The purpose of this study was to retrospectively analyze the clinical features and surgical outcomes of a distinct subgroup of patients who underwent sequential bilateral ulnar shortening osteotomy with arthroscopic triangular fibrocartilage complex (TFCC) foveal repair for ulnar impaction syndrome (UIS) associated with distal radioulnar joint (DRUJ) instability, with a particular focus on the development of contralateral symptoms following initial unilateral surgery.

A retrospective review was conducted of 26 patients who underwent bilateral ulnar shortening osteotomy with TFCC foveal repair between 2015 and 2022, with at least 2 years of follow-up for each wrist. The inclusion criteria were radiologically positive ulnar variance (≥3 mm), arthroscopic evidence of lunate chondromalacia, definitive foveal TFCC detachment, and DRUJ instability in both wrists.

In 88% of the patients, the initial surgery was performed on the dominant side with the mean age of 34.08 years. All preoperative statuses improved at the final follow-up. Subsequent surgeries were conducted on the contralateral side with a mean interval of 15.7 months. At follow-up, significant improvement from the preoperative status was observed, while the contralateral surgery group showed less preoperative deterioration in grip strength, VAS, MMWS, and DASH scores than at the initial surgery. However, both groups showed comparable improvements in all outcome measures at the final follow-up.

Sequential bilateral ulnar shortening osteotomy with TFCC foveal repair yielded consistently favorable outcomes, regardless of surgical side or baseline functional deficit. The interval between surgeries and the absence of a history of trauma suggest that contralateral pathology may develop in the context of degenerative changes, potentially influenced by compensatory overuse during postoperative recovery.

Level IV, retrospective case series.