Phemister graft

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Phemister graft
Blausen 0096 BoneGraft.png
Illustration of an autograft harvested from iliac crest
SpecialtyOrthopedic surgery

A Phemister 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] They are considered effective for fractures in some long bones, such as the tibia.[8] Due to internal forces, the procedure is not recommended for the femur, humerus, or radius bones.[9] It can be used for areas of bone which have undergone the first two stages of osteonecrosis.[10] 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.[11] In this instances it is a more conservative treatment, and in the long term can postpone the need for a hip replacement.[12] 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.[10][13]


  1. ^ Stedman, Thomas Lathrop (2005). Stedman's Medical Eponyms. Lippincott Williams & Wilkins. ISBN 9780781754439.
  2. ^ Connolly, John F. (1995). Fractures and Dislocations: Closed Management. Saunders. ISBN 9780721626017.
  3. ^ Cantor, Paul David (1959). Traumatic medicine and surgery for the attorney. Butterworths.
  4. ^ a b Huitieme Congres International de chirurgie orthopedique…. International Society of Orthopaedic Surgery and Traumatology. 1961.
  5. ^ a b Santoni-Rugiu, Paolo; Sykes, Philip J. (2007-08-10). A History of Plastic Surgery. Springer Science & Business Media. ISBN 9783540462415.
  6. ^ Marcus, Neal D.; Enneking, W. F.; Massam, Robert A. (October 1973). "The Silent Hip in Idiopathic Aseptic Necrosis: Treatment by Bone-Grafting". The Journal of Bone and Joint Surgery. p. 1352. Retrieved 2018-09-02.
  7. ^ Anderson, Graham (November 1967). "Bone Grafting of Fractures of the Tibial Shaft with Special Reference to the Use of the Phemister Principle". ANZ Journal of Surgery. 37 (2): 159–162. doi:10.1111/j.1445-2197.1967.tb04003.x. ISSN 1445-1433.
  8. ^ Goud, Dr. S Hari Kumar (2017-10-01). "Surgical treatment for un-united bony fractures by modified phemister bone grafting". International Journal of Orthopaedics Sciences. 3 (4m): 920–922. doi:10.22271/ortho.2017.v3.i4m.125. ISSN 2395-1958.
  9. ^ Proces-verbaux, rapports, discussions et communications particulieres. 1961.
  10. ^ a b Marcus, Enneking & Massam 1973, p. 1365.
  11. ^ Pierce, Raymond O. (January 1979). "Aseptic Necrosis of the Hip in Sickle Cell Disease". Journal of the National Medical Association. 71 (1): 45–48. ISSN 0027-9684. PMC 2537226. PMID 423275.
  12. ^ Wu, Cheng-Ta; Yen, Shih-Hsiang; Lin, Po-Chun; Wang, Jun-Wen (2018-06-18). "Long-term outcomes of Phemister bone grafting for patients with non-traumatic osteonecrosis of the femoral head". International Orthopaedics. 43 (3): 579–587. doi:10.1007/s00264-018-4013-9. ISSN 0341-2695. PMID 29916000.
  13. ^ Nelson, Lynn M; Clark, Charles R (1993-06-01). "Efficacy of phemister bone grafting in nontraumatic aseptic necrosis of the femoral head". The Journal of Arthroplasty. 8 (3): 253–258. doi:10.1016/S0883-5403(06)80086-0. ISSN 0883-5403.