Management of a Case of Adult Mid-Shaft Femur Fracture in Osteogenesis Imperfecta by Long Proximal Femoral Nail: A Case report.

Introduction: Osteogenesis imperfecta (OI) is a rare inherited connective tissue disorder caused by defective type I collagen, which predisposes patients to recurrent fractures, skeletal deformities, and long-term disability. Intramedullary nailing is widely regarded as the gold standard for surgical stabilization of long bone fractures in OI due to its load-sharing capacity, deformity correction, and ability to prevent future fractures. Case Report: We describe the case of a 34-year-old female with type IA OI who presented with a spontaneous mid-shaft femur fracture while weight-bearing. She had a history of multiple previous fractures, including bilateral forearm fractures and an atypical femoral fracture, all managed conservatively. Intervention: The patient underwent closed reduction and internal fixation with a proximal femoral nail (PFN). Under fluoroscopic guidance, a long intramedullary nail was inserted, and proximal and distal locking screws were applied to ensure stability. The procedure was performed with minimal soft-tissue disruption. Outcome: Radiographic follow-up demonstrated progressive fracture consolidation at 8 weeks, allowing transition to full weight-bearing by 5 months. The patient regained near pre-injury functional status without complications such as implant migration, delayed union, or infection. Conclusion: This case highlights the effectiveness of PFN in managing femoral fractures in OI patients. PFN provides stable fixation, facilitates early mobilization, and reduces refracture risk. With careful implant selection, surgical planning, and vigilant post-operative monitoring, intramedullary nailing significantly improves functional outcomes and quality of life in OI patients.