Intramedullary pin fixation is a common total wrist fusion technique, particularly for patients with rheumatoid arthritis. However, appropriate alignment of the proximal carpal row on the carpus can be challenging. Inflammatory arthropathy may also degrade the proximal carpal bones to chondral shells, retention of which may promote failure of fusion. We describe an intramedullary rod technique for total wrist fusion that incorporates a proximal row carpectomy.