Avascular necrosis of the metacarpal head: a report of two cases and review of literature

Avascular necrosis (AVN) of the metacarpal head is a rare condition that can go unrecognized on radiography and progress to degenerative arthritis. Few reports describe the association with trauma, steroid use and systemic lupus erythematosus (SLE). Optimal treatment for this condition has not been established and long-term prognosis is unknown. We present two cases of children with AVN of the fourth metacarpal head with a relatively recent history of indirect hand trauma. Both of our cases had radiographs and MRI of the hand. MRI was diagnostic in both cases; however, radiographs were reported as normal in the early stage in one case. AVN of the metacarpal head is rare but can occur in children. Pediatric radiologists should be aware of this uncommon clinical entity, especially in light of increased involvement of children in sporting activities. Active children with hand trauma and children treated with steroids for a variety of conditions are particularly at risk.