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Orthopedics · Hand and wrist

Wrist surgery

Does your wrist hurt on the thumb side, is your grip getting weaker, or does the joint crunch, perhaps long after a fall on your hand? The cause may be an injured ligament between the carpal bones, an unhealed fracture of the scaphoid bone, or osteoarthritis. Depending on the findings, the ligament can be reconstructed, the unhealed bone can be supplemented with a bone graft, or the wrist can be partially or fully fused. If everything is in order, the procedure can take place as soon as within a week of the consultation.

Book an orthopedic consultation How the procedure works
  • No referral from a GP needed
  • Operated by Prof. MUDr. Radek Hart

Wrist reconstruction and fusion

1 weekthat soon the procedure can happen
the wrist consists of
8 bonesin two rows, connected by ligaments
until the procedure
1 weekfrom the consultation, if everything is in order
after a bone graft
3–6 monthsfull recovery usually takes
after ligament reconstruction
6–12 monthsfull recovery can take

When a procedure is considered

Pain, weak grip and crunching in the wrist

The wrist is made up of eight small bones in two rows that connect the hand to the two bones of the forearm. Ligaments hold them together. The scaphoid bone on the thumb side links both rows and is especially important for the motion and stability of the wrist. Problems often begin with a fall on an outstretched hand that at first seems like an ordinary sprain.

  1. Instability after a ligament injury (SLAC)

    When the ligament between the scaphoid and lunate bones tears, the bones move against each other more than they should. It hurts mainly on the thumb side, grip strength weakens, the wrist swells, and the joint may crunch or grind. Without treatment, the joint gradually wears down.

  2. Unhealed scaphoid fracture (SNAC)

    A scaphoid fracture is easily mistaken for a sprain and may not show on the first X-ray. Part of the bone has a poor blood supply, so it heals slowly and sometimes not at all; a nonunion develops. The wrist hurts, swells and stiffens, grip strength weakens, and osteoarthritis develops over time.

  3. Osteoarthritis of the wrist

    The cartilage wears away with age, after a fracture or ligament injury, often many years after the injury, or with rheumatoid arthritis. The wrist hurts, swells, stiffens and weakens; lifting or a firm grip may be difficult.

  4. A recent injury?

    HR Clinic is not an emergency room. A recent wrist injury is first treated by a trauma outpatient clinic or the emergency room. If the pain does not subside after the injury, come in for an examination afterwards; early treatment can prevent later problems.

Simplified diagram of the right wrist from the back of the hand: carpal bones in two rows; the scaphoid on the thumb side is healed and intactHealed scaphoid bonescaphoidboneradiusboneulnabonemetacarpalbones Simplified diagram of the wrist with an unhealed fracture at the waist of the scaphoid: a gap remains between the fragments, and over time the joint with the radius wears downUnhealed fracture (nonunion)fracture atscaphoid waisthas nothealedover time theradius jointwears down
  • outline of the hand
  • bones
  • scaphoid bone
Simplified diagram of the right wrist seen from the back of the hand, not an actual image.

When to operate

When surgery is appropriate

With both an injured ligament and an unhealed scaphoid fracture, the joint gradually wears down without treatment. Whether and when to operate is decided by the doctor at the consultation.

Symptoms

Pain and weak grip

They limit work and everyday activities.

  • The wrist hurts on the thumb side, swells and stiffens
  • Grip weakens; lifting or a firm squeeze is difficult
  • The joint crunches or grinds

Ligament

Unstable wrist

The bones move more than they should.

  • Torn ligament between the scaphoid and lunate bones
  • Instability leads to joint wear

Bone

Unhealed fracture

The scaphoid has not knitted together.

  • The poorly supplied part of the bone heals slowly and sometimes not at all
  • A nonunion develops into osteoarthritis over time

Which operations are options

The choice depends on what damaged the wrist, how far the wear has progressed, and how much motion you need in the wrist. Prof. Hart will explain what each approach means for your hand.

  • Ligament reconstruction

    For wrist instability, the torn ligament is reattached to the bone or replaced with a graft from a tendon. The goal is a stable wrist and grip strength.

