556
Case report
Fracture dislocation of the pisiform bone in children: a case report and review of the literature Yannick Hurnia, Cesare Fusettib and Vincenzo de Rosaa Simultaneous fracture and dislocation of the pisiform is a rare condition, and only two cases have been reported in children. We retrospectively collected and reviewed clinical and radiographic data of a child with a type II Salter–Harris fracture of the distal radius, associated with fracture dislocation of the pisiform. In addition, we performed a systematic review of the literature available to date. J Pediatr Orthop B 24:556–560 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Introduction Pisiform bone dislocation is a rare condition, and only a few cases have been reported in pediatric patients [1–6]. Simultaneous fracture and dislocation of the pisiform has only been described twice in children [1]. We report a child with type II Salter–Harris fracture of the distal radius, associated with fracture dislocation of the pisiform.
Methods We retrospectively collected and reviewed clinical and radiographic data of the above-mentioned patient. In addition, we performed a systematic review of the literature available to date. We used a multimethod approach to identify all reported cases of fractures and dislocations of the pisiform bone in pediatric patients. We performed a systematic search in the PubMed and Google Scholar databases. The terms used in the search were ‘pisiform’ combined with any of the following words: ‘fracture’, ‘dislocation’, ‘fracture-dislocation’, ‘luxation,’ and ‘displacement’. The same combination of words translated in French, Italian, German, and Spanish was used in the search in the Google Scholar database. We included all relevant original articles written in English, French, Italian, German, and Spanish. Bibliographies of all included articles were reviewed for other relevant articles. We finally selected all articles reporting fractures and/or dislocations of the pisiform bone in patients younger than 16 years old. Six articles were included, with a total of seven reported cases.
Case report An 11-year-old boy, involved in a motor-vehicle accident, was transferred to our hospital for suspected right wrist fractures. The patient did not remember the mechanism of the trauma or the exact position of his wrist at the time of the collision. No other trauma was reported. Physical examination indicated swelling and tenderness all over the wrist, with no obvious anatomic deformity. The range 1060-152X Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Journal of Pediatric Orthopaedics B 2015, 24:556–560 Keywords: hand surgery, pisiform bone, pisiform dislocation, pisiform fracture a Department of Pediatric Orthopedics and bHand Surgery Unit, Department of Orthopedics and Trauma Surgery, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
Correspondence to Yannick Hurni BSc, MSc, Department of Pediatric Orthopedics, Ospedale Regionale Bellinzona e Valli, 6500 Bellinzona, Switzerland Tel: + 41 0 91 811 88 80; fax: + 41 0 91 811 87 87; e-mail: [email protected]
of motion was severely limited by the pain. The neurovascular examination was normal. Standard anteroposterior and lateral radiographs showed a slightly displaced Salter–Harris type II distal radius physeal fracture (Fig. 1a). Volar dislocation and nondisplaced fracture of the pisiform were also observed (Fig. 1b). To appreciate the carpal architecture, radiographs of the contralateral wrist were performed (Fig. 1c). The diagnosis was subsequently confirmed by computed tomographic scanning of the right hand and wrist (Fig. 2). No rotational displacement of the pisiform was observed. Closed reduction of the distal radius and pisiform was performed under light sedation. Direct manual pressure from the volar aspect was applied on the pisiform. The wrist was then immobilized in slight extension, allowing the closest anatomic position between pisiform and triquetral bones. A long-arm cast was applied for 30 days (Fig. 3a). Upon removal of the cast, the wrist showed no limited range of motion, and normal muscular strength was found compared with contralateral side. No tenderness on the hypothenar eminence, and no ulnar nerve neurapraxia were observed. The pisotriquetral joint appeared to be stable, with no inducible pisiform subluxation or dislocation. Radiologic examinations performed at this time indicated complete healing of the distal radial fracture and of the fracture dislocation of the pisiform (Fig. 3b). The patient was re-evaluated 3 months after the accident. At this time, he was very comfortable and pain free. He was performing all activities of daily living and was actively participating in sports. Clinical examination was comparable with the previous evaluation.
