The intervertebral disc is characterized by a tension-resisting annulus fibrosus and a compression-resisting nucleus pulposus composed largely of proteoglycan. The most important function of the annulus and nucleus is to provide mechanical stability to the disc. Degenerative disc disease in the lumbar spine is a serious health problem. Although the three joint complex model of the degenerative process is widely accepted, the etiological basis of this degeneration is poorly understood. With the recent progress in molecular biology and modern biological techniques, there has been dramatic improvement in the understanding of aging and degenerative changes of the disc. Knowledge of the pathophysiology of the disc degeneration can help in the appropriate choice of treatment and to develop tissue engineering for biological restoration of degenerated discs.

We reviewed 15 patients with femoral nonunion after interlocking intramedullary nailing treated with plate augmentation and bone grafting with the nail in situ. The mean time from primary nailing to plate augmentation and bone grafting was 10 months. At the time of presentation, the patients had undergone an average of 1.6 operations from the time of their original injury. To achieve stability of the fracture, we applied an AO plate on the lateral aspect of the femur. The retained nail maintained alignment of the fracture, and plating did not require an extensive surgical approach. In all patients, there was visible motion at the fracture site; however, the motion disappeared after plate augmentation. All patients achieved radiological solid union at an average of 7.2 months.

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