Arthrodesis of the arthritic wrist

Although arthroplasty has developed tremendously in the last few years, there are still indications for arthrodesis of the wrist, particularly in nonrheumatoid patients where fairly heavy loads are imposed on the joint. Fusion is also a salvage procedure for failures of other procedures. The authors recommend fusion in a neutral position for unilateral or bilateral cases. Neutral is defined as 0 degree on the lateral with about 10 degrees ulnar deviation. This gives an arc of motion from pronation and supination, which substitutes for palmar flexion and dorsiflexion. The important factors in securing arthrodesis are: internal fixation with intramedullary pins, bony contact, bone graft if necessary, compression, and obtaining or maintaining rotation of the forearm. In selected cases arthrodesis of the wrist produces a very good result.