Management of patients with deformities due to congenital pseudarthrosis of the tibia continues to be controversial. The use of free vascularized fibular grafts in the reconstruction of these deformities appears to be successful in this patient population but is not without potential for significant complications. Long-term evaluation, at least to skeletal maturity, is necessary to judge the success of any procedure done for any pediatric patient. This case illustrates the natural history of the vascularized free fibular graft for congenital pseudarthrosis of the tibia in a young child. Complications of this treatment modality did occur, including probable recurrence and fracture at almost 11 years post-index procedure. However, stable reconstruction leading to fracture union was achieved, and the patient has resumed full activities with little residual deformity.