Objective: To investigate the therapeutic advantages of closed reduction and Kirschner wire fixation versus open reduction and plate fixation in patients with hand surgery fractures. Methods: The sample was collected from May 2021 to May 2025, consisting of 80 patients with hand surgery fractures. These patients were randomly divided into two groups using the red and blue ball method: the plate fixation group (40 cases, treated with open reduction and plate fixation) and the Kirschner wire fixation group (40 cases, treated with closed reduction and Kirschner wire fixation). The therapeutic effects between the two groups were randomly compared. Results: The Kirschner wire fixation group outperformed the plate fixation group in all indicators except for hand function scores (p < 0.05). There was no statistically significant difference in hand function scores between the two groups (p > 0.05). Conclusion: Compared with open reduction and plate fixation, closed reduction and Kirschner wire fixation for patients with hand surgery fractures achieves a more pronounced therapeutic effect, with advantages such as less trauma, shorter operation time, less bleeding, and a lower incidence of complications. It is suitable for hand surgery fractures with good stability. Open reduction and plate internal fixation have greater advantages in complex fractures and cases requiring high stability, and are worthy of promotion and application.