J Korean Orthop Assoc.  2012 Apr;47(2):146-149. 10.4055/jkoa.2012.47.2.146.

Avascular Necrosis of the Head of the Third Metacarpal Bone

• Heo YM
• Kim SB
• Yi JW
• Kim KK
• Lee JB
• Ryu SK

• KMID: 2185391
• DOI: http://doi.org/10.4055/jkoa.2012.47.2.146

Abstract

Avascular necrosis of the metacarpal head named as 'Dieterich disease' is a very rare condition. Because of the lack of information about the natural course and treatment of this disease, the ideal treatment has not been established as yet. We report a case of avascular necrosis that occurred at the 3rd metacarpal head after fractures of the 4th and 5th metacarpal base; this was treated conservatively and obtained the spontaneous resolution.

Keyword

Metacarpal bones; head; Avascular necrosis of bone

MeSH Terms

Head
Metacarpal Bones
Metacarpus
Necrosis
Osteonecrosis
Metacarpus
Osteonecrosis

Figure

• 

  Figure 1 Images of fractures of 4th and 5th metacarpal base. Initial radiograph (A), computed tomography image (B) and image at postoperative 2 months (C) were showing no bony lesion of 3rd metacarpal head.

• 

  Figure 2 An 18-year-old boy complained of pain in right 3rd metacarphophalangeal joint. (A) Plain radiograph shows the osteolytic lesion with peripheral sclerotic change at distal epiphysis of right 3rd metacarpal bone. (B) Coronal T2-weighted image of the 3rd metacarpal head shows low-signal-intensity lesion. (C) Coronal T1-weighted image shows the fragmentation. (D) Sagittal T1-weighted image shows the 7.0×3.8×7.5 mm lesion in dorsal aspect of the 3rd metacarpal base.

• 

  Figure 3 Radiograph at 10 months follow-up. Avascular necrosis of 3rd metacarpal head was spontaneously regenerated.

Reference

1. Dieterich H. Die subchondrale Herderkrankung am Metacarpale III. Arch Klin Chir. 1932. 171:555–567.

2. Sagar P, Shailam R, Nimkin K. Avascular necrosis of the metacarpal head: a report of two cases and review of literature. Pediatr Radiol. 2010. 40:1895–1901.

3. Hu MH, Chen WC, Chang CH. Idiopathic osteonecrosis of the third metacarpal head. J Formos Med Assoc. 2008. 107:89–92.

4. Kalenderer O, Ağuş H, Ozlük S. Avascular necrosis of the third metacarpal head: a case report. Acta Orthop Traumatol Turc. 2004. 38:154–156.

5. Carstam N, Danielsson LG. Aseptic necrosis of the head of the fifth metacarpal. Acta Orthop Scand. 1966. 37:297–300.

6. Gilsanz V, Cleveland RH, Wilkinson RH. Aseptic necrosis: a complication of dislocation of the metacarpophalangeal joint. AJR Am J Roentgenol. 1977. 129:737–738.

7. Barrueco JL, Zapatero M, Lignereux Y, Regodon S. Osteochondritis dissecans of the head of the second metacarpal bone. J Hand Surg Am. 1992. 17:1079–1081.

8. Lightfoot RW Jr, Lotke PA. Osteonecrosis of metacarpal heads in systemic lupus erythematosus. Value of radiostrontium scintimetry in differential diagnosis. Arthritis Rheum. 1972. 15:486–492.

9. Fette AM. Case report: Dieterich's disease in a teenage boy. J Pediatr Orthop B. 2010. 19:191–194.

10. Wright TC, Dell PC. Avascular necrosis and vascular anatomy of the metacarpals. J Hand Surg Am. 1991. 16:540–544.