Hand fractures constitute 20% of hand injuries applying to emergency services. Conservative approaches are satisfactory in the majority of the cases. However, the minority group in need of surgery reaches a serious number of patients considering the frequency of these injuries. Retrospective questioning of the indications of the performed surgeries is a proper way of understanding the decisional process for surgery.

Patients treated for hand fractures were retrospectively reviewed. Patient gender, age, finger/fingers involved, soft tissue involvement, treatment method (conservative/surgery) and if operated, devices used for fixation were noted. Patient plain radiographs were evaluated. Descriptive statistics of these variables and the effect of each variable on the decision for surgery were analysed.

Study involved 1430 fractures of 1303 patients (1016 male, 287 female). Fifth finger was the most commonly injured digit (31%). Comminuted fractures (29%) followed by transverse fractures (29%) and spiral/oblique fractures (22%) were commonly diagnosed fracture types. Thirteen percent (13%) of the study group needed tendon/nerve/vessel repairs. Male patients, cases with soft tissue involvement, 2nd, 3rd and 4th finger fractures, fractures involving multiple digits, fractures with an intra-articular component, fractures with dislocation more than 4 mm and angulation more than 15° had a significantly higher rate of surgery.

Less than half of hand fractures require surgery, and conservative treatment is usually preferred. Certain variables that indicates surgical treatment were identified with our study. These findings may help to weigh the options and choose the right path in doubtful conditions.

Level 4, Case-control study