BACKGROUND: This study aimed to evaluate and compare the clinical effects and complications of cannulated compression headless screws (CHS) and anatomical locking compression hook plates (LCP) for fractures of the displaced fifth metatarsal base zone I in athletes and young adults. METHODS: Between May 2021 and June 2023, 50 patients were retrospectively evaluated. The patients were divided into two groups according to the fixation method: screw (CHS group, n = 20) or plate (LCP group, n = 30). General patient information, preoperative time, length of hospital stay, operative time, and intraoperative blood loss were recorded. Therapeutic effects were evaluated at follow-up using a visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score, and the incidence of postoperative complications. RESULTS: All patients were followed-up for an average of 16 months (range, 12-25 months). All patients had primary union. The operative time was shorter in the CHS group (p <
0.05). The VAS score in the CHS group immediately after surgery was lower than that in the LCP group (p <
0.05). The AOFAS midfoot score was significantly better in the LCP group at 3 months postoperatively (p <
0.05), but was not significantly different at 6 and 12 months after surgery and at the last follow-up (p >
0.05). In the LCP group, frequent mild to moderate plantar pain occurred in four patients, foreign body sensation occurred in five patients, and internal fixation was removed in seven patients with a second operation one year postoperatively. In the CHS group, a foreign body sensation occurred in one patient. There were significant differences in the complications related to internal fixation between the two groups (p <
0.05). No infections or sural nerve injuries were observed. CONCLUSION: In athletes and young adults with displaced fractures of the fifth metatarsal base zone I, the LCP provides early mobilisation and rehabilitation while increasing the incidence of complications associated with internal fixation compared with CHS.