Limb deformities have a close pathological link with peripheral nerve injuries; however, there is currently a lack of analysis and summary of research trends in this field aimed at elucidating the close relationship between limb deformities and peripheral nerve repair. Based on the Web of Science Core Collection database, this study retrieved 897 articles published between 2001 and 2025. A bibliometric analysis using CiteSpace and VOSviewer was therefore conducted to comprehensively map the research landscape, hotspots, and evolving trends in this field, revealing a sustained annual upward trend in research output. The University of Washington (UW, Seattle) was the institution with the most publications and the greatest impact. The Journal of Pediatric Orthopaedics was the journal with the most publications, while the Journal of Bone and Joint Surgery-American Volume was the journal with the greatest academic impact. Keyword analysis identified two major clusters of interest: diabetic peripheral neuropathy and foot deformities, involving studies on Charcot neuroarthropathy, diabetic foot ulcers, and amputation prevention; and birth-related brachial plexus palsy and its secondary shoulder and elbow deformities, focusing on functional reconstruction strategies such as tendon transfer and osteotomy. Burst keyword analysis revealed a clear shift in the research focus. From 2003 to 2013 (the early period), studies primarily focused on single-site functional impairments and conservative treatments (such as botulinum toxin). From 2014 to 2025 (the recent period), the focus shifted toward investigating "prevalence" and "risk factors," as well as conducting in-depth studies on "reconstructive" surgery, diabetic foot ulcers, and molecular mutation mechanisms. Current research in this field focuses on the bidirectional relationship between "malformations" and "nerves," exploring how nerve injuries cause malformations and investigating secondary nerve compression and damage following malformations. Peripheral neuropathies, such as diabetic peripheral neuropathy, Charcot-Marie-Tooth disease, and obstetric brachial plexus palsy, are the key direct or indirect causes of specific limb deformities (such as foot deformities, talipes, and forearm supination deformities). Research on the mechanical effects of deformities on nerves focuses on how skeletal deformities (such as elbow valgus/varus or knee valgus) result in or exacerbate nerve entrapment syndromes (such as ulnar nerve or common peroneal nerve injuries) through abnormal biomechanical mechanisms (such as excessive traction or dynamic compression). During surgeries for correcting complex deformities, the use of intraoperative nerve monitoring provides real-time early warning to avoid iatrogenic brachial plexus injuries and ensure patient safety, which has become a prominent technical focus. Previous studies have established the criteria for early monitoring of shoulder deformities and Mallet functional assessment following obstetric paralysis. Research over the past 5 years has focused on the mechanisms by which deformities exert mechanical effects on nerves, as well as the application of precision surgical techniques and intraoperative nerve monitoring. Surgical repair strategies for cubital tunnel syndrome and ulnar nerve palsy-induced claw hand are also among the key clinical areas of interest. Overall, these findings indicate that research on limb deformities associated with peripheral neuropathy and injury repair has evolved into two major research domains, focusing on nerve repair for deformities caused by diabetic peripheral neuropathy and limb deformities resulting from obstetric paralysis. Current research trends are moving toward precision, minimally invasive approaches, and multidimensional efficacy assessments. Future research should deepen the understanding of the "deformity-nerve" interaction mechanisms, focus on early warning systems, intraoperative nerve monitoring, and individualized functional reconstruction, and thereby improve patient outcomes and surgical safety.

