Hand fractures, a frequent emergency department complaint, are the most common fractures of the body. Hand fractures account for about 1.5% of all emergency room visits and 40% of upper extremity fractures.  Proper management at initial evaluation of hand injuries can prevent a significant amount of morbidity and disability. Emergency physicians, often the first to assess these fractures, must have the skills to properly evaluate and manage these injuries.
This article focuses entirely on fractures of the hand. Please see other articles for information on wrist injuries, soft-tissue hand injuries, and dislocations. Also see Medscape's Fracture Resource Center.
Basic concepts about bony structures of the hand help to understand injury patterns and manage hand fractures. The hand is a group of gliding bones surrounded by soft tissue. A relatively immobile center consisting of the second and third metacarpal bones provides fixed support on which intrinsic movements of the hand depend. More mobile bones of the hand, such as the first, fourth, and fifth metacarpals, may tolerate a greater degree of angulation without disability, while the less mobile second and third metacarpal bones must have more precise reduction to ensure proper function.
More than 16 million people each year receive emergency care for hand injuries. Common emergencies include fractures, ligamentous injuries, and infections. Disability from hand injuries may result in loss of sensation, strength, and flexibility, the chief functions of the hands. Preserving function relies on maintaining the structural relationships of the intrinsic hand structures as well as musculotendinous connections from the forearm.
Prevention of disability from hand injuries is the primary goal of treatment. Maintenance of function, rather than cosmesis, is of paramount concern in the management of hand injuries.
Hand fractures occur in all age groups, although fractures in young children should prompt suspicion of child abuse.
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