Comparative Biomechanical Evaluation of Hook-Plate Versus Bicortical Screw Fixation for Fifth Metatarsal Avulsion...

Background/Objectives: Avulsion fractures of the fifth metatarsal often require surgical fixation when displacement or instability is present. This study aimed to compare the biomechanical performance of hook-plate and bicortical screw fixation using anatomically accurate 3D-printed metatarsal models analyzed through digital image correlation (DIC). Methods: Multi-material 3D-printed specimens were subjected to simulated gait-phase loading (α = 0°, 90°, 180°), combined with three interfragmentary distances (d = 0.1, 0.5, 1 mm) following a replicated 3 × 3 factorial design (n = 27 per fixation method). Full-field strain and displacement maps were quantified using ARAMIS DIC. Results: Hook-plate fixation consistently produced lower maximum stresses compared with bicortical screws (reductions of 9-36 MPa across conditions). The highest stresses were observed for screw fixation at α = 90° and d = 0.1 mm (100.3 ± 1.5 MPa), while the lowest occurred for hook plates at α = 180° and d = 1 mm (33.3 ± 1.5 MPa). ANOVA confirmed significant α×d interactions (p < 0.01). Conclusions: Hook-plate fixation provided superior angular stability and suggested improved cyclic performance compared to bicortical screws, favoring early mobilization. The combined use of 3D printing and DIC represents a valuable framework for preclinical implant evaluation. These results provide useful insights for selecting the optimal fixation technique in clinical management of fifth metatarsal avulsion fractures.