If radiographs show no translation or subluxation, complete ligament tears involving the proximal or distal interphalangeal joints are usually stable and may be treated with buddy taping during waking hours and static extension splinting during hours of sleep. Otherwise, open ligament repair is indicated. Small proximal interphalangeal joint volar plate avulsion fractures are very common with hyperextension injuries, and usually heal as a painless nonunion, unlike fractures involving either the central articular surface or the lateral cortex the base of the middle phalanx (Fig. 3). This latter finding should prompt consideration for reduction and fixation. Lateral angulation of the finger must be assessed with radiographs. Angulation may not be obvious clinically because of swelling and stiffness in the acute setting. However, if allowed to heal, almost any radial or ulnar angulation will be ob vious and difficult to correct later on.