The pisiform bone is a small, pea-shaped bone located at the base of the palm, near the wrist. Dislocations or fractures of the pisiform can be problematic, as they can lead to ulnar nerve compression and other complications. Fortunately, there are effective treatment options available.
Immediate Closed Reduction
The best treatment for a dislocated pisiform bone, especially when accompanied by ulnar nerve neurapraxia (nerve dysfunction), is immediate closed reduction. This involves manually manipulating the bone back into its proper position without surgery. To achieve optimal closed reduction, the wrist is flexed in combination with pronation of the forearm, which helps relax the flexor carpi ulnaris (FCU) muscle and facilitate the repositioning of the pisiform.
Surgical Options
If closed reduction is not possible or the dislocation persists, surgical treatment may be necessary. This can include open reduction and internal fixation, where the bone is surgically repositioned and held in place with hardware like screws or pins. In some cases, particularly with painful nonunions or comminuted (fragmented) fractures, the entire pisiform bone may need to be excised (removed) to alleviate symptoms and decompress the ulnar nerve.