Research status and clinical progress of ulnar shortening osteotomy for ulnar impaction syndrome_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WAN Yushan ,  ZHANG Jun , LI Yuqi

Department of Orthopedics, the Second Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650101, P. R. China;

Corresponding?author：

ZHANG Jun, Email: hxzhangjun08@163.com

Keywords：

Ulnar impaction syndrome; ulnar shortening osteotomy; triangular fibrocartilage complex; clinical progress; research status

DOI：

10.7507/1002-1892.202603042

Video：

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Objective To systematically review the research status and clinical progress of ulnar shortening osteotomy (USO) in the treatment of ulnar impaction syndrome (UIS). Methods Domestic and foreign literatures about USO in the treatment of UIS were extensively reviewed, and the morbidity mechanism of UIS, biomechanical principles of USO, methods of osteotomy, digital and arthroscopic techniques, and prevention of postoperative complications were comprehensively analyzed and summarized. Results USO alleviates the abnormal load of the ulnar head on the carpal bone through biomechanical mechanism, which is regarded as the “gold standard” for the treatment of UIS, and can significantly improve the wrist function and relieve pain. With the progress of technology, osteotomy has evolved from traditional transverse osteotomy to oblique, stepped and metaphyseal minimally invasive osteotomy, and the application of compression plate has effectively reduced the incidence of bone nonunion. The introduction of three-dimensional printing guide plate and wrist arthroscopy technology has promoted the development of minimally invasive and precise surgery. However, the irritation of internal fixation and long healing time are still clinical challenges to be solved. Conclusion USO is effective in the treatment of UIS, but there is still a certain risk of complications. Future research should focus on the precise quantification of the length of individualized osteotomy, the deepening of minimally invasive concept and the development of new biomaterial fixation devices, in order to further optimize postoperative recovery and reduce the rate of secondary surgery.

Citation： WAN Yushan, ZHANG Jun, LI Yuqi. Research status and clinical progress of ulnar shortening osteotomy for ulnar impaction syndrome. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(9): 1438-1443. doi: 10.7507/1002-1892.202603042 Copy

