Primary care of finger, hand, and wrist fractures involves accurate diagnosis, pain control, reduction and splinting of the fracture, and timely appropriate referral to a hand surgeon.

●The initial evaluation of hand fractures includes a focused history and examination for swelling, deformity, open wounds, alignment of the fingers, neurovascular status, and local tenderness. Details of the mechanism of injury and an understanding of common injury patterns associated with particular mechanisms help to guide the examination and choice of radiologic studies. (See 'Initial evaluation' above.)

●Plain radiographs of the injured part of the finger and/or hand should be obtained. The radiographs obtained depend on the injuries suspected, as determined by the physical examination and mechanism of injury. (See 'Radiographic evaluation' above.)

●A precise description of the location and details of any hand fracture helps in guiding the proper radiologic examination and management, and helps when obtaining hand surgery consultation. (See 'Fracture description' above.)

●An open wound may not necessarily communicate with the underlying fracture, but it is better to treat all such fractures as open fractures. An open fracture implies that the fracture is contaminated. Patients with open fractures require immediate removal of any gross contaminants, gentle irrigation of the wound with isotonic saline, placement of an appropriate dressing, and prophylactic antibiotics. They should be referred to a hand surgeon as soon as possible. (See 'Open fracture' above.)

●Patients with open fractures should immediately be given a dose of a broad spectrum antibiotic to reduce the risk of soft tissue infection and osteomyelitis. For patients at risk for methicillin-resistant Staphylococcus aureus (MRSA), prophylactic antibiotics should include an agent with activity against MRSA. (See 'Open fracture' above.)

●Distinguishing between stable and unstable fracture patterns helps to determine the urgency of referral to the hand surgeon. Patients with closed unstable fractures should be evaluated by the surgeon within two to three days of injury, whereas patients with closed stable fractures can be evaluated in approximately 7 to 10 days. In the intervening period, the hand is splinted, appropriate analgesics are prescribed, and the patient is advised to keep the limb elevated to reduce swelling and pain. (See 'Stability' above.)

●Splinting plays an important role in the management of musculoskeletal injuries, particularly those involving extremity fractures and joint dislocation. Immobilization of the extremity by splinting decreases pain and bleeding and prevents further soft tissue, vascular, and neurologic compromise. (See 'Splinting' above.)

●Fractures of the distal phalanx and the middle and proximal phalanges require differing approaches depending on the characteristics of the injury. (See 'Phalangeal fractures' above.)

●Metacarpal fractures are classified by location, and include head, neck, shaft, and base fractures. (See 'Metacarpal fractures' above.)

●Carpal fractures are classified primarily by their location. (See "Overview of carpal fractures".)