Dorsal to the middle phalanx
The dorsal approach is indicated for oblique, spiral, comminuted, or transverse fractures of the diaphysis, or metaphysis of the middle phalanx.
It can also be used for corrective osteotomies of malunited fractures.
Midaxial to the PIP joint
This approach is indicated for intraarticular basal and condylar fractures.
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.
Midaxial to the middle phalanx
The midaxial approach is indicated for long and short oblique fractures, spiral, comminuted, and transverse fractures of the diaphysis and metaphysis of the middle phalanx.