Chronic synovialitis of the tendon sheaths and intercarpal joints in rheumatoid patients leads to instability and luxation of the extensor carpi ulnaris tendon and the carpus. Wrist arthrodesis is indicated if the luxation is combined with destruction of the carpal bones. Wrist fusion is the oldest procedure for stabilising the rheumatoid wrist and is still seen as the "gold standard." Patient satisfaction is usually very high. The situation of thin skin combined with subcutaneous atrophy has led to several modifications of the operative procedure over time. Today we are able to achieve high primary stability of the wrist fusion by using a special plate and covering it with soft tissues to avoid internal decubitus. Because of this, patients usually do not need any cast immobilisation, thus making this procedure much more comfortable for these multimorbid patients.