Review Question - QID 214018

The first carpal bone to ossify is the capitate, which is also the largest of the 8 carpal bones.

The ossification centers of the carpal bones appear in a fairly predictable manner. The capitate appears around 1-3 months of age, occasionally corresponding with the ossification of the hamate bone. This progression continues in a clockwise pattern (right wrist) ending with the pisiform bone. The appearance and timing of the various ossification centers in the hand and wrist can be used in the evaluation of children with suspected growth disorders.

Goodell et al. reviewed the various fractures that can occur about the fingers and hand in pediatric patients. They discussed the order of the ossification centers starting with the capitate around 1-3 months. The hamate follows shortly after and the pattern continues in a circular pattern ending with the pisiform around the age of 9-10.

Daneff et al. studied the ability of ultrasound to assess the various ossification centers in the carpal bones to predict bone age and avoid the added radiation of serial hand radiographs. They found that in most patients the capitate was the first to appear around 1-3 months often simultaneously with the capitate.

Illustration A is a table with the expected ossification times of the various carpal bones.

Incorrect Answers:
Answer 1: The scaphoid is the bone affected by AVN in Preisser's disease and its ossification center appears around 6 years of age.
Answer 2: The lunate is the bone affected by AVN in Keinbock's disease and its ossification center appears around 5 years of age.
Answer 3: The trapezium articulates with the proximal thumb metacarpal and its ossification center appears around 6 years of age.
Answer 4: The pisiform is the only sesamoid carpal bone and its ossification center appears around 12 years of age.