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This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

• Total wrist fusion should only be used in exceptional circumstances [1].
• Total wrist fusion should only be used for exceptional circumstances [2].
• Radioscapholunate (RSL) fusion is a palliative procedure that preserves some of the wrist's mobility but has a significant nonunion rate [4].
• Nonspanning arthrodesis is an alternative method for total wrist fusion with a high union rate and minimal risk of complications at the carpometacarpal joint [5].
• Total wrist arthroplasty and partial wrist arthroplasty have a noteworthy potential for complications requiring additional surgery [6].
• 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 [7].
• Additional studies are required to confirm findings regarding partial wrist denervation and investigate who may benefit from it [8].
• There is a low rate of conversion to total wrist arthrodesis following scaphoid excision and four-corner arthrodesis for advanced carpal collapse [9].
• Proximal row carpectomy using decellularized dermal allograft expands the indications for PRC to include select patients with degeneration of the capitate head [16].
• Total wrist arthroplasty and total wrist arthrodesis are both extremely cost-effective procedures in rheumatoid arthritis [22].
• Limited wrist arthrodesis techniques are reliable and effective for a wide range of wrist disorders, with low complication rates and high patient satisfaction [45].

Anatomy & Pathophysiology

• Total wrist fusion is reserved for exceptional circumstances [1].
• Wrist arthrodesis predictably relieves pain and provides a stable wrist for power grip [39].
• Despite loss of wrist motion, most patients report satisfactory functional outcomes and can accomplish most daily activities with adaptation and compensation [11].
• The lateral approach to wrist arthrodesis preserves the distal radio-ulnar joint, avoids scarring of the extensor mechanism, and maintains normal wrist appearance [26].
• Radialization or lateralization of a translocated ulna, aligned with the second metacarpal, decreases reduction in wrist circumference and reduces wrist narrowing [27].
• Radiolunate arthrodesis is effective for unstable wrists with preserved midcarpal joint space [43].
• The choice of procedure for the rheumatoid wrist depends on the pattern of wrist destruction and stability [43].
• The MIRLIN procedure addresses critical stabilizers to prevent carpal instability and collapse [37].
• Proximal row carpectomy (PRC) provides satisfactory postoperative wrist range of motion and grip strength with few complications, particularly in the absence of capitolunate arthrosis [24].
• PRC provides good pain relief with preservation of wrist motion [17].
• PRC individuals demonstrate improved performance and greater wrist motion compared to midcarpal arthrodesis (MA) during hammering [30].
• PRC provides improved flexion-extension with a circumduction curve concentric with the nonsurgical wrist [31].
• Most tasks are performed significantly quicker by patients after PRC compared to four-corner fusion [35].
• PRC has improved motion and fewer complications in patients younger than age 45 years [40].
• Four-corner arthrodesis (4CF) outcomes show significant differences in range of motion and grip strength depending on osteosynthesis methods, but these differences are unlikely to be clinically relevant [28].
• Wrist motion following 4CF correlates positively with preoperative motion, although most patients do not differ significantly in postoperative motion [38].
• Arthrodesis of the reconstructed radiocarpal joint provides better grip strength and functional outcomes than arthroplasty following giant cell tumor excision of the distal radius [41].