Discussion Pisiform bone dislocation occurs predominantly in young and active adults, and more frequently in males. This condition has rarely been reported in children, in whom it DOI: 10.1097/BPB.0000000000000210
Copyright r 2015 Wolters Kluwer Health, Inc. All rights reserved.
Fracture dislocation of the pisiform Hurni et al. 557
Fig. 1
(a) Anteroposterior and (b) lateral radiograph of the right wrist, showing Salter–Harris type II fracture of the distal radius and fracture dislocation of the pisiform. (c) Radiograph of the contralateral wrist.
can occur isolated [5,6] or in combination with distal radius physeal fractures [1,3,4,6]. Simultaneous fracture dislocation of the pisiform has also been described [1]. The pisiform bone lies in the proximal row of the carpal bones and forms a synovial joint by articulating with the triquetrum. Its stability is ensured by a complex structure composed of 10 soft tissue attachments [7]. Among these the transverse carpal ligament, abductor digiti minimi, and flexor carpi ulnaris (FCU) play an important role. Under normal circumstances, many forces act on the pisiform, causing remarkable displacement of the pisotriquetral joint [7]. The exact function of this bone is not fully understood, but it seems to act as a sesamoid bone in the FCU tendon, mechanically enhancing the action of this muscle [7]. The dislocation of the pisiform can result from direct trauma on the hypothenar eminence or from an indirect mechanism. In the latter case, forced passive extension of the actively flexed wrist, with consequent eccentric contraction of the FCU, can dislocate the pisiform [8]. The pull of this powerful muscle, associated with hyperextension of the wrist, can tear the capsule of the pisotriquetral joint and, if severe enough, the pisiform distal attachments. The FCU function becomes impaired and the pisiform moves proximally. Lifting of heavy
objects and falling onto outstretched hand are typical reported indirect trauma mechanisms. Pisiform dislocation may be favored by constitutional hyperlaxity of the wrist ligaments [9] or secondarily to capsular tissue relaxation because of distal radial injuries [4]. Dislocation of the pisiform can manifest with swelling and tenderness at the base of the hypothenar eminence [1–4], and visible or palpable depression at this site [10]. Abnormal pisiform mobility can also be present. Neurovascular injuries are uncommon. Only one case of symptomatic damage of the ulnar nerve has been reported [10]. The diagnosis of pisiform fracture and dislocation is made on the basis of radiological findings. In association with classical anteroposterior and lateral radiographs, carpal tunnel view and lateral view of the extended wrist with supination of the forearm at 30°–45° are suggested [11 –13]. Specific radiological criteria for the diagnosis of pisiform dislocation have been proposed in adults [12], but none has been defined for children. Dislocations are usually ventral, but dorsal displacement has also been reported [14]. The pisiform typically moves distally after direct trauma and proximally after indirect mechanism. Its rotation may be very important, up to completely upside down [8]. A contralateral radiographic comparison
Copyright r 2015 Wolters Kluwer Health, Inc. All rights reserved.
558 Journal of Pediatric Orthopaedics B 2015, Vol 24 No 6
Fig. 2
(a) Axial, (b) coronal, (c) sagittal, and (d) 3D reconstruction computed tomographic images showing fracture dislocation of the pisiform.
can be useful to confirm pisiform dislocation and ascertain its actual displacement direction [15]. Computed tomography and MRI may also be very useful, but their benefit has not often been reported [8,16]. Pisiform dislocation is not always easy to observe because of the small size of this bone and the complexity of the carpal joints [1]. In addition, involuntary relocations are likely to occur spontaneously or secondary to associated wrist fracture reduction [12]. This diagnosis may be missed in preschool children because of the lack of the pisiform center of ossification [17]. Therefore, dislocation of the pisiform bone may occur more frequently than reported. Closed reduction and immobilization [10], open reduction with internal fixation [8,18], and removal of the pisiform both primarily [19] and secondarily [8,9,20] have all been reported in adults. In children, the initial management of pisiform dislocation typically consists of closed reduction and plaster cast immobilization [1–4]. Surgical resection has only been reported twice [5,6].
