Pisiform and hamulus fractures: easily missed wrist fractures diagnosed on a reverse oblique radiograph

Nonunion of the pisiform bone in a 9-year-old boy

An isolated fracture of the pisiform bone is a rare condition, especially in children. The fracture may be missed in the emergency department because of the complex anatomy of the carpal region. Early diagnosis and treatment are, however, important for the functional outcome of the patient, since untreated dislocated carpal fractures may result in nonunion. We report one case of a 9-year-old boy with an unrecognized fracture of the pisiform bone who underwent a pisiformectomy 10 months after injury due to a nonunion of the pisiform bone. Good results were obtained and the wrist did not show any functional impairment.

Pisotriquetral joint disorders: an under-recognized cause of ulnar side wrist pain

Pisotriquetral joint disorders are often under-recognized in routine clinical practice. They nevertheless represent a significant cause of ulnar side wrist pain. The aim of this article is to present the main disorders of this joint and discuss the different imaging modalities that can be useful for its assessment.

Hook of hamate pull test

Hook of hamate fractures are often missed despite a distinct history. The purpose of this report was to describe a specific physical examination test that is diagnostic for a hook of hamate fracture, the hook of hamate pull test. It is highly sensitive and was positive in a consecutive series of 5 patients treated for a hook of hamate fracture. These patients also had a distinctive history of playing racket- or club-type sports and presented with longstanding wrist or palm pain.

Carpal bone fractures

Carpal bone fractures make up a significant proportion of injuries to the wrist. The complex bone shape and articulations make diagnosis more difficult and missed injuries more common. This article reviews carpal bone fractures excluding the scaphoid.

Carpal bone fractures

Carpal bone fractures make up a significant proportion of injuries to the wrist. The complex bone shape and articulations make diagnosis more difficult and missed injuries more common. This article reviews carpal bone fractures excluding the scaphoid.

Carpal fractures excluding the scaphoid

Although carpal fractures other than of the scaphoid are uncommon, vigilance in diagnosing these potentially serious fractures is paramount to early and effective treatment. Physical examination and standard plain radiographs may reveal only subtle findings. Use of special radiographic views and computed tomography may help elucidate the diagnosis. Treatment is particular to each fracture. Nondisplaced fractures should be treated nonoperatively. For intra-articular carpal bone fractures, virtually any amount of displacement is unacceptable and requires reduction and fixation. This article organizes current knowledge of these potentially difficult fractures, with a table of diagnosis and treatment guidelines.

Pathologic Conditions of the Hypothenar Eminence: Evaluation with Multidetector CT and MR Imaging

Pain, weakness, and sensory loss occur frequently in the hypothenar eminence. However, clinical examination is difficult and nonspecific, and the prescribed imaging technique may be inadequate, or images may be misinterpreted. Different imaging modalities have various degrees of usefulness for the diagnosis of painful pathologic conditions of the hypothenar eminence. Radiography, multidetector computed tomography (CT), multidetector CT arthrography, and magnetic resonance (MR) imaging of the wrist are useful for surveying the anatomy of the hypothenar eminence, the Guyon canal, and the ulnar nerve and artery and for determining the cause of pain or other symptoms. A fracture of the pisiform bone or the hook of the hamate bone, osteoarthritis or osteochondromatosis of the pisotriquetral joint, Guyon canal syndrome, hypothenar hammer syndrome, tendinopathy of the flexor carpi ulnaris, an anomalous muscle, a ganglion cyst, or a tumor may be responsible for ulnar neuropathy. Specific radiographic views, such as the semisupinated oblique view and the lateral view with the hand radially deviated and the thumb abducted, often provide a sufficient basis for the diagnosis of acute fracture of the hook of the hamate or the pisiform bone. Multidetector CT angiography is an efficient method for diagnosing hypothenar hammer syndrome, and multidetector CT arthrography is well suited for evaluation of the pisotriquetral joint. MR imaging is the modality of choice for depiction of the ulnar nerve.

Optimierung von konventionellen Röntgenaufnahmen zur Erkennung von Hamulus ossis hamati Frakturen

Fractures of the hook of the hamate are a rare event. The fracture cannot always be detected clinically and standard radiographs do not always provide an overlap-free image of the hook of the hamate, so that fractures can easily be overlooked. The objective of the present study was to examine if the sensitivity of detecting hamulus ossis hamati fractures can further be improved by a modified conventional radiographic projection. After dissection of the hook of the hamate on 10 cadaver hands, a fracture was produced close to the base using a surgical chisel. Conventional radiographs were then performed in four different projections (dorso-palmar, lateral, carpal-tunnel and oblique view). The oblique view was obtained in a 45 degrees supination position, slight extension and radial duction, with the tube tilted from distal to proximal by 30 degrees. An axial spiral CT was used as a reference for detection of the fracture. The highest sensitivity of the conventional radiographs, with 8/10 identified fractures (80%), was achieved by the oblique view. The carpal-tunnel view with 4/10 (40%) and the dorso-palmar projection with 3/10 (30%) were much lower. All fractures were missed in the lateral projection. If all of the conventional radiographic projections are taken into account, the sensitivity is increased to 90%. All of the fractures were reliably detected in the axial CT-image. If a hamulus ossis hamati fracture is suspected clinically, in addition to the dorso-palmar and carpal-tunnel view, the special oblique view described here should be performed as a third projection plane, while the lateral view can be dispensed with. However, even if all projections are taken into account, a negative finding in the conventional radiographic imaging does not exclude a fracture with absolute certainty. In such cases, a CT or MRI should be performed to exclude a fracture.

Fracture of hamate hook--diagnosis by the hamate hook lateral view

Ten intact wrist joints were examined to evaluate the hamate hook visualisation by a hamate hook lateral radiographic view. Results of the study indicated that this 30 degrees -tilted lateral wrist radiographic projection with palmar abduction of the thumb clearly revealed the hamate hook from its base to the tip in the first web space away from the metacarpal bases and carpal bones. This radiographic technique was applied on patients who experienced pain at the hypothenar eminence. Fracture can be detected at the hamate hook in two cases and bilateral bipartite hamulus in one case. This specific supplementary projection is recommended in patients with the relevant physical signs.