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Health condition · Clinically reviewed

A broken hand, from a boxer\'s knuckle to the hidden scaphoid.

Not every fracture needs a plate - but some need urgent surgery. The difference is anatomy, alignment and, in the scaphoid, blood supply.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against BOAST, BSSH and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice for metacarpal, phalangeal, scaphoid and perilunate injuries.

Key facts

A broken hand at a glance.

The essentials, in plain English - the common patterns, the dangerous ones, and how they are treated in the UK today.

  • What it is

    A broken hand covers metacarpal, phalangeal and carpal fractures - each with a different pattern, risk profile and treatment.

  • Most common

    Fifth metacarpal neck (boxer's fracture) from a punch, and distal phalanx crush injuries from doors and hammers.

  • The dangerous one

    Scaphoid fractures - easily missed on first X-ray, high risk of avascular necrosis and non-union if untreated.

  • Rotational deformity

    A twisted metacarpal or phalanx causes scissoring of the fingers on flexion - a strong signal for surgery.

  • Foundation care

    Splint or cast, elevate, control pain, then early hand-therapy movement to prevent stiffness.

  • Surgery

    K-wires, Herbert screws or plates for unstable, displaced, intra-articular or rotationally malaligned injuries.

Why this guide matters

Not every knuckle needs a plate - but some fractures need surgery today.

The hand is unforgiving of malunion and stiffness. Three principles shape everything on this page.

  • Alignment matters more than a perfect X-ray

    Rotation and shortening drive function. A perfectly reduced bone with a twisted finger is still a surgical problem.

  • Scaphoid fractures are easily missed

    One in ten do not show on the first X-ray. If snuff-box tenderness is present, splint and re-image - or get an MRI.

  • Early hand therapy prevents stiffness

    Hands stiffen fast. Once safe, early movement and expert hand therapy protect the long-term result.

How the diagnosis is made

From injury to a clear plan.

The steps a UK emergency team or hand surgeon will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    Focused history and mechanism

    Punch, fall onto outstretched hand, crush, sports injury, human bite - each points to different fracture patterns.

  2. 02

    Assessing

    Look, feel, move

    Swelling, bruising, deformity, tenderness, ability to make a fist, and rotational alignment on gentle flexion.

  3. 03

    Assessing

    Neurovascular check

    Median (thenar and palmar sensation), ulnar (hypothenar and intrinsics), radial (dorsum) and capillary refill in each digit.

  4. 04

    Confirming

    X-ray AP, lateral and oblique

    The standard first line for suspected metacarpal or phalangeal fractures - three views to catch subtle steps.

  5. 05

    Confirming

    Scaphoid series

    Dedicated PA in ulnar deviation, Ziter and supinated oblique views for any snuff-box tenderness or scaphoid tubercle pain.

  6. 06

    Confirming

    CT or MRI when needed

    CT for complex intra-articular and carpal fractures. MRI within 24 hours is the gold standard for occult scaphoid fractures.

  7. 07

    Preparing

    Hand-surgeon referral

    Displaced, intra-articular, rotationally malaligned, open, scaphoid and perilunate injuries need urgent specialist review.

Typical timeline: a diagnosis on the day, a definitive plan within a week.

Symptoms

What a broken hand actually looks like.

The classic mix of pain, swelling, bruising and deformity - plus the subtle signs that point to specific fracture patterns.

  • Pain, swelling and bruising

    Immediate pain over the injured bone, swelling within minutes and bruising that spreads over hours.

  • Visible deformity

    A dropped knuckle in a boxer's fracture, a bent finger or a shortened digit - all point to displacement.

  • Rotational scissoring

    When you gently curl the fingers, an injured digit crosses over its neighbour - a clear sign of rotational deformity.

  • Mallet finger

    A dropped fingertip that cannot be straightened - a distal phalanx avulsion by the extensor tendon.

  • Snuff-box tenderness

    Pain in the hollow at the base of the thumb, worse with longitudinal thumb compression - the classic scaphoid sign.

  • Weak or painful grip

    Reduced pinch and grip strength, sometimes with a click or catch on movement.

  • Open wound over a knuckle

    A cut over the MCP joint after a punch is a fight bite until proven otherwise - high infection risk.

  • Red flag - pale, cold or numb hand

    Vascular or nerve compromise, an open fracture or a suspected perilunate dislocation needs A&E immediately.

Treatment

How a broken hand is treated in the UK.

Splint, buddy tape or cast for stable injuries - K-wires, screws or plates for unstable, rotational or intra-articular ones - and a dedicated pathway for the scaphoid.

  • Splint or buddy taping

    The starting point for most stable, undisplaced metacarpal and phalangeal fractures - protecting position while allowing early motion.

  • Boxer's fracture care

    Fifth metacarpal neck fractures tolerate up to 40 degrees of angulation - reduction and a splint for 3 to 4 weeks with early movement.

  • Closed reduction

    Manipulation under local or regional block to restore length, alignment and rotation before splinting or wiring.

  • K-wire fixation (CRPP)

    Percutaneous wires for displaced metacarpal and phalangeal fractures - minimally invasive, removed at 4 to 6 weeks.

  • Plate and screw ORIF

    For unstable shaft fractures, intra-articular injuries or when rigid fixation is needed for early rehabilitation.

  • Bennett and Rolando fixation

    First metacarpal base fractures - Bennett usually needs CRPP or ORIF, Rolando is comminuted and often plated.

