Skip to content

Patients › Hand

手指骨折

PDF Evidence

Phalangeal and metacarpal fractures of the hand — non-operative care and indications for fixation.

Updated Jun 2026
一幅手绘的骨折指骨插图。
X线显示指骨骨折模式。 Servier Medical Art / smart.servier.com, CC BY 4.0

本页面由机器翻译，尚未经临床医生审核。英文版本为权威版本。

您的感受

您可能正在经历手指或手部的剧烈疼痛和肿胀。当您活动受伤的手指或将重量施加于手部时，疼痛通常会加重。如果骨骼发生移位，您可能会注意到瘀伤或可见的畸形。简单的闭合性骨折很常见，且通常稳定，意味着骨块保持在原位。然而，如果损伤涉及开放性伤口或严重的挤压伤，疼痛可能会更加剧烈和复杂。

由于手部功能异常，日常任务变得困难。您可能会在简单的动作中遇到困难，例如伸手到背后扣文胸或塞衬衫。抓握物体时感觉无力且疼痛。如果骨折发生在拇指或食指，这些挑战往往更为明显。这些特定的手指对于捏握和抓握至关重要，因此此处的损伤会显著影响您执行日常活动的能力。

您的手部可能会感到僵硬，尤其是在早晨或休息一段时间后。这种僵硬会使您难以完全伸直或弯曲手指。在某些情况下，特别是对于指骨骨折，如果管理不当，活动范围可能会随着时间的推移而减小。您可能会发现由于受伤的手部受到压力，难以侧卧睡觉。

如果您的骨折是开放性的，并发症的风险更高。约四分之一的开放性指骨骨折需要一次以上的手术。如果需要额外手术，这种情况在损伤严重、涉及挤压机制或影响手指血液供应时尤为常见。对于大多数其他掌骨骨折，对整体健康的影响很小，许多骨折无需手术即可良好愈合。然而，个体治疗方案取决于骨折的具体模式以及软组织的状况。

实际发生了什么

当指骨骨折时，坚硬的骨皮质会出现裂纹。这可能发生在手掌的长骨（掌骨）或手指的较小骨骼（指骨）中。大多数此类骨折为简单、闭合且稳定的骨折。这意味着皮肤完整，骨折断端移位不明显。在这种情况下，手部通常无需手术即可良好愈合。

然而，某些骨折更为复杂。如果骨折线延伸至关节面，或骨端发生移位，骨折断端可能无法正确对位。您的外科医生必须仔细评估骨折的具体形态、骨骼移位程度以及皮肤和软组织的状况。这有助于决定是否需要手术固定骨骼以促进愈合。

如果需要手术，目标是使骨骼恢复至正常形态。这允许您早期活动手部。早期活动可预防僵硬，并帮助恢复手部功能。例如，某些微创技术可在3周内实现拇指骨折后的完全活动。其他方法则使用接骨板和螺钉来固定骨骼。这种刚性支撑使您能够更早开始使用手部，从而提高满意度和外观效果。

请注意，某些损伤伴随较高的风险。拇指或食指骨折更可能需要计划外再次手术。如果血管受损，这种情况尤为常见。此外，约四分之一的开放性指骨骨折（皮肤破损）可能需要多次手术。这些通常是更严重的损伤，涉及挤压伤或血供不良。

即使修复成功，也可能出现僵硬。在接受钛板治疗的不稳定近节指骨骨折病例中，43%的患者术后出现手指僵硬。这是因为在愈合期间，如果手部活动不足，关节囊和肌腱可能会挛缩。您的外科医生将在稳定固定与早期活动的需求之间取得平衡，以最大限度地降低这一风险。

我们能采取的措施

大多数指骨骨折无需手术即可良好愈合。对于儿童，非手术治疗是标准方法，且疗效良好。您通常可以在家中进行护理。您的外科医生可能会建议采用 buddy taping（邻指固定法），即将受伤的手指与其旁边健康的手指用胶带固定在一起。这相当于一个天然的夹板。无论骨骼是否有移位或是否需要复位，您都可以使用这种方法。对于掌骨骨折（即手掌骨骼的骨折），大多数情况简单且稳定。它们通常无需手术即可良好愈合，对您的日常生活影响极小。

如果您患有近节指骨骨折（即手指第一块骨骼的骨折），您的外科医生会检查是否存在旋转或成角畸形。如果骨骼没有旋转且成角在安全范围内，保守治疗方案是有效的。您可能需要使用热塑性牵引板，这是一种非侵入性装置，有助于保持骨骼位置。手部治疗是康复的关键部分。您的治疗师将根据骨折的位置和稳定性为您提供指导。目标是恢复活动度和力量。对于大多数患者，这一治疗路径可在 10 周内实现功能完全恢复，且无并发症。

