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A 9-year-old female presents with an “extra-octave” fracture – a closed left small finger fracture of the proximal phalanx. The fracture is immediately adjacent to the physis with apex radial and volar displacement. At her initial orthopedic evaluation, she undergoes a reduction maneuver consisting of flexion and adduction under a digital nerve block. She is subsequently placed into an intrinsic plus short arm cast. The fracture heals uneventfully and immobilization is discontinued at 3 weeks.