Symptomatic Congenital Coalition of the Pisiform and Hamate - A Case Report.

We describe a 13-year-old boy with piso-hamate coalition confirmed by X-ray. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed type 1 coalition according to the classification of DeVilliers Minnaar. Piso-hamate coalition is rare, and suspicions should be raised in instances of chronic ulnar-sided wrist pain, particularly in individuals with a history of elevated hand usage, especially amongst athletes engaging in intensive hand grip activities. Surgical resection of the synchondrosis site between the pisiform and the hamate is an efficacious intervention that can mitigate pain. Level of Evidence: Level V (Therapeutic).

Postoperative magnetic resonance imaging following lunate resection and vascularized os pisiform transfer in Kienböck's disease.

Although good clinical results have been reported following lunate resection and vascularized os pisiform transfer for advanced stages of Kienböck's disease, the occurrence of wrist osteoarthritis has been highlighted. We aimed to investigate the postoperative condition of the pisiform and the surrounding bones in patients who underwent surgery for advanced stages of Kienböck's disease using magnetic resonance imaging. We retrospectively reviewed the data of six patients (mean age, 45 years; Lichtman stage, IIIb) who underwent lunate resection and vascularized os pisiform transfer for advanced stages of Kienböck's disease and postoperative magnetic resonance imaging examination. We extracted clinical data on pre- and postoperative range of motion, grip strength, wrist pain, Hand20 and Lichtman's criteria, and pre- and postoperative radiographic and magnetic resonance imaging examinations. Bone marrow lesions in the transferred pisiform were found in five patients. Signal changes of bones around the transferred pisiform were found in these five patients; the greatest change was observed in the capitate bone in three patients. These signal changes were found in the opposite parts of the bones around the transferred pisiform. No patient exhibited signal changes in the transferred pisiform bone only. Wrist osteoarthritis after lunate resection and vascularized os pisiform transfer for advanced stages of Kienböck's disease is more likely to be attributed to the low congruency of the transferred pisiform and surrounding bones than to the compromised perfusion of the pisiform. Signal changes in the opposite bone parts around the transferred pisiform were confirmed in all patients with signal changes in the pisiform.

Isolated distal pisiform dislocation: Case Report / Luxação distal isolada do pisiforme: Relato de caso

Abstract Isolated pisiform dislocation is a rare lesion with few cases described in the literature. This type of lesion is typically observed in young males and can be easily overlooked at first assessment. Isolated proximal dislocation is more common due to the action of the flexor carpi ulnaris (FCU) muscle. We present the case of a 19-year-old male patient with isolated distal pisiform dislocation after wrist trauma. He underwent open reduction and internal fixation with Kirschner wires with excellent functional outcomes. Although there is no consensual therapeutic method, closed reduction is a first-line treatment for acute presentations. Pisiform open reduction or excision may be performed alternatively or after a failed closed reduction.

Resumo A luxação isolada do pisiforme é uma lesão rara com poucos casos descritos na literatura. Esse tipo de lesão é observado tipicamente em adultos jovens do sexo masculino e pode ser facilmente negligenciada numa primeira avaliação. A luxação proximal isolada é mais comum devido à ação do flexor ulnar do carpo (FUC). Apresentamos o caso de um paciente do sexo masculino, com 19 anos de idade, com luxação distal isolada do pisiforme após traumatismo do punho. O paciente foi submetido a uma redução aberta e fixação interna com fios de Kirschner com excelente resultado funcional. Apesar de não existir um método de tratamento consensual, a redução fechada perfila-se como tratamento de primeira linha na apresentação aguda. Em caso de insucesso ou como método alternativo pode-se optar pela redução aberta ou a excisão do pisiforme.

Posttraumatic Arthrosis and Triquetral Nonunion Associated With Pisotriquetral Subluxation in Adolescent Female Softball Players.

Impaction fracture subluxation of the pisotriquetral joint producing arthrosis and ulnar triquetral osteochondral nonunion is a cause for ulnar wrist pain in batting athletes. Two cases of adolescent female softball players managed successfully with pisiform and triquetral fragment excision are reported.

Aneurysmal Bone Cyst of Pisiform Bone: Diagnosis and Treatment of a Rare Entity: Case Report and a Review of the Literature.

Aneurysmal bone cyst (ABC) is a benign expansile bone tumor without metastasis capability. Only 3-4% of ABCs occur in the hand and they mainly take place in metaphysis' of long bones like metacarpals or phalanges. Carpal ABCs have been reported as individual case reports in the literature due to rarity. A patient presented with pain in her right wrist. Magnetic resonance imaging revealed a well circumscribed one cm sized mass in the pisiform bone that resembled an aneurysmal bone cyst. Total pisiformectomy was performed. Treatment options are total excision or curettaging in ABCs. But rarity of these lesions may delay the diagnosis process for the inexperienced surgeon.

Vascularized pisiform graft for the treatment of scaphoid nonunion: An anatomical study.