Reduction maneuvers usually include direct pressure on the pisiform, accompanied by wrist flexion and forearm pronation. This position allows relaxation of the FCU tendon, facilitating the relocation of the pisiform. Subsequent immobilization with both flexed [3,6] and extended [2] wrist have been reported with similar good results. If this conservative management fails, the pisiform bone should be excised and the FCU repaired [16]. Open reduction has not shown encouraging results, and should therefore be avoided in children [8]. Pisiform dislocation in children seems to have good longterm outcomes, with no residual symptoms [1,2,5,21]. However, there could be a risk of multiple redislocations, leading to chronic pain and range of motion reduction, with potential development of osteoarthritis of the pisotriquetral joint [22]. In these cases, surgical excision of the bone may be indicated. Removal of the pisiform seems not to interfere with normal wrist function [8,9,14, 15,19,20,22–24].
Copyright r 2015 Wolters Kluwer Health, Inc. All rights reserved.
Fracture dislocation of the pisiform Hurni et al. 559
Fig. 3
(a) Radiography showing reduced fracture and immobilized right wrist in the extended position. (b) Lateral view showing complete healing of the fracture dislocation of the pisiform after removal of the cast.
Conclusion
2
Dislocation of the pisiform bone is a rare and probably underdiagnosed condition in pediatric traumatology. Associated fracture of this bone is notably rarer. This benign injury should be primarily treated with closed reduction and immobilization. Pisiform bone resection should only be performed in the case of failure of the more conservative approach.
Acknowledgements Conflicts of interest
There are no conflicts of interest.
References 1 Mancini F, de Maio F, Ippolito E. Pisiform bone fracture-dislocation and distal radius physeal fracture in two children. J Pediatr Orthop B 2005; 14:303–306.
Kubiak R, Slongo T, Tschäppeler H. Isolated dislocation of the pisiform: an unusual injury during a cartwheel maneuver. J Trauma 2001; 51: 788–789. 3 Cohen I. Dislocation of the pisiform. Ann Surg 1922; 75:238–239. 4 Ashkan K, O’Connor D, Lambert S. Dislocation of the pisiform in a 9-yearold child. J Hand Surg Br 1998; 23:269–270. 5 Korovessis P. Traumatic luxation of the pisiform bone [article in German]. Handchir Mikrochir Plast Chir 1983; 15:196–197. 6 Pena Marero L, Alvarez Cambra R, Lopez Diaz H, Hernandez Gonzalez R, Oquendo Vazquez P, Castro Soto del Valle A. Pisiform dislocation associated with distal radius epiphysiolysis. Cuban J Orthop Traumatol 2003; 17:88–91 [in Spanish]. 7 Pevny T, Rayan GM, Egle D. Ligamentous and tendinous support of the pisiform, anatomic and biomechanical study. J Hand Surg Am 1995; 20:299–304. 8 Minami M, Yamazaki J, Ishii S. Isolated dislocation of the pisiform: a case report and review of the literature. J Hand Surg Am 1984; 9A:125–127. 9 Ishizuki M, Nakagawa T, Itoh S, Furuya K. Positional dislocation of the pisiform. J Hand Surg Am 1991; 16:533–535. 10 Sharara KH, Farrar M. Isolated dislocation of the pisiform bone. J Hand Surg Br 1993; 18:195–196.
Copyright r 2015 Wolters Kluwer Health, Inc. All rights reserved.
