After using methods commonly employed for nonunion, with varying degrees of success, and after observing the method of Henderson, approximately twenty years ago I began to use the massive onlay graft. It was apparent that two factors are necessary to obtain a high percentage of excellent results in cases of nonunion: (1) absolute fixation and (2) promotion of osteogenesis (callus formation). In 1932 I presented in the Archives of Surgery an analysis of 125 operations. Since that time 136 additional operations have been performed, and a supplementary report is appropriate.
There is no arbitrary time for consolidation of a fracture; much depends on the degree of injury to the extremity, the soft structures involved and the efficiency of treatment. Often when union has not occurred after the lapse of sufficient time, more efficient fixation, with or without functional use of the part, may induce solidification. An ununited fracture is one