Outcomes of phalangeal neck fractures among children are not uniformly good. Our purpose was to delineate factors that affect management and outcomes in the treatment of phalangeal neck fractures among children. The management and outcomes of phalangeal neck fractures among children over a consecutive 7-year period at the Denver Children's Hospital are reported. Fifteen children met the criteria for inclusion in the study. The average age was 6 years. Follow-up periods averaged 36 months. Distinct fracture patterns were classified according to the following system: type I, nondisplaced; type II, displaced. Displaced fractures were subdivided according to the fracture geometry, as follows: type IIa, transverse; type IIb, transverse with a proximally directed spike; type lIc, oblique. Fractures classified as type IIa were not reliably stable after closed reduction and immobilization. Delayed operative stabilization led to digital stiffness. The remaining fracture types were well managed with closed reduction, if necessary, and immobilization. Because of the unreliable stability of type IIa fractures, early operative stabilization is recommended.