Total wrist arthrodesis in patients with advanced osteoarthritis: current implants and outcomes.

Total wrist arthrodesis can be used to treat symptomatic end-stage wrist osteoarthritis after failed conservative treatment. It can also be considered the last-resort option when partial fusion, proximal row carpectomy, denervation or prosthetic arthroplasty is unsuccessful. Currently anatomic pre-contoured low-profile plates with angle stable screws are available with or without inclusion of the carpometacarpal joints. Generally, patients are satisfied after total wrist arthrodesis, although they are not always pain-free, even when wrist flexion and extension remain limited or absent. Complications and reoperations occur frequently, most often due to incomplete bone fusion or hardware-related problems. It is still not known which type of implant is best for degenerative osteoarthritis and if the carpometacarpal joint should be included in the arthrodesis. Future prospective randomized trials may shed more insights on these questions.