Introduction: Tibial fracture union is a lengthy process that begins with the initial trauma and continues for years following clinical and radiological union until the bone regains its previous structure and function. Delayed union and non-union are two typical issues that any surgeon dealing with fracture healing may encounter. Aim/Objective: To evaluate how autogenous bone marrow injection affects clinical and radiographic evidence of union in tibial delyed union fractures. Methodology: The study involved patients admitted with tibial shaft fractures that had not healed. Bone marrow is aspirated from the anterior iliac crest under local anesthetic using a specific bone marrow aspiration needle into heparinized syringes to avoid clotting. Bone marrow is aspirated from various locations to avoid aspirating the blood. Under fluoroscopy supervision, the aspirate is injected percutaneously into and around the fracture site. Results: There were 95 patients with tibial shaft fractures that had not yet healed. There were 66 males and 29 females. The mid-shaft of the tibia was affected in 52 (54.7%) patients, followed by the distal tibia in 25 (26.3%) patients and the proximal tibia in 19 (20%) patients. A total of 36 patients were smokers, while 59 patients were nonsmokers. The right side of the limb was involved in 60 (63.2%) of patients, while the left side was involved in 35 (36.9%). The union rate for delayed tibial fractures was 96.8%. Conclusion: While the retained hardware appears robust and stable, percutaneous autogenous bone marrow injection is a somewhat invasive, safe and affordable therapeutic option for tibial delayed unions. Smoking is a major controllable risk linked to delay fracture healing. After tibia fractures or documented delayed union, smokers__ampersandsignrsquo; bones take longer to fuse