 31 to 40 41 to 50 51 & above
Laminectomy/ Discectomy 19
Epidural injection 14
Pain killers, physio, excersices 34
Type of treatments
28%
21%51%
Patients
Laminectomy/diskectomy
Epidural
painkillers, physio
All operative cases were operated by orthopods or neuro surgeons outside the prison.
All epidural injections were administered inside the Prison Campus by me
Conservative group 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.
Visual Rating Scale
Visual analogue scale
Oswestry disability index
Final evaluation was done by
No Treatment Injection Operation0
5
10
15
20
25
30
35
40
1 1.33.8
1.4 2.14.6
11
18
40
Visual Rating Scale Visual analogue scaleOswestry disability index
No difference between Epidural injection and
No treatment
Conclusions:
Surgery gave the worst results with permanent complications in 19% of the patients
Conclusions:
Never operate on any prolapsed disc.
Even those with neurological deficit or
bladder problems get well after some time.
Moral of the story:
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!!
Principal indications for disc surgery:
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
Dr Prakash’s SC index or B/B Ratio
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
INVALUABLE LESSONS LEARNT
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
Artificial hand, and foot prosthesis
The steps: Plaster mould
Latex rubber pouring, hand casting, painting
106 books, 25 million hand written words. Fiction, non fiction, mythological, adventure
stories, legal thrillers, sensuous, and detective novels.
Other things besides orthopaedics
Twenty five million words look like this
Twenty five million words look like this as books
Twenty five million words look like this as books
I was then bit by the art bug and started doing water colours
More water colors
When the selfie bug hit the world, I was in a small cell without even proper electricity
Water colors
And so I drew my own selfies
Water color selfies
Water color selfies
I progressed in art to acrylic colors
Acrylic paintings
Charcol Skeches
Caricatures
Dr L.Prakash’s Hundred sculpture project
Bronze sculpture work
My experience in metallurgy helped me to cast my TKR prototypes.
I also did a lot of Material research
Masking fluid
Invented PRAKLAY, an air drying polymer clay with numerous applications
Praklay creations
Creations with Praklay
Latex moulding compound
Latex and silicone masks and cinema special efects
I was acquitted in all cases that were foisted on me
And then at last I won!!
When I reached home I was really surprisedFive patients were waiting for me!!
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
Patients were awaiting my return
Nature was kind on me, my experiences in art and sculpting had probably made my fingers more accurate
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
The surgery went off brilliantly
I also received a wholehearted welcome from my orthopaedic colleagues and the Indian Orthopaedic Association
My Colleagues
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
Keep smiling, for no trouble lasts for ever. The rainbow is out there.
Conclusions
Thank You