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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

• Osteoarthritis of the hand and wrist requires an individualized approach to treatment strategies based on site-specific diagnoses and varying disease manifestations [1].
• While functional improvement was observed for arthroplasty patients, robust long-term follow-up data on wrist arthroplasty are not yet available [3].
• Total wrist arthroplasty using the semiconstrained arthroplasty system achieves favorable clinical outcomes with no serious complications requiring revision for 10 years after surgery in patients with rheumatoid arthritis [9].
• While outcomes are generally favorable for therapeutic surgeries like arthrodesis and arthroplasty, further study is required to determine the best indications for ulnar head arthroplasty [36].
• Arthroplasty should be used as an alternative to arthrodesis in the treatment of posttraumatic wrist arthritis, given the proper patient selection and indications [19].
• Minimal arthroplasty may provide a temporary solution for active patients with symptomatic early wrist arthritis who are not candidates for salvage wrist surgery [26].
• The technique of closing wedge radial osteotomy could prove a reliable first line treatment for patients with debilitating wrist osteoarthritis confined to scaphoid/scapholunate articulation with radius as it preserves the ligamentous insertions and the bone stock [4].
• Distal scaphoid excision should be preferred to improve functional results while decreasing scaphotrapeziotrapezoidal osteoarthritis and radiocarpal nonunion rates in radioscapholunate fusion for radiocarpal osteoarthritis [17].
• The authors prefer proximal row carpectomy for SLAC wrists with preserved capitate head cartilage due to socio-economic benefits, lower complication rates, and procedural ease [46].
• Wrist denervation was a viable salvage option for patients with symptomatic SLAC wrist osteoarthritis to preserve motion, decrease pain, and increase function with a low absolute failure rate at mid- to long-term follow-up [12].
• Removal of the trapezium as treatment for basal thumb osteoarthritis does not increase the risk of developing wrist osteoarthritis in the long term [5].

Anatomy & Pathophysiology

• Type I and III wrists in early rheumatoid arthritis exhibit radiographic progression and ultimately undergo deformation [8].
• Combining traditional qualitative evaluation and quantitative measurements may improve the classification of wrist osteoarthritis [11].
• The Watson and Ballet classification of scapholunate advanced collapse (SLAC) wrist osteoarthritis is widely accepted, simple, and a well-recognized guide to treatment despite significant limitations [20].
• Radiographic classification of SLAC wrist has moderate reliability and reproducibility [27].
• Classification of scaphoid nonunion advanced collapse (SNAC) wrist has limited reliability [27].
• Staging systems for SNAC wrist lack agreement [28].
• SNAC wrists differ from SLAC wrists in exhibiting a decreased sagittal lunotriquetral angle, indicating a distinct pathomechanism of carpal instability [34].
• In the early stages of hand osteoarthritis, there is a functional deficit associated with reduced muscle activity of the wrist muscles during manual activities [40].

Classification

• Advanced osteoarthritis of the midcarpal joint without radiocarpal involvement may be more common than previously thought [7].
• Isolated osteoarthritis of the scaphotrapeziotrapezoidal joint is the most prevalent pattern of wrist osteoarthritis [7].
• Reviewing multiview radiographs more commonly yielded Vender stage 3 osteoarthritis classification for SNAC wrist [30].
• The Simmen classification of wrist destruction in rheumatoid arthritis is useful in early disease in about 50% of cases [44].
• The Simmen classification provides reasonably reliable identification of wrists at significant risk of becoming severely unstable, though the false-negative rate is substantial [44].

Clinical Presentation

• Hand manifestations of osteoarthritis can be debilitating, with initial treatment being medical and many patients doing well with splinting and hand therapy [2].
• Subtle differences in history, examination, laboratory values, and imaging, rather than one pathognomonic finding, can improve the diagnostic acumen and expedite appropriate treatment options for monoarticular arthritis of the hand and wrist [6].
• The occurrence of osteoarthritis of the scaphotrapeziotrapezoid and distal radioulnar joints is affected by the presence of osteoarthritis of the adjacent joint [16].
• Patients with wrist arthritis who undergo surgery face higher risks of carpal tunnel syndrome (CTS) and subsequent carpal tunnel release (CTR) than those managed conservatively [13].

