Wrist and hand surgery Perth

Wrist arthroscopy is a minimally invasive procedure where a small 1.9mm diameter camera is inserted into the wrist joint. It may be used to diagnose or treat conditions and injuries affecting the complex structure of the wrist. Arthroscopic surgery can detect a range of conditions, including triangular fibrocartilage complex (TFCC) injuries, wrist ligament tears, carpal bone fractures and early arthritis that may not be visible on scans. It can be used to diagnose wrist pain of unknown cause.

Advanced arthroscopic wrist surgery builds on this technique, allowing surgeons to carry out more complex procedures through keyhole incisions with improved precision. Our Perth-based wrist surgeons are skilled in this technique, having published several papers and presented internationally on both diagnostic distal radioulnar joint (DRUJ) arthroscopy and arthroscopic triangular fibrocartilage complex (TFCC) repair. Arthroscopic TFCC repair is a ‘keyhole’ surgical technique performed through 3-4 small arthroscopic portals to repair injuries to the triangular fibrocartilage complex, a key stabiliser of the wrist.

Arthroscopic wrist ligament repair

The wrist is a complex structure that relies on many ligaments to support a full range of motion. Injury to these ligaments can cause wrist pain, a reduced range of motion and limited function. Wrist ligament injuries are diagnosed on MRI scan or during arthroscopic wrist surgery. The most common wrist ligament injury affects the scapholunate ligament (the ligament that holds the scaphoid and lunate bones together). Torn or damaged ligaments can be repaired arthroscopically. Arthroscopic wrist ligament repair can restore stability and resolve pain. The advantages of using arthroscopic techniques to treat wrist injuries include a more accurate diagnosis, less scarring, quicker recovery and an improved range of motion in the post-operative period.

Wrist arthroscopy

The scaphoid is a small bone on the thumb side of the wrist that is prone to fractures, especially after a fall onto an outstretched hand. Due to its limited blood supply, scaphoid fractures can be difficult to heal if not diagnosed and treated quickly.

Arthroscopic fixation of scaphoid fractures involves stabilisation of the recently fractured scaphoid bone using a screw to encourage union. This is performed through small keyhole portals, resulting in less soft tissue disruption and less scarring.

If a scaphoid fracture is not treated in its initial stages, it can result in a non-union (failure of the bone to heal). These cases can be treated using a more complex procedure called an arthroscopic bone graft for scaphoid non-union. Our Perth-based wrist surgeons have published a journal article and spoken internationally about this complex technique. The non-vascular surfaces of the unhealed bone are excised through small arthroscopic portals, revealing healthy bone with a rich blood supply that is more likely to unite. The defect is then packed with bone taken from the iliac crest (the hip). Wires are inserted through the scaphoid for stability and cut beneath the skin. The entire procedure is performed through small arthroscopic and ‘keyhole’ portals. The wires are removed at 12 weeks.

These techniques help restore stability, reduce pain, improve range of motion and prevent arthritis from developing in the wrist joint.

Scaphoid fracture surgery

Arthritis of the wrist can cause pain, stiffness, and difficulty with everyday tasks such as gripping or lifting. When non-surgical treatments like splints, exercise programs and therapy are no longer effective, surgery to treat arthritis may be considered. Depending on where the arthritis is located (the affected joints),the severity of the condition and lifestyle considerations, options may be partial wrist fusion, total wrist fusion, or in selected cases, joint replacement.

Arthritis of the wrist surgery may be performed via open or arthroscopic approaches, tailored to the type of arthritis, the joints affected and the patient’s activity needs. Based on radiological imaging (x-ray and CT) and a complete wrist examination, your surgeon will discuss what options are available to you and make recommendations based on your specific needs.

Base of thumb arthritis surgery is one of the most common procedures in this group, as arthritis often develops at the trapeziometacarpal joint. In many centres, the trapezium bone is completely removed, however our research conducted at The Wrist + Hand Institute Perth indicates that a partial resection technique (where only a small portion of the bone is removed using arthroscopic techniques) produces excellent pain relief and strong functional outcomes with a reduced complication rate.

The distal radioulnar joint (DRUJ) is critical for forearm rotation, enabling movements like turning a key or opening a door. Injuries, arthritis, or ligament tears in this joint can cause pain and weakness and a reduced range of motion, particularly when twisting the forearm.

DRUJ surgery is designed to restore stability and alignment of the joint. Depending on the cause of DRUJ symptoms, surgery may involve arthroscopic triangular fibrocartilage complex (TFCC) repair or reconstruction using tendon grafts.

In some cases, procedures to realign the bones or reduce pressure on the joint may be recommended.
Whether performed through open or arthroscopic methods, DRUJ surgery helps improve function, grip strength, and forearm rotation for patients with painful instability.

The ligaments in the wrist hold the carpal bones in alignment and allow smooth, coordinated movement. When these ligaments are damaged, torn or stretched, the result is instability that can cause persistent pain, weakness, and even arthritis over time.

Carpal ligament surgery uses arthroscopic techniques to repair or reconstruct these structures to restore strength and stability. Depending on the location and severity of the injury, treatment options may include direct ligament repair or tendon grafting to repair or reinforce the ligament.

Early surgical repair is often preferred in severe cases, as it can prevent long-term complications and improve functional recovery.

Keinbock’s disease is a rare condition caused by loss of blood supply to the lunate, a small central wrist (or ‘carpal’) bone. Over time, the bone may collapse, fragment, or cause surrounding arthritis, leading to significant pain and loss of wrist motion.

Surgery for Keinbock’s disease depends on the stage of the condition. Options may include revascularisation procedures to restore blood flow, joint-levelling surgery to reduce pressure on the lunate, or partial wrist fusion if the bone has collapsed.

In advanced cases, salvage procedures may be required to reduce pain and maintain as much wrist function as possible. Each operation is tailored to the severity of the disease and the patient’s lifestyle needs.

Ulnar carpal impaction occurs when the ulna bone is slightly longer than the radius (the ulna and radius are the two long bones of the forearm). This causes the ulna to impact on the carpal bones in the wrist, resulting in pain, reduced range of motion, and cartilage wear on the ulnar side of the wrist, which is often aggravated by twisting or loading the hand.

Ulnar carpal impaction surgery is most commonly performed as an ulnar shortening osteotomy, where a small section of the ulna is removed and stabilised with a plate to realign the DRUJ and relieve pressure on the carpal bones. In some cases, arthroscopic debridement or wafer resection may be appropriate.

The goal of surgery is to restore balance to the wrist joint, relieve pain, and protect against further cartilage damage. Post-surgery rehabilitation with therapy helps patients return to daily and sporting activities.

Wrist ligament injuries are sometimes mistaken for simple sprains, but in reality they can cause long-term instability and arthritis if left untreated. The most common injury is a scapholunate ligament tear, where the ligament holding the scaphoid and lunate bones together is disrupted, leading to weakness, pain, and clicking. Surgery for wrist ligament injuries may involve arthroscopic ligament repair, tendon reconstruction, or partial wrist fusion in advanced cases. Treatment is aimed at restoring stability, preventing further collapse of the carpal bones, and protecting long-term wrist health. With accurate diagnosis and early intervention, many patients regain pain-free functional wrist strength and motion. Wrist ligament injuries