Pisiform Bone Dislocation in a Pediatric Patient: What is the Best Treatment? Case Report and Review of the Literature

Abstract

Traumatic dislocation of the pisiform bone (PB) is a rare injury of the carpal bones, especially in pediatric patients. A few cases were reported, and there is no consensus about the treatment. Each author supports his own method, such as an open reduction internal fixation (ORIF) approach or a closed reduction. However, failures of both techniques with recurrent dislocation of the PB have been reported in the literature. In this article, a fracture dislocation of the PB was treated with ORIF in an 11-year-old boy with a greenstick radial fracture. In addition, a review of the literature about pisiform fracture dislocation in children has been made.

Fracture Dislocation of the Pisiform Bone in 14-Year-Old Boy—A Case Report

“…In cases where closed reduction attempts are unsuccessful, some authors suggest the joystick maneuver as the next option, which can be challenging, especially in the presence of a fractured bone [16]. If successful repositioning is achieved, open reduction and internal fixation (ORIF) with K-wires can be considered, as demonstrated by Giannetti's one case with very good results [5]. The last resort appears to be pisiformectomy, a technique successfully employed in all young patients identified in the literature [7,9,15].…”

“…Additionally, Giannetti 2020 reported a case involving an 11-year-old boy who fell on a mountain trail, sustaining a greenstick fracture of the radius and a fracture of the ulna styloid [5]. A CT scan confirmed an additional fracture dislocation of the pisiform bone.…”

“…Despite our efforts to address this challenge by partially removing the joint capsule, the complexity and instability of the fracture persisted, impeding our attempts at achieving a stable reduction. While our initial plan was to proceed with screw stabilization in the event of a stable reduction, it is worth noting that there has been only one documented case in the literature involving K-wire stabilization up to this point [5]. Consequently, osteosynthesis was deemed unfeasible under these circumstances.…”

“…Simultaneous fracture and dislocation of the pisiform bone is exceedingly rare in both children and adults, with only a few reported cases in pediatric literature and no established consensus on treatment. Upon comparison with existing literature through a PubMed database search, we identified four pediatric patients with this condition [3][4][5]. Additionally, our analysis encompassed nine patients with simple dislocations [6][7][8][9][10][11][12][13][14] and one patient [15] with isolated fractures of the pisiform bone from available reports of similar injuries.…”