Wrist surgery is usually only indicated after conservative (non surgical) treatment has failed. For amateur athletes this is usually the best course of action. However there are some injuries which require surgery sooner rather than later, especially for professional athletes with limited career spans.
Wrist surgery is required for some injuries to avoid long term complications and loss of function. The wrist comprises many small bones and joints so it is important to get this decision right. Here we outline some important wrist injuries which require urgent surgery.
If you have sustained a wrist injury then we recommend seeking professional advice immediately.
Radius fracture (Colles fracture)
This is a break or fracture of the radius bone in the wrist. It is common in sports, especially those involving contact or falls resulting in high impact wrist trauma.
Read more on Colles fracture.
A Scaphoid fracture is probably the most common wrist fracture. It is a break or fracture of the Scaphoid bone which is one of the small carpal bones in the wrist. It is common in contact sports, or those where you might fall onto your wrist such as cycling and horse riding.
The blood supply to the scaphoid is poor so complications and incomplete healing can occur. Symptoms include pain in the wrist at the time of injury and rapid swelling at the back of the wrist.
Read more on scaphoid fractures.
Extensor carpi ulnaris (ECU) dislocation
This is dislocation or partial dislocation of the ‘ECU’ tendon in the wrist. It is more common in sports involving repetitive rotation of the wrist such as Tennis.
This is more common in contact sports and is a traumatic wrist injury involving dislocation of one of the small carpal bones in the wrist. Specifically it is associated with a fractured Scaphoid. This complex injury is often overlooked, especially if deformity of the wrist is moderate. However, it is essential this is operated on as the long term consequences can be severe, with instability, loss of function and arthritis.
Surgical treatment involves reducing the joint (putting the bones back) and pinning them in position to secure them and enable healing to take place.
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.
Carpal tunnel syndrome (acute)
Carpal tunnel syndrome is a gradual onset condition caused by compression of the median nerve in the wrist. However, if it flares up to be acutely painful with severe numbness then wrist surgery is often indicated to avoid long term disability in the wrist.
Read more on Carpal tunnel syndrome.
Acute forearm compartment syndrome
A compartment syndrome occurs when the pressure inside a muscle or group of muscles increases, putting pressure on the surrounding sheath. This can occur gradually through overuse when the muscle grows too quickly for the sheath to adapt. Or, acute compartment syndrome occurs suddenly through bleeding or swelling within the compartment, often following a crush injury.
Symptoms of acute compartment syndrome include pain which becomes increasingly worse and numbness/tingling. If you suspect an acute compartment syndrome then seek medical advice immediately. It is important the pressure inside the compartment is surgically released as long term nerve damage may occur.
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.