context: Every year, millions of people break bones in their hands. Because we are so dependent on our hands, even a small loss of function can result in a lifelong disability. A broken hand will often require a visit to a doctor, and it may require months of rehabilitation care. The hand is composed of 27 bones, including those in the wrist. Broken bones most commonly result from a direct blow to the hand or a fall onto the hand. Common injuries include fractures of the fingertip, or of the pinkie side of the palm, or of the thumb. When doctors describe the bones in the hand, they use several terms. Carpals are the 8 bones in the wrist. They are not actually part of the hand but are vital for its function. Metacarpals are the 5 bones that form the palm of the hand. Phalanges are the 14 small bones that, when strung together, form the thumb and fingers. The thumb has 2 phalanges. The other 4 fingers are made of 3 phalanges each. The knuckles of the hand are referred to as the MCP joint, which stands for metacarpal-phalangeal joint (because the fingers, composed of phalanges, join the palm, made of metacarpals). The joints in the fingers are called the PIP and DIP joints. The PIP joint is the proximal interphalangeal joint and is the joint closest to the palm. The DIP joint is the distal interphalangeal joint and is the joint closest to the fingertip. The fingers are called the thumb, index finger, middle (or long) finger, ring finger, and pinky (or small) finger. The handedness (right or left) of the person is called the dominance of the hand. If you are left-handed, then you are left-hand dominant. The most common causes of hand injuries include workplace injuries, improper use of tools, crush injuries, falls, and sports injuries. The vast majority of injuries can be prevented. Most injuries of the hand are fairly obvious. The symptoms may include the following: A history of injury Swelling Bruising Pain Misalignment of the fingers Weakness Inability to grasp Reduced range of motion of fingers Your hands are central to being able to function, and you should be certain that no permanent damage has been done. Because your hands are so important, a doctor should see any hand injury, except the most minor. Contact your doctor, who may refer you to the emergency department for diagnosis and treatment. Most injuries of the hand will require an X-ray. The history of how the hand was injured will help the doctor determine the most likely fracture. For example, if the hand was injured by punching, the most likely fracture is that of the fifth metacarpal. The doctor will touch your fingers and hand and wrist to determine the areas that are most painful and to evaluate if any damage has occurred to the blood vessels or nerves or tendons in the hand. Generally, any hand injury -- except for the most minor one -- should be seen by a doctor. Simple first aid, however, can help prevent further injury. Control any bleeding by placing a clean cloth or gauze pad over the wound. As soon as the injury has occurred, apply ice to the injured area to decrease pain and reduce swelling. Remove any jewelry immediately. The hand may swell dramatically, and jewelry will be almost impossible to remove after the swelling has started. Contact your doctor, who will often refer you to an emergency department for diagnosis and treatment. If the hand is obviously deformed, try to support the injured hand by placing it on a pillow and carrying the pillow with you to the hospital or doctor's office. Take acetaminophen ( Tylenol) or ibuprofen ( Advil, Motrin) as directed on the label for pain. Because of the complexity of the hand, treatment of hand injuries can become involved. The procedure is usually as follows: The doctor will usually obtain an X-ray. Your hand may be partially numbed by injecting the nerves at the wrist or at the base of a finger. Wounds will be carefully irrigated and explored. Any cuts usually will be closed carefully (whether with stitches or other means). You may be given antibiotics to keep the wound from becoming infected. The injured part will be immobilized in a splint to hold it in a particular position. You may be referred to a hand specialist (orthopedic or plastic surgeon). You may receive pain medicine to use for several days after the injury. Follow-up After you leave the hospital or doctor's office, you can make your healing process as successful as possible by following this advice. Read any instructions given to you by the hospital and ask questions about those that you do not understand. Several studies have shown that instructional material is often not read or incompletely understood. If you are placed in a splint, do not remove it until you are told to do so. Take the pain medicine as recommended. Often, a hand injury will throb all night, keeping you awake. Keep the hand elevated as much as possible. This will reduce pain and decrease swelling. Keep your follow-up appointments and take all medicines as directed. The vast majority of injuries can be prevented. To prevent hand injuries on the job: Look for hand hazards before an accident can happen. Don't use your hands to wipe away debris in a machine, use a brush that is designed for that purpose. Check your equipment and machinery before you start and after you finish. Be sure that it is in good operating condition. Before you repair or clean machinery, be sure that the power is disconnected and follow all safety procedures. Do not wear gloves, jewelry, or loose clothing when working near a machine with moving parts. Wear the correct protective equipment-gloves, guards, forearm cuffs-for the work you are doing. Be sure your gloves fit properly and are meant for the work you are doing. Use appropriate safety equipment while playing sports to prevent or limit the extent of fractures. Hand and wrist guards are appropriate when playing certain sports (rollerblading, lacrosse, hockey). Sports that involve a ball (football, basketball, baseball, softball, volleyball) are more likely to cause hand injuries. Take special care when playing these games. Practice household safety measures, especially with small children, to decrease the chances of all injuries, including those to the hands. Get timely medical evaluation and treatment to prevent the long-term disability of a hand injury. Avoid using your hands to punch, hit, or pound any objects in anger. Many injuries to the hands are self-inflicted in this manner. Because hand injuries and finger injuries can be handicapping, it is extremely important that they are evaluated thoroughly. The prognosis depends on whether the injury involved a joint, whether tissue was lost, whether infection occurred, and often how well you will follow instructions. Many seemingly minor fractures will require surgery followed by some physical therapy to regain the maximum amount of function. fractured hand, hand injury, broken hand