Aseptic osteonecrosis of the head of the metacarpal
Avascular necrosis of the metacarpal head
AVN of the metacarpal head
Mauclaire's disease
Dietrich's disease
Mauclaire disease, also known as Dietrich disease, is a rare disease and refers to osteonecrosis of the metacarpal heads, which usually appears between the ages of 13 and 18 years 1,2. This condition may lead to early closure of the epiphyseal growth plate and growth disturbance of the involved finger.
It usually appears between the ages of 13 and 18 years. The condition is rare and most often spontaneous but may be associated with trauma, systemic lupus erythematosus or steroid use 3.
Clinical presentation
Localized pain, swelling and restricted range of motion in the affected metacarpophalangeal joint are the main clinical presentations 5. Any metacarpal may be affected however the long metacarpals (2nd and 3rd) are most commonly involved 4.
Pathology
The pathologic changes are equivalent to those of osteonecrosis of other bones. There is disruption of critical blood supply leading to bone infarction, central necrosis and surrounding hyperemia. Microfractures ensue resulting in flattening and deformity of the bone surface.
Radiographic features
Plain radiograph
In plain radiography of the hand, flattening of the metacarpal heads, widening of the joint space, and signs of deforming osteoarthritis may be seen 6,7.
A young male presents with long standing wrist pain and no history of trauma. The only noteworthy finding on wrist radiograph is an abnormally shortened ulna compared to the radius. Given this finding, what condition should be considered now and in the future?
1. Erne HC, Lanz U, Van Schoonhoven J et-al. [Aseptic osteonecrosis of the head of the metacarpal (Mauclaire's disease)-case report and review of the literature]. Handchir Mikrochir Plast Chir. 2008;40 (03): 207-10. doi:10.1055/s-2008-1038752 - Pubmed citation
3. BjöRkman A, JöRgsholm P, Burtscher IM. Osteonecrosis of the metacarpal head in a patient with a prothrombin 20210A gene mutation. Scand J Plast Reconstr Surg Hand Surg. 2005;39 (6): 379-81. doi:10.1080/02844310500228209 - Pubmed citation