With the use of conventional C-arm fluoroscopy for hand surgery, suboptimal positioning of implants, K-wires, insufficient reconstructions and joint incongruities frequently remain unrevealed We prospectively compared the performance of the surgeon interpreted from conventional methods (2D fluoroscopy and direct visual and physical inspection) versus 3D imaging as well as the occurrence of revision surgeries based on post-op radiological findings. Twenty-four intraoperative findings based on 2D fluoroscopy and findings on direct visual and physical inspections were compared with intraoperatively acquired 3D-RX scans by means of a questionnaire. Moreover, record was kept of revision surgery (minimal three months follow up) for all patients treated with the aid of 3D-RX. A clear difference in findings was observed between the performance based on fluoroscopy and direct visual and physical inspection and that based on intraoperative 3D-RX for hand surgery (p < 0.05). Post-operative radiological examinations revealed that none of the 56 patients treated with the aid of 3D-RX needed revision surgery. Intraoperative 3D-RX provides information for the hand surgeon that is additional to the information acquired with conventional fluoroscopy. Intraoperative 3D-RX provides well defined images of the positioning of osteosynthesis material, of the spatial orientation of carpals, and of reconstruction of the wrist joint.