Introduction: It is the present day trend to use external fixator as a temporary measure till soft tissue heals up and switch over to definitive mode of internal fixation. In our study we tried to continue the fixator as a definitive treatment and augment the bony healing by bone grafting by phemister techniquein cases with delayed union. Materials and Method: 31 opentibial fractures (Gustilo type II and III) including 5 segmental fractures, presenting 24 hours after injury were treated between 2013­ 2014 with unilateral uniplanar tubular external fixatorsand were followed up for bony union. 10 patients with delayed union (at 3 months) without pin track infection and pin loosening were operated with bone grafting by phemister technique. The graft materials harvested from autogenous Iliac crest by standard phemister technique were applied to denuded surface of the cortex across the fracture site, without disturbing the fibrous union without removing fixator. Results: 24 male and 7 female patients with open tibial fractures were included in this study with average age of 34.03 years.2 patients were lost to follow up and 4 patients had implant failure during the course of the study.Bone healing time ranged from 24­28 weeks with mean of 26.67 weeks in patients with external fixator without bone grafting.Bone healing time in patients with phemister bone grafting for delayed union ranged from 30­36 weeks with mean of 32.3 weeks. Conclusion: The results were very encouraging in our study which can be considered particularly important in our country with economically poor patients who face considerable hardship to afford for the 1st operation with external fixator and it becomes difficult for them to undergo another major operation with instrumentation.In situations where external fixators serve its purpose of stability without loosening and pin track infection and where patient compliance is good,these can be continued till there is bony union.If there is evidence of delayed union at 3 months,bone grafting by phemister technique is the gold standard proceduregiving satisfactory outcome which helps in conversion of fibrous union to osseous union.

Keywords: Phemister; Delayedunion; External Fixation; Bone Grafting; Open Fractures.