OBJECTIVE To investigate the epidemiology of pediatric hand fractures and to provide recommendations regarding prevention. METHODS Medical records and x-rays were retrospectively reviewed for age at the time of injury, gender, fracture pattern, place where the injury occurred, and mechanism of injury. The study was conducted at King Khalid University Hospital, Riyadh, Saudi Arabia between January 2005 and December 2011. RESULTS Of 361 cases reviewed, there were 291 (80.6%) male and 70 (19.4%) female patients. Most (46.2%) were in the age group of 13-18 years. For age group 1-4 years, the  most common place of occurrence was at home (81.3%) and for the group 13-18 years, outdoors was the place of occurrence (64.7%). Females were mostly injured at home while males had similar distribution of indoor and outdoor injuries. The most common causes of fractures were: door slams in the 1-8 years age group; falls at home, in the 9-12 years age group; and both falls at home and sports in the oldest age group (13-18 years). The little finger ray are the most frequently injured part of the hand followed by the middle finger. CONCLUSIONS Our series showed that most hand fractures in children occurred at home, which requires reevaluation of home settings. Implementation of safety measures during sports activities are relevant in the oldest age group.