Dysfunction of the pisotriquetral joint: Treatment by excision of the pisiform (2022)

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The Journal of Hand Surgery

Volume 10, Issue 5,

September 1985

, Pages 703-707

Sixty-seven painful pisotriquetral joints were treated by excision of the pisiform over a 30-year period. Forty-two patients had a previous history of trauma. Ulnar neuropathy was noted in 22 patients, particularly in those with associated wrist-hand fractures and subluxations or dislocations of the pisiform. The abductor and flexor digiti minimi and the palmar carpal ligament with their common fibrous origin were the most common compressing structures on the ulnar nerve. Chondromalacia was found in 29 and osteoarthritis in 20 pisotriquetral joints. Excision of the pisiform provided complete relief of localized hypothenar pain in 65 wrists with no loss of wrist motion or strength. Neurolysis produced full sensory recovery in all 22 patients and full motor recovery in five of six. No late problems associated with the flexor carpi ulnaris tendon were found after excision of the pisiform.

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(Video) Pisiform bone 🦴 Everything Human Anatomy Bones 🦴

Cited by (92)

  • Vascularized pisiform graft for the treatment of scaphoid nonunion: An anatomical study

    2021, Hand Surgery and Rehabilitation

    Scaphoid fracture can evolve into scaphoid nonunion leading to wrist arthritis. Vascularized bone flaps used to treat scaphoid nonunion are supplied by delicate, small, or short arteries that are not always reliable. The pisiform bone has never been considered as a possible treatment of scaphoid nonunion since the traditionally harvested pedicle is too short. This study aimed to characterize the vascularization of the pisiform with the goal of developing a method of harvesting it with a longer pedicle that can be used as a graft to treat scaphoid nonunion. A cadaver study on 30 upper limbs was done in two parts: firstly, we dissected 20 cadaver specimens and documented the pisiform's vascularization (size, length, and articular surface) as well as anatomical characteristics of the dorsal ulnar artery; secondly, we used 10 cadaver specimens to study an experimental surgical procedure in which a vascularized pisiform graft is used to treat an artificially created nonunion and confirm its feasibility. The pisiform artery originated from the dorsal ulnar artery in all 20 dissections. Its average length of 4.036cm could be increased by 11% by ligating the upstream collateral branches from the dorsal ulnar artery. The pedicled vascularized pisiform flap was grafted to the scaphoid in 10 experimental procedures performed on fresh cadavers. The vascularized pisiform graft consists of a reliable vascular pedicle and well vascularized multi-cortical bone with a cartilaginous surface. However, more studies are needed to confirm the feasibility of this flap as an alternative for treating unstable scaphoid nonunion.

    Les fractures du scaphoïde peuvent évoluer vers une pseudarthrose avec apparition progressive d’une arthrose du poignet. Les greffons vascularisés actuellement proposés sont basés sur des artères inconstantes ou fines dont la perfusion après mise en place du greffon peut être aléatoire. Le pisiforme n’a jamais été proposé comme un traitement de la pseudarthrose du scaphoïde du fait d’un pédicule jugé trop court. Cette étude visait à caractériser la vascularisation du pisiforme afin de proposer le prélèvement d’un pédicule plus long permettant de l’utiliser comme greffon vascularisé pour traiter la pseudarthrose du scaphoïde. Il s’agissait d’une étude cadavérique comprenant 30 avant-bras: la première partie du travail a consisté à disséquer 20 membres supérieurs et documenter la vascularisation du pisiforme (taille, longueur et surface articulaire) ainsi que les caractéristiques anatomiques de l’artère dorso-ulnaire; la seconde partie a consisté en 10 dissections supplémentaires pour étudier une technique chirurgicale expérimentale utilisant un greffon vascularisé de pisiforme pour traiter une pseudarthrose créée artificiellement. L’artère du pisiforme naissait toujours du tronc de l’artère dorso-ulnaire. Sa longueur moyenne était de 4,036cm et pouvait être augmentée de 11,22% via la ligature des branches successives provenant de l’artère dorso-ulnaire. Le lambeau pédiculé vascularisé de pisiforme a été greffé sur le scaphoïde lors de 10 opération expérimentales effectuées sur cadavres frais. Le greffon vascularisé de pisiforme est composé d’un pédicule vasculaire fiable et d’un os pluricortical bien vascularisé avec une surface cartilagineuse. D’autres études sont nécessaires pour confirmer la faisabilité de ce greffon comme alternative dans le traitement chirurgical de la pseudarthrose du scaphoïde.

