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BMJ Case Reports Jan 2021A pisiform dislocation is an uncommon injury which can lead to significant morbidity if missed. The literature regarding pisiform dislocation is limited and largely from...
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.
Topics: Accidental Falls; Casts, Surgical; Closed Fracture Reduction; Humans; Joint Dislocations; Male; Middle Aged; Pisiform Bone; Treatment Outcome; Wrist Injuries
PubMed: 33408102
DOI: 10.1136/bcr-2020-237482 -
The Journal of Hand Surgery Jan 2018Pisotriquetral instability is an often-overlooked condition that can lead to ulnar-sided wrist pain and dysfunction. Various case series and biomechanical studies have... (Review)
Review
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.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Arthrodesis; Carpal Joints; Glucocorticoids; Humans; Immobilization; Joint Instability; Ligaments, Articular; Medical History Taking; Physical Examination; Pisiform Bone; Triquetrum Bone
PubMed: 29169722
DOI: 10.1016/j.jhsa.2017.10.020 -
Hand Clinics Feb 2017A thorough understanding of the swing phases and mechanisms of injury in golf allows accurate diagnosis, treatment, and future prevention of injuries. Recommended... (Review)
Review
A thorough understanding of the swing phases and mechanisms of injury in golf allows accurate diagnosis, treatment, and future prevention of injuries. Recommended initial treatment starts with cessation of practice to rest the wrist, a splint or orthotic brace, and nonsteroidal antiinflammatory drug medication with corticosteroid injection and swing modification. Pisiform excision is the best treatment of the most severe chronic cases of pisiform ligament complex syndrome. Delayed diagnosis of hook of hamate fracture may lead to complications, including flexor tendon rupture. Prompt surgical resection is recommended to hasten return to sport and to prevent further complications.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Braces; Fractures, Bone; Golf; Hand Injuries; Humans; Rupture; Splints; Tendon Injuries; Wrist Injuries
PubMed: 27886842
DOI: 10.1016/j.hcl.2016.08.012 -
Journal of Hand and Microsurgery Jun 2024Various pathologies of the adult carpus result in clinical scenarios where excision can be considered and even recommended. In the appropriate patient population,... (Review)
Review
Various pathologies of the adult carpus result in clinical scenarios where excision can be considered and even recommended. In the appropriate patient population, isolated carpal excision can alleviate pain and improve mobility. Excisions of the pisiform, trapezium, and trapezoid have abundant literature evidence to support positive long-term functional outcomes. In contrast, isolated excision of the capitate, hamate, and triquetrum has limited support in the literature secondary to compromise of carpal mechanics and lead to recurrent pain. Additionally, isolated scaphoid and lunate excision are best avoided secondary to carpal collapse and should be paired with concomitant stabilizing procedures in the carpus. This article provides a comprehensive literature review of isolated excision of each osseous carpal bone, their indications, and previously assessed outcomes.
PubMed: 38855507
DOI: 10.1055/s-0043-1769748 -
Journal of Medical Imaging and... Feb 2022
Topics: Humans; Pisiform Bone
PubMed: 33969624
DOI: 10.1111/1754-9485.13189 -
Journal of Orthopaedic Science :... May 2018The association of scaphoid or other carpal bone fractures with distal radius fractures is frequently reported, whereas few studies have described pisiform malalignment...
BACKGROUND
The association of scaphoid or other carpal bone fractures with distal radius fractures is frequently reported, whereas few studies have described pisiform malalignment associated with distal radius fractures. The purpose of this study was to investigate the frequency and characteristics of pisiform malalignment associated with distal radius fractures.
METHODS
We performed a retrospective study by reviewing the data of 152 consecutive patients with a mean age of 63 years who were treated surgically for distal radius fractures during a five-year period. We evaluated the pisotriquetral joint via preoperative sagittal computed tomography (CT) and assessed pisiform malalignment. Pisiform malalignment was defined as follows: (1) wide type, joint space ≥4.0 mm; (2) non-parallel type, loss of parallelism of the joint surface of ≥20°; or (3) overriding type, proximal or distal overriding of the pisotriquetral joint ≥2.0 mm. We investigated the relationship between pisiform malalignment and the patterns of distal radius fractures. Pisiform malalignment was assessed using postoperative CT to determine whether it had been reduced.
