Steel and Grace: The Women Who Shaped Indian Orthopedic Surgery.

Background: Orthopedic surgery remains one of the least diverse medical specialties, historically framed as physically demanding and exclusionary. In India, despite near-parity in medical school enrolments, representation in orthopedics is disproportionately low compared to global averages. Structural barriers-including stereotypes, inequitable training pathways, and limited mentorship-have influenced workforce composition. However, evolving definitions of surgical competence, advances in technology, and advocacy initiatives have begun reshaping the specialty.

Methods: A narrative review was conducted using PubMed, Scopus, and Google Scholar, supplemented by official resources (IOA, IODA), institutional archives, and Royal College records. Eligible material included workforce audits, descriptive studies, and official reports. Purposeful sampling identified key pioneers and leaders in Indian orthopedics, with contributions verified through publications, biographies, and archival sources.

Results: Historical barriers limited entry and progression within orthopedics, reinforcing perceptions of physicality over precision. Notable pioneers established new benchmarks in pediatric orthopedics, hand surgery, scoliosis care, limb reconstruction, and arthroplasty. The establishment of WOICE in 2016 provided a platform for mentorship, advocacy, and leadership development. Despite progress, underrepresentation persists in subspecialties such as spine and arthroplasty, alongside systemic challenges including limited institutional support and inconsistent mentorship.

Conclusion: The evolution of orthopedics in India highlights gradual but meaningful change. Continued progress requires structural reforms in training, equitable leadership opportunities, and inclusive professional policies. Advancing diversity is not only a matter of equity but also central to clinical excellence and improved patient outcomes.