The purpose of this study was to review tractor-related childhood hand injuries. Seventy children (53 males, 17 females; range 1 to 11 years) were admitted to our unit. Patients were analyzed according to sex, age, pattern of injury, type of treatment and functional results. The first step of the treatment included extensive debridement and irrigation. Patients with complex tissue defects were treated with multi-stage reconstruction procedures. Patients with amputations or partial amputations were treated with amputation of the devascularized digits. The most common injuries were amputations and complex tissue defects. Other types of injuries were fractures, partial amputations and skin defects. In 20 cases, skin defects were covered with split-thickness skin grafts and the functional results were good. In 40 cases with complex soft tissue injuries, skin defects were covered with flaps. The functional results were good in 30 and fair in 10. In 50 digits with complete amputations, attempts at revascularization immediately after injury failed in all patients. The functional results were good in 40, fair in 5 and poor in 5. All fractures healed in 6 weeks and no complications related with bone healing were observed. The concepts of aggressive debridement, fracture reduction, and early soft tissue coverage are central to the care of these hand injuries.