Investigations

• Initial treatment for hand manifestations of osteoarthritis is medical, with many patients doing well with splinting and hand therapy [2].
• Subtle differences in history, examination, laboratory values, and imaging can improve diagnostic acumen and expedite appropriate treatment options for monoarticular arthritis of the hand and wrist [6].
• Type I and III wrists had radiographic progression and ultimately underwent deformation [8].
• The occurrence of osteoarthritis of the scaphotrapeziotrapezoid and distal radioulnar joints was affected by the presence of osteoarthritis of the adjacent joint [16].
• Reviewing multiview radiographs more commonly yielded Vender stage 3 osteoarthritis classification for SNAC wrist arthritis [30].
• With CT as the reference method, MRI showed moderate sensitivity and good specificity and accuracy for detection of erosions in rheumatoid arthritis and healthy wrist bones [49].
• Radiography showed very low sensitivity for detection of bone erosions in rheumatoid arthritis and healthy wrist bones [49].
• Subjective radiographic grading of the radioscaphoid joint was unable to detect mild arthritis but was able to distinguish between mild and moderate/severe arthritis [50].
• Bone density was greater at the capitolunate joint, the radial styloid, and the radiolunate joint in SNAC wrists compared to controls [52].
• Computed tomography is more sensitive than conventional radiography for detecting bone erosions in rheumatoid arthritis [53].

Treatment

Non-Operative Management

• Neuromuscular exercise therapy and range-of-motion training show no clinically meaningful differences in the treatment of wrist osteoarthritis at 6 and 12 months [39].

Surgical Management: General Principles

• Surgical intervention markedly improves hand and wrist function for many rheumatoid patients [29].
• Preservation of movement is beneficial to function, and a preferable compromise may be selective excision and partial fusion of the wrist using knowledge of the aetiology and pattern of degenerative change [25].
• Arthroplasty should be used as an alternative to arthrodesis in the treatment of posttraumatic wrist arthritis, given proper patient selection and indications [19].

Surgical Management: Arthrodesis and Fusion

• Patients tolerate the restrictions caused by a stiff wrist provided it is painless [21].
• Four-corner fusion and scaphoid excision using headless compression screws for SLAC and SNAC wrist deformities result in most patients being pleased postoperatively, with improvement in wrist pain being the most common finding [10].
• Radioscapholunate fusion for radiocarpal osteoarthritis benefits from distal scaphoid excision to improve functional results while decreasing scaphotrapeziotrapezoidal osteoarthritis and radiocarpal nonunion rates [17].
• Closing wedge radial osteotomy is a reliable first-line treatment for patients with debilitating wrist osteoarthritis confined to the scaphoid/scapholunate articulation with the radius, as it preserves ligamentous insertions and bone stock [4].

Surgical Management: Arthroplasty

• Newer fourth-generation wrist implants appear to be performing better than earlier designs [18].
• Minimal wrist arthroplasty may provide a temporary solution for active patients with symptomatic early wrist arthritis who are not candidates for salvage wrist surgery [26].

Surgical Management: Salvage and Other Procedures

• Wrist denervation is a viable salvage option for patients with symptomatic SLAC wrist osteoarthritis to preserve motion, decrease pain, and increase function with a low absolute failure rate at mid- to long-term follow-up [12].
• Arthroscopic synovectomy of the wrist can provide pain relief and functional improvement with control of synovitis in 75% of rheumatoid wrists that have not responded to medication [51].

