Why fixation is needed
An osteotomy creates two bone fragments that must heal in a new relationship. Although the V-shaped Chevron cut has useful inherent stability, walking forces can still move the fragments before union. Internal fixation helps maintain translation, rotation and length while new bone bridges the osteotomy. Fixation is therefore a temporary mechanical support for a biological healing process.
Common fixation options
Modern distal Chevron osteotomies are commonly fixed with one or more screws. Depending on the technique, these may be headed screws, low-profile screws or headless compression screws. Some procedures use pins, wires or specialised implants, and certain minimally invasive techniques use screws inserted through small incisions. The choice is influenced by the osteotomy design, amount of displacement, bone quality, available equipment and surgeon preference.
What the screw does
A screw may compress the bone surfaces or hold them securely against translation and rotation. Compression can improve stability and maximise contact between the healing surfaces. The screw does not replace the need for protection during the early recovery. Bone union still requires time, circulation and appropriate loading. Even with stable fixation, excessive activity or an accidental injury can disrupt the correction.
Materials
Fixation is often made from titanium or a medical-grade alloy. These materials are selected for strength and compatibility with the body. They do not normally trigger airport security systems, although screening equipment varies. Most standard metal fixation is compatible with future MRI scanning, but patients should always tell the imaging provider that an implant is present so the device and scan requirements can be checked.
Do screws remain permanently?
In many patients, the screw remains permanently and is never noticed after the foot has healed. Routine removal is generally unnecessary because another procedure creates additional cost, inconvenience and surgical risk. Once bone union has occurred, the implant is no longer carrying the same mechanical role, but it may safely remain within the bone if it is not causing a problem.
When removal may be considered
A screw may occasionally become prominent or irritate footwear, skin, a tendon or nearby soft tissue. Less commonly, infection, implant loosening, migration, breakage or a reaction around the implant may require assessment. Removal is usually considered only after the osteotomy has united, unless there is an urgent reason to intervene earlier. Not all discomfort near a previous operation is caused by the screw, so examination and imaging are important before deciding on removal.
Can fixation fail?
Fixation failure is uncommon but possible. Risk can increase with poor bone quality, smoking, uncontrolled diabetes, infection, premature loading, accidental trauma or non-union. A screw can loosen or break if the osteotomy does not heal and continued movement places repeated stress on the metal. This illustrates why postoperative restrictions and follow-up are as important as the implant itself.
Fixation and early weight bearing
Stable fixation may allow protected weight bearing in a purpose-designed postoperative shoe after some Chevron procedures. Protected weight bearing is not the same as unrestricted walking. The patient may need to keep pressure through the heel, limit time on the foot, use crutches or another aid, and elevate frequently. Protocols differ, especially when an additional osteotomy or procedure has been performed.
Absorbable implants
Bioabsorbable or resorbable fixation has been used in some foot operations, but it is not universally preferred. These implants are designed to degrade over time, yet they have their own advantages, limitations and potential tissue reactions. Their use depends on the procedure, evidence, implant availability and surgeon experience. Metal screws remain a well-established option for many Chevron osteotomies.
Questions patients can ask
Useful questions include how many implants are expected, whether they are intended to remain, what weight-bearing restrictions apply and whether the implant affects future imaging. The answer should be specific to the actual operation rather than based on another patient's experience. The most important outcome is stable bone healing in the intended position, not the use of a particular brand or number of screws.