[Objective] To evaluate and compare the results of internal fixation with locking compression hook plate versus headless cannulated screw for fractures at the base of fifth metatarsal bone at zone I. [Methods] Collected the clinic data of the 32 cases with fractures at the base of fifth metatarsal bone at zone I at Orthopedic of Tianjin TEDA Hospital from January 2015 to April 2018. All cases were unilateral closed fractures , underwent surgery treatment. The locking compression hook plate (hook plate group) and headless cannulated screw (screw group) were used for fixation respectively. The operation time, length of hospital stay, the time to bony union，American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score at 12 months postoperatively in each group were recorded and compared, and the incidence of postoperative complications was calculated. [Results] All patients were followed up for 12 to 15 months with an average of (13.32?1.65) months. Compared with the screw group, the operation time, hospital stay and the time to bony union，the hook plate group were shortened, with statistically significant differences(P<0.05). There was no significant difference in AOFAS scores between the two groups at 12 months postoperatively(P>0.05). The incidence of postoperative complications in the hook plate group was 12.5% (2/16), including 1 case of skin numbness around the incision and 1 case of joint degeneration. The incidence of postoperative complications in the screw group was 25.0% (4/16), including 2 cases of skin numbness around the incision, 1 case of joint degeneration and 1 case of internal fixation loosening. [Conclusions] Locking compression hook plate for fixation of the fifth metatarsal basal fracutes at zone I have shown that the good fracture reduction and compression , shorter fracture healing time, fewer complications compared with the screw, was conducive to the postoperative recovery and exercise, clinical effect was satisfied.