Impact of Hand Fractures on Return to Skate, Performance, Time on Ice, and Physicality in the National Hockey League

Introduction Hand fractures in ice hockey players have the potential to profoundly impact performance, but the associations between specific fracture characteristics and performance have yet to be quantified. The objective of this study is to assess the rates of hand fractures in the National Hockey League (NHL) over the past 25 years and determine the impact of fracture site and laterality on return to skate (RTS), games missed, performance, and time on ice (TOI) after injury. Methods Carpal, metacarpal, and phalangeal fractures sustained by active players were retrospectively collected from the 2000-2001 through 2024-2025 seasons of the NHL using the public database Pro Sports Transactions. Date of injury, RTS, games missed, injury laterality, performance metrics (Corsi, Fenwick, and PDO), TOI, and hits were collected and verified using player game logs and team schedules. RTS, games missed, change in performance, TOI, and hits were compared between fracture site and laterality. Results There were 170 fractures reported over 25 seasons (24 carpal, 58 metacarpal, 88 phalanx), with significantly more fractures occurring in the non-dominant shooting hand. The average RTS was 34.1 days, with players missing an average of 12.1 games. Phalanx fractures had a significantly faster RTS than carpal or metacarpal fractures. Overall, Corsi and Fenwick performance metrics significantly decreased after hand fractures, whereas hits and short- and long-term TOI were not significantly affected. Conclusion Hand fractures can result in significant declines in NHL player performance after RTS. Fractures to the non-dominant hand may be particularly detrimental to players, resulting in a slower RTS than fractures to the dominant hand. These insights highlight potential focus areas for prevention and rehabilitation protocols for ice hockey players with hand fractures.