A 55-year-old woman with longstanding rheumatoid arthritis undergoes total wrist arthrodesis. The preferred position of arthrodesis for maximum functional benefit (balance of power grasp and ADL performance) is:

• A Full extension (45°) with ulnar deviation
• B Neutral (0°) flexion-extension with radial deviation
• C 20° of wrist flexion to aid pinch grip
• D 15–20° of wrist extension with neutral radioulnar deviation ✓

Explanation

Total wrist arthrodesis is performed for end-stage rheumatoid arthritis with pan-carpal destruction when motion-sparing arthroplasty is not feasible. The standard position is 10–20° of wrist extension with neutral-to-slight ulnar deviation; this position optimises the intrinsic muscle length-tension relationship (tenodesis effect), maximises grip strength (the 'power position'), and facilitates perineal hygiene and ADL tasks. Full extension reduces grip strength by over-shortening the flexor tendons. Wrist flexion significantly impairs power grasp.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.