Long-Term Results of Pisiformectomy in a Cohort of 57 Patients

Abstract

Background Excision of the pisiform is an infrequently used option for pisotriquetral joint dysfunction when nonoperative treatment is ineffective. This study reviews the patient-reported outcomes of patients treated with pisiformectomy, and furthermore focuses on the complications and the need for and time to revision procedure. Materials and Methods Medical records of 57 patients were manually reviewed and assessed for complications, rate of unplanned reoperations, and type of reoperations. Thirty-seven patients (65%) completed patient-rated outcomes surveys at a median of 10 years after their procedure. Results The complication rate was 13% (n = 7). Ulnar nerve symptoms were noted in three patients. No reoperations were performed after the pisiform excision. Out of the 16 patients who had preoperative symptoms of ulnar nerve compression at the wrist, 10 patients reported that their symptoms had completely resolved after the surgery. The median Quick Disability of Arm, Shoulder and Hand (QuickDASH) score after surgery was 4.5 (2.3–16), median score for pain 0 (interquartile range [IQR]: 0–2), and median score for overall satisfaction 10 (IQR: 8–10). Conclusions Pisiformectomy is a surgery used sparingly in cases with refractory pain associated with arthrosis of the pisotriquetral joint or enthesopathy of the flexor carpi ulnaris/pisiform interface. When utilized in this fashion, patients report limited disability on patient-rated outcome measures, low pain scores, and high satisfaction at mid- to late follow-up.

Long-term outcomes after ulna shortening osteotomy: a mean follow-up of six years

“…Next to hardware removal and nonunion, other subsequent procedures were performed for persistent/recurrent ulnar-sided wrist pain in some patients. This observation is also noted in other studies addressing surgical outcomes of ulnar-sided wrist pain 33 , 35 , 42 and may result from coexisting pathology. 43 In our study, none of the patients underwent DRUJ arthroplasty for DRUJ OA.…”

Patient Satisfaction with Pisiform Excision for Pisotriquetral Instability or Arthritis: A Prospective Review

“…They recommended the procedure for refractory pisiform pain or FCU enthesopathy. 24 We measured grip strength in our series and found that there was a trend toward transient loss of grip strength at 3 months postoperatively, which was not statistically significant, and grip strength returned to baseline by the 12month follow-up. Lam and colleagues also found that there was no significant difference in grip strength or ROM after pisiform excision.…”

“…Retrospective studies have shown good patient satisfaction that is maintained over long-term follow-up. 10,12,24 In one of the earliest large retrospective case series, Carroll and Coyle described complete relief in 65 of 76 wrists treated with pisiform excision with no loss of strength and no late problems associated with the FCU function. 25 Many patients had coincident diagnoses such as ulnar nerve symptoms (22/66) and median nerve symptoms (7/66), pisiform nonunion (3/66), and ulnar impaction syndrome treated previously with ulnar shortening osteotomy (4/66).…”

Isolated Osseous Excision in the Adult Carpus: A Narrative Review

“…[60][61][62][63] Total pisiformectomy caters to a wide array of pisotriquetral (PT) joint, ulnar nerve, and median nerve pathologies with long-term studies demonstrating its reliability in improving pain and wrist functionality. 64,65 Tumors and masses involving the pisiform have a low threshold for treatment with pisiformectomy as it is totally curative and maintains wrist function. ABCs are frequently diagnosed on magnetic resonance imaging, and when managed with pisiformectomy, have good results with no complications or recurrence.…”

“…60 61 62 63 Total pisiformectomy caters to a wide array of pisotriquetral (PT) joint, ulnar nerve, and median nerve pathologies with long-term studies demonstrating its reliability in improving pain and wrist functionality. 64 65…”