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Pisiform Fracture
From WikiSM
Contents
Other Names
- N/A
Background
Pathophysiology
- Mechanism is typically direct blow, less commonly from repetitive trauma
- Sudden contraction of the Flexor Carpi Ulnaris may create an avulsion-type injury
- Associated injuries
- 50% isolated
- 50% associated with other Carpal Fractures, Distal Radius Fracture
Risk Factors
- Unknown
Differential Diagnosis
Carpal Bone Fractures
- Scaphoid Fracture
- Lunate Fracture
- Triquetrum Fracture
- Pisiform Fracture
- Trapezium Fracture
- Trapezoid Fracture
- Capitate Fracture
- Hamate Fracture
Differential Diagnosis Wrist Pain
- Fractures
- Dislocations
- Wrist Dislocation (Radiocarpal and/or Ulnocarpal)
- Carpometacarpal Joint Dislocation
- Distal Radioulnar Joint Dislocation
- Lunate Dislocation
- Perilunate Dislocation
- Instability & Degenerative
- Tendinopathies & Ligaments
- Neuropathies
- Pediatric Considerations
- Distal Radial Epiphysitis (Gymnast's Wrist)
- Torus Fracture
- Arthropathies
- Cartilage
- Vascular
- Other
Clinical Features
- General: Physical Exam Wrist
- Pain, tenderness under the Hypothenar Muscles
- Neuropathic symptoms in Ulnar Nerve distribution can occur
Evaluation
Radiographs
- Standard Radiographs Wrist
- 3 view initially
- Not very sensitive
- May require 30° supinated view, 45° supinated oblique or carpal tunnel view
CT
- Better evaluate fracture pattern, management plan
MRI
- High index of suspicion despite negative radiographs
Classification
- Transverse
- Parasagittal
- Comminuted
- Pisiform-triquetral impaction fractures
Management
Nonoperative
- In general, fracture pattern does not dictate management
- Encouraged to consult hand surgery for definitive decision making
- Potential Indications
- Parasagittal
- Non-displaced transverse intra-articular fractures
- Cast: Short Arm Cast in wrist flexion and ulnar deviation for 6-8 weeks
Operative
- Indications
- Displaced
- FCU Dysfunction
- Comminuted
- Procedures
- Pisiform excision
Return to Play
- At discretion of surgeon
- Minimum 6 weeks
Complications
- Chronic pain
- Non-union
- Pisotriquetral arthritis
- Malunion
- Decreased grip strength
See Also
- Internal
- External
- Sports Medicine Review Wrist Pain: https://www.sportsmedreview.com/by-joint/wrist/
References
- ↑ Suh, Nina, Eugene T. Ek, and Scott W. Wolfe. "Carpal fractures." The Journal of hand surgery 39.4 (2014): 785-791.