Nonunion of the Pisiform Bone in a 9-Year-Old Boy

Abstract

An isolated fracture of the pisiform bone is a rare condition, especially in children. The fracture may be missed in the emergency department because of the complex anatomy of the carpal region. Early diagnosis and treatment are, however, important for the functional outcome of the patient, since untreated dislocated carpal fractures may result in nonunion. We report one case of a 9-year-old boy with an unrecognized fracture of the pisiform bone who underwent a pisiformectomy 10 months after injury due to a nonunion of the pisiform bone. Good results were obtained and the wrist did not show any functional impairment.

Fracture Dislocation of the Pisiform Bone in 14-Year-Old Boy—A Case Report

“…If successful repositioning is achieved, open reduction and internal fixation (ORIF) with K-wires can be considered, as demonstrated by Giannetti's one case with very good results [5]. The last resort appears to be pisiformectomy, a technique successfully employed in all young patients identified in the literature [7,9,15]. Pisiformectomy can also be performed later in symptomatic patients with posttraumatic PTJ osteoarthritis, yielding good results [22].…”

“…In 2015, Brouwers documented the case of a 9-year-old boy with non-union of the pisiform bone, after missed diagnosis [15]. He was treated 10 months after the injury with excising of the superficial, non-united pole of the pisiform bone, resulting in an excellent outcome 1 year after the surgery.…”

“…Upon comparison with existing literature through a PubMed database search, we identified four pediatric patients with this condition [3][4][5]. Additionally, our analysis encompassed nine patients with simple dislocations [6][7][8][9][10][11][12][13][14] and one patient [15] with isolated fractures of the pisiform bone from available reports of similar injuries.…”

Hamate-pisiform coalition complicated by fracture in a pediatric patient

“…Isolated fractures of the pisiform bone are very rare in the pediatric population [14] . This is an interesting case in that there is a rare complication of a rare coalition type and unfortunately the plain radiograph imaging findings were overlooked twice, leading to a delay in treatment.…”

Re: Rothenfluh E, Mürset A, Vögelin E. Avascular necrosis of the pisiform bone in a child. J Hand Surg Eur. 2022 Jun 1; 17531934221101825. doi: 10.1177/17531934221101825

“…The incidence is estimated to be 1% to 3% of all carpal bone fractures (Geissler, 2001). In children there are only three cases described in literature (Brouwers et al., 2015; Mancini et al., 2005), which were all reported as fracture dislocations.…”