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A 12-year-old male patient with OI type I underwent percutaneous osteotomies with the FD telescopic nail (diameter 5.6). The clinical and radiological follow-ups of the implant were satisfactory, with good bone callus formation and correct positioning of the nail. The patient was permitted to resume swimming from the 9th post-operative month, though, unbeknownst to his caregivers, he began a semiprofessional freestyle swimming training load. As a result, the patient experienced acute thigh pain with immediate functional impotence 18 months after surgery. The X-rays showed an incomplete transverse fracture in the upper middle third of the femur. The patient was subsequently placed in a long leg cast, with no weight bearing for 3 weeks, and prescribed magnetotherapy until clinical and radiological healing was reached, 2 months later. We believe this case should give pause for thought as to which indications to give these patients with regard to sports activities, and the need to increase awareness in OI patients and their families. We also believe it is best to discourage, in these particular patients, any form of semi-professional competitive activity, including competitive swimming. [ABSTRACT FROM AUTHOR]

Osteogenesis imperfecta (OI) is a rare congenital osteodystrophy. Patients with OI present with osteoporosis, extreme bone fragility and severe deformities of the lower limbs, which predispose them to frequent fractures. The aim of our study is to describe the minimally invasive osteotomy technique to correct the tibial deformities in patients with OI type III, using the Fassier-Duval (FD) intramedullary nailing, which is considered the gold standard in this kind of surgery. We analyzed the results obtained from 14 patients with OI type III, treated for tibial deformities with the minimally invasive percutaneous osteotomy technique and osteosynthesis with the FD telescopic nail. The results were compared with that of a control group composed of 18 patients with OI type III, treated for tibial deformities with open technique osteotomies and osteosynthesis with FD telescopic nail. The follow-up was set at 18 months postoperatively. The data concerning the following were collected from the two groups: duration of surgery, number of osteotomies performed, postoperative pain, time required for functional recovery, and for the formation of bone callus. To analyze the variations in the quality of life, all the patients were given the Pediatric Outcomes Data Collection Instrument questionnaire, before surgery and at the end of the follow-up. In patients who underwent corrective surgery with the percutaneous technique, the average duration of surgery was inferior, the postoperative pain was significantly lower, the recovery of 90° range of motion of knee flexion was reached at an average of 37.8 days, and they ambulated bearing full weight on the leg without auxiliary aids on average 45 days after surgery. The Pediatric Outcomes Data Collection Instrument questionnaire values were satisfactory in both groups. The osteosynthesis with the FD telescopic nail, performed with the minimally invasive surgical technique, has improved the management of deformities in OI. The minimally invasive technique, however, requires the maturation of three distinct learning curves: surgery on patients with OI, open technique with the FD nail, and percutaneous technique with the FD nail.