1.	Bell MJ, Hill RJ, McMurtry RY. Ulnar impingement syndrome[J]. J Bone Joint Surg (Br), 1985, 67(1): 126-129.
2.	Palmer AK. The distal radioulnar joint. Anatomy, biomechanics, and triangular fibrocartilage complex abnormalities[J]. Hand Clin, 1987, 3(1): 31-40.
3.	Palmer AK, Werner FW. The triangular fibrocartilage complex of the wrist—anatomy and function[J]. J Hand Surg (Am), 1981, 6(2): 153-162.
4.	Feldon P, Terrono AL, Belsky MR. Wafer distal ulna resection for triangular fibrocartilage tears and/or ulna impaction syndrome[J]. J Hand Surg (Am), 1992, 17(4): 731-737.
5.	Mesas Aranda I, Haas-Lützenberger EM, Imam S, et al. Algorithm-guided treatment of ulna impaction syndrome: A 10-year follow-up study of ulna shortening osteotomy and wafer procedure[J/OL]. J Clin Med, 2024, 13(13): 3972. doi: 10.3390/jcm13133972.
6.	Chun S, Palmer AK. The ulnar impaction syndrome: follow-up of ulnar shortening osteotomy[J]. J Hand Surg (Am), 1993, 18(1): 46-53.
7.	Xu W, Ho PC, Nakamura T, et al. Guidelines for the diagnosis and treatment of ulnar impaction syndrome (2024)[J]. J Wrist Surg, 2025, 14(1): 2-13.
8.	Valentini M, Kalcher E, Z?tsch S, et al. Ulnar shortening osteotomy for ulna impaction syndrome with positive ulnar variance: retrospective outcome analysis[J]. Acta Orthop, 2025, 96: 235-242.
9.	Shin EK. Impaction syndromes about the wrist[J]. Curr Rev Musculoskelet Med, 2023, 16(1): 1-8.
10.	Cerezal L, del Pi?al F, Abascal F, et al. Imaging findings in ulnar-sided wrist impaction syndromes[J]. Radiographics, 2002, 22(1): 105-121.
11.	Tatebe M, Nishizuka T, Hirata H, et al. Ulnar shortening osteotomy for ulnar-sided wrist pain[J]. J Wrist Surg, 2014, 3(2): 77-84.
12.	Papatheodorou LK, Sotereanos DG. Step-cut ulnar shortening osteotomy for ulnar impaction syndrome[J/OL]. JBJS Essent Surg Tech, 2017, 7(1): e3. doi: 10.2106/JBJS.ST.16.00062.
13.	Kim KW, Kim JH, Lim HR, et al. Outcomes of ulnar shortening osteotomy with an intramedullary bone graft for idiopathic ulnar impaction syndrome[J]. Clin Orthop Surg, 2024, 16(2): 313-321.
14.	Liu Y, Li X, Su X, et al. A modified partial wedge-shaped metaphyseal ulnar osteotomy for the treatment of ulnar impaction syndrome with reverse oblique sigmoid notch[J]. J Hand Surg (Eur Vol), 2025, 50(2): 228-237.
15.	Chen KL, Yin CY, Huang HK, et al. Enabling the design of surgical instruments for under-resourced patients through metal additive manufacturing: ulnar shortening osteotomy as an example[J/OL]. 3D Print Med, 2024, 10(1): 18. doi: 10.1186/s41205-024-00220-3.
16.	Lu C, Wang P, Zhang L, et al. Clinical study of wrist arthroscopy combined with oblique ulnar shortening osteotomy in the treatment of ulnar impaction syndrome[J]. Orthop Surg, 2022, 14(11): 2947-2954.
17.	Schmidle G, Kastenberger T, Arora R. Time-dependent recovery of outcome parameters in ulnar shortening for positive ulnar variance: A prospective case series[J]. Hand (N Y), 2018, 13(2): 215-222.
18.	Teunissen JS, van der Oest MJW, Selles RW, et al. Long-term outcomes after ulna shortening osteotomy: a mean follow-up of six years[J]. Bone Jt Open, 2022, 3(5): 375-382.
