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

INTRODUCTION

The report describes hook plate fixation for an isolated, displaced pisiform fracture characterized by a small proximal fragment.

CASE REPORT: A 64-year-old woman presented with ulnar-sided wrist pain after a fall. Radiography and computed tomography revealed intra-articular 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 wrist was immobilized in a volar splint in neutral position for 3 weeks, 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.