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Traumatic dislocation of the pisiform bone is uncommon. The authors report a case treated by primary excision with a good result. The literature is reviewed and treatment choices are discussed.
The case is reported of a patient with a fracture of the pisiform bone. The causation, diagnosis, treatment and complications of this lesion are discussed.
Since 1986, 7 necrosed lunate bones (Kienbock disease) in 7 patients were replaced by the nearby pisiform bone with a pedicle of its own nutrient vessels and tendon of the flexor carpi ulnaris. Anatomically, the situation of the pisiform, after being released, is fit for proximal and radioward transfer; the size of the pisiform together with soft tissue surrounding it is, after being rotated 90 degrees, just apt to fill the dimensional space left by the lunate excised. Follow-up for 4 to 18 months manifested satisfactory results. The operative technic is described in detail.
Taking into consideration the enlargement and sclerosis of the entire pisiform bone and the smooth articular surfaces of the pisotriquetral joint, the author has speculated that this may represent a nonspecific avascular necrosis with an as yet unknown cause.
The authors report their experience with the use of a vascularised pisiform bone graft based on the dorsal branch of the ulnar artery to provide osseous support and an efficient vascular aid especially in non-unions of the carpal navicular bone with avascular necrosis of its proximal pole and in stage III Kienböck's disease. The pisiform can replace the proximal pole of the navicular bone in totality. When implanted into the lunate, it stops its collapse and helps to revascularize it. The authors present the results achieved in 14 patients (12 male, 2 female), of which eight had a follow-up longer than 5 years The technique appears as an interesting alternative to carpectomies and partial intracarpal fusions which are usually proposed in advanced cases of these conditions.
A 17-year-old man had chronic pain and recurrent radial dislocation of the pisiform bone following a fall on his outstretched arm. The bone was excised, along with a 3 x 4-mm osteocartilaginous fragment from the distal triquetrum. Pisotriquetral joint instability should be considered in the differential diagnosis of palmar-ulnar wrist pain.
Volleyball players commonly complain of pain in the hypothenar area. Fatigue fracture of the pisiform bone is suggested as a cause of this sport incapacity. The diagnostic importance of oblique and axial X-ray views of the Wrist is demonstrated. Early treatment by immobilization for 6 weeks usually results in complete functional recovery.
We report two children with a Salter-Harris type 1 and 2 distal radius physeal fracture associated with a fracture-dislocation of the pisiform bone. The two patients were treated with closed reduction of both the distal radius and dislocated pisiform under general anaesthesia. Then a long-arm cast was applied for 30 days resulting in full healing of the fractures. The patients were re-evaluated after 30 years, and the wrists did not show any functional impairments. On radiographic evaluations, there were no signs of osteoarthritis or misalignment between the pisiform and the triquetral, in contrast to what has been reported in adult carpal fractures.
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Isolated diseases of the os pisiforme is seldom described in the literature. Since 1973 wehave seen 7 patients with typical signs: pain at the region of pisiform, increased by dorsiflexion and radial deviations of the wrist and by compressing the pisiform in the palmar-dorsal plane. The diagnosis of pisiform disease is based on clinical and X-ray examination and followed by histological study after operation. Five of the seven patients came to operation for the following disorder: local, circumscribed chondrosis, chondromatosis of flexor carpi ulnaris with osteochondromatosis, atrophy of the pisiform and in the two cases aseptic osteonecrosis. After partial resection of the pisiform, once combined with Z-shaped lengthening of the tendon of Flexor carpi ulnaris or complete enucleation of the bone all patients were free of discomfort and remained so.
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The medial aspect of the pisiform, the medial and dorsal aspect of the triquetrum are vascularized by the dorsal branch of the ulnar artery. The lateral aspects of the pisiform is vascularized by a pedicle, which arises from the ulnar artery. The deep and sub-capsular arterial system is constant too. Several anastomotic networks strengthen that arterial pattern. The concentration of their links in one trunk may give rise to inconstant arteries. The pisiform can replace the lunarium if it is transplanted with its pedicle, including the dorsal branch of the ulnar artery.
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3 rare cases of accessory osseous carpal elements are described and compared with similar cases of the literature. Especially a case of a well developed metastyloid bone combined with a parastyloid bone is remarkable. Furthermore a very regressive metastyloid bone and, appearing in another hand, a pisiforme secundarium is described.
A case is reported of dislocation of the pisiform, successfully treated by conservative means.