Background: Hand fractures are one of the most common fractures presenting at accident and emergency units. Because of the complexity of the hand; management of hand fractures can be very challenging. Fixation of hand fractures can be done by multiple methods including percutaneous K-wires fixation and open reduction and internal fixation with either interosseous wiring or mini plate and screws. This comparative clinical study is to review the indications and long term results of each method.Methods: Thirty patients with hand fractures were included in our study, ten of them treated with percutaneous K wire fixation (group A), another ten patients were treated with open reduction and internal fixation with interosseous wiring (group B)and the last ten patients were treated with open reduction and internal fixation with miniplate and screws (group C). The duration of this study was for eleven months with patient's age ranging from 15-50 years old. The type of surgical intervention used was determined according to the fracture pattern.Results: All patients treated in this study had clinical and radiological union by the 10th week. Patients treated with percutaneous K wire fixation had better range of movement and earlier return to work with less complications than patients treated with open reduction and internal fixation with interosseous wiring or mini-plate and screws.Conclusion: Percutaneous fixation of unstable metacarpal and phalangeal fractures is a reliable and safe method for the majority of fracture patterns with higher ROM and less complications in comparison with the other two methods.