How to manage a self-reducing pisiform bone dislocation
Dislocation of the pisiform bone, a small carpal sesamoid located within the tendon of the flexor carpi ulnaris (FCU) is an uncommon but potentially important injury to recognize in athletes with wrist pathology. Early treatment is essential in reducing morbidity especially that due to compression over ulnar nerve neurapraxia.
Treatment Approaches
Immediate Closed Reduction:
This is the primary treatment of acute pisiform dislocations. During this procedure the pisiform is manually reduced back into its normal anatomic location without surgery. The wrist should be in a flexed position and the forearm fully pronated for maximal effect. This positioning also enables the flexor carpi ulnaris (FCU) muscle to relax, making reduction easier123’s.
Immobilization:
Following a successful closed reduction, immobilization is required to keep the pisiform at its correct location. The wrist may be immobilized in a neutral or slight flexed position as prescribed by the physician according to individual needs24. Other studies report that inadequate immobilization increases the risk of redislocation and require immediate follow-up care during recovery (Table 34).
Open Reduction and Internal Fixation
In cases of failed closed reduction or with delayed diagnosis, it may be necessary to use an open surgical approach. Through an incision, the pisiform is directly exposed and repositioned manually with additional fixation means i.e Kirschner wires present to fixate the bone16. Open reduction is normally used in complex cases where conservative measures are not helpful.
Excision of the Pisiform:
Excision of the pisiform is sometimes indicated in chronic cases or where complications follow multiple dislocations. Such procedure is able to help reduce chronic pain and rehabilitate the wrist, because that bone236 can be removed.
Considerations for Recovery
Monitoring for Complications:
After any treatment, patients must be monitored and checked for signs of complications such as continuing pain or decreasing function in the wrist. They are, however cases where early intervention can make a big difference in outcomes25.
Rehabilitation:
It is important for the patient to follow post-treatment rehabilitation which will allow quick strengthening and regaining of ROM in his wrist.pisiform bone treatment (ad) Custom physical therapy programs help to speed up recovery and prevent subsequent injuries.
Conclusions Timely recognition and appropriate management of pisiform dislocation are essential for optimal recovery. The treatment is still based on immediate closed reduction, with or without a surgical technique for more complex fractures.
