Abstract:   Introduction: Hand fractures are traditionally managed with fluoroscopic imaging for diagnosis and intraoperative imaging. The associated costs of the equipment including acquisition, maintenance, need for technicians, shielding and radiation precautions can be prohibitive for the solo practice plastic surgeon.  Ultrasound has been used as a low cost alternative for diagnosis of hand fractures. We present our initial experience with ultrasound for treatment of hand fractures without need for fluoroscopy.   Materials and Methods: A  GE LOGIQ 7 (General Electric, Fairfield, CT) ultrasound machine, using a 10L 3.5 to 9.5 MHz probe was used to identify and reduce and percutaneously pin hand fractures. We started by practicing with in the anatomy laboratory with five cadavers before using this technique on a live patient.   Results: Ultrasound imaging allowed us to clearly identify fractures in the fingers and metacarpals (84%-100% sensitivity), although we had some difficulty with carpal bone fractures (less than 50% sensitivity). Reduction of the fracture was easily confirmed with ultrasound imaging. The main advantage of ultrasound was seen in percutaneous pinning, where the images allowed for precise placement of the pins without the problem of skiving which may be seen with fluoroscopy.   Conclusion: Ultrasound imaging can be used instead of fluoroscopy to diagnose and treat hand fractures. This can result in significantly lower costs and allows for precise imaging of K-wires during their placement.