Nonunions of medial malleolus (MM) are a relatively rare entity, especially after previous surgical stabilization. These are routinely managed with compression screws and autografts. Usage of tension band wiring (TBW) is very common in acute MM fractures; however, its usefulness in nonunion scenarios has been sporadically reported. We treated a 7-year-old MM nonunion with TBW, which united well after 5 months of follow-up. We present this technique highlighting its critical steps and additionally review previous cases that were treated similarly with good outcomes.