Abstract:[Objective] To compare the clinical efficacy of ulnar oblique shortening osteotomy versus the osteotomy combined with wristarthroscopic debridement and repair in the treatment of ulnar impaction syndrome. [Methods] A retrospective study was performed on 40 pa-tients who received surgical treatment for ulnar impaction syndrome in our hospital from June 2014 to June 2021. Based on doctor-patientcommunication, 20 patients underwent simple oblique-shortening osteotomy of ulna (shortening group), while the remaining 20 patients un-derwent oblique-shortening osteotomy of ulna combined with wrist arthroscopy (combination group). The perioperative, follow-up and imag-ing data were compared between the two groups. [Results] All patients in both groups had operation performed successfully. The shorteninggroup proved significant better than the combination group regarding operation time [(61.3±17.4) min vs (119.5±29.4) min, P＜0.05], incisionlength [(6.2±1.6) cm vs (8.4±2.1) cm, P＜0.05] and blood loss [(48.3±9.3) ml vs (61.3±10.2) ml, P＜0.05], whereas no significant differences inintraoperative fluoroscopy times, length of stay, incision healing time and active activity time between the two groups (P＞0.05). The followupperiod lasted for 12 to 30 months, and there was no significant difference in the time to resume full weight-bearing activities between thetwo groups (P＞0.05). the VAS score, modified Mayo score, carpal palmar flexion-dorsalis extension, ulnar-radial deviation, and pronationsupinationrange of motion (ROM) significantly improved in both groups over time (P＜0.05). The combination group was significantly betterthan the shortening group in terms of VAS [6 months postoperatively (1.9±0.9) vs (2.7±1.3), P＜0.05; the last follow-up (1.5±1.1) vs (2.5±1.2),P＜0.05], Mayo score [6 months postoperatively (86.2±10.3) vs (78.3±9.5), P＜0.05; the last follow-up (87.5±7.0) vs (80.5±10.4), P＜0.05].However, there was no significant differences in ROMs between the two groups at any time points accordingly (P＞0.05). Radiographically, ul-nar variation length and lateral radioulnar space were significantly improved in both groups immediately after surgery (P＜0.05), whereas which were not significantly different between the two groups at any corresponding time points (P＞0.05). [Conclusion] Compared with thesimple oblique-shortening osteotomy of ulna, the osteotomy combined with wrist arthroscopic surgery does better relieve the pain and re-store the wrist function.