A commentary on ‘Current management of avascular necrosis of the metacarpal head: a comprehensive literature review’
Year: 2024
Type: article
Abstract: Avascular necrosis of the metacarpal head, originally described by Mauclaire [1] , was further described by Dieterich in 1932 [2] .This rare condition is frequently associated with trauma, systemic lupus erythematosus, steroid use, and renal transplantation.The vascular supply of the metacarpal heads of each of the digits has been studied and it has been shown that the distal metacarpal epiphysis of the middle finger is supplied by small pericapsular vessels with an absence of large nutrient vessels in 60% of specimens, compared to 25-50% of other metacarpals [3] .Such anatomy may make the metacarpal head of the middle finger more susceptible to avascular necrosis when exposed to insults such as trauma, systemic diseases, or steroids.Currently, no consensus exists on the optimal management of avascular necrosis of the metacarpal head.Options may include nonsurgical (rest, placement of an orthosis, nonsteroidal antiinflammatory drugs, and occupational therapy) and operative management.Fan et al. [4] performed a comprehensive literature review to describe the epidemiology, possible risk factors, clinical presentation, diagnostic workup, and treatment of the rare condition of avascular necrosis of the metacarpal head.They concluded that nonoperative treatment may be recommended for young people to take advantage of the regenerative potential of growing bones.When nonoperative treatment fails, preservation surgery of the metacarpal head may be attempted in younger patients.Arthroplasty or arthrodesis could be reliable options for older, lower-demand patients.In the advanced stage that demonstrates collapse of the metacarpal head on imaging, arthrodesis, partial resection, prosthesis, and denervation surgeries are appropriate for pain relief [5] .However, in the early stage, without metacarpal head None.
Source: International Journal of Surgery
Authors: Liyun Jiang, Zongping Xiao, Teng Chen, Rui Jiang
Language: English
Topic: Bone and Joint Diseases
Subfield: Orthopedics and Sports Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,450
OpenAlex ID: W4396601596