OBJECTIVE:Surgical treatment of scaphoid nonunion after failed screw fixation is a unique challenge for hand surgeons. This retrospective study evaluated the clinical results of revisional reconstruction by a hand trauma plate system with bone grafting for this situation. METHODS:From 2019 to 2022, 12 patients with scaphoid nonunion after failed closed or open reduction and internal fixation surgery were treated with revisional surgery using a 1.7-mm nonlocking hand trauma plate system. Pure cancellous bone was harvested from the iliac crest or olecranon of the patient to fill the bony defect between the proximal and distal segments of the fracture. Visual analog scale scores and functional outcomes were assessed after at least 2 years of follow-up. RESULTS:We used computed tomography (CT) to assess the union, and all fractures healed. The mean interval between primary and definitive surgery was 14.4 (range, 6-36) months. The mean follow-up period was 43.4 (range, 27-72) months. The mean union time was 11 (range, 8-16) weeks. The clinical outcomes included active wrist range of motion (67.2 % ± 16.4 % vs. 82.9 % ± 12.0 %, P = 0.002), visual analog scale score (5.0 ± 1.3 vs. 2.3 ± 1.2, P < 0.001), grip strength (69.4 % ± 11.3 % vs. 88.5 % ± 16.6 %, P < 0.001), and modified Mayo wrist score (51.7 ± 16.1 vs. 71.7 ± 8.9, P < 0.001). Three patients complained of clicking at the volar part of the wrist joint, which was resolved by plate removal. CONCLUSION:A hand trauma plate system can be used to stabilize the scaphoid fracture nonunion in the treatment of failed screw fixation for scaphoid waist fractures. Hardware removal may be considered if impingement symptoms persist after fracture healing.

Background: Currently, large-sample epidemiological studies on congenital upper limb differences (CULD) in China are relatively rare. This report presents our centre’s experience on the spectrum of diseases and related factors. Methods: Information was collected from patients with CULD who underwent surgical treatment at our centre from September 2018 to October 2023. Data collection included patient name, gender, age, clinical features and diagnosis, family history, parents’ age, parents’ medical history, pregnancy history and family income. Bivariate relationships between these variables were examined. Results: The average age of the patients was 4 years; 1,398 patients (99%) were aged 9 months to 18 years, and 17 patients (1%) were adults. There were 848 males (60%) and 567 females (40%), with a statistically significant gender distribution (p < 0.05). The most common differences were polydactyly and syndactyly, accounting for 47% and 14%, respectively. Syndromic patients accounted for 14%, and cardiac conditions were the most prevalent non-musculoskeletal issue (55%). First-born patients accounted for 54% of patients, and the average age of parents for first-born patients was 30 ± 5 years for fathers and 29 ± 2 years for mothers. For non-first-born patients, the average age of parents was 33 ± 6 years for fathers and 32 ± 5 years for mothers, with a statistically significant difference between the two groups (p < 0.001). Conclusions: In China, congenital limb differences are still dominated by polydactyly and syndactyly. Heart conditions occur most frequently in patients with syndromes. Level of Evidence: Level IV (Epidemiological)

Objectives To Investigate the value of 3D printed guide-assisted percutaneous management of minimally displaced scaphoid waist fractures(Herbert’s B2) with delayed diagnosis or presentation. Methods From October 2018 to February 2022, 10 patients with established delayed diagnoses and presentation of minimally displaced scaphoid waist fractures were treated with 3D printed guides assisted with percutaneous internal fixation without bone grafting. This technique was based on the patient’s preoperative CT and imported into the software. Based on Boolean subtraction, the most centralized screw placement position was identified and a customized guide was produced. Intraoperative percutaneous insertion of the guide wire was assisted by the custom guide. Results All 10 patients were successful in one attempt. The fractures healed at a mean of 7.7 weeks postoperatively (range 6–10 weeks). At a mean follow-up of 7.7 months (6–13 months), patients had excellent recovery of wrist function with minimal pain reduction. There were no major postoperative complications and the patients all returned to their previous activities before the injury. Conclusions Percutaneous internal fixation based on 3D printed guides is a safe and effective technique for delayed diagnosis or presentation of patients with minimally displaced fractures of the scaphoid waist. This method allows for easy insertion of screws and avoids multiple attempts.

PurposeThis study reports the clinical outcomes of double-screw fixation with bone grafting for displaced scaphoid nonunions.Patients and methodsThis study was a retrospective survey. From January 2018 to December 2019, 21 patients with displaced scaphoid fractures underwent open debridement and two headless compression screw fixation with bone grafting. The preoperative and postoperative lateral intrascaphoid angle (LISA) and scapholunate angle (SLA) were recorded. Preoperative and postoperative grip strength (% of the healthy side), active range of motion (AROM), visual analogue scale (VAS), and patient-rated wrist evaluation (PRWE) scores at the final follow-up were obtained for all patients for comparison.ResultsPatients were treated for an average of 38.3 months (range 12–250) after the injury. The average time of postoperative follow-up was 30.5 months (range 24–48). All fractures achieved union at a mean of 2.7 months (range 2–4) after surgery, and 14 scaphoids of 21 patients (66.7%) healed by 8 weeks. CT scans showed no evidence of cortical penetration of either screw in all patients. There was a statistically significant improvement in AROM, grip strength, and PRWE. No complications occurred in this study, and all patients returned to work.ConclusionThis study indicates that double-screw fixation with bone grafting is an effective technique for treating displaced scaphoid nonunions.

