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Partial Wrist Fusion (Four-Corner and Capitolunate Arthrodesis)

Limited intercarpal arthrodesis options — four-corner fusion (with scaphoid excision) and capitolunate (two-corner) fusion — for SLAC/SNAC wrist; preserves some midcarpal motion vs total wrist fusion.

87 citationsUpdated Sep 2026
Illustration: Partial Wrist Fusion (Four-Corner and Capitolunate Arthrodesis)

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Partial wrist fusion is a salvage operation indicated when clinical and radiographic evidence confirms wrist arthritis [2]. These procedures are effective methods for treating specific carpal disorders, optimizing postoperative wrist motion, strength, and stability while reducing pain [11]. Adherence to the basic principles of limited wrist fusions results in a good outcome [1], and good long-term results can be obtained from motion-preserving procedures if indications are accurately respected and the technique is well performed to prevent complications [3]. Capitolunate arthrodesis is a feasible option for scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists [13], while midcarpal arthrodesis serves as a long-lasting treatment option for advanced carpal collapse with good long-term results [32].

Indications vary by disease stage and joint integrity. Proximal row carpectomy is preferred for stage II SLAC wrist with a preserved capitolunate joint because it is technically less demanding and yields durable results [4, 27]. Conversely, scaphoid excision and four-corner fusion is the choice for stage III SLAC wrist [27], and four-bone fusion with scaphoid excision is preferred when capitolunate arthritis is present [21]. Radioscapholunate arthrodesis with compression screws and local autograft is an effective method for appropriately selected patients with a preserved midcarpal joint [18]. Once Kienböck disease extends outside of the lunate, reconstruction with proximal row carpectomy or partial or total wrist arthrodesis should be considered based on which articular surfaces are affected [19].

Wrist fusion is performed nearly 5 times more frequently than total wrist arthroplasty [6]. While short-term findings suggest that total wrist arthroplasty compares favorably with wrist fusion [6], total wrist fusion should only be used in exceptional circumstances [8]. 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 [31]. The decision between total wrist arthroplasty and total wrist arthrodesis is based on technical experience with newer implants, the patient's ability to adhere to strict activity limitations, and the willingness to accept the higher complication rate and eventual implant failure of arthroplasty in exchange for maintaining some wrist motion [177]. Both procedures are extremely cost-effective [44]. Arthroscopic resection arthroplasty may serve as a temporary alternative to partial wrist arthrodesis for younger patients or a definitive procedure for less demanding patients, though results may be short-lived [5]. Pyrocarbon capitate resurfacing implant surgery may represent a good alternative to total and partial wrist arthrodesis [9].

Anatomy & Pathophysiology

Bony Anatomy

The wrist comprises eight carpal bones arranged in a proximal row (scaphoid, lunate, triquetrum, pisiform) and a distal row (trapezium, trapezoid, capitate, hamate) [72]. The distal radius articular surface features two concave facets for the scaphoid and lunate, separated by a ridge corresponding to the scapholunate interval [76]. This surface has an average volar tilt of 11 degrees and a radial inclination of 23 degrees [76]. The capitate is the largest carpal bone and articulates with seven other bones [72]. The lunate is broader palmarly than dorsally [82]. The triquetrum articulates with the lunate radially, the triangular fibrocartilage proximally, and the hamate distally [64].

Ligamentous Anatomy

Extrinsic carpal ligaments connect the radius or ulna to the carpus, with volar ligaments generally stronger than dorsal ligaments [77]. The scapholunate interosseous ligament (SLIL) is C-shaped in the sagittal plane, with the dorsal portion being the thickest and strongest [77]. The lunotriquetral interosseous ligament (LTIL) is C-shaped, with the volar portion being the thickest and strongest [77]. The SLIL provides a flexion force on the lunate due to its attachment to the scaphoid [77], while the LTIL provides an extension moment on the lunate due to its attachment to the triquetrum [77]. The dorsal radiocarpal ligament has a trapezoidal shape, passing from the dorsal rim of the distal radius to the lunate and triquetrum [77]. The dorsal intercarpal ligament passes from the dorsal tubercle of the triquetrum to the distal pole of the scaphoid [77]. The space of Poirier is a weak area adjacent to the proximal capitate without ligamentous attachment, situated ulnar to the radioscaphocapitate ligament and radial to the long radiolunate ligament [77].

