Review of extraosseous and intraosseous blood supply of the carpal bones

Abstract

The blood supply of the carpal bones has been updated and described with new dissection, vascular filling and imaging techniques. It is very important to know the vascular anatomy of the carpal bones in order to predict vascular insufficiency and associated avascular necrosis that may occur as a result of any injury such as fracture. This article reviews the extraosseous and intraosseous vascular supply of the carpal bones. The carpal bones are supplied by three vascular arches formed by the radial, ulnar and anterior interosseous arteries on the dorsal and palmar sides of the wrist. These contribute to the dorsal and palmar carpal vascular systems, which consist of transverse arteries connected by longitudinal anastomoses. The scaphoid and capitate have a high risk of avascular necrosis, while the trapezium, triquetrum, pisiform and 80% of the lunate have a lower risk. With the development of new imaging techniques, new information is added to the literature. With the increase in three-dimensional studies, intraosseous vascularity and its correlation with carpal bone fractures and its relationship with avascular necrosis will be revealed more clearly.

Keywords

• arterial supply
• carpal bone
• extraosseous vascularity
• intraosseous vascularity
• vascular anatomy

References

1. Gelberman RH, Panagis JS, Taleisnik J, Baumgaertner M. The arterial anatomy of the human carpus. Part I: the extraosseous vascularity. J Hand Surg Am 1983;8:367–75.
2. Standring S. Gray’s anatomy: the anatomical basis of clinical practice. 42nd ed. China: Elsevier Health Sciences; 2021. p. 1584.
3. Doyle JR. Orthopaedic surgery essentials. Hand & wrist. Baltimore (MD): Lippincott Williams & Wilkins; 2006. p. 259.
4. Freedman DM, Botte MJ, Gelberman RH. Vascularity of the carpus. Clin Orthop Relat Res 2001;(383):47–59.
5. Gelberman RH, Gross MS. The vascularity of the wrist. Identification of arterial patterns at risk. Clin Orthop Relat Res 1986;(202):40–9.
6. Gelberman RH, Menon J. The vascularity of the scaphoid bone. J Hand Surg Am 1980;5:508–13.
7. Oehmke MJ, Podranski T, Klaus R, Knolle E, Weindel S, Rein S, Oehmke HJ. The blood supply of the scaphoid bone. J Hand Surg Eur Vol 2009;34:351–7.
8. Morsy M, Sabbagh MD, van Alphen NA, Laungani AT, Kadar A, Moran SL. The vascular anatomy of the scaphoid: new discoveries using micro-computed tomography imaging. J Hand Surg Am 2019; 44:928–38.

9. Xiao Z, Xiong G, Zhang W. New findings about the intrascaphoid arterial system. J Hand Surg Eur Vol 2018;43:1059–65.
10. Taleisnik J. The ligaments of the wrist. J Hand Surg Am 1976;1:110–8.
11. Kadar A, Morsy M, Sur YJ, Laungani AT, Akdag O, Moran SL. The vascular anatomy of the capitate: new discoveries using micro-computed tomography imaging. J Hand Surg Am 2017;42:78–86.
12. Xiong G, Xiao ZR, Zhang WG. Vascular anatomy of the capitate determined by micro-computed tomography angiography. J Hand Surg Eur Vol 2017;42:966-7.
13. Panagis JS, Gelberman RH, Taleisnik J, Baumgaertner M. The arterial anatomy of the human carpus. Part II: the intraosseous vascularity. J Hand Surg Am 1983;8:375–82.
14. Rozen WM, Niumsawatt V, Ross R, Leong JC, Ek EW. The vascular basis of the hemi-hamate osteochondral free flap. Part 1: vascular anatomy and clinical correlation. Surg Radiol Anat 2013;35:585–94.
15. Xiao ZR, Zhang WG, Xiong G. Features of intra-hamate vascularity and its possible relationship with avascular risk of hamate fracture. Chin Med J (Engl) 2019;132:2572–80.
16. Wang DY, Li X, Shen ZC, Gu PL, Pei YR, Zeng G, Leng HJ, Zhang WG. Three-dimensional architecture of intraosseous vascular anatomy of the hamate: a micro-computed tomography study. [Article in Chinese] Beijing Da Xue Xue Bao Yi Xue Ban 2018;50:245–8.
17. Lamas C, Carrera A, Proubasta I, Llusà M, Majó J, Mir X. The anatomy and vascularity of the lunate: considerations applied to Kienböck’s disease. Chir Main 2007;26:13–20.
18. Dubey PP, Chauhan NK, Siddiqui MS, Verma AK. Study of vascular supply of lunate and consideration applied to Kienböck disease. Hand Surg 2011;16:9–13.
19. van Alphen NA, Morsy M, Laungani AT, Kadar A, Vercnocke AJ, Lachman N, Ritman EL, Moran SL. A three-dimensional micro-computed tomographic study of the intraosseous lunate vasculature: implications for surgical intervention and the development of avascular necrosis. Plast Reconstr Surg 2016;138:869e–78e.
20. Balci A, Yildiran G, Kendir S, Karahan ST, Apaydin N. The morphologic and morphometric features of the triquetrum. Hand Surg Rehabil 2023;42:40–4.
21. Grettve S. Arterial anatomy of the carpal bones. Acta Anat (Basel) 1955;25:331–45.
22. Canovas F, Prudhomme M, Bonnel F. Circular arterial supply of the pisiform bone. Acta Anat (Basel) 1996;157:159–63.
23. Iwanaga J, Singh V, Takeda S, Ogeng’o J, Kim HJ, Moryś J, Ravi KS, Ribatti D, Trainor PA, Sañudo JR, Apaydin N, Sharma A, Smith HF, Walocha JA, Hegazy AMS, Duparc F, Paulsen F, Del Sol M, Adds P, Louryan S, Fazan VPS, Boddeti RK, Tubbs RS. Standardized statement for the ethical use of human cadaveric tissues in anatomy research papers: recommendations from anatomical journal editors-in-chief. Clin Anat 2022;35:526–8.