当保守治疗不足或损伤严重时，会考虑手术治疗。如果您患有开放性骨折（即皮肤破损），则可能需要手术。约四分之一的此类病例需要多次手术，特别是当手指遭受挤压或存在血流问题时。对于无法通过胶带或夹板固定的不稳定骨折，也会采用手术治疗。您的外科医生可能会使用钢板、螺钉或小钢针将骨折块固定在一起。这有助于确保骨骼在正确的位置愈合。在某些情况下，即使有手术选项，也倾向于采用非手术治疗，特别是对于闭合性螺旋形掌骨骨折，因为手术带来的益处有限。您的外科医生将根据您的具体损伤情况讨论最佳治疗方案，以最大限度地减少僵硬并恢复手部正常功能。

预期情况

大多数指骨骨折，尤其是儿童患者，无需手术即可良好愈合。您的外科医生可能会使用夹板或将受伤的手指与相邻的健康手指进行固定。这种简单的支撑有助于骨骼重新愈合。通过这种非手术方法，您可以期待良好的治疗效果。即使骨骼有轻微移位，对于儿童而言，邻指固定法通常也能取得良好效果。

对于成人，许多掌骨（手掌内的骨骼）骨折较为简单且稳定。这些骨折通常也能在无需手术的情况下完美愈合。在恢复过程中，您可能会感到一些肿胀和僵硬。大多数人可在十周内恢复全部功能。您的手部应恢复如常，对日常生活或福祉的影响微乎其微。

如果您的骨折不稳定，或涉及拇指或食指，您的外科医生可能会建议进行手术。这能确保骨骼保持在正确的位置。大多数患者在术后能恢复极佳的活动范围和握力。在接下来的几个月里，您应会感到手部力量逐渐增强。随访就诊对于检查您的恢复进度至关重要。

请注意，可能会出现一些并发症。约四分之一的开放性骨折（皮肤破损）可能需要多次手术。如果伤势严重、遭受挤压或影响血流，这种情况更有可能发生。约 8% 的掌骨手术需要进行非计划内的再次手术。这些再次手术通常是为了移除引起不适的内固定物，通常发生在初次手术后两个月左右。

僵硬是另一个常见问题。在接受钢板和螺钉治疗的近节指骨不稳定骨折患者中，有 43% 会出现僵硬。您可能需要更多时间才能恢复完全的活动范围。与其他手指相比，拇指和食指受伤后更有可能需要二次手术。

如果您错过了一个月后的随访，您的外科医生可能无法准确追踪您的愈合情况。这一组患者的社会背景往往与按时就诊的患者不同。请务必按时就诊，以便您的外科医生确保您处于正确的康复轨道上。通过适当的护理，大多数人可以完全康复并恢复正常活动。

何时就医

若出现休息后仍不缓解的持续性疼痛，或手指出现无力和不稳，请咨询全科医生。若手指出现交锁或无力感，或症状影响睡眠或工作，请要求专科医生评估。某些损伤需及时识别以尽量减少并发症。例如，约四分之一的开放性指骨骨折需要多次手术。若存在挤压伤或血流问题，再次手术的可能性尤其高。拇指和食指损伤更可能需要非计划性再次手术。若为掌骨骨折，大多数第五指（小指）基底部和颈部骨折无需随访X线检查。但您应按时参加一个月后的随访，以确保愈合良好。

Reviewed by AI synthesis (v2) — pending human review · 18 May 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

