Clinical and Anatomical Aspects of Anterior Dislocation of the Pisiform Bone

Abstract

Introduction The pisiform bone is the fourth bone of the proximal row of the carpal bones, and it is located in the tendon of the flexor carpi ulnaris muscle, being considered a sesamoid bone. Traumatic dislocation of the pisiform bone is a rare condition, which usually results from a trauma in dorsal flexion of the wrist. Its treatment can be conservative or surgical, ending or not with the removal of the pisiform bone.

Objective To report a case of a child who fell from his own height and presented wrist pain, diagnosed with dislocation of the pisiform bone. We emphasize the importance of anatomy knowledge in the evaluation of wrist trauma.

Case Report The anamnesis confirmed that the fall occurred with the wrist in hyperextension. The physical examination showed a slight limitation of movement due to pain. Radiographic exams and a computed tomography (CT) scan of the wrist were performed, in which an anterior deviation/luxation of the pisiform bone was evidenced. A conservative treatment with plaster immobilization for analgesia was performed for 1 week. As there were no symptoms and no signs of trauma consistent with the images, such as edema and local ecchymosis, in addition to the early complete disappearance of pain, the responsible team proposed the hypothesis of asymptomatic chronic dislocation of the pisiform bone.

Conclusion Imaging exams in orthopedic traumatology are fundamental for an accurate diagnosis. Nevertheless, they must be associated with knowledge of the anatomy to correlate the image findings with the anamnesis, leading to a better understanding of silent, asymptomatic, and preexisting conditions in the clinical practice.

Keywords

anatomy - pisiform bone - trauma - dislocation

• References

• 1 Kalaria GP, Vora PH, Memon RR. An isolated pisiform fracture: a case report. Int J Res Orthop 2018; 4: 173-175
• 2 Verma V, Singh A, Kumar S, Singh MP. Isolated fracture of pisiform: case report of a rare injury of wrist. Int J Medical Update 2016; 11 (01) 19-21
• 3 Pevny T, Rayan GM, Egle D. Ligamentous and tendinous support of the pisiform, anatomic and biomechanical study. J Hand Surg Am 1995; 20 (02) 299-304
• 4 Kjosness KM, Hines JE, Lovejoy CO, Reno PL. The pisiform growth plate is lost in humans and supports a role for Hox in growth plate formation. J Anat 2014; 225 (05) 527-538
• 5 Fleege MA, Jebson PJ, Renfrew DL, Steyers Jr CM, el-Khoury GY. Pisiform fractures. Skeletal Radiol 1991; 20 (03) 169-172
• 6 Yamaguchi S, Viegas SF, Patterson RM. Anatomic study of the pisotriquetral joint: ligament anatomy and cartilagenous change. J Hand Surg Am 1998; 23 (04) 600-606
• 7 Werner Platzer. Taschenatlas der Anatomie, in 3 Bãnden. 1: Bewegungsapparat. 9th ed. Stuttgart: Georg Thieme Verlag KG; 2005: 137-139
• 8 Rayan GM, Jameson BH, Chung KW. The pisotriquetral joint: anatomic, biomechanical, and radiographic analysis. J Hand Surg Am 2005; 30 (03) 596-602
• 9 Moojen TM, Snel JG, Ritt MJPF, Venema HW, den Heeten GJ, Bos KE. Pisiform kinematics in vivo. J Hand Surg Am 2001; 26 (05) 901-907 . Doi: 10.1053/jhsu.2001.26199
• 10 Raval P, Saeed N, Mahapatra AN. Isolated dislocation of pisiform in an 11-year-old, following a horse bite: a rare injury. Eur Orthop Traumatol 2013; 4: 273-275
• 11 Goriainov V, Bayne G, Warwick DJ. Traumatic dislocation of the pisiform: a case report. J Orthop Surg (Hong Kong) 2010; 18 (03) 389-390
• 12 Jacobs LG. Isolated fracture of the pisiform bone; a case report. Radiology 1948; 50 (04) 529-531
• 13 McCARTY V, Farber H. Isolated fracture of the pisiform bone. J Bone Joint Surg Am 1946; 28: 390-391
• 14 Applanaidu R. An Isolated Acute Pisiform Fracture. Int J Orthop Surg 2008; 11(01).
• 15 Hurni Y, Fusetti C, de Rosa V. Fracture dislocation of the pisiform bone in children: a case report and review of the literature. J Pediatr Orthop B 2015; 24 (06) 556-560