Tips and tricks for femoral Fassier-Duval rod revision in osteogenesis imperfecta

Purpose Osteogenesis Imperfecta (OI) is characterized by severe bone fragility, requiring intramedullary telescopic rodding such as the Fassier-Duval (FD) rod to correct and prevent progressive deformities. Although the FD rod is widely used, the revision rates, especially in the femur, remain high. This study aims to evaluate a structured decision-making framework and detailed surgical techniques for FD femoral revision in OI. Methods We retrospectively reviewed a cohort of 76 limbs from 37 patients with OI who underwent surgery between 2020 and 2024. A specific sub-cohort of 21 femoral FD revisions was evaluated to establish baseline failure characteristics. Within this group, a sample of 9 patients (10 limbs) was reviewed in detail to analyze specific technical strategies and mid-term clinical outcomes. Results Among 21 femoral revision limbs evaluated at a median follow-up of 28 months (range, 12 - 42 months), union was achieved in 89.5% of indicated cases (17/19) at a median of 16 weeks (range, 12–28 weeks). Postoperative complications occurred in 6 of 21 limbs (28.6%), of which three were managed nonoperatively, and three (14.3%) required secondary re-revision including refracture with rod bending, distal pull-out, and symptomatic nonunion. Overall, 18 limbs maintained functional hardware in situ, yielding an 85.0% FD rod survival rate (17/20 limbs) at a median of approximately two years post-revision. Conclusion Femoral FD rod revision requires a tailored approach for each patient. Using a systematic decision-making flowchart, combined with meticulous surgical techniques, could help reduce the potential lifetime burden of surgery and provide reliable mid-term implant survival.