BACKGROUND Hand trauma is one of the most complex injuries treated in the emergency department. They are time sensitive and require highly specialized care. Patients may have difficulty accessing appropriate hand trauma care due to a variety of factors. We aimed to evaluate the state of the hand trauma system by examining articles that reported on access to hand trauma care. METHODS We conducted a literature review on hand trauma care using PubMed, Ovid MEDLINE, and EMBASE databases. We included English language articles from the U.S. that described access to hand trauma care in the emergency health system. RESULTS Fourteen studies met our inclusion criteria. Ten studies evaluated access to hand trauma care on a patient level. Of these 10 studies, five reported on access to care for transferred patients and five reported on access to care for patients with amputation injuries. The other four studies evaluated access to hand trauma care at a hospital level. CONCLUSIONS Lack of hand trauma guidelines at emergency departments and a severe shortage of on-call hand specialists at community hospitals and trauma centers have created a suboptimal system of hand emergency care in the U.S. The current system of hand trauma care in the U.S. may not only drive up the cost of care but may also adversely affect patients’ health and well-beings.