June 20, 2024

Congenital pseudo-arthrosis of the tibia is a congenital deformity characterized by anterior bowing of the tibia.

Anterolateral bowing: The precursor of congenital pseudoarthrosis of the tibia, present at birth, although the fractures and the ensuring pseudoarthrosis are rarely seen.

Etiology of Congenital pseudo-arthrosis

  • Unknown
  • Neurofibromatosis
  • Fibrous dysplasia


Failure of normal bone formation in the distal half of the tibia, resulting in segmental defect of bone, anterolateral angulation and pathological fracture

The site of pseudoarthrosis is usually surrounded by thickened periosteum and a heavy cuff of fibrous tissue.

Classification of Congenital pseudo-arthrosis of the tibia

Anderson’s Classification

  1. Dysplastic type
  2. Cystic type
  3. Late type
  4. Clubfoot type
  5. Angulated type

Boyd’s Classification

Type IAnterior bowing with tibia defect
Type IIPseudoarthrosis with hourglass constriction
Type IIIPseudarthrosis with a bone cyst
Type IVSclerotic segment, March fracture
Type VDysplastic fibula
Type VIIntraosseous neurofibroma
Congenital Pseudoarthosis classification
Congenital Pseudoarthosis classification

Crawford’s Classification

Non-dysplastic typeDysplastic type
1. Anterolateral bowing with increased density2. With the failure of tubulation
Sclerosis of the medullary canal3. Cystic pre-fracture or canal enlargement from prior fracture
May convert to dysplastic type following osteotomy4. Frack pseudoarthrosis with atrophy sucked candy narrowing ends
Crawford’s Classification

Treatment Options

Treatment options for Congenital pseudo-arthrosis are summarized below:

  • Ilizarov method
  • Vascularized fibular graft
  • Extending intramedullary nailing and bone grafting
  • Electrical Stimulation