Vascular Anatomy

The scaphoid's primary vascular supply is a branch of the radial artery at the dorsal ridge, with smaller vessels supplying the distal 30% via the palmar tubercle [82]. The lunate has a dorsal and palmar vascular supply in 80% of wrists, while 20% have only a palmar supply [82]. The capitate head often relies on a retrograde vascular supply [82].

Meniscal Anatomy

The triangular fibrocartilage complex (TFCC) includes the central meniscus homolog, dorsal and volar radioulnar ligaments, the floor of the extensor carpi ulnaris tendon sheath, and volar ulnocarpal ligaments [82]. Only the peripheral 10% to 40% of the volar, ulnar, and dorsal TFCC has a vascular supply [82].

Kinematics and Biomechanics

The wrist functions as a two-joint system linking the hand to the forearm via the mobile proximal carpal row [83]. The proximal carpal row has no muscular or tendinous attachments and functions as an intercalary segment [82]. During wrist flexion, the proximal row translates dorsally, while during wrist extension, it translates palmarly [77]. Approximately 62% of wrist extension occurs through the radiocarpal joint and 62% of wrist flexion occurs through the midcarpal joint [77]. The midcarpal joint is primarily responsible for 20 degrees of radial deviation and 40 degrees of ulnar deviation [77]. More than half the motion of the carpus when the wrist is loaded in extension occurs at the midcarpal joint [101]. The "dart thrower's motion" involves moving from radial extension into ulnar flexion and occurs almost exclusively through the midcarpal joint [83]. This motion defines the transition between flexion and extension of the scaphoid and lunate, during which proximal row motion approaches zero [83].

The radius bears 80% of the axial load transmitted through the radiocarpal joint, while the ulna bears 20% in neutral ulnar variance [77]. With axial loading through the neutral wrist, approximately 60% of forces are transmitted through the scaphoid facet and 40% through the lunate facet of the distal radius [82]. The contact areas between the scaphoid and distal radius are maximized during full extension of the wrist [104]. During forearm rotation, the contact site of the scaphoid and lunate on the distal radial articular surface changes minimally [119].

Pathophysiology

Scapholunate advanced collapse (SLAC) wrist is a pattern of degenerative arthritis initially involving the radioscaphoid junction, progressing to the midcarpal joint while sparing the radiolunate articulation [56]. SLAC wrist may result from chronic pseudogout and can appear bilaterally without a clear history of injury [56]. Scaphoid nonunion advanced collapse (SNAC) is caused by trauma [56]. Scaphoid nonunions have a dramatic impact on carpal kinematics, partially uncoupling the proximal and distal carpal rows [98]. SNAC wrists differ from SLAC wrists by exhibiting a decreased sagittal lunotriquetral angle, indicating a distinct pathomechanism of carpal instability [124].

Scapholunate ligament injury results in a pattern of kinematic changes despite individual variance [109]. The effect of ligament sectioning on producing carpal instability may be moderated by the bone geometry of the radiocarpal joint [120]. There is a relationship between scapholunate kinematics and laxity at the level of the interosseous ligaments [133]. The SLIL counteracts the extension moment imparted by the LTIL by transferring the flexion moment from the scaphoid to the lunate [172]. Partial injuries to the SLIL can lead to attenuation of structures, ultimately culminating in arthritis [172].

Classification

SLAC/SNAC Staging: Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) arthritis are staged 1–4 [117]. Stage I involves degenerative changes limited to the radial styloid/scaphoid articulation [49], with Stage 1 SNAC specifically characterized by radial styloid arthritis [117]. Stage II involves degenerative changes of the entire radioscaphoid joint with mild or no changes at the capitolunate or radiolunate joint [49]. Stage IIIA is defined by mild or no changes at the capitolunate joint and moderate to severe changes at the radiolunate joint [49]. Stage IIIB is defined by moderate to severe changes at the capitolunate joint and mild or no changes at the radiolunate joint [49]. Stage IV involves moderate to severe changes at both the capitolunate and radiolunate joints [49]. The subdivision of stage III into IIIA and IIIB describes different patterns of degeneration seen by inspection rather than a sequence of degeneration [49].

Operative Indications: Stage IIIA wrists are considered candidates for proximal row carpectomy [49]. Stage IIIB wrists are considered candidates for scaphoid excision and four-corner arthrodesis [49].

Other Considerations: The modified classification of SLAC/SNAC stages is based on intraoperative findings [49]. This modified classification calls into question the validity of the accepted classification of Krakauer et al. [49]. Triquetro-lunate fusions are the commonest type of fusions in the carpal region [167].

