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2Operative treatment: caveat

These injuries may be complete disruptions or partial disruptions.

Inexperienced handling of this area may harm the germinative matrix of the nail and cause permanent deformity. Consider that nonoperative treatment is almost always a viable alternative in these fractures, often with comparable results. Operative treatment should only be attempted by experienced hand surgeons, in selected cases.

Absolute indications for surgical intervention are:

  • Open fractures
  • Palmar subluxation of the DIP joint


It is wise always to use magnifying loupes in these surgical procedures.