The surgical approaches for phalangeal fractures include the posterior median approach on the dorsal side of the palm and the lateral approach on the dorsal side of the phalanx. 1. Posterior median approach of dorsal metacarpal: after satisfactory anesthesia, incise the superficial fascia of the skin to reveal the tendon, split the extensor tendon longitudinally or peel the tendon to reveal the fracture, then fix the fracture with a steel plate or Kirschner’s pin after anatomical restoration. after the C-arm shows a good alignment, close the fracture to the skin one layer by one layer, and fix it in a plaster cast or a support to end the operation. 2. Lateral approach to the dorsal side of the phalanx: generally, the lateral approach can avoid the tendon, and after the same anesthesia is satisfied, cut the skin, superficial fascia, deep fascia to the fracture break to anatomically reposition the fracture, and then use the plate or Kirschner’s pin for internal fixation. after good alignment is shown in the C-arm, suture layer by layer to the skin, and then fix it in a plaster or a brace, and then end the surgery.