Complications

• Robust long-term follow-up data on wrist arthroplasty are not yet available [3].
• Total wrist arthroplasty using the semiconstrained arthroplasty system achieves favorable clinical outcomes with no serious complications requiring revision for 10 years after surgery [9].
• Most patients were pleased postoperatively following four-corner fusion and scaphoid excision, with improvement in wrist pain being the most common finding [10].
• There is an approximate 10% risk of secondary wrist arthrodesis in patients with persistent or progressive ulnar wrist pain following partial wrist denervation [14].
• Functional results of four-corner fusion for SLAC and SNAC wrist were good at long-term follow-up despite radiographic changes in the radiolunate joint in 73% of patients [15].
• Elbow, wrist, and hand surgery provided long-lasting benefits in rheumatoid arthritis patients [23].
• The overall survival probability of partial wrist denervation in painful wrist osteoarthritis is above 50% at 5 years [24].
• Delayed-onset ulnar neuropathy at the wrist can occur 12 to 30 years after conservatively treated distal radius fractures with malunion and distal radioulnar joint (DRUJ) arthritis [31].

Recovery

• Partial wrist denervation in inflammatory arthritis carries an approximate 10% risk of secondary wrist arthrodesis in patients with persistent or progressive ulnar wrist pain [14].
• Functional results of 4-corner fusion for SLAC and SNAC wrist are good at long-term follow-up despite radiographic changes in the radiolunate joint in 73% of patients [15].
• Elbow, wrist, and hand surgery provided long-lasting benefits in rheumatoid arthritis patients according to patient-reported outcome assessments [23].
• Partial wrist denervation in painful wrist osteoarthritis has an overall survival probability above 50% at 5 years [24].
• Delayed-onset ulnar neuropathy at the wrist can occur 12 to 30 years after conservatively treated distal radius fractures with malunion and distal radioulnar joint arthritis [31].

