Pouliot M, Yao J

Abstract: Ulnar impaction syndrome (UIS) is a degenrative condition of the ulnar wrist typically seen in patients with statis or dynamic ulnar-positive variance. Impactions of the distal ulna on the proximal lunate and triquetrum leads to degenerations of the triangular fibrocartilage complex and/or the chondral surfaces of the lunate and triquetrum. Patients with UIS present with pain in the ulnar aspect of the wrist. In cases of UIS refractory to nonperative treatment, several surgical techniqes have been described, including arthroscopic triangular fibrocartilage complex debrideent, arthroscopic wafer procedure, and ulnar shortening osteotomy (USO). USO has gained favor as a reliable technique to offload the forces seen at the ulnar wrist extra-articularly while preserving the distal radioulnar joint stabilizing structures. We describe a technique utilizing a jig-facilitated, oblique, diaphyseal USO and fixed with a TriMed ulnar osteotomy compression plate. This system allows for precise measured ulnar shortening and reliable compression across the osteotomy site, and has been shown to decrease operative times and achieve to high union rates. Plate prominence is minimized by utilizing the volar surface of the ulna, although plate prominence and subsequent need for hardware removal remain a relatively common complication.