In this case, the fracture line is evident in the frontal and lateral projection, with cortical and trabeculae disruption.

Pisiform fractures account for less than 1% of carpal bone fractures. They are a rare injury and often missed. Mechanism of injury usually results from direct impact on a hard surface or a FOOSH, as in this case. 

CT study is recommended to further evaluate acute or chronic bony injury, delineate fracture pattern and determine treatment plan.