Objective:To investigate the clinical efficacy of surgical treatment of osteochondroma with finger deviation deformity in chidren.Methods:From December 2014 to December 2019, 21 patients with 45 tubular bones diagnosed as osteochondroma of the hand by X-ray were included in this study. Among them, 18 patients (28 tubular bones) received tumor resection and wedge osteotomy. A total of 11 patients (21 tubular bones) were follow-up for 6 to 24 months. The pathological diagnosis of all patients was consistent with that before operation. According to the basic information of the patient collected by the electronic medical record system and the concomitant symptoms before operation, the palmar inclination angle, radial ulnar deviation angle and tubular bone length of the X-ray anterioposterior and lateral films of the fingers before and after operation were measured by the electronic imaging system, and whether there were concomitant symptoms after operation was followed up. The above factors were statistically analyzed.Results:After osteochondroma resection, the radial and ulnar deviation angle of the tubular bone in the hand was (5.94±6.62)°, which was significantly improved from (17.06±15.40)° ( P=0.005). The palm inclination angle was (15.03±21.43)° after operation, which was significantly improved compared with (24.01±25.91)° before operation ( P=0.006). Children aged 0 to 6 years had the most obvious improvement in postoperative deflections and deformities, and the length of tubular bone was not significantly shortened after operation. Among the 21 tubular bones that were followed up, 3 (14.3%) showed new tumors on postoperative X-ray films. Conclusion:The osteochondroma resection and wedge osteotomy can effectively correct finger deviation on the basis of tumor resection.

Purpose We compared robotic-assisted scaphoid screw fixation to conventional technique in terms of accuracy, surgical times, radiation exposure, and clinical outcomes, including range of motion, grip strength, functional score, and complications.Methods This study was a registered, prospective, randomized, controlled trial. From May 2019 to December 2019, 1 surgeon performed 18 robotic-assisted and 18 conventional scaphoid screw fixations and these patients were eligible for participation in this study. Surgical time, including the time of the overall procedure, set-up time, and time for ideal guidewire placement, was recorded. The number of guidewire attempts also was recorded. All patients were evaluated clinically and radiographically at follow-up with respect to the severity of pain, wrist motion, grip strength, complications, and Mayo modified wrist score.Results The average set-up time and overall time of the procedure were longer in the robotic -assisted than in the conventional groups, while the mean guidewire insertion time and the mean guidewire attempts was less in the robotic-assisted group than that of the conventional group. The overall radiation exposure was lower in the robotic group.Conclusions Robotic-assisted technique provided a useful tool to improve implantation accu-racy and shorten radiation exposure. Additional cost and prolonged duration of surgery without evidence of improved clinical scores may limit widespread acceptance of this tech-nique. (J Hand Surg Am. 2022;47(12):1172-1179. Copyright (c) 2022 by the American Society for Surgery of the Hand. All rights reserved.)Type of study/level of evidence Therapeutic II.

Objective:To evaluate the clinical efficacy of percutaneous double screw fixation without bone grafting for the treatment of delayed union or nonunion of scaphoid fractures.Methods:From January 2018 to February 2019, 20 patients with delayed union or nonunion of scaphoid fractures were treated with internal fixation by percutaneous placement of two cannulated screws with the assistance of orthopedic robot technology or bare hands, and the fracture end was not grafted. All the patients were followed up at least 1 year after operation, and their clinical and imaging data were collected. The visual analogue scale (VAS), Mayo wrist score, grip strength and joint range of motion (ROM) were collected and compared before operation and at follow-up.Results:The average time from injury to operation was 6.8 months (ranged, 3 to 12 months). All the cases achieved bone healing at 8.55 weeks (ranged, 6 to 12 weeks). During postoperative follow-up, imaging examination did not find internal fixation complications such as screw invasion of the distal scaphoid or the cortex of scaphoid tubercle. The VAS, ROM, Mayo score and grip strength of all the cases were significantly improved compared with those before operation. All the patients could return to their normal daily life.Conclusion:Compared with the traditional surgical method, the application of percutaneous double screw internal fixation without bone grafting for the treatment of delayed union or nonunion of scaphoid fractures has better stability of internal fixation, less surgical trauma, more rapid fracture healing and better functional recovery.

