Orthotropic Steel Decks have been used in long-span bridges for several decades because of their high capacity to weight ratio. However, many fatigue related issues have been reported. This paper provides an overview of the main existing fatigue prediction models and discusses their relevance for the fatigue life assessment of Orthotropic Steel Bridge Decks (OSBDs). Several case studies have proven the importance of considering the combined effect of wind and traffic loadings to estimate the fatigue life of long-span bridges. The importance of incorporating welding residual stresses is also well documented while it is often disregarded in design practices. Reliability-based fatigue assessment methods make it possible to quantify how the sources of uncertainty related to loading conditions, welding residual stresses or fabrication defects can affect the fatigue reliability of OSBDs. Monte Carlo simulations are often used to perform probabilistic analyses, but machine-learning algorithms are very promising and computationally efficient. The shortcomings of the Palmgren-Miner rule are discussed and the need for alternative damage accumulation indexes is clear. A number of conclusions are drawn from the analysis of fatigue tests conducted on OSBDs.