Pisiform Fractures

Introduction

The pisiform is uncommonly fractured. When the radiographer is presented with a suspected pisiform fracture, a knowledge of the appropriate supplementary views will potentially assist in confirming the fracture.

Mechanism of Injury

The pisiform is typically injured by a fall on an outstretched hand in a dorsiflexed position, with the impact on the hypothenar eminence <a class="external" href="http://emedicine.medscape.com/article/828746-overview" rel="nofollow" target="_blank">Bryan C Hoynak, Laura Hopson, MD, e medicine</a>

Anatomy

The pisiform is a sesamoid bone within the tendon of the flexor carpi ulnaris. It articulates only with the triquetrum and lies near the deep ulnar nerve and artery.

Incidence

The average incidence of pisiform fractures is 0.2% of all carpal fractures and approximately half of them are isolated fractures.
<a class="external" href="http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijra/vol3n2/pisiform.xml" rel="nofollow" target="_blank">M. Tayfun Altınok MD. </a> <a class="external" href="http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijra/vol3n2/pisiform.xml" rel="nofollow" target="_blank">, Kadir Ertem MD , Ahmet Sığırcı MD , Alpay Alkan MD An Isolated Acute Pisiform Fracture: Usefulness Of MR Imaging
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Radiography

		<a class="external" href="http://resources.metapress.com/pdf-preview.axd?code=g308wk5172125n27&size=largest" rel="nofollow" target="_blank">Michael A Fleege, Pisiform Fractures, Skeletal Radiology, 1991: 20 p161</a>

Demonstration of pisiform fractures will usually require dedicated radiographic techniques. In particular, a 20 degree supinated lateral wrist and carpal tunnel view may be helpful. In a study by Fleege et al (1991), the PA view was also found beneficial in demonstrating pisiform fractures.

	<a class="external" href="http://resources.metapress.com/pdf-preview.axd?code=g308wk5172125n27&size=largest" rel="nofollow" target="_blank">Michael A Fleege, Pisiform Fractures, Skeletal Radiology, 1991: 20 p161</a>

The PA wrist view demonstrates a suspected pisiform fracture	The scaphoid view tends to superimpose the pisiform over the hamate to no particular advantage	In a correctly positioned lateral wrist, the pisiform will be superimposed over the scaphoid	A lateral wrist with 20 degrees of supination will result in a useful demonstration of the pisiform	A carpal tunnel view will also demonstrate the pisiform well, and in this case, demonstrates the suspected pisiform fracture

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