Total Wrist Arthrodesis: An Update on Indications, Technique and Outcomes



1 Department of Orthopedic Surgery, La Paz University Hospital, Madrid, Spain

2 Department of Orthopaedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

3 Orthopedic Research Center, Department of Orthopedic, Hand, and Microsurgery, St.Marien Stift Medical Campus, Friesoythe, Germany

4 4 Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, USA 5 Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran



Painful end-stage wrist arthritis unresponsive to conservative treatment is frequently managed with total wrist 
arthrodesis (TWA), which might render pain alleviation and ameliorate function, pain, and grip strength. Usual 
indications for TWA include inflammatory arthritis, idiopathic degenerative osteoarthritis (OA) and posttraumatic OA, 
Kienböck's illness, brachial plexus palsy, cerebral paralysis, infraclavicular brachial plexus blocks and other spastic 
and contracture base illnesses, scapholunate advanced collapse, scaphoid nonunion advanced collapse, and failure 
of other surgical techniques such as after failed total wrist arthroplasty, four-corner fusion, proximal row carpectomy 
and severe ligament injuries (this procedure is carried out when all other treatment alternatives have failed to control 
the individual's symptoms). TWA is commonly carried out with a dorsal plate fixed from the distal radius to the third 
metacarpal. However, other surgical procedures have been reported, including intramedullary fixation and new 
implants that do not cross the third carpometacarpal joint or some procedures without utilizing hardware for example 
using a vascularized fibular grafting In individuals with rheumatoid arthritis. TWA has been shown to give persistent 
and painless stability for 20 years or more. The rate of adverse events for TWA ranges from 0.1% to 6.1%, though 
some authors have published that it can be as high as 27%. The most common adverse events are tendon ruptures, 
peri-implant fractures of the third metacarpal, the need for hardware removal, and constant pain at the third 
carpometacarpal joint. In idiopathic degenerative OA, the reoperation rate following TWA has been reported as high 
as 63%. While TWA can render foreseeable pain alleviation and ameliorate function, orthopedic surgeons should 
remember that this surgical technique is not without its risks and that the accessibility of many surgical procedures 
requires orthopedic surgeons to scrupulously contemplate the risks and benefits of each alternative for the individual 
in front of them. 
 Level of evidence: III


Main Subjects

Volume 11, Issue 3
March 2023
Pages 144-153
  • Receive Date: 08 June 2022
  • Revise Date: 01 March 2023
  • Accept Date: 13 September 2022
  • First Publish Date: 26 February 2023