目的 分析镜影手畸形的临床特征和形态学特点,为准确及全面了解该罕见畸形的形态学规律提供依据.方法 纳入2011年至2020年就诊于我院手外科,形态学诊断为镜影手的患儿18例,依据首次就诊时查体及检查结果对患儿形态学特征展开分析.结果 18例均符合镜影手Al-Qattan诊断标准,均无家族遗传史.男55.6％,女44.4％,初次手术平均月龄为39.6个月(n=16).15例为单侧发病,另有Laurin-Sandrow综合征(Laurin-Sandrow syndrome,LSS)1例,Martin综合征2例;11例伴有尺骨复肢畸形.11例为7指畸形,3例8指畸形,3例6指畸形和1例罕见的5指畸形.常见手部伴发畸形:并指(n=11/18),指间及掌指关节挛缩(n=10/18)和指间关节发育不良(n=8/18).10例存在优势指蹼,7例位于尺侧4～5指间,2例位于尺侧5～6指间,1例位于尺侧3～4指间.结论 镜影手畸形以镜像性多指为特征表现,散发发病为主,并指、关节挛缩和关节发育不良是其常见伴发畸形,也可伴发手指偏斜、腕关节桡偏及肉赘样多指.

目的 探究改良Snow-Fink肌腱移位术对重建先天性拇指发育不良患儿拇指对掌功能的效果.方法 回顾性分析我科从2014年至2021年收治的25例拇指发育不良患儿(Ⅱ型7例,ⅢA型8例,ⅢB型7例,Ⅳ型3例)的临床资料,其中Ⅱ型及4例ⅢA型患儿行改良Snow-Fink肌腱移位术,另4例ⅢA型患儿行一期虎口开大术及二期改良Snow-Fink肌腱移位术,ⅢB型及Ⅳ型患儿行一期虎口开大术+掌骨重建术,二期行改良Snow-Fink肌腱移位术.术后对患儿进行随访.从拇指外展功能、拇指对指功能、拇指对捏功能、拇指综合功能4个方面进行评价.结果 本组25例平均19.9个月,拇指桡侧外展角度平均61.0°,掌侧外展角度平均68.8°,Kapandji评分平均7.4分(满分10分),拇指对捏功能评分平均1.84分(满分2分),Goldfarb评分平均3.12分(满分4分).其中1例术后出现环指指屈肌腱粘连.结论 改良Snow-Fink肌腱移位术可用于重建Ⅱ型及一期或多期拇指重建术后的Ⅲ、Ⅳ型拇指发育不良患者的对掌功能,其操作简便,损伤小,术后可恢复良好的拇指对掌功能,是重建拇指发育不良对掌功能的手术选择之一.

Objective:To explore the morphological characteristics and diagnostic criteria of Proteus syndrome.Methods:From January 2016 to November 2019, 7 patients with morphologically diagnosed Proteus syndrome were tested for all exons. The morphological and histological characteristics of positive and negative results were compared.Results:Among the 7 patients, 5 patients were genetically diagnosed as Proteus syndrome and the other two did not support the diagnosis. The morphology of patients with Proteus syndrome has the following characteristics: asymmetric progressive overgrowth; there were sulcus like connective tissue lesions in the lesions; the above lesions involve multiple fingers/toes, even the whole hand/foot or more; combined with multi organ and multi system diseases. Histologically, white round like characteristic tumors derived from epiphyseal cartilage or articular cartilage can be seen.Conclusion:The existing diagnostic criteria of Proteus syndrome need to be further revised and improved. We believe that Proteus syndrome can be preliminarily diagnosed with the above characteristics, but it may be misdiagnosed, and the diagnosis still depends on gene detection. The effect of surgical treatment of Proteus syndrome is not ideal, and more in-depth research is needed to find a more accurate treatment.

