- Kevin deWeber, MD, FAAFP, FACSM
Kevin deWeber, MD, FAAFP, FACSM
- Family Medicine of SW Washington Residency
- PeaceHealth SW Medical Center
- Affiliate Associate Professor of Family Medicine
- Oregon Health and Science University
- Clinical Instructor of Family Medicine
- University of Washington School of Medicine
- Section Editors
- Patrice Eiff, MD
Patrice Eiff, MD
- Section Editor — Adult Orthopedics; Sports-Related Injuries
- Professor of Family Medicine
- Oregon Health & Science University
- Chad A Asplund, MD, FACSM, MPH
Chad A Asplund, MD, FACSM, MPH
- Associate Professor of Health and Kinesiology
- Director of Athletic Medicine
- Head Team Physician
- Georgia Southern University
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Emergency Medicine (Adult and Pediatric)
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
While upper extremity fractures are among the most common, and carpal fractures account for approximately 18 percent of hand and wrist fractures and 6 percent of all fractures , pisiform fractures account for a relatively small number.
This topic reviews fractures of the pisiform in adults. General overviews of wrist pain and carpal fractures, as well as topics devoted to other specific carpal fractures in adults, are presented separately. (See "Evaluation of the adult with acute wrist pain" and "Evaluation of the adult with subacute or chronic wrist pain" and "Overview of carpal fractures" and "Scaphoid fractures" and "Hamate fractures" and "Lunate fractures and perilunate injuries" and "Capitate fractures".)
Of the carpal fractures, injuries to the proximal row are most frequent. However, fractures of the pisiform bone occur less often than fractures of the scaphoid, lunate, or triquetrum, and account for only one to three percent of osseous injuries involving the carpal bones [2,3]. The estimated incidence of pisiform fractures ranges from 1 in 100 to 1 in 460 of all carpal fractures . They may occur in isolation , or be concomitant with other wrist injuries, especially distal radial fractures .
The pisiform is a sesamoid bone contained within the flexor carpi ulnaris (FCU) tendon (image 1). Ossification occurs between 7 and 10 years of age, and is complete by age 12. It is the last carpus to completely ossify. Segmentation may be present before age 12 and should not be confused with fracture .
The pisiform is easily palpable on the volar surface of the wrist directly proximal to the fifth (little finger) metacarpal at the distal wrist crease. Ligamentous attachments travel from the pisiform to the triquetrum, hamate and fifth metacarpal, while the abductor digiti minimi originates at the pisiform. The pisiform marks the ulnar border of Guyon's canal (figure 1). With pisiform fracture there can be concomitant injury to the ulnar nerve, which traverses the canal.
- Eiff MP, Hatch RL. Chapter 5: Carpal fractures. In: Fracture Management for Primary Care, 3rd, Saunders, Philadelphia 2011.
- Geissler WB. Carpal fractures in athletes. Clin Sports Med 2001; 20:167.
- Seitz WH Jr, Papandrea RF. Fractures and dislocations of the wrist. In: Rockwood and Green's Fractures in Adults, 5th ed, Bucholz RW, Heckman JD (Eds), Lippincott Williams & Wilkins, Philadelphia 2002.
- Fleege MA, Jebson PJ, Renfrew DL, et al. Pisiform fractures. Skeletal Radiol 1991; 20:169.
- Balci A, Basara I, Çekdemir EY, et al. Wrist fractures: sensitivity of radiography, prevalence, and patterns in MDCT. Emerg Radiol 2015; 22:251.
- Komura S, Yokoi T, Nonomura H, et al. Incidence and characteristics of carpal fractures occurring concurrently with distal radius fractures. J Hand Surg Am 2012; 37:469.
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- Urch EY, Lee SK. Carpal fractures other than scaphoid. Clin Sports Med 2015; 34:51.
- Moraux A, Lefebvre G, Pansini V, et al. Pisotriquetral joint disorders: an under-recognized cause of ulnar side wrist pain. Skeletal Radiol 2014; 43:761.
- Welling RD, Jacobson JA, Jamadar DA, et al. MDCT and radiography of wrist fractures: radiographic sensitivity and fracture patterns. AJR Am J Roentgenol 2008; 190:10.
- Cassidy C, Ruby LK. Fractures and dislocations of the carpus. In: Skeletal Trauma: Basic Science, Management, and Reconstruction, 5th ed, Browner BD, Jupiter JB, Krettek C, Anderson PA. (Eds), Saunder Elsevier, Philadelphia 2015. p.1217.
- Sawardeker PJ, Baratz ME. Carpal injuries. In: DeLee & Drez's Orthopaedic Sports Medicine: Principles and Practice, 4th ed, Miller MD, Thompson SR. (Eds), Saunders Elsevier, Philadelphia 2015. p.850.
- CLINICAL ANATOMY
- MECHANISM OF INJURY
- SYMPTOMS AND EXAMINATION FINDINGS
- RADIOGRAPHIC FINDINGS
- DIFFERENTIAL DIAGNOSIS
- Fracture of other carpal bones
- Fracture-dislocations of carpal bones
- Distal radius fractures
- Wrist sprain
- Hypothenar hammer syndrome
- Pisotriquetral osteoarthritis
- Flexor carpi ulnaris tendinopathy
- INDICATIONS FOR SURGICAL REFERRAL
- INITIAL TREATMENT
- FOLLOW-UP CARE
- RETURN TO SPORT OR WORK
- SUMMARY AND RECOMMENDATIONS