RESULTS
Pisiform malalignment was observed in 48 cases involving 44 patients with a mean age of 58 (17-81) years. The patients included 16, 17, and 15 cases of the wide type, non-parallel type, and overriding type, respectively. Distal radius fractures with dorsal displacement exhibited pisiform malalignment significantly more frequently than those with volar displacement. No significant difference was noted between intra- and extra-articular fractures or between patients with and without distal ulnar fractures. Among the 22 pisiform malalignment cases assessed via postoperative CT, 15 cases were reduced, and 7 cases remained malaligned. The non-parallel type exhibited the lowest reduction rate among the 3 types.
CONCLUSIONS
Among distal radius fractures, 29% were complicated by pisiform malalignment. Distal radius fractures with dorsal displacement exhibited a significantly increased frequency of pisiform malalignment compared to those with volar displacement.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone Malalignment; Female; Humans; Incidence; Intra-Articular Fractures; Male; Middle Aged; Pisiform Bone; Radius Fractures; Reproducibility of Results; Retrospective Studies; Risk Factors; Tomography, X-Ray Computed; Young Adult
PubMed: 29503035
DOI: 10.1016/j.jos.2018.02.010 -
Hand Surgery & Rehabilitation Feb 2023Fractures of the triquetrum are the second most common form of isolated carpal bone fracture after the scaphoid. However, data on triquetrum morphology and morphometry...
Fractures of the triquetrum are the second most common form of isolated carpal bone fracture after the scaphoid. However, data on triquetrum morphology and morphometry are sparse. The aim of this study was to describe the morphology of triquetrum using anatomical landmarks, evaluate its morphometric features, and determine its vascular entry points. The morphological and morphometrical features of 87 adult dry triquetral bones (39 left, 48 right) were determined by measuring length, width and thickness. The number and locations of nutrient foramina wider than 0.5 mm were recorded. Mean length, width and thickness were 17.37 mm (range, 14.26-22.13), 12.65 mm (range, 10.37-15.85) and 11.41 mm (range, 8.98-18.23), respectively. The facet articulating with the pisiform was oval in 40 bones, round in 8 and amorphous (neither round nor oval) in 39. The mean length of the interarticular ridge was 7.09 ± 0.9 mm. The mean number of nutrient foramina was significantly greater on the dorsal than on the other aspects. The dorsal predominance of nutrient foramina makes the bone weaker in the dorsal region, which could explain why fractures are more common in this region. Also, the dorsal aspect is rich in blood supply, which could explain why avascular necrosis is less common in triquetral fractures. As most of the vascularization is on the dorsal side, there is need for caution when performing triquetrum surgery. LEVEL OF EVIDENCE: Level 2.
Topics: Adult; Humans; Triquetrum Bone; Scaphoid Bone; Upper Extremity; Fractures, Bone; Wrist Injuries
PubMed: 36400416
DOI: 10.1016/j.hansur.2022.11.002 -
Australasian Journal of Ultrasound in... Aug 2020Numerous works of literature have assessed the use of ultrasound to detect carpal tunnel syndrome, suggesting various techniques and cut-off values. Currently, an... (Review)
Review
Numerous works of literature have assessed the use of ultrasound to detect carpal tunnel syndrome, suggesting various techniques and cut-off values. Currently, an effective parameter and cut-off value are still debated. The aim of this review is to determine if these parameters have sufficient rigour to allow their use in clinical practice. Twenty-one studies using sonographic parameters to identify carpal tunnel syndrome in comparison with electrodiagnostic testing (EDx) were selected for review. Methodological differences were found between studies in the use of EDx criteria, scanning and recruitment protocols, with participant biometrics often not reported. Parameters including the cross-sectional area of the median nerve at the level of the pisiform bone in addition to the wrist-to-forearm difference demonstrated high diagnostic utility for set cut-off values. Doppler techniques and mobility are promising, and further research is required to understand the effectiveness of these techniques.
PubMed: 34760599
DOI: 10.1002/ajum.12219