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pseudarthrosis of the tibia - a limb-reconstruction team, planning the whole child or adult, not just the fracture.

Congenital pseudarthrosis of the tibia and adult non-union of the tibial shaft - assessed and treated by a limb-reconstruction team with vascularised bone grafting, Ilizarov and Taylor Spatial frame, intramedullary rods and modern biological adjuncts.

See indicative pricing
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What private pseudarthrosis of the tibia costs in the UK.

Indicative ranges across our limb-reconstruction partners. Firm quotes account for imaging, theatre, implants, frame and follow-up.

In short

£16,000–£45,000, staged over 6–18 months.

OptionIndicative range
Limb-reconstruction consultation + imaging review£350–£650
CT tibia with 3D reconstruction£400–£700
Intramedullary rodding + BMP£12,000–£22,000
Ilizarov / Taylor Spatial Frame application£18,000–£35,000
Vascularised free fibular graft£28,000–£45,000
Frame removal and cast£3,000–£6,000
Below-knee amputation + prosthetic pathway£18,000–£35,000

Prices vary by clinic, by consultant seniority and by whether combined visits or extra work-up is needed.

The problem

A non-union of the tibia is a whole-limb problem.

Length, alignment, soft tissue, infection, deformity and the child’s (or adult’s) whole life - all of them matter more than any single implant choice.

  • Congenital vs acquired - different problems

    Congenital pseudarthrosis of the tibia (often NF1-associated) behaves nothing like an adult fracture non-union. Same word, different medicine.

  • Rule out - and treat - infection first

    Infected non-union responds only when the infection is controlled. CRP, WBC scan, tissue sampling and staged debridement before definitive fixation.

  • Amputation is a legitimate option

    For recurrent failure, chronic pain, deformity and functional loss, a well-fitted below-knee prosthesis can outperform many-year reconstruction. We say when.

When it helps

The tibial non-unions worth reconstructing.

The situations where limb reconstruction is the right path - and the red flag that means amputation should also be on the table.

  • Congenital pseudarthrosis of the tibia (CPT)

    Anterolateral bowing progressing to fracture, often before age 3, frequently associated with neurofibromatosis type 1.

  • Post-traumatic tibial non-union

    A tibial shaft fracture that has failed to unite by 6–9 months after appropriate fixation.

  • Infected non-union

    Non-union with previous open fracture, wound breakdown or positive tissue cultures - needs staged debridement and infection control first.

  • Hypertrophic non-union

    Bulky bone response without bridging - mechanical instability the main problem, biology usually adequate.

  • Atrophic non-union

    Thin, avascular fracture ends - biology is the issue and needs bone graft or BMP alongside fixation.

  • Non-union with deformity or shortening

    Angulation over 10°, rotation, or shortening more than 2 cm - Ilizarov or Taylor Spatial Frame can correct while healing.

  • Failed prior surgery (revision)

    A tibial non-union that has failed one or two prior operations - often needs vascularised fibula grafting.

  • Red flag: uncontrolled infection with sepsis

    Fever, spreading redness, tachycardia and confusion is sepsis - A&E and IV antibiotics, not an orthopaedic outpatient booking.

Surgical options

One diagnosis, several very different operations.

The main surgical strategies for tibial pseudarthrosis, and how the choice depends on age, aetiology and prior surgery.

  • Intramedullary rodding

    A rod through the marrow canal from the top or bottom of the tibia - the workhorse for straightforward mid-shaft non-union with acceptable alignment.

  • Plate and screw fixation

    A locking plate on the surface of the bone - chosen where the canal cannot be used or when compression across the non-union is needed.

  • Ilizarov / Taylor Spatial Frame

    External circular frames that stabilise, compress, distract and correct alignment and length. The main tool for deformity, infection and bone loss.

  • Vascularised free fibular graft

    A section of your own fibula transferred with its blood supply - the gold-standard biological answer for large defects and recurrent congenital pseudarthrosis.

  • BMP (bone morphogenetic protein)

    A biological adjunct that stimulates bone healing. Now selective in use - powerful but not without cost and side-effect considerations.

  • Autograft (iliac crest)

    Cancellous bone from your own pelvis - the traditional biological booster. Reliable, but donor-site pain and volume limits.

  • Cross-union with fibular graft

    A modern technique for congenital pseudarthrosis using the fibula as a bridge - improves long-term stability.

  • Amputation with modern prosthesis

    For recurrent failure, chronic pain or poor limb function, a well-fitted transtibial prosthesis can restore mobility faster than continuing reconstruction.

Safety and recovery

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  • Non-union may recur

    Even with best-in-class reconstruction, congenital pseudarthrosis can refracture. Long-term bracing after healing is standard until skeletal maturity.

