Unstable comminuted distal phalanx shaft fracture with nail bed laceration

Shaft fractures are usually stable and can be managed with a simple splint that immobilizes the distal interphalangeal joint (DIPJ) but leaves the proximal interphalangeal joint (PIPJ) free. However, comminution of the distal phalanx shaft can render the fracture unstable. In such cases, open reduction with internal fixation (ORIF) is needed. This figure shows a comminuted unstable distal phalanx fracture requiring ORIF.