Ulnar Shortening Osteotomy Versus the Wafer Procedure in the Treatment of Idiopathic Ulnar Impaction Syndrome: A Systematic Review and Meta-Analysis

Purpose: Ulnar impaction syndrome is a common cause of ulnar wrist pain. The purpose of this study was to determine whether there are any differences between ulnar shortening osteotomy (USO) and the wafer procedure (WP) in terms of clinical outcomes, radiologic outcome, and postoperative complication rate by means of a systematic literature review and meta-analysis. Materials and Methods: MEDLINE, Embase, and the Cochrane Library were searched systematically for studies published before August 22, 2021, that compared USO and the WP for ulnar impaction syndrome. The pooled analysis was designed to compare the visual analog scale pain score, Disabilities of the Arm, Shoulder and Hand score, modified Mayo score, postoperative ulnar variance, and complication rate between USO and WP. Results: The initial literature search yielded 72 articles. After applying our inclusion and exclusion criteria, 5 studies were eligible for the qualitative and quantitative data syntheses. Surgical indications for performing USO or WP were similar in all patients with idiopathic ulnar impaction syndrome. There were no significant differences in the visual analog scale score (P = .73), Disabilities of the Arm, Shoulder and Hand score (P = .09), modified Mayo score (Positive outcome, P = .85/Negative outcome, P = .39), postoperative ulnar variance (P = .29), and complications, other than implant irritation (P = .42), between the USO and WP groups. However, overall complication rate was higher in patients treated with USO (P < .05). Conclusions: The WP and USO for idiopathic ulnar impaction syndrome achieve similar clinical and radiologic outcomes. Although overall complications are significantly more frequent in patients treated with USO, complications not including implant irritation are similar in both groups. (c) 2024 by the American Society for Surgery of the Hand. All rights reserved.) Type of study/level of evidence Therapeutic IV.