Background: This study aims to evaluate the clinical outcomes of the Lapidus procedure utilizing either plate osteosynthesis or screw fixation in a significantly sized patient group with a minimum of 2 years follow-up. Materials and methods: This is a retrospective analysis of prospectively collected data of 68 consecutive hallux valgus in 56 patients who underwent the Lapidus procedure with a plate (Synthes X plate 38 feet) or screw fixation (29 feet) by a single surgeon in a single institution from 2007 to 2011. Patients were followed up at 6 months and 2 years and evaluation included clinical assessment, weight-bearing radiographs, and patient-reported outcome measures, namely pain visual analog score (VAS), American Orthopedic Foot and Ankle Society (AOFAS) hallux score. Results: In the plate osteosynthesis group, the VAS score improved significantly from 5.09 to 0.94 (p < 0.001) 2 years postoperatively. Similarly, the AOFAS hallux score improved significantly from 53.5 to 83.7 (p < 0.001) 2 years postoperatively. In the screw fixation group, the VAS score improved significantly from 4.68 preoperatively to 1.74 (p = 0.03) 2 years postoperatively. Similarly, the AOFAS hallux score improved significantly from 53.5 preoperatively to 76.6 (p < 0.001) 2 years postoperatively. Comparing the two groups, there was no difference in the improvement of VAS and AOFAS hallux scores. Similarly, at 2 years, there was no difference between the groups regarding patient's satisfaction and expectations. Conclusion: The Lapidus procedure utilizing either plate osteosynthesis or screw fixation is a reliable and safe option for hallux valgus, with good clinical outcomes and low complication rates. Level of evidence: Level II