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Twenty-nine patients with tibial non-union or delayed union were treated by onlay grafting, using long struts from the ipsilateral fibula and without disturbing the non-union site. Internal fixation and excessive dissection can be avoided. Follow-up in 28 patients showed solid healing in all; 20/28 patients united the fracture within 7 months. Removal of the fibula as a distracting force, combined with the principles of onlay grafting advocated by Phemister, is effective surgical treatment.
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