(iv) Bone injury

Summary Bone injuries are a daily challenge for the hand surgeon. The majority of the injuries are extra-articular, closed, simple, undisplaced or minimally displaced fractures and are best treated nonoperatively. Most closed fractures requiring manipulation and fixation are amenable to closed reduction and minimally invasive surgery. Open reduction and internal fixation, using mini plates or screws, of closed fractures is generally reserved for irreducible, displaced, intra-articular, comminuted, multiple displaced unstable or pathological fractures as well as displaced unstable fractures accompanied by ipsilateral extremity injuries or bilateral injuries. Open injuries of the hand are not only frequently associated with bone fractures but accompanied by additional soft tissue damage. The functional outcome of these injuries correlates with the severity of the injury but can be favourably influenced by the surgical treatment of all the involved structures, including stabilization and/or reconstruction of the bones. Most of these injuries have to be addressed individually. The hand surgeon treating these injuries has to be familiar with all techniques of bone reconstruction and stabilization to be able to individually choose the optimal combination of internal and external fixations.