This article reports the results using a previously described technique of obtaining iliac crest bone graft using an acetabular reamer in a consecutive series of patients with complex acute traumatic injuries and nonunions. A retrospective chart review was conducted on a cohort of 34 consecutive patients who underwent complex orthopedic procedures for the definitive management of acute or reconstructive problem fractures and nonunions using autogenous iliac crest bone graft. All of the patients had autogenous bone graft prepared using a low speed, high torque power source and small acetabular reamers. The inner or outer wall of the ileum or the posterior superior iliac spine was reamed providing a large volume of corticocancellous graft. This material was used to pack defects in established nonunions, to augment plate osteosynthesis in segmental fractures, or to facilitate arthrodesis. Follow-up averaged 10 months (range: 6-18 months). Thirty-three out of 34 patients went on to uneventful union. No patients experienced morbidity from the graft harvest site. Specifically, no patients developed a superficial or deep wound hematoma or infection, nor did they experience persistent donor-site pain or paresthesias. Autogenous iliac crest bone graft harvest using the reaming technique provides a large volume of corticocancellous graft that has proven effective in treating complex acute nd reconstructive trauma cases.