Classification

• Radiolunate fusion provides good and excellent clinical results in the majority of patients, and these outcomes do not depend on the fixation device [3].
• Radioscapholunate (RSL) fusion is a palliative procedure that preserves some wrist mobility but has a significant nonunion rate [4].
• Nonspanning arthrodesis is an alternative method for total wrist fusion that offers a high union rate and minimal risk of complications at the carpometacarpal joint [5].
• Four-corner arthrodesis (scaphoid excision) has a low rate of conversion to total wrist arthrodesis [9].
• Proximal row carpectomy (PRC) and four-corner arthrodesis (FCA) demonstrate similarly low rates of conversion to total wrist arthrodesis [10].
• Primary wrist arthrodesis results are slightly more favorable than those for salvage of failed total wrist arthroplasty via total wrist arthrodesis [12].
• Complications and reoperations following total wrist arthrodesis occur frequently, most often due to incomplete bone fusion or hardware-related problems [14].
• It remains unknown which implant type is best for total wrist arthrodesis or if the carpometacarpal joint should be included [14].
• Total wrist arthrodesis combined with proximal row carpectomy (PRC) provides reliable and reproducible benefits in the rheumatoid wrist [15].
• Newer fourth-generation wrist implants appear to perform better than earlier designs [19].
• Proximal row carpectomy is a motion-preserving salvage procedure with a low rate of conversion to wrist arthrodesis [21].
• Four-corner arthrodesis using headless compression screws yields results comparable to or better than previously published techniques regarding fusion rates, pain alleviation, grip strength, range of motion, Mayo wrist score, and Disabilities of the Arm, Shoulder, and Hand questionnaire score [44].

Clinical Presentation

• Radiolunate fusion yields good and excellent clinical results in the majority of patients, independent of the fixation device used [3].
• Nonspanning arthrodesis is an alternative method for total wrist fusion characterized by a high union rate and minimal risk of complications at the carpometacarpal joint [5].
• Total wrist arthroplasty (TWA) and partial wrist arthroplasty carry a noteworthy potential for complications requiring additional surgery [6].
• Additional studies are required to confirm findings regarding partial wrist denervation and to investigate which patients may benefit from it [8].
• Most patients report satisfactory functional outcomes after wrist arthrodesis despite loss of motion, confirming the ability to accomplish most daily activities with adaptation and compensation [11].
• Primary wrist arthrodesis results are slightly more favorable than those for salvage of failed total wrist arthroplasty [12].
• There is an approximate 10% risk of secondary wrist arthrodesis in patients with persistent or progressive ulnar wrist pain following partial wrist denervation [13].
• Total wrist arthrodesis combined with proximal row carpectomy (PRC) provides reliable and reproducible benefits [15].
• Proximal row carpectomy provides good pain relief with preservation of wrist motion [17].
• Awareness of complications associated with wrist arthrodesis is essential for appropriately counseling patients on different options and expectations [18].
• Total wrist arthrodesis using a Wrist Fusion Rod is expected to provide long-lasting pain relief and stability in cases of severe wrist deterioration and ulnar carpal shift [23].
• Both proximal row carpectomy and four-corner fusion provide improvements in pain and subjective outcome measures for patients with symptomatic SLAC or SNAC wrists [29].
• Wrist arthrodesis using the AO Titanium Wrist Fusion Plate is an excellent option for treating various painful disorders of the wrist [34].
• Arthrodesis of the rheumatoid wrist was successful in all but two patients, resulting in increased strength and function [36].

Investigations

• Good and excellent clinical results following radiolunate fusion do not depend on the fixation device [3].
• Despite loss of wrist motion, most patients report satisfactory functional outcomes and are able to accomplish most daily activities with adaptation and compensation [11].
• Proximal row carpectomy using decellularized dermal allograft expands indications to include select patients with degeneration of the capitate head [16].
• Awareness of complications associated with wrist arthrodesis is essential for appropriate patient counseling on different arthrodesis options and expectations [18].
• Proximal row carpectomy (PRC) provides satisfactory postoperative wrist range of motion and grip strength with few complications, especially when there is no capitolunate arthrosis [24].
• Partial denervation of the wrist is feasible and efficacious as an alternative to arthrodesis [25].
• 26-33% of scaphoid fractures judged nondisplaced on radiograph were found to be displaced on CT scan [48].
• Resection followed by wrist arthrodesis and structural iliac bone graft achieved satisfactory oncologic and functional results, although one-third of patients experienced complications at a minimum of 10 years of follow-up [49].
• Radiological adaptation in the radiocapitate joint occurs after proximal row carpectomy (PRC) [51].
• Scaphoidectomy and midcarpal fusion is a useful salvage procedure in a variety of degenerative conditions [52].

