A Phemister graft is a type of

bone graft Bone grafting is a surgical procedure that replaces missing bone in order to repair bone fractures that are extremely complex, pose a significant health risk to the patient, or fail to heal properly. Some small or acute fractures can be cured wit ...

which uses bone tissue harvested from the patient to treat slow-healing, or delayed union

bone fracture A bone fracture (abbreviated FRX or Fx, Fx, or #) is a medical condition in which there is a partial or complete break in the continuity of any bone in the body. In more severe cases, the bone may be broken into several fragments, known as a '' ...

s. Thus, it is a form of

autotransplantation Autotransplantation is the organ transplantation, transplantation of Organ (anatomy), organs, Biological tissue, tissues, or even particular proteins from one part of the body to another in the same person (''wikt:auto-, auto-'' meaning "self" ...

. Typically, the tissue used in the graft is

cancellous bone A bone is a rigid organ that constitutes part of the skeleton in most vertebrate animals. Bones protect the various other organs of the body, produce red and white blood cells, store minerals, provide structure and support for the body, and ...

harvested from the patient's

Iliac crest The crest of the ilium (or iliac crest) is the superior border of the wing of ilium and the superiolateral margin of the greater pelvis. Structure The iliac crest stretches posteriorly from the anterior superior iliac spine (ASIS) to the posterior ...

and laid in strips across the fracture site. The use of the patient's living bone stimulates

osteogenesis Osteoblasts (from the Greek combining forms for "bone", ὀστέο-, ''osteo-'' and βλαστάνω, ''blastanō'' "germinate") are cells with a single nucleus that synthesize bone. However, in the process of bone formation, osteoblasts function ...

, the growth of bones. The Phemister graft was first described in a paper published in 1914 by American

surgeon In modern medicine, a surgeon is a medical professional who performs surgery. Although there are different traditions in different times and places, a modern surgeon usually is also a licensed physician or received the same medical training as ...

Dallas B. Phemister, and it was named for him. Its efficacy was confirmed the same year by Canadian surgeons

William Gallie William Edward Gallie (January 29, 1882 – September 25, 1959) was a Canadian medical educator and orthopedic surgeon. He was born in Barrie, Ontario, studied medicine at the University of Toronto and interned at The Hospital for Sick Childr ...

and D.E. Robertson. In 1949, Phemister described a variation on the technique where the graft tissue was inserted into the base of the

greater trochanter The greater trochanter of the femur is a large, irregular, quadrilateral eminence and a part of the skeletal system. It is directed lateral and medially and slightly posterior. In the adult it is about 2–4 cm lower than the femoral head.Stan ...

and

femoral neck The femoral neck (femur neck or neck of the femur) is a flattened pyramidal process of bone, connecting the femoral head with the femoral shaft, and forming with the latter a wide angle opening medialward. Structure The neck is flattened from ...

in order to treat

osteonecrosis Avascular necrosis (AVN), also called osteonecrosis or bone infarction, is death of bone tissue due to interruption of the blood supply. Early on, there may be no symptoms. Gradually joint pain may develop which may limit the ability to move. Co ...

. 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 The tibia (; ), also known as the shinbone or shankbone, is the larger, stronger, and anterior (frontal) of the two bones in the leg below the knee in vertebrates (the other being the fibula, behind and to the outside of the tibia); it connects ...

. The Phemister graft is preferred when a fracture demonstrates delayed union, meaning the fracture is slow to heal. Due to internal forces, the procedure is not recommended for the

femur The femur (; ), or thigh bone, is the proximal bone of the hindlimb in tetrapod vertebrates. The head of the femur articulates with the acetabulum in the pelvic bone forming the hip joint, while the distal part of the femur articulates with ...

humerus The humerus (; ) is a long bone in the arm that runs from the shoulder to the elbow. It connects the scapula and the two bones of the lower arm, the radius and ulna, and consists of three sections. The humeral upper extremity consists of a roun ...

, or

radius In classical geometry, a radius ( : radii) of a circle or sphere is any of the line segments from its center to its perimeter, and in more modern usage, it is also their length. The name comes from the latin ''radius'', meaning ray but also the ...

bones. It can be used for areas of bone which have undergone the first two stages of osteonecrosis. For example, in young patients, or those with

sickle cell disease Sickle cell disease (SCD) is a group of blood disorders typically inherited from a person's parents. The most common type is known as sickle cell anaemia. It results in an abnormality in the oxygen-carrying protein haemoglobin found in red blo ...

, it can serve as an effective long-term treatment for osteonecrosis, as long as it is performed in the early stages. In this instances, it is a more conservative treatment, and in the long term can postpone the need for a

hip replacement Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant, that is, a hip prosthesis. Hip replacement surgery can be performed as a total replacement or a hemi (half) replacement. Such joint replacement o ...

. 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.

References

{{Bone, cartilage, and joint procedures Tissue transplants Orthopedic surgical procedures