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Avascular necrosis and vascular anatomy of the metacarpals
1Department of Orthopaedics, University of Florida, Gainesville 32610.
Abstract:
Aseptic necrosis of the metacarpal head is extremely rare and has been described in association with systemic lupus erythematosus, steroid use, trauma, and other sites of bone infarction. The long metacarpal is the most commonly involved. The extrinsic and intrinsic vascular anatomy of the metacarpal is described in fifty metacarpal specimens. No definite conclusions can be drawn about anatomic variations in blood supply between the different metacarpals. However, in 35% of the specimens, a main arteriole in the distal epiphysis was absent, making these metacarpal heads solely dependent on small circumferential pericapsular arterioles. This group of metacarpals, when associated with other risk factors, such as trauma, systemic lupus erythematosus, or steroid use, may be at increased risk for the development of aseptic necrosis.
Insights
Aseptic necrosis of the metacarpal head is rare, often affecting the long metacarpal. Some metacarpal heads lack a main arteriole, increasing risk with factors like steroid use or lupus.
Area of Science:
- Orthopedic Surgery
- Vascular Anatomy
- Bone Pathology
Background:
- Aseptic necrosis of the metacarpal head is a rare condition.
- It has been associated with systemic lupus erythematosus, steroid use, and trauma.
- The long metacarpal is the most frequently affected bone.
Purpose of the Study:
- To describe the extrinsic and intrinsic vascular anatomy of the metacarpal.
- To identify potential anatomical variations predisposing to aseptic necrosis.
Main Methods:
- Dissection and description of vascular anatomy in fifty metacarpal specimens.
- Analysis of blood supply patterns in different metacarpals.
Main Results:
- No definitive conclusions on blood supply variations between different metacarpals were drawn.
- A main arteriole in the distal epiphysis was absent in 35% of specimens.
- These specimens were solely dependent on small circumferential pericapsular arterioles.
Conclusions:
- Metacarpal heads lacking a main distal epiphyseal arteriole may be at higher risk for aseptic necrosis.
- This risk is amplified when combined with risk factors such as trauma, systemic lupus erythematosus, or steroid use.