Clinical Presentation

A salvage operation, such as a partial wrist fusion, is indicated when clinical and radiographic evidence confirms wrist arthritis [2]. Wrist arthrodesis is no longer the exclusive solution for arthritic wrists [24], and four-corner arthrodesis or proximal row carpectomy should not always serve as standard management for advanced radiocarpal arthritis [26]. The choice of procedure depends on the pattern of wrist destruction and stability [15]. 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 [4]. Once disease extends outside of the lunate, reconstruction with proximal row carpectomy or partial or total wrist arthrodesis should be considered based on which articular surfaces are affected [19]. When capitolunate arthritis is present, four-bone fusion with scaphoid excision is the preferred option [21].

Indications for Partial Fusion: * Radiolunate Arthrodesis: Effective for unstable wrists with preserved midcarpal joint space [15]. * RSL Fusion: With distal scaphoidectomy and entire triquetrum excision, this serves as a useful alternative to total wrist arthrodesis for patients with an intact midcarpal joint [25]. * Capitolunate Arthrodesis: A feasible option for scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists, with complications similar to those encountered in four-corner arthrodesis [13]. * Lunocapitate Arthrodesis: With scaphoid excision, this provides functional and radiological results comparable to four-corner fusion without the deleterious effect on ulnocarpal and proprioceptive dysfunction associated with including the triquetrum in the fusion site [10].

Long-term Outcomes and Stability: If the basic principles of limited wrist fusions are adhered to, a good outcome can be obtained [1]. Although some may view motion-preserving procedures as a staged full wrist fusion, good long-term results can be obtained if indications are accurately respected and the technique is well performed to prevent complications [3]. Scaphoid excision and four-corner fusion remains a viable option for patients with advanced wrist arthritis, providing reliable, resilient functional results that remain stable over time [65]. The outcome of scaphoid excision and four-corner arthrodesis is favorable at one year and does not deteriorate significantly between one and 10 years [41]. Functional results were good at long-term follow-up despite radiographic changes in the radiolunate joint in 73% of patients [30]. The midcarpal arthrodesis is a long-lasting treatment option for advanced carpal collapse with good long-term results [32]. Despite radiographic progression, radiolunate and radioscapholunate arthrodeses yield good clinical results at long-term follow-up [33]. Good and excellent clinical results in the majority of patients following radiolunate fusion do not depend on the fixation device [14].

Functional Expectations and Counseling: The technique of partial intercarpal fusion relieves pain in all but two instances and restores a strong grip in all but one patient, with wrist immobilization required for only two months [37]. 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 [68]. Patients are generally satisfied after total wrist arthrodesis, although they are not always pain-free despite limited or absent wrist motion [69]. Bilateral total wrist arthrodesis improved pain while enabling patients with severe carpal arthrosis to maintain a satisfactory level of extremity function and quality of life [40]. Complete or total wrist arthrodesis is a well-established reconstructive surgical procedure that results in predictable pain relief and satisfactory function in patients who have various inflammatory, degenerative, and post-traumatic conditions [162]. 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 [163].

Alternative Procedures and Comparisons: Conversion to arthrodesis after failed wrist arthroplasty is worthwhile and reliably improves wrist function over failed wrist arthroplasty [7]. The results between the two groups were slightly in favour of patients with a primary wrist arthrodesis [23]. Although wrist fusion is performed nearly 5 times more frequently than total wrist arthroplasty, short-term findings suggest that total wrist arthroplasty compares favorably with wrist fusion [6]. This surgical procedure may represent a good alternative to total and partial wrist arthrodesis [9]. It may serve as a temporary alternative to partial wrist arthrodesis for younger patients or a definitive procedure for less demanding patients, though results may be short-lived [5].

Investigations

Plain radiography: Initial wrist imaging comprises four standard views: posteroanterior with the wrist in ulnar deviation, lateral, semi-pronated oblique, and semi-supinated oblique [96]. An anteroposterior view with the fist clenched is added when scapholunate injury is suspected [96]. On the lateral radiograph, the axes of the radius, lunate, capitate, and third metacarpal are co-linear, while the scaphoid projects at an angle of approximately 45 degrees to this line [96]. Dorsal intercalated segmental instability is identified by the lunate tilting backwards and the axes of the capitate and metacarpals lying dorsal to that of the radius [96]. Conversely, volar intercalated segment instability presents with the lunate and scaphoid tilting volarwards and the capitate and metacarpals lying anterior to the radius [96]. Clinicians must note that 10–15% of scaphoid fractures are not visible on initial X-rays [96].