19.	Slade JF 3rd, Gillon TJ. Osteochondral shortening osteotomy for the treatment of ulnar impaction syndrome: a new technique[J]. Tech Hand Up Extrem Surg, 2007, 11(1): 74-82.
20.	Hammert WC, Williams RB, Greenberg JA. Distal metaphyseal ulnar-shortening osteotomy: surgical technique[J]. J Hand Surg (Am), 2012, 37(5): 1071-1077.
21.	Sennwald G, Della Santa D, Beaulieu JY. A comparison of diaphyseal and metaphyseal techniques of ulna shortening[J]. J Hand Surg (Eur Vol), 2013, 38(5): 542-549.
22.	Oh W, Kang H, Chun Y, et al. Arthroscopic wafer procedure versus ulnar shortening osteotomy as a surgical treatment for idiopathic ulnar impaction syndrome[J]. Arthroscopy, 2018, 34(2): 421-430.
23.	Shi H, Huang Y, Shen Y, et al. Arthroscopic wafer procedure versus ulnar shortening osteotomy for ulnar impaction syndrome: a systematic review and meta-analysis[J/OL]. J Orthop Surg Res, 2024, 19(1): 149. doi: 10.1186/s13018-024-04611-4.
24.	Teunissen JS, Wouters RM, Al Shaer S, et al. Outcomes of ulna shortening osteotomy: a cohort analysis of 106 patients [J/OL]. J Orthop Traumatol, 2022, 23(1): 1. doi: 10.1186/s10195-021-00621-8.
25.	Owens J, Compton J, Day M, et al. Nonunion rates among ulnar-shortening osteotomy for ulnar impaction syndrome: A systematic review[J/OL]. J Hand Surg (Am), 2019, 44(7): 612. e1-612. e12. doi: 10.1016/j.jhsa.2018.08.018.
26.	Pereira GF, Fletcher AN, O’Donnell JA, et al. Ulnar resection length: A risk factor for nonunion in ulnar shortening osteotomy[J]. Hand (N Y), 2024, 19(1): 74-81.
27.	Teunissen JS, Al Shaer S, van der Heijden BPA, et al. The association between plate location and hardware removal following ulna shortening osteotomy: a cohort study[J]. J Hand Surg (Eur Vol), 2022, 47(8): 831-838.
28.	Rajgopal R, Roth J, King G, et al. Outcomes and complications of ulnar shortening osteotomy: an institutional review[J]. Hand (N Y), 2015, 10(3): 535-540.
29.	Tolat AR, Stanley JK, Trail IA. A cadaveric study of the anatomy and stability of the distal radioulnar joint in the coronal and transverse planes[J]. J Hand Surg (Br), 1996, 21(5): 587-594.
30.	Gilbert F, Jakubietz RG, Meffert RH, et al. Does distal radio-ulnar joint configuration affect postoperative functional results after ulnar shortening osteotomy[J/OL]? Plast Reconstr Surg Glob Open, 2018, 6(4): e1760. doi: 10.1097/GOX.0000000000001760.
31.	Ha JW, Kwon YW, Lee S, et al. Is ulnar shortening osteotomy or the wafer procedure better for ulnar impaction syndrome?: A systematic review and meta-analysis[J/OL]. Medicine (Baltimore), 2023, 102(39): e35141. doi: 10.1097/MD.0000000000035141.
32.	尺骨撞擊綜合征診斷與治療指南亞太腕關節協會專家制訂小組. 尺骨撞擊綜合征診斷與治療指南(2024)[J]. 中國修復重建外科雜志, 2026, 40(9): 1325-1335.
33.	Dong Z, Yang S, Zhao Y, et al. Improved perioperative outcomes and early functional recovery with 3D-printed osteotomy guide plates in ulnar shortening osteotomy: A retrospective study[J/OL]. J Exp Orthop, 2025, 12(4): e70553. doi: 10.1002/jeo2.70553.
34.	Zhang C, Dai L. Biomechanical evaluation of plate positioning in ulnar shortening osteotomy for nonunion prevention[J]. Proc Inst Mech Eng H, 2026, 240(1): 25-33.

