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Total Wrist Fusion

Surgeon-side topic for wrist fusion. Backed by 424 articles from the corpus, retrieved via combined MeSH + title-text matching.

117 citationsUpdated Oct 2026

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Overview

Total wrist arthrodesis is a definitive procedure for severe wrist joint destruction, particularly in rheumatoid arthritis, where it remains the gold standard for unstable, destroyed joints [2, 34]. It is performed nearly five times more frequently than total wrist arthroplasty [3]. While total wrist fusion should be reserved for exceptional circumstances in advanced carpal collapse such as SNAC or SLAC wrists [13], it serves as a reliable salvage option for failed wrist arthroplasty [14, 23, 36]. The decision between arthrodesis and arthroplasty hinges on the surgeon’s technical experience with newer implants, the patient’s ability to adhere to strict activity limitations, and the willingness to accept higher complication rates and eventual implant failure in exchange for preserved motion [39].

Outcomes are generally favorable, with patients reporting high satisfaction [5]. However, hand function is significantly diminished following fusion [5]. Short-term data suggest total wrist arthroplasty compares favorably with fusion [3], yet long-term outcomes for total wrist fusion are comparable and possibly better than arthroplasty in rheumatoid patients [37]. Both procedures are extremely cost-effective [153]. Although total wrist arthroplasty offers a more ambitious functional goal, it carries greater complication risks [34]. Consequently, total wrist arthrodesis remains the gold standard for salvage despite high complication rates [155].

Limited wrist fusions and motion-preserving procedures offer alternatives when indications are accurately respected and technique is well performed to prevent complications [6, 11]. A series of 28 selective limited arthrodeses, primarily intercarpal fusions, demonstrated good outcomes when basic principles were adhered to [11, 21]. Specific techniques, such as intramedullary rod fixation with proximal row carpectomy or nonspanning arthrodesis, provide reliable, efficient, and cost-effective options with high union rates and minimal carpometacarpal joint risk [4, 35]. Scaphotrapeziotrapezoid fusion is a viable option for high-demand young patients with significant pathology [26]. For patients with good range of motion, wrist denervation is a first-choice alternative [155].

Anatomy & Pathophysiology

Bony Anatomy

The wrist comprises eight carpal bones arranged in a proximal row (scaphoid, lunate, triquetrum, pisiform) and a distal row (trapezium, trapezoid, capitate, hamate) [71]. The capitate is the largest carpal bone and articulates with seven other bones, while the pisiform and trapezoid are the smallest [71]. The distal radius articular surface features two concave facets for the scaphoid and lunate, separated by a ridge corresponding to the scapholunate interval [76]. The sigmoid notch of the distal radius is a convex structure that allows articulation with the ulna [76]. The distal radius is oriented with an average of 11 degrees of volar tilt and 23 degrees of radial inclination [76]. Radial length, measured from the tip of the radial styloid to the ulnar articular surface, averages 13 mm [76].

Vascular Supply

The scaphoid's primary vascular supply is a branch of the radial artery at the dorsal ridge, with smaller vessels entering the palmar tubercle to supply the distal 30% [81]. The lunate has a dorsal and palmar vascular supply in 80% of wrists, while 20% have only a palmar supply [81]. The capitate head often relies on a retrograde vascular supply [81]. The pisiform is a sesamoid bone within the flexor carpi ulnaris tendon [81]. Terminal branches of the radial, ulnar, and anterior interosseous arteries provide extraosseous blood supply to the carpus through three dorsal and three palmar transverse arterial arches [84]. The dorsal intercarpal arch is the largest of the dorsal arches and supplies the distal carpal row [84]. The palmar intercarpal arch is the most variable and does not contribute to nutrient vessels in the carpus [84].

Ligaments and Soft Tissue

The triangular fibrocartilage complex (TFCC) consists of the central meniscus homolog, dorsal and volar radioulnar ligaments, the floor of the extensor carpi ulnaris tendon sheath, and volar ulnocarpal ligaments [81]. The dorsal and volar radioulnar ligaments are the primary stabilizers of the distal radioulnar joint [81]. Only the peripheral 10% to 40% of the volar, ulnar, and dorsal TFCC has a vascular supply [81]. The scapholunate interosseous ligament (SLIL) is C-shaped in the sagittal plane, with the dorsal third being the thickest and strongest portion [81]. The volar portion of the lunotriquetral ligament is the thickest [81].

Extrinsic carpal ligaments connect the radius or ulna to the carpus, with volar ligaments generally stronger than dorsal ligaments [77]. The radioscaphocapitate ligament connects to the waist of the scaphoid and limits ulnar translation of the carpus [77]. The long radiolunate ligament helps limit ulnar translocation of the carpus [77]. The short radiolunate ligament helps control lunate position [77]. The radioscapholunate ligament is a vascular conduit rather than a true ligament, also known as the ligament of Testut [77]. The dorsal radiocarpal ligament has a trapezoidal shape, passing from the dorsal rim of the distal radius to the lunate and triquetrum [77]. The dorsal intercarpal ligament passes from the dorsal tubercle of the triquetrum to the distal pole of the scaphoid [77].

The space of Poirier is a weak area adjacent to the proximal capitate without ligamentous attachment, situated ulnar to the radioscaphocapitate ligament and radial to the long radiolunate ligament [77]. The distal carpal row separates from the lunate through the space of Poirier during a perilunate dislocation [77].

Biomechanics and Kinematics

The wrist functions as a two-joint system linking the hand to the forearm around the mobile proximal carpal row [82]. The proximal carpal row has no muscular or tendinous attachments and acts as an intercalary segment [81]. With axial loading through the neutral wrist, approximately 80% of forces are transmitted through the distal radius and 20% through the distal ulna [81]. Of the force transmitted through the distal radius, 60% passes through the scaphoid facet and 40% through the lunate facet [81].

Approximately 62% of wrist extension occurs through the radiocarpal joint and 62% of wrist flexion occurs through the midcarpal joint [77]. The midcarpal joint is responsible for 20 degrees of radial deviation and 40 degrees of ulnar deviation [77]. The midcarpal joint is responsible for the "dart thrower's motion," which involves moving from radial extension into ulnar flexion [77]. During wrist flexion, the proximal row translates dorsally, while during wrist extension, it translates palmarly [77]. The joints within the proximal carpal row govern 35% of the wrist extension-flexion arc and 33% of the wrist radial-ulnar deviation arc [119]. Wrist ligaments coordinate the positioning of carpal bones in the mid-range of motion and restrict further motion in extreme positions [127]. The dart-thrower's motion is a unifying concept of functional wrist motion that is uniquely human [134].

