This patient had pain on the ulnar aspect of his wrist after catching a baseball with his bare hands. On examination, he had tenderness at the base of his hypothenar eminence. The PA radiograph shows a subtle fracture of his pisiform.

Lateral and oblique radiographs from the same patient:

Another example of a pisiform fracture is shown below. A wide, lucent line is visible on the PA radiograph running through the pisifrom bone (indicated by arrows). Unlike the first example which was very subtle, this fracture is much easier to appreciate. Together, these two examples of fractures illustrate the great variation in radiographic appearance that is possible.