1. Bell MJ, Hill RJ, McMurtry RY. Ulnar impingement syndrome[J]. J Bone Joint Surg (Br), 1985, 67(1): 126-129.
2. Palmer AK. The distal radioulnar joint. Anatomy, biomechanics, and triangular fibrocartilage complex abnormalities[J]. Hand Clin, 1987, 3(1): 31-40.
3. Palmer AK, Werner FW. The triangular fibrocartilage complex of the wrist—anatomy and function[J]. J Hand Surg (Am), 1981, 6(2): 153-162.
4. Feldon P, Terrono AL, Belsky MR. Wafer distal ulna resection for triangular fibrocartilage tears and/or ulna impaction syndrome[J]. J Hand Surg (Am), 1992, 17(4): 731-737.
5. Mesas Aranda I, Haas-Lützenberger EM, Imam S, et al. Algorithm-guided treatment of ulna impaction syndrome: A 10-year follow-up study of ulna shortening osteotomy and wafer procedure[J/OL]. J Clin Med, 2024, 13(13): 3972. doi: 10.3390/jcm13133972.
6. Chun S, Palmer AK. The ulnar impaction syndrome: follow-up of ulnar shortening osteotomy[J]. J Hand Surg (Am), 1993, 18(1): 46-53.
7. Xu W, Ho PC, Nakamura T, et al. Guidelines for the diagnosis and treatment of ulnar impaction syndrome (2024)[J]. J Wrist Surg, 2025, 14(1): 2-13.
8. Valentini M, Kalcher E, Z?tsch S, et al. Ulnar shortening osteotomy for ulna impaction syndrome with positive ulnar variance: retrospective outcome analysis[J]. Acta Orthop, 2025, 96: 235-242.
9. Shin EK. Impaction syndromes about the wrist[J]. Curr Rev Musculoskelet Med, 2023, 16(1): 1-8.
10. Cerezal L, del Pi?al F, Abascal F, et al. Imaging findings in ulnar-sided wrist impaction syndromes[J]. Radiographics, 2002, 22(1): 105-121.
11. Tatebe M, Nishizuka T, Hirata H, et al. Ulnar shortening osteotomy for ulnar-sided wrist pain[J]. J Wrist Surg, 2014, 3(2): 77-84.
12. Papatheodorou LK, Sotereanos DG. Step-cut ulnar shortening osteotomy for ulnar impaction syndrome[J/OL]. JBJS Essent Surg Tech, 2017, 7(1): e3. doi: 10.2106/JBJS.ST.16.00062.
13. Kim KW, Kim JH, Lim HR, et al. Outcomes of ulnar shortening osteotomy with an intramedullary bone graft for idiopathic ulnar impaction syndrome[J]. Clin Orthop Surg, 2024, 16(2): 313-321.
14. Liu Y, Li X, Su X, et al. A modified partial wedge-shaped metaphyseal ulnar osteotomy for the treatment of ulnar impaction syndrome with reverse oblique sigmoid notch[J]. J Hand Surg (Eur Vol), 2025, 50(2): 228-237.
15. Chen KL, Yin CY, Huang HK, et al. Enabling the design of surgical instruments for under-resourced patients through metal additive manufacturing: ulnar shortening osteotomy as an example[J/OL]. 3D Print Med, 2024, 10(1): 18. doi: 10.1186/s41205-024-00220-3.
16. Lu C, Wang P, Zhang L, et al. Clinical study of wrist arthroscopy combined with oblique ulnar shortening osteotomy in the treatment of ulnar impaction syndrome[J]. Orthop Surg, 2022, 14(11): 2947-2954.
17. Schmidle G, Kastenberger T, Arora R. Time-dependent recovery of outcome parameters in ulnar shortening for positive ulnar variance: A prospective case series[J]. Hand (N Y), 2018, 13(2): 215-222.
18. Teunissen JS, van der Oest MJW, Selles RW, et al. Long-term outcomes after ulna shortening osteotomy: a mean follow-up of six years[J]. Bone Jt Open, 2022, 3(5): 375-382.
19. Slade JF 3rd, Gillon TJ. Osteochondral shortening osteotomy for the treatment of ulnar impaction syndrome: a new technique[J]. Tech Hand Up Extrem Surg, 2007, 11(1): 74-82.
20. Hammert WC, Williams RB, Greenberg JA. Distal metaphyseal ulnar-shortening osteotomy: surgical technique[J]. J Hand Surg (Am), 2012, 37(5): 1071-1077.
21. Sennwald G, Della Santa D, Beaulieu JY. A comparison of diaphyseal and metaphyseal techniques of ulna shortening[J]. J Hand Surg (Eur Vol), 2013, 38(5): 542-549.
22. Oh W, Kang H, Chun Y, et al. Arthroscopic wafer procedure versus ulnar shortening osteotomy as a surgical treatment for idiopathic ulnar impaction syndrome[J]. Arthroscopy, 2018, 34(2): 421-430.
23. Shi H, Huang Y, Shen Y, et al. Arthroscopic wafer procedure versus ulnar shortening osteotomy for ulnar impaction syndrome: a systematic review and meta-analysis[J/OL]. J Orthop Surg Res, 2024, 19(1): 149. doi: 10.1186/s13018-024-04611-4.
24. Teunissen JS, Wouters RM, Al Shaer S, et al. Outcomes of ulna shortening osteotomy: a cohort analysis of 106 patients [J/OL]. J Orthop Traumatol, 2022, 23(1): 1. doi: 10.1186/s10195-021-00621-8.
25. Owens J, Compton J, Day M, et al. Nonunion rates among ulnar-shortening osteotomy for ulnar impaction syndrome: A systematic review[J/OL]. J Hand Surg (Am), 2019, 44(7): 612. e1-612. e12. doi: 10.1016/j.jhsa.2018.08.018.
26. Pereira GF, Fletcher AN, O’Donnell JA, et al. Ulnar resection length: A risk factor for nonunion in ulnar shortening osteotomy[J]. Hand (N Y), 2024, 19(1): 74-81.
27. Teunissen JS, Al Shaer S, van der Heijden BPA, et al. The association between plate location and hardware removal following ulna shortening osteotomy: a cohort study[J]. J Hand Surg (Eur Vol), 2022, 47(8): 831-838.
28. Rajgopal R, Roth J, King G, et al. Outcomes and complications of ulnar shortening osteotomy: an institutional review[J]. Hand (N Y), 2015, 10(3): 535-540.
29. Tolat AR, Stanley JK, Trail IA. A cadaveric study of the anatomy and stability of the distal radioulnar joint in the coronal and transverse planes[J]. J Hand Surg (Br), 1996, 21(5): 587-594.
30. Gilbert F, Jakubietz RG, Meffert RH, et al. Does distal radio-ulnar joint configuration affect postoperative functional results after ulnar shortening osteotomy[J/OL]? Plast Reconstr Surg Glob Open, 2018, 6(4): e1760. doi: 10.1097/GOX.0000000000001760.
31. Ha JW, Kwon YW, Lee S, et al. Is ulnar shortening osteotomy or the wafer procedure better for ulnar impaction syndrome?: A systematic review and meta-analysis[J/OL]. Medicine (Baltimore), 2023, 102(39): e35141. doi: 10.1097/MD.0000000000035141.
32. 尺骨撞擊綜合征診斷與治療指南亞太腕關節協會專家制訂小組. 尺骨撞擊綜合征診斷與治療指南(2024)[J]. 中國修復重建外科雜志, 2026, 40(9): 1325-1335.
33. Dong Z, Yang S, Zhao Y, et al. Improved perioperative outcomes and early functional recovery with 3D-printed osteotomy guide plates in ulnar shortening osteotomy: A retrospective study[J/OL]. J Exp Orthop, 2025, 12(4): e70553. doi: 10.1002/jeo2.70553.
34. Zhang C, Dai L. Biomechanical evaluation of plate positioning in ulnar shortening osteotomy for nonunion prevention[J]. Proc Inst Mech Eng H, 2026, 240(1): 25-33.

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