Scarf-Akin osteotomy is a widely used joint-preserving procedure for the correction of hallux valgus and provides strong three-dimensional correction through combined first metatarsal and proximal phalangeal osteotomies. Although this technique has demonstrated reliable outcomes in pain relief, functional improvement, and radiographic correction, it is technically demanding, and the choice of fixation method remains controversial. Among the available options, externalized Kirschner wire fixation may offer advantages, including lower implant cost, ease of removal, and avoidance of retained hardware, but current clinical evidence remains limited. This review summarizes the advantages and challenges of the Scarf-Akin osteotomy and compares screw fixation, Kirschner wire fixation, bioabsorbable fixation, and non-fixation techniques in terms of indications, stability, complications, reoperation rates, and cost-effectiveness. The aim is to provide a reference for perioperative management and individualized fixation selection after hallux valgus correction.
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