Fractures of the diaphysis can be transverse, oblique, or comminuted.
Obliquity of the fracture is possible either in the plane visible in the AP view, or in the plane visible in the lateral view. Always confirm the fracture configuration with views in both planes.
Indirect reduction is achieved by traction and digital manipulation. When the reduced fracture is stable, it can be treated nonoperatively. If the fracture is irreducible, ORIF is indicated. Other indications for surgical fixation are open fractures, or associated soft-tissue lacerations. Outcome of fractures of the middle phalanx is usually more favourable than those of the proximal phalanx. This is largely due to the fact that limitations in DIP joint motion is not such a disability as similar stiffness of the PIP and MCP joints. However, since the fragments in middle phalangeal fractures are generally smaller than in the proximal phalanx, fixation can be more challenging.