Multi-metatarsal fractures are a particular type possibly associated with worse functional outcomes. Existing studies are scarce, fragmented, and lack control for confounders. This study aimed to explore the functional prognosis of isolated closed extra-articular multi-metatarsal fractures and the different outcomes between the plate-screw and K-wire fixation. This retrospective study included 79 patients who underwent surgery for isolated closed extra-articular multi-metatarsal fractures from May 2017 to December 2020. We recorded baseline characteristics. The primary outcome measure was Visual Analogue Scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) score, and Foot and Ankle Outcome Score (FAOS). Exploratory correlation analysis of the variables with VAS, AOFAS score, and FAOS was performed. The differences between the plate-screw group (n=58) and K-wire group (n=21) were compared. 79 patients (79 feet) were included with a follow-up of (47.3±12.7) months (range, 26-70). Full weight bearing time was (11.7±5.3) weeks. VAS was (1.4±1.8) points, AOFAS score was (86.4±13.3) points, and FAOS was (79.0±11.1) points. Complications were observed in 17 cases (21.5%). According to exploratory correlation analysis, VAS was weakly associated with fixation method and gender, AOFAS was weakly associated with fixation method, FAOS was weakly associated with trauma mechanism. When the plate-screw group (n=58) was compared with the K-wire group (n=21), we found the former was superior to the latter in terms of full weight bearing time, VAS, AOFAS score, and malunion rate (all P<0.05). FAOS was nonsignificant (P=0.056). Operative treatment of isolated closed extra-articular multi-metatarsal fractures showed good mid-term results. Plate-screw fixation was associated with faster rehabilitation as well as lower malunion rate. The mid-term follow-up results showed patients with plate-screw fixation had better VAS and AOFAS scores.Copyright © 2023. Published by Elsevier Inc.