Congenital pseudarthrosis of the tibia was perhaps described almost 300 years ago, yet it remains one of the most difficult conditions to treat in orthopedic surgery. Recent advances in surgical techniques have given much more encouraging results. Coleman has played a significant role in this progress with his concept of complete correction of the tibial and fibular deformities and fixation with strong and long intramedullary rods. To this technique have been added autologous cancellous bone grafting and electrical stimulation. These advances have increased the rate of successful union of the pseudarthrosis of the tibia. More recently, transfer of a vascularized fibular graft with correction at the same time of the leg-length discrepancy has offered even greater hope for achieving successful bony union of the tibia. This treatment involves surgery on the normal leg. Long-term results of this method of management are eagerly awaited.