MRI: MRI is the modality of choice for imaging radiographically occult fractures of the hand and wrist [80]. Its primary advantages over CT and radiography include improved tissue characterization, particularly of soft tissues such as ligamentous structures and synovium, and the absence of ionizing radiation [80]. A static magnetic field strength of at least 1.5 T using a dedicated wrist coil is recommended for analyzing interosseous, intrinsic, and extrinsic ligament insertions [93]. Higher magnetic field strengths yield a higher signal-to-noise ratio with shorter scan times [93]. The volar extrinsic, scapholunate interosseous, dorsal intercarpal, and lunotriquetral ligaments are best visualized using 1 mm slices with no interslice gap in the coronal plane [93]. MRI provides earlier detection of synovitis and erosive bone changes associated with rheumatoid arthritis than radiographs [95]. It is also useful in detecting additional marrow abnormalities in osteonecrosis, as seen in the lunate in Kienböck disease or in the scaphoid after fracture [95]. Asymmetry of marrow signal in proximal and distal fragments of a fractured scaphoid on MRI is suggestive of proximal pole ischemia [95]. Perforations in the triangular fibrocartilage complex appear as linear defects or gaps filled with hyperintense fluid on coronal gradient-echo or T2-weighted pulse sequences [95]. The addition of arthrographic contrast improves the visualization of scapholunate and lunotriquetral ligaments on MR images [95]. Real-time MRI has been used to investigate dynamic instabilities, although its routine use in clinical practice is yet to be further determined [93].

CT: CT scanning enables 3D analysis of carpal dysfunction [93].

Arthroscopy: Arthroscopy is considered by many to be the diagnostic intervention of choice for determining the degree of injury to the wrist [93]. It allows assessment of the condition of the cartilage, including whether it is normal or degenerative [93]. Arthroscopy also assesses the ability to reduce the carpus and any other associated injuries [93]. The degree of intrinsic and extrinsic ligament injury can be identified from arthroscopic evaluation [93]. Geissler grade II scapholunate interosseous ligament injuries tend to be isolated, whereas grade IV injuries often involve complete dorsal extrinsic ligament disruption [93].

Dynamic Fluoroscopy: Dynamic fluoroscopy shows abnormal motion between the scaphoid and lunate and changes in the kinematics of the midcarpal joint [93]. Live fluoroscopic imaging shows whether dorsal intercalated segmental instability is reducible, providing information for treatment planning [93].

Other Considerations: The choice of procedure depends on the pattern of wrist destruction and stability [15].

Treatment

Non-Operative

Partial wrist fusion is considered a salvage operation when clinical and radiographic evidence of wrist arthritis persists after failed non-surgical treatment [2, 178].

Operative

Indications: The ideal surgical treatment for the arthritic wrist balances mobility and pain relief, often prioritizing effective pain relief [164]. Wrist arthrodesis is no longer the only solution, as various techniques can preserve a functional wrist [24]. Specific indications vary by pathology: scaphoid excision and four-corner fusion is the choice for stage III SLAC wrist, whereas proximal row carpectomy is indicated in stage II SLAC where the capitolunate joint is intact [27]. Radiolunate arthrodesis is effective for unstable wrists with preserved midcarpal joint space in the rheumatoid wrist [15]. In Kienböck disease, once disease extends outside of the lunate, reconstruction with proximal row carpectomy or partial or total wrist arthrodesis should be considered based on which articular surfaces are affected [19]. Radiocarpal fusion aims to alleviate pain and improve range of motion in patients with isolated radiolunate or radioscapholunate arthritis who have failed non-surgical treatment [178].

Surgical Approach / Technique: Midcarpal arthrodesis is a long-lasting treatment option for advanced carpal collapse with good long-term results [32]. The technique of radioscapholunate arthrodesis with compression screws and local autograft is effective in appropriately selected patients with a preserved midcarpal joint, achieving a 100% union rate at mean follow-up of 12 months with no complications [18]. A combination of proximal row carpectomy and rigid internal fixation is a highly predictable operation with much less morbidity and fewer complications than older techniques using distant bone graft [153]. Total wrist arthrodesis combined with proximal row carpectomy provides reliable and reproducible benefits [29]. Nonspanning arthrodesis is advocated as an alternative method for total wrist fusion, offering a high union rate and minimal risk of complications at the carpometacarpal joint [38].

