Beyond Density: Fixation Strategies and Healing Paradoxes in Osteogenesis Imperfecta Fractures.

» Osteogenesis imperfecta (OI) produces lifelong skeletal fragility from collagen synthesis defects, with fracture risk 13-fold higher than the general population, despite bone mineral density-increasing drugs lacking fracture reduction evidence. » Telescoping intramedullary rods remain the gold standard for pediatric OI fractures and deformity correction, pioneered by Bailey-Dubow and refined by Fassier-Duval to accommodate growth. » Surgical fixation faces unique challenges including thin cortices and poor screw purchase. Adjunctive plating reduces complications from 45% (rods alone) to 16% by enhancing stability. » Early operative intervention, before the age of 3 years in severe type III OI, prevents disuse osteopenia cycles, while concurrent deformity correction at fracture sites optimized alignment and function.