Midcarpal arthrodesis adversely affects dart-throwing motion compared with radiocarpal arthrodesis [136]. A wrist joint is considered biomechanically unstable when it cannot bear loads and does not exhibit normal kinematics throughout its arc of motion [69]. The longitudinal 'columnar' concept of wrist kinematics does not fit with many recent findings related to carpal instabilities [70]. Computed fiber elongations in the dorsal carpal ligaments vary linearly with wrist position despite complex carpal anatomy [80]. Traction or distraction changes normal carpal kinematics, and combined motion with traction induces abnormal patterns of motion [85].

The radioscapholunate fusion exhibits the most biomechanically similar behavior to a healthy wrist among compared fusion types [50]. Wrist biomechanics are significantly altered following trapeziectomy, with LRTI reconstruction most closely resembling intact biomechanics in cadaveric models [73]. The experimental kinetic behavior of the chronic scapholunate advanced collapse (SLAC) wrist is similar to that of a recent scapholunate dissociation without carpal collapse [130]. Intercarpal arthrodeses prevent constant radiocarpal and midcarpal congruence during radioulnar deviation in normal wrists [140].

The primary function of the scapholunate interosseous ligament is to counteract the extension moment imparted by the lunotriquetral interosseous ligament by transferring the flexion moment from the scaphoid to the lunate [194]. The scapholunate interosseous ligament is strongest dorsally, where it is supported by the dorsal intercarpal and dorsal radial carpal ligaments [194]. Progressive rotatory subluxation of the scaphoid reduces the radio-scaphoid contact area, with a 44% reduction at 5 degrees of subluxation and a 77% reduction at 20 degrees [177]. At 20 degrees of scaphoid subluxation, the contact area shifts radially to the dorsal lip of the radial styloid [177]. The kinematic consequences of resecting the distal scaphoid include diminished flexion-extension motion of the proximal row during deviations at the expense of increased radioulnar translational motion [103]. Wrist range of motion within 20% extension and radial abduction to 50% flexion limits torque and lever force exacerbation between scaphoid fragments [126].

Classification

SLAC/SNAC Staging: Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) arthritis are staged 1–4 [38]. A modified classification defines Stage I as degenerative changes limited to the radial styloid/scaphoid articulation [60]. Stage II involves the entire radioscaphoid joint with mild or no changes at the capitolunate or radiolunate joint [60]. Stage IIIA presents with mild or no changes at the capitolunate joint and moderate to severe changes at the radiolunate joint [60]. Stage IIIB features moderate to severe changes at the capitolunate joint and mild or no changes at the radiolunate joint [60]. Stage IV is characterized by moderate to severe changes at both the capitolunate and radiolunate joints [60]. The subdivision of Stage III into IIIA and IIIB describes different patterns of degeneration seen by inspection rather than a sequence of degeneration [60].

Herbert and Lanzetta: Three classification systems have been devised for grading scaphoids afflicted with Preiser's disease [174]. The Herbert and Lanzetta classification system is based on the progression of the disease as seen with plain radiographs and consists of four stages [174]. Stage 1 is characterized by normal radiographs but a positive bone scan [174]. Stage 4 is characterized by total collapse of the scaphoid and periscaphoid arthritis [174].

Kienbock's Disease: The Kienbock's disease classification allows surgeons to tailor surgical reconstruction to anatomical findings, such as performing a proximal row carpectomy or radio-scapholunate fusion [49].

Other Considerations: The most common forms of wrist arthritis are post-traumatic in origin, including SLAC and SNAC arthritis [38]. Post-traumatic changes in the distal radius secondary to distal radius fractures can lead to secondary wrist arthritis [38]. Less common causes include avascular necrosis of the scaphoid bone (Preiser's disease) and avascular necrosis of the lunate bone (Kienbock's disease) [38]. Radiographic findings of wrist arthritis correlate poorly to symptoms [38]. Degenerative disorders of the wrist are complex in their clinical and radiographic manifestations, with classification and understanding of pathomechanics important for treatment selection [54]. Wrist arthritis treatment depends upon the pathology to be addressed, involvement of the various articulations, and determination of which bones may be reconstructable, salvageable, or amenable to continued motion without pain [38]. Surgical options for SLAC and SNAC arthritis depend on the age of the patient, expectations, and involvement of the joints [38]. Failure of nonoperative treatment, including education, symptom adaptation, splinting, or corticosteroid injection, may represent an indication to consider surgical treatment for wrist joint arthritis [38]. In a modified SLAC/SNAC classification, Stage IIIA wrists are considered candidates for proximal row carpectomy [60]. In a modified SLAC/SNAC classification, Stage IIIB wrists are considered candidates for scaphoid excision and intercarpal arthrodesis [60].

Clinical Presentation

Wrist pain is a common presenting symptom for patients visiting the hand surgeon, yet a routine history and physical examination often fails to uncover the underlying cause [97]. Degenerative disorders of the wrist are complex in their clinical and radiographic manifestations [54]. Awareness of complications associated with wrist arthrodesis is essential for the treating physician to appropriately counsel patients on different arthrodesis options and to inform them on what to expect from the procedure [120].

Functional Outcomes: Patients are on the whole very satisfied with the results of wrist fusion, although hand function is significantly diminished [5]. Solid fusion, pain relief, and satisfactory functional results can be achieved following wrist arthrodesis [27]. In every wrist, the four activities chosen as functional outcome criteria could be performed after surgery, whereas they were impossible before the surgery [88]. Wrist pain was non-existent and scored as 0 on the VAS for all cases following wrist arthrodesis with intercalated iliac crest graft in mutilans rheumatoid arthritis [88].

Stability and Pain Relief: All patients had a solid wrist arthrodesis at final follow-up examination and no patients complained of wrist pain or instability [29]. This report confirms the advantages of pain relief and stability obtained following wrist fusion [31]. Wrist arthrodesis with the AO/ASIF Titanium wrist fusion plate is an excellent option for treatment of various painful disorders of the wrist [137]. Total wrist arthrodesis with Wrist Fusion Rod is expected to provide long-lasting pain relief and stability with severe wrist deterioration and ulnar carpal shift [115].

Specific Indications: Wrist fusion is a valuable method for treating a wrist joint with severe destruction due to rheumatoid arthritis [2]. Wrist fusion in patients receiving double free muscle transfers for reconstruction following complete brachial plexus paralysis resulted in improved finger range of motion and overall hand function [18].

Patient Acceptance: Two of the 10 patients declined wrist arthrodesis secondary to difficulty with daily activities, while eight patients who underwent wrist arthrodesis were satisfied with wrist position and function [135].

Investigations

Plain radiography: Wrist radiographs demonstrate a 47% sensitivity and 94% specificity in predicting end-stage scaphotrapezoid joint arthritis [198]. Simple plain radiographic signs and measures can be used to diagnose acute scapholunate ligament injuries [83]. CT is more useful than plain X-rays for evaluating partial carpal arthrodesis [196].

