Fractures of small bones of hand are one of commonest injury. Unfortunately it is still not taken seriously by doctors or patients themselves this notion is may be because of the size of bone or they are not life threatening but 20 degrees of angulation/rotation would cause more disability to a person than any of the long bones. Goal of treatment in hand fractures is not only union but to preserve function foremost and cosmesis also by preventing deformities.

There are many ways to treat hand fractures

1. Non operatively by plaster and splints
2. Minimally invasive methods like percutaneous wires and screws
3. Open reduction and fixation with plates 
4. Open reduction and fixation with variable angle locking plates.

Variable angle locking plates for hand were first time introduced in India at hand course conducted by Dr Vikas Gupta at New Delhi on 19^th may 2019.

In absolute there is no one method superior over another but for more unstable fractures you need more stable fixation. GOAL always remain same stable fixation early mobilization to get best possible function.

22 year old male with injury right hand with multiple fractures in hand. 4 bones were fixed with plates and screws. Allowing patient to be mobilized early as fixations were stable therefore end result was excellent movements.

In cases of associated tendon, nerve or other soft tissue injuries these injuries should also be treated at same sitting whenever possible or as early as possible.

Case study

27 year old male had fracture metacarpal 5^th finger (little finger) following a fall. Patient was initially treated in Emergency where primary treatment was given in form of splint and analgesics.

Next day patient consulted Dr Vikas Gupta who discussed treatment options with patient.

After discussion patient was taken up for surgery.

During surgery open reduction of fracture was done followed by internal fixation with plate and screw.

After anatomical fixation and stable fixation finger was mobilized early resulting in excellent movements.