OBJECTIVE To assess the complications after plate fixation of phalangeal fractures, their correlation with the type of injury, and the outcome. METHODS We retrospectively reviewed the clinical records and the x-rays of 54 consecutive patients with 64 phalangeal fractures treated by open reduction and plate fixation with regard to fracture healing, plate loosening or failure, infection, complex regional pain syndrome, pain, return to work, and range of motion. RESULTS In 31 out of 54 patients (57%) and 33 out of 64 fractures (52%), one or more major complications occurred. Stiffness (definition is composite range of motion of metaphalangeal, proximal interphalangeal, and distal interphalangeal joints added together equaling <180 degrees) contributed the highest number (22 patients, 24 fractures). The complication rates were not different whether the fracture was open or closed, if it was located in the proximal or middle phalanx, the presence or absence of an associated soft tissue lesion, and the patient's occupation. CONCLUSIONS In spite of early mobilization, stiffness is the most frequent complication after open reduction and plate fixation of phalangeal fractures. The undue amount of scarring and adhesion may arise from the implant itself or the difficulty in finding the perfect mixture between the minimal surgical invasiveness and a sufficient restoration of skeletal stability. Otherwise, plate fixation of unstable and complex phalangeal fractures proved efficient and reliable, although not free of potential problems.