While undergoing a distal femoral osteotomy to facilitate expandable femoral rod placement, a 3 year old with osteogenesis imperfecta (OI) sustained an injury to the femoral artery and vein that subsequently led to the development of an arteriovenous (AV) fistula and overgrowth of her lower extremity. Percutaneous osteotomies performed at the apex of the typically deformed femur in OI patients place the femoral artery at risk in the distal third of the thigh. Strategies to decrease this risk are presented.