Implant Selection: Good and excellent clinical results following radiolunate fusion do not depend on the fixation device [14]. Plate fixation offers little benefit over previous stabilization techniques when performing scaphoid excision and four-corner fusion [157]. Most patients were pleased postoperatively after four-corner fusion and scaphoid excision using headless compression screws, with improvement in wrist pain being the most common finding [174].

Outcomes and Efficacy: Functional results of four-corner fusion were good at long-term follow-up despite radiographic changes in the radiolunate joint in 73% of patients [30]. Clinical scores were markedly improved following radiolunate arthrodesis for rheumatoid arthritis, although there was a decrease in flexion [60]. The senior author did not have to revise or convert any patient into a wrist fusion or a total wrist arthroplasty after scaphocapitolunate arthrodesis and radial styloidectomy, suggesting that a longer survival rate of this procedure may be possible [16].

Comparison with Alternative Procedures: A pyrocarbon capitate resurfacing implant may represent a good alternative to total and partial wrist arthrodesis [9]. Arthroplasty should be used as an alternative to arthrodesis in the treatment of posttraumatic wrist arthritis, given proper patient selection and indications [156].

Other Considerations: Load is preferentially transferred to the radiolunate joint after scaphoid excision with four-corner fusion [67]. The combination of triquetral and distal scaphoid pole excision after RSL fusion improves wrist motion to levels close to normal in the cadaver model [39]. Computed tomography is the most reliable radiographic method of evaluating osseous union in midcarpal fusions, as plain films are unreliable in making a definitive assessment of union [52].

Complications

Nonunion and Hardware Complications

Four-corner arthrodesis carries an increased risk of complications, including nonunion, painful hardware, or implant failure [61]. In a large cohort, seventy-five patients (1.48%) required a secondary procedure for the removal of symptomatic fusion hardware following the index four-corner fusion [134]. Proximal migration of hardware in patients undergoing midcarpal fusion with headless compression screws can necessitate hardware removal and potential conversion to total wrist fusion or proximal row carpectomy [140]. Conversely, no implant-related complications were observed in a comparison of conventional K-wire technique versus a new locking plate for four-corner fusion [132]. The complication rate was low, and hardware did not require removal in most cases following Modified Clayton-Mannerfelt Arthrodesis of the Wrist in Rheumatoid Arthritis [192].

Infection and Wound Complications

Infection following wrist arthroplasty and arthrodesis is relatively uncommon in a nationally representative Medicare database cohort [194]. One patient developed a postoperative wound infection following K-wire fixation for four-corner fusion, which was sufficiently treated conservatively [132]. Perioperative morbidity in open reduction for perilunate injuries included one patient requiring revision surgery for infection [151].

Neurological and Soft Tissue Complications

One patient developed carpal tunnel syndrome following plate fixation for four-corner fusion, which was treated by surgical release [132]. Additionally, one patient required secondary carpal tunnel release for acute median nerve compression after open reduction and internal fixation through a single dorsal approach for perilunate injuries [151]. Lunocapitate arthrodesis with scaphoid excision provides functional and radiological results comparable to four-corner fusion without the deleterious effect on ulnocarpal and proprioceptive dysfunction associated with including the triquetrum in the fusion site [10].

Arthritic Progression and Joint Degeneration

Procedure-specific complications are more common with four-corner arthrodesis, while joint space narrowing is more common after proximal row carpectomy, particularly in patients under 35 years of age [187]. Radiographic follow-up beyond 2 years following proximal row carpectomy revealed joint narrowing and arthritic changes within the radiocapitate joint [53].

Conversion to Total Wrist Arthrodesis

Subsequent total wrist arthrodesis was performed in 135 patients (2.67%) who had a previous four-corner fusion [134]. Subsequent total wrist arthrodesis was performed in 65 patients (1.79%) with a previous proximal row carpectomy [134]. PRC and FCA demonstrated similarly low rates of conversion to total wrist arthrodesis [189]. Twelve patients had undergone a wrist arthrodesis following proximal row carpectomy in a long-term follow-up study [53]. One case in the plate group of a four-corner fusion study had to be converted to a total wrist fusion due to persisting pain without implant-related complications [132]. The results between patients with salvage total wrist arthrodesis for failed total wrist arthroplasty and primary wrist arthrodesis were slightly in favour of patients with a primary wrist arthrodesis [23].

