Metacarpal Head Avascular Necrosis

ICD-9 Classification / Treatment
Etiology / Natural History Associated Injuries / DDx
Anatomy Complications
Clinical Evaluation Follow-up Care
Xray / Diagnositc Tests Review References

synonyms:avascular necrosis of the metacarpal head, Dieterich's diseasae, AVN metacarpal, osteonecrosis metacarpal 

Dieterich's Disease ICD-9


Dieterich's Disease Etiology / Epidemiology / Natural History

  • Rare
  • Most commonly affects Middle finger metacarpal head
  • etiology: trauma, steriod use, systemic lupus erythematous
  • Age: 6-54
  • May resolve spontaneously in pediatric cases. 

Dieterich's Disease Anatomy

  •  35% of people lack main arteriole to the distal epiphysis with metacarpal head vascularity provided by small pericapsular arterioles. 

Dieterich's Disease Clinical Evaluation

  •  Gradual pain onset, swelling, stiffness in MCP joint

Dieterich's Disease Xray / Diagnositc Tests

  • AP, lateral, oblique view of hand demonstrate subchondral lucency, flattening of metacarpal head, sclerosis, cystic change, joint space loss. 
  • Consider MRI 
  • Consider ESR, coagulation screening, lupus screening, rheumatology screening

Dieterich's Disease Classification / Treatment

  • Pediatric: may resolve spontaneously
  • NSAIDs, activity modifications, splinting
  • Surgical: decompression/curettage; volar flexion osteotomy, osteochondral mosaicplasty, arthrodesis, arthroplasty-Ascension Orthopedics

Dieterich's Disease Associated Injuries / Differential Diagnosis


Dieterich's Disease Complications

Dieterich's Disease Follow-up Care


Dieterich's Disease Review References

  • Bhatia S, Orthopedic Today April 2014, 46