Avascular necrosis and vascular anatomy of the metacarpals

Conservative Management of Dieterich Disease: Case Report

“…8 A cadaveric study investigating the blood supply to the metacarpals (in normal adult cadavers not affected by Dieterich disease) found that, in 35% of the specimens, a main arteriole in the distal epiphysis was absent, making those metacarpal heads solely dependent on small, circumferential pericapsular arterioles. 9 One reason that avascular necrosis might follow minor trauma is that the raised intracapsular pressure could compress the periosteal blood vessels, causing ischemia. 9 In skeletally immature individuals, there are no vessels crossing the open physis; therefore, the distal metacarpal epiphysis depends on epiphyseal and periosteal blood supply.…”

“…9 One reason that avascular necrosis might follow minor trauma is that the raised intracapsular pressure could compress the periosteal blood vessels, causing ischemia. 9 In skeletally immature individuals, there are no vessels crossing the open physis; therefore, the distal metacarpal epiphysis depends on epiphyseal and periosteal blood supply. This could render the pediatric metacarpal head vulnerable to avascular necrosis.…”

Irreducible Displacement of Comminuted Metacarpal Head Fracture

“…We blame the degree of displacement responsible for the development of avascular necrosis in our patient, since the blood supply of the distal metacarpals is provided quite frequently only by small pericapsular arterioles [14].…”

The idiopathic avascular osteonecrosis of the third metacarpal head (M. Mauclaire/Dieterich's disease)

“…Wright et al [15] suggest a predisposition in vascular malformations of the epiphyseal vascular network that was found in 35% of specimens.…”