Short 4th Metacarpal

Differential considerations for a short 4th metacarpal include:

• Trauma:
• Normal variant:
• Turner syndrome:
• Pseudohypoparathyroidism:
• Pseudopseudohypoparathyroidism :
• Acrodysostosis: Rare disorder characterized by peripheral dysostosis, nasal hypoplasia, and mental retardation.
• Multiple epiphyseal dysplasia: Hypoplasia of the epiphyseal cartilage of tubular bones with essentially normal vertebrae. Epiphyseal ossification alterations are bilateral, symmetrical, and more marked in the lower extremities. Mild short stature. Early in childhood, there are delayed epiphyseal growth centers, which eventually ossify with an irregular fragmented appearance. Older children will have coxa vara with and increased incidence of slipped capital femoral epiphysis. Young adults and adults have premature osteoarthritic changes, particularly in the hips and knees. A double-layered patella is highly diagnostic for the recessive forms of multiple epiphyseal dysplasia.

References

• Ablow RC, Hsia YE, Brandt IK. Acrodysostosis coinciding with pseudohypoparathyroidism and pseudo-pseudohypoparathyroidism. AJR Am J Roentgenol. 1977 Jan;128(1):95-9.
• Rubenstein JD, Christakis MS. Case 95: fracture of double-layered patella in multiple epiphyseal dysplasia. Radiology. 2006 Jun;239(3):911-3.