Treatment

• Total wrist arthroplasty (TWA) and partial wrist arthroplasty have a noteworthy potential for complications requiring additional surgery [6].
• Total wrist arthrodesis provides reliable pain relief, good functional outcomes, and high patient satisfaction, particularly for end-stage arthritis and as a salvage technique [7].
• There is a low rate of conversion to total wrist arthrodesis following scaphoid excision and four-corner arthrodesis [9].
• Total wrist arthrodesis combined with PRC provides reliable and reproducible benefits [15].
• Patients undergoing proximal row carpectomy experience good pain relief with preservation of wrist motion [17].
• Total wrist arthroplasty and total wrist arthrodesis are both extremely cost-effective procedures [22].
• For stage II SLAC wrist with a preserved capitolunate joint, proximal row carpectomy is preferred because it is technically less demanding and yields durable results [32].
• Radioscapholunate arthrodesis with compression screws and local autograft is an effective method for appropriately selected patients with a preserved midcarpal joint, achieving a 100% union rate at mean follow-up of 12 months with no complications [33].
• Arthroplasty should be used as an alternative to arthrodesis for posttraumatic wrist arthritis given proper patient selection and indications [42].
• Limited data suggest that partial denervation procedures can provide short-term pain relief without altering proprioception, but future studies are needed to assess the duration of relief and possible acceleration of underlying pathology [46].
• Patients undergoing wrist arthrodesis with bone autograft and Hoffmann external fixation regained full finger movements and forearm rotation, though complete pain relief was rare and they had significant limitations in activities of daily living [47].

Complications

• There remains a noteworthy potential for complications requiring additional surgery following total wrist arthroplasty and partial wrist arthroplasty [6].
• Awareness of complications associated with wrist arthrodesis is essential for appropriately counseling patients on different arthrodesis options and informing them on what to expect from the procedure [18].
• Cautious patient selection and consideration of potential complications are crucial for good outcomes in wrist arthrodesis and soft tissue rebalancing for the spastic hand [55].
• Some intercarpal arthrodeses yield good, predictable outcomes, while others are infrequently used due to unpredictable results and high complication rates [61].
• Hardware complications were common in wrist arthrodesis for cerebral palsy, leading to a routine recommendation for hardware removal [60].
• The complication rate for the modified Clayton-Mannerfelt arthrodesis of the wrist in rheumatoid arthritis was low, and hardware did not have to be removed in most cases [53].
• Infection following wrist arthroplasty and arthrodesis is relatively uncommon in a nationally representative Medicare database cohort [58].
• There is an approximate 10% risk of secondary wrist arthrodesis in patients with inflammatory arthritis and persistent or progressive ulnar wrist pain following partial wrist denervation [13].

Recovery

• Proximal row carpectomy (PRC) and four-corner arthrodesis (FCA) demonstrated similarly low rates of conversion to total wrist arthrodesis [10].
• Despite the loss of wrist motion, most patients report satisfactory functional outcomes and are able to accomplish most daily activities of living with some adaptation and compensation [11].
• Results between primary wrist arthrodesis and salvage of failed total wrist arthroplasty were slightly in favour of patients with primary wrist arthrodesis [12].
• Patients undergoing proximal row carpectomy experienced good pain relief with preservation of wrist motion [17].
• While functional improvement was observed for wrist arthroplasty patients, robust long-term follow-up data on wrist arthroplasty are not yet available [20].
• Four-corner arthrodesis with a dorsal locking plate significantly reduced pain and significantly improved wrist function compared with preoperative status at a mean follow-up of 6 years [50].
• Four-corner bone wrist arthrodesis by dorsal rectangular plating achieves acceptable preservation of range of motion, good pain relief, an excellent consolidation rate, and minimal complications [54].
• Four-corner arthrodesis employing the native scaphoid as the principal donor graft demonstrates favourable functional outcomes for functionally demanding patients with Stage II or III collapse deformity [56].

