ObjectiveTo systematically review the research status and clinical progress of ulnar shortening osteotomy (USO) in the treatment of ulnar impaction syndrome (UIS). MethodsDomestic 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. ResultsUSO 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. ConclusionUSO 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.