MRI: MRI is the modality of choice for imaging radiographically occult fractures of the hand and wrist [79]. The primary advantages of MRI compared with CT and radiography are improved tissue characterization, especially of soft tissues such as ligamentous structures and synovium, and the lack of ionizing radiation [79]. Modern MRI is generally at 1.5T or 3T, with 3T preferred for hand and wrist imaging, especially for small fields of view [79]. A static magnetic field strength of at least 1.5 T using a dedicated wrist coil is recommended for analyzing interosseous, intrinsic, and extrinsic ligament insertions [92]. The volar extrinsic, scapholunate interosseous, dorsal intercarpal, and lunotriquetral ligaments are best visualized using 1 mm slices with no interslice gap in the coronal plane [92]. The dorsal radiocarpal and intercarpal ligaments are best viewed on both coronal and sagittal images [92]. Oblique axial views along the longitudinal axes of ligaments allow further analysis, especially when an injury is suspected [92]. Concomitant cartilage-sensitive imaging is integrative to influence assessment and surgical management, particularly in the setting of SLAC wrist [92]. Real-time MRI has been used to investigate dynamic instabilities, although its routine use in clinical practice is yet to be further determined [92]. MRI can serve as an important adjunct in the diagnosis of wrist tuberculosis, offering insights into bone, joint, and soft tissue involvement that may not be visible on plain radiographs [182]. MRI provides earlier detection of synovitis and erosive bone changes associated with rheumatoid arthritis than radiographs [95]. Magnetic resonance imaging and clinical tests have been evaluated for efficacy in the diagnostics of wrist ligament injuries [83].

CT: CT scanning enables the 3D analysis of carpal dysfunction [92]. Adding motion in real time (4D CT) may hold promise to potentially quantify the location and degree of injury noninvasively and help surgeons plan surgical treatment [92].

Arthroscopy: Arthroscopy is considered by many to be the diagnostic intervention of choice for determining the degree of injury to the wrist [92]. Arthroscopy can assess the condition of the cartilage, including whether it is normal or degenerative [92]. Arthroscopy can assess the ability to reduce the carpus and any other associated injuries [92]. The degree of intrinsic and extrinsic ligament injury can be identified from arthroscopic evaluation [92]. Geissler grade II scapholunate interosseous ligament injuries tend to be isolated, whereas grade IV injuries often involve complete dorsal extrinsic ligament disruption [92]. The inconsequent use of available modern MRI techniques and the lack of reliable preoperative diagnoses necessitated pure diagnostic arthroscopies for ulnar-sided wrist pain [197].

Other Considerations: Physical examination of the wrist includes useful provocative maneuvers [83]. The wrist insufflation test is a confirmatory test for detecting intercarpal ligament and triangular fibrocartilage complex tears [83]. Dynamic fluoroscopy shows abnormal motion between the scaphoid and lunate as well as changes in the kinematics of the midcarpal joint [92]. Live fluoroscopic imaging shows whether a DISI is reducible, providing valuable information for treatment planning [92].

Treatment

Non-Operative

The provided evidence does not detail specific conservative management protocols such as weight loss, physical therapy, NSAIDs, or injections. Wrist arthrodesis is a well-established procedure that may be performed by a variety of techniques [114], but the text notes that wrist arthrodesis is no longer the only solution for arthritic wrists, as various surgical techniques can preserve a functional wrist [131].

Operative

Indications: Total wrist arthrodesis remains the gold standard for unstable destroyed rheumatoid wrists, but total wrist arthroplasty offers a more ambitious functional goal with greater complication risks [34]. Total wrist fusion should only be used for exceptional circumstances [13]. Arthroplasty should be used as an alternative to arthrodesis in the treatment of posttraumatic wrist arthritis, given the proper patient selection and indications [145]. Despite extensive investigations to optimize treatment algorithms and surgical techniques for wrist arthritis, controversy remains regarding the optimal treatment for young patients and laborers, the best fusion technique, and the role of arthroscopy [17].

Surgical Approach / Technique: The procedure is performed under general anaesthesia with a tourniquet, involving a longitudinal skin incision centered on the head of the ulna, resection of the ulnar head, and creation of a rectangular longitudinal trench into the distal radius and carpus [161]. A 4–5 cm dorsal incision with its apex at the scapholunate interval provides wide access to the radiocarpal capsule, and the scaphoid is excised en bloc with a partial radial styloidectomy [187]. The 6 cm longitudinal midline incision affords a safe internervous approach between the superficial radial and dorsal cutaneous branch ulnar nerves for 4-corner fusion [169]. A surgical technique is described for unilateral arthrodesis of the wrist through a radial wrist approach with an inner iliac-bone graft, and results were successful in twenty-three of twenty-four patients treated by this method over a ten to twelve-year period [175].

Implant Selection: The locked intramedullary wrist arthrodesis system yields acceptable fusion rates [19]. Authors advocate nonspanning arthrodesis as an alternative method for total wrist fusion with a high union rate and minimal risk of complications at the carpometacarpal joint [35].

Outcomes and Functional Results: Patients are on the whole very satisfied with the results of wrist fusion, although hand function, as assessed by the methods used in this study, is significantly diminished [5]. Although wrist fusion is performed nearly 5 times more frequently than total wrist arthroplasty, short-term findings suggest that total wrist arthroplasty compares favorably with wrist fusion [3].

Complications and Reoperations: Overall, 63 of the 82 complications resolved, although 19 wrists required additional surgery, most frequently for plate removal [12]. Complications and reoperations occur frequently, most often due to incomplete bone fusion or hardware-related problems, and it remains unknown which implant type is best or if the carpometacarpal joint should be included [62].

Revision: Conversion from total wrist arthrodesis to a modern wrist arthroplasty is feasible, yielding good functional results, significant pain relief, and stable implants [8]. This technique for conversion of a failed total wrist arthroplasty to a wrist arthrodesis is safe, effective, and versatile [14]. Arthrodesis after failed wrist implant arthroplasty is a satisfactory procedure, and a fresh-frozen allograft can be used effectively in wrist fusion [152].

Other Considerations: A specific technique was used in 17 patients for either limited or complete wrist fusion [1]. Another group presents a reliable, efficient, and cost-effective technique for wrist fusion [4]. In one series, fusion was successful in all 10 wrists [9]. In another cohort, all wrist fusions united except that the index carpometacarpal joint failed to unite in one patient [10]. The technique used provided a reliable fusion method for a variety of wrist disorders [15]. The technique resulted in bony union of 22 wrists in 20 patients with no major postoperative complications [51]. In a mixed surgical cohort, the surgical treatment was a wrist arthrodesis in 8 cases and wrist arthroplasty in the other 4 cases [164].