Overview

  • The majority of hand fractures can be treated without surgery [1].
  • Surgery offers distinct advantages in properly selected cases of hand fractures [1].
  • Most hand fractures can be managed successfully without operation [5].
  • Conservative functional techniques are the optimum treatment for the majority of patients with single metacarpal fractures [5].
  • Most pediatric phalangeal fractures can be treated nonsurgically [14].
  • A small subset of pediatric phalangeal fractures benefits from surgical intervention [14].
  • A quarter of open finger fractures will likely need more than one surgical procedure [3].
  • Open finger fractures in more severely injured fingers are especially likely to need more than one surgical procedure due to crush or vascular impairment [3].
  • Taping finger fractures can be recommended irrespective of the degree of displacement or the need for reduction in children with displaced extra-articular phalangeal finger fractures [19].
  • External fixation is an efficient alternative treatment method for combined open fractures of the thumb metacarpal and trapezium, with encouraging short-term clinical and radiographic results [6].
  • Retrograde intramedullary screw (RIS) fixation in metacarpal fractures appears to provide adequate stability with satisfactory clinical outcomes and minimal complications [20].
  • More high-quality studies are needed to fully examine retrograde intramedullary screw fixation as a modality for metacarpal fractures [20].
  • Intramedullary fixation is an approach reviewed for metacarpal fractures, phalangeal fractures, and interphalangeal joint arthrodesis [23].
  • Surgeons who treat metacarpal and phalangeal fractures inevitably treat complications associated with these fractures [4].
  • A poorly functioning finger may represent a liability to the hand [16].
  • Achievement of union or improved alignment alone may not be sufficient to justify retention of a digit if it is poorly functioning [16].

Anatomy & Pathophysiology

  • The majority of hand fractures can be treated without surgery [1].
  • Surgery offers distinct advantages in properly selected cases of hand fractures [1].
  • Most hand fractures can be managed successfully without operation [5].
  • Conservative functional techniques are the optimum treatment for the majority of patients with single metacarpal fractures [5].
  • Surgeons who treat metacarpal and phalangeal fractures inevitably treat complications associated with these fractures [4].
  • A poorly functioning finger may represent a liability to the hand [16].
  • Achievement of union or improved alignment alone may not be sufficient to justify retention of a digit [16].
  • Surgical treatment is usually indicated for fractures and dislocations of the base of the thumb metacarpal to restore the anatomy and biomechanics of the trapeziometacarpal joint [22].
  • Conservative treatment of base of thumb metacarpal fractures and dislocations often yields poor results [22].
  • Intramedullary fixation is an approach reviewed for metacarpal fractures, phalangeal fractures, and interphalangeal joint arthrodesis [23].
  • Mini-external fixation and Kirschner wire internal fixation have similar effects on postoperative traumatic arthritis and postoperative hand functions in Bennett fracture treatment [25].
  • Each of eight patients treated with traction for hand fractures achieved a useful, painless range of motion while in traction and afterward [26].
  • Full use of the hand was obtained eight to ten weeks from the time of injury in patients treated with traction [26].
  • Both volar plating and external fixation can obtain a good range of motion at the proximal interphalangeal joint in unstable dorsal fracture-dislocations [33].
  • The pins and rubbers traction system (PRTS) significantly increases flexion forces of the proximal interphalangeal (PIP) joint [38].
  • The pins and rubbers traction system (PRTS) prevents narrowing of the PIP joint [38].
  • Most pediatric hand fractures can be treated by closed methods with immobilization for 3 to 4 weeks [41].
  • Children have a great potential for malalignment correction of hand fractures by remodeling with growth [41].
  • Osteochondral autograft from the hamate for treating partial defect of the proximal interphalangeal joint results in generally acceptable functional recovery and well-restored joint architecture [44].
  • Mini-external fixators (MEFs) are effective to establish union and correct alignment of the hand skeleton with minimal tissue trauma [45].
  • Mini-external fixators (MEFs) retain a good clinical outcome even in the most complex hand injuries [45].

Classification

  • The majority of hand fractures can be treated without surgery [1].
  • Surgery offers distinct advantages in properly selected cases of hand fractures [1].
  • Most hand fractures can be managed successfully without operation [5].
  • Conservative functional techniques are the optimum treatment for the majority of patients with single metacarpal fractures [5].
  • Treatment of fractures of the proximal phalanx and metacarpals is based on the presentation of the fracture, degree of displacement, and difficulty in maintaining fracture reduction [18].
  • A quarter of open finger fractures will likely need more than one surgical procedure [3].
  • Reoperation for open finger fractures is especially likely in more severely injured fingers due to crush or with vascular impairment [3].
  • Patients undergoing surgery for metacarpal or proximal/middle phalangeal fractures are not at greater risk for infection based on the diagnosis of open fracture alone [12].
  • External fixation is an efficient alternative treatment method for combined open fractures of the thumb metacarpal and trapezium [6].
  • Patients with combined ring and little finger carpometacarpal joint fracture-dislocations have similar functional outcomes to patients with only a little finger carpometacarpal joint fracture-dislocation [7].
  • The frequency, pattern, and treatment of pediatric hand fractures vary among different age groups [10].
  • Only two studies were found on the diagnostic accuracy of history taking for hand and wrist fractures [9].
  • Phalangeal fractures tend to deteriorate in total active motion (TAM) more than metacarpal fractures [13].
  • Taping finger fractures can be recommended irrespective of the degree of displacement or the need for reduction in children [19].
  • Patients with type 3 and 5 jersey finger fractures treated with buttress plating exhibited a functional distal interphalangeal joint range of motion [47].

