Fracture Dislocation of the Pisiform Bone in 14-Year-Old Boy-A Case Report.

We present the case of a 14-year-old patient who suffered fracture dislocation of the pisiform bone (PB) along with fractures of the scaphoid, proximal radius, and proximal phalanx of the thumb due to high-energy trauma directly to the extended wrist. This combination of fractures has not been previously reported in the literature. Currently, there is no consensus in the literature regarding the optimal treatment approach for such cases. In our management, initial attempts at closed and open reduction were unsuccessful, leading to the decision for primary pisiformectomy. Our report includes a follow-up of 3.5 years, demonstrating a very good outcome. Based on this case and a few similar published cases, primary pisiformectomy appears to be a viable and well-accepted option, particularly among young patients. Additionally, we conducted a review of radiographic criteria and management strategies for this specific injury and related conditions.

An uncommon case of traumatic pisiform dislocation with triquetral fracture.

The pisiform is a sesamoid bone that acts as one of the key medial stabilizers of the wrist. We present a case of a 35-year-old gentleman who presented with medial wrist pain following a fall while rollerblading. Radiographs and Magnetic resonance imaging (MRI) revealed a rare combination of an acute pisiform dislocation with associated triquetral fracture. Subsequently, he was successfully treated with excision of the pisiform. Pisiform dislocation is an uncommon injury and can easily be missed in an acute emergency presentation. Therefore, it is important to be aware of the characteristic imaging appearance to avoid a delay in diagnosis and treatment.

Pisiform dislocation.

A pisiform dislocation is an uncommon injury which can lead to significant morbidity if missed. The literature regarding pisiform dislocation is limited and largely from case reports. In this case, we present a 51-year-old right-hand dominant male who sustained the injury after a fall. He attended the emergency department on the same day and a closed reduction was able to be performed under a haematoma block. On review in follow-up clinic the patient's symptoms had completely resolved.

Locked Traumatic Pisiform Dislocation: A Case Report.

CASE: A 32-year-old man presented to the emergency department with several carpal bone fractures and a locked distal pisiform dislocation after trauma. Treatment consisted of open surgical and reduction, osteosynthesis with a single Kirschner wire, and ligament repair. The patient's functional outcome was excellent, and his Mayo wrist score was 90 at 36 months after injury. CONCLUSIONS: Pisiform dislocations may be difficult to diagnose because anteroposterior and lateral radiographs may not be sufficient to visualize the injury. A 30° semisupinated wrist x-ray and computed tomography can be helpful. A satisfactory clinical result may be achieved if distal pisiform dislocations are detected early and managed surgically with open reduction and ligament repair.

Suture Fixation Using Polyblend Polyethylene Sutures With Hydroxyapatite Block for an Intra-articular Depression Fracture of the Pisiform Bone.

Few cases in which open reduction and internal fixation was performed for displaced pisiform fractures have been reported. We present a new surgical technique for the treatment of depressed intra-articular pisiform fractures. First, the depressed fragment was reduced by pushing the bone tamp. Then, the fracture void resulting from the reduction of the depressed fragment was filled with a shaped hydroxyapatite block. Finally, the fragments were sutured using braided polyblend polyethylene sutures. The postoperative radiography could achieve a well-reduced articular facet, and this procedure had a good clinical outcome.

Fracture dislocation of the pisiform bone in children: a case report and review of the literature.

Simultaneous fracture and dislocation of the pisiform is a rare condition, and only two cases have been reported in children. We retrospectively collected and reviewed clinical and radiographic data of a child with a type II Salter-Harris fracture of the distal radius, associated with fracture dislocation of the pisiform. In addition, we performed a systematic review of the literature available to date.

The effect of pisiform excision on wrist function.