Patient Satisfaction and Functional Outcomes

Forty-six patients (74%) were not satisfied with the results of their proximal row carpectomy surgery due to persistent pain or inability to return to previous occupational activities [53]. Fifty-two patients required daily pain medication for wrist pain following proximal row carpectomy [53]. A high rate of re-operation was observed in patients receiving radioscapholunate arthrodesis, and the expected benefit of preserving the midcarpal joint was not observed [42]. Findings suggest an approximate 10% risk of secondary wrist arthrodesis in patients with persistent or progressive ulnar wrist pain following partial wrist denervation in inflammatory arthritis [43].

Recovery

Rehabilitation protocol: Rehabilitation for capitolunate arthrodesis may be started after only 1 week to decrease wrist stiffness [141]. Wrist immobilization is required for only two months following partial intercarpal fusion [37].

Other Considerations: Patients treated with Ilizarov for scaphoid nonunion had the capacity to continually improve their wrist function beyond 3 years following treatment [152].

Key Evidence

  • [L5] If the basic principles of limited wrist fusions are adhered to, a good outcome can be obtained. [1] (10.1055/s-0032-1329548)
  • [L5] A salvage operation, such as a partial wrist fusion, should be considered when there is clinical and radiographic evidence of wrist arthritis. [2] (10.1016/j.hcl.2015.04.013)
  • [Paper] Although some may see the motion preserving procedures of the wrist as a staged full wrist fusion, if the indications are accurately respected and the technique is well performed to prevent complications, then good long-term results can be obtained. [3] (10.1055/s-0032-1330070)
  • [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. [4] (10.5435/00124635-200307000-00007)
  • [L4] It may serve as a temporary alternative to partial wrist arthrodesis for younger patients or a definitive procedure for less demanding patients, though results may be short-lived. [5] (10.1016/j.jhsa.2012.08.039)
  • [L4] Although wrist fusion is performed nearly 5 times more frequently than total wrist arthroplasty, short-term findings suggest that total wrist arthroplasty compares favorably with wrist fusion. [6] (10.1177/1558944716668846)
  • [L4] Conversion to arthrodesis after failed wrist arthroplasty is worthwhile and reliably improves wrist function over failed wrist arthroplasty. [7] (10.1177/1753193416674929)
  • [L4] Total wrist fusion should only be used in exceptional circumstances. [8] (10.1097/01.sap.0000194245.94684.54)
  • [L4] This surgical procedure may represent a good alternative to total and partial wrist arthrodesis. [9] (10.1177/1753193413501730)
  • [L4] When properly executed, lunocapitate arthrodesis with scaphoid excision provides functional and radiological results comparable to four-corner fusion without the deleterious effect on ulnocarpal and proprioceptive dysfunction associated with including the triquetrum in the fusion site. [10] (10.1177/1753193409105683)
  • [L4] Partial carpal fusions are effective methods of treating specific carpal disorders, optimizing postoperative wrist motion, strength, and stability while reducing pain. [11] (10.1055/s-0032-1330071)
  • [L4] Capitolunate arthrodesis is a feasible option for scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists with complications similar to those encountered in 4-corner arthrodesis. [13] (10.1016/j.jhsa.2019.10.007)
  • [L4] Good and excellent clinical results in the majority of the patients following radiolunate fusion do not depend on the fixation device. [14] (10.1177/1753193409342054)
  • [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. [15] (10.1016/j.hcl.2005.08.005)
  • [L4] The senior author did not have to revise or convert any patient into a wrist fusion or a total wrist arthroplasty, suggesting that longer survival rate of this procedure may be possible. [16] (10.1055/s-0032-1329592)
  • [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. [18] (10.1016/j.jhsa.2013.01.026)
  • [L4] Once disease extends outside of the lunate, reconstruction with proximal row carpectomy or partial or total wrist arthrodesis should be considered on the basis of which articular surfaces are affected. [19] (10.2106/jbjs.24.01090)
  • [L3] Proximal row carpectomy is a motion-preserving salvage procedure with a low rate of conversion to wrist arthrodesis. [20] (10.1016/j.jhsa.2021.09.031)
  • [L5] When capitolunate arthritis is present, the author prefers four-bone fusion with scaphoid excision. [21] (10.1016/s0749-0712(21)01451-7)
