A prospective study of total hip arthroplasty for failed proximal femur fracture fixation

Background: Proximal femur fractures have been widely studied and there are several well-accepted management modalities for the same such as PFN A2, IMIL nails, and DHS. Despite several management options we do encounter significant failure rates which could be due to several factors such as post-operative time rehabilitate patients related comorbidity and differences in surgical techniques. Aim of the study was to assess the outcomes of total hip arthroplasty (THA) after failed surgical management in proximal femur fractures Methods: The 50 patients who underwent surgical management for proximal femur fractures at any given point in time and presented with non-union or malunion and inability to bear weight affecting their activities of daily living assessed with Harris hip score were enrolled in a prospective cohort study during 2015 and 2022 after obtaining IRB approval. All these patients underwent surgical management for proximal femur fractures within 3 weeks of sustaining a fracture. Results: A strong statistically significant difference is seen with pain, functional gait, functional activity, range of movement and total score in post-operative group of patients in comparison to patients of pre-operative group. THA had excellent outcomes in 42 patients (85.71%) of the study group. About 6 (14.29%) patients of the study group had good outcome. 2 patients that lost to follow up were removed from the study. Conclusions: THA is an effective procedure for failed proximal femur fracture fixation patients despite the challenges such as distorted anatomy of femoral head, poor bone quality, longer operative times, larger amounts of blood loss, high rates of intra-operativities and post operative complications

A clinical study to compare the efficacy and safety of pregabalin sustained release formulation with pregabalin immediate release formulation in patients of diabetic peripheral neuropathic pain

Objective: To compare the efficacy and safety of sustained release (SR) formulation of pregabalin with immediate release (IR) formulation in patient with diabetic peripheral neuropathic pain. Materials and Methods: In this open label, randomized, comparative, multicentric study, the primary efficacy measure was reduction in visual analogue scale (VAS) of short form McGill pain questionnaire (SF-MPQ) score from baseline to last visit. The secondary evaluation measures included reduction in SF-MPQ descriptive score and present pain intensity score and change in clinical global impression - improvement of illness (CGI-I) and clinical global impression - severity of illness (CGI-S) from baseline to last visit. Total duration of the study was 12 weeks. Safety evaluation was done by recording treatment emergent adverse events and laboratory investigations at baseline and end of treatment. Results: Of 265 randomized patients, 133 received pregabalin SR tablets and 132 pregabalin IR. Patients randomized to both treatments responded to respective treatments. The least square means of VAS score in both the groups were reduced significantly (P <0.01). Reduction in both groups was similar (P = ns). At the end of the trial in both the groups, there was a significant reduction in the SF-MPQ descriptive score (P <0.01), severity of illness as well as clinically significant improvement in the symptoms. Difference between the groups for CGI-I (P = 0.37) and CGI-S (P = 0.41) score was not statistically significant. Treatment in both the groups was found safe and well tolerated. Conclusion: The study shows that the pregabalin SR is safe and effective in patients of diabetic peripheral neuropathic pain. The results of the study demonstrated that pregabalin SR has comparable efficacy and safety as pregabalin IR