Pisiform fracture: Difference between revisions
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==Background== | ==Background== | ||
*Occurs via fall onto hypothenar eminence | *Occurs via fall onto hypothenar eminence | ||
*Must exclude injury to ulnar nerve/artery (pisiform forms bony wall of Guyon canal) | *Forced wrist flexion or strain from lifting heavy objects can avulse the pisiform<ref name="Hand and wrist emergencies">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.</ref> | ||
*Must exclude injury to ulnar nerve/artery (pisiform forms bony wall of Guyon's canal) | |||
==Clinical Features== | ==Clinical Features== | ||
*Localized tenderness on the pisiform itself | *Localized tenderness on the pisiform itself, especially if with resisted wrist flexion<ref name="Hand and wrist emergencies">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.</ref> | ||
== | ==Differential Diagnosis== | ||
*Obtain x-rays in partial supination or carpal tunnel view (removes overlap | {{Carpal fractures}} | ||
==Evaluation== | |||
*Obtain x-rays in partial supination or carpal tunnel view (removes overlap with triquetrum) | |||
*May require CT for confirmation | |||
[[File:Pisiform_Fracture.jpg|thumb|Pisiform fracture]] | |||
==Management== | ==Management== | ||
*Compression dressing or splint in 30 degrees of flexion | {{General Fracture Management}} | ||
===Immobilization=== | |||
*Compression dressing or [[forearm volar splint]] in 30 degrees of flexion with ulnar deviation | |||
== | ==Disposition== | ||
*Discharge with referral to orthopedic surgery | |||
==See Also== | ==See Also== | ||
[[ | *[[Carpal fractures]] | ||
== | ==References== | ||
<references/> | |||
[[Category: | [[Category:Orthopedics]] | ||
Latest revision as of 15:37, 30 April 2022
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
Carpal fractures
- Scaphoid fracture
- Lunate fracture
- Triquetrum fracture
- Pisiform fracture
- Trapezium fracture
- Trapezoid fracture
- Capitate fracture
- Hamate fracture
Evaluation
- Obtain x-rays in partial supination or carpal tunnel view (removes overlap with triquetrum)
- May require CT for confirmation
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