Phalangeal fractures of the hand are characterized by a great diversity of fracture patterns. Various concepts exist for conservative and surgical treatment. A wide range of appropriate implants are available for internal fixation. However, treatment of phalangeal fractures must respect the complex anatomy of the hand and must strive to achieve the greatest possible protection of soft tissue structures. Recovery of function is the main goal of therapy. Protection of soft tissues and especially preservation of tendon sliding have to be weighed against anatomic reduction and absolute stability. Early mobilization with a high degree of patient cooperation is desirable. Treatment of phalangeal fractures always requires consideration of both the injury pattern and the patient's needs in each individual case.