Orthopaedics Beyond

Books
Unusual, unpublished secrets of Orthopaedics

Dr L.Prakash
Dr Arvind Diwaker Jain
Dr Aroop Mukharjee
Dr N. K. Magu
Dr Kir Pat
Dr Satishchandra Gore
Dr Mohammad Younus
Dr Himanshu Kumar
Dr Amjed Hammodi

Indian Academy of Orthopaedic Surgeons (c) 2019

Orthopaedic Surgery, like other medical specialities is a rapidly evolving
subject, with unusual and wonderful strides and progress over the decades.
Before new ideas are published, they undergo a thorough test to ensure that
the new method described, stands to scrutiny, really works, and the results are
reproducible in all hands among a wide spectrum of patients the world over.

In the past this was a long drawn process, with ideas taking years or decades to
make it to text books and then become accepted. Social media has however
changed tings dramatically, and these days new ideas are discussed over these
platforms where they disseminate rapidly. Soon feedback and experiences of
other surgeons gathers, and it does not take too long for the snowball to
become substantial and assume the form of weighty evidence.

This is a one of its kind book in orthopaedics, which teaches you over a dozen
unique and unusual secrets and methods, and rekindles some forgotten arts
and neglected methods. Focussing more towards biology and nature, these
methods will form an invaluable arsenal in the armamentarium of a practicing
orthopaedic surgeon.

Amongst other things this book will teach you methods of non surgical reversal
of Avascular Necrosis of Hip Joint, tricks of hip preservation, a special method
for reducing supracondylar fracture, a new method for reduction of a
dislocated shoulder, secrets of Proximal Fibular Osteotomy for medial OA of
the knee, distal blocks for sciatica, secrets of terminal regional anaesthesia, and
the revolutionary Kir Pat STAC frame for fracture calcaneum. You can start
using these secrets the instant you read and understand the methods, and your
patients will begin to be benefited from the next day.

ISBN No. 978-81937797-6-7

Printed and published by
Indian Academy of Orthopaedic Surgeons
29, Karuneegar Street,
Nerkundram, Chennai – 600 107 India
Mobile: +91-8144311311 / 9840182450
Email: drlprakash@gmail.com
Website: www.iaos.org.in
Orthopaedics Beyond Books
Unusual, unpublished secrets of Orthopaedics

Dr L.Prakash
Dr Arvind Diwaker Jain
Dr Aroop Mukharjee
Dr Kir Pat
Dr Satishchandra Gore
Dr Mohammad Younus
Dr Himanshu Kumar
Dr Amjed Hammodi

Indian Academy of Orthopaedic Surgeons (c) 2019

iii
Copyright © 2019 by Dr L. Prakash, Other Authors, Indian Academy of Orthopaedic

Surgeons
The contributors have asserted their right under the Copyright Designs and Patents Act 1988 to be
identified as the authors of this work.
All Rights Reserved. No part of this publication may be reproduced, stored in a retrieval system, or
transmitted in any form or by any means without the prior permission of the publisher.
A CIP catalogue for this title is available from the British Library

ISBN No. 978-81937797-6-7

Printed and published by

Indian Academy of Orthopaedic Surgeons

29, Karuneegar Street,
Nerkundram, Chennai – 600 107 India
Mobile: +91-8144311311 / 9840182450
Email: drlprakash@gmail.com
Website: www.iaos.org.in

Disclaimer: Science and technology are constantly changing fields.

New research and experience broaden the scope of information and
knowledge. The authors have tried their best in giving information
available to them while preparing the material for this book.
Although all efforts have been made to ensure optimum accuracy of
the material, yet it is quite possible some errors might have been left
uncorrected. The publisher, the printer and the author, will not be
held responsible for any inadvertent errors, omissions or
inaccuracies.

ISBN Number 978-81937797-6-7

iv
 Acknowledgements

My father Mr. T. S. Lakshmanan and late mother Radha Lakshmanan, my

friends, philosophers, guides, and gods.
My beloved sister Dr. Pramila Ramaswamy, and her husband Dr T. S.
Ramaswamy, to whom I owe everything in my life.
Mr. T. G. Seshadri, Mr Mano, Mr S. Partibhan, and Miss Puliarasi, who helped
me to stretch my day well beyond 24 hours. My personal assistants
Geetanjali and Ishwarya, for their hard work in assisting me.
Miss Madhumitha and Mr. M. Babu, who worked hard on the layout and
formatting.
Mr. Ashok L. Rajani, my editor, whose “minor corrections” have made the
narration brisker and crisper.
To the contributing authors who have so generously shared their tied and
tested methods and secrets.
8000 Orthopaedic colleagues connected with me on social media and sites,
who have shared their collective experiences, and contributed clinical
pictures and X-rays, enriching my orthopaedic knowledge making this
book possible.
All my patients who trust me with their life and limbs.

