1. Two cases of congenital pseudarthrosis of the tibia treated by intramedullary nailing and the application of thin osteoperiosteal grafts, have both been successful as judged by the five-year results.
2. The essential feature of the method appears to be mechanical, in so far as all angulatory strains are converted into longitudinal compression forces. The grafts used were relatively unsubstantial and only adjuvant to the nail.
3. The intramedullary nail should remain in situ either permanently or for as many years as is necessary for the tibia to hypertrophy fully.
4. Three important details of technique are: (1) that the distal end of the nail should be blunt to prevent spontaneous extrusion through the sole of the foot, (2) that the nail should be passed through the anterior aspect of the lower end of the tibia so as to traverse the tarsus in the region of the neck of the talus and so avoid penetrating the ankle joint, and (3) that at the time of operation the distal end of the nail should reside in the tarsus, so making it impossible for it to cut out of the distal fragment of the tibia.