Pisiform fractures

Skip to end of metadata
Go to start of metadata

Introduction

The pisiform is a sesamoid bone in the flexor carpi ulnaris tendon. Meaning "pea-shaped," this carpal bone is rare to fracture. Often pisiform fractures are with associated injuries - distal radius, hamate, or triquetrum. The mechanism of injury is usually by a direct blow to the palm when the wrist is dorsiflexed pulling the pisiform against the triquetrum.

Anatomy

With the exception of the pisotriquetral ligament and the articular surface with the triquetrum, the pisiform is entirely embedded in the tendon of the flexor carpi ulnaris. It also serves as the proximal origin of the flexor digiti minimi. The vascular supply to the pisiform is via the ulnar artery with its circumferential foramina on the nonarticular surface.
The pisiform can be approached via the palmar approach to Guyon's canal.

Presentation

Presentation is often delayed when in isolation and it can be overlooked when the pisiform fractures in association with other injuries. Point tenderness can be found on physical examination.

Diagnosis

Fractures may be missed on AP and lateral wrist films requiring a external rotation view or carpal tunnel view. When in question, a CT may be required to make the diagnosis.

Treatment

Generally, cast immobilization is warranted as a first line treatment. The cast should be in ulnar deviation with 30 degrees of flexion. Should the fracture progress to a symptomatic non-union, the pisiform can be excised.

Complications

Non-unions are excised.
Loss of grip strength occurs after excision, but the difference between hands is not significant.
Pisotriquetral joint degeneration can also be treated with pisiform excision.

Unknown macro: {corr}
Unknown macro: {springerlink}
Unknown macro: {panel}

Internet resources validated by OrthopaedicWebLinks.com

Unknown macro: {cache}
Unknown macro: {report-on}
Error formatting macro: rss: java.lang.IllegalArgumentException: Invalid uri 'http://www.orthopaedicweblinks.com/cgi-bin/owl/search.cgi?query=%content:title > url encode%&xml_feed=1': Invalid query
Unknown macro: {panel-related}
Unknown macro: {rate}
Cite this page
Unknown macro: {div}

. *

Unknown macro: {page-info}

*. _

Unknown macro: {builder-spacetitle}

. _In: OrthopaedicsOne - The Orthopaedic Knowledge Network. Created

Unknown macro: {page-info}

. Last modified

Unknown macro: {page-info}

ver.

Unknown macro: {page-info}

. Retrieved

Unknown macro: {report-info}

, from

Unknown macro: {page-info}

.

Unknown macro: {builder-hide}
Page contributions
Unknown macro: {div}

The following individuals have contributed to this page:

Unknown macro: {contributors-summary}