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Circular arterial supply of the pisiform bone.

The arterial vascularization of the pisiform bone was studied from 15 cadavers to assess the possibility of pedicled pisiform transfer in Kienböck's disease. The arterial vascularization of the pisiform bone comes from three pedicles: an upper pedicle arising from the dorsal carpal artery, a lateral pedicle arising from the ulnar artery, and a lower pedicle arising from the deep palmar branch of the ulnar artery. The pisiform bone is well vascularized and, whatever the distribution of the pedicles within the bone itself, we always found an arterial circle around it. The lengths of the upper and lower pedicles expressed as ratios of the length or width of the pisiform bone were variable, as indicated by the coefficient of variation that was greater than 36%. There was no significant correlation between the length of the upper or lower pedicle and the length or width of the pisiform bone. The length of the upper pedicle, which was greater than the distance between the origin of the dorsal carpal artery and the center of the lunate, allows a pedicled pisiform transfer in Kienböck's disease. Nevertheless, it is difficult to assert definitively that the upper pedicle is sufficient to avoid a partial necrosis of the pedicled pisiform bone.