In general, fractures of the phalanges (proximal-P-1, middle-P-2, and distal-P-3) can be treated nonoperatively. If angulation, displacement or malrotation require reduction, I will often do this under local anesthesia--and at times provisionally stabilize the fracture with removeable pins.
Occasionally, more rigid fixation is adviseable to allow early motion at the PIP joint. Interfragmentary screws, alone, are ideal since these diminish the risk of tendon adgerence and stiffness. Though the use of plates on the phalanges is associated with potential extensor tendon adherence, stiffness, and second-stage removal, they are needed occasionally. In fact, the newest most innvative designs now allow low profile and extraordinary stability through locking technology.
I will discuss your particular fracture type with you as well as the basis for my recommendation regarding ideal treatment.