560
11 12 13 14 15 16
17
Journal of Pediatric Orthopaedics B 2015, Vol 24 No 6
Soete P, Docquier J, Forthomme JP, Stainier E. Dislocation of the pisiform bone [article in French]. Acta Orthop Belg 1988; 54:87–89. Vasilas A, Grieco RV, Bartone NF. Roentgen aspects of injuries to the pisiform bone and pisotriquetral joint. J Bone Joint Surg Am 1960; 42:1317–1328. Jameson BH, Rayan GM, Acker RE. Radiographic analysis of pisotriquetral joint and pisiform motion. J Hand Surg Am 2002; 27:863–869. Muñiz AE. Unusual wrist pain: pisiform dislocation and fracture. Am J Emerg Med 1999; 17:78–79. McCarron RF, Coleman W. Dislocation of the pisiform treated by primary resection. A case report. Clin Orthop Relat Res 1989; 241:231–233. Levante S, Ebelin M. Traumatic dislocation of the pisiform bone: a case report and review of the literature [article in French]. Chir Main 2002; 21:264–268. Michelson N. Studies in the physical development. V. The ossification time of the os pisiforme. Human Biol 1945; 17:142–146.
18
19 20 21
22 23 24
Pai CH, Wei DC, Hu ST. Carpal bone dislocations: an analysis of twenty cases with relative emphasis on the role of crushing mechanisms. J Trauma 1993; 35:28–35. Gainor BJ. Simultaneous dislocation of the hamate and pisiform: a case report. J Hand Surg Am 1985; 10:88–90. Goriainov V, Bayne G, Warwick DJ. Traumatic dislocation of the pisiform: a case report. J Orthop Surg (Hong Kong) 2010; 18:389–390. Schädel-Höpfner M, Böhringer G, Junge A. Dislocation of the pisiform bone after severe crush injury to the hand. Scand J Plast Reconstr Surg Hand Surg 2003; 37:252–255. Immermann EW. Dislocation of the pisiform. J Bone Joint Surg Am 1948; 30A:489–492. Carroll RE, Coyle MP Jr. Dysfunction of the pisotriquetral joint: treatment by excision of the pisiform. J Hand Surg Am 1985; 10:703–707. Arner M, Hagberg L. Wrist flexion strength after excision of the pisiform bone. Scand J Plast Reconstr Surg 1984; 18:241–245.
Copyright r 2015 Wolters Kluwer Health, Inc. All rights reserved.
Case report
Fracture dislocation of the pisiform bone in children: a case report and review of the literature Yannick Hurnia, Cesare Fusettib and Vincenzo de Rosaa Simultaneous fracture and dislocation of the pisiform is a rare condition, and only two cases have been reported in children. We retrospectively collected and reviewed clinical and radiographic data of a child with a type II Salter–Harris fracture of the distal radius, associated with fracture dislocation of the pisiform. In addition, we performed a systematic review of the literature available to date. J Pediatr Orthop B 24:556–560 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Introduction Pisiform bone dislocation is a rare condition, and only a few cases have been reported in pediatric patients [1–6]. Simultaneous fracture and dislocation of the pisiform has only been described twice in children [1]. We report a child with type II Salter–Harris fracture of the distal radius, associated with fracture dislocation of the pisiform.
Methods We retrospectively collected and reviewed clinical and radiographic data of the above-mentioned patient. In addition, we performed a systematic review of the literature available to date. We used a multimethod approach to identify all reported cases of fractures and dislocations of the pisiform bone in pediatric patients. We performed a systematic search in the PubMed and Google Scholar databases. The terms used in the search were ‘pisiform’ combined with any of the following words: ‘fracture’, ‘dislocation’, ‘fracture-dislocation’, ‘luxation,’ and ‘displacement’. The same combination of words translated in French, Italian, German, and Spanish was used in the search in the Google Scholar database. We included all relevant original articles written in English, French, Italian, German, and Spanish. Bibliographies of all included articles were reviewed for other relevant articles. We finally selected all articles reporting fractures and/or dislocations of the pisiform bone in patients younger than 16 years old. Six articles were included, with a total of seven reported cases.
