There is well-defined lytic destruction of the first proximal phalanx and 2nd metacarpal, with a preserved honeycomb trabecular pattern in these areas. These lesions extend throughout the entire length and diameter of the involved bones. The 2nd metacarpal is mildly expanded overall, with irregular areas of calcification along the ventral and radial aspect of the diaphysis likely representing callus formation from a healing pathological fracture.
The exostotic area along the ulnar aspect of the 5th metacarpal is likely from previous fracture, given the anterior angulation at this site. Multiple traction enthesophytes are noted along the medial and lateral aspects of the phalanges (e.g. 4th proximal).