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Purpose To evaluate the outcome of hand fractures managed with mini-external fixators (MEFs) in order to assess their usefulness in different fracture types and to make recommendations regarding potential applications. Methods Fifty-one patients with 59 metacarpal and phalangeal fractures were treated with MEFs. Fixators were used to reduce the fracture or to achieve volar plate arthroplasty when anatomical joint reconstruction was impossible. The mean period from injury to MEF application was 4.5 days. Results The procedure was performed using regional anesthesia and fluoroscopic control, and it lasted 20 to 45 minutes. MEFs were removed in a mean period of 6 weeks, and follow-up was 18 to 55 months. Forty-nine patients with 57 fractures remained in the follow-up group. In all cases the skeleton was successfully reconstructed, whereas the clinical outcome varied according to the type of the original injury: intra-articular fractures had worse outcome than extra-articular (p=.035 for grip strength and p=.0005 for total active motion), and open fractures had worse outcome than closed (p=.06 for grip strength and p=.001 for total active motion). In all cases, patients' satisfaction was high; the Disabilities of the Arm, Shoulder, and Hand score was Conclusions The findings of this series demonstrate the efficacy of versatile MEFs to establish union and correct alignment of hand skeleton with minimal tissue trauma while retaining a good clinical outcome even in the most complex injuries. MEFs can be considered for all hand fractures requiring surgical treatment, and especially for the intra-articular and comminuted fractures. Type of study/level of evidence Therapeutic IV.