PURPOSE: To investigate the effect of pisiform excision on wrist function compared with age- and sex-matched control subjects. METHODS: The authors evaluated the charts of 11 consecutive patients who had undergone pisiform excision. Nine of these patients could be included and clinically examined, and results were compared with 9 matched controls. Measurements included range of motion, strength measurements, neurological examination, and questionnaires. RESULTS: Extension in the operated wrist was reduced in patients compared with controls. The Disabilities of the Arm, Shoulder, and Hand and Michigan Hand Outcomes Questionnaires were significantly different between patients and controls. All other entities were equal between groups. Subjectively, patients experienced impairments in function of the operated wrist, but these could not be identified objectively. CONCLUSIONS: Although great care must be taken in handling the surrounding soft tissue, pisiform excision is a well-tolerated, safe treatment for pain in the pisotriquetral joint resulting from arthrosis and not controlled by nonsurgical means. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.

Pisiform excision for pisotriquetral instability and arthritis.

PURPOSE: To evaluate wrist strength and kinematics after pisiform excision and preservation of its soft tissue confluence for pisotriquetral instability and arthritis. METHODS: We evaluated 12 patients, (14 wrists) subjectively and objectively an average of 7.5 years after pisiform excision. Three additional patients were interviewed by phone. Subjective evaluation included inquiry about pain and satisfaction with the treatment. Objective testing included measuring wrist flexion and extension range of motion, grip strength, and static and dynamic flexion and ulnar deviation strengths of the operative hand compared with the nonsurgical normal hand. Four patients had concomitant ulnar nerve decompression at the wrist. RESULTS: All patients were satisfied with the outcome. Wrist flexion averaged 99% and wrist extension averaged 95% of the nonsurgical hand. Mean grip strength of the operative hand was 90% of the nonsurgical hand. Mean static flexion strength of the operative hand was 94% of the nonsurgical hand, whereas mean dynamic flexion strength was 113%. Mean static ulnar deviation strength of the operative hand was 87% of the nonsurgical hand. The mean dynamic ulnar deviation strength of the operative hand was 103% of the nonsurgical hand. CONCLUSIONS: Soft tissue confluence-preserving pisiform excision relieved pain and retained wrist motion and static and dynamic strength. Associated ulnar nerve compression was a confounding factor that may have affected outcomes. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Carpal fractures.

Carpal fractures are exceedingly rare clinical entities and are often associated with concomitant injuries. In this review, we focus on fractures of the carpus, excluding the scaphoid, and provide an update on the current consensus as to mechanism, diagnosis, management, outcomes, and complications after such injuries.

Pisotriquetral joint disorders: an under-recognized cause of ulnar side wrist pain.

Pisotriquetral joint disorders are often under-recognized in routine clinical practice. They nevertheless represent a significant cause of ulnar side wrist pain. The aim of this article is to present the main disorders of this joint and discuss the different imaging modalities that can be useful for its assessment.

Conservative treatment of the isolated dislocation of the pisiform bone.

We report isolated dislocation of the right pisiform bone dislocated distal and medial to the triquetrum bone in a young adult after a fall. Manipulation and closed reduction under intravenous regional anaesthesia resulted in full functional recovery and a good radiological outcome.

El pisiforme, una nueva zona de desencadenamiento segmental de los contenidos cinesiológicos de la mano en la terapia Vojta. Aplicaciones en rehabilitación / The pisiform, a new segmental triggering point of the kinesiology contents of the hand in Vojta therapy. Its applications in rehabilitation