Clinical Presentation

  • The majority of hand fractures can be treated without surgery [1].
  • Surgery offers distinct advantages in properly selected cases of hand fractures [1].
  • Most hand fractures can be managed successfully without operation [5].
  • Conservative functional techniques are the optimum treatment for the majority of patients with single metacarpal fractures [5].
  • Treatment of fractures of the proximal phalanx and metacarpals is based on the presentation of the fracture, degree of displacement, and difficulty in maintaining fracture reduction [18].
  • A quarter of open finger fractures will likely need more than one surgical procedure [3].
  • Open finger fractures requiring more than one surgical procedure are especially associated with more severely injured fingers, crush injuries, or vascular impairment [3].
  • Patients undergoing surgery for metacarpal or proximal/middle phalangeal fractures are not at greater risk for infection based on the diagnosis of open fracture alone [12].
  • Only two studies were found on the diagnostic accuracy of history taking for hand and wrist fractures [9].
  • The frequency, pattern, and treatment of pediatric hand fractures vary among different age groups [10].
  • Most pediatric phalangeal fractures can be treated nonsurgically, but a small subset benefits from surgical intervention [14].
  • Isolated fifth metacarpal fractures can be managed definitively in the ED without further face to face review, with good patient satisfaction and acceptable functional results [29].
  • Patients with combined ring and little finger carpometacarpal joint fracture-dislocations have similar functional outcomes to patients with only a little finger carpometacarpal joint fracture-dislocation [7].
  • Early diagnosis and appropriate treatment can allow athletes to return to play quickly after they sustain fractures or dislocations of the hand or wrist [11].

Investigations

  • Only two studies were found on the diagnostic accuracy of history taking for hand and wrist fractures [9].

Treatment

  • The majority of hand fractures can be treated without surgery [1].
  • Surgery offers distinct advantages in properly selected cases of hand fractures [1].
  • Most hand fractures can be managed successfully without operation [5].
  • Conservative functional techniques are the optimum treatment for the majority of patients with single metacarpal fractures [5].
  • A quarter of open finger fractures will likely need more than one surgical procedure [3].
  • Reoperation for open finger fractures is especially likely in more severely injured fingers due to crush or with vascular impairment [3].
  • External fixation is an efficient alternative treatment method for combined open fractures of the thumb metacarpal and trapezium [6].
  • Patients with combined ring and little finger carpometacarpal joint fracture-dislocations have similar functional outcomes to patients with only a little finger carpometacarpal joint fracture-dislocation [7].
  • The frequency, pattern, and treatment of pediatric hand fractures vary among different age groups [10].
  • Most pediatric phalangeal fractures can be treated nonsurgically [14].
  • A small subset of pediatric phalangeal fractures benefits from surgical intervention [14].
  • With non-operative treatment of fractures of the neck of the fifth metacarpal, similar results were achieved with dorsal angulation either above or below 30 degrees [17].
  • Treatment of fractures of the proximal phalanx and metacarpals is based on the presentation of the fracture [18].
  • Treatment of fractures of the proximal phalanx and metacarpals is based on the degree of displacement [18].
  • Treatment of fractures of the proximal phalanx and metacarpals is based on the difficulty in maintaining fracture reduction [18].
  • Buddy taping after reduction of displaced extra-articular phalangeal finger fractures in children can be recommended irrespective of the degree of displacement or the need for reduction [19].
  • Retrograde intramedullary screw (RIS) fixation in metacarpal fractures appears to provide adequate stability with satisfactory clinical outcomes and minimal complications [20].
  • The vast majority of metacarpal fractures in athletes are managed nonoperatively with protective bracing and rapid return to play [30].
  • Patients with a single displaced spiral and/or oblique finger metacarpal shaft fracture treated with unrestricted mobilization have outcomes comparable to those treated operatively [31].
  • Operative treatment of single displaced spiral and/or oblique finger metacarpal shaft fractures may result in metacarpal shortening [31].
  • Intramedullary splinting for displaced fractures of the little finger metacarpal neck offers an aesthetic advantage compared to conservative treatment [32].
  • Intramedullary splinting for displaced fractures of the little finger metacarpal neck does not offer a functional advantage compared to conservative treatment [32].
  • Surgical indications for fractures or fracture-dislocations include displaced articular fragments [36].
  • Surgical indications for fractures or fracture-dislocations include rotational misalignment [36].
  • Surgical indications for fractures or fracture-dislocations include significant digit angulation or shortening [36].
  • Surgical indications for fractures or fracture-dislocations include irreducible dislocation [36].
  • Surgical indications for fractures or fracture-dislocations include significant injury to the joint supporting structures [36].
  • Buddy taping is a non-inferior treatment modality for most paediatric finger fractures compared to splint immobilization [37].
  • Non-locking plates are appropriate for most metacarpal and phalangeal fractures necessitating plate fixation [39].
  • Social deprivation influences the pattern of hand fractures [46].
  • Social deprivation influences the management of hand fractures [46].

