The purpose of this prospective clinical study was to identify the true incidence, pattern, and location of the injury and nature of fracture after hand injuries in different pediatric age groups attending a hand unit. Three hundred sixty children (237 boys, 123 girls) under 16 years of age who presented with hand injuries between April 1, 2000, and Sept. 30, 2000, were included in the study. Bony injuries accounted for 65.5% (236 injuries); 33.3% (120 injuries) were soft tissue injuries. The projected annual incidence rate for skeletal injuries was 418/100,000 children. The incidence was low in toddlers (34/100,000), more than doubled in preschool children (73/100,000), and steeply increased to around 20-fold after the 10th year (663/100,000). Girls had a higher incidence of hand injuries among toddlers and preschool children. Crushing was the most common cause of hand injury (64%), and most injuries were sustained at home (45%). Toddlers sustained soft tissue injuries predominantly (86%) and older children sustained more bony injuries (77%). Sport was the cause of injures commonly in the older children. There was a higher incidence of fracture in the little finger (52%) followed by the thumb (23%). The proximal phalanx was the most frequently fractured bone (67%) among the phalanges. Diaphyseal fractures (46%) were more common in the metacarpals, and basal fractures (51%) were common in the phalanges. At discharge more than 80% of the patients felt that they were cured or significantly better. This paper highlights the changing pattern and the different varieties of hand injuries in different pediatric age groups.