Dieterich Disease: Avascular Necrosis of the Third Metacarpal Head in an Adult

Dieterich disease, or avascular necrosis of the metacarpal head, is a rare condition predominantly affecting adolescents, with fewer than 60 reported cases. We report a rare presentation in a 59-year-old adult with multiple systemic comorbidities.

A 59-year-old man with diabetes, hypertension, and chronic kidney disease presented with progressive right third metacarpophalangeal joint pain without prior trauma. Following radiographic and magnetic resonance imaging (MRI) evaluation, the patient underwent surgical curettage of the necrotic bone followed by autologous iliac cancellous bone grafting. Histopathological examination supported the diagnosis.

At the long-term nearly 5-year follow-up, the patient maintained complete symptom resolution, fully restored range of motion, and durable osseous graft integration without secondary collapse or osteonecrotic recurrence.

Although most frequently described in adolescents, Dieterich disease should be considered in adults presenting with unexplained metacarpophalangeal joint pain, especially alongside vascular-compromising comorbidities. MRI serves as a valuable adjunct for early lesion detection when radiographs are inconclusive. In this patient, joint-preserving curettage with autologous bone grafting provided durable structural support and favorable long-term functional recovery.