Surgical Results of Zones I and II Fifth Metatarsal Base Fractures Using Hook Plates

The purpose of this study was to evaluate the results of surgical treatment of fifth metatarsal base fractures using a mini-hook plate. Seventeen patients with Lawrence classification zones I (n=6) and II (n=11) fifth metatarsal base fractures with an initial fracture displacement more than 2 mm and a small (less than 2 mm) comminuted avulsion fragment were included in the study. Patients treated using a mini-hook plate fixation method were prospectively evaluated. A mini-hook tubular plate was designed so that the last hole functioned as a hook for the application of compression force, grasping of comminuted fragments, and rotational stabilization in metatarsal base fractures. Clinically, the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scale questionnaire was administered preoperatively and 1 year postoperatively. Union was determined by 3-dimensional computed tomography as clinically nontender callus formation. Time to union and return to sports were calculated. Mean AOFAS midfoot scale scores were 48+/-8 points (range, 35-60 points) preoperatively and 91+/-7 points (range, 85-100 points) 1 year postoperatively. Mean time to complete union, as determined by computed tomography, was 54+/-11 days (range, 38-74 days). All patients reported returning to prior activities of daily living at a mean of 74+/-10 days (range, 63-98 days). One patient reported hardware irritation secondary to inadequate plate bending and screw curving. Mini-hook plate fixation is an effective alternative surgical method for zones I and II displaced fifth metatarsal base fractures or comminuted small fragment fractures.