Tips and Tricks for Installation of the SLIM Nail: A Surgical Guide with Case Insights

Introduction: Osteogenesis imperfecta (OI) presents significant surgical challenges due to bone fragility, narrow medullary canals, and complex deformities. While telescoping rods like the Fassier-Duval (FD) system are commonly used in growing patients, they are unsuitable when the canal diameter is too small or when patients approach skeletal maturity. The Simple Locking Intramedullary (SLIM) nail offers a solid, non-telescoping alternative in these cases. Methods: We describe the surgical technique for SLIM nail implantation and highlight key technical pearls developed through institutional experience, focusing on preoperative planning, intraoperative strategies, and the management of unique anatomical challenges in OI patients. Results: Three cases illustrate the application of these techniques: the first case demonstrates SLIM nail insertion in a 3-year-old child with a narrow IM canal to correct significant bowing; reaming was performed retrograde from the osteotomy site for the proximal segment and antegrade for the distal segment. The second case is a 15-year-old OI patient with a disengaged FD rod and narrow IM canal showing insertion of SLIM rod, and the third case is a 16-year-old patient with femoral deformity and telescoping rod who needed revision with SLIM nail and supplemental plate fixation. Conclusion: The SLIM nail is a viable option for select OI patients.