Reverse Wafer Procedure for Ulnar Impaction Syndrome

Ulnar impaction syndrome occurs when excessive load across the ulnocarpal joints results in pathologic changes, especially over the articular surface of the ulnar head and proximal ulnar corner of the lunate. The 2 main surgical options in ulnar impaction syndrome are ulnar shortening osteotomy and wafer procedure, whether open or arthroscopically, to decompress the ulnocarpal joint load. However, all of these techniques have their shortcomings and drawbacks. The current study demonstrates a novel technique to decompress the ulnocarpal joint load: the “reverse wafer procedure” for ulnar impaction syndrome. In this surgical technique, we resected the proximal ulnar side of the lunate instead of partial resection of the thin wafer of the distal ulnar head dome in the standard wafer procedure. This technique avoids iatrogenic central tear of triangular fibrocartilage and distal radioulnar joint portal arthroscopy, which is technically demanding while preserving the distal radioulnar joint.