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Resident PGY 3
Henry Ford Macomb
Avascular necrosis of the metacarpal head is a rare condition, documented in less than 50 patients since 1932 when it was first described (2). The disease most commonly associated with steroid use, trauma, autoimmune disease, or idiopathic, which characterizes Dieterich’s disease (3). The patient generally presents with MCP joint stiffness and pain, with possible loss of active range of motion. As the disease advances, the subchondral bone can collapse causing joint incongruity. When non-operative treatment has failed, proposed treatment options include: simple debridement, curettage with cancellous bone grafting, osteochondral auto graft, arthroplasty, flexion osteotomy, and arthrodesis (1).There has been non consensus on optimal treatment due to the rarity of the disease. This case presentation describes the treatment of chronic AVN of the metacarpal head in a 15 year old female using a previously documented osteochondral autograft transfer system (OATS) technique. An osteochondral autograft plug from the non–weight-bearing articular surface of the lateral femoral condyle was transferred and press-fit to the focal defect present in the ring metacarpal head, resurfacing the collapsed defect (1). The articular surface was restored which allowed for full range of motion of ring metacarpal joint without crepitance or clicking. The patient is 8 months post op and has resumed all baseline activities without pain or functional deficit. This case represents an exceedingly rare condition that has several surgical options, none of which have enough data to be recommended as the "gold standard" of care. We reproduced previously documented results that using an osteochondral autograft from the lateral femoral condyle provides an adequate match for the unique articular shape of the metacarpal head and provided full pain relief, full metacarpal joint range of motion, no loss of function, and no morbidity from the donor site.
Wortham, Heather; King, Cameron; and Scott, Michael N., "Osteochondral Autograft Used to Treat Avascular Necrosis of Metacarpal Head" (2019). Case Reports. 91.