目的 探讨应用不带阔筋膜的股前外侧皮瓣移植修复小儿轮辐伤致足踝皮肤缺损的临床效果.方法 对2013年5月至2016年10月山东省烟台市烟台山医院手外一科采用不带阔筋膜的股前外侧皮瓣移植治疗的轮辐伤致足踝皮肤缺损患儿6例的临床资料进行回顾性分析.其中男3例,女3例,平均年龄6(4～12)岁;均为电瓶车或摩托车轮辐伤;皮肤缺损部位:足背4例,足跟2例;皮瓣面积4 cm×10 cm～15 cm×8 cm.全部患儿在接受一期手术行创面清创、骨折固定、肌腱修复、负压封闭引流(VSD),待创面稳定且无异常分泌物之后,二期行超薄游离股前外侧皮瓣移植修复.术后平均随访时间为16(6～22)个月.观察受区创面皮瓣外观与质地;采用中华医学会肢体功能评定试用标准对下肢功能进行评价.结果 二期修复手术平均用时4(3～5)h,术中平均出血量为75(60～100)ml.6例皮瓣均顺利成活,无血管危象发生;皮瓣血运良好,质地薄而柔软,无臃肿,外形满意,无需二次手术整形;下肢皮肤未见明显瘢痕挛缩及色素沉着,恢复深浅感觉;邻近关节屈伸活动无明显受限,下肢功能均为优.结论 应用不带阔筋膜的股前外侧皮瓣移植修复小儿轮辐伤致足踝皮肤缺损,可获得良好的临床效果.

We retrospectively reviewed 12 minimally displaced fractures of the scaphoid waist in 12 patients who developed delayed or nonunions with or without conservative treatment. Mean time between injury and surgery was 6 months (range 3–12). The fractures were stabilized with double screws, which were percutaneously inserted with robot assistance, and without bone grafting. All fractures united at a mean of 8 weeks (range 6–10) after surgery. The patients were followed-up at 6 months and 1 year. The patients recovered good wrist function. No major postoperative complications were reported, and the patients returned to their usual level of activity. Robot assistance gave a high degree of accuracy when placing the cannulated screws since only two attempts were needed for correct placement of the guide wires. We explain the high union incidence by patient selection, good stabilization and not disturbing the vascular supply. Level of evidence: IV

Objective:Objective To explore the X-ray classification of thumb duplication of cleft type at the metacarpophalangeal joint level according to the imaging features on X-ray.Methods:From January 2013 to June 2019, 264 cases of thumb duplication of cleft type at the metacarpophalangeal joint level were treated in our department. According to the relative development degree of the radial and ulnar thumbs on the X-ray film, the deformity can be divided into four types. In type A, the development of radial and ulnar thumbs was basically the same; in type B, the development of radial thumb was more dysplasia; in type C, the development of ulnar thumb was more dysplasia; in type D, the development of distal and proximal ends of radial and ulnar thumbs was unbalanced. According to the degree of development and the force line of joint, the subtypes could be further divided. Type B cases can be divided into five subtypes. In type B1, the force line of metacarpophalangeal joint and interphalangeal joint of ulnar thumb was abnormal; in type B2, the force line of metacarpophalangeal joint of ulnar thumb was abnormal; in type B3, the force line of ulnar thumb had no obvious abnormality; in type B4, the proximal phalanx of ulnar thumb was malformed and hypertrophic, and the force line was abnormal; in type B5, the radial thumb was floating. There was no subtype in other types.Results:According to the relative development degree of the radial and ulnar thumbs on the X-ray film and the force line of joint, 41 cases were classified as type A and 216 cases as type B. There were 64 cases of type B1, 54 cases of type B2, 63 cases of type B3, 26 cases of type B4, 9 cases of type B5, 1 case of type C and 6 cases of type D.Conclusion:The basis of this classification method is clear, which can comprehensively reflect the pathoanatomical mechanism of joint of thumb duplication of cleft type at the metacarpophalangeal joint level, and provide guidance for surgical treatment.

目的 探讨手部血管淋巴管瘤的临床特点及外科治疗时机.方法 回顾分析2010年1月至2019年6月北京积水潭医院手外科收治的13例手部血管淋巴管瘤患儿的病历资料.13例均接受手术治疗,其中12例获得随访.总结该疾病的临床特点及外科治疗时机.结果 手部血管淋巴管瘤本质是一种先天性静脉及淋巴管发育畸形,在出生后2年内多可确诊,手背部易受累.随访25(8～68)个月,术后未见复发,手部外形及功能恢复效果令人满意.结论 手部血管淋巴管瘤虽然为良性病变,但因肿瘤生长迅速,易影响手部外观及功能,甚至出现出血、溃疡、感染等并发症,因此宜尽早予以手术治疗.早期手术的难度较低,疗效满意.若肿瘤范围广泛,建议予以分期手术.

目的 对23个轴前性多指家系进行临床及基因分析,探讨其遗传学病因.方法 收集23个轴前性多指患者家系临床资料及外周血样本,进行全外显子基因测序,并对1例伴三节指骨拇指的多并指家系进行基于全外显子组测序的拷贝数变异分析及实时荧光定量PCR检测.结果 5例先证者为综合征性轴前性多指,18例为单纯性轴前性多指.共有2例携带致病性突变,其中1例临床诊断为Townes-Brocks综合征的患者携带SALL1基因致病突变[NM_002968.2:c.2712_2715 del(p.Gly906Valfs*59)].1例非综合征性轴前性多指家系携带ZRS区域(7q36.3)杂合性扩增.另有5例分别携带临床意义未明的KCNH1、BMPR1B、CITED2、C2CD3、FANCI基因突变.另有2例家系中分别发现恶性高热1型RYR1和家族性乳腺-卵巢癌易感性2型BRCA2基因突变.结论 ZRS区域(7q36.3)杂合性扩增和SALL1突变是轴前性多指致病原因;对于综合征性多指及有条件进行基因分析的非综合征性多指宜进行基因检测,以明确病因、早期发现合并异常,利于日后遗传咨询.

Objective:To analyze the clinical characteristics of hemangiolymphangiomas of hand and upper extremity.Methods:From January 2010 to October 2018, 12 patients with hemangiolymphangiomas of hand and upper extremity were treated. The epidemiological characteristics, clinical characteristics, diagnosis and treatment were summarized, and the results of 11 cases followed up were analyzed.Results:Hemangiolymphangioma is a congenital malformation of venous and lymphatic vessels. It is rare in hand and upper extremity. It is often found after birth. The dorsal part of the hand is susceptible, and the radial half is common. After operation, 11 cases obtained follow-up. The follow-up time was 6 to 60 months, with an average of 22 months. The results of operation were satisfactory and definite.Conclusion:Although hemangiolymphangioma is a benign disease, it is easy to affect the appearance and even function of hands or limbs because of its rapid growth. It is advisable to treat it as early as possible. The special attention should be paid to the closure of lymphatics and vascular stumps. If the tumor has a wide range, staging operation is recommended.

目的 探究示指背侧转位皮瓣治疗先天性拇指发育不良拇指撲挛缩的治疗效果.方法 2014年至2018年,在我院手外科就诊的27例(29指)拇指指撲挛缩患者,手术采取示指背侧转位皮瓣.以瘢痕情况、色素沉着、质地、厚度、屈伸畸形5个方面进行评价,分别赋值评分后得出总和,最高分为14分,其中0～2分为优,3～5分为良,6～8分为中,9～14分为差.结果 本组27例(29指)获得平均12个月的随访,转位皮瓣及示指背侧供区植皮均存活,其中优65.52％,良31.03％,可3.45％,差0％.结论 示指背侧转位皮瓣用于治疗Ⅱ型及Ⅲ型拇指发育不良的拇指撲狭窄手术操作简便,术后皮瓣质量好,外观满意,功能良好,是一种治疗拇指撲狭窄的良好手术方式.