Complications

General Complication Rates and Outcomes: Complications and reoperations occur frequently in total wrist arthrodesis for advanced osteoarthritis, most often due to incomplete bone fusion or hardware-related problems [62]. In a series of 82 complications following AO/ASIF wrist arthrodesis, 63 resolved, while 19 wrists required additional surgery [12]. The most frequent reason for additional surgery following AO/ASIF wrist arthrodesis was plate removal [12]. In a study of 115 patients, wrist fusion was found to be a valuable method for treating severe wrist joint destruction due to rheumatoid arthritis [2]. In a systematic review of total wrist arthroplasty compared with total wrist arthrodesis for rheumatoid arthritis, outcomes for total wrist fusion were comparable and possibly better than those for total wrist arthroplasty [37]. Complication rates for total wrist arthroplasty were higher than wrist fusion, with reports of radiological loosening and osteolysis [33]. In a systematic review of outcomes of wrist arthrodesis and wrist arthroplasty in patients with rheumatoid arthritis, robust long-term follow-up data on wrist arthroplasty are not yet available [63].

Nonunion and Pseudarthrosis: Nonunion and deep infection are serious complications described for wrist arthrodesis with femoral head structural allograft after failed total wrist arthroplasty [158]. Owing to the high incidence of distal graft-metacarpal pseudarthrosis, more rigid fixation techniques are recommended in patients with failed wrist arthroplasties undergoing arthrodesis [217]. In a comparative study of total wrist arthrodesis for salvage of failed total wrist arthroplasty versus primary wrist arthrodesis, fusion was achieved in 26 of 32 wrists in the converted group and 34 of 39 wrists (87%) in the primary group [28]. In the same comparative study, non-union became evident after plate removal in an additional patient who had had converted wrist arthrodesis [28]. In that study, final union was achieved in 25 of 32 wrists (78%) in the converted group [28]. In a study of wrist arthrodesis using a dynamic compression plate, the union rate was 17 out of 18 wrists, with the single failure occurring in a patient who used only local bone graft [226]. In a study of the Stein and Gill technique for wrist arthrodesis, the index fusion rate was 87.5% (14 of 16), increasing to 93.75% with reoperation [221]. In a study of multiple stapling for wrist arthrodesis in the nonrheumatoid patient, fusion occurred in 25 cases with complications in three cases and uneventful results in 22 cases (88%) [173]. In a study of total and subtotal arthrodesis of the wrist, only one pseudarthrosis occurred among eight operations performed over eight years [228].

Hardware-Related Complications: In a study of wrist arthrodesis for traumatic conditions using plate and local bone graft application, all patients had a solid wrist arthrodesis at final follow-up examination [29]. In a study of wrist arthrodesis with excision of the proximal carpal bones using the AO/ASIF wrist fusion plate and local bone graft, all patients achieved radiographic fusion [40]. In a study of total wrist arthrodesis using bowed crossed K-wires, the technique resulted in bony union of 22 wrists in 20 patients with no major postoperative complications [51]. In a study of wrist arthrodesis using a sliding radial graft and plate fixation, the report confirmed the advantages of pain relief and stability obtained following wrist fusion [31]. In a study of arthrodesis of the wrist with bioabsorbable fixation in patients with rheumatoid arthritis, 24 wrist arthrodeses were performed on 18 patients [45]. In a study of the modified Clayton-Mannerfelt arthrodesis of the wrist in rheumatoid arthritis, the complication rate was low, and the hardware did not have to be removed in most cases [223]. In a study of nonspanning total wrist arthrodesis with a low-profile locking plate, nonspanning arthrodesis is advocated as an alternative method for total wrist fusion with a high union rate and minimal risk of complications at the carpometacarpal joint [35]. In a study of early experience with locked intramedullary wrist arthrodesis, the system yields acceptable fusion rates [19].

Other Considerations: In a study of radiolunate fusion in the rheumatoid wrist with Shapiro staples, good and excellent clinical results in the majority of the patients following radiolunate fusion do not depend on the fixation device [20]. In a study of total wrist arthroplasty for the patient with non-rheumatoid arthritis, the decision between arthroplasty and arthrodesis involves accepting the higher complication rate of arthroplasty [39]. In a study of total wrist arthroplasty: a systematic review of the evidence from the last 5 years, complication rates were higher than wrist fusion [33]. In a study of total wrist arthroplasty and total wrist arthrodesis in rheumatoid arthritis: a decision analysis from the hand surgeons' perspective, utility values were assigned to scenarios including arthrodesis with no complication, minor complication, intermediate complication, and major complication [96]. In a decision analysis from the hand surgeons' perspective, the mean utility value for arthrodesis with no complication was 0.82 (95% CI 0.75-0.88) [96]. In a decision analysis from the hand surgeons' perspective, the mean utility value for arthrodesis with a major complication was 0.82 (95% CI 0.76-0.88) [96]. In a decision analysis from the hand surgeons' perspective, the mean utility value for arthroplasty with a major complication resulting in revision arthroplasty was 0.82 (95% CI 0.76-0.88) [96]. In a decision analysis from the hand surgeons' perspective, the mean utility value for arthroplasty with a major complication resulting in arthrodesis was 0.82 (95% CI 0.76-0.88) [96]. In a study of reconstructing the rheumatoid wrist: a utility analysis comparing total wrist fusion and total wrist arthroplasty from the perspectives of rheumatologists and hand surgeons, total wrist arthroplasty was associated with the highest expected gain in quality-adjusted life-years for each subgroup [112]. Total wrist arthroplasty was associated with the highest expected gain in quality-adjusted life-years for each subgroup in a utility analysis comparing it to total wrist fusion [112]. The decision between total wrist arthroplasty and total wrist arthrodesis is based on technical experience, the patient's ability to adhere to strict activity limitations, and the willingness to accept the higher complication rate and eventual implant failure of arthroplasty in exchange for maintaining some wrist motion [39]. It remains unknown which implant type is best for total wrist arthrodesis or if the carpometacarpal joint should be included [62].

