gms | German Medical Science

Objective: Although the pisotriquetral Joint (PTJ) is small, it is an anatomically complex structure. The pisiform serves as attachment for several muscles and ligaments, including the flexor carpi ulnaris, abductor digiti minimi, pisometacarpal ligament, pisohamate ligament, and ulnar collateral ligament. It is well recognized that instability of the PTJ ultimately leads to pisotriquetral arthrosis associated with chronic ulnar-sided wrist pain.

Material/Methods: A 22-year-old professional downhill mountain bike rider developed unilateral increasing instability of the PTJ of the left wrist. The history of the injury revealed no single high-impact trauma to the PTJ. Nevertheless, the wrist was exposed to chronic force in extension according to the position when downhill mountain biking. Computed tomography scans in neutral position revealed correct alignment of the PTJ. In extension, however, ulnar luxation of the pisiform was seen on computed tomography scan. The patient elected to proceed with pisotriquetral arthrodesis, which was performed 10 weeks after the initial incident.

Results: To preserve full function of the pisiform bone, we performed pisotriquetral arthrodesis. Under both direct and fluoroscopic vision, we placed a 1.0-mm guide wire through the pisiform into the triquetrum. A 3.0-mm cannulated Herbert screw was then placed across the PTJ after drilling and tapping with cannulated instruments. The wrist was splinted until suture removal at 14 days, and a removable wrist splint was applied for another 6 weeks.

Conclusion: Ten months after the splint was removed, the patient was free of symptoms and returned to professional downhill mountain biking without limitations. This uncommon method seems to be a feasible treatment strategy and can be recommended in high-demand patients.