Hand fracture repair is a surgical procedure used to realign and stabilize broken bones in the hand when fractures are unstable, displaced, involve joints, or cannot heal properly with splinting or casting alone. The hand contains many small bones (phalanges and metacarpals) that must heal in precise alignment to preserve motion, strength, and fine motor function. Surgery is often recommended for open fractures, fractures involving the joint surface, multiple broken bones, or injuries that threaten long-term hand function if left untreated. Several surgical techniques may be used depending on the fracture pattern, bone involved, soft tissue condition, and overall severity of the injury. Percutaneous pin fixation (K-wires) is commonly used for simpler fractures and involves placing thin metal pins through the skin to hold the bone fragments in proper alignment while they heal. Open Reduction Internal Fixation (ORIF) is used for more complex or unstable fractures and requires an incision to directly visualize and realign the bones, which are then secured using plates, screws, or wires. In severe cases—such as open fractures, crush injuries, or fractures with significant soft tissue damage—external fixation may be used. This technique stabilizes the bones with pins connected to an external frame, minimizing disruption to injured tissue and reducing infection risk. Hand fracture surgery is typically performed under regional or general anesthesia, often with a tourniquet to limit bleeding and improve visibility. After surgery, the hand is immobilized with a splint or cast to protect the repair during early healing. Swelling, stiffness, and discomfort are common initially, and elevation is important to control swelling. Rehabilitation is a critical part of recovery and often begins early under the guidance of a certified hand therapist. Therapy focuses on restoring range of motion, preventing stiffness, rebuilding strength, and retraining fine motor skills. Pins placed through the skin are usually removed once the fracture has healed, while plates and screws typically remain in place unless they cause irritation or complications. Full recovery can take several months, depending on the complexity of the fracture, but surgical repair is highly effective at restoring alignment and maximizing long-term hand function when combined with proper rehabilitation.