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Health condition · Clinically reviewed

Hand fractures, from wrist to fingertip - who needs urgent hand surgery, and why.

One in five fractures seen in the ED involves the hand or wrist. The right imaging, the right splint and early specialist hand input decide how well it heals.

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A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

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 hand-trauma pathways, imaging standards and specialist hand-therapy input.

Key facts

Hand fractures at a glance.

The essentials, in plain English - what breaks, how it presents, and which fractures need specialist hand surgery.

  • What it is

    A break in one or more bones of the wrist, carpus, metacarpals or phalanges. Very common, accounting for up to a fifth of all fractures seen in the emergency department.

  • Main patterns

    Distal radius (Colles, Smith, Barton), scaphoid, other carpal bones, metacarpal, phalangeal and volar plate avulsion injuries.

  • Most common

    Distal radius fracture from a fall on outstretched hand (FOOSH) is the commonest upper-limb fracture across all age groups.

  • High-risk scaphoid

    Scaphoid waist fractures carry a real risk of non-union and avascular necrosis. Clinical scaphoid injury with normal X-ray needs MRI or CT and specialist review.

  • Boxers and Bennett

    Fifth metacarpal neck (boxer’s) fractures follow a punch. Bennett and Rolando fractures of the thumb base need urgent specialist input.

  • Recovery

    Most heal with the right immobilisation and specialist hand therapy. Displaced, intra-articular or open injuries usually need surgery.

Why this guide matters

Small bones, big consequences.

A stiff, weak or malaligned hand affects work, sport and everyday life. The three points below shape everything else on this page.

  • Imaging is not optional

    Plain films are the start. A tender snuffbox with a normal X-ray still needs MRI or CT to protect the scaphoid.

  • Displacement changes the plan

    Undisplaced fractures often do well in a cast. Displaced, intra-articular or rotationally malaligned fractures usually need surgery.

  • Hand therapy drives outcomes

    Structured hand therapy after immobilisation is not an extra - it is central to regaining movement, strength and dexterity.

How the diagnosis is made

From injury to a definitive plan.

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

  1. 01

    Assessing

    Mechanism and history

    FOOSH, punch, crush, axial load or twisting injury. Handedness, occupation and prior hand injuries all shape the plan.

  2. 02

    Assessing

    Focused examination

    Inspection for deformity or open wounds, palpation of the anatomical snuffbox and scaphoid tubercle, range of movement and neurovascular check.

  3. 03

    Assessing

    Compartment and open-injury check

    Tense swelling, pain out of proportion or a wound over a fracture triggers immediate BOAST-4 open-fracture and compartment-syndrome pathways.

  4. 04

    Confirming

    Plain radiographs

    AP, lateral and oblique views of the hand or wrist. Dedicated scaphoid views if the snuffbox is tender or FOOSH is the mechanism.

  5. 05

    Confirming

    CT for complex patterns

    Intra-articular distal radius, Rolando, hamate hook or comminuted carpal fractures are best characterised with CT for surgical planning.

  6. 06

    Confirming

    MRI for occult scaphoid

    Clinical scaphoid injury with a normal X-ray warrants MRI within 10 to 14 days to catch occult fractures early (see /treatments/wrist-mri/).

  7. 07

    Referring

    Specialist hand referral

    Scaphoid, Bennett, Rolando, intra-articular, open and neurovascular injuries all need same-day or next-day hand-surgery review.

Typical timeline: from arrival to a definitive plan within hours, not days.

Symptoms

What a hand fracture looks like.

Pain, swelling and deformity are the obvious clues. The subtler signs - rotational malalignment, snuffbox tenderness and neurovascular change - matter just as much.

  • Pain and tenderness

    Sharp, well-localised pain over the fracture site. Snuffbox tenderness raises the suspicion of a scaphoid fracture.

  • Swelling and bruising

    Soft-tissue swelling appears within minutes to hours. Extensive bruising suggests significant underlying injury.

  • Visible deformity

    Dinner-fork deformity of the wrist (Colles), rotational malalignment of a finger, or a depressed knuckle in a boxer’s fracture.

  • Reduced range of movement

    Guarding, stiffness and pain on wrist or finger movement. Grip strength drops sharply.

  • Neurovascular signs

    Numbness, tingling, colour change or a cool hand. Median-nerve symptoms are common with distal radius injuries.

  • Open wound over fracture

    Any wound overlying a suspected fracture is treated as an open injury under BOAST-4 pathways.

  • Rotational malalignment

    When flexed, fingers should point to the scaphoid. Rotation or scissoring flags a metacarpal or phalangeal fracture needing correction.

  • Red flag - compartment syndrome

    Progressive severe pain, tense swelling and pain on passive stretch. A surgical emergency needing urgent decompression.

Treatment

How hand fractures are treated in the UK.

Cast, splint, K-wire or plate - the choice depends on the bone, the pattern and the demands you place on your hand.

  • Cast or splint immobilisation

    For undisplaced, stable fractures. Position, duration and follow-up vary by fracture pattern and are guided by the hand team.

  • Closed reduction and cast

    For displaced Colles-type distal radius fractures. Reduction under haematoma block or sedation, then moulded cast and check radiographs.

  • Percutaneous K-wire fixation

    Small pins holding reduction for unstable distal radius, metacarpal or phalangeal fractures. Removed in clinic once healed.

  • Volar plate ORIF

    Open reduction and internal fixation with a volar locking plate for unstable or intra-articular distal radius fractures (see /treatments/distal-radius-orif-plate/).

