Congenital pseudarthrosis of the tibia (CPT) refers to non-union of a tibial fracture. A pseudarthrosis is defined as a “false joint” and is a break in the bone that fails to heal on its own. It stems from the periosteum being abnormal and preventing proper bone healing. To treat this condition, we can use combined internal and external fixation techniques with periosteal grafting (and/or tibia-fibular synostosis). The periosteum is a membrane that covers the outer surface of all bones. Periosteal grafting involves harvesting periosteum from other bones in the body, such as the ilium (upper portion of the hip bone and pelvis), and using it to heal the fracture of the tibia.