  • [L3] The results between the two groups were slightly in favour of patients with a primary wrist arthrodesis. [23] (10.1177/17531934211057389)
  • [L5] Various surgical techniques can preserve a functional wrist, and wrist arthrodesis is no longer the only solution for arthritic wrists. [24] (10.1016/j.otsr.2013.06.015)
  • [L5] RSL fusion with distal scaphoidectomy and entire triquetrum excision can be a useful alternative to total wrist arthrodesis for patients with an intact midcarpal joint. [25] (10.1055/s-0033-1364095)
  • [L4] Four corner arthrodesis and proximal row carpectomy should not always be standard management for advanced radiocarpal arthritis. [26] (10.1177/1753193420973322)
  • [L4] The procedure is the choice for stage III SLAC wrist, whereas proximal row carpectomy is indicated in stage II SLAC where the capitolunate joint is intact. [27] (10.1053/otor.2003.36321)
  • [Paper] Total wrist arthrodesis combined with PRC provides reliable and reproducible benefits. [29] (10.1016/j.otsr.2015.09.032)
  • [L4] Functional results were good at long-term follow-up despite radiographic changes in the radiolunate joint in 73% of patients. [30] (10.1177/1558944716681949)
  • [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. [31] (10.5435/jaaos-d-15-00424)
  • [L4] The midcarpal arthrodesis is a long-lasting treatment option for advanced carpal collapse and has good long-term results. [32] (10.1055/s-0032-1329616)
  • [L4] Despite radiographic progression, radiolunate and radioscapholunate arthrodeses yield good clinical results at long-term follow-up. [33] (10.1016/j.jhsa.2011.10.012)
  • [L4] The technique of partial intercarpal fusion relieves pain in all but two instances and restores a strong grip in all but one patient, with wrist immobilization required for only two months. [37] (10.2106/00004623-196648040-00008)
  • [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. [38] (10.1055/s-0037-1606257)
  • [L5] The combination of triquetral and distal scaphoid pole excision after RSL fusion improves wrist motion to levels close to normal in the cadaver model. [39] (10.1016/j.jhsa.2009.02.007)
  • [L3] Bilateral total wrist arthrodesis improved pain while enabling patients with severe carpal arthrosis to maintain a satisfactory level of extremity function and quality of life. [40] (10.1016/j.jhsa.2014.10.032)
  • [L4] The outcome of scaphoid excision and 4-corner arthrodesis is favorable at one year and does not deteriorate significantly between one and 10 years. [41] (10.1016/j.jhsa.2010.01.025)
  • [L1] A high rate of re-operation was observed in patients receiving radioscapholunate arthrodesis, and the expected benefit of preserving the midcarpal joint was not observed. [42] (10.1177/1753193418778471)
  • [L4] Our findings suggest an approximate 10% risk of secondary wrist arthrodesis in patients with persistent or progressive ulnar wrist pain. [43] (10.1007/s10067-019-04645-8)
  • [L2] Total wrist arthroplasty and total wrist arthrodesis are both extremely cost-effective procedures. [44] (10.1016/j.jhsa.2009.12.013)
  • [L4] [49] (10.1016/j.jhsa.2014.03.032)
  • [Paper] [52] (10.1007/s12593-011-0030-2)
  • [L3] [53] (10.1007/s11552-011-9368-y)
  • [L5] [56] (10.1016/j.jhsa.2011.01.018)
  • [L4] [60] (10.1016/j.jhsa.2013.05.007)
  • [L1] [61] (10.1177/1753193414554359)
  • [L5] [64] (10.1016/s0749-0712(21)00119-0)
  • [L4] Scaphoid excision and four-corner fusion remains a viable option for patients with advanced wrist arthritis with reliable, resilient functional results that remain stable over time. [65] (10.1016/j.jhsa.2014.06.118)
  • [L5] Our findings suggest that load is preferentially transferred to the radiolunate joint after scaphoid excision with four-corner fusion. [67] (10.1007/s11552-007-9048-0)
  • [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. [68] (10.1016/j.hcl.2009.11.003)
  • [L5] Patients are generally satisfied after total wrist arthrodesis, although they are not always pain-free despite limited or absent wrist motion. [69] (10.1177/17531934241295343)
  • [L4] Scaphoid nonunions have a dramatic impact on carpal kinematics, partially uncoupling the proximal and distal carpal rows. [98] (10.1016/j.jhsa.2008.03.008)
  • [L4] More than half the motion of the carpus when the wrist was loaded in extension occurred at the midcarpal joint. [101] (10.1016/j.jhsa.2012.10.035)
  • [L5] The contact areas between the scaphoid and distal radius are maximized during full extension of the wrist, which helps stabilize the radiocarpal joint and potentially reduces the risk of injury to the carpus and the distal radius. [104] (10.1177/1753193413507810)