Dr L. Prakash
M.S. (Orth), M.Ch. (Orth) (Liverpool)
26th January 2019

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ISBN: 978-81937797-6-7

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 Contents

1, Fractures in children rarely need surgery. Dr L.Prakash,

Dr Arvind Dewaker Jain. 1
2, Paediatric fractures: A manga comic. Dr L.Prakash, Dr
Arvind Dewaker Jain. 4
3, Avoid Total hip Replacements in Avascular Necrosis of
the hip joint; The Mukharjee Regimen. Dr Aroop Mukharjee 14
4, Avoid nails and plates; Extension casting for fractures
shaft of humerus. Dr L.Prakash 25
5, Logic behind extension casting for fractures shaft of
humerus. Dr L.Prakash 35
6, STAC frame of calcaneal fractures. Dr Kir Pat and Dr
Himanshu 49
7, Reversal in Ankylosing Spondylosis. Dr Arvind Diwaker
Jain 70
8, Three and four wire magic for distal Radial fractures. Dr
L.Prakash and Dr Mohammad Younus 84
9, Terminal Regional anaesthesia and haematoma blocks.
Dr L.Prakash 148
10, Gore test, scientific background. Dr Satish Chandra
Gore 156
11, Avoid Surgery on back aches; Distal blocks for
managing acute sciatica non operatively. Dr Amjed
Hammkodi, Dr Arvind Diwaker Jain, Dr L.Prakash, Dr Satish
Chandra Gore 172
12, Avoid anaesthesia in dislocated shoulder; Prakash
Method of Reduction of shoulder joint Dr L.Prakash 185

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13, Gravity conquers all; Diwaker Gravity method for
reduction of supracondylar fractures of humerus. Dr
Arvind Diwaker Jain 200
14, PFO; Proximal Fibular Osteotomy for medial
compartment arthritis of knee joint. Dr L.Prakash 231
15, PFO updates. Dr L.Prakash 270
16, How to post proper X-rays on social media. Dr
L.Prakash 297
17, How to reverse heart disease and diabetes by life
style modifications alone. Dr L.Prakash 311

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Orthopaedics Beyond Books

17
Reversal of Essential lifestyle modifications
for all of us

Diabetes, Heart
disease and
coronary artery
blocks

Non Surgical Reversal of Coronary blocks,
Heart disease, Diabetes, and Obesity
This last chapter is rather different as it is not
just orthopaedics, but our life itself. I am
certain that what I have undergone, is not
something unusual, but something that is a
regular event with all of us! This is about how I
saved my life!
Until the age of 30, I was slim, weighed 75 kg,
active and healthy. I was a smoker, often heavy,
a moderate drinker, and a “no exercise except
surgery” kind of a person! It was then that I

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began my own orthopaedic hospital and things
became hectic. It was a small 30 bedded
arthroplasty and Ilizarov unit, and I operated
some 100 cases a month! My lifestyle remained
unchanged, my diet became lesser and rather
more erratic, alcohol consumption increased,
smoking also was more, but surprisingly my
weight began increasing. It soon crossed 80 kg,
and by 2001, when I was touching 45, became
a steady 90 kilos. I began panting when I
climbed stairs, but otherwise felt fine!
I got myself medically examined when I was
44, and my parameters were as below:
1, Random blood sugar: 170
2, HbA1C 7.1
3, No other abnormality in the tests!
Exactly in my 45th year, a major upheaval
happened in my life, when I was arrested and
sent to prison. At the time of my arrest, little
did I know that I was a part of a major
conspiracy, whereby it was planned that I spend
the next decade and a half (almost) in the
dreaded Chennai Prison! From a successful
orthopaedic surgeon, and an affluent
flamboyant socialite to a convict prisoner in an
overcrowded prison was a long haul indeed,
and my experiences deserve a movie, if not a
20 part serial, but that story is for another place,
and another time! This chapter is about
something entirely different!
In the prison, my life dramatically changed
from an active one to a sedentary one. I, who
would not stay at one place at a time, and was
always rushing around or struggling in the
operation theatre, suddenly found myself inside
a small locked dingy cell with no physical
activity.
I changed from a surgeon to a thinker and
writer, and spent most of my time in the chair
or bed, reading, writing or sleeping. Fast
forward eight years and this story starts when I
was 51 years old!
Fates had conspired with me so badly, and my
enemies had planned so well that for eight
years after my arrest, I never saw the outside
world. I was closeted in the prison, and shunted
between the various courts, until 2008, when
the first conviction in a narcotics case was
handed over to me. It is besides the point that I
have never even seen a narcotic substance,
leave alone use it! It is a matter of record that
the high court acquitted me of this narcotics
case a few years later and censured the officers
for filing a false case.
I am a fastidious person as far as record
keeping is concerned, and here is my diary
entry about my health in 2008.
Dr. L. Prakash 2008 Age-51, Weight 91 kg.
Asymptomatic, but Smoked 20 cigarettes per
day.
Daily food intake in prison
1.1 litre of Coffee with milk and sugar
2. 6 Chapatis
3. Subzi and dhall
4. 2 cups of Yoghurt
It was in 2009 that I got my first parole, I was
52 years old, considered myself healthy, and
saw my sister and parents after a long time. My
brother in law, a famous physician, insisted that
I get my routine blood tests, and then came the
first shock!
Here is what I wrote in my diary, which I copy
here:
Dr. L.Prakash in 2009, Age-52,Weight- 91 kgs.
HbA1C -13.2
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Random Blood Sugar-316 I read, studied, and evolved a system. I

