ABSTRACT Objective Severe destruction of the wrist joint after trauma, disease, or iatrogenic causes can lead to significant bone defects and deformities, limiting the options for surgeries. Bespoke 3D‐printed metal prostheses were designed and used for four patients. This study aimed to describe the design rationale and report the clinical outcomes. Methods Between 2022 and August 2024, we followed up on four patients with significant bone defects and deformities caused by various factors, who opted against arthrodesis. These patients were treated with customized 3D‐printed prostheses replacements. All cases underwent assessment through clinical and radiological examinations, evaluating parameters including passive range of motion (ROM) of the wrist, grip strength, VAS of pain, and functional scales such as the Mayo score, Patient‐Rated Wrist Evaluation (PRWE), and Quick Disabilities of the Arm, Shoulder, and Hand (quick DASH) score. A paired t‐test was conducted to compare pre‐ and postoperative outcomes. Result The mean follow‐up period lasted 11.9 ± 6.7 months (range 6–18 months). All patients reported satisfying pain relief and enhanced function. The average ROM was 23.3° ± 5.7° of extension and 27.0° ± 18.6° of flexion. The average VAS score of pain was 1.5. The mean Mayo score, PRWE, and Quick DASH were 60.0, 31.5, and 28.3, respectively. No complications such as loosening, dislocation, or infection were observed during the follow‐up period. Conclusions Customized 3D‐printed prosthetic replacements for severely destroyed wrists can provide good functional outcomes with a higher satisfaction rate. Level of Evidence IV.