Iranian Journal of Orthopedic Surgery

Abstract Introduction: Carpal tunnel syndrome (CTS) represents the most prevalent form of compressive neuropathy. Although electrodiagnostic assessments (EMG–NCV) are routinely used for diagnosis and demonstrate good accuracy, they are invasive procedures and can sometimes produce false‑negative outcomes. In recent years, high‑resolution ultrasonography has gained attention as a noninvasive, widely available, and cost‑efficient diagnostic option. The purpose of this study was to investigate the usefulness of sonographic evaluation in diagnosing CTS and to examine how its findings relate to clinical symptoms and electrophysiological results.
Materials & Methods: In this cross‑sectional diagnostic study, individuals with a clinical suspicion of carpal tunnel syndrome were assessed. Each participant underwent both EMG–NCV testing and bilateral wrist ultrasonography. Sonographic variables, including the cross‑sectional area (CSA) and the width of the median nerve at various points along the forearm and within the carpal tunnel, were compared among electrodiagnostic severity categories classified as normal, mild, moderate, and severe. The sensitivity and specificity were determined for chosen CSA and nerve‑width cutoff values.
Results & Discussion: 60 patients with the mean age of 49.5±10.4 years and mean BMI of 26.8±3.6 kg/m² being 90% female and 80% with bilateral involvement were studied. Age was not significantly associated with CTS severity (P=0.344), whereas higher BMI correlated with greater severity (P=0.01). Median nerve CSA width increased parallel with disease severity. In the right hand, a CSA cut off of 8.5 mm² at the carpal tunnel yielded 87.5% sensitivity and 81.7% specificity; in the left hand, a CSA cut off of 8 mm² provided 70% sensitivity and 95.5% specificity. Nerve width ≥ 5 mm showed high sensitivity but lower specificity.
Conclusion: Ultrasonography—especially assessing the cross‑sectional area of the median nerve—serves as a dependable, noninvasive, and precise complementary tool alongside EMG–NCV for both identifying and grading the severity of CTS.

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: Spine is a critical component of the musculoskeletal system, and lesions involving vertebrae may significantly affect patients’ quality of life. Benign spinal lesions, such as infections, can be curable but are often difficult to diagnose, whereas malignant lesions—including sarcomas and metastatic tumors—carry a poor prognosis. Materials & Methods: This descriptive cross-sectional study included 114 patients diagnosed with benign and malignant spinal lesions between 2008 and 2018 in 2 teaching hospital. Data were collected using a structured questionnaire and analyzed using SPSS version 22. Variables included age, sex, pathology type, lesion type (benign/malignant), size, anatomical origin, and year of diagnosis. Results & Discussion: 114 patients with mean age of 52.1 ± 20.5 years (range: 1 month–89 years) were studied. Males accounted for 80 (70.2%) of cases. Of all the lesions, 63 (55.3%) were benign and 51 (44.7%) malignant. Lumbar involvement was the most location frequent (64%), followed by thoracic (20.2%), sacral (13.2%), and cervical (2.6%). Pathologically, inflammatory lesions were most common (49.1%), followed by cancers (38.6%), lymphomas (4.4%), benign tumors (3.5%), sarcomas (0.9%), and others (3.5%). No significant association was observed between lesion type and sex, age, lesion site, or age at diagnosis (p>0.05). Conclusion: Benign lesions—particularly inflammatory ones—represented the majority of spinal pathologies, though malignant lesions comprised nearly half of cases. The lumbar region was most commonly affected. These findings underscore the importance of comprehensive diagnostic approaches and points to need for further multicenter studies to improve management of spinal lesions.

Abstract Introduction: Pelvic fractures, although comprising a small proportion of musculoskeletal injuries, are clinically significant due to their proximity to vital anatomic structures. These injuries may carry a mortality rate of up to 20%. The location of the bladder and ureters within the pelvic cavity makes them highly vulnerable to trauma. Urological injuries are reported in approximately 6–15% of pelvic fracture cases. This study aimed to investigate the association between the type of pelvic fracture and the pattern of lower urinary tract symptoms. Materials & Methods: In this study, medical records of patients diagnosed with pelvic fractures who were admitted to a tertiary referral hospital within 5 years were reviewed. Patients with a history of prior pelvic fractures or urological surgeries were excluded. Data were analyzed using SPSS25 software. Results & Discussion: A total of 134 patients were included, of whom 86 (64.2%) were male. The mean age was 40.7 ± 21.5 years. The most common fracture type was LC (Lateral Compression) (82.8%), followed by anterior-posterior compression (9.7%) and vertical shear (7.5%). A statistically significant association was found between fracture type and urinary symptoms (P=0.047). Gross hematuria was more frequent in anterior-posterior compression fractures, while microscopic hematuria was more common in vertical shear fractures. Patients with LC fractures were less likely to exhibit urinary symptoms. Conclusion: The type of pelvic fracture is associated with the presence and nature of lower urinary tract symptoms. Early recognition of this relationship may improve diagnostic accuracy and guide appropriate management in trauma settings.

