Intramedullary Screw versus Locking Plate Fixation for Traumatic Displaced Proximal Fifth Metatarsal Fractures: A Systematic Review

Background/Objectives: Intramedullary screw fixation (IMS) and locking plate fixation (LPF) are currently recommended treatments for proximal fifth metatarsal fractures (PFMF). However, treating comminuted or small displaced avulsion PFMF with IMS poses challenges due to complications. A novel alternative fixation method, the locking compression plate for distal ulna hook plate fixation (LPF), has been introduced recently for distal ulna fractures and has shown improved clinical results. This scoping review aims to assess whether LPF yields superior outcomes, such as postoperative AOFAS scores and rate of postoperative complications, compared to IMS in PFMF treatment. Methods: This review included randomized controlled trials (RCTs), prospective cohort studies, retrospective cohort studies, or case series involving patients with PFMF who underwent plate fixation or screw fixation. The primary outcome was the postoperative American Orthopedic Foot and Ankle Society (AOFAS) score. Studies were sourced from databases including PubMed, Embase, and Scopus, with the search conducted up to February 2024. The Systematic Review protocol was registered in the CRD PROSPERO database (CRD42024532593). Results: Ten studies were included, comprising 3 cohort studies, 1 case-control study, and 6 case series, with a total of 309 patients (158 with LPF and 142 with IMS). The postoperative AOFAS scores showed no significant difference between LPF and IMS in treating PFMF. However, LPF demonstrated efficient surgical procedures and enhanced functional outcomes. Complications were minimal in both groups, with no significant difference in the rate of postoperative complications. Conclusions: Although there was no significant difference in AOFAS scores between LPF and IMS, LPF demonstrated efficient surgical procedures and enhanced functional outcomes, making it a reasonable alternative method for PFMF. Effective shared decision-making (SDM) with patients becomes paramount in choosing the optimal surgical approach. In the surgical landscape, thoughtful deliberation, patient engagement, and adherence to biomechanical principles are crucial for achieving successful outcomes in the treatment of PFMF.