Acute isolated traumatic anterior pisiform dislocation in an adult: A case report

Isolated pisiform dislocation without associated carpal bone injuries is a rare clinical entity, with few reported cases. This report describes a 23-year-old, right-handed male who presented in March 2024 with acute anterior pisiform dislocation following indirect trauma while lifting furniture. The patient experienced pain, mild swelling, and tenderness in the distal ulnar region of the right hand, with initial radiographs confirming the dislocation. Spontaneous repositioning occurred during transfer to a trauma hospital after cast immobilization, eliminating the need for further imaging or invasive treatment. The patient had no history of hypermobility syndrome. Early physiotherapy facilitated full recovery of range of motion. After one-year follow-up, the patient showed a Quick-DASH score of 0, indicating complete functional recovery; therefore, no control radiographs were performed to avoid unnecessary radiation exposure in this young patient. The Quick-DASH (Disabilities of the Arm, Shoulder and Hand) score of 0/100 confirms excellent objective and subjective outcome with no residual disability. The injury likely resulted from wrist hyperextension and forceful flexor carpi ulnaris contraction. Diagnosis typically relies on clinical findings and radiographs, though advanced imaging may be required in ambiguous cases. Treatment options include immobilization, closed reduction, open reduction with internal fixation, or pisiform excision, depending on the case. This report underscores the importance of considering isolated pisiform dislocation in young patients with ulnar-sided wrist pain post-trauma and highlights the efficacy of conservative management when spontaneous reduction occurs.