To estimate the overt need for hand surgery in an average sized district general hospital and to assess the resources required to meet this need, data were collected prospectively on all new trauma and elective patients presenting from 1 June to 30 November 1989 to the Derby Hand Unit, Derbyshire Royal Infirmary, Derby. In all, 1740 new patients with hand disorders (1082 trauma and 658 elective) were seen. All were followed up for 6 months or until discharge. Based on the Derby Hand Unit practice, the overt need for hand surgery in an average sized district general hospital was estimated and the resources required to satisfy this need were defined. Such a hospital serving a population of 250,000 should expect about 23 new trauma patients and 17 new elective patients each week. To service this demand requires between three and six outpatient clinics, between three and eight inpatient beds and three operating sessions each week. The net annual cost of such a service in 1989-1990 would be 318,753 pounds.