Avoiding fusion in wrist arthritis

Advanced non-inflammatory arthritis of the wrist can lead to significant disability. Traditionally, the treatment for arthritis of the wrist which does not respond to either anti-inflammatory medication, splintage, steroid injections and time, would be a total wrist fusion. However, wrist fusion substantially diminishes function1 and is usually avoidable. Two facts should prompt the surgeon to avoid wrist fusion. First, arthritis rarely affects all the joints of the wrist; secondly, there are now several movementsparing procedures which can give predictably good outcomes. The history, examination and investigation of a patient with non-inflammatory arthritis of the wrist, and who is a candidate for surgery, should be directed towards one goal – avoiding total wrist fusion if possible. This article describes the options available for surgical treatment of arthritis of the wrist and emphasises the ways in which the disability of total wrist fusion can be avoided.