Background <p>This study aimed to evaluate the clinical efficacy of a modified application of Ilizarov external mini-fixation (IEP) in comparison with conventional surgical.</p> Methods <p>A retrospective analysis was conducted on 45 patients with boxer’s fractures who underwent surgical intervention between January 2018 and December 2023. Thirteen patients were treated with the modified IEF. Baseline characteristics, intraoperative parameters, and postoperative outcomes—including fracture healing time, residual angulation, metacarpophalangeal (MP) joint range of motion (ROM), return-to-work time, and complication rates—were assessed and compared among the IEF, KW, and LP groups.</p> Results <p>Complete fracture healing was achieved in all cases, with no significant differences in mean healing time among the three groups. However, residual angulation was significantly greater in the KW group than in the IEF and LP groups. At 4 weeks postoperatively, the IEF group demonstrated excellent MP joint ROM compared to the KW and LP groups. At the final follow-up, the ROM in the IEF group was comparable to the KW group and slightly better than that observed in the LP group. Patients in the IEF group returned to work significantly earlier than those in the KW. No significant differences in the overall complication rates were observed among the groups. </p> Conclusions <p>The modified IEF technique demonstrated early functional advantages, including improved early ROM and expedited return to work, while maintaining long-term efficacy and complication rates comparable to established fixation methods. Despite its inherent limitations, this method may be particularly beneficial for patients with high functional demands or those prioritizing early rehabilitation.</p>