Pisiform Fracture

Topic updated on 01/26/15 7:25pm
  • A rare carpal fracture
  • Epidemiology
    • incidence
      • <1% of carpal fractures  
      • rare injury and often missed
  • Pathophysiology
    • mechanism of injury
      • usually occurs by direct impact against a hard surface
      • fall on outstretched hand 
  • Associated conditions
    • 50% occur as isolated injuries
    • 50% occur in association with other carpal fractures or distal radius fractures
  • Pisiform Bone
    • osteology
      • pea shaped, seasmoid bone
    • location 
      • most ulnar and palmar carpal bone in proximal row
      • located within the FCU tendon
    • function
      • contributes to the stability of the ulnar column by preventing triquetral subluxation
  • Symptoms
    • ulnar sided wrist pain after a fall
    • grip weakness
  • Physical exam
    • inspection
      • hypothenar tenderness and swelling
      • rule out associated injury to other carpal bones and distal radius
  • Radiographs 
    • recommended views
      • AP and lateral views of wrist  
    • additional views
      • pronated oblique and supinated oblque views
      • carpal tunnel view
    • findings
      • best seen with 30 deg of wrist supination or utilizing the carpal tunnel view
  • CT 
    • indications  
      • may be required to delineate fracture pattern and determine treatment plan
  • MRI
    • indications
      • suspected carpal fracture with negative radiographs
    • findings
      • may show bone marrow edema within the pisiform indicating fracture
  • Nonoperative
    • early immobilization
      • indications
        • first line of treatment 
      • technique
        • short arm cast with 30 degrees of wrist flexion and ulnar deviation for 6-8 weeks
      • outcomes
        • most often go on to heal without posttraumatic osteoarthritis
  • Operative
    • pisiformectomy
      • indications
        • severely displaced and symptomatic fractures
        • painful nonunion 
      • outcomes
        • studies show a pisiformectomy is a reliable way to relieve this pain and does not impair wrist function
  • Malunion
  • Non-union
  • Chronic ulnar sided pain
  • Decreased grip strength


Please Rate Educational Value!
Average 3.0 of 16 Ratings

Qbank (1 Questions)

(OBQ07.102) A 28-year-old man fell while ice skating 6 months ago and has had ulnar-sided wrist pain ever since. The patient's lateral radiograph of the wrist is shown in Figure A and a CT scan is shown in Figure B. What is the most appropriate treatment? Topic Review Topic
FIGURES: A   B        

1. Scapholunate ligament repair
2. Excision of the hook hamate
3. Excision of the pisiform
4. Open reduction internal fixation of the hamate
5. Open reduction internal fixation of the pisiform



Topic Comments