Basilar Opening and Closing Wedge Osteotomy Procedures

Basilar opening and closing wedge osteotomies are generally utilized in patients with high intermetatarsal angles. The basilar closing osteotomy has fallen out of favor due to concerns regarding dorsiflexion malunions, consistency of correction, and shortening. Closing wedge osteotomies should be avoided in patients with pronation of the first metatarsal or high proximal articular set angles (PASA). The basilar opening osteotomy has become more popular in recent years due to locking plate fixation with high union rates, although with particular complications. Opening wedge osteotomies should be avoided in patients with significant pronation of the first metatarsal, high PASA, and positive metatarsal protrusion distances because the osteotomy increases the length of the first metatarsal. Basilar wedge osteotomies have a high learning curve and are associated with higher complication rates in meta-analysis. Basilar wedge osteotomies require precision of the osteotomy to avoid over- or under correction.