Key Evidence

• [L5] Osteoarthritis of the hand and wrist requires an individualized approach to treatment strategies based on site-specific diagnoses and varying disease manifestations. [1] (10.1016/j.jht.2022.01.001)
• [L5] The hand manifestations of osteoarthritis can be debilitating, with initial treatment being medical and many patients doing well with splinting and hand therapy. [2] (10.1016/j.hcl.2010.09.003)
• [L2] While functional improvement was observed for arthroplasty patients, robust long-term follow-up data on wrist arthroplasty are not yet available. [3] (10.1177/1753193420953683)
• [L4] The technique could prove a reliable first line treatment for patients with debilitating wrist osteoarthritis confined to scaphoid/scapholunate articulation with radius as it preserves the ligamentous insertions and the bone stock. [4] (10.1016/j.jisako.2025.100448)
• [L3] Removal of the trapezium as treatment for basal thumb osteoarthritis does not increase the risk of developing wrist osteoarthritis in the long term. [5] (10.1186/s13018-021-02856-x)
• [L5] Subtle differences in history, examination, laboratory values, and imaging, rather than one pathognomonic finding, can improve the diagnostic acumen and expedite appropriate treatment options for monoarticular arthritis of the hand and wrist. [6] (10.1016/j.jhsa.2012.04.010)
• [L4] Advanced osteoarthritis of the midcarpal joint without radiocarpal involvement may be more common than previously thought, with isolated osteoarthritis of the scaphotrapeziotrapezoidal joint being the most prevalent pattern. [7] (10.1177/17531934241275450)
• [L2] Type I and III wrists had radiographic progression and ultimately underwent deformation. [8] (10.1016/j.jhsa.2009.01.016)
• [L4] Total wrist arthroplasty using the semiconstrained arthroplasty system achieves favorable clinical outcomes with no serious complications requiring revision for 10 years after surgery. [9] (10.1016/j.jhsa.2024.03.002)
• [L4] Most patients were pleased postoperatively, with improvement in wrist pain being the most common finding. [10] (10.1097/bth.0b013e3181f60fec)
• [L4] Combining traditional qualitative evaluation and quantitative measurements may improve the classification of wrist osteoarthritis. [11] (10.1177/1753193416669261)
• [L4] This method of wrist denervation was a viable salvage option for patients with symptomatic SLAC wrist osteoarthritis to preserve motion, decrease pain, and increase function with a low absolute failure rate at mid- to long-term follow-up. [12] (10.1016/j.jhsa.2021.02.023)
• [L2] Patients with wrist arthritis who undergo surgery face higher risks of CTS and subsequent CTR than those managed conservatively. [13] (10.1016/j.jhsa.2026.01.013)
• [L4] Our findings suggest an approximate 10% risk of secondary wrist arthrodesis in patients with persistent or progressive ulnar wrist pain. [14] (10.1007/s10067-019-04645-8)
• [L4] Functional results were good at long-term follow-up despite radiographic changes in the radiolunate joint in 73% of patients. [15] (10.1177/1558944716681949)
• [L4] The occurrence of osteoarthritis of the scaphotrapeziotrapezoid and distal radioulnar joints was affected by the presence of osteoarthritis of the adjacent joint. [16] (10.1016/j.jhsa.2023.05.009)
• [L4] Distal scaphoid excision should be preferred to improve functional results while decreasing scaphotrapeziotrapezoidal osteoarthritis and radiocarpal nonunion rates. [17] (10.1055/s-0039-1688939)
• [L1] The newer fourth-generation wrist implants appear to be performing better than earlier designs. [18] (10.1055/s-0038-1646956)
• [L3] Arthroplasty should be used as an alternative to arthrodesis in the treatment of posttraumatic wrist arthritis, given the proper patient selection and indications. [19] (10.1016/j.jhsa.2013.02.013)
• [L5] Despite its significant limitations, the Watson and Ballet classification of SLAC wrist osteoarthritis is widely accepted, simple, and a well-recognized guide to treatment. [20] (10.1097/corr.0000000000000451)
• [L4] Patients tolerate the restrictions caused by a stiff wrist provided it is painless. [21] (10.1054/jhsb.2002.0806)
• [L4] Our original patient-reported outcome assessment tool revealed that elbow, wrist and hand surgery provided long-lasting benefits in RA patients. [23] (10.1111/1756-185x.13340)
• [L3] The study found an overall survival probability above 50% at 5 years after partial wrist denervation in painful wrist OA. [24] (10.1177/17531934261425490)
• [L5] Preservation of movement is beneficial to function, and a preferable compromise may be selective excision and partial fusion of the wrist using knowledge of the aetiology and pattern of degenerative change. [25] (10.1302/0301-620x.97b10.35717)
• [L4] Minimal arthroplasty as described may provide a temporary solution for active patients with symptomatic early wrist arthritis who are not candidates for salvage wrist surgery. [26] (10.1055/s-0033-1338255)
• [L4] Radiographic classification of SLAC wrist has moderate reliability and reproducibility, whereas classification of SNAC wrist has limited reliability. [27] (10.1177/1753193413484629)
• [Paper] Staging systems for SNAC wrist lack agreement. [28] (10.1007/s12593-012-0062-2)
• [L5] Surgical intervention markedly improves hand and wrist function for many rheumatoid patients. [29] (10.5435/jaaos-d-20-00102)
• [L4] Reviewing multiview radiographs more commonly yielded Vender stage 3 osteoarthritis classification. [30] (10.1177/1558944720937359)
• [L4] Delayed-onset ulnar neuropathy at the wrist can occur 12 to 30 years after conservatively treated distal radius fractures with malunion and DRUJ arthritis. [31] (10.1016/j.jhsa.2009.11.005)
• [L4] SNAC wrists differ from SLAC wrists in exhibiting a decreased sagittal lunotriquetral angle, indicating a distinct pathomechanism of carpal instability. [34] (10.1186/s12891-025-08652-6)
• [L5] While outcomes are generally favorable for therapeutic surgeries like arthrodesis and arthroplasty, further study is required to determine the best indications for ulnar head arthroplasty. [36] (10.1016/j.jht.2013.12.002)
• [L1] We found no clinically meaningful differences between the neuromuscular exercise therapy program and range-of-motion training in the treatment of wrist osteoarthritis at 6 and 12 months. [39] (10.1186/s12891-025-09463-5)
• [L3] In the early stages of HOA, there is a functional deficit associated with a reduced muscle activity of the wrist muscles during manual activities. [40] (10.1016/j.jht.2019.12.010)
• [L3] The Simmen classification of wrist destruction in rheumatoid arthritis is useful in early disease in about 50% of cases and provides reasonably reliable identification of wrists at significant risk of becoming severely unstable, though the false-negative rate is substantial. [44] (10.1054/jhsb.1999.0196)
• [L3] The authors prefer proximal row carpectomy for SLAC wrists with preserved capitate head cartilage due to socio-economic benefits, lower complication rates, and procedural ease. [46] (10.1177/1753193408087116)
• [L4] With CT as the reference method, MRI showed moderate sensitivity and good specificity and accuracy for detection of erosions in rheumatoid arthritis and healthy wrist bones, while radiography showed very low sensitivity. [49] (10.1186/ar2378)
• [L3] Subjective radiographic grading of the radioscaphoid joint was unable to detect mild arthritis but was able to distinguish between mild and moderate/severe arthritis. [50] (10.1007/s11552-013-9522-9)
• [L4] Arthroscopic synovectomy of the wrist can provide pain relief and functional improvement with control of synovitis in 75% of rheumatoid wrists that have not responded to medication. [51] (10.1016/j.jhsa.2014.04.022)
• [L3] Bone density was greater at the capitolunate joint, the radial styloid, and the radiolunate joint in SNAC wrists compared to controls. [52] (10.2106/jbjs.22.01350)
• [L3] Computed tomography is more sensitive than conventional radiography for detecting bone erosions in rheumatoid arthritis. [53] (10.1186/1471-2474-14-265)