  • Scaphoid fixation

    Herbert screw for displaced, proximal-pole or delayed-union scaphoid fractures. Vascularised bone graft for AVN or non-union.

  • Mallet splint

    Continuous DIP extension in a Stack or plaster splint for 6 to 8 weeks - surgery reserved for large articular fragments or joint subluxation.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your A&E team, GP or hand surgeon knows your injury and history and can tell you which parts apply to you. If in doubt, get seen.

  • BOAST. British Orthopaedic Association Standards for Trauma - hand and wrist fractures.

  • British Society for Surgery of the Hand (BSSH). Guidance on scaphoid, metacarpal and phalangeal fractures.

  • NICE. Fractures (non-complex): assessment and management (NG38).

  • Royal College of Emergency Medicine. Suspected scaphoid fracture best-practice guideline.

Red flags

When a broken hand needs urgent attention.

Most hand fractures can be managed in an urgent-care clinic. These are the situations that can\'t - and where a hand-surgery opinion is needed today.

  • Suspected scaphoid fracture

    Snuff-box tenderness, scaphoid tubercle pain or pain on longitudinal thumb compression - splint and image, even if the first X-ray looks normal.

  • Rotational deformity

    Scissoring fingers on flexion mean a twisted metacarpal or phalanx - surgical correction is nearly always needed.

  • Open fracture

    Any wound communicating with a fracture is an emergency - IV antibiotics, tetanus cover and urgent surgical washout.

  • Fight bite

    A wound over the MCP joint from a human tooth - assume septic arthritis, admit for IV co-amoxiclav and open joint washout.

  • Perilunate or lunate dislocation

    A rare, high-energy carpal injury that is often missed. Needs urgent reduction and specialist fixation to save the wrist.

  • Neurovascular compromise

    A pale, cold, numb or weak hand after injury needs immediate reduction and hand-surgical review.

  • Compartment syndrome

    Disproportionate pain, tense swelling and pain on passive stretch of the intrinsics - fasciotomy may be needed.

  • Delayed union or non-union

    Persistent pain and tenderness weeks after injury - especially in scaphoid - warrants CT and specialist review.

  • Kienbock disease

    Avascular necrosis of the lunate - progressive wrist pain and stiffness after apparently minor injury needs MRI and hand-surgery input.

Living with it

A treatable injury, with a clear rehab ladder.

Four things make the biggest difference day to day - protection early, movement soon, patience through the healing weeks, and a low threshold to escalate.

A quiet reminder

Stiffness is the enemy of a hand.

Once your team says it is safe, moving your fingers protects your long-term function far more than resting them.

  1. 01 Protect

    Splint, elevate and ice

    Keep the hand elevated above the heart in the first 48 hours and use ice through a cloth for 15 minutes at a time.

  2. 02 Move

    Start hand therapy early

    Once your surgeon or A&E team gives the go-ahead, gentle finger and thumb movement prevents stiffness far better than rest alone.

  3. 03 Patience

    Bone healing takes weeks

    Most metacarpal and phalangeal fractures need 4 to 6 weeks in a splint. Scaphoid fractures need 6 to 12 weeks - sometimes longer.

  4. 04 Escalate

    Don't ignore persistent pain

    Pain that lingers beyond the expected healing window, or new symptoms, deserves re-imaging and a hand-surgeon opinion.

Frequently asked

Everything we get asked about a broken hand.

Quick answers on metacarpal, phalangeal and scaphoid fractures, mallet finger and fight bites.

  • What is a broken hand?

    It is any fracture of the 27 bones of the hand and wrist - the metacarpals (palm bones), phalanges (finger bones) and carpal bones (including the scaphoid, lunate and triquetrum). Each pattern behaves differently and needs a slightly different treatment.

  • What is a boxer's fracture?

    A fracture of the neck of the fifth metacarpal, usually from throwing a punch. Because the little finger has a mobile carpometacarpal joint, up to 40 degrees of angulation is often tolerated with a splint and early movement. Rotation is not tolerated and needs correction.

  • Why is a scaphoid fracture so serious?

    The scaphoid has a fragile blood supply that runs backwards from the distal pole. A fracture at the waist or proximal pole can cut off the blood supply to the top of the bone, leading to avascular necrosis and non-union. Around one in ten scaphoid fractures are not visible on the first X-ray, so a repeat film at 2 weeks, or an early MRI, is often needed.

  • What is a mallet finger?

    A fingertip that droops and cannot be straightened, caused by an avulsion of the extensor tendon from the base of the distal phalanx - sometimes with a small bone fragment. Most cases heal in a Stack or plaster splint that holds the DIP joint straight continuously for 6 to 8 weeks. Larger fragments or joint subluxation need surgery.

  • When does a broken hand need surgery?

    When the fracture is displaced, rotated, intra-articular, unstable, open, or involves a scaphoid waist or proximal pole. Surgery uses K-wires, Herbert screws or plates and screws to restore alignment and allow early movement.

  • Why is a wound over the knuckle after a punch so worrying?

    Because it is almost always a fight bite - a human tooth has broken the skin over the MCP joint. Human mouths carry aggressive bacteria and the injury often penetrates the joint. It needs a thorough washout, IV co-amoxiclav, tetanus cover and, in most cases, formal open exploration by a hand surgeon.

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