Isolated dislocation of the pisiform

Abstract

From the literature it would appear that an isolated dislocation of the pisiform is a very rare entity. It may wrell be that the diagnosis is made less frequently than its true occurrence. An isolated dislocation of the pisiform is described with an accompanying brief review of the literature, clinical features and options of management. A 57-year-old fireman fell on his outstretched left hand. He noted stiffness, swelling and pain with flexion of the wrist but was not bothered sufficiently to seek immediate medical attention. He continued to work normally but experienced mild discomfort on lifting. Ten days following the injury he went to the emergency department. Radiographs were taken and no abnormality was noted (Fig. 1a, 1b). He was treated without immobilization for a sprained wrist. Subsequent to evaluation of the radiographs, in the Radiology Department, the patient was contacted and returned three weeks following the injury for re-evaluation. Examination at that time revealed no swelling or limitation of motion and only very minimal pain with flexion of the wrist. Dislocation of the pisiform. Isolated dislocation of the pisiform is a rarely reported entity because of its radiographically elusive nature and benign course when untreated. The last paper on the subject that we were able to find in the English literature was by Immerman (1948). In 1960 Vasilas et al. described 13 pisiform fractures culled from a retrospective review of 6,000 radiographs. The pisiform subluxations they described were associated with other obvious injuries of the wrist.