References

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[2] Current Concepts in the Surgical Management of Rheumatoid and Osteoarthritic Hands and Wrists. Hand Clinics. 2011. DOI: 10.1016/j.hcl.2010.09.003

[3] A systematic review of outcomes of wrist arthrodesis and wrist arthroplasty in patients with rheumatoid arthritis. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193420953683

[4] Case Series: Closing Wedge Radial Osteotomy for Scaphoid Nonunion and Scaphoid Nonunion Advanced Collapse (SNAC) Wrists. Journal of ISAKOS. 2025. DOI: 10.1016/j.jisako.2025.100448

[5] Trapeziectomy for basal thumb osteoarthritis does not increase the risk of developing wrist osteoarthritis in the long term. Journal of Orthopaedic Surgery and Research. 2021. DOI: 10.1186/s13018-021-02856-x

[6] Diagnostic Considerations for Monoarticular Arthritis of the Hand and Wrist. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.04.010

[7] Patterns of osteoarthritis of the wrist: a single-centre observational cohort study. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934241275450

[8] Prediction of Wrist Prognosis in Patients With Early Rheumatoid Arthritis According to Radiographic Classification. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.01.016

[9] Clinical Outcomes of Total Wrist Arthroplasty in Patients With Rheumatoid Arthritis: Minimum 10-Year Follow-Up Study. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.03.002

[10] Four-Corner Fusion and Scaphoid Excision Using Headless Compression Screws for SLAC and SNAC Wrist Deformities. Techniques in Hand & Upper Extremity Surgery. 2011. DOI: 10.1097/bth.0b013e3181f60fec

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[12] Midterm Patient-Reported Outcomes in Wrist Denervation for Post-Traumatic Arthritis. The Journal of Hand Surgery. 2021. DOI: 10.1016/j.jhsa.2021.02.023

[13] Surgical Management of Wrist Arthritis Is Linked to Increased Carpal Tunnel Syndrome/Carpal Tunnel Release Risk: Rethinking Preoperative Evaluation. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2026.01.013

[14] Patient satisfaction and outcomes of partial wrist denervation in inflammatory arthritis. Clinical Rheumatology. 2019. DOI: 10.1007/s10067-019-04645-8

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[19] Clinical Outcomes of Arthrodesis and Arthroplasty for the Treatment of Posttraumatic Wrist Arthritis. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.02.013

