Abstract
PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: Zone 1 and 2 plate fixation demonstrated union rates comparable to those for traditional fifth metatarsal base fracture management. LEVEL OF CLINICAL EVIDENCE: Level 3, Prognostic. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s43465-025-01383-9.