Most hand fractures can be treated non-operatively, encouraging early mobilization once stable (typically after 2–3 weeks). The authors emphasize the tremendous powers of recovery of the hand from injury and that a mobile malaligned hand is much better than a stiff, normally aligned hand. In deciding upon the best treatment for any injury it is important to consider the patient as a whole, local resources and skills, as well as the specific injury. For most hand fractures non-operative treatment reliably gives good outcomes (which we have classified as Group A injuries) and typically cannot be improved upon with surgery. In some, surgery is clearly the best option (which we have classified as Group B injuries). The challenging group is where there is uncertainty (which we have classified as Group C injuries), especially where there is little or no good published evidence; for these we give our opinions based upon experience.
Al-QattanMM.Outcome of conservative management of spiral/long oblique fractures of the metacarpal shaft of the fingers using a palmar wrist splint and immediate mobilisation of the fingers. J Hand Surg Eur. 2008, 33: 723–7.
2.
BansalRCraigenMA.Fifth metacarpal neck fractures: is follow-up required?J Hand Surg Eur. 2007, 32: 69–73.
3.
BoeckstynsMEH. Current methods, outcomes and challenges for the treatment of hand fractures. J Hand Surg Eur. 2020, 45: 547–59.
4.
BoeckstynsMEH. Challenging the dogma: severely angulated neck fractures of the fifth metacarpal must be treated surgically. J Hand Surg Eur. 2021, 46: 30–6.
5.
DaviesAHainesSGiddinsG.Non-operative management of proximal phalanx spiral fractures: the use of elastic strapping to treat malrotation. J Hand Surg Eur. 2025; 50: 421–3.
6.
EdwardsGAGiddinsGE.Management of Bennett’s fractures: a review of treatment outcomes. J Hand Surg Eur. 2017, 42: 201–3.
7.
JannDCalcagniMGiovanoliPGiesenT.Retrograde fixation of metacarpal fractures with intramedullary cannulated headless compression screws. Hand Surg Rehabil. 2018, 37: 99–103.
8.
KhanAGiddinsG.The outcome of conservative treatment of spiral metacarpal fractures and the role of the deep transverse metacarpal ligaments in stabilizing these injuries. J Hand Surg Eur. 2015, 40: 59–62.
9.
LowCKWongHCLowYPWongHP.A cadaver study of the effects of dorsal angulation and shortening of the metacarpal shaft on the extension and flexion force ratios of the index and little fingers. J Hand Surg Br. 1995, 20: 609–13.
10.
MejiaALichtigAEGhoshABalasubramaniyanAMassDAmiroucheF.The effect of metacarpal shortening on finger strength and joint motion: a cadaveric biomechanical study. J Hand Surg Glob Online. 2023, 5: 407–12.
11.
MeunierMJHentzenERyanMShinAYLieberRL.Predicted effects of metacarpal shortening on interosseous muscle function. J Hand Surg Am. 2004, 29: 689–93.
12.
NobelMMuderD.Impact of metacarpal shortening on finger strength following non-surgical treatment of spiral and oblique metacarpal shaft fractures. BMC Musculoskelet Disord. 2025, 26: 525.
13.
PeyronsonFOstwaldCSHailerNPGiddinsGVedungTMuderD.Nonoperative versus operative treatment for displaced finger metacarpal shaft fractures: a prospective, noninferiority, randomized controlled trial. J Bone Joint Surg Am. 2023, 105: 98–106.
14.
SawantNKulikovYGiddinsGEB. Outcome Following Conservative Treatment of Metacarpophalangeal Collateral Ligament Avulsion Fractures of the Finger. J Hand Surg Eur2007; 32: 102–104.
15.
ShewringDJThomasRH.Avulsion fractures from the base of the proximal phalanges of the fingers. J Hand Surg Br. 2003, 28: 10–4.
16.
ShewringDJMillerACGhandourA. Condylar fractures of the proximal and middle phalanges. J Hand Surg Eur. 2015a, 40: 51–8.
17.
ShewringDJTrickettRWSubramanianKNHnydaR. The management of clenched fist ‘fight bite’ injuries of the hand. J Hand Surg Eur. 2015b, 40: 819–24.
18.
ShewringDJTrickettRWSmithA.Fractures at the junction of diaphysis and metaphysis of the proximal phalanges in adults. J Hand Surg Eur. 2018, 43: 506–12.
19.
SlettenINHellundJCOlsenBClementsenSKvernmoHDNordslettenL. Conservative treatment has comparable outcome with bouquet pinning of little finger metacarpal neck fractures: a multicentre randomized controlled study of 85 patients. J Hand Surg Eur. 2015, 40: 76–83.
20.
Statius MullerMGPoolmanRWvan HoogstratenMJStellerEP.Immediate mobilization gives good results in boxer’s fractures with volar angulation up to 70 degrees: a prospective randomized trial comparing immediate mobilization with cast immobilization. Arch Orthop Trauma Surg. 2003, 123: 534–7.
21.
StrubBSchindeleSSondereggerJSproedtJvon CampeAGruenertJG.Intramedullary splinting or conservative treatment for displaced fractures of the little finger metacarpal neck? A prospective study. J Hand Surg Eur. 2010, 35: 725–9.
22.
SwansonAB.Fractures involving the digits of the hand. Orthop Clin North Am. 1970, 1: 261–74.
23.
TangJBBlazarPEGiddinsGLalondeDMartinezCSolomonsM.Overview of indications, preferred methods and technical tips for hand fractures from around the world. J Hand Surg Eur. 2015, 40: 88–97.
24.
TrickettRWBrockJShewringDJ.The non-operative management of bony mallet injuries. J Hand Surg Eur. 2021, 46: 460–5.
25.
VadstrupLSJorringSBerntPBoeckstynsME.Base fractures of the fifth proximal phalanx can be treated conservatively with buddy taping and immediate mobilisation. Dan Med J. 2014, 61: A4882.