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.

Abstract Knee osteoarthritis (KOA) is a common degenerative joint disease that mostly impacts adults over 5 years of age. Its prevalence is considerably higher in women, individuals with excess body weight and people with prior joint trauma. Current treatment strategies primarily focus on symptom control, which underscores the urgent need for more effective and disease-modifying therapies. Recent advances in both nonsurgical and surgical modalities have introduced promising regenerative options. Therapeutic modalities notably mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP) have demonstrated substantial potential in attenuating inflammatory responses and facilitating cartilage regeneration, particularly during the early pathological phases of knee osteoarthritis. Intra-articular hyaluronic acid (HA) injections provide only temporary symptomatic relief and show limited long-term efficacy. For advanced cases, surgical interventions including autologous chondrocyte implantation (ACI) and knee arthroplasty (TKA) remain viable options, with their associated risks and complications. Personalized treatment approaches based on disease severity, progression, and patient-specific factors are likely to yield optimal outcomes. Future directions in KOA management may include gene-edited MSCs, smart implants, and the integration of machine learning to enhance therapeutic precision and long-term success.

Abstract Concurrent femoral shaft fractures and lower limb amputations around the knee are rare but complex injuries, often resulting from high-energy trauma. This report reviews the challenges and treatment strategies for such cases, focusing on innovative fracture table positioning and fixation methods in transfemoral, through-knee, and transtibial amputations. We present two novel cases: a 29-year-old man with an above-knee amputation and midshaft femoral fracture treated with delayed intramedullary nailing after external fixation, and a 40-year-old man with a through-knee amputation and open midshaft femoral fracture managed with external fixation, skin grafting, and subsequent plate fixation. Key challenges include patient instability, soft tissue defects, osteoporotic bone, and positioning without distal anchors. Techniques such as Schanz pins, Kirschner wires, inverted boots, and skin traction facilitate the reduction. The review underscores the need for staged approaches and standardized protocols to optimize outcome in such rare scenarios.

Abstract Introduction: Pillar pain is one of the common sequelae after carpal tunnel release (CTR), presenting as deep pain or tenderness upon pressure on the thenar and hypothenar regions. It potentially interferes with return to work and patient satisfaction. This narrative review was conducted with a focus on the etiology, emerging therapeutic approaches, and a practical management algorithm for pillar pain. Materials & Methods: A structured search of PubMed and complementary sources was performed from 2018 up to December 2025. Clinical trials, systematic reviews and meta-analyses, cohort studies, and high-quality narrative reviews addressing pillar pain, risk factors, pathophysiology, or post‑CTR treatments were identified and categorized. Results & Discussion: The evidence suggests that pillar pain is a self‑limiting condition, and approximately half of the patients may experience it, with most cases resolving within 3 to 6 months. The etiology is multifactorial and includes biomechanical alterations of the carpal arch after division of the transverse carpal ligament, soft‑tissue inflammation or scarring, irritation or neuroma of the palmar cutaneous branch of the median nerve, and central mechanisms. Non‑surgical treatment is the mainstay of management and encompasses patient education and reassurance, occupational hand therapy modalities (desensitization, massage, graded exercises), non‑opioid analgesics and anti‑inflammatory medications. In refractory cases, minimally invasive options such as extracorporeal shock wave therapy (ESWT) and photo biomodulation may be used. Emerging evidence on fractional CO₂ laser therapy for treatment‑resistant pillar pain is promising but still limited. From a preventive standpoint, minimally invasive techniques and appropriate choice of skin closure method may influence short‑term pillar pain. Conclusion: Pillar pain after CTR is usually benign and transient but requires a stepwise, multimodal approach. Combining patient education, targeted rehabilitation, and non‑opioid pain strategies, with selective use of minimally invasive interventions in refractory cases, offer safe and efficacious treatment.