Total wrist arthrodesis or fusion (TWF) is a complex procedure that is indicated for advanced wrist arthritis. It is indicated for the management of advanced rheumatoid arthritis and posttraumatic arthritis such as scapholunate advanced collapse or scaphoid nonunion advanced collapse. At the expense of wrist motion, it provides adequate pain relief and therefore, patients should be carefully selected. Multiple techniques have been described through both open and arthroscopic approaches. In this article, we will review the indications for TWF and discuss both approaches.