  • [L5] Despite individual variance, a pattern of kinematic changes was established after scapholunate ligament injury. [109] (10.1177/1753193415600669)
  • [L5] [117] (10.1016/j.jht.2022.01.001)
  • [L5] During forearm rotation, the contact site of the scaphoid and the lunate on the distal radial articular surface changed minimally. [119] (10.1016/j.jhsa.2013.01.021)
  • [L5] The effect of ligament sectioning on producing carpal instability may be moderated by the bone geometry of the radiocarpal joint. [120] (10.1016/j.jhsa.2006.10.018)
  • [L4] SNAC wrists differ from SLAC wrists in exhibiting a decreased sagittal lunotriquetral angle, indicating a distinct pathomechanism of carpal instability. [124] (10.1186/s12891-025-08652-6)
  • [L3] [132] (10.1007/s00402-016-2416-x)
  • [L5] Our findings support the theory that there is a relationship between scapholunate kinematics and laxity at the level of the interosseous ligaments. [133] (10.1016/j.jhsa.2019.10.024)
  • [L3] [134] (10.1016/j.jhsa.2019.12.010)
  • [L4] [140] (10.1055/s-0034-1384750)
  • [L4] Rehabilitation may be started after only 1 week to decrease wrist stiffness. 12 of 13 patients achieved capitolunate fusion in an average of 9 weeks, and no radiolunate arthritis was noted. [141] (10.1097/bth.0b013e31802caa87)
  • [L4] [151] (10.1016/j.jhsa.2010.06.021)
  • [L4] These patients also had the capacity to continually improve their wrist function beyond 3 years following their treatment. [152] (10.1016/j.injury.2013.01.016)
  • [L4] This technique of wrist arthrodesis combining proximal row carpectomy and rigid internal fixation has proved to be a highly predictable operation with much less morbidity and fewer complications than with older techniques using distant bone graft. [153] (10.1016/j.jhsa.2012.11.010)
  • [L3] Arthroplasty should be used as an alternative to arthrodesis in the treatment of posttraumatic wrist arthritis, given the proper patient selection and indications. [156] (10.1016/j.jhsa.2013.02.013)
  • [L3] Plate fixation offers little benefit over previous stabilization techniques when performing scaphoid excision and four-corner fusion. [157] (10.1016/j.jhsa.2005.08.007)
  • [L5] Complete or total wrist arthrodesis is a well established reconstructive surgical procedure that results in predictable pain relief and satisfactory function in patients who have various inflammatory, degenerative, and post-traumatic conditions. [162] (10.1016/j.hcl.2005.08.004)
  • [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. [163] (10.1016/j.jhsg.2026.101024)
  • [L5] The ideal wrist balances mobility and pain relief, with the optimal surgical treatment often prioritizing effective pain relief. [164] (10.1016/j.otsr.2011.03.007)
  • [L5] Triquetro-lunate fusions are the commonest type of fusions in the carpal region. [167] (10.1016/0020-1383(95)00192-1)
  • [L5] [172] (10.1016/j.eats.2025.103820)
  • [L4] Most patients were pleased postoperatively, with improvement in wrist pain being the most common finding. [174] (10.1097/bth.0b013e3181f60fec)
  • [L4] The decision between total wrist arthroplasty and total wrist arthrodesis is based on technical experience with newer implants, the patient's ability to adhere to strict activity limitations, and the willingness to accept the higher complication rate and eventual implant failure of arthroplasty in exchange for maintaining some wrist motion. [177] (10.1016/j.jhsa.2011.01.033)
  • [L5] The procedure aims to alleviate pain and improve range of motion in patients with isolated radiolunate or radioscapholunate arthritis who have failed non-surgical treatment. [178] (10.1016/j.jhsa.2022.04.002)
  • [L4] Procedure-specific complications are more common with four-corner arthrodesis, while joint space narrowing is more common after PRC, particularly in patients under 35 years of age. [187] (10.1016/j.jhsa.2009.06.020)
  • [L3] PRC and FCA demonstrated similarly low rates of conversion to total wrist arthrodesis. [189] (10.2106/jbjs.19.00965)
  • [L4] The complication rate was low, and the hardware did not have to be removed in most cases. [192] (10.1016/j.jhsa.2013.02.029)
  • [L3] Infection following wrist arthroplasty and arthrodesis is relatively uncommon in a nationally representative Medicare database cohort. [194] (10.1177/1558944719890036)

See Also

References

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iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.