In a study of "Remotion" total wrist arthroplasty: preliminary results of a prospective international multicenter study of 215 cases, the use of TWA to treat end-stage rheumatoid and non-RA arthritis is very controversial due to the high range of complications reported in previous series [116]. In a study of "Remotion" total wrist arthroplasty: preliminary results of a prospective international multicenter study of 215 cases, historically, the first total silicone wrist implants were abandoned because of unacceptable revision rates [116]. In a study of "Remotion" total wrist arthroplasty: preliminary results of a prospective international multicenter study of 215 cases, first generation metal-polyethylene total wrist arthroplasties had high complications and revisions rates [116]. In a study of "Remotion" total wrist arthroplasty: preliminary results of a prospective international multicenter study of 215 cases, even some newer metal-polyethylene prostheses designs showed at first promising results followed by unacceptable longer follow-up results [116]. In a study of "Remotion" total wrist arthroplasty: preliminary results of a prospective international multicenter study of 215 cases, loosening with implant migration was observed in 4% of the rheumatoid wrists and 3% of the non-RA wrists [116]. In a study of "Remotion" total wrist arthroplasty: preliminary results of a prospective international multicenter study of 215 cases, loosening without implant migration was observed in 8% of the rheumatoid wrists and 15% of the non-RA wrists [116]. In a study of "Remotion" total wrist arthroplasty: preliminary results of a prospective international multicenter study of 215 cases, the overall incidence of signs of periprosthetic loosening was 12% in the rheumatoid group compared with 18% in the non-RA group [116]. In a study of disillusioning midterm results after UNI 2 total wrist arthroplasty in RA patients, midterm results show an array of problems focussing on the carpal component, with a revision rate rising markedly after an average of 5 years [232]. In a study of clinical outcomes of total wrist arthroplasty, total wrist arthroplasty performed for pancarpal arthritis as an alternative to wrist arthrodesis can yield successful outcomes with low short-term failure rates [229].

In a study of fate of failed Meuli total wrist arthroplasty, revision arthroplasty may be a useful alternative to arthrodesis for the salvage of primary wrist arthroplasties in rheumatoid patients, but complications and reoperations may occur after both revision arthroplasty and arthrodesis [214]. In a study of salvage of total wrist arthroplasty using the TMW prosthesis, salvage arthroplasty using a modular wrist system offers a second chance with a reliable form of fixation and adequate functional results [22]. In a study of conversion of total wrist arthrodesis to a total wrist arthroplasty: twelve patients followed for 7 (2–16) years, conversion from total wrist arthrodesis to a modern wrist arthroplasty is feasible, yielding good functional results, significant pain relief, and stable implants [8]. In a study of wrist arthrodesis for failed total wrist arthroplasty, this technique for conversion of a failed total wrist arthroplasty to a wrist arthrodesis is safe, effective, and versatile [14]. In a study of successful conversion of wrist prosthesis to arthrodesis in 11 patients, conversion to arthrodesis after failed wrist arthroplasty is worthwhile and reliably improves wrist function over failed wrist arthroplasty [23]. In a study of wrist arthrodesis as a salvage procedure for failed implant arthroplasty, wrist arthrodesis is a reasonable option for salvage of a failed wrist arthroplasty [36]. In a study of total wrist fusion using an intramedullary rod technique with proximal row carpectomy, the authors present a reliable, efficient, and cost-effective technique for wrist fusion [4]. In a study of motion preserving procedures of the wrist, if the indications are accurately respected and the technique is well performed to prevent complications, then good long-term results can be obtained [6]. In a study of scaphocapitolunate arthrodesis and radial styloidectomy: a treatment option for posttraumatic degenerative wrist disease, the senior author did not have to revise or convert any patient into a wrist fusion or a total wrist arthroplasty [7]. In a study of radiocarpal fusion, radioscapholunate fusion can allow patients up to 60° of wrist flexion and extension in arthritic conditions isolated to the proximal joint of the wrist [16]. In a study of surgical management of osteoarthritis of the hand and wrist, radiographic findings of arthritis correlate poorly to symptoms [38]. In a study of union of radiocarpal fusion with and without proximal row carpectomy: a systematic review, the study followed the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [44].

In a study of proximal row carpectomy versus 4-corner fusion: incidence, conversion to fusion, and cost, 75 (1.48%) patients required a secondary procedure for removal of symptomatic fusion hardware after the index procedure [99]. In a study of proximal row carpectomy versus 4-corner fusion: incidence, conversion to fusion, and cost, subsequent total wrist arthrodesis was performed in 135 patients (2.67%) who had a previous 4CF [99]. In a study of proximal row carpectomy versus 4-corner fusion: incidence, conversion to fusion, and cost, subsequent total wrist arthrodesis was performed in 65 patients (1.79%) with a previous PRC [99]. In a study of proximal row carpectomy versus 4-corner fusion: incidence, conversion to fusion, and cost, including both hardware removal and subsequent total wrist arthrodesis, 220 (4.16%) of 4CF patients required a secondary procedure [99]. In a study of risk of total wrist arthrodesis or reoperation following 4-corner arthrodesis or proximal row carpectomy for stage-II SLAC/SNAC arthritis, PRC and FCA demonstrated similarly low rates of conversion to total wrist arthrodesis [219]. In a study of the outcome of scaphoid excision and four-corner arthrodesis for advanced carpal collapse at a minimum of ten years, there is a low rate of conversion to total wrist arthrodesis [123]. In a study of four-corner fusion: comparison of patient satisfaction and functional outcome of conventional K-wire technique vs. a new locking plate, no implant-related complications were observed [157]. In a study of four-corner fusion: comparison of patient satisfaction and functional outcome of conventional K-wire technique vs. a new locking plate, one case (plate group) had to be converted to a total wrist fusion due to persisting pain without implant-related complications [157]. In a study of four-corner fusion: comparison of patient satisfaction and functional outcome of conventional K-wire technique vs. a new locking plate, one patient was observed with postoperative wound infection (K-wire) that was sufficiently treated conservatively [157]. In a study of four-corner fusion: comparison of patient satisfaction and functional outcome of conventional K-wire technique vs. a new locking plate, one patient (plate) developed a carpal tunnel syndrome, which was treated by surgical release [157].

In a study of proximal migration of hardware in patients undergoing midcarpal fusion with headless compression screws, one patient underwent a total wrist fusion [168]. In a study of proximal migration of hardware in patients undergoing midcarpal fusion with headless compression screws, one patient had proximal row carpectomy and interposition arthroplasty [168]. In a study of proximal migration of hardware in patients undergoing midcarpal fusion with headless compression screws, another patient was recommended to have conversion to total wrist fusion, but refused [168]. In a study of proximal migration of hardware in patients undergoing midcarpal fusion with headless compression screws, at the most recent follow-up visits three of four patients (cases 1, 3, and 4) reported complete pain relief [168]. In a study of proximal migration of hardware in patients undergoing midcarpal fusion with headless compression screws, one patient (Case 2) reported substantial relief following hardware removal but had persistent stiffness and pain with activities [168]. In a study of a new method for radiolunate arthrodesis in ulnar translocation of the carpus in the rheumatoid wrist, the authors have not experienced any complications [162]. In a study of a new method for radiolunate arthrodesis in ulnar translocation of the carpus in the rheumatoid wrist, considerable complications can occur, such as nonunion of the arthrodesis, bowstring of the extensor tendons, and severe ulnar deviation of the wrist and fingers if the extensor retinaculum is not reconstructed [162]. In a study of a new method for radiolunate arthrodesis in ulnar translocation of the carpus in the rheumatoid wrist, rupture of the finger extensors can occur when ulnar head resection is performed in conjunction with this arthrodesis [162]. In a study of a new method for radiolunate arthrodesis in ulnar translocation of the carpus in the rheumatoid wrist, infection of the wound and reflex sympathetic dystrophy also can

Recovery

Functional Outcomes and Satisfaction: Total wrist arthrodesis provides reliable pain relief and good functional outcomes with high patient satisfaction, particularly for end-stage arthritis and as a salvage technique [224]. In patients receiving double free muscle transfers, wrist fusion resulted in improved finger range of motion and overall hand function [18]. While no salvage procedure can restore entirely full wrist function [141], total wrist arthrodesis remains the primary salvage solution for severe wartime wrist injuries, predictably restoring grip strength and reducing disability [165].

