The wrist joint complex includes the radiocarpal joint (radius to proximal carpal row) and the midcarpal joint (proximal to distal carpal row), which together produce the full range of wrist motion. Approximately 60% of wrist extension occurs at the radiocarpal joint and 40% at the midcarpal; 60% of flexion occurs at the midcarpal. The proximal carpal row acts as an intercalated segment whose position is controlled by ligamentous connections.
Wrist arthritis from distal radius malunion, scaphoid non-union advanced collapse (SNAC), or scapholunate advanced collapse (SLAC) is managed in a stepwise fashion: conservative, injection, joint denervation, proximal row carpectomy, four-corner fusion, and total wrist arthrodesis.
Scapholunate advanced collapse from chronic scapholunate dissociation producing wrist arthritis managed with four-corner fusion or proximal row carpectomy.
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