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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 -
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 -
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 -
Hand (New York, N.Y.) Jan 2020Increasing severity of carpal tunnel syndrome (CTS), as graded by nerve conduction studies (NCS), has been demonstrated to predict the speed and completeness of...
Increasing severity of carpal tunnel syndrome (CTS), as graded by nerve conduction studies (NCS), has been demonstrated to predict the speed and completeness of recovery after carpal tunnel release (CTR). The purpose of this study is to compare the cross-sectional area (CSA) of the median nerve in patients with severe and nonsevere CTS as defined by NCS. Ultrasound CSA measurements were taken at the carpal tunnel inlet at the level of the pisiform bone by a hand fellowship-trained orthopedic surgeon. Severe CTS on NCS was defined as no response for the distal motor latency (DML) and/or distal sensory latency (DSL). A total of 274 wrists were enrolled in the study. The median age was 51 years (range: 18-90 years), and 72.6% of wrists were from female patients. CSA of median nerve and age were comparatively the best predictors of severity using a linear regression model and receiver operator curves. Using cutoff of 12 mm for severe CTS, the sensitivity and specificity are 37.5% and 81.9%, respectively. Ultrasound can be used to grade severity in younger patients (<65 years) with a CTS-6 score of >12.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carpal Tunnel Syndrome; Electrodiagnosis; Female; Humans; Linear Models; Male; Median Nerve; Middle Aged; Neural Conduction; Pisiform Bone; ROC Curve; Reference Values; Reproducibility of Results; Sensitivity and Specificity; Severity of Illness Index; Ultrasonography; Wrist; Young Adult
PubMed: 30027757
DOI: 10.1177/1558944718788642 -
Hand Clinics Aug 2019Vascularized bone flaps (VBFs) improve union rates for scaphoid nonunions compared with nonvascularized grafts. Volar VBFs are indicated in cases of scaphoid nonunion... (Review)
Review
Vascularized bone flaps (VBFs) improve union rates for scaphoid nonunions compared with nonvascularized grafts. Volar VBFs are indicated in cases of scaphoid nonunion with avascular necrosis and/or humpback deformity. Four volar VBFs are described in this article. The volar carpal artery and pronator quadratus VBFs are most commonly used. The pisiform VBF can be used for replacement of the proximal pole of the scaphoid; it is covered by articular cartilage. The ulna VBF has greater donor morbidity; the ulnar artery is harvested and a palpable donor site deformity results.
Topics: Cancellous Bone; Cortical Bone; Fracture Fixation, Internal; Fractures, Ununited; Humans; Muscle, Skeletal; Osteonecrosis; Pisiform Bone; Postoperative Care; Radius; Scaphoid Bone; Ulna
PubMed: 31178092
DOI: 10.1016/j.hcl.2019.03.012 -
The Journal of Hand Surgery... Dec 2021Aneurysmal 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'... (Review)
Review
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.
Topics: Bone Cysts, Aneurysmal; Bone Neoplasms; Female; Finger Phalanges; Humans; Magnetic Resonance Imaging; Pisiform Bone
PubMed: 34789109
DOI: 10.1142/S2424835521720231