Arthroscopic Wafer Procedure

Hi everyone

I couldn't find any thread with this topic, so I created this one. 

It is a long shot, but here it goes:

I was diagnosed with positive Ulnar variance on my strong hand (right one) and at first consultation, I was told by the doctor that ulnar osteotomy would be the answer to my problem (I'm not a climber but I seem to suffer from the same type of pain). In the meantime (and after several consultations with different surgeons), I realized that the best for me is an arthroscopic wafer procedure (basically shortening the ulnar but at the top, close to the articulation instead of in the middle of the arm).

Most surgeons I talked to say "they can do it". But none seems to want to share how many they usually do! And one or other surgeon admits that it is not a very common surgery.

SO: I am now looking for THE surgeon that performs this surgery. I need someone that is experienced enough and can give me some guarantees when going under the knife.

Did anyone experience this or knows someone that also had to undergo the same surgery?

Any answer will be appreciated!

PS: I'm based in Switzerland, so I would prefer a surgeon based anywhere in Europe.

My 2 cents, as a surgeon. You should definitely find someone with experience with the procedure. However, the docs who give you "guarantees" aren't usually the ones you want operating on you. A good surgeon will know that there aren't any guarantees in medicine and even with a high success rate sometimes things don't work out. A surgeon who gives you guarantees is trying to get your business. 

Hey Marco, I am in Switzerland and was diagnosed with the same issue some time ago. For some time I was in a lot of pain, but acute symptoms disappeared after a cortisone injection. I get inflammations from time to time but have since decided not to seek surgery if possible. 

Why do you think the arthroscopic procedure is better? I spoke with two different orthopedic surgeons specializing on hand/wrist surgery, both recommended getting ulnar shortening surgery for treatment if I was chosing to get surgery. One of them strongly discouraged the arthroscopic procedure. Not sure if I can be of much help as I ultimately decided against surgery, but feel free to write me directly for more info.

Hi Daniel and Pino

Apologies for a late reply, life got in the way!

In the meantime, I have had surgery: wafer procedure, together with stitching of the ligaments between lunate and triquetrum. This took place last Thursday and I am now typing with my left hand... very slow and tiring...!

So far I can't tell if it was the right decision or not, but I definitely looked for the surgeon with most experience I could find. And although independently of where he/she was based, I narrowed down the search to Europe and I ended up in Italy, with Dr.Andrea Atzei. He never gave me guarantees but at least I found out that he had enough "flight hours" on his CV with arthroscopic surgery. And I got to see what he was doing in a display at the same time as I discussed with him, while lying down on the OR!. I got a good feeling about him and that also accounted for the decision to choose him.

Ulnar osteotomy was my first choice, unfortunately my DRUJ has a very particular shape (oblique interface instead of a parallel one). Reducing the ulnar length would bring a lot of mechanical pressure on it, resulting in a premature disruption of the joint and bringing me to the OR again and much earlier than the wafer procedure could/can.

Cortisone injection could have been an option for me, since I waited for two years to do this surgery (including reflecting if I should do it or not, consulting with 9 different surgeons, assessing risks and benefits). But at the end, my cartilage was diagnosed as almost fully destroyed (confirmed during the procedure) and so, the arthroscopic wafer procedure ended up being the logic solution. Additionally, the outcomes that I found in literature showed better results with wafer than the osteotomy.

In a couple of weeks, I'll be free of the cast that is preventing me from moving both elbow and wrist and I will be starting with physiotherapy. Hopefully, I will have good news soon.

Not sure this helps anyone. Hopefully, it does!

Marco M wrote:

Hi Daniel and Pino

Apologies for a late reply, life got in the way!

In the meantime, I have had surgery: wafer procedure, together with stitching of the ligaments between lunate and triquetrum. This took place last Thursday and I am now typing with my left hand... very slow and tiring...!

So far I can't tell if it was the right decision or not, but I definitely looked for the surgeon with most experience I could find. And although independently of where he/she was based, I narrowed down the search to Europe and I ended up in Italy, with Dr.Andrea Atzei. He never gave me guarantees but at least I found out that he had enough "flight hours" on his CV with arthroscopic surgery. And I got to see what he was doing in a display at the same time as I discussed with him, while lying down on the OR!. I got a good feeling about him and that also accounted for the decision to choose him.

Ulnar osteotomy was my first choice, unfortunately my DRUJ has a very particular shape (oblique interface instead of a parallel one). Reducing the ulnar length would bring a lot of mechanical pressure on it, resulting in a premature disruption of the joint and bringing me to the OR again and much earlier than the wafer procedure could/can.

Cortisone injection could have been an option for me, since I waited for two years to do this surgery (including reflecting if I should do it or not, consulting with 9 different surgeons, assessing risks and benefits). But at the end, my cartilage was diagnosed as almost fully destroyed (confirmed during the procedure) and so, the arthroscopic wafer procedure ended up being the logic solution. Additionally, the outcomes that I found in literature showed better results with wafer than the osteotomy.

In a couple of weeks, I'll be free of the cast that is preventing me from moving both elbow and wrist and I will be starting with physiotherapy. Hopefully, I will have good news soon.

Not sure this helps anyone. Hopefully, it does!

Would love to know how you’re doing now. I’m having a hard time deciding what I want to do with my wrist 

Marco M wrote:

Hi Daniel and Pino

Apologies for a late reply, life got in the way!

In the meantime, I have had surgery: wafer procedure, together with stitching of the ligaments between lunate and triquetrum. This took place last Thursday and I am now typing with my left hand... very slow and tiring...!

So far I can't tell if it was the right decision or not, but I definitely looked for the surgeon with most experience I could find. And although independently of where he/she was based, I narrowed down the search to Europe and I ended up in Italy, with Dr.Andrea Atzei. He never gave me guarantees but at least I found out that he had enough "flight hours" on his CV with arthroscopic surgery. And I got to see what he was doing in a display at the same time as I discussed with him, while lying down on the OR!. I got a good feeling about him and that also accounted for the decision to choose him.

Ulnar osteotomy was my first choice, unfortunately my DRUJ has a very particular shape (oblique interface instead of a parallel one). Reducing the ulnar length would bring a lot of mechanical pressure on it, resulting in a premature disruption of the joint and bringing me to the OR again and much earlier than the wafer procedure could/can.

Cortisone injection could have been an option for me, since I waited for two years to do this surgery (including reflecting if I should do it or not, consulting with 9 different surgeons, assessing risks and benefits). But at the end, my cartilage was diagnosed as almost fully destroyed (confirmed during the procedure) and so, the arthroscopic wafer procedure ended up being the logic solution. Additionally, the outcomes that I found in literature showed better results with wafer than the osteotomy.

In a couple of weeks, I'll be free of the cast that is preventing me from moving both elbow and wrist and I will be starting with physiotherapy. Hopefully, I will have good news soon.

Not sure this helps anyone. Hopefully, it does!

Would love to know how you’re doing now. I’m having a hard time deciding what I want to do with my wrist 

Would also be interested to know how you are doing. My wrist is acting up from time to time but mostly ok.