Complications

  • A quarter of open finger fractures require more than one surgical procedure [3].
  • Reoperation is especially likely in more severely injured fingers due to crush injury or vascular impairment [3].
  • Surgeons treating metacarpal and phalangeal fractures inevitably encounter associated complications [4].
  • Patients undergoing surgery for metacarpal or proximal/middle phalangeal fractures are not at greater risk for infection based on the diagnosis of open fracture alone [12].
  • Phalangeal fractures tend to deteriorate in total active motion (TAM) more than metacarpal fractures [13].
  • A poorly functioning finger may represent a liability to the hand, and achieving union or improved alignment alone may not justify retention of the digit [16].
  • Retrograde intramedullary screw fixation in metacarpal fractures is associated with minimal complications [20].
  • Transcarpal migration of a broken Kirschner wire can cause ulnar neurapraxia [28].

Recovery

  • The majority of hand fractures can be treated without surgery, though surgery offers distinct advantages in properly selected cases [1].
  • Early diagnosis and appropriate treatment can allow athletes to return to play quickly after they sustain fractures or dislocations of the hand or wrist [11].
  • A quarter of open finger fractures will likely need more than one surgical procedure, especially in more severely injured fingers, due to crush or with vascular impairment [3].
  • Patients with combined ring and little finger carpometacarpal joint fracture-dislocations have similar functional outcomes to patients with only a little finger carpometacarpal joint fracture-dislocation [7].
  • Both cases of combined dislocation of the trapezoid and finger carpometacarpal joints demonstrate similar mechanisms resulting in nearly identical wrist injuries with good short-term functional outcomes when injuries are quickly recognized and appropriately addressed at initial surgery [15].
  • A poorly functioning finger may represent a liability to the hand, and achievement of union or improved alignment alone may not be sufficient to justify retention of the digit [16].
  • With non-operative treatment of fractures of the neck of the fifth metacarpal, similar results were achieved with dorsal angulation either above or below 30 degrees [17].
  • The patient regained satisfactory grip and thumb function with minimal donor site morbidity following functional reconstruction of a subtotal thumb metacarpal defect with a vascularized medial femoral condyle flap [21].
  • Each of the eight patients in the traction study achieved a useful, painless range of motion while in traction and afterward, and full use of the hand was obtained eight to ten weeks from the time of injury [26].
  • The only variables that lessen the return-to-play time for metacarpal fractures in the National Football League are involvement of lesser digit metacarpals and operative intervention for treatment of thumb metacarpal fractures [27].
  • DEF provides excellent functional results for closed phalangeal fractures at the PIP joint, with a low incidence of postoperative complications similar to other commonly used surgical techniques [42].
  • Recent reports confirm that small amounts of metacarpal shortening or dorsal angulation cause minimal functional impairment, and early motion of adjacent joints in closed simple metacarpal fractures expedites recovery of motion and strength without adversely affecting fracture alignment [43].

