Fractures of the phalanges can often be managed nonoperatively, but displaced phalangeal fracture patterns, including malrotation, are more amenable to operative treatment. There are several described methods for surgical management of phalanx fractures, but there remains no consensus on a clearly superior method of fixation. Percutaneous Kirschner wires, interfragmentary screws, plate and screw constructs, intramedullary nails, and cannulated intramedullary headless screws are all utilized in the treatment of these fractures. Intramedullary headless screws for phalanx fractures may provide suitable fixation allowing early motion and recovery. Here, we describe a technique for antegrade and retrograde intramedullary headless screw fixation for phalanx fractures.