Operative treatment of articular fractures of the hand

Articular fractures of the hand present a formidable challenge to the treating physician. The goal is restoration ofarticular congruity, preservation of joint stability, and return of hand function. The treatment algorithm is different, depending on the particular joint, degree of instability, and amount of articular involvement. The surgical technique requires careful handling of the soft tissue and the small fracture fragments. Fracture fixation may be accomplished by miniscrews, K-wires, or tension band wiring. Early motion is initiated if rigid fixation is obtained. Outcome varies with the severity of injury and ability to restore articular and joint alignment. This article discusses the operative treatment of articular fractures at the interphalangeal, metacarpophalangeal, and carpometacarpal joints of the hand.