SummaryFailure of internal fixation following treatment of a fracture or fracture nonunion presents a challenging clinical situation. In certain cases, Ilizarov external fixation may be the preferred method to treat bony injuries that have failed to unite following one or more attempts at internal fixation. This paper reviews the modes of failure following internal fixation, revision internal fixation as an option, and the application of the Ilizarov method following failure of internal fixation.