We aim to define the characteristics of patients with hand injuries in the emergency department (ED), their management and operative findings. Decision on admission was also analyzed between the ED and the hand and reconstructive microsurgical team. We reviewed 504 patients seen at the ED over a 3-month period with isolated hand injuries and found more males (88%) who were between 20 and 30 years of age (51%). Most had industrial injuries (43%) from lacerations or crush. Left hand injuries were more common. About 62% of the patients were discharged after treatment at the ED while 38% were admitted. A high level of concurrence in the decisions made by the ED and hand and reconstructive microsurgery signifies good quality assessment performed by the ED. The operative findings of fractures, tendon, nerve and vessel injuries for those who were admitted to the wards are higher than those admitted to ‘day surgery’.