Pathologic fractures occur in bone weakened by a disease process. In the hand, the most common cause of pathologic fracture is a solitary enchondroma, although many other less common causes exist, including bone cysts, benign and malignant tumors, and other rarer entities. Arriving at a correct diagnosis is the key to successful treatment. If the fracture seems the result of a benign process, the fracture can be allowed to heal prior to definitive treatment of the underlying lesion. Fractures associated with aggressive or malignant lesions require more urgent treatment, although the overall prognosis for pathologic fracture due to malignancy is poor.