Vol. 11, Issue 3 (2025)

Femoral shaft fractures in patients with osteogenesis imperfecta (OI) and paraparesis due to meningomyelocele are rare and complex, requiring careful surgical and rehabilitative management. We report a 12-year-old male with OI, paraparesis, and multiple skeletal deformities who presented with a spontaneous femoral shaft fracture. Clinical and radiological evaluation revealed generalized osteopenia, multiple healed fractures, Wormian bones, and dentinogenesis imperfecta, confirming OI. The fracture was managed by open reduction and stabilization with double Titanium Elastic Nailing System (TENS) in a retrograde manner. Postoperative rehabilitation included early passive knee motion and bisphosphonate therapy. The outcome demonstrated satisfactory alignment, stability, and functional preservation. This case underscores the importance of individualized surgical intervention, multidisciplinary care, and the role of intramedullary fixation in achieving favorable outcomes in children with OI complicated by neurological comorbidities.