Key Evidence

  • [L5] The majority of hand fractures can be treated without surgery, though surgery offers distinct advantages in properly selected cases. [1] (10.1016/j.jhsa.2013.02.017)
  • [L3] A quarter of open finger fractures will likely need more than one surgical procedure, especially in more severely injured fingers, due to crush or with vascular impairment. [3] (10.1177/15589447211043191)
  • [L5] Surgeons who treat metacarpal and phalangeal fractures inevitably treat complications associated with these fractures. [4] (10.1016/j.hcl.2010.01.005)
  • [L5] Most hand fractures can be managed successfully without operation, and conservative functional techniques are the optimum treatment for the majority of patients with single metacarpal fractures. [5] (10.1177/1753193420928820)
  • [L4] Short-term clinical and radiographic results encouraged the authors about the efficiency of external fixation as an alternative treatment method for combined open fractures of the thumb metacarpal and trapezium. [6] (10.1007/s11552-007-9026-6)
  • [L4] Patients with combined ring and little finger carpometacarpal joint fracture-dislocations have similar functional outcomes to patients with only a little finger carpometacarpal joint fracture-dislocation. [7] (10.1177/1753193414562706)
  • [L1] Only two studies were found on the diagnostic accuracy of history taking for hand and wrist fractures. [9] (10.1186/s12891-019-2988-z)
  • [L4] The frequency, pattern, and treatment of pediatric hand fractures vary among different age groups. [10] (10.1177/1558944719900565)
  • [L5] Early diagnosis and appropriate treatment can allow athletes to return to play quickly after they sustain fractures or dislocations of the hand or wrist. [11] (10.1016/j.csm.2016.05.005)
  • [L2] Patients undergoing surgery for metacarpal or proximal/middle phalangeal fractures are not at greater risk for infection based on the diagnosis of open fracture alone. [12] (10.1016/j.jhsa.2018.04.032)
  • [L2] The phalangeal fractures tend to deteriorate %TAM than metacarpal fractures. [13] (10.1016/s0363-5023(11)60047-6)
  • [Paper] Most pediatric phalangeal fractures can be treated nonsurgically, but a small subset benefits from surgical intervention. [14] (10.1016/j.jhsa.2025.08.015)
  • [Case_report] Both cases demonstrate similar mechanisms resulting in nearly identical wrist injuries with good short-term functional outcomes when injuries are quickly recognized and appropriately addressed at initial surgery. [15] (10.1016/j.jhsa.2010.06.005)
  • [L5] A poorly functioning finger may represent a liability to the hand, and achievement of union or improved alignment alone may not be sufficient to justify retention of the digit. [16] (10.2106/00004623-200506000-00028)
  • [L3] With non-operative treatment of fractures of the neck of the fifth metacarpal, similar results were achieved with dorsal angulation either above or below 30 degrees. [17] (10.1016/j.injury.2008.03.016)
  • [L5] Treatment of fractures of the proximal phalanx and metacarpals is based on the presentation of the fracture, degree of displacement, and difficulty in maintaining fracture reduction. [18] (10.5435/00124635-200810000-00004)
  • [L1] With the current data, we can conclude that taping these finger fractures can be recommended irrespective of the degree of displacement or the need for reduction. [19] (10.1177/17531934241293338)
  • [L2] RIS use in metacarpal fractures appears to provide adequate stability with satisfactory clinical outcomes and minimal complications, although more high-quality studies are needed to fully examine this modality. [20] (10.1177/1558944720988073)
  • [Case_report] The patient regained satisfactory grip and thumb function with minimal donor site morbidity. [21] (10.1016/j.jhsa.2014.06.002)
  • [L4] Surgical treatment is usually indicated to restore the anatomy and biomechanics of the trapeziometacarpal joint, as conservative treatment often yields poor results. [22] (10.1177/1753193414554357)
