Piece of pie sign (wrist)

Last revised by Adam Eid Ramsey, MD on 16 Dec 2019

The piece of pie sign refers to an abnormal triangular appearance of the lunate on a PA image of the wrist representing either lunate dislocation or perilunate dislocation 1,2. A lateral image will help differentiate whether there is lunate or perilunate dislocation, with lunate dislocation demonstrating a spilled teacup sign. This is largely due to disruption of Gilula arcs and disruption of the spaces between the proximal and distal carpal bones.

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Cases and figures

  • Figure 1: piece of pie
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  • Case 1: lunate dislocation
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  • Case 2
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  • Case 3
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  • Case 4
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  • Case 5
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