The results of 40 extensible intramedullary nailing procedures in 15 c
hildren who had osteogenesis imperfecta were reviewed to identify risk
factors leading to complications of this method of treatment, There w
ere 40 complications 17 major and 23 minor, The 17 major complications
led to 15 additional procedures, 10 of which were to remove or replac
e the implant, The prevalence of major complications was highest in pa
tients who were younger than 5 years when the nail was inserted, Nails
placed in the tibia tended to produce a higher incidence of major com
plications than did those placed in the femur, but this difference was
not statistically significant, By survivorship analysis, patients had
a greater risk of requiring a revision procedure when a technical err
or occurred at the time the nail was inserted, Patients who had nails
placed in the femur tended to have a loner risk of needing revision su
rgery than did those who had nails placed in the tibia, but this diffe
rence was not statistically significant, The results suggested that th
e extensible nail is most advantageous in the femur and in patients ol
der than 5 years, Avoiding technical errors when inserting the nail ma
y improve the longevity of the device.