Carpal bones (from within the cartilage) and the ossific centers appear only after birth. The formation of these centers roughly follows a chronological spiral pattern starting in the capitate and hamate during the first year of life. The ulnar bones are then ossified before the radial bones, while the sesamoid pisiform arises in the tendon of the flexor carpi ulnaris after more than ten years. There are four groups of ligaments in the region of the wrist: The hand is said to be in straight position when the third finger runs over the capitate bone and is in a straight line with
Carpal bones or "distal surfaces" are articular, the superior generally convex, the inferior concave; the "medial" and "lateral surfaces" are also articular where they are in contact with contiguous bones, otherwise they are rough and tuberculated. The structure in all is similar: cancellous tissue enclosed in a layer of compact bone. Occasionally accessory bones are found in the carpus, but of more than 20 such described bones, only four (the central, styloid, secondary trapezoid, and secondary pisiform bones) are considered to be proven accessory bones. Sometimes the scaphoid, triquetrum, and pisiform bones are divided into two. The carpal bones are ossified endochondrally