Pisiform Fracture

Topic updated on 07/03/14 10:18am
  • 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
  • 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.
  • Symptoms
    • ulnar sided wrist pain
  • Physical exam
    • point tenderness
  • 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
  • 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)

(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



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