Congenital pseudarthrosis of the tibia is a rare condition. It usually presents during early childhood, at which time the surgeon is faced with numerous challenges including difficulties in achieving union and preventing refractures and recurrences. Patients frequently end up with a severe deformity or an amputation. When an adult patient presents with previously untreated congenital pseudarthrosis of the tibia, the surgeon is faced with the additional problems of a longstanding soft tissue contracture and disuse atrophy of the limb. Two patients with congenital pseudarthrosis of the tibia were treated by free vascularized iliac crest graft. Soft tissue deformity was corrected using an external fixation device. The patients were not freely ambulatory before surgery. Union across the pseudarthrosis was achieved in both patients with a double‐staged operation, within a short period of time. A functional stable painless limb with good knee and ankle motion has allowed both patients to resume bipedal gait and achieve a successful rehabilitation. © 1994 Wiley‐Liss, Inc.
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