  • Scaphoid screw fixation

    A headless compression screw for displaced or unstable scaphoid fractures, and often chosen for acute waist fractures to speed return to function (see /treatments/scaphoid-screw-fixation/).

  • Bennett and Rolando fixation

    Thumb base intra-articular fractures usually need urgent specialist hand surgery with K-wires or ORIF to restore joint congruity.

  • Buddy taping and boxer’s brace

    Simple, effective immobilisation for many phalangeal and fifth metacarpal neck fractures when angulation is within accepted limits.

  • Specialist hand therapy

    Structured rehabilitation to restore movement, strength and dexterity. Central to outcomes after any hand fracture (see /conditions/hand-and-wrist-manual-therapies/).

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 emergency doctor or hand surgeon knows your injury and history and can tell you which parts apply to you. If in doubt, get seen.

  • BOAST. Open fractures (BOAST 4) and management of distal radius fractures.

  • British Society for Surgery of the Hand (BSSH). Guidance on hand and wrist fracture management.

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

  • Royal College of Radiologists. iRefer guidance on wrist and hand imaging.

Red flags

When a hand fracture needs urgent attention.

Most hand fractures do well with structured care. These are the situations that need urgent specialist input.

  • Open fracture

    Any wound over a suspected fracture is an open injury. BOAST-4 pathway: photograph, saline gauze, splint, antibiotics and urgent orthopaedic and plastic-surgery review.

  • Neurovascular compromise

    A cold, pale or pulseless hand, or new dense numbness. Needs immediate reduction and specialist assessment to protect the limb.

  • Compartment syndrome

    Severe, escalating pain, tense swelling, pain on passive stretch and paraesthesia. A surgical emergency requiring urgent fasciotomy.

  • Scaphoid fracture

    High risk of non-union and avascular necrosis. Clinical scaphoid injury needs specialist review and MRI or CT even when the initial X-ray is normal.

  • Bennett or Rolando fracture

    Intra-articular thumb-base fractures. Poor outcomes without early anatomical reduction and specialist hand fixation.

  • Rotational malalignment

    A rotated finger will not correct itself. Needs reduction and, often, K-wire or ORIF stabilisation to prevent long-term dysfunction.

  • Suspected non-accidental injury

    Unusual patterns in children, or an inconsistent history in vulnerable adults, trigger safeguarding review alongside orthopaedic care.

  • Delayed presentation

    A missed scaphoid or metacarpal fracture presenting weeks later still deserves urgent specialist assessment for non-union and CRPS risk.

  • CRPS features

    Disproportionate pain, swelling, temperature or colour change after a hand fracture warrants prompt review (see /conditions/crps-complex-regional-pain-syndrome/).

Living with it

A well-managed hand fracture, back to full function.

Four things that make the biggest difference day to day - elevation, movement of free joints, structured hand therapy and knowing when to speak up.

A quiet reminder

Stiffness is easier to prevent than to reverse.

Small, steady habits - movement, elevation, therapy exercises - do more than a heroic week that doesn’t last.

  1. 01 Elevation

    Keep the hand above the heart

    For the first 72 hours, elevation controls swelling more than any tablet. Small habits, kept up, protect the outcome.

  2. 02 Movement

    Move the free joints

    Fingers, elbow and shoulder should keep moving even in a cast. Stiffness is the enemy of hand recovery.

  3. 03 Therapy

    Start hand therapy early

    Specialist hand therapy is central to a good outcome. It is not an optional extra - book it in as soon as the plan allows.

  4. 04 Escalate

    Speak up if pain climbs

    Escalating pain, new numbness or a tight cast are never normal. Get seen the same day rather than waiting for the next appointment.

Frequently asked

Everything we get asked about hand fractures.

Quick answers on scaphoid injuries, boxer’s fractures, surgery and recovery times.

  • What are the most common hand fractures?

    Distal radius fractures (Colles, Smith and Barton patterns) are the commonest, usually from a fall on an outstretched hand. Scaphoid, metacarpal (particularly the fifth metacarpal neck, or boxer’s fracture) and phalangeal fractures make up most of the rest.

  • Why is a scaphoid fracture treated so cautiously?

    The scaphoid has a fragile blood supply that runs from the distal pole backwards. A waist fracture can cut off flow to the proximal fragment, leading to non-union and avascular necrosis. Even with a normal X-ray, clinical scaphoid injury needs specialist review, immobilisation and further imaging with MRI or CT.

  • When does a hand fracture need surgery?

    Displaced, unstable, intra-articular, open or rotationally malaligned fractures usually need surgery. Common examples include unstable distal radius fractures needing volar plate ORIF, Bennett and Rolando fractures at the thumb base, and displaced scaphoid or phalangeal fractures.

  • How long does a hand fracture take to heal?

    Most metacarpal and phalangeal fractures unite in about six weeks. Distal radius fractures often need six to eight weeks in a cast or splint, with hand therapy for several months after. Scaphoid fractures can take three months or more, and displaced ones often heal faster with surgical fixation.

  • What is a boxer’s fracture?

    A fracture of the fifth metacarpal neck, almost always caused by punching a solid object with a closed fist. Many are managed with buddy taping or a boxer’s brace when angulation is within accepted limits. Excessive angulation, rotational malalignment or an open wound (fight bite) needs specialist review.

  • Do I really need specialist hand therapy?

    Yes, in almost every case. Hand therapists are specialist physio and occupational-therapy colleagues who tune splints, guide movement and rebuild strength. Outcomes after hand fractures depend far more on structured therapy than most patients expect.

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