The wrist has up to 20 described accessory ossification centres that may persist as separate bones rather than fusing to adjacent carpals. The most common and clinically relevant are the os centrale carpi (between scaphoid, capitate, and trapezoid), the os paratrapezium (adjacent to the trapezium), and the os Gruberi (adjacent to the triquetrum). All are incidental radiographic findings in most individuals but the os centrale carpi is fused in humans in contrast to most other primates where it remains separate.
The presence of unexpected bony densities in the wrist of a patient with wrist pain requires CT or MRI to determine whether they represent acute fractures with cortical disruption and adjacent oedema versus incidental accessory ossicles with smooth corticated margins and no signal change. The os centrale in humans is incorporated into the scaphoid during fetal development, and its separate persistence is a rare atavistic variant associated with a more primitive primate carpus.
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