Rehabilitation Protocol: Starting early range of motion (ROM) after surgery enables patients to regain functional wrist and forearm ROM earlier with fewer therapy visits required [148]. During the first eight weeks of hand therapy, pain and disability in patients referred to hand therapy improved at a faster rate than in the larger group of all distal radius fractures at any given time over a one-year period [149].

Key Evidence

• [L4] This technique was used in 17 patients for either limited or complete wrist fusion. [1] (10.1016/s0363-5023(87)80273-3)
• [L4] Wrist fusion is still a valuable method for treating a wrist joint with severe destruction due to rheumatoid arthritis, especially if combined with a total wrist arthroplasty on the other side. [2] (10.1016/j.jhsb.2004.11.008)
• [L4] Although wrist fusion is performed nearly 5 times more frequently than total wrist arthroplasty, short-term findings suggest that total wrist arthroplasty compares favorably with wrist fusion. [3] (10.1177/1558944716668846)
• [L5] We present a reliable, efficient, and cost-effective technique for wrist fusion. [4] (10.1097/bth.0000000000000093)
• [L4] Patients are on the whole very satisfied with the results of wrist fusion, although hand function, as assessed by the methods used in this study, is significantly diminished. [5] (10.1016/s0266-7681(96)80039-8)
• [Paper] Although some may see the motion preserving procedures of the wrist as a staged full wrist fusion, if the indications are accurately respected and the technique is well performed to prevent complications, then good long-term results can be obtained. [6] (10.1055/s-0032-1330070)
• [L4] The senior author did not have to revise or convert any patient into a wrist fusion or a total wrist arthroplasty, suggesting that longer survival rate of this procedure may be possible. [7] (10.1055/s-0032-1329592)
• [L4] Conversion from total wrist arthrodesis to a modern wrist arthroplasty is feasible, yielding good functional results, significant pain relief, and stable implants. [8] (10.1016/j.jhsa.2024.10.007)
• [L4] Fusion was successful in all 10 wrists. [9] (10.1016/0363-5023(89)90177-9)
• [L4] All wrist fusions united except that the index carpometacarpal joint failed to unite in one patient. [10] (10.1016/s0266-7681(03)00146-3)
• [L5] If the basic principles of limited wrist fusions are adhered to, a good outcome can be obtained. [11] (10.1055/s-0032-1329548)
• [L4] Overall, 63 of the 82 complications resolved, although 19 wrists required additional surgery, most frequently for plate removal. [12] (10.1016/s0363-5023(05)80037-1)
• [L4] Total wrist fusion should only be used for exceptional circumstances. [13] (10.1054/jhsb.2000.0434)
• [L4] This technique for conversion of a failed total wrist arthroplasty to a wrist arthrodesis is safe, effective, and versatile. [14] (10.1016/j.jhsa.2016.02.012)
• [L4] The technique used provided a reliable fusion method for a variety of wrist disorders. [15] (10.1016/0363-5023(94)90176-7)
• [Paper] Radioscapholunate fusion can allow patients up to 60° of wrist flexion and extension in arthritic conditions isolated to the proximal joint of the wrist. [16] (10.1097/00130911-200306000-00004)
• [Commentary] Despite extensive investigations to optimize treatment algorithms and surgical techniques for wrist arthritis, controversy remains regarding the optimal treatment for young patients and laborers, the best fusion technique, and the role of arthroscopy. [17] (10.1016/j.jhsa.2025.06.014)
• [L4] Wrist fusion in patients receiving double free muscle transfers resulted in improved finger range of motion and overall hand function. [18] (10.1016/j.jhsa.2011.10.003)
• [L4] The locked intramedullary wrist arthrodesis system yields acceptable fusion rates. [19] (10.1016/j.jhsa.2020.11.015)
• [L4] Good and excellent clinical results in the majority of the patients following radiolunate fusion do not depend on the fixation device. [20] (10.1177/1753193409342054)
• [L4] A series of 28 selective limited wrist arthrodeses was presented, with most being intercarpal fusions and some including the radius or index metacarpal. [21] (10.1016/s0363-5023(81)80074-3)
• [L4] Salvage arthroplasty using a modular wrist system offers a second chance with a reliable form of fixation and adequate functional results. [22] (10.1016/s0363-5023(03)80306-4)
• [L4] Conversion to arthrodesis after failed wrist arthroplasty is worthwhile and reliably improves wrist function over failed wrist arthroplasty. [23] (10.1177/1753193416674929)
• [L2] Total wrist arthroplasty declined despite reports of positive early outcomes for fourth-generation implants. [24] (10.1016/j.jhsa.2023.11.009)
• [L4] Scaphotrapeziotrapezoid fusion is a viable treatment option especially for a high– functional-demand young population with significant wrist pathology. [26] (10.1053/jhsu.2003.50072)
• [L4] Solid fusion, pain relief, and satisfactory functional results can be achieved following wrist arthrodesis. [27] (10.1016/s0363-5023(86)80142-3)
• [L3] [28] (10.1177/17531934211057389)
• [L4] All patients had a solid wrist arthrodesis at final follow-up examination and no patients complained of wrist pain or instability. [29] (10.1016/s0363-5023(05)80058-9)
• [L4] This report confirms the advantages of pain relief and stability obtained following wrist fusion. [31] (10.1016/0266-7681(94)90171-6)
• [L3] Complication rates were higher than wrist fusion, with reports of radiological loosening and osteolysis. [33] (10.1177/1753193414539796)
• [L5] Total wrist arthrodesis remains the gold standard for unstable destroyed rheumatoid wrists, but total wrist arthroplasty offers a more ambitious functional goal with greater complication risks. [34] (10.1016/j.jhsa.2008.06.004)
• [L4] They advocate nonspanning arthrodesis as an alternative method for total wrist fusion with a high union rate and minimal risk of complications at the carpometacarpal joint. [35] (10.1055/s-0037-1606257)
• [L4] Wrist arthrodesis is a reasonable option for salvage of a failed wrist arthroplasty. [36] (10.1177/1753193410376283)
• [L4] In this systematic review, outcomes for total wrist fusion were comparable and possibly better than those for total wrist arthroplasty in rheumatoid patients. [37] (10.1097/prs.0b013e318180ece3)
• [L5] [38] (10.1016/j.jht.2022.01.001)
• [L4] The decision between total wrist arthroplasty and total wrist arthrodesis is based on technical experience with newer implants, the patient's ability to adhere to strict activity limitations, and the willingness to accept the higher complication rate and eventual implant failure of arthroplasty in exchange for maintaining some wrist motion. [39] (10.1016/j.jhsa.2011.01.033)
• [L4] All patients achieved radiographic fusion with good or excellent clinical outcomes regarding current condition and improvement. [40] (10.1054/jhsb.2000.0488)
• [L4] [44] (10.1016/j.jhsa.2020.09.019)
• [L4] [45] (10.1054/jhsb.2002.0806)
• [L4] The classification allows surgeons to tailor surgical reconstruction to anatomical findings, such as performing a proximal row carpectomy or radio-scapholunate fusion. [49] (10.1097/00130911-200603000-00003)
• [L4] The technique resulted in bony union of 22 wrists in 20 patients with no major postoperative complications. [51] (10.1054/jhsb.1999.0170)
• [Paper] Degenerative disorders of the wrist are complex in their clinical and radiographic manifestations, with classification and understanding of pathomechanics important for treatment selection. [54] (10.1016/s0363-5023(85)80025-3)
• [L4] [60] (10.1016/j.jhsa.2014.03.032)
• [L5] Complications and reoperations occur frequently, most often due to incomplete bone fusion or hardware-related problems, and it remains unknown which implant type is best or if the carpometacarpal joint should be included. [62] (10.1177/17531934241295343)
• [L2] While functional improvement was observed for arthroplasty patients, robust long-term follow-up data on wrist arthroplasty are not yet available. [63] (10.1177/1753193420953683)
• [L5] A wrist joint should be considered biomechanically unstable when it is not able to bear loads and does not exhibit normal kinematics throughout its arc of motion. [69] (10.1053/jhsu.1999.0866)
• [L5] The longitudinal 'columnar' concept of wrist kinematics does not fit in with many of the recent findings related to carpal instabilities. [70] (10.1016/s0363-5023(83)80025-2)
• [L5] Wrist biomechanics were significantly altered following trapeziectomy, and of the reconstructions tested, LRTI most closely resembled the intact biomechanics in this cadaveric model. [73] (10.1016/j.jhsa.2019.10.003)
• [L5] Despite complex carpal bone anatomy and kinematics, computed fiber elongations were found to vary linearly with wrist position. [80] (10.1016/j.jhsa.2012.04.025)
