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Winter is a critical period for aquatic organisms; however, little is known about the ecological significance of its extreme events. Here, we link winter ecology and disturbance research by synthesizing the impacts of extreme winter conditions on riverine habitats and fish assemblages in temperate and cold regions. We characterize winter disturbances by their temporal pattern and abiotic effects, explore how various drivers influence fish, and discuss human alterations of winter disturbances and future research needs. We conclude that (a) more data on winter dynamics are needed to identify extreme events, (b) winter ecology and disturbance research should test assumptions of practical relevance for both disciplines, (c) hydraulic and population models should incorporate winter- and disturbance-specific aspects, and (d) management for sustainability requires that river managers work proactively by including anticipated future alterations in the design of restoration and conservation activities.