Key Evidence

• [L4] Total wrist fusion should only be used in exceptional circumstances. [1] (10.1097/01.sap.0000194245.94684.54)
• [L4] Total wrist fusion should only be used for exceptional circumstances. [2] (10.1054/jhsb.2000.0434)
• [L4] Good and excellent clinical results in the majority of the patients following radiolunate fusion do not depend on the fixation device. [3] (10.1177/1753193409342054)
• [L4] RSL fusion is a palliative procedure that preserves some of the wrist's mobility but has a significant nonunion rate. [4] (10.1016/j.otsr.2017.07.012)
• [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. [5] (10.1055/s-0037-1606257)
• [L4] Although TWA and partial wrist arthroplasty are attractive treatment options for the painful arthritic wrist, there remains a noteworthy potential for complications requiring additional surgery. [6] (10.1016/j.jhsa.2015.10.021)
• [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. [7] (10.5435/jaaos-d-15-00424)
• [L3] Additional studies are required to confirm these findings and investigate who may benefit from partial wrist denervation. [8] (10.1177/17531934261425490)
• [L4] There is a low rate of conversion to total wrist arthrodesis. [9] (10.1016/j.jhsa.2010.01.025)
• [L3] PRC and FCA demonstrated similarly low rates of conversion to total wrist arthrodesis. [10] (10.2106/jbjs.19.00965)
• [L5] Despite the loss of wrist motion, most patients report satisfactory functional outcomes, confirming that they are able to accomplish most daily activities of living with some adaptation and compensation. [11] (10.1016/j.hcl.2005.08.004)
• [L3] The results between the two groups were slightly in favour of patients with a primary wrist arthrodesis. [12] (10.1177/17531934211057389)
• [L4] Our findings suggest an approximate 10% risk of secondary wrist arthrodesis in patients with persistent or progressive ulnar wrist pain. [13] (10.1007/s10067-019-04645-8)
• [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. [14] (10.1177/17531934241295343)
• [Paper] Total wrist arthrodesis combined with PRC provides reliable and reproducible benefits. [15] (10.1016/j.otsr.2015.09.032)
• [L4] This technique adds another surgical option for the treatment of wrist arthritis and expands the indications for PRC to include select patients with degeneration of the capitate head. [16] (10.1016/j.jhsa.2018.01.012)
• [L3] Patients experienced good pain relief with preservation of wrist motion. [17] (10.1177/1753193415597096)
• [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. [18] (10.1016/j.hcl.2009.11.003)
• [L1] The newer fourth-generation wrist implants appear to be performing better than earlier designs. [19] (10.1055/s-0038-1646956)
• [L2] While functional improvement was observed for arthroplasty patients, robust long-term follow-up data on wrist arthroplasty are not yet available. [20] (10.1177/1753193420953683)
• [L3] Proximal row carpectomy is a motion-preserving salvage procedure with a low rate of conversion to wrist arthrodesis. [21] (10.1016/j.jhsa.2021.09.031)
• [L2] Total wrist arthroplasty and total wrist arthrodesis are both extremely cost-effective procedures. [22] (10.1016/j.jhsa.2009.12.013)
• [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. [23] (10.1016/j.jhsg.2026.101024)
• [L5] PRC provides satisfactory postoperative wrist range of motion and grip strength with few complications, especially when there is no capitolunate arthrosis. [24] (10.1016/j.hcl.2012.08.022)
• [L4] The authors report preliminary clinical experience in 24 patients to demonstrate the feasibility and efficacy of this technique as an alternative to arthrodesis. [25] (10.1097/00130911-199803000-00004)
• [L3] Radialization/lateralization of the translocated ulna achieved from the alignment with the second metacarpal decreases the reduction in the wrist circumference and therefore reduces wrist narrowing. [27] (10.1097/corr.0000000000001604)
• [L4] While there are some significant differences in range of motion and grip strength, these differences are unlikely to be clinically relevant. [28] (10.1016/j.jhsa.2021.06.002)
• [L4] Both procedures provide improvements in pain and subjective outcome measures for patients with symptomatic and appropriately staged SLAC or SNAC wrists. [29] (10.1177/1753193408100954)
• [L4] PRC individuals demonstrated improved performance and greater wrist motion compared to MA during hammering. [30] (10.1016/j.jht.2011.07.007)
• [L4] The PRC provided improved flexion-extension with a circumduction curve concentric with the nonsurgical wrist. [31] (10.1016/j.jhsa.2014.09.005)
• [L4] For stage II SLAC wrist with a preserved capitolunate joint, proximal row carpectomy is preferred because it is technically less demanding and yields durable results. [32] (10.5435/00124635-200307000-00007)
