The use of Wide-Awake Local Anesthesia No Tourniquet (WALANT) is well documented in elective surgery but remains understudied in emergency hand surgery. The emergency setting presents distinct challenges, including preoperative pain, patient stress, and inflamed or damaged soft tissue. This study aims to evaluate the efficacy and safety of the WALANT procedure for soft tissue and bone surgery in acute hand and wrist injuries. A prospective cohort study was conducted, involving 245 hand injuries in 207 patients. Pain scores during injection were 3.7/10 for wounds and 3.8/10 for bone procedures. Pain scores during surgery were 1.6 for wounds and 2.8 for bone procedures. Over 96% of patients reported being satisfied or very satisfied with the procedure. No complications were observed. These results suggest that WALANT is a safe and well-tolerated technique for emergency hand surgery, yielding high patient satisfaction.