Pisiform fracture
Background
- Occurs via fall onto hypothenar eminence
- Forced wrist flexion or strain from lifting heavy objects can avulse the pisiform[1]
- Must exclude injury to ulnar nerve/artery (pisiform forms bony wall of Guyon's canal)
Clinical Features
- Localized tenderness on the pisiform itself, especially if with resisted wrist flexion[1]
Differential Diagnosis
Evaluation
- Obtain x-rays in partial supination or carpal tunnel view (removes overlap with triquetrum)
Pisiform fracture
Management
General Fracture Management
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
Immobilization
- Compression dressing or forearm volar splint in 30 degrees of flexion with ulnar deviation
Disposition
- Discharge with referral to orthopedic surgery
See Also
References
- German C. Hand and wrist emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.
This article is issued from
Wikem.
The text is licensed under Creative
Commons - Attribution - Sharealike.
Additional terms may apply for the media files.