Of 823 pediatric hand fractures treated between 1981 through 1996, only 11 (1.3%) were Salter-Harris type III fractures of the proximal phalanx. We review the anatomic basis, etiology, age prevalence, treatment, and results of these epiphyseal injuries. The average age at injury was 14.9 years, with a narrow range from 14 years 2 months to 15 years 11 months. Nine of 11 fractures were displaced and treated with open reduction and internal fixation. At an average follow-up of 21 months, 9 of 11 had full joint motion. The other two had minimal loss of motion, and all had normal function and collateral ligament stability. The displacement and size of the epiphyseal fragment, avulsed and rotated by the collateral ligament, are often underestimated by radiographs. We found that anatomic reduction and fixation yielded good results in all displaced fractures. This restores both the stability of the collateral ligament and a smooth articular surface.