Forty patients with unstable phalangeal fractures were randomized to receive fracture fixation with a Kirschner wire (K-wire) or with titanium plates and screws. The primary outcome of interest was total active motion. Secondary outcomes of interest included time to clinical and radiographic fracture union, pain on a Visual Analog Scale (VAS), grip strength, loss of grip strength relative to the healthy hand, Quick-Disability of the Arm, Shoulder and Hand (DASH) scores, operative time and complications. Results revealed significantly greater total active motion in the titanium plate group compared to the K-wire group. Operative time was longer in the titanium plate group compared to the K-wire group. No significant differences in VAS pain scores, grip strength, loss of grip strength relative to the healthy hand, and Quick-DASH scores were observed between the two groups. Fewer complications were observed in the titanium plate group compared to the K-wire group.