Objetivo Estudiar el efecto de la estimulación del hueso pisiforme en la activación del patrón segmental de la mano en los complejos de coordinación globales de la locomoción refleja de Vojta. Material y método Ensayo clínico cruzado, con 32 sujetos adultos (23,56 años, desviación estándar 2,96). Muestreo causal. Criterio de inclusión: sujetos sanos, sin conocimiento de la intervención. Se mide mediante electromiografía de superficie la contracción en microvoltios, no voluntaria, del músculo extensor común de los dedos (ECD), estimulando la zona pisiforme aislada, en contraste y combinación con otras zonas de la LR. Resultados La estimulación del pisiforme activa la contracción (11,73 μV) significativamente (p = 0,00) del ECD en relación con la zona estiloides (4,83 μV), en el patrón del volteo reflejo (VR), siendo menor en el patrón de la reptación refleja (RR) (4,46 μV), p = 0,015 en relación con la zona estiloides (2,49 μV). Además activa significativamente (p = 0,00) componentes cinesiológicos del patrón global en el segmento opuesto al estimulado (9,47 μV). Asimismo, la medición en sedestación (9,45 μV) muestra diferencias significativas con el estado de reposo (p = 0,00).Conclusiones La estimulación aislada de la zona pisiforme en el complejo de coordinación del VR activa el patrón segmental de la mano en ambos lados. Con esta zona, el terapeuta puede disponer de nuevas aferencias que emplear en la clínica cuando el patrón segmental de la mano no es accesible desde otras zonas. No obstante, es necesario estudiar su potencial terapéutico en la rehabilitación de pacientes con alteraciones en la función manual (AU)

Objective: To study the effect of pisiform bone stimulation in the segmental pattern of the hand in the overall coordination complexes of Vojta reflex locomotion therapy. Material and method: A clinical trial was conducted with 32 healthy adults (average 23.56years, standard deviation 2.96 years) with causal sampling. Inclusion criteria: healthy subject blind to the intervention type. Measurement was by surface electromyography of non-voluntary contraction in microvolts of the fingers extensor muscle (ECD), stimulating the pisiform area separately in contrast and combination with other LR areas. Results: Pisiform stimulation activates significant contraction (11.73 V), p = 0.00 of the ECD in relation with the styloid area (4.83 V) in the reflex rolling pattern (RR), this being lesson the reflex creeping (RC) (4.46 V), p = 0.015 compared to the styloid area (2.49uV). It also significantly activates (p = 0.00) the kinesiological main pattern components of the opposite stimulated segment (9.47uV). The measurement in the sitting position (9.45 V) also shows significant differences with the resting state (p = 0.00).Conclusion: Isolated stimulation of the pisiform area in the reflex rolling pattern activates the segmental pattern on both sides of the hand. With this, the therapist has new aids that canbe used during work when the segmental hand pattern is not accessible from other points. However, its potential therapeutic in rehabilitation with hand function alterations needs to be studied (AU)

Open pisiform fracture: excision or internal fixation?

A 53-year-old man presented with an open fracture of the pisiform after a fall on his left wrist. Treatment of the patient presented a dilemma between excision of the proximal fragment and internal fixation. The patient underwent internal fixation with a 2.5 cortical screw. At 6 months follow-up the fracture appeared fully consolidated with full functional recovery of the wrist.

Fractures of the hamate and pisiform bones.

Osseous injuries to the ulnar aspect of the carpus are increasing in frequency because of greater participation in sporting activities. Hamate body fractures are subdivided into coronal, sagittal oblique, proximal pole, and medial tuberosity fractures. Successful treatment of coronal fractures requires identification and treatment of associated disruption or instability of the ulnar 2 carpometacarpal joints. Displaced hamate hook fractures are optimally treated with early excision to avoid sequelae such as flexor tendon and nerve injury, and to allow early return to activity. Undisplaced pisiform fractures are managed nonoperatively, whereas displaced fractures and nonunions are treated by simple excision.

Pisotriquetral arthrodesis for pisotriquetral instability: case report.

A 22-year-old professional downhill mountain bike rider developed increasing posttraumatic pisotriquetral instability. To preserve full function of the pisiform bone, we performed pisotriquetral arthrodesis using a Herbert screw. Ten months after the splint was removed, the patient was free of symptoms and returned to professional downhill mountain biking without limitations. This uncommon method seems to be a feasible treatment strategy and can be recommended in high-demand patients.