Total wrist arthroplasty with the ellipsoidal designed biaxial implant has shown success in maintaining motion, relieving pain and providing stability in reconstruction of arthritic wrists, but twenty percent of distal components have loosened in five-year follow up studies. This has prompted modifications in surgical technique (Van Leeuwen) and stem elongation (Beckenbaugh), both of which have resulted in decreased distal component loosening. Prosthetic wrist implants utilizing distal screw fixation combined with carpal bone fusion was developed by Menon and resulted in minimal loosening in a similarly designed total wrist arthroplasty. Many features of the biaxial wrist implant offer advantages in stability, alignment and favorable wear characteristics. In view of this an alternative distal, modular, screw fixed component has been developed for the biaxial wrist system, which will maintain the favorable characteristics of the biaxial wrist design, but offer alternatives for improved distal component fixation when needed. This paper will discuss the rationale for these changes and describe the new implant and technique of insertion.