followed it, and struggled hard to do that. But
Screwed up Lipid profile
fear of death had scared me no end, and I was
ECG showed Inferior wall ischaemia, and determined to live. I am now copying my diary
Treadmill could not be completed beyond the entries for the next three years or even later!
second stage! Later I will explain how I worked this magic,
My brother in law, the physician was shocked! and how I reversed heart disease and diabetes!
He was worried that I might get a heart attack Dr L.Prakash in 2009 , 3 months later
soon. He insisted that I cut short my Kerala
Age-52, Weight- 81 kgs
visit, rush back to Chennai, and consult a
cardiologist, and get an angiogram done. I was HbA1C-9.2
equally worried, and agreed. The results from
Pulse- 106
my diary notation are below:
No panting while brisk walking
Dr.L.Prakash in 2009, Age-52, Weight-91 kgs
BP-140/90
HbA1C-13.2
Pulse- 126
Dr L.Prakash in 2010, 6 months later
Painting while brisk walking
Age-53, Weight- 68 kgs
BP-170/100
HbA1C-4.1
Angiogram- Triple vessel Coronary block.
Advised urgent angioplasty by cardiologist and Random sugar-72
cardiothoracic surgeon. Pulse- 68
Now was the major dilemma! I simply could BP-110/70
not get operated, as I had to return to the prison
the next day! Paroles are simply not extended! Able to run up 6 flights or stairs without
No matter what! Else every prisoner out on panting
parole would get admitted in a hospital and
refuse to go back! I fixed up a date for surgery
in six months when I would be eligible for the Dr L.Prakash in 2010
next parole, and went back to prison, a shocked 6 months later
and devastated person. I had so much to do, and
life was ending so fast! It was indeed shocking! Age-53, Weight- 68 kgs

However, as I simply cant sit idle, I began Treadmill 9 stages no ECG changes
reading. In prison, I was allowed to read as Repeat Angio- No blockage and full perfusion
many medical books as I desired, and so began
Able to run for 5 kms
my quest and journey. Was there any way to
cure myself without the knife? Or could I at
least survive until I could get the benefit of the Dr L.Prakash in 2019
knife!

