Traumatic Pisiform Dislocation Associated with Distal Forearm Fracture in an Adolescent: A Case Report and Literature Review

Abstract

Aims: To report an exceptionally rare case of traumatic pisiform dislocation in a pediatric patient, associated with a displaced forearm fracture, and to review the diagnostic and therapeutic options available in the current literature. Presentation of Case: A 14-year-old male presented following a fall onto his outstretched left hand. Clinical examination revealed a forearm deformity with complete functional impairment. Radiographs demonstrated a displaced fracture of both forearm bones at the distal quarter, with concomitant anterolateral dislocation of the pisiform onto the ulnar border of the triquetrum. Closed reduction of the forearm fracture achieved simultaneous spontaneous relocation of the pisiform, without additional carpal intervention. Postoperative course was uneventful. At six-week follow-up, the patient achieved full painless wrist motion with no evidence of instability or recurrence. Discussion: Fewer than fifty cases of traumatic pisiform dislocation have been reported in the literature since the first description by Gras in 1835. Diagnosis is primarily radiological and may be missed on standard views; supplementary projections such as Garraud's 30-45 degrees supination lateral view are recommended. When associated with a displaced forearm fracture, indirect reduction through fracture management may suffice. Otherwise, open reduction with temporary K-wire fixation or pisiform excision are accepted alternatives. Conclusion: Pisiform dislocation is rare and easily overlooked, especially when associated with other injuries. Systematic radiographic assessment of the carpus in any distal forearm trauma is essential to ensure early diagnosis and optimal functional outcomes.