Intramedullary tension band technique versus distal ulnar hook plate in treating the fifth metatarsal base fractures.

Background: Displaced or comminuted fifth metatarsal base fractures remain challenging, with no consensus on optimal surgical treatment.

Purpose: To compare clinical outcomes between intramedullary tension-band and distal ulna hook plate fixation for treating Zone 1 (tuberosity avulsion) fractures of the fifth.

Study design: Retrospective cohort study.

Methods: This study included 43 patients with Zone 1 fractures treated surgically between August 2019 and August 2023. Patients were divided into two groups: 22 treated with intramedullary tension-band and 21 treated with hook plate fixation. Clinical and radiographic outcomes were assessed, including operative time, incision length, reduction quality, fracture healing time, AOFAS scores at 3, 6, and 12 months, and postoperative complications.

Results: The tension-band group showed significantly shorter operative time (28.4 ± 3.2 vs. 48.9 ± 8.6 min, P < 0.01) and smaller incisions (3.5 ± 0.3 vs. 6.1 ± 0.6 cm, P < 0.01), with no cases of implant irritation or nerve symptoms. The hook plate group achieved better immediate reduction (0.2 ± 0.2 vs. 0.7 ± 0.3 mm, P = 0.01), faster union (6 vs. 8 weeks, P < 0.01), and higher AOFAS scores at 3 months (P < 0.01). However, functional outcomes were similar at 6 and 12 months. Both groups achieved complete fracture union.

Conclusion: Both techniques are effective for Zone 1 fifth metatarsal base fractures. Tension-band fixation offers a less invasive alternative with reduced morbidity and need for implant removal, while the hook plate provides faster early recovery.