Fifth metatarsal fractures are among the most common foot injuries, with their management remaining a subject of debate due to the unique vascular supply of the bone. Treatment decisions are influenced by fracture location, patient factors, and surgeon preference, with improper management potentially leading to delayed union, non-union, or functional impairment. This chapter explores key surgical techniques, including intramedullary screw fixation, plantar plate fixation, and hook plate fixation, detailing their indications, technical considerations, and potential pitfalls. Postoperative care protocols, rehabilitation strategies, and return-to-activity guidelines are outlined to optimize healing outcomes. Additionally, specific cases such as delayed and non-union fractures, revision surgeries are discussed. By providing a comprehensive overview of fixation strategies and postoperative management, this chapter aims to equip surgeons with the knowledge to achieve optimal outcomes in treating fifth metatarsal fractures.