M.H., a 3-year-old boy with osteogenesis imperfecta (OI) type III, was admitted to the pediatric orthopedic hospital for treatment of yet another fracture. Since he was born he has had 15 fractures of his arms and legs. His congenital disease is manifested by a defect in the creation of bone matrix, which gives normal bone its strength. His bones are very brittle and break with little pressure or trauma. This latest fracture occurred when he twisted at the hip while standing in his wheeled walker. He has been in a research study and receives a bisphosphonates infusion every 2 months. He is short in stature with short limbs for his age, and has bowing of both legs. He also has a pectus cavernosus of his chest, an inversion or concavity of the sternum.

M.H. was transferred to the OR and carefully lifted to the OR table by the staff. After he was anesthetized, he was positioned with gentle manipulation, and his left hip was elevated on a small gel pillow. After skin preparation and sterile draping, a stainless steel rod was inserted into the medullary canal of his left femur to reduce and stabilize the femoral fracture. The muscle, fascia, subcutaneous tissue, and skin were sutured closed. Three nurses gently held M.H. in position on a pediatric spica box while the surgeon applied a hip spica (body cast) to stabilize the fixation, protect the leg, and maintain abduction. M.H. was transferred to the PACU for recovery. The surgeon dictated the procedure as an open reduction internal fixation (ORIF) of the left femur with intramedullary rodding (IM) and application of spica cast.

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