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Phemister graft

Phemister graft
Illustration of an autograft harvested from iliac crest
Specialty	Orthopedic surgery
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APhemister graft is a type of bone graft which uses bone tissue harvested from the patient to treat slow-healing, or delayed union bone fractures.^[1] Thus, it is a form of autotransplantation. Typically, the tissue used in the graft is cancellous bone harvested from the patient's Iliac crest and laid in strips across the fracture site.^[2][3] The use of the patient's living bone stimulates osteogenesis, the growth of bones.^[4]

The Phemister graft was first described in a paper published in 1914 by American surgeon Dallas B. Phemister, and it was named for him.^[5] Its efficacy was confirmed the same year by Canadian surgeons William Gallie and D.E. Robertson.^[5] In 1949, Phemister described a variation on the technique where the graft tissue was inserted into the base of the greater trochanter and femoral neck in order to treat osteonecrosis.^[6] A 1967 study found the original Phemister graft to be more effective than the cortical sliding graft and cancellous graft for fractures of the tibia.^[7]

The Phemister graft is preferred when a fracture demonstrates delayed union, meaning the fracture is slow to heal.^[4] Due to internal forces, the procedure is not recommended for the femur, humerus, or radius bones.^[8] It can be used for areas of bone which have undergone the first two stages of osteonecrosis.^[9] For example, in young patients, or those with sickle cell disease, it can serve as an effective long-term treatment for osteonecrosis, as long as it is performed in the early stages.^[10] In this instances, it is a more conservative treatment, and in the long term can postpone the need for a hip replacement.^[11] In the later stages of osteonecrosis (3 through 6), where the bone has begun to collapse or has fully collapsed, the Phemister graft is not recommended.^[9][12]