Introduction The Northern Territory (NT) has a unique geography and remoteness as well as a sizeable Indigenous population, often underrepresented in other states and territories. The standard rate of injury hospitalisation rate in the NT is 70% higher than the rest of the country with hand and wrist traumas being the predominant injuries. Method A ten year retrospective review is undertaken from the Royal Darwin Hospital database from Jan 2007 – Dec 2017. The aim was to stratify them into types of fractures, Indigenous vs non-Indigenous presentation, age, sex and treatment completion in each group. Results A total of 996 hand fractures were seen in this 10 year period, with indigenous population accounting for 40% of presentation despite being 29% of the local population. The mean age was 26 years with slightly higher male to female ratio (1:0.87) and having association with alcohol (90%), drugs (30%) and domestic violence. Metacarpal fractures were commonest followed by phalangeal fractures. Absondement rate was very high at 23%, with only 73% completing treatment at hospital. Conclusion Hand fractures in the NT are high (24%), with incidence in Indigenous population double that of other groups. High rate of abscondement lead to suboptimal treatment. To date this is unique study on hand fractures in the indigenous population in the NT. Mitigating alcohol, drug related injuries and prevention through Indigenous health workers in rural communities need to be looked at as well as increasing awareness and resource allocation to overcome cultural barries in unique, remote setting.