title: Avascular necrosis of the metacarpal head: a report of two cases and review of literature.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  We present two cases of children with AVN of the fourth metacarpal head with a relatively recent history of indirect hand trauma.
  
  
  METHODS
  Both of our cases had radiographs and MRI of the hand.
  
  
  RESULTS
  MRI was diagnostic in both cases; however, radiographs were reported as normal in the early stage in one case.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiology, Division of Pediatric Radiology, Massachusetts General Hospital, Ellison 237, Boston, MA 02114, USA. psagar@partners.org
authors.forename: Pallavi
authors.initials: P
authors.lastname: Sagar
authors.forename: Randheer
authors.initials: R
authors.lastname: Shailam
authors.forename: Katherine
authors.initials: K
authors.lastname: Nimkin
mesh_terms: D000293:Adolescent; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D050279:Metacarpal Bones / Q000000981:diagnostic imaging* / Q000473:pathology*; D010020:Osteonecrosis / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed