Ulnar impaction syndrome is abutment of the ulna on the lunate and triquetrum that increases stress and load, causing ulnar-sided wrist pain. Typically, ulnar-positive or -neutral variance is seen on a posteroanterior radiograph of the wrist. The management of ulnar impaction syndrome varies from conservative, symptomatic treatment to open procedures to shorten the ulna. Arthroscopic management has become increasingly popular for management of ulnar impaction with ulnar-positive variance of less than 3 mm and concomitant central triangular fibrocartilage complex tears. This method avoids complications associated with open procedures, such as nonunion and symptomatic hardware. The arthroscopic wafer procedure involves debridement of the central triangular fibrocartilage complex tear, along with debridement of the distal pole of the ulna causing the impaction. Debridement of the ulna arthroscopically is taken down to a level at which the patient is ulnar neutral or slightly ulnar negative. Previous studies have shown good results with relief of patient symptoms while avoiding complications seen with open procedures.U lnar impaction syndrome is abutment of the ulna on the lunate and sometimes the triquetrum seen with increases in stress and load across the joint. The continuum of findings includes ulnar-positive variance, triangular fibrocartilage complex (TFCC) tear, and lunate-triquetrum ligament tear.1 Small changes in variance can dramatically affect loads across the joint. Palmer and Werner 2,3 showed that a neutral wrist has 18% of its load through the ulna whereas 42% of the load crosses the ulna in a 2-mm ulnar-positive wrist and 4% in a 2-mm ulnar-negative wrist. Common associated findings are TFCC tears, lunotriquetral ligament tears, scapholunate ligament tears, and radial shortening from previous trauma. Presenting symptoms include pain over the dorsal and ulnar wrist, with ulnar deviation and with axial loading. Findings on radiographs include ulnar-positive variance and sclerosis of the lunate and/or ulnar head. Conservative measures involve immobilization, anti-inflammatory medications, and corticosteroid injections. Surgical options include isolated TFCC debridement and ulnar shortening procedures including open or arthroscopic wafer procedures, as well as diaphyseal or distal metaphyseal osteotomies. 3,4,5 The arthroscopic wafer procedure is an effective method to debride TFCC tears, along with decompressing ulnar-positive wrists. It has been found to have equivalent results to an open procedure, with fewer complications. 6 This technique avoids hardware complications and the risk of nonunion associated with ulnar shortening osteotomy. Indications for the wafer procedure are failed nonoperative treatment for at least 3 months, central TFCC tear, and less than 3 mm of ulnar-positive variance.
Surgical TechniqueThe patient is placed in the supine position after undergoing general or regional anesthesia and receiving appropriate preoperative antibiotics. Video 1 illustrates the procedure. Th...