Abstract
Pediatric orthopedics contains various musculoskeletal deformities. Functional distortion, biological and structural abnormalities are the common denominator among congenital or acquired pediatric deformities. Leg bowing, shortening, and catastrophic fracture representing the predominant characteristics of congenital pseudoarthrosis of the tibia in this case report. Plate and screw internal fixation with bone graft augmentation, and complementary pharmacological therapy by zoledronic acid peri-operation are used in the treatment plan after failure of conservative and rigid external fixation trial. An accepted healing, restoration of the mechanical alignment, and minor shortening were the final results of 4 years follow up.