Imaging-Based Classification of Fifth Metatarsal Fractures and Its Impact on Clinical Decision-Making: A Systematic Review.

Fifth metatarsal fractures are common forefoot injuries with variable healing potential and treatment outcomes depending on fracture location and type. Imaging-based classification systems provide radiographic frameworks to guide diagnosis, prognostication, and management, yet their reliability can vary. This systematic review evaluated existing imaging-based classifications for fifth metatarsal fractures, focusing on anatomical and radiographic criteria, reproducibility, and clinical impact. A comprehensive search of PubMed, Embase, Scopus, and the Cochrane Library was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, including studies reporting reliability or clinical relevance of imaging-based classifications. Findings indicate that structured imaging classifications improve interobserver agreement, facilitate standardized treatment decisions, and correlate with functional outcomes. While traditional systems provide foundational guidance, imaging-integrated approaches, especially using CT or MRI, enhance accuracy in subtle or stress-related fractures. In conclusion, imaging-based classifications are essential for accurate diagnosis, risk stratification, and management of fifth metatarsal fractures, and future research should focus on standardized, multimodality frameworks to optimize clinical outcomes.