Scaphoid fracture can evolve into scaphoid nonunion leading to wrist arthritis. Vascularized bone flaps used to treat scaphoid nonunion are supplied by delicate, small, or short arteries that are not always reliable. The pisiform bone has never been considered as a possible treatment of scaphoid nonunion since the traditionally harvested pedicle is too short. This study aimed to characterize the vascularization of the pisiform with the goal of developing a method of harvesting it with a longer pedicle that can be used as a graft to treat scaphoid nonunion. A cadaver study on 30 upper limbs was done in two parts: firstly, we dissected 20 cadaver specimens and documented the pisiform's vascularization (size, length, and articular surface) as well as anatomical characteristics of the dorsal ulnar artery; secondly, we used 10 cadaver specimens to study an experimental surgical procedure in which a vascularized pisiform graft is used to treat an artificially created nonunion and confirm its feasibility. The pisiform artery originated from the dorsal ulnar artery in all 20 dissections. Its average length of 4.036cm could be increased by 11% by ligating the upstream collateral branches from the dorsal ulnar artery. The pedicled vascularized pisiform flap was grafted to the scaphoid in 10 experimental procedures performed on fresh cadavers. The vascularized pisiform graft consists of a reliable vascular pedicle and well vascularized multi-cortical bone with a cartilaginous surface. However, more studies are needed to confirm the feasibility of this flap as an alternative for treating unstable scaphoid nonunion.

Arthroscopic Pisiform Excision in Pisotriquetral Osteoarthritis Technique Using a Direct Pisotriquetral Portal.

Pisotriquetral (PT) joint arthritis is a common cause of ulnar-sided wrist pain. Open pisiform excision is a well-established procedure and is indicated when the conservative treatment fails. Although arthroscopic visualization of the PT joint is part of the routine examination in a patient with ulnar-sided wrist pain, therapeutic arthroscopy of the PT joint is limited to one case in the literature through the standard dorsal portals. Arthroscopic pisiform excision is a novel technique described by the authors. The first aim of this procedure is pain relief maintaining wrist stability and strength. With this minimally invasive approach we believe that preserving the flexor carpi ulnaris and the PT ligament complex we maintain their biomechanical function, while at the same time, reducing scar tenderness and postoperative discomfort with better esthetic results and less recovery time. In addition to standard dorsal portals, a direct PT portal was used to have access to the PT space and as a working portal to complete the pisiform excision.

Pisiform dislocation.

A pisiform dislocation is an uncommon injury which can lead to significant morbidity if missed. The literature regarding pisiform dislocation is limited and largely from case reports. In this case, we present a 51-year-old right-hand dominant male who sustained the injury after a fall. He attended the emergency department on the same day and a closed reduction was able to be performed under a haematoma block. On review in follow-up clinic the patient's symptoms had completely resolved.

Pisiformectomy in advanced pisotriquetral joint arthritis: A retrospective study of 12 wrists with a mean follow-up of 7.5 years.

Pisiformectomy is the gold standard treatment for pisotriquetral arthritis resistant to conservative treatment. We evaluated the long-term clinical and functional outcomes after pisiformectomy in resistant pisotriquetral arthritis cases. We retrospectively evaluated 11 patients (12 wrists), mean age of 59 years (49-69) treated by pisiformectomy using a standardized surgical technique. Pisiformectomy was performed for primary osteoarthritis in 10 cases, for post-traumatic osteoarthritis in 1 case and for pisotriquetral instability in 1 case. The clinical and functional evaluation was carried out by an independent examiner. Mean time to review was 90 months (63-151). Pain on a Visual Analog Scale (/10) decreased significantly to 1.1 from 6.8 preoperatively. Mean range of motion was 79° in flexion, 61.5° in extension, 18° in ulnar deviation and 36° in radial deviation. Mean grip strength of the operated wrist was 86% of the non-operated wrist. Functional scores significantly improved with a gain of 40 points for the QuickDASH and 53 points for the PRWE. Based on this long-term follow-up study, pisiformectomy seems to alleviate wrist pain and improve the quality of life in a low-demand population with pisotriquetral osteoarthritis resistant to conservative treatment. When compared to the pisotriquetral arthrodesis, pisiformectomy is easier to perform, allows quicker mobilization of the wrist and leads to good functional outcomes.

"Silent Ruptures" of the Flexor Digitorum Profundus of the Little Finger due to Pisotriquetral Arthroses.

Asymptomatic pisotriquetral arthroses caused ruptures of the flexor digitorum profundus tendon of the little finger in 2 elderly patients. Ruptures occurred with unnoticeable onset, and bilateral ruptures separately occurred with interval of several years in one patient. The tendon was ruptured in zone IV with perforation of the gliding floor through which the degenerative pisiform was visible. The gliding floor was repaired followed with excision of the pisiform, and the ruptured tendon was then transferred to the profundus tendon of the ring finger. Asymptomatic pisotriquetral arthrosis in old age can be an aspect of the pathological background of flexor tendon ruptures of the little finger that occur unnoticed.

Suture Fixation Using Polyblend Polyethylene Sutures With Hydroxyapatite Block for an Intra-articular Depression Fracture of the Pisiform Bone.

