Ossification centers of the hand

Last revised by Leonardo Lustosa on 21 Jul 2021

Primary ossification centers present at birth

Visible on x-ray from birth:

  • metacarpal diaphyses: 9 weeks in utero
  • phalangeal diaphyses: 9-12 weeks in utero
Primary ossification centers developing after birth

Ossification of the carpal bones occurs in a predictable sequence, starting with the capitate and ending with the pisiform.

At birth, there is no calcification in the carpal bones. Although there is great individual variability, approximate ossification times are as follows (visible on x-ray):​

  • capitate: 1-3 months
  • hamate: 2-4 months
  • triquetral: 2-3 years
  • lunate: 2-4 years
  • scaphoid: 4-6 years
  • trapezium: 4-6 years
  • trapezoid: 4-6 years
  • pisiform: 8-12 years

Excluding the pisiform, a handy way to remember the order of ossification is to start at the capitate then move in an counterclockwise direction on the volar surface of the right carpus.

Secondary ossification centers
  • metacarpal heads: 1-2 years and fuse at 14-19 years
  • phalangeal bases: 1-3 years and fuse at 14-19 years

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