Abstract
Congenital pseudarthrosis of the tibia is a rare but clinically significant condition that leads to progressive deformity of the lower limb, impaired bone regeneration, repeated fractures, and substantial long-term functional limitations in affected children. Although the disorder has been described for more than a century, its underlying mechanisms remain incompletely understood, and current evidence pointsto a complex interaction of genetic, molecular, and biomechanical factors that contribute to the formation of fibrous nonunion. A wide range of therapeutic strategies has been proposed, including intramedullary fixation, circular external fixation using the Ilizarov technique, vascularized bone grafts, combined surgical approaches, and modern procedures aimed at creating a stable tibiofibular bone block. Despite significant progress in surgical management, the risks of persistent nonunion, recurrent deformity, and refracture remain considerable. Parallel to surgical advances, biological and pharmacological methods intended to enhance bone healing—such as bone morphogenetic proteins, bisphosphonates, platelet-rich plasma, cellular therapies, and engineered osteogenic constructs—are being actively explored, although current clinical evidence remains heterogeneous. Given the variability of treatment protocols and the limited number of high-quality comparative studies, a comprehensive synthesis of available datais essential for identifying the most effective approaches and guiding future research. This review summarizes contemporary knowledge on the pathogenesis, clinical presentation, and treatment strategies for congenital pseudarthrosis of the tibia and highlights the need for standardized protocols and multicenter studies to improve long-term outcomes in pediatric patients.Keywords: congenital pseudarthrosis of the tibia, Ilizarov apparatus, intramedullary rod, cross-union.