Pisiform Fracture

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Topic updated on 02/08/14 4:07pm
Introduction
  • The pisiform is a sesamoid bone located within the FCU tendon
    • origin for abductor digiti minimi
  • Epidemiology
    • incidence
      • 1%-3% of carpal fractures
  • Mechanism
    • fall on outstretched hand
  • Associated conditions
    • 50% of pisiform fractures occur with distal radius, hamate, or triquetral fractures
Anatomy
  • Function
    • pisiform mechanically contributes to the stability of the ulnar column by
      contributes to the stability of the ulnar column by preventing triquetral subluxation
    • acts as a fulcrum for forces transmitted from the forearm to the hand.
      preventing triquetral subluxation and also acts as a
      fulcrum for the powerful forces that are transmitted
      from the forearm to the hand.
Presentation
  • Symptoms
    • ulnar sided wrist pain
  • Physical exam
    • point tenderness
Imaging
  • Radiographs
    • recommended views
      • pisotriquetral joint is best seen in lateral view with 30 deg of wrist supination or utilizing the carpal tunnel view
  • CT
    • best seen on CT scan
Treatment
  • Nonoperative
    • immobilization
      • indications
        • first line of treatment
        • short arm cast with 30 degrees of wrist flexion and ulnar deviation for 6 weeks
      • outcomes
        • patients that sustain fracture of pisiform most often go on to heal without posttraumatic osteoarthritis
  • Operative
    • pisiformectomy
      • indications
        • painful nonunion 
      • outcomes
        • studies show a pisiformectomy is a reliable way to relieve this pain and does not impair wrist function

 

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Qbank (1 Questions)

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(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

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Lam KS, Woodbridge S, Burke FD
J Hand Surg Br. 2003 Feb;28(1):69-72. PMID: 12531672 (Link to Pubmed)
2/8/2014
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