ABSTRACT BACKGROUND: Aseptic tibial non union after initial locked intramedullary nail fixation is not common. There are many techniques that deal with this complication. Which is the best method is controversial. An algorithm is suggested to help choice of the most suitable technique for each case. MATERIALS AND METHODS: In the period from august 2010 to august 2014, 29 cases of aseptic tibial non union after locked intramedullary nail fixation were treated according to a suggested algorithm based on the location of non union, percent of bone contact and nail diameter relative to the diameter of the medullary canal. The mean follow up period was 14 months. Sepsis was excluded before active management of any case. RESULTS: All cases had united but with variable time differed according to the method of treatment and the underlying pathology. The complications were few and related mainly to cases treated with the augmentation plate. CONCLUSION: Successful treatment of aseptic tibial non union after locked intramedullary nail fixation depends on proper identification of the exact etiology of the non union whether it was a stability problem or a biological problem or both conditions.