The “jammed finger” is among the most common hand injuries and may include simple sprains, dislocations, fractures, and fracture-dislocations. In contrast, irreducible dislocations of the proximal interphalangeal joint are rare injuries. However, they must not be overlooked in the primary assessment, because persistent subluxation may lead to joint contracture, severely compromising hand function. Irreducible dislocations are challenging injuries with interposed soft tissues, preventing closed reduction. Thorough preoperative diagnosis and soft-tissue imaging guide the approach to open reduction and repair of injured periarticular structures. We introduce a systematic algorithm with considerations on classification and management of irreducible proximal interphalangeal joint dislocations. The algorithm is useful for the primary assessment and for hand surgeons responsible for open reduction and rehabilitation.