Dieterich Disease Treated with Curettage and Bone Grafting:
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.

Published in the Journal of Orthopaedic Case Reports, the authors present a case of 57-year-old male who reported 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 made and 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.

Learning Points:_
• 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 outcome in patients with persistent symptoms after conservative treatment has failed.

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