Congenital tibial pseudarthrosis in children is a very specific congenital lesion of unknown etiology. From the clinical and case characteristics, this disease has some association with neurofibromatosis and osteofibrous dysplasia, or it may be an independent disease. The nature of the disease is not the same and the difficulty of treatment is not the same for the tibial pseudarthrosis seen in the clinic at present, although the diagnosis is the same, that is, the nature of the lesion is different, so many scholars have classified it into different types. In recent years we have gained a lot of experience in the treatment of congenital tibial pseudarthrosis, and our observations show that although the literature reports that the age of surgery can be as early as 2 years old, the indications need to be strictly selected, and in general the cure rate is higher in older children than in younger children. In addition, the extent of the diseased bone wave in children is closely related to age, i.e., the extent of the diseased bone is larger at birth, and with increasing age, the new bone of the epiphyseal plate will The new bone in the epiphyseal plate will replace and push some of the diseased bone, thus making the extent and proportion of the diseased bone smaller and gaining a fixed space for surgical treatment. Therefore, the selection of the age of surgery must be based on the staging of the diseased bone and the patient’s physical condition. In addition, by applying our original acetabular quadrilateral bone extraction, we can provide the maximum amount of donor bone for small-aged children while reducing the surgical trauma to a minimum, and can provide about 30 ml of autologous cancellous bone, which greatly improves the healing rate. The following reports a case of treatment in a child aged 4 years and 5 months. The deformity was found at birth, and the online consultation recommended that the child wear a brace after toddlerhood, but after one year of age the child was obstinate and the parents did not respect the will and walked without the brace, and a severe external anterior protrusion appeared over time. In June 2013 (Figure 2), the tibia and fibula had become pseudarthrosis, and the angle of the severed end had become large, but the structure of the tibial bone segment was close to normal, with only the remaining sclerosis near the severed end and a long length of bone segment on both sides for surgical fixation. A combination of internal and external approach was used to remove all the sclerotic bone at the severed end and implant autogenous cancellous bone. The brace was removed after 3 months and the intramedullary elastic nail was left in place, and the tibiofibula healed well on review 9 months after surgery, and continues to be under observation. Figure 1 July 2010 film Total tibial sclerosis Figure 2 June 2013 film Angle of the broken end of the bone, but the bone quality on both sides is obviously improved Figure 3 Pre-operative appearance, the left calf deformity is obvious Figure 4 Post-operative appearance, the ring brace is fixed Figure 5 Post-operative X-ray