Paediatric Surgery (Ukraine). 2026. 1(90): 14-21. doi: 10.15574/PS.2026.1(90).1421
Khmara T. V., Biryuk I. G., Pankiv T. V., Kryvchanska M. I., Kozariichuk N. Ya.
Bukovinian State Medical University, Chernivtsi, Ukraine

For citation: Khmara TV, Biryuk IG, Pankiv TV, Kryvchanska MI, Kozariichuk NYa. (2026). Features of upper limb bone development in human embryos and fetuses. Paediatric Surgery (Ukraine). 1(90): 14-21. doi: 10.15574/PS.2026.1(90).1421.
Article received: Oct 14, 2025. Accepted for publication: Mar 16, 2026.

The main stages of formation and ossification of the human upper limb bones during the embryonic and early fetal periods have been determined. The temporal framework and morphological changes significant for the diagnosis of normal and pathological fetal development have been outlined.
Aim – to identify the specific features of the formation and development of the bones of the upper limb during the embryonic and pre-fetal periods of human ontogenesis in order to assess osteogenesis under normal conditions and to diagnose forms of ossification anomalies and skeletal dysplasias.
Materials and methods. The study was based on serial histological sections of 17 human embryos and early fetuses aged 4-12 weeks (parieto-coccygeal length: 5.0-79.0 mm). Microscopy and three-dimensional reconstruction were used to analyze morphological features of upper limb bone development.
Results. The morphogenesis of human upper limb bones was examined during the embryonic (4-6 weeks) and early fetal (7-12 weeks) periods. The stages of appearance and remodeling of cartilaginous and osseous primordia, along with changes in their shape and topography, were identified. The onset of ossification and the growth patterns of the diaphyses and epiphyses of the humerus, ulna, and radius were determined.
Conclusions. The formation of the upper limb bones follows a well-defined sequence, beginning with the development of cartilaginous models, followed by gradual differentiation and ossification. Primary ossification centers appear  in the diaphyses at 8-9 weeks, coinciding with intensive limb growth. The identified developmental patterns may be applied in medico-biological expertise and for refining the normal parameters of prenatal development.
No conflict of interest was declared by authors.
Keywords: upper limb, clavicle, scapula, humerus, forearm bones, hand, embryogenesis, embryo.
REFERENCES:

1. Al-Qattan MM, Yang Y, Kozin SH. (2009, Sep). Embryology of the upper limb. J Hand Surg Am. 34(7): 1340-1350. https://doi.org/10.1016/j.jhsa.2009.06.013; PMid:19700076

2. Aparisi Gómez MP, Watkin S, Perry D, Simoni P, Trisolino G, Bazzocchi A. (2021). Anatomical considerations of embryology and development of the musculoskeletal system: Basic notions for musculoskeletal radiologists. Seminars in Musculoskeletal Radiology. 25(1): 3-21. https://doi.org/10.1055/s-0040-1716660

3. Arvind V, Huang AH. (2017, Dec). Mechanobiology of limb musculoskeletal development. Ann N Y Acad Sci. 1409(1): 18-32. Epub 2017 Aug 22. https://doi.org/10.1111/nyas.13427; PMid:28833194 PMCid:PMC5730481

4. Basic Medical Key. (2020). Development of the pectoral girdle and upper limb. URL: https://basicmedicalkey.com/development-of-the-pectoral-girdle-and-upper-limb/

5. Clelland AD, Duncan Ó, Lam WL. (2022, May). The importance of embryology for parents of children with congenital hand differences. J Hand Surg Eur Vol. 47(5): 475-480. Epub 2021 Dec 8. https://doi.org/10.1177/17531934211064185; PMid:34878948 PMCid:PMC9008554

6. Da Cunha MR, Dias AAM, de Brito JM, da Silva Cruz C, Silva SK. (2020). Anatomical study of the brachial plexus in human fetuses and its relation with neonatal upper limb paralysis. Einstein (Sao Paulo). 18: eAO5051. https://doi.org/10.31744/einstein_journal/2020AO5051; PMid:31994607 PMCid:PMC6980293

7. Erickson JR, Walker SE, Arenas Gomez CM, Echeverri K. (2024). Sall4 regulates downstream patterning genes during limb regeneration. Developmental Biology. 515: 151-159. https://doi.org/10.1016/j.ydbio.2023.11.008; PMid:38040078 PMCid:PMC11195640

8. Gasser RF, Cork RJ, Stillwell BJ, McWilliams DT. (2014). Rebirth of human embryology. Developmental Dynamics. 243(5): 621-628. https://doi.org/10.1002/dvdy.24168; PMid:25045063 PMCid:PMC4206589

9. Guéro S. (2018, Oct). Developmental biology of the upper limb. Hand Surg Rehabil. 37(5): 265-274. Epub 2018 Jul 21. https://doi.org/10.1016/j.hansur.2018.03.007; PMid:30041930

10. Hita-Contreras F, Martinez-Amat A, Ortiz R et al. (2012). Development and morphogenesis of human wrist joint during embryonic and early fetal period. Journal of Anatomy. 220(6): 580-590. https://doi.org/10.1111/j.1469-7580.2012.01524.x; PMid:22747582 PMCid:PMC3406365

11. Hjazi A, Jasim SA, Al-Dhalimy AMB et al. (2024). HOXA9 versus HOXB9; particular focus on their controversial role in tumor pathogenesis. Journal of Applied Genetics. 65(3): 473-492. https://doi.org/10.1007/s13353-024-00868-x; PMid:38753266

