Balancing surgical and conservative management in hand fractures: a practical classification approach

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.Level of evidence: V.