• [L4] This technique is an effective method to perform radioscapholunate arthrodesis in appropriately selected patients with a preserved midcarpal joint, achieving a 100% union rate at mean follow-up of 12 months with no complications. [33] (10.1016/j.jhsa.2013.01.026)
• [L4] Wrist arthrodesis with the AO/ASIF Titanium wrist fusion plate is an excellent option for treatment of various painful disorders of the wrist. [34] (10.1054/jhsb.2001.0600)
• [L3] Most tasks were performed significantly quicker by the patients after proximal row carpectomy. [35] (10.1177/1753193416638812)
• [L4] The technique addresses critical stabilizers to prevent carpal instability and collapse. [37] (10.1016/j.jhsa.2024.10.019)
• [L3] Although wrist motion following 4CF correlates positively with preoperative motion, most patients do not differ significantly in postoperative motion. [38] (10.1016/j.jhsa.2022.06.011)
• [L4] Wrist arthrodesis is a well-established procedure that predictably relieves pain and provides a stable wrist for power grip. [39] (10.5435/00124635-200101000-00006)
• [L4] Proximal row carpectomy has improved motion and fewer complications. [40] (10.1016/j.jhsa.2017.03.015)
• [L3] Arthrodesis of the reconstructed radiocarpal joint provided better grip strength and functional outcomes than arthroplasty. [41] (10.1177/1753193418809785)
• [L3] Arthroplasty should be used as an alternative to arthrodesis in the treatment of posttraumatic wrist arthritis, given the proper patient selection and indications. [42] (10.1016/j.jhsa.2013.02.013)
• [L4] The choice of procedure depends on the pattern of wrist destruction and stability, with radiolunate arthrodesis being effective for unstable wrists with preserved midcarpal joint space. [43] (10.1016/j.hcl.2005.08.005)
• [L4] The results were comparable to or better than previously published techniques in terms of fusion rates, alleviation of pain, grip strength, range of motion, Mayo wrist score, and Disabilities of the Arm, Shoulder, and Hand questionnaire score. [44] (10.1016/j.jhsa.2011.12.022)
• [L4] The study demonstrates that limited wrist arthrodesis techniques are reliable and effective for a wide range of wrist disorders, with low complication rates and high patient satisfaction. [45] (10.1054/jhsb.1999.0066)
• [L4] Limited data suggest that partial denervation procedures can provide short-term pain relief without altering proprioception, but future studies are needed to assess the duration of relief and possible acceleration of underlying pathology. [46] (10.1016/j.jhsa.2017.12.012)
• [L4] All patients regained full finger movements and rotation of the forearm, though complete pain relief was rare and patients had significant limitations in activities of daily living. [47] (10.1177/1753193411416565)
• [L3] 26-33% of scaphoid fractures were judged nondisplaced on radiograph, but displaced on CT scan. [48] (10.1016/j.jhsa.2015.06.021)
• [L2] Resection followed by wrist arthrodesis and structural iliac bone graft achieved satisfactory oncologic and functional results, albeit with one-third of all patients experiencing some complications at a minimum of 10 years of follow-up. [49] (10.1097/corr.0000000000003738)
• [L4] At a mean follow-up of 6 years, pain was significantly reduced and wrist function was significantly improved compared with preoperative status. [50] (10.1177/1753193420930587)
• [Paper] Radiological adaptation in the radiocapitate joint after PRC was found in this study. [51] (10.1016/j.otsr.2020.03.038)
• [L4] Scaphoidectomy and midcarpal fusion is a useful salvage procedure in a variety of degenerative conditions. [52] (10.1177/1753193410395357)
• [L4] The complication rate was low, and the hardware did not have to be removed in most cases. [53] (10.1016/j.jhsa.2013.02.029)
• [L4] Four-corner bone wrist arthrodesis by dorsal rectangular plating achieves an acceptable preservation of range of motion with good pain relief, an excellent consolidation rate and minimal complications. [54] (10.1177/1753193409105684)
• [L4] Cautious patient selection and consideration of potential complications are crucial for good outcomes. [55] (10.1177/17531934231205548)
• [L4] For functionally demanding patients with Stage II or III collapse deformity, this method demonstrates favourable functional outcomes. [56] (10.1177/1753193416676663)
• [L3] Infection following wrist arthroplasty and arthrodesis is relatively uncommon in a nationally representative Medicare database cohort. [58] (10.1177/1558944719890036)
• [L4] Hardware complications were common, and consequently, the authors now routinely recommend hardware removal. [60] (10.1016/j.jhsa.2009.03.006)
• [L5] While some procedures yield good, predictable outcomes, others are infrequently used due to unpredictable results and high complication rates. [61] (10.1016/j.jhsa.2013.09.014)

