Osteochondritis of the second metacarpal head: a case report
Luc De Smet
Received: 14 June 2007 / Accepted: 28 November 2007 / Published online: 20 December 2007
Abstract Osteochondritis dissecans is rare in the metacar-
pal head. To our knowledge, only one previous case report
has been published. The initial diagnosis was ulnar
collateral instability. Intraoperatively, the osteochondritis
lesion was noticed and the loose cartilage flap was
removed. The patient was symptom free after surgery.
Keywords Osteochondritis dissecans
Osteochondritis dissecans is a localised injury of cartilage,
which leads to the separation of the cartilage from the
underlying subchondral bone . It has been described
most commonly in the knee, ankle and elbow  but
appears in many different joints. These include the
temporomandibular  joint to the hip , tibia  and
smaller bones such as the scaphoid , lunate ,
trapezium  and the interphalangeal joints . The
etiology of this condition is still unclear in spite of it
having been recognised as far back as 1951 . Hereditary,
vascular and traumatic mechanisms have been described
. Of these, repetitive microtrauma seems to be one of the
key issues .
A localisation on the metacarpal head of the index finger
is reported. To our knowledge, only one similar other case
has been reported in the literature so far .
A 26-year-old woman consulted our outpatient hand clinic
with a complaint of pain and loss of strength in her left
hand. Her dominant hand is her right. She complained of
having difficulties with opening of bottles and the door of
her car. She related a history of trauma to the left
metacarpophalangeal (MCP) II joint, with a luxation of
the MCP II joint during a basketball match. This was
treated with a short period of immobilisation of the joint
using a Zimmer splint. Two months before the present
consultation, she sustained a new injury to her left index
when it became stuck in the pocket of her coat. This was
treated elsewhere with a short arm plaster for a week.
Clinical examination showed pain elicited by palpation of
the ulnar side of the MCP II, with increased laxity while
performing radial and dorsal translation. There was a
normal active and passive range of motion (ROM).
Radiographs showed the presence of what seemed to be an
old avulsion fracture at the base of the proximal phalanx of the
index finger with subsequent osteophyte formation (Fig. 1).
Initial diagnosis was a chronic ulnar collateral complex
lesion with instability and secondary early stage arthrosis.
The patient was scheduled for a collateral ligament
The patient was operated under regional anesthesia. A
dorsal incision was made over the ulnar side of the MCP II
joint. The capsule of the MCP II joint was incised
longitudinally, and the joint was inspected. The loose
cartilage body of an osteochondritis dissecans lesion was
obvious (Fig. 2a) and was then removed (Fig. 2b).
Immediate mobilisation was initiated. The patient was
seen after 2 weeks with normal healing of the scar and full
active and passive ROM, with disappearance of the initial
Eur J Plast Surg (2008) 31:81–82
H. Lowyck (*)
L. De Smet
Pellenberg Orthopedic Hospital,
University Hospitals Leuven,
3212 Pellenberg, Belgium