Journal of Orthopedics and Joint Surgery

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VOLUME 2 , ISSUE 1 ( January-June, 2020 ) > List of Articles

CASE REPORT

Avascular Necrosis of Metacarpal Head in an Amateur Volleyball Player: A Case Report

Prahalad Kumar Singhi, Venkatappa Somashekar, Raghava Kumar

Citation Information : Singhi PK, Somashekar V, Kumar R. Avascular Necrosis of Metacarpal Head in an Amateur Volleyball Player: A Case Report. 2020; 2 (1):46-48.

DOI: 10.5005/jp-journals-10079-1020

License: CC BY-NC 4.0

Published Online: 17-10-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Abstract

Avascular necrosis of the metacarpal head is very rare compared to that of femoral head, talus, or scaphoid. Mauclaire disease also known as Dietrich's disease is a rare condition that refers to osteonecrosis of the metacarpal head. It can be multifactorial, usually associated with systemic lupus erythematosus (SLE), steroid use, or trauma. We present a case of 13-year-old boy, an amateur volleyball player presented with pain and swelling of the right index finger for 3 months. Initial X-rays were normal but subsequent X-rays revealed a mild flattening of the second metacarpal head; blood investigations were normal. The MRI revealed osteonecrosis with mild flattening of the second metacarpal head with synovial effusion. The patient was misdiagnosed as tuberculosis of the metacarpal head before presenting to us. The patient was treated conservatively with good functional outcome. Though several cases of Dietrich's disease have been reported in the literature but none in a volleyball player, just to stress that repeated microtrauma could also be an etiological factor and a rare differential diagnosis in patients with the painful metacarpophalangeal (MCP) joint. Most of the patients can be managed conservatively with good functional outcome. Curettage and bone grafting, transfer of metatarsal head, osteotomies, arthroplasty (excision or prosthesis), or arthrodesis have been described as various surgical means of treatment.


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  1. Epiphysite des tetes metacarpiennes avec main un peucreuse. Bull Mem Soc Nat Chir 1927;53:1377–1378.
  2. Legg-Calve-Perthes syndrome and related osteochondroses of youth. Springfield, IL: Charles C. Thomas; 1954.
  3. Radiographic findings in the hands in patients with systemic lupus erythematosus. Radiology 1978;126(2):313–317. DOI: 10.1148/126.2.313.
  4. Idiopathic osteonecrosis of the third metacarpal head. J Formos Med Assoc 2008;107(1):89–92. DOI: 10.1016/S0929-6646(08)60014-5.
  5. Avascular necrosis of the metacarpals in juvenile dermatomyositis. J Clin Rheumatol 2010;16(5):233–236. DOI: 10.1097/RHU.0b013e3181e9345d.
  6. Avascular necrosis of the metacarpal head. J Hand Surg Br 1998;23(4):552–554. DOI: 10.1016/S0266-7681(98)80149-6.
  7. Conservative management of Dieterich disease: case report. J Hand Surg Am 2012;37(4):807–810. DOI: 10.1016/j.jhsa.2011.12.018.
  8. Dieterich disease treated with curettage and bone grafting: A case report. J Orthop Case Rep 2018;8(2):13–15. DOI: 10.13107/jocr.2250-0685.1026.
  9. Osteochondral mosaicplasty as a treatment method for bilateral avascular necrosis of the long finger metacarpal: Case report. J Hand Surg Am 2010;35(8):1264–1268. DOI: 10.1016/j.jhsa.2010.04.014.
  10. Flexion osteotomy of the metacarpal neck: A treatment method for avascular necrosis of the head of the third metacarpal: A case report. J Bone Joint Surg Am 2002;84-A(2):274–276. DOI: 10.2106/00004623-200202000-00016.
  11. The idiopathic avascular osteonecrosis of the third metacarpal head (M. Mauclaire/Dieterich's disease). Int J Case Rep Images 2017;8(2):92–95. DOI: 10.5348/ijcri-201714-CR-10753.
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