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We used free vascularized fibula transfers to treat 12 patients with congenital pseudarthrosis of the tibia. The mean age at surgery was 6.5 years, and the average follow-up was 3.4 years. Only one patient had persistent nonunion at the time of last follow-up, but he had 2.2 operations after the initial vascularized procedure. Problems included delayed union at the distal anastomosis and refracture. Union can be achieved in most patients, but attention to technical detail is very important. All angulation must be corrected and, at the first sign of delayed union, the site should be regrafted and intramedullary fixation should be used.
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