A broken bone in the hand or wrist is one of the most common injuries there is, and most of them heal well. What decides the result is usually not how bad the break looks on the first X-ray. It is whether the bone is in an acceptable position, whether it is stable enough to start moving early, and in one particular case, whether it was found at all.
This page explains what we treat, what we do not, and how the decision between a splint and an operation is made. Each of the main injuries then has its own page.
What we treat, and what we do not
We treat fractures of the wrist and hand from the radiocarpal joint downwards. That means the scaphoid and the other small carpal bones, the metacarpals, and the bones of the fingers and thumb.
A broken wrist in the sense most people mean it, a fracture of the lower end of the radius, is not something we treat. That is the forearm bone just above the wrist joint. It is the most common fracture in the body, and it is managed by upper limb orthopaedic surgeons. If that is what you have, you should be seen by one, and your GP or the emergency department can arrange it. We would rather tell you now than after an appointment.
The distinction matters more than it sounds, because the two injuries happen the same way, a fall onto an outstretched hand, and they hurt in roughly the same place. An X-ray settles it. If a scan has shown a distal radius fracture, you need an upper limb orthopaedic surgeon. If it has shown a scaphoid fracture, or if your wrist still hurts and the X-ray looked normal, that is us.
The injuries we see, and where to read about them
- Scaphoid fracture. The most commonly broken bone in the wrist, and the one most often missed. Its blood supply makes it slow and unreliable to heal, which is why it is treated more carefully than its size suggests.
- Scaphoid nonunion. A scaphoid fracture that has not healed, often because it was missed at the time. Treated at this practice with arthroscopic bone grafting, which is Dr Nicholas Smith's particular interest.
- Hand and finger fractures. The metacarpals and the bones of the fingers and thumb. Most are splinted and moved early with a hand therapist. Some need pinning or fixation, and rotation is usually what decides which.
How a broken bone in the hand is treated
Three broad options, and the choice is made on the position of the bone, how stable it is, and which bone it is.
- A splint or a cast. Suits the majority. The bone is held while it heals, and where possible the neighbouring joints are kept moving so the hand does not stiffen while it waits.
- Pinning through the skin. Fine wires are passed through small punctures to hold the bone, usually without opening the fracture. The wires come out once the bone has united.
- Open fixation. The fracture is exposed and held with screws or a plate. Used where the bone cannot be reduced any other way, or where the joint surface needs to be rebuilt.
A stable repair allows gentle movement within a week or so, which is the real argument for fixing an unstable fracture. A hand that is moved early recovers motion that a hand held still for six weeks often never gets back.
Hand therapy
Almost every hand fracture involves a therapist, whether or not it involves an operation. They make and fit the splint, decide what can safely move and when, manage the swelling, and get the stiffness out afterwards. Our therapists work on site, so this starts within days rather than after another referral.
When to be seen sooner
Go to an emergency department, or contact us, if you have:
- A finger that crosses over or under its neighbour when you make a fist, which suggests the bone is rotated
- An obvious deformity, or a bone that has broken through the skin
- A wound over a knuckle sustained by striking someone in the mouth, which needs treating urgently whatever the X-ray shows
- Numbness, or fingers that are pale or cold
- A wrist that has not settled ten to fourteen days after a fall, even if the X-ray was normal
Frequently asked questions
Do you treat broken wrists?
It depends which bone. If you mean the scaphoid or one of the other small bones of the wrist, yes. If you mean the lower end of the radius, which is what most people mean by a broken wrist, no. Those are treated by upper limb orthopaedic surgeons and your GP or the emergency department can refer you to one.
Does a broken finger always need a cast?
No, and rigid immobilisation of a whole hand is usually the wrong answer. Many hand fractures are stable enough to be protected in a splint or taped to the neighbouring finger while movement continues. Holding a hand still for six weeks reliably produces a stiff hand.
My X-ray was normal but my wrist still hurts. What now?
Go back and ask specifically about the scaphoid. It is the one fracture that is regularly invisible on the first X-ray, and it is also the one where a delay matters most. Ten to fourteen days of pain after a fall onto the hand is enough reason to look again.
Do I need a referral?
A referral from your GP or another specialist means you can claim a Medicare rebate on the consultation. We can see you without one, but the rebate will not apply.
Written and clinically reviewed by Dr Paul van Minnen, MD, PhD, EBOPRAS, FRACS (Plast)
Last reviewed 12 September 2026