Five adult patients with voluntary hand control, complicated by severe flexion contracture and spasticity secondary to brain injury, underwent subtotal carpectomy and radio-carpal or radio-metacarpal fusion. None of the patients were capable of functional prehension before surgery, and all had difficulty with hygiene due to their deformity. The deformities were beyond the scope of correction with soft tissue release. Two of the patients had previously undergone flexor-pronator origin release, musculo-tendinous lengthening of the wrist and finger flexors, or a combination of both. All five patients progressed to union without complication. Four achieved meaningful gains in functional grasp-release of the hand following the surgery.