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Congenital Pseudarthrosis of the Tibia (CPT) is a rare condition in which a child is born with a weak or broken shinbone (tibia) that fails to heal correctly. Over time, the bone may bend or break, making it hard for the child to walk or stand.

To treat this, doctors perform surgery to help the bone grow and become strong. One standard method uses an external fixator, a special frame placed outside the leg to straighten and support the bone while it heals. Another method is placing a metal rod inside the bone (called intramedullary nailing) to keep it stable.

In some cases, doctors may replace the damaged part of the bone with healthy bone from another part of the body, usually the lower leg (fibula). The primary goal of the surgery is to repair the bone, promote normal growth, and enable the child to walk without pain or difficulty.

CPT surgery treats a rare condition in which the tibia, or shinbone, fails to develop or heal properly, often from birth. This condition results in a fragile, bowed, or fractured bone that does not unite naturally. The surgery aims to correct the deformity, encourage healthy bone growth, and stabilise the leg to prevent future fractures. It also helps restore mobility and improves the child’s quality of life.

Parents should consult a doctor if their child shows signs of bowing in the lower leg at birth or soon after, or if a tibial fracture occurs and does not heal. Recurrent fractures, instability while walking, or noticeable differences in leg length are also warning signs. Children with neurofibromatosis type 1 are especially prone to CPT and should be monitored regularly for early signs of bone deformity.

Preparing for CPT surgery involves a detailed diagnostic process, including X-rays, CT scans, or MRIs, to assess the condition of the bone. The child may undergo blood tests and a physical exam to ensure they can handle anesthesia and surgery. Parents will receive information on the surgical plan, the expected recovery timeline, and post-operative care.

During the procedure, the surgeon removes the abnormal pseudarthrosis tissue and any fibrous or non-healing bone. A bone graft, often taken from the child’s pelvis, is used to promote bone healing. To stabilise the tibia, the surgeon may use internal fixation with rods or plates, or external fixation with devices like the Ilizarov frame. In severe cases, vascularized fibular grafting is performed to improve blood supply and help bone regeneration.

CPT surgery usually takes 3 to 5 hours, depending on its complexity and whether bone grafts or fixators are used. After surgery, the child stays in the hospital for about 4 to 7 days for pain management, monitoring, and initial rehabilitation. Recovery can last several months, with ongoing assessments to track bone healing and alignment.

Infection at surgical or pin sites.
Failure of bone healing, nonunion, or re-fracture.
Nerve or blood vessel injury.
Limb length discrepancy or recurring deformity.

Promotes solid bone healing in a tibia that previously did not heal.
Improves leg alignment, strength, and mobility.
Reduces the risk of fractures and the need for future surgeries.
Improves overall quality of life and physical activity.

Following surgery, the leg is immobilised with a cast or an external fixator. Physical therapy begins once healing has progressed, focusing on exercises to improve strength, joint flexibility, and gait. The child will attend regular follow-up appointments, and X-rays will be taken to monitor the progress of the bone. Once healing is sufficient, any hardware or frames may be removed. Full recovery can take anywhere from 6 months to longer, depending on the individual's healing process.

CPT surgery has a success rate of approximately 70% to 85% in achieving bone union, although some children may require multiple surgeries. The outcome largely depends on the child’s age at the time of treatment, the severity of the deformity, and the surgical technique employed. Early diagnosis, skilled orthopaedic intervention, and consistent follow-up can lead to improved long-term results.