Fixation of metatarsal head osteotomies: when, why, and how?

There are many variables that factor into the decision to fixate a metatarsal head osteotomy. These decisions should be based on a thorough understanding of all of these factors. This article discusses osteotomies in a generic sense and the many variables that should be considered. It should be noted that whether internal fixation is employed or not, a thorough understanding of ASIF principles and bone healing is greatly beneficial. Many factors affect stability; these are discussed, as well as subtle changes in various procedures that can dramatically alter stability and therefore the need for fixation.