Case report An 11-year-old boy, involved in a motor-vehicle accident, was transferred to our hospital for suspected right wrist fractures. The patient did not remember the mechanism of the trauma or the exact position of his wrist at the time of the collision. No other trauma was reported. Physical examination indicated swelling and tenderness all over the wrist, with no obvious anatomic deformity. The range 1060-152X Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Journal of Pediatric Orthopaedics B 2015, 24:556–560 Keywords: hand surgery, pisiform bone, pisiform dislocation, pisiform fracture a Department of Pediatric Orthopedics and bHand Surgery Unit, Department of Orthopedics and Trauma Surgery, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
Correspondence to Yannick Hurni BSc, MSc, Department of Pediatric Orthopedics, Ospedale Regionale Bellinzona e Valli, 6500 Bellinzona, Switzerland Tel: + 41 0 91 811 88 80; fax: + 41 0 91 811 87 87; e-mail: [email protected]
of motion was severely limited by the pain. The neurovascular examination was normal. Standard anteroposterior and lateral radiographs showed a slightly displaced Salter–Harris type II distal radius physeal fracture (Fig. 1a). Volar dislocation and nondisplaced fracture of the pisiform were also observed (Fig. 1b). To appreciate the carpal architecture, radiographs of the contralateral wrist were performed (Fig. 1c). The diagnosis was subsequently confirmed by computed tomographic scanning of the right hand and wrist (Fig. 2). No rotational displacement of the pisiform was observed. Closed reduction of the distal radius and pisiform was performed under light sedation. Direct manual pressure from the volar aspect was applied on the pisiform. The wrist was then immobilized in slight extension, allowing the closest anatomic position between pisiform and triquetral bones. A long-arm cast was applied for 30 days (Fig. 3a). Upon removal of the cast, the wrist showed no limited range of motion, and normal muscular strength was found compared with contralateral side. No tenderness on the hypothenar eminence, and no ulnar nerve neurapraxia were observed. The pisotriquetral joint appeared to be stable, with no inducible pisiform subluxation or dislocation. Radiologic examinations performed at this time indicated complete healing of the distal radial fracture and of the fracture dislocation of the pisiform (Fig. 3b). The patient was re-evaluated 3 months after the accident. At this time, he was very comfortable and pain free. He was performing all activities of daily living and was actively participating in sports. Clinical examination was comparable with the previous evaluation.
Discussion Pisiform bone dislocation occurs predominantly in young and active adults, and more frequently in males. This condition has rarely been reported in children, in whom it DOI: 10.1097/BPB.0000000000000210
Copyright r 2015 Wolters Kluwer Health, Inc. All rights reserved.
Fracture dislocation of the pisiform Hurni et al. 557
Fig. 1
(a) Anteroposterior and (b) lateral radiograph of the right wrist, showing Salter–Harris type II fracture of the distal radius and fracture dislocation of the pisiform. (c) Radiograph of the contralateral wrist.
can occur isolated [5,6] or in combination with distal radius physeal fractures [1,3,4,6]. Simultaneous fracture dislocation of the pisiform has also been described [1]. The pisiform bone lies in the proximal row of the carpal bones and forms a synovial joint by articulating with the triquetrum. Its stability is ensured by a complex structure composed of 10 soft tissue attachments [7]. Among these the transverse carpal ligament, abductor digiti minimi, and flexor carpi ulnaris (FCU) play an important role. Under normal circumstances, many forces act on the pisiform, causing remarkable displacement of the pisotriquetral joint [7]. The exact function of this bone is not fully understood, but it seems to act as a sesamoid bone in the FCU tendon, mechanically enhancing the action of this muscle [7]. The dislocation of the pisiform can result from direct trauma on the hypothenar eminence or from an indirect mechanism. In the latter case, forced passive extension of the actively flexed wrist, with consequent eccentric contraction of the FCU, can dislocate the pisiform [8]. The pull of this powerful muscle, associated with hyperextension of the wrist, can tear the capsule of the pisotriquetral joint and, if severe enough, the pisiform distal attachments. The FCU function becomes impaired and the pisiform moves proximally. Lifting of heavy
objects and falling onto outstretched hand are typical reported indirect trauma mechanisms. Pisiform dislocation may be favored by constitutional hyperlaxity of the wrist ligaments [9] or secondarily to capsular tissue relaxation because of distal radial injuries [4]. Dislocation of the pisiform can manifest with swelling and tenderness at the base of the hypothenar eminence [1–4], and visible or palpable depression at this site [10]. Abnormal pisiform mobility can also be present. Neurovascular injuries are uncommon. Only one case of symptomatic damage of the ulnar nerve has been reported [10]. The diagnosis of pisiform fracture and dislocation is made on the basis of radiological findings. In association with classical anteroposterior and lateral radiographs, carpal tunnel view and lateral view of the extended wrist with supination of the forearm at 30°–45° are suggested [11 –13]. Specific radiological criteria for the diagnosis of pisiform dislocation have been proposed in adults [12], but none has been defined for children. Dislocations are usually ventral, but dorsal displacement has also been reported [14]. The pisiform typically moves distally after direct trauma and proximally after indirect mechanism. Its rotation may be very important, up to completely upside down [8]. A contralateral radiographic comparison
Copyright r 2015 Wolters Kluwer Health, Inc. All rights reserved.
