Phemister graft

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Phemister graft
Blausen 0096 BoneGraft.png
Illustration of an autograft harvested from iliac crest
Specialty Orthopedic 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] 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]

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References

  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. 1 2 Huitieme Congres International de chirurgie orthopedique…. International Society of Orthopaedic Surgery and Traumatology. 1961.
  5. 1 2 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. PMID   4864142.
  8. Proces-verbaux, rapports, discussions et communications particulieres. 1961.
  9. 1 2 Marcus, Enneking & Massam 1973, p. 1365.
  10. 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.
  11. 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. S2CID   49300087.
  12. 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. PMID   8326305.