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Outcomes Following Pisiformectomy for Pisotriquetral Arthrosis
Maureen O'Shaughnessy, MD; Marco Rizzo, MD; Laura Lewallen, MD; Kapil Mehrotra, MD; Steven L. Moran, MD
Mayo Clinic, Rochester, MN

Introduction: Ulnar sided wrist pain can be a daunting problem for hand surgeons. Pisiform pathology, including pisotriquetral arthritis, fracture or instability, may be the culprit. At our institution pisiformectomy has been clinically found to have good outcomes, with formal review lacking. This study reviews the long term outcomes of patients treated with pisiformectomy, focusing on need for and time to revision procedure.

Methods: IRB-approved retrospective study was performed over a 27 year period (1988-2015) of all patients undergoing pisiformectomy. At latest follow up, data including range of motion, grip strength, complications and need for revision surgery were recorded.

Results: The series includes 61 wrists in 60 patients (45 female, 15 male) with an average age at surgery of 46 (range 18 to 74). Average follow up was 98 months (8.2 years) (range 3-288 months). The main diagnosis in this series was pisotriquetral degenerative arthritis (idiopathic osteoarthritis 81%, post-traumatic arthritis 13%, inflammatory arthritis 6%); no patients had pisotriquetral instability. 63% of patients had documentation of failed nonoperative management (splinting, injections, and immobilization). Surgery consisted of open pisiformectomy in all patients. Patients underwent concomitant procedures in about half of cases (48%). Most common procedures included TFCC/DRUJ debridement or repair (12), diagnostic arthroscopy (10), synovectomy (5), Guyon's canal release (4) and CMC procedure (4). Two complications were noted (3%); a postoperative ulnar nerve palsy (resolved with observation) and symptomatic retained suture (taken for operative removal). 4 patients required repeat surgery which included removal of symptomatic suture and FCU debridement (1), volar ganglion excision (1), DRUJ stabilization procedure (1) and four-corner fusion (1). Average time to revision surgery was 92 months (range 15-177). The majority of the patients in the series did not require revision procedures for pain or instability at average follow up of 98 months (range 3-288). At final follow up, average flexion to extension arc was 81% (expressed as percent of contralateral), radioulnar deviation arc was 88% and average grip strength was 89%.

Conclusions: Pisiformectomy is a reliable motion preserving procedure with low complication rates for patients with chronic ulnar sided wrist pain related to pisotriquetral arthritis or instability. In this series, 66% of patients experienced pain relief and did not require further procedures at an average of 8.2 years of follow up. The significance of these results better enable surgeons to give time estimates and expectations regarding pain control following pisiformectomy.

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