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. 2023 Nov 7;14(2):170-176.
doi: 10.1055/s-0043-1775799. eCollection 2025 Apr.

Arthroscopic Wafer Procedure for Ulnar Impaction Syndrome in an Intact Triangular Fibrocartilage Complex

Muntasir Mannan Choudhury  1   2   3 , Suraj Sajeev  1 , Brandon Yew Bao Sheng  1 , Dashishka Thanuranga Wijetunga  1 , Andrew Yuan Hui Chin  1   2   3
Affiliations

Arthroscopic Wafer Procedure for Ulnar Impaction Syndrome in an Intact Triangular Fibrocartilage Complex

Muntasir Mannan Choudhury et al. J Wrist Surg. .

Abstract

Ulnocarpal impaction or ulnar abutment symptom occurs secondary to abnormal load bearing on the ulnar side of the wrist leading to pain symptoms and degeneration of the structures of the ulnocarpal joint. The two classical surgical methods used to address this problem are ulnar shortening osteotomy and the wafer procedure, which can either be open or arthroscopic. With the advent of arthroscopy, with surgeon harboring arthroscopy skills, arthroscopic wafer resection has been intensely popularized which requires a central perforation of the triangular fibrocartilage to approach the ulna dome through the ulnocarpal joint. So, what happens in symptomatic patients with ulnocarpal abutment with an intact triangular fibrocartilage complex who have failed conservative management. Do we perform an open procedure or do we create a perforation in the central disc of the triangular fibrocartilage complex to expose the ulnar dome? Or do we just do an ulnar shortening osteotomy? Here, we describe our arthroscopic technique of conducting arthroscopy in the narrow confines of the space below the triangular fibrocartilage complex above the ulnar dome to carry out an arthroscopic wafer procedure in a triangular fibrocartilage complex with no central perforation. The procedure can produce results similar to those of the classical arthroscopic wafer procedure described explicitly in the literature.

Keywords: abutment; arthroscopy; complex; intact triangular fibrocartilage; neutral variance; ulnar impaction; wafer.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Plain radiograph of the wrist showing ulnar neutral variance.
Fig. 2
Fig. 2
Coronal section of the MRI showing lunate edema, cartilage loss, and chondromalacia secondary to ulnar impaction.
Fig. 3
Fig. 3
Scope view from the 3–4 portal showing lunate cartilage loss over the inferior pole.
Fig. 4
Fig. 4
The scope as inserted for viewing through the distal DRUJ portal.
Fig. 5
Fig. 5
Using a green needle to confirm the site of creation of the mid-DRUJ portal. Placement confirmed by fluoroscopy.
Fig. 6
Fig. 6
Though this picture shows the scope and shaver position after it has been interchanged, it emphasizes the holding of the instruments for fine control.
Fig. 7
Fig. 7
Scope view from the distal DRUJ portal with it turned more than 90 degrees clockwise to view the dorsoradial aspect of the ulnar dome (see arrow at 5′ o clock position).
Fig. 8
Fig. 8
The relative positions of the mid- and distal DRUJ portals after the scope and instrument positions have been switched.
Fig. 9
Fig. 9
Radiograph images comparing pre and post resection. Arthroscopic view of the resected dome of the ulna.
See this image and copyright information in PMC

References

    1. Viegas S F, Ballantyne G. Attritional lesions of the wrist joint. J Hand Surg Am. 1987;12(06):1025–1029. - PubMed
    1. Friedman S L, Palmer A K, Short W H, Levinsohn E M, Halperin L S. The change in ulnar variance with grip. J Hand Surg Am. 1993;18(04):713–716. - PubMed
    1. Friedman S L, Palmer A K. The ulnar impaction syndrome. Hand Clin. 1991;7(02):295–310. - PubMed
    1. Palmer A K, Glisson R R, Werner F W. Relationship between ulnar variance and triangular fibrocartilage complex thickness. J Hand Surg Am. 1984;9(05):681–682. - PubMed
    1. Tomaino M M. Ulnar impaction syndrome in the ulnar negative and neutral wrist. Diagnosis and pathoanatomy. J Hand Surg [Br] 1998;23(06):754–757. - PubMed