Background: The understanding of the anatomy of the proximal portion of the fifth metatarsal is essential as it explains the injury process and cures of various kinds of fifth metatarsal fractures that influence the appropriate treatment decision. Work objective: Comparison of clinical and radiographic outcomes among conservation therapy and acute surgical therapy of the fifth-metatarsal fracture base. Methods and patients: Twenty patients have been treated with percutaneous fixation with a 4,0 mm cannula screw and 20 have been conservatively treated with a lower knee cast. The length of the injury to hospital admission varied from 1 to 3 days with an average of 2 days between September 2020 and May 2021. The average follow-up time was six months (range from 5 to 7 months). Findings: Our results revealed that for zone 2 and zone 3 the acute fixation is superior than casting with respect to the union time and the AOFAS score. Conclusion: Early screw fixing is a safe and efficient therapeutic technique for acute fifth metatarsal base fractures, particularly zones 2 and 3. Early operational therapy leads to before clinical union and enables patients to return to regular daily activities rather than to cast therapy, leading to a high delayed union rate.