• [L5] Traction (distraction) changes normal carpal kinematics and motion of the wrist combined with traction induces abnormal patterns of motion. [85] (10.1053/jhsu.1999.jhsu24a0113)
• [L4] [88] (10.1016/j.main.2014.07.007)
• [L4] [96] (10.1016/j.jhsa.2008.06.022)
• [Paper] [97] (10.1016/s0363-5023(85)80133-7)
• [L3] [99] (10.1016/j.jhsa.2019.12.010)
• [L4] The kinematic consequences of resecting the distal scaphoid are different: the flexion-extension motion of the proximal row during deviations is diminished at the expense of increased radioulnar translational motion. [103] (10.1097/00130911-199909000-00004)
• [L4] Total wrist arthroplasty was associated with the highest expected gain in quality-adjusted life-years for each subgroup. [112] (10.1007/s11552-009-9194-7)
• [L5] Arthrodesis of the wrist is a well established procedure that may be performed by a variety of techniques. [114] (10.1016/s0363-5023(86)80223-4)
• [L4] Total wrist arthrodesis with Wrist Fusion Rod is expected to provide long-lasting pain relief and stability with severe wrist deterioration and ulnar carpal shift. [115] (10.1016/j.jhsg.2026.101024)
• [L4] [116] (10.1055/s-0032-1323642)
• [L5] The joints within the proximal carpal row govern 35% of the wrist extension-flexion arc and 33% of the wrist radial-ulnar deviation arc. [119] (10.1016/0363-5023(90)90101-v)
• [L4] Awareness of complications associated with wrist arthrodesis and how best to avoid them is essential for the treating physician to appropriately counsel patients on different arthrodesis options and to inform them on what to expect from the procedure. [120] (10.1016/j.hcl.2009.11.003)
• [L4] There is a low rate of conversion to total wrist arthrodesis. [123] (10.1016/j.jhsa.2010.01.025)
• [L5] Wrist ROM within 20% extension and radial abduction to 50% flexion limits torque and lever force exacerbation between scaphoid fragments. [126] (10.1186/s13018-020-01897-y)
• [L5] Wrist ligaments co-ordinate the positioning of the bones in the mid-range of carpal motions, and restrict further motion in extreme positions of the wrist joint. [127] (10.1016/0266-7681(93)90015-8)
• [L5] The experimental kinetic behavior of the chronic SLAC wrist is similar to the one with a recent scapholunate dissociation without carpal collapse associated. [130] (10.1177/1558944716660555w)
• [L5] Various surgical techniques can preserve a functional wrist, and wrist arthrodesis is no longer the only solution for arthritic wrists. [131] (10.1016/j.otsr.2013.06.015)
• [L5] The 'dart thrower's motion' of the wrist, from radial extension to ulnar flexion, may be a unifying concept of functional wrist motion that is uniquely human. [134] (10.5435/00124635-201001000-00007)
• [L4] Two of the 10 patients declined wrist arthrodesis secondary to difficulty with daily activities, while eight patients who underwent wrist arthrodesis were satisfied with wrist position and function. [135] (10.1016/j.jhsb.2004.09.019)
• [L5] This report updates information on wrist dart-throwing motion based on recent research regarding its kinematics, kinetics, and clinical applications, noting that a wide range of DT planes exists and that midcarpal arthrodesis adversely affects DT motion compared with radiocarpal arthrodesis. [136] (10.1016/j.jhsa.2014.02.035)
• [L4] Wrist arthrodesis with the AO/ASIF Titanium wrist fusion plate is an excellent option for treatment of various painful disorders of the wrist. [137] (10.1054/jhsb.2001.0600)
• [L5] The study confirms that constant radiocarpal and midcarpal congruence during radioulnar deviation in normal wrists is no longer possible with intercarpal kinematic modifications after these arthrodeses. [140] (10.1177/17531934231176004)
• [L4] No salvage procedure can restore entirely full wrist function. [141] (10.1177/1753193419876063)
• [L3] Arthroplasty should be used as an alternative to arthrodesis in the treatment of posttraumatic wrist arthritis, given the proper patient selection and indications. [145] (10.1016/j.jhsa.2013.02.013)
• [L3] Starting early ROM after surgery enables patients to regain functional wrist and forearm ROM earlier with fewer therapy visits required. [148] (10.1016/j.jht.2009.06.003)
• [L3] During the first eight weeks of hand therapy, pain and disability in the patients referred to hand therapy improved at a faster rate than in the larger group of all distal radius fractures at any given time over a one-year period. [149] (10.1197/j.jht.2006.07.012)
• [L4] Arthrodesis after failed wrist implant arthroplasty is a satisfactory procedure, and a fresh-frozen allograft can be used effectively in wrist fusion. [152] (10.1016/s0363-5023(98)80169-x)
• [L2] Total wrist arthroplasty and total wrist arthrodesis are both extremely cost-effective procedures. [153] (10.1016/j.jhsa.2009.12.013)
• [L4] The article recommends simplifying decision-making between treatment options based on author experience and literature evidence, noting that wrist denervation is a first choice for patients with good range of motion, while total wrist arthrodesis remains the gold standard for salvage despite high complication rates. [155] (10.1016/j.hcl.2005.03.005)
• [L3] [157] (10.1007/s00402-016-2416-x)
• [L4] [158] (10.1097/bth.0000000000000165)
• [L4] [161] (10.1016/0266-7681(93)90012-5)
• [L4] [162] (10.1097/00130911-200006000-00006)
• [L4] The surgical treatment was a wrist arthrodesis in 8 cases and wrist arthroplasty in the other 4 cases. [164] (10.1177/1558944716660555hd)
• [L4] Total wrist arthrodesis remains the primary salvage solution for severe wartime wrist injuries, predictably restoring grip strength and reducing disability. [165] (10.1177/17531934251337589)
• [L4] [168] (10.1055/s-0034-1384750)
• [L5] [169] (10.1007/s12593-009-0008-5)
• [L4] Fusion occurred in 25 cases in an average of 31.5 months with complications in three cases and uneventful results in 22 cases (88%). [173] (10.1016/s0363-5023(84)80155-0)
• [Paper] [174] (10.1016/j.hcl.2006.07.005)
• [L5] [177] (10.1016/s0363-5023(87)80066-7)
• [L4] MRI can serve as an important adjunct in the diagnosis of wrist TB, offering valuable insights into bone, joint, and soft tissue involvement that may not be visible on plain radiographs. [182] (10.1016/j.jhsa.2025.05.015)
• [L4] [187] (10.1177/1753193416676663)
• [L5] [194] (10.1016/j.eats.2025.103820)
• [L4] We conclude that CT is more useful than plain X-rays for evaluating partial carpal arthrodesis. [196] (10.1016/s0266-7681(97)80367-1)
• [L4] The inconsequent use of available modern magnetic resonance imaging (MRI) techniques and the lack of reliable preoperative diagnoses necessitated pure diagnostic arthroscopies for ulnar-sided wrist pain. [197] (10.1177/1558944716660555hs)
• [L3] Wrist radiographs demonstrate a 47% sensitivity and 94% specificity in predicting end-stage ST joint arthritis, emphasizing the importance of directly visualizing the ST joint after trapeziectomy. [198] (10.1177/1558944718765246)
• [L4] Revision arthroplasty may be a useful alternative to arthrodesis for the salvage of primary wrist arthroplasties in rheumatoid patients, but complications and reoperations may occur after both revision arthroplasty and arthrodesis. [214] (10.1054/jhsb.2002.0812)
• [L4] Owing to the high incidence of distal graft-metacarpal pseudarthrosis, the authors recommend using more rigid fixation techniques in patients with failed wrist arthroplasties. [217] (10.1016/s0363-5023(97)80129-3)
• [L3] PRC and FCA demonstrated similarly low rates of conversion to total wrist arthrodesis. [219] (10.2106/jbjs.19.00965)
• [L4] The index fusion rate was 87.5% (14 of 16), increasing to 93.75% with reoperation, which is lower than rates reported for plate fixation. [221] (10.1097/00130911-199909000-00006)
• [L4] The complication rate was low, and the hardware did not have to be removed in most cases. [223] (10.1016/j.jhsa.2013.02.029)
• [L4] Total wrist arthrodesis provides reliable pain relief and good functional outcomes with high patient satisfaction, particularly for end-stage arthritis and as a salvage technique. [224] (10.5435/jaaos-d-15-00424)
• [L4] The union rate was 17 out of 18 wrists, with the single failure occurring in a patient who used only local bone graft. [226] (10.1016/s0266-7681(96)80041-6)
• [L4] Only one pseudarthrosis occurred among eight operations performed over eight years. [228] (10.2106/00004623-196446070-00011)
• [L4] Total wrist arthroplasty performed for pancarpal arthritis as an alternative to wrist arthrodesis can yield successful outcomes with low short-term failure rates. [229] (10.1016/j.jhsa.2012.05.016)
• [L4] Midterm results show an array of problems focussing on the carpal component, with a revision rate rising markedly after an average of 5 years. [232] (10.1016/j.main.2015.10.065)