558 Journal of Pediatric Orthopaedics B 2015, Vol 24 No 6
Fig. 2
(a) Axial, (b) coronal, (c) sagittal, and (d) 3D reconstruction computed tomographic images showing fracture dislocation of the pisiform.
can be useful to confirm pisiform dislocation and ascertain its actual displacement direction [15]. Computed tomography and MRI may also be very useful, but their benefit has not often been reported [8,16]. Pisiform dislocation is not always easy to observe because of the small size of this bone and the complexity of the carpal joints [1]. In addition, involuntary relocations are likely to occur spontaneously or secondary to associated wrist fracture reduction [12]. This diagnosis may be missed in preschool children because of the lack of the pisiform center of ossification [17]. Therefore, dislocation of the pisiform bone may occur more frequently than reported. Closed reduction and immobilization [10], open reduction with internal fixation [8,18], and removal of the pisiform both primarily [19] and secondarily [8,9,20] have all been reported in adults. In children, the initial management of pisiform dislocation typically consists of closed reduction and plaster cast immobilization [1–4]. Surgical resection has only been reported twice [5,6].
Reduction maneuvers usually include direct pressure on the pisiform, accompanied by wrist flexion and forearm pronation. This position allows relaxation of the FCU tendon, facilitating the relocation of the pisiform. Subsequent immobilization with both flexed [3,6] and extended [2] wrist have been reported with similar good results. If this conservative management fails, the pisiform bone should be excised and the FCU repaired [16]. Open reduction has not shown encouraging results, and should therefore be avoided in children [8]. Pisiform dislocation in children seems to have good longterm outcomes, with no residual symptoms [1,2,5,21]. However, there could be a risk of multiple redislocations, leading to chronic pain and range of motion reduction, with potential development of osteoarthritis of the pisotriquetral joint [22]. In these cases, surgical excision of the bone may be indicated. Removal of the pisiform seems not to interfere with normal wrist function [8,9,14, 15,19,20,22–24].
Copyright r 2015 Wolters Kluwer Health, Inc. All rights reserved.
Fracture dislocation of the pisiform Hurni et al. 559
Fig. 3
(a) Radiography showing reduced fracture and immobilized right wrist in the extended position. (b) Lateral view showing complete healing of the fracture dislocation of the pisiform after removal of the cast.
Conclusion
2
Dislocation of the pisiform bone is a rare and probably underdiagnosed condition in pediatric traumatology. Associated fracture of this bone is notably rarer. This benign injury should be primarily treated with closed reduction and immobilization. Pisiform bone resection should only be performed in the case of failure of the more conservative approach.
Acknowledgements Conflicts of interest
There are no conflicts of interest.
References 1 Mancini F, de Maio F, Ippolito E. Pisiform bone fracture-dislocation and distal radius physeal fracture in two children. J Pediatr Orthop B 2005; 14:303–306.