  • Reconstruction of a scaphoid nonunion

    A bone graft, sometimes with its own blood supply, is placed at the site of the unhealed fracture, and the bone is secured with a screw, plate or wires so that it heals. The graft is taken, for example, from the forearm or the pelvis.

  • Partial wrist fusion (arthrodesis)

    Only the bones between which the joint is damaged are joined and grow together into one bone. The healthy joints remain, so part of the wrist's motion is preserved.

  • Total wrist fusion (arthrodesis)

    In extensive osteoarthritis, the carpal bones fuse with the radius. Pain from movement in the joint subsides, but the wrist no longer bends. Forearm rotation and the motion of the fingers and thumb are usually preserved.

Not sure whether surgery is right for you? The examination will decide. Book a consultation

How the procedure works

From booking to going home

The extent of the procedure depends on the findings, from ligament reconstruction to fusion of the whole wrist. Prof. Hart will explain the exact approach based on the examination and images.

  1. Booking

    Online or by phone. A referral from your GP is not required.

    online or by phone

  2. Consultation and examination

    Prof. Hart examines the wrist and assesses the bones and joints on the X-ray. If needed, he recommends an MRI or CT scan.

    diagnosis and treatment plan

  3. Procedure

    Under anesthesia. How long it takes depends on the extent of the procedure.

    within a week of consultation

  4. Going home

    As soon as everything is in order, in a cast or brace.

    follow-ups and physical therapy

Recovery and physical therapy

Your wrist needs time

Bones and ligaments in the wrist heal slowly. Expect a cast or brace and months of exercises. The doctor follows the healing at follow-up visits, and if needed we continue with physical therapy right at the clinic.

HR Clinic corridor

  1. After ligament reconstruction

    The ligament usually heals in 8 to 12 weeks. First the wrist is immobilized, then come exercises for motion and strength. Full recovery can take 6 to 12 months.

  2. After a bone graft

    You wear the cast or brace until the bone has healed; for the scaphoid this can take several months. Until then, do not lift heavy things, avoid sports with a risk of falling on the hand, and do not smoke, as smoking slows bone healing.

  3. After fusion

    The bones fuse over several months.

  4. What to expect

    People who have wrist surgery are usually most satisfied with the pain relief. Range of motion and strength sometimes do not fully return, even with careful exercises.

Prof. MUDr. Radek Hart, Ph.D., FRCS, MHA

Who operates

Prof. MUDr. Radek Hart, Ph.D., FRCS, MHA

Orthopedic surgeon and traumatologist of the musculoskeletal system, head physician of HR Clinic. He sees patients in Znojmo and Vienna; after a consultation in Vienna, the procedure can be performed in Znojmo.

More about Prof. Hart Professional website ortho-hart.at

Price We will tell you the price of the procedure at the consultation, based on the findings and the extent of the procedure.

Frequently asked questions

What patients ask most often

Related articles and procedures

Carpal tunnel surgery Osteoarthritis of the thumb and finger joints Minor hand procedures
What do the abbreviations SLAC and SNAC mean?

Both describe progressive wear of the wrist. SLAC develops after an injury of the ligament between the scaphoid and lunate bones, SNAC after a scaphoid fracture that did not heal. In both cases the bones move incorrectly and the cartilage wears away over time.

Will my wrist stay mobile?

After ligament reconstruction and after the scaphoid has healed, yes, although it may not be quite as it was before. After partial fusion, part of the motion remains. After total fusion the wrist no longer bends, but forearm rotation and finger motion usually remain.

I fell on my hand years ago. Does it make sense to deal with it now?

Yes. A ligament injury and an unhealed fracture can make themselves felt only after years, when the joint starts to wear down. The examination will show the condition of the wrist and what can be done about it.

How long will I stay at the clinic?

The stay at the clinic lasts 24 hours at most. When you can go home depends on the extent of the procedure.

Do I need a referral from my GP?

No. You can simply book online or by phone.

How soon can I have the procedure?

If everything is in order, the procedure can take place as soon as within a week of the consultation. We will arrange the date based on the examination results.

Booking

Book an orthopedic consultation

Online or by phone, at the clinic in Znojmo. A referral from your GP is not required.

Book a consultation
Book a consultation