Introduction Since the nature of complications following the harvesting of bone from the tibia in children is not well documented in the literature, we undertook this study in order to determine the frequency and nature of donor site complications following the harvesting of large cortical strut grafts from the tibial diaphysis in children. Materials and methods During the past 19 years, tibial cortical grafts were harvested from 47 children on 77 separate occasions, mainly for the treatment of congenital pseudarthrosis of the tibia. The technique of graft harvesting was identical in every case. Case records of these 47 children were reviewed. Forty of these children were reviewed at a mean period of 5.5 years.Results No immediate post-operative complications were noted and, at follow-up, apart from mild bowing of the anterior cortex of the tibia, no deformities were encountered. The tibial cortex reformed completely and this facilitated repeat graft harvesting when required. The only major complication was a stress fracture of the tibia in one boy. Conclusion Harvesting cortical bone graft from the tibia is simple and is fraught with negligible morbidity.