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[21] Arthrodesis of the Wrist with Bioabsorbable Fixation in Patients with Rheumatoid Arthritis. Journal of Hand Surgery. 2002. DOI: 10.1054/jhsb.2002.0806

[23] Long‐term patient reported outcomes of elbow, wrist and hand surgery for rheumatoid arthritis. International Journal of Rheumatic Diseases. 2018. DOI: 10.1111/1756-185x.13340

[24] Revision rate and long-term outcome after partial wrist denervation in wrist osteoarthritis. Journal of Hand Surgery (European Volume). 2026. DOI: 10.1177/17531934261425490

[25] The treatment of arthritis of the wrist. The Bone & Joint Journal. 2015. DOI: 10.1302/0301-620x.97b10.35717

[26] A Minimal Wrist Arthroplasty for Early Wrist Osteoarthritis. Journal of Wrist Surgery. 2013. DOI: 10.1055/s-0033-1338255

[27] Reproducibility of radiographic classification of scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrist. Journal of Hand Surgery (European Volume). 2013. DOI: 10.1177/1753193413484629

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[29] Collaboration in Hand Surgery: Experiences From Silicone Arthroplasty in Rheumatoid Arthritis, Finger Replantation and Amputation Challenges in Assessing Impairment, Satisfaction, and Effectiveness, Wrist and Radius Injury Surgical Trial, and Surgery of the Ulnar Nerve. Journal of the American Academy of Orthopaedic Surgeons. 2020. DOI: 10.5435/jaaos-d-20-00102

[30] A Reliability Study of Multiplanar Radiographs for the Evaluation of SNAC Wrist Arthritis. HAND. 2020. DOI: 10.1177/1558944720937359

[31] Delayed-Onset Ulnar Neuropathy at the Wrist Associated With Distal Radioulnar Joint Arthritis After Radius Malunion: Report of Two Cases. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2009.11.005

[34] Computer-aided three-dimensional analysis of carpal alignment in scaphoid nonunion advanced collapse wrists: A comparative study with scapholunate advanced collapse and healthy wrists. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08652-6

[36] Update on the surgical treatment for rheumatoid arthritis of the wrist and hand. Journal of Hand Therapy. 2014. DOI: 10.1016/j.jht.2013.12.002

[39] Long-term effects of neuromuscular exercise therapy and the need for surgical conversion in wrist osteoarthritis: 24-month results from a randomized controlled trial. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-09463-5

[40] Impairment of electrical activation of wrist flexor and extensor muscles during gripping and functional activities in the early stage of hand osteoarthritis: A cross-sectional study. Journal of Hand Therapy. 2021. DOI: 10.1016/j.jht.2019.12.010

[44] The Simmen Classification of Wrist Destruction in Rheumatoid Arthritis. Journal of Hand Surgery. 1999. DOI: 10.1054/jhsb.1999.0196

[46] Proximal Row Carpectomy Versus Four-Corner Arthrodesis as a Treatment for SLAC (Scapholunate Advanced Collapse) Wrist. Journal of Hand Surgery (European Volume). 2008. DOI: 10.1177/1753193408087116

[49] Detection of bone erosions in rheumatoid arthritis wrist joints with magnetic resonance imaging, computed tomography and radiography. Arthritis Research & Therapy. 2008. DOI: 10.1186/ar2378

[50] Joint Space Height Correlates with Arthroscopic Grading of Wrist Arthritis. HAND. 2013. DOI: 10.1007/s11552-013-9522-9

[51] Long-Term Results of Arthroscopic Wrist Synovectomy in Rheumatoid Arthritis. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.04.022

[52] Quantitative 3-D CT Demonstrates Distal Row Pronation and Translation and Radiolunate Arthritis in the SNAC Wrist. Journal of Bone and Joint Surgery. 2023. DOI: 10.2106/jbjs.22.01350

[53] Validity of a computer-assisted manual segmentation software to quantify wrist erosion volume using computed tomography scans in rheumatoid arthritis. BMC Musculoskeletal Disorders. 2013. DOI: 10.1186/1471-2474-14-265