References

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[6] Complications Following Partial and Total Wrist Arthroplasty: A Single-Center Retrospective Review. The Journal of Hand Surgery. 2016. DOI: 10.1016/j.jhsa.2015.10.021

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[21] Risk of Total Wrist Arthrodesis Following Proximal Row Carpectomy: An Analysis of 1,070 Patients. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2021.09.031

[22] A Cost-Utility Analysis of Nonsurgical Management, Total Wrist Arthroplasty, and Total Wrist Arthrodesis in Rheumatoid Arthritis. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2009.12.013

[23] Total Wrist Arthrodesis Using a Wrist Fusion Rod for the Dislocated Rheumatoid Wrist. Journal of Hand Surgery Global Online. 2026. DOI: 10.1016/j.jhsg.2026.101024

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[26] Arthrodesis of the Wrist: A SURGICAL TECHNIQUE.. The Journal of Bone and Joint Surgery. American Volume. 1967.

[27] Does a Modified Technique to Achieve Arthrodesis of the Wrist After Resection of the Distal Radius and Translocating the Ipsilateral Ulna as a Vascularized Graft to Reconstruct the Defect Improve Grip Strength and Outcomes Scores?. Clinical Orthopaedics & Related Research. 2021. DOI: 10.1097/corr.0000000000001604

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[30] Comparison of Wrist Kinematics and Functional Performance After Midcarpal Arthrodesis and Proximal Row Carpectomy. Journal of Hand Therapy. 2011. DOI: 10.1016/j.jht.2011.07.007

[31] Dynamic Assessment of Wrist After Proximal Row Carpectomy and 4-Corner Fusion. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.09.005

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[33] Radioscapholunate Arthrodesis With Compression Screws and Local Autograft. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.01.026

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[35] Comparison of activities of daily living after proximal row carpectomy or wrist four-corner fusion. Journal of Hand Surgery (European Volume). 2016. DOI: 10.1177/1753193416638812

[36] Arthrodesis of the Rheumatoid Wrist: AN EVALUATION OF SIXTY PATIENTS AND A DESCRIPTION OF A DIFFERENT SURGICAL TECHNIQUE.. The Journal of Bone and Joint Surgery. American Volume. 1973.

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