A34-year-old patient jammed his finger at work. He sustained a closed articular fracture of thebaseofthe middle phalanx (Fig. 8A). Aclosed reduction was performed under fluoroscopic X-raycontrol using traction andafine-pointed cannulated reduction forceps (Fig. 8B). One guide wire was placed centrally into the condylar fragment parallel to the articular surface and just distal to the insertion of the collateral ligament (Fig. 8B,C). This site should be selected so as to assurethat the mini screw threads do not penetrate the adjacent joint surface. The guide wire is advanced through the reduced fracturefragments and through the skin on the opposite side of the digit so that it can be removed easily should it break. Asecond guide wire is inserted eccentrically into the condylar and major phalangeal fragments to prevent fragment rotation during reaming and mini screw insertion (Fig. 8D,E). A1to 2cmmidlateral incision is centered over the condylar fragment (“target”) (Fig. 8F). Blunt dissection is continued with ahemostat to the level of the bone surface. Acannulatedreamerslides over thecentral guide wire (Fig. 8G). The bone is then reamed across both bone cortices. Recently,aself-drilling headless cannulatedminiscrew (variable pitchminiAcutrak screw, Acumed,Hillsboro, Oregon, U.S.A.) has been introduced. With this new self-drilling cannulated headless mini screw,only the near cortex has to be reamed, and the self-drilling screw is then inserted over the guide wire(Fig. 8H). The screw is inserted over the guide wire so that it fits entirely inside the bone on both the PA and lateral X-ray views. The final mini screw position is fluoroscopically confirmed by both PA and lateral views. The guide wires are then removed(Fig.8I,J).Asingleminiscrew may provide adequatestability.The fracturehealedand thepatienthad recovered full finger motion six weeks after surgery (Fig. 8K,L).