[Subperiosteal pisiform excision in misaligned fractures of the triquetrum]

Isolated fractures of the os triquetrum are a very rare condition, since they are usually combined with other fractures of the carpus. An undetected isolated fracture of the os triquetrum in a 28-year-old pieceworker revealed an osseous consolidation with a misalignment of the joint surface on presentation 6 months after his primary injury. During the whole time he was unable to work due to the severely painful restricted range of movement of his wrist. There are no general guidelines for treatment. Instead of correction of the anatomy of the os triquetrum, we decided to perform a subperiosteal pisiform excision according to Palmieri. As early as 6 weeks later, the patient was able to go back to work and demonstrated a pain-free full range of movement of his wrist. We encourage this procedure not only for degenerated joint disease but also for posttraumatic lesions in the early onset of painful blocking of the joint between the os triquetrum and os pisiforme.