Nonunion with or without a late pelvic deformity remains a formidable reconstructive problem [1, 2]. For the present discussion, a nonunion is defined as a failure to achieve a union of a pelvic fracture, within six months after the time of injury, as documented by clinical and radiographic assessment. Most of the cases follow conservative management or the initial application of external fixation of a displaced and unstable injury pattern. While most of the nonunions represent a combination of a significant traumatic event, a smaller subgroup constitute pathological fractures or so-called "insufficiency fractures" of osteopenic bone [3]. By definition, the latter group represents a variety of pathological conditions including senile, post-menopausal and post-irradiation osteopenia or after the harvesting of massive autologous bone graft from the posterior ilium. Active malignancy as a factor is wholly excluded from these cases. The present report is based upon our clinical experience of two hundred cases that were managed during the past twenty year period [4]. The results constitute a summary of the observations whereupon certain recommendations for a therapeutic protocol have evolved. With the unusual nature of this clinical problem and the great diversity of presenting problems, no attempt to randomize the treatment modalities was deemed to be realistic.