Avascular Necrosis of the Metacarpal Head: A Case of Dietrich’s Disease and Review of the Literature

Abstract

Patient: Male, 36Final Diagnosis: Dietrich’s diseaseSymptoms: —Medication: —Clinical Procedure: —Specialty: OrthopaedicsObjective:Rare diseaseBackground:Isolated avascular necrosis of the metacarpal head, also known as Dietrich’s disease, is a rare entity with few cases reported previously in the literature. It has been associated with steroid use, lupus, and trauma. We describe the clinical presentation, pathogenesis, and treatment options associated with this uncommon condition.Case Report:A 36-year-old man presented with a 1-year history of a painful right middle finger metacarpophalangeal joint (MCPJ). There was no preceding history of trauma. Routine blood investigations and plain-film imaging were unremarkable. Magnetic resonance imaging (MRI) revealed a focus of osteonecrosis in the middle finger MCPJ consistent with Dietrich’s disease. Given the patient’s excellent functional status, conservative therapy was been successfully undertaken.Conclusions:Dietrich’s disease, although a rare entity, must be considered in the differential diagnosis of painful MCPJ, where routine blood investigations and plain-film imaging studies are unremarkable.

Conservative management of avascular necrosis of the metacarpal head: Retraction

“…Moreover, conservative treatment has also been reported as being successful. [ 2 , 3 , 21 ] However, the duration of the course of nonsurgical management was ambiguous. In most cases, the nonsurgical management was followed up for 3 months.…”

Clinical-Pathological Conference Series from the Medical University of Graz

“…These manifestations in the MCP joints are specifically found in Dietrich’s disease, an avascular necrosis. Causes for avascular necrosis include trauma (fracture or dislocation), caisson disease, hemoglobinopathies such as sickle cell disease, pregnancy, radiotherapy, connective tissue disorders, renal transplantation, corticosteroid excess (both endogenous and exogenous), pancreatitis, gout, Gaucher’s disease, and alcohol abuse [5]. However, since none of these causes seem to apply to our patient, I would exclude Dietrich’s disease as a differential diagnosis.…”

Operative Therapie der avaskulären Nekrose des Metakarpalekopfes (M. Dieterich) mittels eines osteochondralen Zylinders aus dem ipsilateralen Os pisiforme: Ein Fallbericht

“…Am häufigsten betroffen ist der Mittelhandknochen des Mittelfingers, gefolgt vom Ring-, Zeige-, und Kleinfinger und selten der Daumen [4]. Bei der Geschlechterverteilung imponiert ein Mehrbefall der männlichen Bevölkerung An therapeutischen Optionen wird in der Literatur übereinstimmend zunächst die konservative Therapie mit Gips-oder Orthesenruhigstellung und systemischer Gabe von nicht-steroidalen Antirheumatika empfohlen [7][8][9]. Bei gescheiterter konservative Therapie gibt es zahlreiche operative Behandlungsansätze.…”