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Age-62, Weight- 71 kgs
Random sugar- 79
Able to run up stairs without painting
HbA1C-4.6
Pulse- 68
BP-110/70
How was all this possible?
The first clue I got was from the wonderful
book by Dean Ornish. “Reversing Heart
Disease” published in 1990, and an
international bestseller.
Other clues I got from books on anthropology
and zoology. It took me two months to
understand the philosophy and begin following
it regularly.
The philosophy of diet and lifestyle:
Human beings are the top most animals on the
evolutionary chain, and are at the apex of the
food pyramid, scrounging on 70% of the worlds
resources. Man’s lifestyle has changed
dramatically to the worse in the last 50,000
years, and most of the diseases which we suffer
from is due to our own making.
Man was not born to eat rice, wheat, milk, dairy
products, salt or sugar! Man is an omnivore,
whose essential staple diet was raw or rotting
food. Fifty thousand years ago, man ate fruits,
vegetables and nuts raw. He hunted fowl and
animal, which he skinned, and are after roasting
in fire. He caught fish and water animals which
he either ate raw of grilled. And he lived to a
100 years, with minimal issues. Fossils of
prehistoric men show complete set of natural
teeth, broken bones set with some
imperfections, and anthropological and dating
evidence pointing to their long age!
Wheat as wild grass was just 1% of the flora
population on earth, and rice a slush grass was
.7%. Today between rice and wheat, they
occupy 60% of the land area, and have been
responsible for exterminating thousands of
useful plant species.
Chicken as a bird was less than 2% of all fowl
population fifty thousand years ago. Today
chicken constitute for 60% of the bird
population, while thousands of bird species
have vanished. Man has modified the
environment around him to suit his
conveniences. To avoid the troubles and perils
of hunting and gathering, he has invented
shortcuts, and these have proved undoings for
his survival and longevity!
Neither rice nor wheat are meant to be eaten by
humans. We can not chew the grains, eat them
and expect them to be digested with the chaff
and husk. We ned to de husk, grind, boil, par
boil, bake, roast or otherwise cook these, to
make them semi digested enough to allow them
to be made edible. In contrast a tomato or apple
can be eaten straight off the plant and digested
brilliantly.
Carbohydrates, proteins and fats are the triad of
foods that a man survives on. However cooked
foods alter the proportions so much that it
damages our metabolism! Complex
carbohydrates and fructose coming from fruits
and vegetables, are replaced by simple ones,
which just get converted to fat, add to the body
weight, and bring a horde of diseases. Add fat
to this diet in the form of dairy products, oils
and butter, and the way to the grave via the
stomach begins, reducing the longevity
dramatically!
Human body use3s up carbohydrates fro
energy, and daily activity. A human being’s
BMR or basal metabolic rate is between 1800
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to 3600 KCL over a 24 hour period. This is the
energy required for running the body and all
systems at rest. Activities need additional
energy! Thus people with high BMR can afford
to eat generously and still not become obese or
overweight. However for those with low BMR,
any additional carbohydrates, are converted to
fat and stored.
Carbohydrates are like a current account in a
bank, and body uses it up easily. However fat is
like a term deposit or fixed deposit, which our
body is unwilling to metabolise, because of
greater cellular requirements. Instead if the
available stocks of carbohydrates are depleted
or exhausted, the body does not begin to use up
the available fat. It begins using up protein for
energy. Only when available protein is
exhausted, does it begin burning fat.
Excess of fat automatically increases useless
body weight, clogs up your blood vessels,
produces insulin resistance, increases blood
pressure and adds up to the plethora of
problems associated with obesity including a
dramatic increase on the load over heart even
for simple activities like stair climbing!
Then of course start the plaques, small clots,
and vessel blocks, and these occurring in
coronary vessels begin blocking blood supply
to heart causing angina, and myocardial
infarcts. Diabetes, hypertension, obesity, and
lifestyle changes, have increased the rate of
heart issues manifold and the incidence of this
is rising with passage of time! These days even
young men of 35 are known to die of heart
attack!
I decided to modify my diet to include only
uncooked fruits and vegetables. In addition for
protein, I decided to have 150 grams of boiled
or grilled protein every day. occasionally nuts
would be substituted for chicken, mutton, fish
or eggs! I decided to stop milk, dairy products,
sugar, salt, grains, pulses, and all from of
cooked food except grilled or boiled animal
protein. Those were the times I was reading the
vedas and Puranas in original Sanskrit, and I
found three types of diet mentioned there:
1. Tamsik food
2. Rajsik food
3. Satvik food
Satvik food is uncooked raw fruits and
uncooked raw vegetables with a small amount
of raw nuts, almonds, dates etc. Rishis were
allowed to eat meat or fish so long as it was
grilled.
Rajsik food was grains, cooked and flavoured
vegetables and meat, salt, sugar, dairy products
and spices.
Tamsik food was rotting food or that cooked 8
hours before eating, including ferments.
The scriptures gave a life expectancy of 100, 75
and 50 years for the three types of diets!
The diet was not as difficult as it sounds and
soon the results were with me! I managed to
reverse my diabetes, heart disease,
hypertension, metabolic disorders, BHP, and
even grey hair. Ten years down the line, I am a
62 year old surgeon with high energy levels and
who is operating very regularly.
Bellow is my diet and lifestyle schedule that
brought about this dramatic change in my life:
Not allowed
4. Sugar
5. Rice, wheat, grain, or pulses
6. Cooked food except grills
7. Milk and dairy products
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8. Food cooked more than three hours

before eating
9. Ready made juices or drinks
What I ate and what is allowed:
• Salads of all varieties
• Raw vegetables, any quantity
• All types of fruits. All seasonal
fruits. Though sweet, fruits have fructose and
are not bad for diabetes
The diet thus provides complex carbohydrates
and excellent roughage
1. For protein I added the following:
2. Grilled oil free chicken pieces about
150 grams per day
3. Else six boiled egg whites per day
4. Else 200 grams of streamed fish per
day
5. Add 15 grams of any fat for grill or a
marination mix or as mayonnaise
6. In the initial stage I stopped all fats,
lost my subcutaneous fat and could not tolerate
the AC. So 15 grams of fat per day was added.
The pictures from my presentation on this
subject are self-explanatory. Eleven years after
starting this diet and lifestyle, I am disease free,
take no medications and my parameters remain
essentially normal with a HbA1C of 4, BP of
110/78, and Fasting sugar of 76. Try this and I
assure you that your life will be healthier and
happier!

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