The distal phalangeal region of the hand is prone to injury because of its anatomical placement. Since the injury mechanism is commonly direct trauma, concomitant soft tissue injury is serious. When the mechanism is indirect trauma, diagnosis of the fractures may be difficult. Careful evaluation of the soft tissues and properly taken direct roentgenograms determine the management and prognosis. In order to regain function, the soft tissues, especially the nail components have to be treated properly in addition to treatment of the fracture. Distal phalanx traumas are generally evaluated and sub-optimally managed in emergency units and polyclinics; as a result, these are prone to nail deformities, painful nonunions and phalangeal joint deformities. Whereas, with proper determination of injury and management, it is possible to achieve satisfactory results. In this review, the treatment principles of soft tissue injuries and fractures of distal phalangeal region are discussed.