  • [L5] The article reviews the background, biomechanics, applications, techniques, outcomes, and costs of this approach for metacarpal fractures, phalangeal fractures, and interphalangeal joint arthrodesis. [23] (10.1016/j.jhsa.2023.08.011)
  • [L1] Both fixations have similar effects on postoperative traumatic arthritis and postoperative hand functions. [25] (10.1016/j.otsr.2012.07.015)
  • [L4] The only variables that lessen the return-to-play time are involvement of lesser digit metacarpals and operative intervention for treatment of thumb metacarpal fractures. [27] (10.1016/j.jhsa.2022.01.011)
  • [L4] The mechanism in this case was purely traumatic without predisposing causes such as inflammatory arthropathy or distal radius fracture. [28] (10.1177/1753193408102118)
  • [L4] Isolated fifth metacarpal fractures can be managed definitively in the ED without further face to face review, with good patient satisfaction and acceptable functional results. [29] (10.1007/s11552-015-9749-8)
  • [L5] The vast majority of metacarpal fractures in athletes are managed nonoperatively with protective bracing and rapid return to play. [30] (10.1016/j.hcl.2012.05.028)
  • [L2] Patients with a single displaced spiral and/or oblique finger metacarpal shaft fracture treated with unrestricted mobilization have outcomes comparable to those treated operatively, despite metacarpal shortening. [31] (10.2106/jbjs.22.00573)
  • [L2] Intramedullary splinting for displaced fractures of the little finger metacarpal neck offers an aesthetic, but not a functional advantage compared to conservative treatment. [32] (10.1177/1753193410377845)
  • [L4] Both methods can obtain a good range of motion at the proximal interphalangeal joint. [33] (10.1177/17531934211059300)
  • [L5] Surgical indications for fractures or fracture-dislocations include displaced articular fragments, rotational misalignment, significant digit angulation or shortening, irreducible dislocation, and significant injury to the joint supporting structures. [36] (10.1016/j.csm.2014.09.002)
  • [L1] Buddy taping is a non-inferior treatment modality for most paediatric finger fractures compared to splint immobilization. [37] (10.1177/1753193418822692)
  • [L4] The PRTS significantly increases flexion forces of the PIP joint and prevents narrowing of the joint. [38] (10.1007/s00402-007-0526-1)
  • [L5] Non-locking plates are appropriate for most metacarpal and phalangeal fractures necessitating plate fixation. [39] (10.1016/j.jhsa.2011.09.023)
  • [L5] Most pediatric hand fractures can be treated by closed methods with immobilization for 3 to 4 weeks, as children have a great potential for malalignment correction by remodeling with growth. [41] (10.1016/j.hcl.2005.10.001)
  • [L2] DEF provides excellent functional results for closed phalangeal fractures at the PIP joint, with a low incidence of postoperative complications similar to other commonly used surgical techniques. [42] (10.1177/17531934251350453)
  • [L5] Recent reports confirm that small amounts of metacarpal shortening or dorsal angulation cause minimal functional impairment, and early motion of adjacent joints in closed simple metacarpal fractures expedites recovery of motion and strength without adversely affecting fracture alignment. [43] (10.1097/01.blo.0000205888.04200.c5)
  • [L4] The functional recovery is generally acceptable, with a well-restored joint architecture. [44] (10.1016/j.jhsa.2021.11.007)
  • [L4] The findings demonstrate the efficacy of versatile MEFs to establish union and correct alignment of hand skeleton with minimal tissue trauma while retaining a good clinical outcome even in the most complex injuries. [45] (10.1016/j.jhsa.2008.12.017)
  • [L3] Social deprivation influences both the pattern and management of hand fractures. [46] (10.1177/1753193410381823)
  • [L4] Patients with type 3 and 5 injuries exhibited a functional distal interphalangeal joint range of motion. [47] (10.1016/j.jhsa.2025.07.038)

