The four middle phalanges (absent in the thumb) articulate with the proximal phalanges above and the distal phalanges below at the interphalangeal joints, carrying the insertions of the flexor and extensor digitorum tendons.
Middle phalanx fractures are commonly associated with PIP joint dislocations and volar plate injuries. The attachment of the FDS at the sides of the middle phalanx and the central slip of the extensor mechanism at the base make the fracture displacement pattern complex and dependent on fracture level relative to these insertions. Condylar fractures of the middle phalanx producing lateral instability at the DIP joint require fixation to prevent permanent deformity.
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