Few cases in which open reduction and internal fixation was performed for displaced pisiform fractures have been reported. We present a new surgical technique for the treatment of depressed intra-articular pisiform fractures. First, the depressed fragment was reduced by pushing the bone tamp. Then, the fracture void resulting from the reduction of the depressed fragment was filled with a shaped hydroxyapatite block. Finally, the fragments were sutured using braided polyblend polyethylene sutures. The postoperative radiography could achieve a well-reduced articular facet, and this procedure had a good clinical outcome.

Management of Pisotriquetral Instability.

Pisotriquetral instability is an often-overlooked condition that can lead to ulnar-sided wrist pain and dysfunction. Various case series and biomechanical studies have been published regarding the diagnosis and treatment of this condition. We review current methods for examining, diagnosing, and treating pisotriquetral instability.

Pisiform excision for refractory flexor carpi ulnaris tendinopathy of the wrist.

The aim is to report the long-term clinical results after pisiform excision in patients with refractory flexor carpi ulnaris (FCU) tendinopathy. We performed pisiform excision in 14 patients with recalcitrant FCU tendinopathy, who had failed conservative treatment. Nine patients were followed-up for more than 2 years. Pre-operative pain visual analog scale (VAS) was extracted from the electronic medical records. Post-operative symptoms and function were assessed with pain VAS, quick disabilities of arm, shoulder and hand (DASH) score, patient rated wrist evaluation (PRWE) score, and satisfaction VAS for surgery at the final follow-up. After the mean follow-up period of 6 years, all patients showed improvement in pain VAS (from 5.9 to 1.2). The post-operative scores of quick DASH and PRWE were 3.5 and 13.1, respectively. Satisfaction VAS score was 8.8 and all patients returned to their work. Excision of the pisiform bone improved symptoms in patients with refractory FCU tendinopathy.

Joint Space Narrowing in Patients With Pisotriquetral Osteoarthritis.

BACKGROUND: Patients with suspected pisotriquetral osteoarthritis may show joint space narrowing. However, the extent of joint space narrowing and its deviation from the joint space width (JSW) in normal anatomy is unknown. In this pathoanatomic study, we therefore compared the JSW in the pisotriquetral joint between osteoarthritic patient wrists and healthy wrists. METHODS: We reviewed preoperative computed tomography (CT) scans of 8 wrists of patients with ulnar-sided wrist pain who underwent a pisiformectomy with confirmed pisotriquetral osteoarthritis at surgery. We also reviewed CT scans of 20 normal wrists from healthy volunteers serving as control group. Three-dimensional CT models of the pisiform and triquetrum were obtained from both affected and normal wrists, after which the minimum JSW was calculated in an automated fashion. RESULTS: In the patient group, the median (interquartile range) of the minimum JSW was 0.1 mm (0.0-0.2), and in the control group, 0.8 mm (0.3-0.9) ( P = .007). CONCLUSIONS: We showed that the pisotriquetral joint space in osteoarthritic patient wrists was significantly narrowed compared with healthy wrists. These results suggest that JSW evaluation has a potential diagnostic value in the work-up of patients with suspected pisotriquetral osteoarthritis. This is an interesting area for future clinical research, especially because no gold standard for diagnosing pisotriquetral osteoarthritis has been established yet.

Aneurysmal Bone Cyst Involving the Pisiform: A Case Report.

BACKGROUND: Aneurysmal bone cysts are an uncommon form of benign primary bone tumors; affection of the hand is very rare. METHODS: A rigorous review of the literature showed that this type of tumor has not previously been described in the pisiform. In this article, we report the occurrence of an aneurysmal bone tumor in the pisiform of the left hand of a 19-year-old male. RESULTS: This tumor was successfully treated through surgical excision with an uneventful recovery. We describe the process behind the diagnosis of the lesion and the subsequent treatment in an attempt to highlight the rare but possible occurrence of aneurysmal bone cysts in the pisiform. CONCLUSION: Appropriate treatment of aneurysmal bone cysts in this location is required, due to the anatomical nature of the pisiform itself with the risks of pathologic fracture and ulnar nerve compression.

Conventional chondrosarcoma in the right hand with the invasion of the pisiform and the hamate bones - case report.

Chondrosarcoma is a malignant hyaline cartilage forming tumor. It is a rare pathology, with an estimated incidence of one in 200 000 individuals per year. It appears in two forms: primary, representing 90% of all cases and secondary emergence that develops on preexistent lesions. Primary chondrosarcomas are uncommon in the hand, with a frequency of only 1.5-3.2% of all chondrosarcomas. In conventional chondrosarcoma (cCS), the histological malignancy grading represents the main prognostic factor for surgical planning and prognosis. We present the case of a 60-year-old male, examined in the First Department of Orthopedics and Traumatology, "Dr. Pius Branzeu" Clinical Hospital, Timisoara, Romania, with non-specific symptoms in the right hand. After clinical examination and imagistics, surgery and histopathological examination of the tumor were performed. This showed a conventional well differentiated - G1 chondrosarcoma, as suggested also by imagistic and clinical context.