Kubiak R, Slongo T, Tschäppeler H. Isolated dislocation of the pisiform: an unusual injury during a cartwheel maneuver. J Trauma 2001; 51: 788–789. 3 Cohen I. Dislocation of the pisiform. Ann Surg 1922; 75:238–239. 4 Ashkan K, O’Connor D, Lambert S. Dislocation of the pisiform in a 9-yearold child. J Hand Surg Br 1998; 23:269–270. 5 Korovessis P. Traumatic luxation of the pisiform bone [article in German]. Handchir Mikrochir Plast Chir 1983; 15:196–197. 6 Pena Marero L, Alvarez Cambra R, Lopez Diaz H, Hernandez Gonzalez R, Oquendo Vazquez P, Castro Soto del Valle A. Pisiform dislocation associated with distal radius epiphysiolysis. Cuban J Orthop Traumatol 2003; 17:88–91 [in Spanish]. 7 Pevny T, Rayan GM, Egle D. Ligamentous and tendinous support of the pisiform, anatomic and biomechanical study. J Hand Surg Am 1995; 20:299–304. 8 Minami M, Yamazaki J, Ishii S. Isolated dislocation of the pisiform: a case report and review of the literature. J Hand Surg Am 1984; 9A:125–127. 9 Ishizuki M, Nakagawa T, Itoh S, Furuya K. Positional dislocation of the pisiform. J Hand Surg Am 1991; 16:533–535. 10 Sharara KH, Farrar M. Isolated dislocation of the pisiform bone. J Hand Surg Br 1993; 18:195–196.
Copyright r 2015 Wolters Kluwer Health, Inc. All rights reserved.
560
11 12 13 14 15 16
17
Journal of Pediatric Orthopaedics B 2015, Vol 24 No 6
Soete P, Docquier J, Forthomme JP, Stainier E. Dislocation of the pisiform bone [article in French]. Acta Orthop Belg 1988; 54:87–89. Vasilas A, Grieco RV, Bartone NF. Roentgen aspects of injuries to the pisiform bone and pisotriquetral joint. J Bone Joint Surg Am 1960; 42:1317–1328. Jameson BH, Rayan GM, Acker RE. Radiographic analysis of pisotriquetral joint and pisiform motion. J Hand Surg Am 2002; 27:863–869. Muñiz AE. Unusual wrist pain: pisiform dislocation and fracture. Am J Emerg Med 1999; 17:78–79. McCarron RF, Coleman W. Dislocation of the pisiform treated by primary resection. A case report. Clin Orthop Relat Res 1989; 241:231–233. Levante S, Ebelin M. Traumatic dislocation of the pisiform bone: a case report and review of the literature [article in French]. Chir Main 2002; 21:264–268. Michelson N. Studies in the physical development. V. The ossification time of the os pisiforme. Human Biol 1945; 17:142–146.
18
19 20 21
22 23 24
Pai CH, Wei DC, Hu ST. Carpal bone dislocations: an analysis of twenty cases with relative emphasis on the role of crushing mechanisms. J Trauma 1993; 35:28–35. Gainor BJ. Simultaneous dislocation of the hamate and pisiform: a case report. J Hand Surg Am 1985; 10:88–90. Goriainov V, Bayne G, Warwick DJ. Traumatic dislocation of the pisiform: a case report. J Orthop Surg (Hong Kong) 2010; 18:389–390. Schädel-Höpfner M, Böhringer G, Junge A. Dislocation of the pisiform bone after severe crush injury to the hand. Scand J Plast Reconstr Surg Hand Surg 2003; 37:252–255. Immermann EW. Dislocation of the pisiform. J Bone Joint Surg Am 1948; 30A:489–492. Carroll RE, Coyle MP Jr. Dysfunction of the pisotriquetral joint: treatment by excision of the pisiform. J Hand Surg Am 1985; 10:703–707. Arner M, Hagberg L. Wrist flexion strength after excision of the pisiform bone. Scand J Plast Reconstr Surg 1984; 18:241–245.
Copyright r 2015 Wolters Kluwer Health, Inc. All rights reserved.
