Age estimation based on appearance of pisiform bone in selected Nepalese children of Gandaki Province Nepal

Background: Age estimation is based on general physical examination, radiological examination of bones and dental examination. The appearance of ossification center of pisiform bone is one of the important evidence for estimating age among young children between nine to 13 years. The objective of this study is to estimate the age of appearance of pisiform among the Nepalese children. Materials and methods: It is a cross sectional descriptive study conducted at the department of Radiology, Pokhara Academy of Health Sciences, Western Regional Hospital on the month of July 2020. The Antero posterior view of X Rays of either hand (left or right) including the carpal bones of the patients aged seven to 15 years of 183 Nepalese children archived at the department of Radiology were taken as samples. The X rays were checked for the appearance or non appearance of Pisiform and the age of appearance analysed. Results: One hundred and twenty seven (69.40%) of total 183 cases were males and 56 (30.60%) were females. The minimum age of appearance of pisiform was 9 years in females and 10 years in males. All the subjects had pisiform bone appeared at the age of 13 years and above. Conclusion: The minimum age of appearance of Pisiform in the study subjects was 9 years in females and 10 years in males. All the cases have pisiform ossified at the age of 13 years and above.

Pisiform Bone Dislocation in a Pediatric Patient: What is the Best Treatment? Case Report and Review of the Literature

Traumatic dislocation of the pisiform bone (PB) is a rare injury of the carpal bones, especially in pediatric patients. A few cases were reported, and there is no consensus about the treatment. Each author supports his own method, such as an open reduction internal fixation (ORIF) approach or a closed reduction. However, failures of both techniques with recurrent dislocation of the PB have been reported in the literature. In this article, a fracture dislocation of the PB was treated with ORIF in an 11-year-old boy with a greenstick radial fracture. In addition, a review of the literature about pisiform fracture dislocation in children has been made.

Clinical and Anatomical Aspects of Anterior Dislocation of the Pisiform Bone

Introduction The pisiform bone is the fourth bone of the proximal row of the carpal bones, and it is located in the tendon of the flexor carpi ulnaris muscle, being considered a sesamoid bone. Traumatic dislocation of the pisiform bone is a rare condition, which usually results from a trauma in dorsal flexion of the wrist. Its treatment can be conservative or surgical, ending or not with the removal of the pisiform bone. Objective To report a case of a child who fell from his own height and presented wrist pain, diagnosed with dislocation of the pisiform bone. We emphasize the importance of anatomy knowledge in the evaluation of wrist trauma. Case Report The anamnesis confirmed that the fall occurred with the wrist in hyperextension. The physical examination showed a slight limitation of movement due to pain. Radiographic exams and a computed tomography (CT) scan of the wrist were performed, in which an anterior deviation/luxation of the pisiform bone was evidenced. A conservative treatment with plaster immobilization for analgesia was performed for 1 week. As there were no symptoms and no signs of trauma consistent with the images, such as edema and local ecchymosis, in addition to the early complete disappearance of pain, the responsible team proposed the hypothesis of asymptomatic chronic dislocation of the pisiform bone. Conclusion Imaging exams in orthopedic traumatology are fundamental for an accurate diagnosis. Nevertheless, they must be associated with knowledge of the anatomy to correlate the image findings with the anamnesis, leading to a better understanding of silent, asymptomatic, and preexisting conditions in the clinical practice.

Isolated dislocation of the pisiform bone in a 10-year-old boy

Introduction. Isolated dislocation of the pisiform bone is a very rare condition due to robust ligamentous attachments that stabilize the pisiform to the carpus. This type of injury is usually a result of direct trauma to the ulnar and volar aspect of the wrist. Case outline. We present an isolated dislocation of the pisiform, with no other carpal bone injuries, treated successfully with closed reduction. Diagnosis was based on clinical findings, plain radiographs, and computer tomography examination of the wrist. Elongation and partial rupture of the pisometacarpal ligament was found on magnetic resonance imaging. Conclusion. Fracture and dislocation of the pisiform is an extremely rare injury in children, which could be easily neglected or misdiagnosed. Closed reduction with plaster cast immobilization should always be considered as the first method of treatment in the pediatric population, since the conservative approach provides excellent results.

Ultrasonography Findings in Severe Carpal Tunnel Syndrome

Background: Increasing severity of carpal tunnel syndrome (CTS), as graded by nerve conduction studies (NCS), has been demonstrated to predict the speed and completeness of recovery after carpal tunnel release (CTR). The purpose of this study is to compare the cross-sectional area (CSA) of the median nerve in patients with severe and nonsevere CTS as defined by NCS. Methods: Ultrasound CSA measurements were taken at the carpal tunnel inlet at the level of the pisiform bone by a hand fellowship–trained orthopedic surgeon. Severe CTS on NCS was defined as no response for the distal motor latency (DML) and/or distal sensory latency (DSL). Results: A total of 274 wrists were enrolled in the study. The median age was 51 years (range: 18-90 years), and 72.6% of wrists were from female patients. CSA of median nerve and age were comparatively the best predictors of severity using a linear regression model and receiver operator curves. Using cutoff of 12 mm2 for severe CTS, the sensitivity and specificity are 37.5% and 81.9%, respectively. Conclusions: Ultrasound can be used to grade severity in younger patients (<65 years) with a CTS-6 score of >12.

Diffusion tensor imaging findings of the median nerve before and after carpal tunnel corticosteroid injection in patients with carpal tunnel syndrome: a preliminary study

Background Corticosteroid injections are a popular technique for carpal tunnel syndrome (CTS) treatment and are believed to provide rapid symptom relief. Purpose To use magnetic resonance diffusion tensor imaging (MR-DTI) to determine the association between diffusion values of the median nerve (MN) at several anatomic locations and symptom relief in patients with CTS following corticosteroid injection. Material and Methods MR-DTI was performed on 15 wrists of 12 patients with CTS before and two weeks after ultrasound-guided corticosteroid injections. We recorded the patients’ clinical data including sex, age, side of injection, satisfaction, and symptom relief. Satisfaction and symptom relief were rated using a Likert scale and the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) scale. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of the MN at the levels of the distal radioulnar joint (DRUJ), pisiform bone, and hamate bone were determined. Results All patients had ≥50% satisfaction on the injection side. In comparison with baseline values, post-injection ADC was significantly lower ( P = 0.001) but FA was not significantly higher ( P = 0.11) at the pisiform bone level on the injected wrists. At the DRUJ and hamate bone levels, no obvious inter-scan change in FA and ADC ( P > 0.05) was observed. The decrease in ADC at the pisiform bone level strongly correlated with the decrease in BCTQ scores (r = 0.628; P = 0.012). Conclusion Symptom relief in patients with CTS receiving corticosteroid injection is related to the change in ADC of the median nerve at the level of the pisiform bone, as determined using MR-DTI.