  • Frame care is a daily commitment

    Pin-site cleaning, dressings and photographs; wound assessment; and steady, incremental frame adjustment. Six to fifteen months of it.

  • Infection is the everyday risk

    Pin-site infection, deep infection and osteomyelitis all possible. Any fever, spreading redness or pin-site discharge needs same-week review.

  • Nerve, artery and compartment risk

    Peroneal nerve, tibial artery and compartment pressures are all in play. Numbness, cold foot or a very swollen calf is an emergency.

  • Length inequality is common

    Post-reconstruction leg-length difference is managed with shoe raise, lengthening or contralateral epiphysiodesis where relevant.

  • Vascularised fibula donor morbidity

    Weakness of ankle dorsiflexion or big-toe extension, mild ankle instability, donor-site tenderness - all discussed openly before consent.

  • BMP side effects

    Ectopic bone, seroma and cost are the practical concerns. Used selectively, not as a default.

  • Rehabilitation is the second operation

    Physiotherapy, hydrotherapy and gait training - 6–18 months of it. The result depends on rehab as much as on the metal.

  • Amputation is not failure

    For some patients, a well-timed conversion to a modern prosthesis restores function faster than repeated reconstruction - a legitimate choice.

Reading your operation record

Your reconstruction record in four parts. Read the last one first.

The operation note, imaging, biological adjuncts and rehab plan - the parts a limb-reconstruction team should send in one bundle.

A UK consultant reviewing a patient record

A quiet reminder

A frame comes off when biology and images both agree, not on a date fixed in advance.

If you would like us to talk you through the record before your review, just ask.

  1. 01Indication

    Aetiology, prior surgery, infection status

    Congenital or post-traumatic, prior operations, prior fixation, infection cultures and whether the non-union is hypertrophic or atrophic.

  2. 02Technique

    Fixation, deformity correction, biology

    What was done - rod, plate or frame; how deformity was corrected; and what biology (autograft, BMP, vascularised fibula) was added.

  3. 03Rehab

    Weight-bearing and frame protocol

    The written weight-bearing schedule, frame adjustment protocol, pin-site care instructions and physiotherapy plan.

  4. 04Impression

    Expected timeline and next step

    Read this first: expected time to union, next clinic date, contingency if healing stalls, and the criteria for frame removal.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Pseudarthrosis reconstruction is usually covered when medically indicated. Length and complexity mean firm cover confirmation is done case-by-case.

Frequently asked

Everything we get asked about pseudarthrosis of the tibia.

Quick answers on cost, safety, recovery and how we compare with the NHS pathway.

  • What is pseudarthrosis of the tibia?

    A "false joint" - the tibia has failed to heal after fracture or, in congenital cases, never fully formed as intact bone. It behaves as a mobile segment rather than solid bone, and needs surgical reconstruction to unite.

  • What causes it?

    In children it is usually congenital and often associated with neurofibromatosis type 1. In adults it is usually the sequel of a tibial shaft fracture that has failed to unite - high-energy injury, open fracture, infection, smoking, poor blood supply or inadequate fixation all contribute.

  • What are the treatment options?

    Intramedullary rodding, plate fixation, Ilizarov or Taylor Spatial frame, vascularised fibular graft, and biological adjuncts such as autograft or BMP - often in combinations chosen for the specific pathology. For recurrent failure, below-knee amputation with a modern prosthesis is a legitimate and sometimes preferable option.

  • How long does treatment take?

    Reconstruction is a 6–18 month project - surgery, then months in a frame or partial weight-bearing, then rehab. Frames are typically on for 6–15 months, vascularised grafts consolidate over 6–12 months.

  • How much does private treatment cost in the UK?

    Roughly £12,000–£22,000 for rodding, £18,000–£35,000 for frame reconstruction and £28,000–£45,000 for vascularised fibular grafting - with imaging, follow-up and frame removal on top. Firm quote within one working week.

  • Is it available on the NHS?

    Yes - pseudarthrosis is a supra-regional service on the NHS with defined limb-reconstruction centres. Waiting times and geography drive many patients to private care for choice of surgeon or faster access.

  • When is amputation the better answer?

    For recurrent failure, chronic pain, poor limb function or when reconstruction would take years for a modest functional result. A modern below-knee prosthesis can restore mobility faster than continued reconstruction, and it is not a "failure" decision - it is a choice about time and quality of life.

  • Will I walk again after reconstruction?

    Most patients do. Function depends on age, aetiology, soft tissue, alignment and rehabilitation. Realistic expectations are set at the first consultation, and re-set at every stage of the pathway.

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