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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.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/hook-plate-fixation-of-an-isolated-pisiform-fracture-with-a-small-proximal-fragment-a-case-report/447503/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/hook-plate-fixation-of-an-isolated-pisiform-fracture-with-a-small-proximal-fragment-a-case-report/447503.png","ImageObject",300,407,{"name":92,"@type":93},"anakgang17","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":29},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why are isolated pisiform fractures difficult to diagnose and treat?","Question",{"text":112,"@type":113},"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.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What surgical approach was used in the case report?",{"text":117,"@type":113},"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.",{"name":119,"@type":110,"acceptedAnswer":120},"What were the key functional and radiographic outcomes at 12 months?",{"text":121,"@type":113},"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.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},447503,1790790365,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":29,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},962090883568,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","Case Report  Journal of Orthopaedic Case Reports 2025 December:15( 12) :Page 84-88   \nHook Plate Fixation of an Isolated Pisiform Fracture with a Small  \nProximal Fragment: A Case Report  \nIkuo Nakai1,2,3  \nLearning Point of the Article:  \nFor 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.  \nAbstract  \nIntroduction: 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.  \nConclusion: 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.  \nKeywords: Pisiform bone, carpalbones, isolated pisiform fracture, fracture fixation,bone plates.  \nIntroduction  \nIsolated 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,  \ndisplacement, 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].  \nInternal 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].  \n\n| \u003Cbr>Access this article online\u003Cbr>\u003Cbr>Website: [www.jocr.co.in](www.jocr.co.in)\u003Cbr>\u003Cbr>DOI:\u003Cbr>[https://doi.org/10.13107/jocr.2025.v15.i12.6462](https://doi.org/10.13107/jocr.2025.v15.i12.6462) | Author’s Photo Gallery\u003Cbr>\u003Cbr>\u003Cbr>Dr. Ikuo Nakai\u003Cbr>1Department of Orthopedic Surgery, Nishi Omiya Hospital, Saitama, Japan,\u003Cbr>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.\u003Cbr>Address of Correspondence:\u003Cbr>Dr. Ikuo Nakai,\u003Cbr>Department of Orthopedic Surgery, Nishi Omiya Hospital, Saitama, Japan.\u003Cbr>[E-mail:](E-mail: nykkuo@gmail.com)[ nykkuo@gmail.com](E-mail: nykkuo@gmail.com) |\n| --- | --- |\n| Submitted: 05/09/2025; Review: 27/10/2025;","cbCaihKNI0KmZOFq","https://ap.wps.com/l/cbCaihKNI0KmZOFq","pdf",7576858,"English","# Introduction\n## Surgical technique\n## Postoperative management\n## Outcomes and follow-up\n## Conclusion","[{\"question\":\"Why are isolated pisiform fractures difficult to diagnose and treat?\",\"answer\":\"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.\"},{\"question\":\"What surgical approach was used in the case report?\",\"answer\":\"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.\"},{\"question\":\"What were the key functional and radiographic outcomes at 12 months?\",\"answer\":\"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.\"}]","Hook Plate Fixation of an Isolated Pisiform Fracture with a Small Proximal Fragment - A Case Report | PDF",1790720955,13]