Although 30% of 662 burn patients had some hand involvement, only 6% had severe hand injury. Seventeen patients (2.5%) were managed by early internal fixation. Severe hand injury was closely associated with severe burns. Most hand injuries were managed successfully with early splinting, active range of motion, and good wound management. In the severe hand burns, early internal fixation of the proximal interphalangeal joints was valuable in preventing the typical claw contracture of dorsal third-degree hand burns. The metacarpal phalangeal joints were pinned at grafting, and all pins removed at five to seven days after grafting. This was found to be safe, with very few complications, and essentially no risk or mortality. Claw deformity was successfully prevented, and very good motion of joints was maintained.