Fingers are at risk for severe crush and other high force mechanisms which results in many small fracture fragments. Treatment requires ingenuity, judgment, patience and luck to achieve a satisfactory result. In addition to the usual treatment options, these fractures may require treatment with immediate bone grafting and/or external fixation (Fig. 5). Unfortunately, after a high-energy phalangeal fracture, many fingers are doomed to stiffness regardless of surgical efforts (Duncan).