This disease is a rare congenital disease of the tibia in infants and children, the lesions are mostly located in the lower and middle tibia, the tibia alone is commonly involved, some can be combined with fibular deformity, the first Hatcocher first described this disease, clinical treatment is difficult, easy to leave disability, and even the risk of amputation. Etiology: The detailed pathogenesis of the disease is still to be studied. According to the literature, many scholars have proposed various possible causes for the disease, but none of them is supported by definite evidence. The most popular view is the neurofibroma theory, which believes that the local pathological changes in the tibia are caused by neurofibroma lesions, which affect the normal development of bone and lead to bending of the tibia and even bone discontinuity, resulting in pseudo-articulation. However, in some cases, no neurofibroma or cutaneous café-au-lait is seen, which needs to be studied in more depth. Some scholars have also proposed the theory of abnormal fibrous accretion, which, combined with tibial X-ray examination and pathology, also suggests that the disease is related to fibrous accretion. The pathology of this disease is divided into two parts: 1. skeletal changes, including deformities of the bones, pseudarthrosis and local bone abnormalities of the bending and pseudarthrosis. 2. soft tissue abnormalities This disease is a multifactorial disease, according to the intraoperative suggestion, the soft tissue fibrosis at the bend of the tibia is obvious, and the microscopic suggestion is a large amount of fibrous tissue hyperplasia and fibroblasts. Boyd divided the disease into six types according to the severity of the tibial lesion. type I The tibia is bent forward with pseudoarticular formation, accompanied by partial loss of the tibia; type II The tibia is bent forward in an arc, the local medullary cavity is narrowed in a gourd-like change, the local bone cortex is obviously thickened and sclerotic, with the development of the disease, pathological fracture; type III The tibia is bent forward, there may be local pseudoarticular formation, the bone at the bend is cystic Type IV: Osteosclerosis and partial or complete occlusion of the medullary cavity at the junction of the middle and lower tibia 1.3, with easy fracture as the disease progresses, but relatively good healing; Type V: Pseudarthrosis of the tibia and pseudarthrosis of the fibula, with poor healing; Type VI: Pseudarthrosis of the tibia due to neurofibroma, with poor healing. Clinical manifestations: Depending on the degree of disease development and the type of lesion, there are different clinical manifestations. Generally, after birth, there is no obvious pseudarthrosis formation, mainly manifesting as forward bending of the tibia and obvious bulging, some cases may have shortening deformity of the affected lower limb due to large tibial angulation; as the age increases and the weight-bearing of the lower limb increases, the bending of the tibia becomes more and more obvious, some cases have pathological fractures and form tibial pseudarthrosis, sometimes the affected side of the foot inversion, small appearance, etc. In a few cases, there is coffee In a few cases, there are coffee pigmented spots on the body. Imaging manifestations: X-ray examination is mainly used to clarify the diagnosis and classification. The lesions are mostly located at the junction of the lower and middle tibial bones, and the tibia is bent and deformed, the bone marrow cavity is narrowed or even disappeared, the bone cortex at the bend is thickened and sclerotic, the bone is cystic-like changes, some of them have tibial pseudo-joint formation, and in a few cases, both tibia and fibula have pseudo-joint formation. Treatment and prognosis: Since there are several types of tibial pseudarthrosis, the treatment of the disease needs to be decided according to its classification and age of consultation. Since the current surgical results are not ideal, various surgical methods have been proposed by different scholars, but the surgical results need to be further improved and enhanced. For infants and children, if there is only a bending deformity of the tibia and no pseudarthrosis is formed, conservative treatment can be used, including health education for parents, prevention of trauma to the affected limb, regular X-ray examination to understand the progress of the disease, and external braces for fixation and protection to reduce the formation of pseudarthrosis. For patients who are older and already have pseudarthrosis at the time of consultation, the main purpose of surgery is to achieve the disappearance of pseudarthrosis and re-healing of bone discontinuity, and there is a lack of uniform opinion on the specific age of surgery. The hospital has good technical support and can operate early, which is beneficial to the patient’s recovery and the development of the tibia. For the specific surgery, there are many kinds, and the following are some of the common ones. Vascularized fibula grafting: Due to the rapid development and widespread use of microsurgery techniques, it is not a problem to perform vascularized grafting surgery, in which the contralateral fibula is displaced and then the fibula with blood vessels is transplanted to the tibial pseudo-joint on the affected side, which is fixed in a cast after surgery, but it is often easy to fracture, and part of the displaced fibula on the affected side is resorbed and the pseudo-joint still exists. External fixation with compression lengthening: with the advancement of technology, the current range of Ilizarov applications is continuously carried out. According to the literature, the use of bone grafting and compression at the tibial pseudarthrosis and bone lengthening of the proximal tibia has shown good surgical results. Therefore this procedure has become the first choice of some scholars. The specific method includes complete resection of the tibial pseudarthrosis, penetration of the tibial marrow cavity, release of the surrounding soft tissue, followed by iliac bone extraction, strip bone insertion at both ends of the tibia, external fixation and compression, and simultaneous osteotomy and lengthening at the proximal tibia, with surgical attention to the speed and duration of lengthening.