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The treatment of osteogenesis imperfecta requires a multidisciplinary team to maximize function and comfort, and decrease fracture incidence. Medical treatment with bisphosphonates has allowed for safer, more effective surgical management of children with osteogenesis imperfecta. The purpose of this review is to outline treatment indications and choices of surgical techniques based on recent clinical studies, and in addition to identify persistent clinical problems addressed in recent literature.Several new intramedullary rodding surgical techniques and modifications of older techniques have been developed to correct deformities of the long bones. These techniques decrease the trauma associated with surgical treatment. The newer techniques limit postoperative immobilization, enabling earlier rehabilitation, and allowing for treatment of multiple bones simultaneously.Recent medical and surgical advances have allowed improved safety, function and comfort in treating children with osteogenesis imperfecta. The selection of surgical techniques is dependent on surgeon experience, severity of disease and patient function, and availability of specific instrumentation. Intramedullary fixation rather than plating is preferred, and allowing early protected weight bearing and rehabilitation of children with ambulatory potential is the ideal goal.