Does proximal metatarsal Osteotomy need internal fixation?
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Internal fixation for proximal metatarsal osteotomies is generally not required since many authors state that weight bearing may promote fusion of the metatarsal segments in the correct position. This study reports a case of a 54 years old woman affected by metatarsalgia who was treated surgically with a proximal metatarsal osteotomy. Radiography showed a non-union of the metatarsal osteotomy and MRI, bone scintigraphy and blood tests excluded infection. Surgical treatment consisted in debridement of fibrous non-union, autologous bone grafting and plate and screw fixation. The plate was removed 12 months after the surgery because of soft tissue irritation and hardware prominence. At the last follow-up, the patient was pain-free and resumed her daily activities. In general, proximal osteotomies are safe procedures for the treatment of metatarsalgia. Although fixation is a controversial topic, it should be reconsidered in order to avoid nonunion.

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