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This book focuses on improving orthopaedic surgery in low and middle-income countries (LMIC). Over the last 35 years, orthopaedic surgeons have made multiple innovations locally in Pakistan that have never come to the surface. Many surgeons in our world work in a resource-constrained setting and have to use frugal innovations to work their way out. These are the ground realities of working in a LMIC, which will be shared globally through this book.Starting from seeing patients in the clinic and to the operating room, very high standards have been set in Pakistan for others to follow and replicate within their own resources. This book will be a narrative of how these innovations were achieved and the way forward considering the resource constraints that are present in low-middle-income countries compared to Western countries.