Mateusz Gładysz FESSH prep

FESSH prep Wrist trauma Carpal bone anatomy and fracture

Pisiform bone

Last reviewed v1.0

FESSH-023Wrist trauma●●○ intermediate

Regarding the pisiform bone and its pathology, which of the following statements are true?

  1. 1.The pisiform is a sesamoid bone embedded in the distal flexor carpi ulnaris tendon and articulates only with the triquetrum.

  2. 2.Isolated pisiform fractures account for approximately 0.2–2% of all carpal fractures.

  3. 3.Pisiform fractures are typically managed with internal fixation because of the bone's weight-bearing role in the carpus.

  4. 4.Pisotriquetral osteoarthritis may develop after pisiform fracture, chronic instability of the pisiform stabilising ligaments, or repetitive trauma in racquet sports.

  5. 5.The ulnar nerve and ulnar artery lie in Guyon's canal immediately radial to the pisiform and must be identified and protected during pisiformectomy.

FESSH marking: +1 per correct statement, 0 for blank, −1 for incorrect. Click the same TRUE/FALSE button twice to clear it.

Question ID
FESSH-023
First published
Last reviewed
Version
v1.0
Answer key and explanations — open after answering

  1. 1. The pisiform is a sesamoid bone embedded in the distal flexor carpi ulnaris tendon and articulates only with the triquetrum.

    True

    The pisiform is the smallest carpal bone and the only one that develops as a sesamoid within the flexor carpi ulnaris tendon. It articulates exclusively with the triquetrum and provides insertion for the pisohamate and pisometacarpal ligaments and origin for the abductor digiti minimi.

    • Rayan GM, Jameson BH, Chung KW. The pisotriquetral joint: anatomic, biomechanical, and radiographic analysis. J Hand Surg Am. 2005;30(3):596-602. PMID 15925173
    • Yamaguchi S, Viegas SF, Patterson RM. Anatomic study of the pisotriquetral joint: ligament anatomy and cartilaginous change. J Hand Surg Am. 1998;23(4):600-606. PMID 9708372

  2. 2. Isolated pisiform fractures account for approximately 0.2–2% of all carpal fractures.

    True

    Pisiform fractures are among the rarest carpal fractures, with reported incidence ranging from 0.2% to 2% across published series. Approximately half occur in association with other wrist injuries — most commonly distal radius fracture or perilunate dislocation — and isolated injury is often missed because the pisiform overlaps the triquetrum on standard posteroanterior views.

    • Fleege MA, Jebson PJ, Renfrew DL, Steyers CM, El-Khoury GY. Pisiform fractures. Skeletal Radiol. 1991;20(3):169-172. PMID 2057787
    • Pan T, Lögters TT, Windolf J, Kaufmann R. Uncommon carpal fractures. Eur J Trauma Emerg Surg. 2016;42(1):15-27. PMID 26676306

  3. 3. Pisiform fractures are typically managed with internal fixation because of the bone's weight-bearing role in the carpus.

    False

    The pisiform is non-weight-bearing. Standard treatment of non-displaced pisiform fractures is short-arm cast immobilisation for 4–6 weeks. Displaced fractures, comminuted fractures with ulnar nerve compression, and symptomatic nonunions are managed by pisiformectomy rather than internal fixation.

    • Chang MK, Yap RTJ. Acute ulnar nerve compression associated with pisiform fracture — a case report and literature review. Case Reports Plast Surg Hand Surg. 2019;6(1):31-34. PubMed
    • Agathangelidis F, Boutsiadis A, Ditsios K. Open pisiform fracture: excision or internal fixation?. BMJ Case Rep. 2013;2013:bcr2012007621. PMID 23307459

  4. 4. Pisotriquetral osteoarthritis may develop after pisiform fracture, chronic instability of the pisiform stabilising ligaments, or repetitive trauma in racquet sports.

    True

    Symptomatic pisotriquetral osteoarthritis is recognised after acute pisiform trauma and after chronic overuse of pronation–supination from the wrist, as in racquet sports. Pisiform excision is the standard surgical treatment for refractory pisotriquetral pain.

    • Rayan GM, Jameson BH, Chung KW. The pisotriquetral joint: anatomic, biomechanical, and radiographic analysis. J Hand Surg Am. 2005;30(3):596-602. PMID 15925173
    • Carroll RE, Coyle MP Jr. Dysfunction of the pisotriquetral joint: treatment by excision of the pisiform. J Hand Surg Am. 1985;10(5):703-707. PMID 4045152

  5. 5. The ulnar nerve and ulnar artery lie in Guyon's canal immediately radial to the pisiform and must be identified and protected during pisiformectomy.

    True

    Guyon's canal is bounded medially by the pisiform; the ulnar neurovascular bundle lies along its radial border. Pisiformectomy is performed through a longitudinal incision over Guyon's canal with direct visualisation and protection of the ulnar nerve, particularly its deep motor branch.

    • Palmieri TJ. Pisiform area pain treatment by pisiform excision. J Hand Surg Am. 1982;7(5):477-480. PMID 7130657
    • Chang MK, Yap RTJ. Acute ulnar nerve compression associated with pisiform fracture — a case report and literature review. Case Reports Plast Surg Hand Surg. 2019;6(1):31-34. PubMed