Large trials of broken wrists found that wires matched plates and that older adults did as well with a cast as with surgery, so wrist surgery today is chosen by what your wrist needs to do, from fracture fixation to arthroscopy and arthritis surgery.
About This Department
Orthopedics
A wrist that works matters more than a perfect X-ray. Two large trials showed it.
In a trial of 461 adults with a displaced wrist fracture, function at one year was the same after wire fixation and after a volar locking plate.
461
Adults in the DRAFFT trial of wires against plates
3,174
Wrists pooled to compare carpectomy and four-corner fusion
3 to 7 days
Usual stay in Istanbul after wrist surgery
Free
Review of your X-rays and MRI before you book
Free consultation
The review costs nothing and carries no obligation. Send your wrist X-rays, any CT or MRI and earlier operation notes, and a hand and wrist surgeon will tell you which operation fits, whether it can be done through an arthroscope, and how long to plan for. A coordinator replies in your own language.
A broken wrist that has not healed straight, pain on the little finger side when you turn a key, a clunk when you grip, a lump on the back of the wrist, or arthritis that makes every push-up and every doorknob hurt has brought you to the question of surgery. Wrist surgery covers the operations that fix fractures of the radius, repair torn ligaments and cartilage through an arthroscope, remove ganglions, and relieve arthritis with partial fusions, carpectomy or, in selected patients, a joint replacement. Below you will find the common problems and what fixes each, what large trials found for wrist fractures, how arthroscopy helps, the choices for wrist arthritis, how to prepare, the risks, the recovery, how long to stay in Istanbul, and the follow-up at home.
Common wrist problems and their operations
Eight small bones and two forearm bones make up the wrist, held together by a web of ligaments.
This table scrolls sideways on a narrow screen. Swipe or drag to see every column.
Wrist problems and the usual surgical answer
Problem
Usual operation
Typical stay
Displaced distal radius fracture
Volar plate, wires or external fixator
Day case or one night
Badly healed radius fracture
Corrective osteotomy with a plate
One to two nights
Triangular fibrocartilage tear
Arthroscopic repair or debridement
Day case
Scapholunate ligament tear
Repair or reconstruction, often arthroscopically assisted
Day case or one night
Ganglion cyst
Open or arthroscopic excision
Day case
Ulnar impaction
Ulnar shortening osteotomy
One night
Wrist arthritis
Proximal row carpectomy, partial fusion, total fusion or replacement
One to three nights
Before choosing, the surgeon answers three questions.
Where exactly does it hurt, and when?
What do the X-rays, CT or MRI show?
What does your work or sport ask of the wrist?
Carpal tunnel release and scaphoid fractures have their own pages, on hand surgery and hand fracture repair.
Distal radius fractures, what the trials show
Wrist fractures lead the list of adult fractures. Two large trials changed how they are treated.
In the British DRAFFT trial, 461 adults whose dorsally displaced fracture needed surgery were assigned either to wires through the skin or to a volar locking plate, and at three, six and twelve months their wrist scores did not differ in any way that mattered, nor did complications, while wires took less operating time. The WRIST trial in 24 centers across the US, Canada and Singapore treated 304 adults aged 60 or older with a plate, an external fixator, wires or a cast, and at 24 months the function scores were all within a few points of each other, although the bone had healed out of alignment in 59.1 percent of the casting group against 8.0 percent of the plate group. Alignment, it turned out, mattered less to older patients' daily lives than surgeons had assumed, so the choice now rests on the patient's age, activity, bone quality and goals as much as on the X-ray.
Straight bone and a good wrist are not the same thing.
Fractures that still favor surgery
A broken joint surface with a step, a fracture that slips after it was set, an open wound over the break, or a young and active patient with a badly tilted wrist.
Surgeons hold a broken radius in four ways.
Cast. After the bone is set, for stable fractures and many older patients.
Wires. Through the skin, removed in clinic after about six weeks.
Volar locking plate. Through the front of the wrist, allowing early movement.
External fixator. A frame outside the skin for shattered or open fractures.
Do not wait too long
In a secondary analysis of the WRIST trial, a one-week delay to surgery was linked to more than three times the odds of chronic pain at one year, so a fracture that needs fixing is best fixed early.
Wrist arthroscopy
Small cuts, a clear view.
A camera the width of a pencil lead enters the wrist through two or three tiny incisions on the back, and the surgeon looks directly at the cartilage, the ligaments between the carpal bones and the triangular fibrocartilage on the little finger side. Tears seen on MRI are confirmed or ruled out, loose flaps are trimmed, torn edges are stitched back to bone, and ganglions arising from the joint are removed from the inside. Recovery is faster than after open surgery for the same problem. A repaired ligament still needs weeks in a splint.
Pain on the little finger side of the wrist
Pain when you turn a door handle, lean on the hand or lift a pan often comes from the triangular fibrocartilage, a cushion between the ulna and the small wrist bones. Many tears settle with a splint and therapy, and arthroscopy is considered when they do not after about three months, or when the ulna is long enough to press on the cartilage, which an ulnar shortening osteotomy corrects.
Choices for wrist arthritis
Wrist arthritis follows a pattern. An old scapholunate ligament tear or a scaphoid that never healed lets the carpal bones collapse, and arthritis spreads from the radius to the middle of the wrist over years.
1
Proximal row carpectomy
The three worn bones of the first row are removed and the wrist moves on the remaining joint. No bones need to heal together.
2
Four-corner fusion
The worn scaphoid is removed and four bones in the middle of the wrist are fused, keeping height and some motion.
3
Total wrist fusion
The whole wrist is fused with a plate. Pain relief is reliable, bending is lost, and forearm rotation stays.
4
Total wrist replacement
For selected, lower-demand patients, mostly with rheumatoid arthritis, who want to keep motion in both wrists.
