Hook Plate Fixation of an Isolated Pisiform Fracture with a Small Proximal Fragment - A Case Report

Sep 29, 2026

Hook plate fixation is evaluated for an isolated, displaced pisiform fracture characterized by a small proximal fragment. A 64-year-old woman developed ulnar-sided wrist pain after a fall; radiography and CT showed intraarticular displacement with mild comminution. Open reduction and internal fixation with a 1.2-mm hook plate achieved stable anatomic reduction without fragment excision. After 3 weeks of immobilization, progressive mobilization followed; at 12 months the patient was pain-free with strong functional recovery and confirmed union.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages5

Reading Time13 min

AccessFree to download

Introduction

Surgical technique

Postoperative management

Outcomes and follow-up

Conclusion

Case Report Journal of Orthopaedic Case Reports 2025 December:15( 12) :Page 84-88 Hook Plate Fixation of an Isolated Pisiform Fracture with a Small Proximal Fragment: A Case Report Ikuo Nakai1,2,3 Learning Point of the Article: For isolated pisiform fractures with tiny proximal fragments, a contoured hook plate enables stable, fragment-preserving fixation with excellent functional outcomes, providing an effective alternative to fragment excision. Abstract Introduction: Thereport describes hookplate fixation for anisolated, displaced pisiform fracture characterized bya small proximal fragment. Case Report: A 64-year-old woman presented with ulnar-sided wrist pain after a fall. Radiography and computed tomography revealed intraarticular displacement with mild comminution. Open reduction and internal fixation using a 1.2-mm hook plate resulted in a stable anatomical reduction without the need for fragment excision. Postoperatively, the wristwas immobilized ina volar splintin neutralposition for 3weeks, after which progressive mobilization was initiated. At 12-month follow-up, the patient was pain-free with wrist extension of 85° and flexion of 75°. Grip strength was 29.6 kg on the operated side, while 24.3 kg on the contralateral side. Patient-reported outcomes were excellent, indicating satisfactory functional recovery and pain relief. Radiographs confirmed bone union and anatomical alignment, with no evidence of pisotriquetral degenerative changes. Conclusion: Hook plate fixation may represent a feasible joint-preserving alternative for select comminuted pisiform fractures with small fragments, offering stable fixation and enabling relatively early rehabilitation. Keywords: Pisiform bone, carpalbones, isolated pisiform fracture, fracture fixation,bone plates. Introduction Isolated fractures of the pisiform are rare, accounting for 0.2–2.0% of all carpal bone fractures [1, 2]. These fractures typically result from direct trauma or repetitive microtrauma and, if missed or inadequately treated, can lead to chronic ulnarsided wrist pain, reduced grip strength, and pisotriquetral instability [1, 3, 4]. Diagnosis is often delayed due to subtle clinical signs and inconspicuous imaging features [3, 4, 5]. Conservative management with immobilization is generally preferred for nondisplaced fractures [ 3, 4, 5 ] . Surgical intervention is indicated in the presence of comminution, displacement, articular incongruity, or persistent pain following conservative treatment [ 1 ] . Previously reported surgical approaches include open reduction and internal fixation (ORIF) using Kirschner wires or cortical screws [6, 7, 8], as well aspisiform excision incasesof irreparable fractures [9, 10]. Internal fixation is technically challenging owing to thepisiform’s small size and potential instability of fracture fragments, and reported outcomes arelargely limited to isolated case reports and small case series [1]. Surgical approaches for pisiform injuries typically involve the use ofKirschner wires, screws, or excision; descriptions of mini-plate or hook plate fixation are rare [6, 7, 8]. |
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Website: [www.jocr.co.in](www.jocr.co.in)

DOI:
[https://doi.org/10.13107/jocr.2025.v15.i12.6462](https://doi.org/10.13107/jocr.2025.v15.i12.6462) | Author’s Photo Gallery

Dr. Ikuo Nakai
1Department of Orthopedic Surgery, Nishi Omiya Hospital, Saitama, Japan,
²Department of Basic Medical Science, Graduate School of Medicine, International University of Health and Welfare, Chiba, Japan.³Department of Anatomy, Faculty of Medicine, School of Medicine, International University of Health and Welfare, Chiba, Japan.
Address of Correspondence:
Dr. Ikuo Nakai,
Department of Orthopedic Surgery, Nishi Omiya Hospital, Saitama, Japan.
[E-mail:](E-mail: nykkuo@gmail.com)[ nykkuo@gmail.com](E-mail: nykkuo@gmail.com) | | --- | --- | | Submitted: 05/09/2025; Review: 27/10/2025;

FAQs

Why are isolated pisiform fractures difficult to diagnose and treat?

They are rare and diagnosis may be delayed due to subtle clinical signs and inconspicuous imaging findings. Missed or inadequate treatment can lead to chronic ulnar-sided wrist pain and pisotriquetral instability.

What surgical approach was used in the case report?

Open reduction and internal fixation using a 1.2-mm contoured hook plate. The technique restored articular alignment and achieved stable fixation without fragment excision.

What were the key functional and radiographic outcomes at 12 months?

The patient was pain-free with wrist extension of 85° and flexion of 75°. Grip strength improved and radiographs confirmed bone union and anatomical alignment without degenerative changes.

Sep 29, 2026

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