See Also

• Proximal Row Carpectomy
• Wrist Ligament Injuries
• Carpal Tunnel Syndrome

References

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[18] Role of Wrist Arthrodesis in Patients Receiving Double Free Muscle Transfers for Reconstruction Following Complete Brachial Plexus Paralysis. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2011.10.003

[19] Early Experience With Locked Intramedullary Wrist Arthrodesis. The Journal of Hand Surgery. 2021. DOI: 10.1016/j.jhsa.2020.11.015

[20] Radiolunate fusion in the rheumatoid wrist with Shapiro staples: clinical and radiological results of 22 cases. Journal of Hand Surgery (European Volume). 2009. DOI: 10.1177/1753193409342054

[21] Limited wrist arthrodesis. Part II: Intercarpal and radiocarpal combinations. The Journal of Hand Surgery. 1981. DOI: 10.1016/s0363-5023(81)80074-3

[22] Salvage of total wrist arthroplasty using the TMW prosthesis. The Journal of Hand Surgery. 2003. DOI: 10.1016/s0363-5023(03)80306-4

[23] Successful conversion of wrist prosthesis to arthrodesis in 11 patients. Journal of Hand Surgery (European Volume). 2016. DOI: 10.1177/1753193416674929

[24] A Changing Landscape in the Surgical Management of Wrist Arthritis: An Analysis of National Trends From 2009 to 2019. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2023.11.009

[26] Scaphotrapeziotrapezoid arthrodesis: A follow-up study. The Journal of Hand Surgery. 2003. DOI: 10.1053/jhsu.2003.50072

[27] Wrist arthrodesis. The Journal of Hand Surgery. 1986. DOI: 10.1016/s0363-5023(86)80142-3

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