Bony Anatomy of Wrist

Joint
Prepared by Dr. Dawood Suliman
First Year Trainee
Wazir Muhammad Akbar Khan Hospital
27/10/1402
Contents

• Carpal bones
• Organization
• Ossification
• Individual carpal bone
• Scaphoid and its fracture types
• lunate
• Triquetrum
• Pisiform
• ...
Carpal Bones
The Carpal bones/Carpus (Carp is a Greek word for “wrist”) are eight
irregularly shaped bones located in the wrist region. These bones
connect the distal aspect of long bones of forearm to the proximal
aspects of the metacarpal bones.
.They are organized into two rows:
1. Proximal (scaphoid, lunate, triquetrum, pisiform)
2. Distal (trapezium, trapezoid, capitate, hamate)
• Dorsal-concave
• Ventral-convex
• Prox border of hypothenar; pisiform is palpable

• 2.5cm distal to P, hook

is palpable

• S and Trapezium
(palmar and snuffbox)
• Radiocarpal,intercarpal
CMT lig attached except
To Tri and Pisiform
Ossification
Cartilaginous at birth
Starts from center
Capitate 2nd month
Hamate end of 3rd month
Triquetrum 3rd year
Scaphoid, lunate, trapezium and trapezoid 4y in F and 5y in M
Pisiform 9-10 in Females and 12th in Males
Order of ossification varies depending on:
Gender, nutrition and race.

Accessory ossicles might appear as well such:

OS CENTRALE – between scaphoid, trapezoid and capitate

Occasionally lunate and triquetral elements may fuse.

Individual carpal bone
• Scaphoid (skaphos/boat)
Largest in prox.
Tubercle on palmer (APB, Flexor.R)
Groove on dorsal
Radial collateral lig on lat surface
42% articular surface
Blood supply of scaphoid and its fracture
• Most commonly fractured carpal bone in hand
• 80% by dorsal branch
• Distal to prox (retrograde)
• Anatomically into
(prox pole ,waist , distal pole)
• AVN 30% of cases
• Non union 10%
Lunate
• Semilunar in shape
• Articulates between scaphoid and triquetrum
• Palmer surface larger than dorsal
• Prox surface articulates with radius and articular disc of radio-ulnar
 Kienbock disease (Lunatomalacia)
• 1910
• AVN of lunate.
• Etiology – unclear
• Might be associated with blood supply
• 8vessels-3D-5P (not exact, might be 1)
• Other etiologies: venous flow obs/disruption
=increased intraosseous pressure,
trauma,variations of lunate shape
Triquetrum and Pisiform
Triquetrum
• Pyramidal in shape
• Oval facet for articulation of pisiform

Pisiform
• Sesamoid bone
• Pea shaped
• Tendon of FCU, Pisometacarpal and pisohamate lig attached to
palmer surface
Trapezium
• Tubercle and groove on palmer.s
• Groove contains FCR, flexor retinaculum
• Thenar muscles attached to tubercle
• Laterally – radial collateral lig, capsular lig of thumb CMC
• Distally with first two metacarps
Trapezoid
• Small and irregular
• Distally articulates with 2nd metacarpal
Capitate (head shaped)
• Largest carpal bone
• 3rd metacarpal, med side of 2nd metacarpal, base of 4th metacarpal
• Rough surface for carpal ligament attachments
Hamate
• Hook on its palmer surface
• Hook contributes to med wall of carpal tunnel (FR attaches to apex of
Hamulus)
• 2 facets for 4th and 5th metacarpal
• Rough surface for attachment of ligaments
Thank you for you attention