Intraarticular fractures of the phalanges and thumb are difficult injuries to manage. These fractures usually result in joint stiffness secondary to the injury and potentially the surgical dissection and implants required to stabilize the fracture. The purpose of this study was to evaluate the results of percutaneous reduction and stabilization utilizing a headless cannulated screw in unicondylar fractures involving the phalanges and thumb. Twelve patients with unicondylar fractures involving the proximal or middle phalanx of the digits or thumb underwent percutaneous reduction and stabilization with a headless cannulated screw. Average age was 22 years (range: 16 to 35 yrs.). There were nine males and three females. The fracture was anatomically reduced under fluoroscopy and temporarily stabilized with a clip. Two guidewires were placed percutaneously across the fracture site (one to control rotation). Through a stab incision only, a 10-mm mini headless cannulated screw was placed entirely in the bone. In nine patients, a single screw only was used and in three patients two screws were utilized. No patient was immobilized and all patients started immediate range of motion. All patients healed clinically and radiographically by six weeks. There was no loss of reduction utilizing a single headless screw. There were no signs of avascular necrosis radiographically to the fracture. In the ten patients with fractures of the phalanges to the digits, the average extension was –3 degrees (range: 0 to –7 degrees). Average flexion was 85 degrees (range: 80 to 95 degrees). In the thumb, the average extension was 16 degrees hyperextension (range: 12 to 20 degrees) and an average flexion of 60 degrees (range: 55 to 65 degrees). Percutaneous screw fixation of fractures to the phalanges and the thumb to the hand has several advantages. By percutaneous only, this limits the potential scarring and results in an excellent range of motion. Also with the compression provided by the cannulated screw, this allows for fixation with a single screw only rather than a screw and Kirschner wire or two screws. The implant is entirely within the bone and does not require removal. The cannulated technique is much simpler than inserting a threaded screw with head and trying to find the drill hole through a limited open approach.