Observations were made on the growth rate of proximal and distal tibial epiphyseal growth plates in three children treated by free vascularized fibular grafts for congenital pseudarthrosis of the tibia. Postoperative measurements show that the distal tibial epiphysis can grow faster than the proximal epiphysis; the successful transfer of vascularized fibula may increase blood supply to the distal tibial epiphyseal plate, thus stimulating its growth.