Abstract
INTRODUCTION: Avascular necrosis of metacarpal head is a rare entity. There are very few reported cases in the literature and most of them are isolated case reports. Multiple treatment options including successful conservative management are described in literature. CASE REPORT: We report a case of 57-year-old male who presented to us with a history of chronic pain over the index finger metacarpophalangeal joint. Clinical examination revealed painful range of movement of the affected joint. Radiographs revealed lytic foci. A magnetic resonance imaging scan to further evaluate the condition revealed decreased joint space, articular cartilage thinning, and subarticular cysts.A diagnosis of Dieterich's disease was madeand initial conservative treatment was given for 3months. Curettage of the lesion and autologous cancellous bone grafting from ipsilateral distal radius was done after failed conservative treatment. The patient was symptom free in up to 1-year follow-up. CONCLUSION: Non-specific pain of the metacarpals is often neglected. High index of suspicion and careful scrutiny of radiographs are needed to diagnose case of Dieterich's disease.Though uncommon Dieterich's disease should be considered as a probable diagnosis in metacarpal pain. Currettage with bone grafting gives satisfactory outcomein patientswith persistent symptoms after conservative treatment has failed.