Base of Fifth Metatarsal Fractures: A Meta-analysis of Plate Fixation.

Abstract

Base of fifth metatarsal fractures are treated according to fracture zones. Proximal tuberosity avulsions (zone 1) are typically treated conservatively, while proximal metaphyseal-diaphyseal junction fractures (zone 2) or proximal diaphyseal fractures (zone 3) are usually treated with intramedullary screw fixation. We performed a systematic review and meta-analysis of plate fixation of base of fifth metatarsal fractures by zones to estimate mean time to union, mean time to return to daily activities, mean 1-year American Orthopaedic Foot and Ankle Society (AOFAS) score, and complication rate. Outcomes were pooled to determine aggregate outcomes if standard errors were included and there were at least 2 studies. Six studies examined zone 1 and 2 fractures treated with plate fixation. Zone 1 fractures had a mean of 6.88 weeks union time, 11.34 weeks to return to daily activities, 1-year AOFAS score of 94.91, and 5.97% complications. Zone 2 fractures had a mean of 7.0 weeks union time and 20.45% complications. Zone 1 and 2 plate fixation demonstrated union rates comparable to those for traditional fifth metatarsal base fracture management. Level 3, Prognostic. The online version contains supplementary material available at 10.1007/s43465-025-01383-9.