A 2024 meta-analysis of 3,174 wrists found that carpectomy gave slightly better extension and pain scores with similar grip strength, and fewer wrists went on to a full fusion afterward, 5.2 percent against 11 percent, while four-corner fusion carried an 8.9 percent rate of bones that failed to fuse.
Signs it may be time
Pain at rest and with use, X-rays showing arthritis in a recognized pattern, splints and injections that no longer help, and a clear idea of how much motion and strength your work needs.
Talk to us first
Mild changes on X-ray with pain from elsewhere, heavy manual work that may suit a total fusion better than a motion-keeping operation, or active infection.
Getting ready
Bring every wrist X-ray since the injury, any CT or MRI, earlier operation notes and a short list of the tasks you most want back. Smoking slows bone healing and should stop weeks before a fusion or osteotomy. Blood thinners are reviewed with the surgeon, and rings come off before you travel because the hand swells.
Risks and how they are managed
Stiffness
Common after any wrist operation. Therapy restores most motion over months.
Tendon irritation from plates
A plate edge can rub a tendon, and the plate comes out once the bone has healed.
Nerve irritation
Small skin nerves near incisions can tingle for weeks, and numbness in the thumb and index finger after a fracture, a sign of pressure in the carpal tunnel, is watched closely and released if it persists.
Nonunion
Fusions and osteotomies that do not heal need further surgery.
Complex regional pain syndrome
Burning pain and swelling out of proportion. Early recognition and therapy matter most.
Taking hardware out later
Plates and screws stay unless they bother you. Removal takes a short day case once the bone has fully healed, usually after a year.
The recovery
Move the fingers from day one.
After a plate for a radius fracture, a removable splint allows gentle wrist movement within the first two weeks, and most daily tasks return by six weeks. Arthroscopic debridement recovers in a few weeks, while ligament repairs, partial fusions and osteotomies need six to eight weeks of splint or cast before strengthening, and grip keeps improving for six months to a year. A hand therapist guides each stage, measuring motion and grip at every visit, adjusting splints as swelling falls and adding strengthening only when the bone or repair can take it, and patients who do the short daily exercise sessions at home between visits recover motion faster than those who wait for therapy appointments to do the work for them. Swelling around the wrist can last three months or more after a fusion or osteotomy, so a compression glove and raising the hand at night help in the first weeks. Office work returns well before manual work.
How long to stay in Istanbul
Plan for three to seven days.
Published wrist procedure packages in Istanbul list two days in hospital for operations such as lunate surgery and radius shortening, and up to five days for larger reconstructions. Patients fly home once the wound is checked and the splint and first exercises are in place.
What decides the cost
The operation, arthroscopy or open surgery, plates and implants, nights in hospital, imaging and therapy sessions set most of the figure.
Published packages list hospitalization, anesthesia, surgical materials, airport transfers and an interpreter, and some add tests, imaging, medicines and a companion's room, while hotel nights are billed separately at several centers, so a quote you can compare names the operation and the hardware, and that figure comes only from a hand and wrist surgeon reading your imaging. The review costs nothing.
Arranging the trip
Send your X-rays and MRI on WhatsApp and one coordinator follows your case from the first review until after you are home. English, Arabic, French, Russian, Serbian, Romanian and Spanish are spoken, with an interpreter for other languages. A companion sleeps in your room on the companion bed, and the international office books a hotel, sends the visa invitation letter ten days before travel and arranges transfers, with halal, vegetarian and diabetic meals, a prayer room and a female physician on request.
Once you are back home
X-rays at six weeks and three months follow fractures, fusions and osteotomies, and a local therapist continues the program written in Istanbul.
Fingers that turn pale, cold or numb, pain that builds under a cast, a wound that leaks, or fever. Each needs a doctor the same day.
Wrist surgery FAQ
Is a plate better than wires for a broken wrist?
In a trial of 461 adults, wrist function at one year was the same with wires and with a volar plate.
Do older adults need surgery for a wrist fracture?
In a trial of adults aged 60 and over, function at 24 months was similar with plates, fixators, wires and a cast, though casts left more bones out of alignment.
What is wrist arthroscopy?
Keyhole surgery through tiny incisions to inspect and repair cartilage and ligaments inside the wrist.
Which is better for wrist arthritis, carpectomy or four-corner fusion?
A meta-analysis of 3,174 wrists found slightly better motion and pain scores and fewer later fusions after carpectomy, with similar grip.
How long is the recovery?
Six weeks for daily tasks after a fracture plate, and six months to a year for full strength after a fusion.
Can a family member stay with me?
Yes. A companion sleeps in your room on the companion bed.
References
Costa ML, Achten J, Parsons NR, et al. Percutaneous fixation with Kirschner wires versus volar locking plate fixation in adults with dorsally displaced fracture of distal radius. Randomised controlled trial. BMJ. 2014;349:g4807.
Chung KC, Kim HM, Malay S, Shauver MJ. Comparison of 24-month outcomes after treatment for distal radius fracture. The WRIST randomized clinical trial. JAMA Netw Open. 2021;4(6):e2112710.
Yoon AP, Wang C, Speth KA, Wang L, Chung KC. Modifiable factors associated with chronic pain 1 year after operative management of distal radius fractures. A secondary analysis of a randomized clinical trial. JAMA Netw Open. 2020;3(12):e2028929.
Hones KM, Hao KA, Rakauskas TR, et al. Four-corner fusion versus proximal row carpectomy for scapholunate advanced collapse and scaphoid nonunion advanced collapse wrist. A systematic review and meta-analysis. J Hand Surg Am. 2024;49(7):633-638.
Editor's note
Written by the Biruni Hospital medical editorial team. Reviewed by Assistant Professor Şafak SAYAR, Orthopedics and Traumatology.
