Non-healing fractures and bone defects are often due to improper fracture treatment or due to post-fracture infection. The common treatment for both is bone grafting, but because of a series of local pathological changes in the non-healing fracture and bone defect (such as sclerosis of the fracture end, closure of the bone marrow cavity, skin defects, multiple soft tissue scars, and poor blood flow); it makes treatment more difficult. Treatment is even more difficult if there have been multiple previous surgeries or extensive recurrent infections. In recent decades, the success rate of bone grafting has improved due to the improvement of technology, but there are still some cases of failure, the reasons for which are closely related to the shortcomings in treatment (such as soft tissue scar not properly treated, poor blood flow around bone graft, insufficient amount of bone graft, poor contact, etc., inadequate internal and external fixation or insufficient time, postoperative infection, etc.) and must be paid attention to and prevented. The causes of non-healing fractures and bone defects and local pathological changes vary, so it is necessary to study them individually and in detail before surgery to determine effective measures and strive for success through a single operation. The important conditions for successful bone grafting are as follows: 1. Complete cure of local bone and soft tissue infections to eliminate the chance of potential infection and recurrence of postoperative infection. 2.Localized skin and soft tissue scars, if any, should be excised first and repaired with appropriate skin flap graft. 3.The scar tissue in and around the sclerotic area of the fracture end must be fully excised and the bone marrow cavity must be drilled through to create a graft bed with rich blood flow and active growth force around the bone graft to ensure successful bone grafting. 4.The number of bone graft should be sufficient, and there should be extensive and close contact between the transplanted bone and the recipient bone, and a firm internal fixation should be applied, preferably using fresh autologous cortical bone for bone grafting, plus cancellous bone inter-end grafting. 5, the scope of external fixation should be sufficient and the time should be adequate. Functional exercises should be performed during fixation to improve local blood circulation and promote healing. 6.Strict aseptic technique to prevent wound infection. [In addition to the preoperative preparation for bone grafting and bone extraction, the following points should be noted: 1. Patients with non-healing fractures and bone defects, most of whom have been bedridden for a long time, repeatedly operated on, repeatedly infected, and in poor general condition, should be improved before surgery; and functional exercises should be performed under guidance to improve heart and lung function and enhance endurance for surgery; and to improve muscle strength, joint function, and osteoporotic decalcification . 2.People with a history of previous infection should be treated with antibiotics before surgery to prevent recurrence of infection. 3, the limbs shortened by bone defects, especially the lower limbs, should be first traction 1 to 2 weeks to restore limb length. [Surgical steps] 1. Position, the position should be selected according to the site of history and the site of bone extraction. (1) Reveal the sclerotic fracture end (2) Remove the sclerotic bone 2. Incision and fracture end exposure. Choose an incision with adequate exposure and little damage at the lesion site, and its length should be based on the length of the grafted bone. The fracture end should be exposed from the muscle gap as much as possible to reduce bleeding; and pay attention to protect the blood vessels and nerves around the incision to avoid injury. The fracture end should be exposed in such a way that the sclerotic end can be resected and the graft plate placed and fixed, and the attachment of the surrounding muscles to the bone should be preserved as much as possible. The peeling of the periosteum should be minimized so that the exposed bone surface is similar to the area of the bone graft, and the attachment of the periosteum and soft tissues to the recipient bone should be preserved as much as possible to preserve good blood flow and osteogenic function. 3. Soft tissue and fracture end treatment. The main purpose is to create a blood-rich environment. Soft tissue scar should be completely excised down to normal tissue. Sclerotic bone at the fracture end should be excised with a wire saw or bone knife until the bulk of the section is normal cortical bone rich in blood flow (generally sclerotic cortical bone is hard, ivory-colored, thickened, and without blood flow). Then, the closed bone marrow cavity is drilled through with a hand crank drill or a small round chisel. (3) Drill through the bone marrow cavity (4) Chisel the cortical bone surface and implant the bone in the marrow cavity (5) Reset the fracture end with a bone-holding forceps under manual traction (4) Reset with bone graft. If the bone graft is planned to be used for internal fixation, the cortical bone in contact with the bone graft at both ends of the fracture should be chiseled flat so that the bone graft and the recipient bone are closely joined. At this point, the surgical steps before bone grafting are completed, and repositioning and bone grafting are feasible. To promote endosteal osteogenesis, a small piece of cancellous bone can be inserted into the medullary cavity. Then, the ends of the fracture are clamped with a bone-holding forceps and repositioned with an assistant in traction, and the other end of the intramedullary bone graft is inserted into the contralateral medullary cavity. In addition to the alignment of the fracture surface, special attention should be paid to the alignment of the axis in order to avoid the formation of rotational deformity. After repositioning, someone should maintain the position of the limb to prevent the fracture end from being displaced and breaking the intramedullary bone graft. The cortical bone plate, which has been cut and is waiting to be grafted, should be placed on the bone surface of the recipient bone (the length of the plate should generally be 5 times the diameter of the recipient bone, ensuring that each end is in contact with the recipient bone surface for more than 3 cm). After the fracture surface should be aligned as much as possible in the upper extremity to eliminate the bone defect, and after the length of the limb should be restored as much as possible in the lower extremity, the recipient bone and the grafted cortical bone plate should be fixed together with a fracture fixator and secured with four to six screws. Finally, the bone defect gap and the area around the grafted bone plate are filled with a large number of small pieces and strips of cancellous bone to eliminate all voids. (6) Supraosseous graft with cortical bone plate (7) Gap around bone defect area and bone plate filled with cancellous bone