Pisiform fracture

Background

• Occurs via fall onto hypothenar eminence
  • Forced wrist flexion or strain from lifting heavy objects can avulse the pisiform
• Must exclude injury to ulnar nerve/artery (pisiform forms bony wall of Guyon's canal)

Clinical Features

• Localized tenderness on the pisiform itself, especially if with resisted wrist flexion

Imaging

• Obtain x-rays in partial supination or carpal tunnel view (removes overlap with triquetrum)

Pisiform fracture

Differential Diagnosis

Carpal fractures

AP view

• Scaphoid fracture
• Lunate fracture
• Triquetrum fracture
• Pisiform fracture
• Trapezium fracture
• Trapezoid fracture
• Capitate fracture
• Hamate fracture

Management

• Compression dressing or forearm volar splint in 30 degrees of flexion with ulnar deviation

See Also

Wrist Fracture

References

• German C. Hand and wrist emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.