Purpose <p>Posterior femoro-acetabular impingement in patients with increased femoral version can result in significant hip pain, chondro-labral injury, and limited range of motion. Femoral rotational osteotomy may address these issues by correcting excessive femoral anteversion.</p> Methods <p>This retro-spective case series included 25 adolescents (mean age 14.8 years) with symptomatic increased femoral version (&gt; 35°) treated between 2015 and 2022. Inclusion required hip pain, limited range of motion, and increased femoral version confirmed on computed tomography. Patients underwent femoral external rotational osteotomy targeting a post-operative femoral version of ~ 15°. Outcomes assessed included femoral version, hip range of motion, and Harris Hip Score pre-operatively, at six months, and at two years post-operatively.</p> Results <p>Mean femoral version improved significantly from 39° ± 3° pre-operatively to 19° ± 7° post-operatively (<i>P</i> &lt; 0.001). Internal rotation decreased from 54° ± 9° to 32° ± 8°, while external rotation increased from 38° ± 4° to 44° ± 5° (<i>P</i> &lt; 0.001). Mean Harris Hip Score improved from 62.5 ± 10.3 to 86.1 ± 6.4 at 6 months, with sustained results at two year follow-up. Radiographic union was achieved in all patients, and no major complications were observed.</p> Conclusion <p>Femoral rotational osteotomy is a safe and effective treatment for posterior hip impingement in young patients with excessive femoral version.</p>