Nonunion of diaphyseal tibial fractures is a complex and challenging process which is difficult to resolve for surgeons and patients in orthopedic practice. Successful outcomes may be achieved by a thorough examination of the patient, and the preparation of a very extensive pre-surgery planning. It is critical to make a conclusive evaluation on the presence of infections, and also to identify whether the nonunion is hypertrophic or atrophic. The factors leading to non-union should be assessed with concomitant pathologies of the patient which may have a negative impact on the process, and controlled prior to initiation of the treatment. The designation of the implant to be used for stabilization purposes (e.g., plate-screw, intramedullary nail, or external fixator), procurement of all sizes as well as availability of alternative options play a key role in the success of the treatment outcome. In cases requiring grafting, the kind of graft to be used and the area in the patient where it will be used in the procurement of an autograft should be planned. The whole process should be shared with the patient, and the possibility of multiple procedures should be explained. In addition to their surgical treatment, patients should be carefully followed up in terms of pain control, and their social status and economic conditions (e.g., loss of workforce). Currently, despite advancing technology, it should be considered that the treatment process may be strenuous and stressful for the physician, and the patient and the amputation option should also be discussed. According to the current literature, success rates are remarkably high in diaphyseal tibial non-unions.