Palmar to PIP joint
The palmar approach is mainly indicated for avulsion fractures of the volar plate, and for fracture dislocations of the PIP joint, or for comminuted impacted fractures of middle phalanx (pilon) fractures.
Dorsal to the MCP joint
This approach is indicated for intraarticular fractures of the metacarpal head, injuries of the metacarpophalangeal (MCP) collateral ligaments (either avulsion fractures or ligament ruptures), and intra- or extraarticular fractures of the base of the proximal phalanx.
Midaxial to the proximal phalanx
The midaxial approach is indicated for oblique, spiral, comminuted, or transverse fractures, of the diaphysis and metaphysis.
Dorsal to phalangeal metaphysis
Use the dorsal approach to access fractures of the proximal phalanx, for intraarticular, metaphyseal, or diaphyseal fractures, or any intraarticular fracture extending into the metaphysis or diaphysis.
Midaxial to the PIP joint
This approach is indicated for intraarticular basal and condylar fractures.