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Locked Traumatic Pisiform Dislocation: A Case Report.

Fevzi Saglam1, Mirza Zafer Dagtas2, Sonmez Sağlam3

  • 1Department of Orthopedıcs and Traumatology, Marmara University Pendik Education and Research Hospital, İstanbul, Turkey.

JBJS Case Connector
|November 27, 2019
PubMed
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Distal pisiform dislocations are challenging to diagnose but can be successfully treated with early surgical intervention, including open reduction and ligament repair. This approach leads to excellent functional outcomes for patients with wrist trauma.

Area of Science:

  • Orthopedic Surgery
  • Trauma Care
  • Radiology

Background:

  • Carpal bone fractures and pisiform dislocations often result from significant trauma.
  • Accurate diagnosis of distal pisiform dislocations can be challenging with standard radiographic views.

Observation:

  • A case of a 32-year-old male with multiple carpal bone fractures and a locked distal pisiform dislocation following trauma is presented.
  • Initial treatment involved open surgical reduction, osteosynthesis with a Kirschner wire, and ligament repair.

Findings:

  • The patient achieved an excellent functional outcome with a Mayo wrist score of 90 at 36 months post-injury.
  • Standard anteroposterior and lateral radiographs may not adequately visualize distal pisiform dislocations.
  • A 30° semisupinated wrist X-ray and computed tomography (CT) scans can aid in diagnosis.

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Implications:

  • Early detection and surgical management of distal pisiform dislocations are crucial for achieving satisfactory clinical results.
  • This case highlights the importance of advanced imaging and prompt surgical intervention in complex wrist trauma.