Wrist surgery is usually only needed if non-surgical treatment hasn’t worked, which is the best approach for most people. However, some injuries need surgery early. If left too long, they can lead to long-term problems like pain, weakness, or loss of movement. Below are the key wrist injuries where early surgery may be needed.
Get medical help immediately if you have:
You may need urgent surgery if you have any of the following:
- Severe pain after an injury
- Visible deformity
- Rapid swelling
- Numbness or tingling
- Loss of movement or strength
If you have these symptoms after a fall or impact, get medical help immediately.
Wrist injuries that may need surgery
Radius fracture (Colles fracture)
A break of the radius near the wrist, usually from a fall onto an outstretched hand. Some fractures can be treated in a cast, but more severe ones need surgery to realign and fix the bone.
Read more on Colles fracture.
Scaphoid fracture
A Scaphoid fracture is a break or fracture of the Scaphoid bone, one of the small carpal bones in the wrist. It is common in contact sports, or those where you might fall onto your wrists such as cycling and horse riding. The blood supply to the scaphoid is poor so complications and incomplete healing can occur.
Read more on scaphoid fractures.
Extensor carpi ulnaris (ECU) dislocation
This is a dislocation or partial dislocation of the ECU tendon in the wrist on the outside of the wrist. It is more common in sports involving repetitive rotation of the wrist such as Tennis. Persistent instability may need surgery.
Perilunate dislocation
A serious injury where the carpal bones are forced out of position, often with a scaphoid fracture. It is sometimes missed initially but needs urgent treatment. If left, it can cause permanent stiffness, weakness, and arthritis. Surgery is usually required to realign and stabilise the wrist.
Kienböck’s disease
Kienbock’s disease is necrosis (dying) of the lunate carpal bone in the wrist due to lack of blood supply. It is more common in Golf or Tennis but can occur in all sports. If it is treated very early on with immobilization/splinting of the wrist then it may heal, but most will require specialist reconstruction.
Acute carpal tunnel syndrome
Usually develops gradually, but in acute cases causes severe pain, numbness, and weakness in the hand. Urgent surgery may be needed to relieve pressure on the nerve.
Read more on Carpal tunnel syndrome.
Acute forearm compartment syndrome
A medical emergency where pressure builds up inside the forearm. Symptoms include severe, worsening pain and numbness or tingling. Requires urgent surgery to prevent permanent damage.
When surgery is NOT usually needed
Most wrist injuries improve with:
- Rest
- Immobilisation (splint or cast)
- Physiotherapy
- Gradual return to activity
References & further reading
- Vitale MA, Seetharaman M, Ruchelsman DE. Perilunate dislocations. J Hand Surg Am 2015;40(2):358–62; quiz 362.
- Forli A, Courvoisier A, Wimsey S et al. Perilunate dislocations and transscaphoid perilunate fracture-dislocations: a retrospective study with minimum ten-year follow-up. J Hand Surg Am 2010;35(1):62–8.
