Pisiform Fracture

Other Names

• N/A

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Background

• Pisiform fractures account for approximately 2% of carpal bone fractures

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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

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Risk Factors

• Unknown

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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
  • Distal Radius Fracture
    • Barton's Fracture
    • Chauffer's Fracture
    • Colles' Fracture
    • Die-Punch Fracture
    • Radial Styloid Fracture
    • Smith's Fracture
  • Distal Ulna Fracture
  • Carpal Fractures
    • Scaphoid Fracture
    • Lunate Fracture
    • Triquetrum Fracture
    • Pisiform Fracture
    • Trapezium Fracture
    • Trapezoid Fracture
    • Capitate Fracture
    • Hamate Fracture
  • Essex Lopresti Fracture
• Dislocations
  • Wrist Dislocation (Radiocarpal and/or Ulnocarpal)
  • Carpometacarpal Joint Dislocation
  • Distal Radioulnar Joint Dislocation
  • Lunate Dislocation
  • Perilunate Dislocation
• Instability & Degenerative
  • Scapholunate Instability
  • Lunotriquetral Instability
  • Scaphoid Nonunion Advanced Collapse
  • Distal Radial Ulnar Joint Instability
  • Kienbocks Disease
  • Dorsal Wrist Impingement
• Tendinopathies & Ligaments
  • De Quervain's Tenosynovitis
  • Intersection Syndrome
  • TFCC Injury
  • Wrist Tendinopathies
  • Extensor Carpi Ulnaris Instability
• Neuropathies
  • Carpal Tunnel Syndrome
  • Pronator Teres Syndrome
  • Anterior Interosseus Nerve Syndrome
  • Posterior Interosseus Nerve Syndrome
  • Guyon Canal Syndrome
• Pediatric Considerations
  • Distal Radial Epiphysitis (Gymnast's Wrist)
  • Torus Fracture
• Arthropathies
  • Wrist Osteoarthritis
  • Rheumatoid Arthritis
  • Gout
• Cartilage
  • Osteochondral Defect
• Vascular
  • Hypothenar Hammer Syndrome
• Other
  • Ganglion Cyst of Wrist
  • Ulnar Impingement Syndrome
  • Infectious Tenosynovitis

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Clinical Features

• General: Physical Exam Wrist
• Pain, tenderness under the Hypothenar Muscles
• Neuropathic symptoms in Ulnar Nerve distribution can occur

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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

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Classification

• Transverse
• Parasagittal
• Comminuted
• Pisiform-triquetral impaction fractures

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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

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Return to Play

• At discretion of surgeon
• Minimum 6 weeks

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Complications

• Chronic pain
• Non-union
• Pisotriquetral arthritis
• Malunion
• Decreased grip strength

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See Also

• Internal
  • Forearm Pain (Main)
  • Wrist Pain (Main)
  • Hand and Wrist Anatomy (Main)
  • Physical Exam Wrist
• External
  • Sports Medicine Review Wrist Pain: https://www.sportsmedreview.com/by-joint/wrist/

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