Background: Surgical treatment is preferred in metacarpal and phalangeal fractures in general can be treated surgically with K-wires, screws or hand plates. Lag screws are the implant of choice for this type of fractures. The aim of this work is to evaluate the outcome of fixation of oblique and spiral fractures of phalanges and metacarpals of the hand by interfragmentary mini screws. Patients and methods: Eighteen oblique and spiral fractures were included in this study with 6 metacarpals and 12 phalangeal fractures. Eight spiral and 10 oblique fractures were followed up for 15 to 31 weeks. Gender distributed as seven females and 11 males with Patients’ mean age of 35 (range 19 - 51) years old. In range of motion, functional and radiological results of treatment of oblique and spiral metacarpal and phalangeal fractures by open reduction and internal fixation using interfragmentary mini screws were evaluated. Results: In our study, the mean value of TAM score for both metacarpals and phalanges at the end of follow up (mean 23.1 weeks) was 87% ± 11.6. Final range of motion assessment revealed three (16.7%) fair, two (11.1%) good and thirteen (72.2%) excellent results. There was statistically insignificant difference between the side of the affected hand with phalangeal and metacarpal fractures and end results of final follow up. Conclusion: Oblique and spiral hand fractures have special characters. They are the result of torsional forces and can cause rotational mal-alignment. Interfragmentary mini Lag screws fixation represents a very good method for dealing with such rotationally unstable fractures.