The outcome in 16 consecutive paediatric cases of phalangeal neck fractures with concurrent vascular injury was investigated. The study group had a mean age of 5 (range 3-11) years. At final follow-up, the outcome was assessed according to Al-Qattan's grading system. The study population was divided into three groups. In group A (n = 3), there was circumferential skin laceration with disruption of both digital arteries and all three patients ended up with an amputation. In group B (n = 11), there was skin laceration on one side of the digit with one disrupted digital artery, and the outcome following surgery was considered good in six, fair in four and poor in the remaining patient. Group C (n = 2) presented with "congested" digits and conservative management resulted in one good and one poor result. Reasons for failure to obtain a single excellent result are discussed. Phalangeal neck fractures with concurrent vascular injury should raise a "red flag" and outcomes may be limited, despite management in a specialist hand surgery facility.