Indications for total wrist arthrodesis are still a matter of discussion. The aim of this study was to investigate the long-term results (mean 118 +/- 49.5 months) of total wrist arthrodesis (TA) in comparison to mediocarpal arthrodesis (MA). A paired study of the TA group and the MA group was performed including 22 patients after posttraumatic wrist arthrosis in each group. Subjective, objective and radiological parameters were assessed. In addition, the modified Mayo wrist score, the DASH score and the SF-36 were utilized. Mean pain did not differ significantly in both groups. Mean wrist function (DASH) was assessed better by MA patients (25.3 +/- 25.8) compared to TA patients (35.5 +/- 25.9; p > 0.1). Mean total wrist motion in the MA group was 66.1 % of the opposite side. The average grip strength of the TA group was 85.5 % +/- 58.4 % and of the MA group 79.9 % +/- 25.4 % of the uninvolved wrist. The Mayo score of the MA group (56.4 +/- 12.4) was significantly higher than in the TA group (65.9 +/- 16.3; p = 0.04). The SF-36 showed no significant difference between both groups. In self-assessment, pain was of higher importance then wrist motion. According to our findings the type of arthrodesis did not influence patient satisfaction. Total wrist arthrodesis should not be excluded categorically as a possible alternative to mediocarpal arthrodesis.