References

[1] Hand Fractures: A Review of Current Treatment Strategies. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.02.017 [3] Reoperation After Operative Treatment of Open Finger Fractures. HAND. 2022. DOI: 10.1177/15589447211043191 [4] Complications After the Fractures of Metacarpal and Phalanges. Hand Clinics. 2010. DOI: 10.1016/j.hcl.2010.01.005 [5] Current methods, outcomes and challenges for the treatment of hand fractures. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193420928820 [6] Management of Combined Open Fractures of Thumb Metacarpal and Trapezium (Surgical Tip). HAND. 2007. DOI: 10.1007/s11552-007-9026-6 [7] Fracture-dislocations of the carpometacarpal joints of the ring and little finger. Journal of Hand Surgery (European Volume). 2014. DOI: 10.1177/1753193414562706 [9] Diagnostic accuracy of history taking, physical examination and imaging for phalangeal, metacarpal and carpal fractures: a systematic review update. BMC Musculoskeletal Disorders. 2020. DOI: 10.1186/s12891-019-2988-z [10] Frequency, Pattern, and Treatment of Hand Fractures in Children and Adolescents: A 27-Year Review of 4356 Pediatric Hand Fractures. HAND. 2020. DOI: 10.1177/1558944719900565 [11] Return to Play After Hand and Wrist Fractures. Clinics in Sports Medicine. 2016. DOI: 10.1016/j.csm.2016.05.005 [12] Comparison of Open and Closed Hand Fractures and the Effect of Urgent Operative Intervention. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2018.04.032 [13] Predictors of the Postoperative Range of Finger Motion for Comminuted Hand and Finger Fractures Treated with a Titanium Plate. The Journal of Hand Surgery. 2011. DOI: 10.1016/s0363-5023(11)60047-6 [14] Pediatric Finger Fractures: Preventing Big Problems After Small Fractures. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2025.08.015 [15] Combined Dislocation of the Trapezoid and Finger Carpometacarpal Joints—The Steering Wheel Injury: Case Report. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.06.005 [16] MALUNION AND NONUNION OF THE METACARPALS AND PHALANGES. The Journal of Bone and Joint Surgery-American Volume. 2005. DOI: 10.2106/00004623-200506000-00028 [17] Effects of fusion angle on functional results following non-operative treatment for fracture of the neck of the fifth metacarpal. Injury. 2008. DOI: 10.1016/j.injury.2008.03.016 [18] Fractures of the Proximal Phalanx and Metacarpals in the Hand: Preferred Methods of Stabilization. Journal of the American Academy of Orthopaedic Surgeons. 2008. DOI: 10.5435/00124635-200810000-00004 [19] Buddy taping after reduction of displaced extra-articular phalangeal finger fractures in children: a randomized controlled trial. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934241293338 [20] Retrograde Intramedullary Screw Fixation for Metacarpal Fractures: A Systematic Review. HAND. 2021. DOI: 10.1177/1558944720988073 [21] Functional Reconstruction of Subtotal Thumb Metacarpal Defect With a Vascularized Medial Femoral Condyle Flap: Case Report. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.06.002 [22] Fractures and dislocation of the base of the thumb metacarpal. Journal of Hand Surgery (European Volume). 2014. DOI: 10.1177/1753193414554357 [23] Intramedullary Fixation of Hand Fractures and Arthrodeses. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2023.08.011 [25] Three-dimensional finite element analysis of mini-external fixation and Kirschner wire internal fixation in Bennett fracture treatment. Orthopaedics & Traumatology: Surgery & Research. 2013. DOI: 10.1016/j.otsr.2012.07.015 [26] 00004623-197961020-00018. 1979. [27] Metacarpal Fractures in the National Football League: Injury Characteristics, Management, and Return to Play. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2022.01.011 [28] Transcarpal migration of a broken Kirschner wire causing ulnar neurapraxia. Journal of Hand Surgery (European Volume). 2009. DOI: 10.1177/1753193408102118 [29] Satisfaction and Functional Outcome with “Self-Care” for the Management of Fifth Metacarpal Fractures. HAND. 2015. DOI: 10.1007/s11552-015-9749-8 [30] Fractures of the Thumb and Finger Metacarpals in Athletes. Hand Clinics. 2012. DOI: 10.1016/j.hcl.2012.05.028 [31] Nonoperative Versus Operative Treatment for Displaced Finger Metacarpal Shaft Fractures. Journal of Bone and Joint Surgery. 2022. DOI: 10.2106/jbjs.22.00573 [32] Intramedullary Splinting or Conservative Treatment for Displaced Fractures of the Little Finger Metacarpal Neck? a Prospective Study. Journal of Hand Surgery (European Volume). 2010. DOI: 10.1177/1753193410377845 [33] Volar plating versus external fixation for unstable dorsal fracture-dislocations of the proximal interphalangeal joint. Journal of Hand Surgery (European Volume). 2021. DOI: 10.1177/17531934211059300 [36] Finger Joint Injuries. Clinics in Sports Medicine. 2015. DOI: 10.1016/j.csm.2014.09.002 [37] Buddy taping versus splint immobilization for paediatric finger fractures: a randomized controlled trial. Journal of Hand Surgery (European Volume). 2019. DOI: 10.1177/1753193418822692 [38] Biomechanical and functional analysis of the pins and rubbers tractions system for treatment of proximal interphalangeal joint fracture dislocations. Archives of Orthopaedic and Trauma Surgery. 2007. DOI: 10.1007/s00402-007-0526-1 [39] Non-Locked and Locked Plating Technology for Hand Fractures. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2011.09.023 [41] Fractures of the Phalanges and Interphalangeal Joints in Children. Hand Clinics. 2006. DOI: 10.1016/j.hcl.2005.10.001 [42] Clinical outcomes of ligamentotaxis in closed phalangeal fractures: a systematic review. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251350453 [43] Extraarticular Hand Fractures in Adults. Clinical Orthopaedics and Related Research. 2006. DOI: 10.1097/01.blo.0000205888.04200.c5 [44] Osteochondral Autograft From the Hamate for Treating Partial Defect of the Proximal Interphalangeal Joint. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2021.11.007 [45] Use of a Mini-External Fixator for the Treatment of Hand Fractures. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2008.12.017 [46] The epidemiology of fractures of the hand and the influence of social deprivation. Journal of Hand Surgery (European Volume). 2010. DOI: 10.1177/1753193410381823 [47] Buttress Plating for Type 3-4-5 Jersey Finger Fractures: Without Bone Fragment Disruption and With a Challenging Rate of Hardware Removal–A Case Series. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2025.07.038

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.