Surgical Management of Pisiform Bone Deformity Associated with Tendonitis of Flexor Carpi Ulnaris

PURPOSE: This study was performed to investigate the degree of symptom improvement after removal of bone fragment in patients with deformed pisiform bone associated with tendonitis of flexor carpi ulnaris. METHODS: Pisiform bone fragment removal was performed in 12 patients who had failed conservative treatment from January 2008 to December 2011. They were followed up at 2 weeks, 1 month, 2 months, 6 months, and 12 months after surgery. Their symptoms were assessed with Green score. RESULTS: Eleven of 12 patients who underwent bone fragment removal showed symptom improvement. Symptoms worsened in 1 patient due to pain and restricted range of motion caused by postoperative scar. CONCLUSION: The results of this study suggest that removal of bone fragment may be an effective treatment in patients with tendonitis of flexor carpi ulnaris accompanied by pisiform bone deformity whose pain does not improve with conservative management.

Long-term effects of vascularized pisiform transfer for Kienb(o)ck's disease / 中华骨科杂志

Objective To evaluate the long-term efficacy of vascularized pisiform transfer for patients with Kienb(o)ck's disease in Lichtman stages Ⅲ-Ⅳ. Methods Eleven patients were reviewed to analyze results after lunate resection and vascularized pisiform transfer for Lichtman stages Ⅲ and Ⅳ. There were six men and five women. Age ranged from 20 to 67 years with a average of 41.0±14.3 years. According to Lichtman stage. There were 4 cases in stage Ⅲa, 5 cases in stage Ⅲb, and 2 cases in stage Ⅳ. Assessment criteria included subjective assessment of pain, visual analogue scale (VAS), range of motion (ROM), grip power,Cooney wrist score and radiographic changes on each follow-up visit. The radiographic changes including pis iform bone location, shape, sclerosis change, osteoarthritis, carpal height ratio, Nattrass index, Radioscaphoid angle and ulnar variance were recorded. Results The follow-up periods of all of cases were 61-202 months,with an average of 104.1 months. Pain had improved in 10 patients and disappeared in 7 cases. The VAS score was 2.2±1.9 at follow-up visit. Range of motion of injured wristw as only 65.3% of opposite side. Grip power was 84.3% of the contralateral hand. According to Cooney score, the results were excellent in 1 case, good in 7cases, fair in 2 cases and poor in 1 case, with the excellent and good rate of 72.7%. Radiologically, 8 cases had normal position of the pisiform bone, 2 had volar displacement and 1 had ulnar displacement which leaded to widen scaphopisiform space. Six pisiform bones had normal trabecular structure, three had degenerative changes. Bone sclerosis was seen in 2 cases and osteoarthritis was found in 3 patients. Compared with radiographic parameter before surgery, carpal height ratio and Nattrass index significantly lowered and radioscaphoid angle significantly increased. Conclusion Lunate resection and vascularized pisiform transfer is an effective method for Kienb(o)k′s disease in stages Ⅲ-Ⅳ. Although carpal collapse appeared postoperatively,the results show high patient satisfaction and good function after vascularized bone transplantation.