Modified Phemister grafting in potentially infected non-union of tibial shaft fractures.

Modified Phemister bone grafting consisting of the raising of an osteoperiosteal flap, bone petalling and a cancellous onlay graft for non-union of tibial shaft fractures was tried in 43 cases. Thirty-eight out of 43 fractures united after one bone grafting procedure, giving a success rate of 88%. The procedure can even be used in the presence of low-grade, active infection. This method of bone grafting is simple and has no significant complications. Knee motion recovers well but ankle and toe stiffness do not improve appreciably from the preoperative status. We recommend that Phemister grafting be performed early.