Objective:To explore and compare the results of the treatment of hypertrophic nonunion of limb fractures by using extracorporeal shock wave therapy (ESWT) or traditional iliac autograft and internal fixation. Method: A prospective randomized control study was designed. A total of 72 patients were recruited from June 2012 to June 2013 according to inclusion-exclusion criteria, and randomly divided into two groups. Group A referred to using ESWT with 39 cases for 3 times with interval of 7 days, while 33 cases in Group B treated with traditional iliac autograft and internal fixation. The baseline of the two groups had no significant difference (P > 0.05). Mean follow-up was 18.2 months. The appearance time of callus, the final healing time of fractures, the cost of treatments and postoperative complications were record. Results: No significant difference was found in the final cure rates of the two groups (P > 0.05). Group B presented earlier in the appearance time of callus (P < 0.05), however, the final healing time of fractures showed no significant difference between the two groups (P > 0.05). Group B showed higher cost of treatment(P < 0.05). Conclusion: Treatment of hypertrophic nonunion of fractures by ESWT is safe and effective with advantages of minimal invasive, high cure rate, low expense and less complications. ESWT is suggested to be used for the hypertrophic nonunion patients before traditional iliac autograft and internal fixation.