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Review
. 2023 May 1;109(5):1509-1517.
doi: 10.1097/JS9.0000000000000377.

Current management of avascular necrosis of the metacarpal head: a comprehensive literature review

Xiao-Lei Fan  1 , Wen-Tao Wang  2 , Jian Wang  3 , Rui Xiao  3
Affiliations
Review

Current management of avascular necrosis of the metacarpal head: a comprehensive literature review

Xiao-Lei Fan et al. Int J Surg. .

Abstract

Background: Avascular necrosis (AVN) of the metacarpal head is a rare disease that may lead to progressive destruction of the metacarpophalangeal joint and hand function. This study aimed to describe the epidemiology, possible risk factors, clinical presentation, diagnostic workup, and treatment of the rare condition of avascular necrosis of the metacarpal head.

Methods: Articles were searched using the subject words "Dieterich disease","Mauclaire's disease", and "avascular necrosis of metacarpal head" in the PubMed and Scopus databases. Studies were retained for review after meeting the inclusion criteria. Those outcomes relevant to diagnose and assessing AVN of the metacarpal head and those related to curative management were extracted.

Results: The literature search revealed 45 studies with 55 patients. Although the aetiology of osteonecrosis has not been clearly delineated, AVN of the metacarpal head most commonly arises from trauma but other risk factors may also be involved. Plain radiographs are often negative and therefore likely to be missed. Early-stage osteonecrosis of the metacarpal head was best assessed using MRI. Given the rarity of this condition, there is no clear consensus on the treatment.

Conclusions: Avascular necrosis of the metacarpal head should be considered in the differential diagnosis of painful metacarpophalangeal joints. An early understanding of this unusual disease will provide an optimal clinical outcome, restoring joint activity, and resolving pain. Nonoperative treatment cannot cure all patients. Surgical management is based on the patient and lesion characteristics.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1
Figure 1
Flowchart presenting the study selection process of publications on avascular necrosis of the metacarpal head. AVN, avascular necrosis.
Figure 2
Figure 2
Anteroposterior radiograph shows subchondral collapse and sclerotic changes in the long finger and ring finger metacarpal head.
Figure 3
Figure 3
Sagittal images of computed tomography demonstrate cystic, osteochondral defect, and sclerotic changes in the metacarpal head.
See this image and copyright information in PMC

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Supplementary concepts