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There were no reported cases of non-union. Complication rates were variable (all cause range of 0-21%) across all studies, with an overall low rate. Intramedullary devices are viable and safe to use for hallux valgus first metatarsal osteotomies, with comparable radiological and functional outcomes to other techniques. Current evidence base is of low methodological quality, therefore high quality studies are required to further evaluate these devices. Intramedullary devices are viable and safe to use for hallux valgus first metatarsal os