Purpose The aim of this study was to evaluate the feasibility and accuracy of scaphoid screw guidewire placement using a computer-assisted-designed, and 3-dimensional-printed, surgical guiding template in cadaver wrists. Methods Computed tomography (CT) scans of 12 fresh-frozen cadaver wrists were performed and the data imported into a surgical planning system. A 3-dimensional skin surface template block with a guiding hole was generated from the CT data to allow a screw guidewire to be placed in the central third of the scaphoid. This 3-dimensional model was printed and then put back onto the wrist. A screw guidewire was inserted through the palmar guide hole into the intact scaphoid and then a postprocedure CT scan was obtained. These postprocedure data were introduced into the surgical planning system. Angular and linear deviation between the preprocedural simulation and the image of the guidewire was measured in the system to assess accuracy. Results Mean angular deviation was 3.85 degrees +/- 1.32 degrees (range, 1.56 degrees-5.35 degrees) and linear deviations of the 12 specimens were less than 1.1 mm No specimen required a repeat drilling to the scaphoid. All the screw guidewires were considered to be centrally placed in the scaphoid based on our criterion of central placement of the scaphoid screw. Conclusions The use of a computer-assisted 3-dimensional-printed surgical guide template to assist screw guidewire placement into an intact scaphoid, mimicking a nondisplaced scaphoid fracture, showed acceptable accuracy in cadaver wrists. (Copyright (C) 2019 by the American Society for Surgery of the Hand. All rights reserved.)

Objective To analyze the prospective effect of pre-existing spinal stenosis of adjacent segment on the short-term effectiveness after lumbar fusion surgery. Methods A prospective comparative study was conducted to divide 183 patients with L 4-S 1 lumbar spinal stenosis who met the selection criteria between July 2015 and December 2017 into two groups according to the status of adjacent segment degeneration (ASD) judged by preoperative disc degeneration and spinal stenosis. There were 98 patients in group A (no degeneration of adjacent segments before operation) and 85 patients in group B (adjacent segments degenerated before operation). There was no significant difference in gender, American Society of Anesthesiologists (ASA) grade, body mass index (BMI), combined spondylolisthesis, and preoperative visual analogue scale (VAS) score of low back pain and leg pain, Japanese Orthopaedic Association (JOA) score, and Oswestry disability index (ODI) score between the two groups ( P>0.05); the age of group A was significantly younger than that of group B ( t=-3.560, P=0.000). The operation time, intraoperative blood loss, hospitalization stay, and perioperative complications were recorded and compared. The VAS score of low back pain and leg pain, JOA score, and ODI score at last follow-up were used to evaluate the effectiveness. The incidence of ASD after operation was compared between the two groups, and logistic regression was used to analyze the independent risk factors affecting the occurrence of ASD after operation. Results There was no significant difference in operation time, intraoperative blood loss, and hospitalization stay between the two groups ( P>0.05). The incidence of perioperative complications in groups A and B was 13.3% and 20.0%, respectively, with no significant difference ( χ 2=1.506, P=0.220). Two groups of patients were followed up, the follow-up time of groups A and B was (24.9±8.8) months and (24.8±7.8) months, respectively, there was no significant difference ( t=0.050, P=0.960). At last follow-up, no adjacent segment disease was found in either group. There was no significant difference in Pfirrmann grade between the two groups at last follow-up ( P>0.05), and there was significant difference in Pfirrmann grade between the two groups before operation and at last follow-up ( P<0.001). At last follow-up, 21 cases (21.4%) in group A and 53 cases (62.4%) in group B had ASD, with significant difference ( χ 2=31.652, P=0.000). The main cause of ASD was the severity of adjacent spinal canal stenosis. The clinical scores of the two groups at last follow-up were significantly improved when compared with those before operation ( P<0.05). The JOA score of group A was significantly higher than that of group B at last follow-up ( P<0.05). In group B, the VAS score of low back pain and ODI score in patients with ASD after operation at last follow-up were significantly higher than those in patients without ASD ( P<0.05). logistic regression analysis showed that preoperative pre-existing degeneration and BMI were independent risk factors for ASD after operation ( P<0.05). Conclusion Pre-existing mild spinal stenosis in adjacent segment can significantly affect the effectiveness, and can significantly increase the risk of ASD early after operation. The main pathological type of ASD was the severity of adjacent segment spinal stenosis. For preoperative assessment of pre-existing degeneration, we should evaluate the overall degeneration of the adjacent segment of the spinal canal, rather than simply evaluating the degeneration of the adjacent disc and facet joints.