  • Carpal Fractures Other than Scaphoid in the Athlete

    2020, Clinics in Sports Medicine

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  • Pisiformectomy in advanced pisotriquetral joint arthritis: A retrospective study of 12 wrists with a mean follow-up of 7.5 years

    2019, Hand Surgery and Rehabilitation

    Pisiformectomy is the gold standard treatment for pisotriquetral arthritis resistant to conservative treatment. We evaluated the long-term clinical and functional outcomes after pisiformectomy in resistant pisotriquetral arthritis cases. We retrospectively evaluated 11 patients (12 wrists), mean age of 59 years (49–69) treated by pisiformectomy using a standardized surgical technique. Pisiformectomy was performed for primary osteoarthritis in 10 cases, for post-traumatic osteoarthritis in 1 case and for pisotriquetral instability in 1 case. The clinical and functional evaluation was carried out by an independent examiner. Mean time to review was 90 months (63–151). Pain on a Visual Analog Scale (/10) decreased significantly to 1.1 from 6.8 preoperatively. Mean range of motion was 79° in flexion, 61.5° in extension, 18° in ulnar deviation and 36° in radial deviation. Mean grip strength of the operated wrist was 86% of the non-operated wrist. Functional scores significantly improved with a gain of 40 points for the QuickDASH and 53 points for the PRWE. Based on this long-term follow-up study, pisiformectomy seems to alleviate wrist pain and improve the quality of life in a low-demand population with pisotriquetral osteoarthritis resistant to conservative treatment. When compared to the pisotriquetral arthrodesis, pisiformectomy is easier to perform, allows quicker mobilization of the wrist and leads to good functional outcomes.

    La pisiformectomie représente la solution chirurgicale la plus utilisée en cas d’échec d’un traitement médical bien conduit dans l’arthrose piso-triquétrale. L’objectif de cette étude était d’évaluer les résultats cliniques et fonctionnels à long terme de cette technique. Il s’agit d’une étude rétrospective monocentrique portant sur 11 patients (12 poignets), d’âge moyen 59 ans (49–69), opérés d’une pisiformectomie selon la même technique chirurgicale. Dans 10 cas, l’étiologie était l’arthrose piso-triquétrale essentielle. Il y avait un cas d’arthrose post-traumatique et une instabilité de l’articulation piso-triquétrale. Une évaluation clinique et fonctionnelle a été réalisée par un examinateur indépendant. Le recul moyen à la révision était de 90 mois (63–151). On retrouvait une amélioration significative de la douleur avec une évaluation visuelle analogique moyenne évaluée à 1,1/10 (versus 6,8/10 en préopératoire). Les mobilités moyennes du poignet étaient de 79°, 61,5°, 18° et 36° en flexion, en extension, en inclinaison ulnaire et en inclinaison radiale respectivement. La force de poigne était de 86% par rapport au côté opposé. Les scores fonctionnels étaient également améliorés significativement avec un gain de 40 points pour le QuickDASH et 53 points pour le PRWE. Au vu de cette étude au recul important, la pisiformectomie semble apporter l’indolence et améliorer le confort de vie chez les patients porteurs d’une arthrose piso-triquétrale avancée. En comparaison à l’arthrodèse piso-triquétrale, principale alternative chirurgicale, la pisiformectomie a l’avantage de la simplicité de réalisation, mais également des suites opératoires rapides permettant de maintenir les mobilités articulaires du poignet.

  • Management of Pisotriquetral Instability

    2018, Journal of Hand Surgery

    Pisotriquetral instability is an often-overlooked condition that can lead to ulnar-sided wrist pain and dysfunction. Various case series and biomechanical studies have been published regarding the diagnosis and treatment of this condition. We review current methods for examining, diagnosing, and treating pisotriquetral instability.

  • Hamate Hook and Pisiform Fractures

    2016, Operative Techniques in Sports Medicine

    Though rare, hook of hamate (hamulus) fractures and pisiform fractures are serious injuries in the athlete that should not be missed or underestimated. Failure to promptly diagnose and treat these fractures may lead to serious complications including avascular necrosis, nonunion, tendon rupture, carpal instability, neurovascular compression, and arthritis. Hamulus fractures should be suspected in the athlete with persistent hypothenar hand, particularly those who use a bat, racket, or club. Complete hamulus excision after fracture has been shown to provide consistent pain relief and return to sport. Pisiform fractures are uncommon. Excision may provide benefit in the setting of a displaced fracture. Return to sport after any carpal fracture should focus primarily on the future health of the athlete, with future play only as a secondary aim.

  • Distal radius joint surface reconstruction using a pedicle pisiform osteochondral transfer

    2015, Journal of Hand Surgery

    A biomechanical study in cadavers demonstrated that a significantly greater FCU force was required to move the wrist after excision of the pisiform,21 and a slight, but not clinically significant, decrease in wrist flexion strength after excision of the pisiform has also been reported.22 In contrast, in a follow-up of more than 30 years, excision of the pisiform provided complete pain relief in almost all of the painful pisotriquetral joints with no loss of wrist motion or strength.23 Pedicle pisiform transfer has several other advantages.

    Treatment of a large articular cartilage defect in the distal radius poses a significant challenge to hand surgeons. To reduce the development of secondary degenerative arthritis, restoration of the articular surface is preferable. Pedicle pisiform transfer has been reported as a useful treatment option for Kienböck’s disease. We describe a surgical technique involving vascularized pisiform transfer for large cartilage defects after intra-articular distal radius fractures and highlight the vascular supply of the pisiform.

View all citing articles on Scopus

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Copyright © 1985 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

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