Eighteen open dorsal dislocations of the proximal interphalangeal joint were treated in 17 patients over a 12-year period. The severity of this injury may be underestimated. Complications included synovitis, stiffness, septic arthritis, and loss of the digit. Factors associated with a poor prognosis included a concomitant injury to the hand, a fracture from the base of the middle phalanx, and treatment in the emergency room. For optimum results, we recommend antibiotic therapy, thorough debridement in the operating room, reattachment of the palmar plate and repair of the collateral ligaments if necessary, and temporary joint immobilization (3 weeks) followed by an aggressive range of motion program.