Introduction and importance: Isolated dislocation of the pisotriquetral joint is a rare and often overlooked condition, with diagnosis frequently delayed because of nonspecific clinical symptoms and inconclusive initial imaging. Case presentation: We report the case of a young, active patient with chronic distal dislocation of the pisiform bone, associated with an initially undiagnosed articular fracture of the triquetrum. Clinically, the patient reported pain rated at 4/10 during wrist flexion, which was slightly limited (76°), while extension and pronation remained preserved. His grip strength was measured at 23 kg on the painful side compared to 35 kg on the opposite side. The patient was treated with pisotriquetral arthrodesis with favorable functional outcomes with no loss of range of motion or pain. Arthrodesis was performed through an open ulnar approach, with careful protection of the dorsal sensory branch of the ulnar nerve. After joint surface preparation and temporary K-wire fixation, stabilization was achieved using a 2.5-mm Autofix® screw without bone graft, followed by 6 weeks of immobilization and progressive rehabilitation. At the 18-month follow-up, the patient showed no functional limitations, with full range of motion and complete resolution of wrist pain. His grip strength was measured at 33 kg during the assessment. This work has been reported in line with the SCARE criteria. Clinical discussion: Although rarely reported in the literature (only two cases and never in traumatic situation), pisotriquetral arthrodesis offers a valuable alternative to pisiformectomy, particularly in young patients or those with high functional demands. Our case appears unique in several respects: it involved a young, active patient with a triquetral joint fracture associated with distal and medial dislocation of the pisiform bone, treated several months after the initial trauma. Conclusion: This case highlights the need for an appropriate treatment strategy in managing pisotriquetral instability, reinforcing the potential role of arthrodesis in selected indications.
Nicolaï et al. (Mon,) studied this question.