Turner Syndrome: This genetic disorder in females is characterized by short stature and often features short fourth metacarpals among other skeletal abnormalities. It is a common cause of short stature in females and the presence of short fourth metacarpals is a significant clue pointing towards this diagnosis.

Noonan Syndrome: Although more commonly associated with heart defects and developmental delays, Noonan Syndrome can also present with short stature and skeletal abnormalities, including short metacarpals.
Pseudohypoparathyroidism: This condition can lead to short stature and short metacarpals due to resistance to parathyroid hormone, affecting bone development.
Leri-Weill Dyschondrosteosis: A rare form of dwarfism characterized by short stature and shortening of the fourth metacarpals, often with a family history.

Rickets: While primarily causing softening of the bones, severe cases of rickets can lead to growth retardation and skeletal deformities, including alterations in metacarpal length. Missing this diagnosis could lead to significant morbidity if left untreated.
Hypoparathyroidism: Similar to pseudohypoparathyroidism, hypoparathyroidism can affect bone health, but it's crucial to differentiate due to the need for distinct management strategies.

Brachydactyly: A group of disorders characterized by short fingers, which can include short metacarpals. While not typically associated with significant short stature, some forms can present with growth issues.
Madelung Deformity: A rare congenital disorder affecting the forearm and wrist, leading to shortening of the radius and ulna, which might indirectly affect metacarpal appearance and overall limb length.
Osteodysplasty (Melnick-Needles Syndrome): An X-linked dominant disorder with skeletal dysplasia, including short stature and potential for short metacarpals, though it's extremely rare and more commonly associated with other distinctive skeletal features.