Pisiform fracture


  • Occurs via fall onto hypothenar eminence
  • Forced wrist flexion or strain from lifting heavy objects can avulse the pisiform[1]
  • 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[1]

Differential Diagnosis

Carpal fractures


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



  • Discharge with referral to orthopedic surgery

See Also


  1. 1.0 1.1 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.