In my previous articles, I have repeatedly mentioned the treatment of congenital tibial pseudarthrosis because this disease is a worldwide problem, unlike the common fracture sequelae, and because children’s bones are developing and there are many variables that cannot be easily dealt with. The Chinese limb reconstruction team led by Dr. Kang Qinglin has been dedicated to the diagnosis and treatment of rare diseases in children in recent years, and has achieved gratifying results in both basic research and clinical treatment. In this article, we use a 4-year-old child’s tibial pseudarthrosis as an example to explain the treatment process of this disease. The child had bilateral lower extremity inequality and lower leg anterior deformity before surgery, and refused to wear a brace. We used our own innovative surgical method and a unique bone grafting method to combine internal and external fixation and adequate bone grafting, and the child walked with a brace half a month after surgery and removed external fixation 2 months after surgery without any auxiliary means, such as braces or casts, and walked with heightened orthopedic shoes. The key to the success of this case is: first, we have sufficient ability and confidence based on the treatment of dozens of similar cases; second, the cooperation and trust of the child’s parents, who decided to accept our treatment plan after only one visit to the clinic after full communication between the child’s parents and us, promoting the righteousness of the doctor-patient combination; third, the child in this case is lively and active, physically strong and able to endure hardships. First, conservative treatment was ineffective, and the tibiofibula had formed a pseudarthrosis, which affected walking, and the child was already 4 years old, with good bone quality and suitable for surgery. Second, the purpose of using a combination of internal and external is to use external fixation in the early stage of fixation, which can play a three-dimensional fixation, with sufficient stability, and can play the role of orthopedic brace, wearing a frame walking, which is incomprehensible to ordinary people, and is also difficult for general orthopedic surgeons to do. Third, after only two months of fixation, the brace was removed because the adequate bone graft had firmly welded the bone discontinuity, relying on the intramedullary nail fixation, which could play the role of the main bone and internal support, and was conducive to early movement. We boldly removed the brace to encourage early movement of the child, which prevented osteoporosis and facilitated remodeling of the bone discontinuity without the need to wear a brace or cast, making the patient more comfortable. Fourthly, our principle is that it is very important to let the bone pseudo-joint heal first at an early stage and leave the unequal length to be treated in later years.