Pearls

• Intra-articular fractures frequently require surgery to stabilize.
• Extra-articular fractures with over 2mm of shortening or 10° of angulation require surgical evaluation.
• Fractures not meeting these criteria are generally treated nonoperatively.
• Lateral flexion X-rays with the PIP in flexion can be used to evaluate for stability. If the joint glides (rolls appropriately) it is likely stable. If the joint pivots (articular surfaces pop-off each other), it will need hand surgery follow up.