Iranian Journal of Orthopedic Surgery

Abstract Introduction: Fingertip injuries are among the most common hand traumas, and the choice of reconstructive technique may influence pain, function, and digital appearance. This study aimed to evaluate the outcome of palmar flap reconstruction for fingertip amputation and assess factors associated with postoperative outcome.
Materials & Methods: Medical records of patients who underwent palmar flap reconstruction from a hospital between 2016 and 2024 were reviewed in a retrospective cross-sectional observational study. Patient-reported outcomes including function, pain, and appearance were measured using a 10-point numeric rating scale. Statistical analysis was performed using the independent t-test, one-way analysis of variance (ANOVA), and Spearman rank correlation.
Results & Discussion: 50 patients with the mean age of 30.14 years with a standard deviation (SD) of 5.58, and 88% being male were studied. All injuries were industrial. The mean scores for appearance, pain, and function were 7.72, 7.72, and 8.26, respectively. No significant differences in outcomes were observed by sex or injured side. Pain scores were higher among patients with three injured fingers (p=0.031). Functional scores were significantly lower in injuries involving the fifth finger (p=0.007). Surgery performed more than 24 hours after injury was associated with higher pain scores (p=0.017), and a borderline trend toward poorer function with increasing surgical delay was observed (p=0.094).
Conclusion: In palmar flap reconstruction for fingertip amputation, the number of injured fingers, involvement of the fifth finger, and surgical delay are key factors associated with lower postoperative outcomes.

Abstract Introduction: Carpal tunnel syndrome (CTS) is a common compressive neuropathy of the upper limb. Given the variable performance of conventional diagnostic approaches, quantitative magnetic resonance imaging may assist clinical decision-making. This study evaluated the diagnostic value of quantitative magnetic resonance imaging metrics.
Materials & Methods: In a cross-sectional diagnostic study of 30 patients at a university center, clinical severity of CTS was assessed using the validated Persian Boston Carpal Tunnel Questionnaire, and electrodiagnostic testing and classified-involvement as mild, moderate, or severe. Wrist magnetic resonance imaging with routine sequences was performed with observer blinding to clinical and electrodiagnostic data. The median nerve cross-sectional area at the distal tunnel outlet, intraneural signal intensity, and the signal intensity ratio of nerve to hypothenar muscle were measured and compared with normal subjects. Analyses used appropriate tests with a significance threshold of p<0.05.
Results & Discussion: The median nerve cross-sectional area was larger in patients than in normal (11.36±1.89 vs 9.70±1.63 mm²; p<0.05). Intraneural signal intensity was higher in patients (597.13±52.95 vs 501.67±40.50; p<0.05). The nerve-to-hypothenar signal intensity ratio was also increased (1.31±0.26 vs 0.80±0.13; p<0.01).
Conclusion: Quantitative magnetic resonance imaging metrics demonstrate significant discriminatory power between patients and normal and may serve as adjuncts in the diagnostic pathway. This pattern accords with the pathobiology of compression (edema and structural change) and supports the utility of quantitative magnetic resonance imaging as a complement to clinical examination and electrodiagnostic testing. Standardization of measurement sites and thresholds, and multicenter prospective studies, are required to translate these findings reliably to practice.