Isolated Non-displaced Pisiform Fracture: A Diagnostic Challenge in Ulnar-Sided Wrist Trauma Managed Conservatively

Carpal bone fractures are uncommon fractures, with pisiform fractures being exceptionally rare. This case report describes a 29-year-old male military member who sustained a non-displaced pisiform fracture after falling approximately six steps. The patient presented to the emergency department with localized left wrist pain and mild swelling over the pisiform bone, without other associated injuries. Initial radiographs, including anteroposterior, lateral, and oblique views, confirmed a transverse non-displaced fracture of the pisiform. The patient was managed conservatively with a below-elbow ulnar gutter splint in mild palmar flexion for two weeks, followed by progressive mobilization. At follow-up, radiographs demonstrated early signs of healing, and the patient regained full wrist range of motion without complications by four to six weeks post-injury. This case underscores several key points: (1) the importance of clinical suspicion for pisiform fractures in patients with ulnar-sided wrist pain following trauma, (2) the utility of standard radiographs in diagnosis when multiple views are obtained, and (3) the effectiveness of conservative management with short-term immobilization for non-displaced fractures. Given the rarity of isolated pisiform fractures and their potential for missed diagnosis, clinicians should maintain a high index of suspicion to ensure timely treatment and prevent long-term complications such as chronic pain or osteoarthritis. The successful outcome, in this case, supports current literature advocating for conservative approaches in uncomplicated pisiform fractures.