Fracture dislocations of the proximal interphalangeal joint may occur by several different mechanisms of injury and are of 3 basic fracture patterns: palmar lip fractures, dorsal lip fractures, and pilon fractures. Proper treatment of these injuries is predicated on maintenance of concentric reduction of the joint, restoration of joint stability, and institution of early motion. Anatomic reconstitution of the articular surface, though ideal, is less important. Many methods are available to treat these injuries. Understanding the fracture within the context of a stability-based classification system helps to guide in the selection of the most appropriate treatment. Copyright © 2002 by the American Society for Surgery of the Hand