Regardless of the clinician’s technical skill, the results of hand fracture treatment may not be optimal. Tissue planes are damaged by the initial trauma, and surgical approaches to restore bony anatomy or develop tendon gliding further violate them with scarring producing adhesions and motion deficits. Close communication with therapists may help reduce complications. Identification and prompt treatment of these complications may allow improved function. However, repeat surgery may be necessary to improve the results. It is critical to work with the patient to match expectations and to minimize frustration of both the patient and the surgeon.