One hundred and seven patients with shaft fractures of the proximal phalanx were randomized to receive surgical fixation using Kirschner wires (K-wires) and bone cement (n=56; 67 cases) or fixation with a plate-and-screw system (n=51; 64 cases). The outcomes of interest included operative time, time to fracture union, incidence of non-union, rehabilitation therapy time, the incidence of additional surgery, total cost, range of motion of the metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints, total active motion scale, pinch strength, pain on a Visual Analog Scale (VAS), VAS scores for appearance, the Quick Disability of the Arm, Shoulder and Hand (QuickDASH) scores, VAS patient satisfaction scores, and the incidence of adverse events. The mean follow-up time was 28 months in the K-wire group and 29 months in the plate fixation group. No statistical differences in operative time (p=0.535), incidence of secondary surgery (tenoylsis, implant removal, revision and bone grafting; p>0.7 for all), or pinch strength (p=0.857) were observed between the K-wire group and plate fixation group. The time to fracture union (p<0.001), incidence of non-union (p=0.019), rehabilitation therapy time (p<0.001), total cost (p<0.001), active range of motion in the PIP joint (p=0.024), VAS pain scores (p<0.001), VAS appearance score (p<0.001), QuickDASH score (p<0.001), and VAS satisfaction scores (p=0.004) were all statistically significantly in favour of the K-wire group compared to the plate fixation group. There were 2 cases of pin track infection observed in the K-wire group. As well, 3 cases of wound infection and 4 cases of non-union were observed in the plate fixation group.