Reverse Wafer Procedure

Purpose  This study aimed to present the results of an alternative technique for treating ulnar impaction syndrome, the "reverse wafer procedure," and assess the mid-term clinical outcomes of patients treated with this technique. Methods  A retrospective evaluation was conducted on 14 patients who underwent the reverse wafer procedure for ulnar impaction syndrome between 2013 and 2020. The inclusion criteria for the study were persistent ulnar-sided wrist pain, even after a minimum of 3 months of nonoperative treatment, the presence of a chondral lesion on the lunate, and an intact triangular fibrocartilage complex (TFCC) based on arthroscopic evaluation. Postoperative clinical and subjective functional outcomes were assessed using measures such as wrist range of motion (ROM), grip strength, the Turkish version of the quick disabilities of the arm, shoulder, and hand questionnaire (Quick DASH), and pain levels measured on a visual analog scale (VAS) and were compared with preoperative values. Patient satisfaction was also evaluated postoperatively. Results  The mean follow-up period was 42.2 months (range: 24-68 months). Postoperatively, none of the patients experienced any restriction in ROM. Grip measurements significantly increased after the surgery ( p  = 0.003). Preoperatively, the patients had a grip strength of 41.14 kg (range 28-48 kg), which improved to 44 kg (range 30-52 kg) postoperatively. Postoperative VAS values and QDASH scores significantly decreased compared with the preoperative values ( p  < 0.001, p  = 0.001). The mean VAS score decreased from 6.1 (range 4-8) preoperatively to 0.9 (range 0-5) postoperatively. The mean Quick DASH score decreased from 49.44 (range 25-68.3) preoperatively to 10.13 (range 3.3-36) postoperatively. When asked about their satisfaction with the operation, 13 out of 14 patients reported being highly satisfied with the results. Conclusions  The reverse wafer procedure presents an alternative treatment option for ulnar impaction syndrome in cases where the TFCC is intact. The mid-term results of this described technique are promising. However, further comparative studies with longer follow-ups are necessary to support these findings. Level of Evidence  IV Therapeutic.