12. Khanal S, Pachya U, Thapaliya S et al. (2022). Congenital limb deficiency: A case report. JNMA Journal of the Nepal Medical Association. 60(249): 485-487. https://doi.org/10.31729/jnma.7486; PMid:35633231 PMCid:PMC9252216

13. Khmara TV, Koval OA, Tsyhykalo OV, Pankiv TV, Zamorskyi II. (2024). Features of the appearance of primary ossification centers in humans. Ukrainian Journal of Perinatology and Pediatrics. 3(99): 115-123. https://doi.org/10.15574/PP.2024.3(99).115123

14. Kloc J, Dzula B, Varga I, Klein M, Steno B. (2023). Camptodactyly: From embryological basis to surgical treatment. Medicina (Kaunas). 59(5): 966. https://doi.org/10.3390/medicina59050966; PMid:37241199 PMCid:PMC10221293

15. Kumano K, Yamada S, Yamaguchi M, Uwabe C, Takakuwa T. (2022). Upper arm posture during human embryonic and fetal development. Anatomical Record (Hoboken). 305(1): 102-112. https://doi.org/10.1002/ar.24932; PMid:35591791

16. Leijnse JN, de Bakker BS, D'Herde K. (2020). The brachial plexus – explaining its morphology and variability by a generic developmental model. Journal of Anatomy. 236(5): 862-882. https://doi.org/10.1111/joa.13277; PMid:32659045 PMCid:PMC7704239

17. Markiewicz M, Stirling P, Brennan S, Hooper G, Lam W. (2023). Age-related changes in patients with upper limb thalidomide embryopathy in the United Kingdom. Journal of Hand Surgery European Volume. 48(8): 773-780. Epub 2023 Apr 6. https://doi.org/10.1177/17531934231164093; PMid:37021538 PMCid:PMC10466990

18. O'Rahilly R, Müller F. (2010). Developmental stages in human embryos: Revised and new measurements. Cells Tissues Organsю 192(2): 73-84. https://doi.org/10.1159/000289817; PMid:20185898

19. Pankiv TV, Khmara TV, Zamorskyi II, Koval YY, Vlasova OV, Skrypnyk VM. (2025). Anatomical-functional and pathological aspects of the mechanisms of interaction of the mother-placenta-fetus system. Modern Pediatrics (Ukraine). 2(146): 111-118. https://doi.org/10.15574/SP.2025.2(146).111118

20. Pichat J, Iglesias JE, Yousry T, Ourselin S, Modat M. (2018). A survey of methods for 3D histology reconstruction. Medical Image Analysis. 46: 73-105. https://doi.org/10.1016/j.media.2018.02.004; PMid:29502034

21. Qi F, Deng Z, Ma Y et al. (2020). From the perspective of embryonic tendon development: Various cells applied to tendon tissue engineering. Annals of Translational Medicine. 8(4): 131. https://doi.org/10.21037/atm.2019.12.78; PMid:32175424 PMCid:PMC7048977

22. Raszweski JA, Singh P. (2023, Aug 14). Embryology, hand. In StatPearls. Treasure Island (FL): StatPearls Publishing. URL: https://www.ncbi.nlm.nih.gov/books/NBK560822/.

23. Rodríguez-Niedenführ M, Burton GJ, Deu J, Sañudo JR. (2001). Development of the arterial pattern in the upper limb of staged human embryos: Normal development and anatomic variations. Journal of Anatomy. 199(4): 407-417. https://doi.org/10.1046/j.1469-7580.2001.19940407.x; PMid:11693301 PMCid:PMC1468351

24. Saxena A, Agarwal KK, Ray B, Pyrtuh S. (2013). A rare finding of the superficial palmar arch – developmental and clinical significance. Journal of Clinical Diagnostic Research. 7(4): 706-708. https://doi.org/10.7860/JCDR/2013/5212.2887; PMid:23730652 PMCid:PMC3644450

25. Sophia L, Singh D, Xalxo N, Yadav A, Agarwal S et al. (2021, Jun 11). Upper limb arterial pattern: clinical correlation and embryological perspective. J Vasc Bras. 20: e20210008. https://doi.org/10.1590/1677-5449.210008; PMid:34188672 PMCid:PMC8210643

26. TeachMeAnatomy. (2024). Development of the Limbs – Formation of Limb Buds – Formation of Digits. URL: https://teachmeanatomy.info/?s=Development+of+the+Limbs+-+Formation+of+Limb+Buds+-+Formation+of+Digits.

27. Thirkannad SM, Patil R. (2021, Apr). The Story of the Hand. Indian J Plast Surg. 54(2): 106-113. Epub 2021 Jul 5. https://doi.org/10.1055/s-0041-1729771; PMid:34239230 PMCid:PMC8257305

28. Vargesson N, Hooper G, Giddins G, Hunter A, Stirling P, Lam W. (2023). Thalidomide upper limb embryopathy – Pathogenesis, past and present management and future considerations. Journal of Hand Surgery European Volume. 48(8): 814-823. https://doi.org/10.1177/17531934231177425; PMid:37226469 PMCid:PMC10466950

29. Vladichenko KA, Koval OA, Smetaniuk OV, Tsyhykalo OV. (2024). Methods of staging prenatal development in comparative embryology. Klinichna ta eksperymentalna patologiya. 23(4): 105-113. https://doi.org/10.24061/1727-4338.XXIII.4.90.2024.15