European Radiology

, Volume 27, Issue 7, pp 3033–3041 | Cite as

Assessment of pisotriquetral misalignment with magnetic resonance imaging: Is it associated with trauma?

  • Hee-Dong Chae
  • Hye Jin Yoo
  • Sung Hwan Hong
  • Ja-Young Choi
  • Heung Sik Kang
Magnetic Resonance



Our objective was to determine whether there is an association between pisotriquetral (PT) malalignment and acute distal radius fracture by using magnetic resonance imaging (MRI).


We evaluated 138 patients who underwent 3-T MRI of the wrists. Group A comprised 85 patients with acute distal radius fracture, and group B comprised 53 patients without trauma. PT interval and angle and pisiform excursion were measured on oblique axial and sagittal multiplanar reformats. The presence of abnormalities in the flexor carpi ulnaris tendon (FCU), pisometacarpal ligament (PML), and pisohamate ligament (PHL) were evaluated.


PT interval was wider in group A on both the axial and sagittal planes (P < 0.001). Axial PT angle opened more radially in group A (P < 0.001), and the absolute value of the sagittal PT angle in group A was wider than that in group B (P = 0.006). Abnormalities in FCU, PML, and PHL were more frequently observed in group A (P < 0.001). On multiple linear regression, distal radius fracture remained significant after adjusting for the patient’s age and PT osteoarthritis.


Acute distal radius fracture can affect normal alignment of the PT joint, resulting in associated injuries to the primary PT joint stabilizers.

Key Points

Acute distal radius fracture is associated with malalignment of PT joints.

Acute distal radius fracture is associated with abnormalities of PT stabilizers.

PT joint alignment can be evaluated with MRI with 3D sequences.

Wrist MRI is useful for evaluating primary PT stabilizer injuries.


Wrist Joint Pisiform bone Triquetrum bone Radius fractures Joint instability 





Flexor carpi ulnaris tendon


Pisometacarpal ligament


Pisohamate ligament


Pisotriquetral ulnar ligament


Triangular fibrocartilage complex



The scientific guarantor of this publication is Hye Jin Yoo. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, observational, performed at one institution.


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Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Hee-Dong Chae
    • 1
  • Hye Jin Yoo
    • 1
  • Sung Hwan Hong
    • 1
  • Ja-Young Choi
    • 1
  • Heung Sik Kang
    • 2
  1. 1.Department of Radiology, Seoul National University College of MedicineSeoul National University HospitalJongno-GuKorea
  2. 2.Department of RadiologySeoul National University Bundang HospitalSeongnam-CityKorea

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