Assessment and management of common hand fractures in adults

Hand fractures represent roughly 20% of all fractures, with a global incidence of 179 per 100 000 individuals.12 In adults, the metacarpals are most commonly fractured, especially the neck of the fifth metacarpal—a boxer’s fracture—which is often a consequence of striking an object or person with a closed fist. Fractures of the phalanges, particularly the fifth, fourth, and third, are common and often result from falls, blunt trauma, crush injuries, and sports injuries—for example, a mallet fracture (avulsion of the dorsal end of the distal phalanx near the distal interphalangeal joint) classically caused by a ball caught with an insufficiently extended distal phalanx.34 Peak incidence of hand fractures occurs in younger individuals (aged 15-40 years) and again in older adults (aged 70-80 years).4 Incorrect management can lead to complications, delayed recovery, and loss of function, potentially detracting from gainful employment, quality of life, and wellbeing.567 Here, we present an approach to diagnosis and management of suspected phalangeal and metacarpal fractures in adults for frontline and acute care clinicians. We do not cover carpal fractures or fractures that occur in children.