Residual deformities of hypophosphatemic rickets can be approached with a corrective osteotomy and fixation with a centromedullary nail, external fixators, Ilizarov devices, Kirschner's nails, cast devices, and plates, including epiphysiodesis. These methods may be used in case of fracture. The purpose of this work is to discuss the management of a 16-year-old patient with X-linked hypophosphatemic rickets at the end-stage of growth, who presented with a shaft fracture of the right femur, treated with alignment osteotomy and fixation, and alignment osteotomy of the contralateral femur in a single surgical stage. The patient currently has signs of delayed healing. The main complications of surgical treatment include recurrence of deformity and delayed healing, both of which, until now, can only be addressed by acting on the calcium and phosphorus metabolism. The patients with fractures caused by medium-impact mechanisms should undergo multidisciplinary management and the best implant for each case must be selected individually.