Congenital pseudarthrosis of the tibia (CPT) is a nonunion of a tibial fracture often occurring spontaneously or as a result of minor trauma. The fracture site fails to heal with bone and is often healed with fibrous tissue that creates a “false joint.” A rare condition usually seen in the first 2 years of life; it is often associated with neurofibromatosis type 1 and occasionally fibrous dysplasia. Treatment is extremely challenging, requiring multiple surgeries to achieve union of the fracture site. Amputation may be required in those children who failed to achieve fracture healing.