For the difficult nonunion, such as large bone defect, severe osteoporosis, nonunion with repeated operations, or nonunion at the metaphyses, authors performed modified dual onlay bone graft. One side was appied wiht plate for the stabilization of the nonunion site and the other side with cortical bone from tibia for the osteogenecity.

We performed this operation in five cases and all of them had good results. This method is believed to be superior in its stronger stabilization and less donor site problem, however, with sufficient osteogenecity, to the original dual onlay graft. Moreover, even to the metaphyseal area, plate can be contoured to the bone shape, which makes this operation applicable to all areas of bone.