The incidence and pattern of hand fractures occurring in children living in Nottingham has been reviewed. The hand is the second commonest site of fracture in children. The incidence is low in infants, but rises steeply after the age of eight, especially in boys. The most common site is the proximal phalanx. The little finger/fifth metacarpal is the most vulnerable area, especially around the metacarpophalangeal joint. Greenstick fractures are more common in metacarpals, while epiphyseal injuries predominate in the phalanges. Over 45% of fractures occurred either at sport or in a fight. Aetiological factors are discussed in relation to the fracture patterns described.