Dietrich disease is the eponymous name given to avascular necrosis (aseptic necrosis) involving a metacarpal head. 1
The condition is rare and most often spontaneous but may be associated with trauma, systemic lupus erythematosus or steroid use. Any metacarpal may be affected however the long metacarpals (2nd and 3rd) are most commonly involved.
The pathologic changes are equivalent to those of avascular necrosis of other bones. There is disruption of critical blood supply leading to bone infarction, central necrosis and surrounding hyperaemia. Microfractures ensue resulting in flattening and deformity of the bone surface.
Contour deformity of the metacarpal heads and a mixed lucent and sclerotic appearance of the subchondral bone. Most commonly 2nd and 3rd metacarpal heads. Secondary degenerative disease may develop.
The condition was first described by H. Dietrich in 1932. 2