1. Posterior bone-grafting of the tibia was used in twenty-six patients with non-union with known successful union in twenty-two.
2. Posterior bone-grafting with autogenous iliac bone for non-union of the shaft of the tibia complicated by infection or scarred soft tissues over the anterior surface of the tibia is a safe physiological procedure that results in a high incidence of union.
3. Posterior bone-grafting of the tibia should probably be given at least one trial before amputation is considered in the management of non-union with osteomyelitis of the tibia.
4. Once union is established through the posterior onlay grafts, the remainder of the fibrous union ossifies.
5. When union is established, the osteomyelitis becomes quiescent and is much easier to manage.
6. Excessive delay in an attempt to control infection before using this procedure is not advisable. Once free drainage of the osteomyelitis has been established and cellulitis has subsided, the operation may be performed safely, even in the presence of drainage anteriorly.