Subungual Exostosis Research Articles

Subungual exostosis of fingers in pediatric practice: clinic, diagnosis, treatment

Subungual exostosis of fingers in pediatric practice: clinic, diagnosis, treatment

Subungual exostosis and chronic onychocryptosis: An intricate relationship - clinical review and management

Subungual exostosis (SE) is a relatively common benign bone tumor occurring primarily in the distal phalanx of the toes, particularly the hallux. Nail deformities, such as onychocryptosis / paronychia, can present concurrently, leading to complex clinical scenarios. Although SE and onychocryptosis are separate conditions, their clinical presentations can sometimes overlap, mainly when SE occurs under the nail bed, leading to nail deformation and subsequent ingrowth. When an ingrown toenail accompanies SE, the situation can become more complex due to increased pain and risk of infection. Diagnosis in these cases requires careful clinical examination and imaging studies. Any surgical intervention for the SE should consider concurrent pathological nail growth and nail bed abnormalities. The ultimate treatment goal is restoring normal anatomy, including salvage of the nail plate.Given these conditions' potential overlap and shared symptomatology, clinical vigilance is essential for appropriate diagnosis and treatment.This paper reviews the interplay between these conditions, their combined impact on patient morbidity, and effective surgical management strategies.

Intra-operative dermoscopy (onychoscopy) of the nail unit-A systematic review.

Dermoscopy of the nail unit (onychoscopy) is a method which allows for non-invasive observation of the nail structures, increasing the accuracy of clinical diagnosis. Currently, it is used in evaluation of both inflammatory and neoplastic conditions of the nail unit. However, in contrast to the skin, the anatomy of the nail unit prevents direct observation of nail bed or nail matrix structure during classic onychoscopy. Intra-operative onychoscopy is a variant of the technique which uses direct visualization of the nail unit structures after nail plate avulsion. The aim of this systematic review was to summarize the current state of knowledge on intra-operative onychoscopy. The MEDLINE, EMBASE and Cochrane databases were systematically searched in January 2024. All types of study designs assessing intra-operative dermoscopy of the nail unit were included in this study. The risk of bias in included studies was assessed using the Joanna Briggs Institute critical appraisal tools. The qualitative synthesis of 19 studies totalling a number of 218 cases in 217 patients included the following entities: melanoma, nevus, hypermelanosis (melanocytic activation), melanocytic hyperplasia, melanophages accumulation, squamous cell carcinoma, glomus tumour, lichen planus, onychomatricoma, onychomycosis and subungual exostosis. The main limitation of the study was a relatively low number of identified studies, most with low levels of evidence. Intra-operative onychoscopy does not replace histologic examination, though it may be useful in determining the modality of surgical diagnostic procedures.

Subungual Osteochondroma of the Great Toe: A Case Report.

Bony outgrowths of the distal phalanx of the great toe have been described in the literature but rarely. These subungual bony outgrowths can be caused by subungual exostosis or subungual osteochondromas. Both of these abnormalities are bony outgrowths with differences in the cartilage cap wherein the exostoses have fibrocartilage, and osteochondromas have hyaline cartilage. The subungual exostosis and osteochondroma that are protruding present symptoms of pain, redness, and deformed nail bed, whereas the nonprotruding osteochondromas have only a lump as the presenting symptom. In both conditions, excision of the lesion and curettage of the base helps prevent a recurrence. Curettage at the end of the excision of the bony outgrowth is required to avoid recurrence. After excision, the specimen should be sent for histopathologic examination to differentiate between the exostosis and osteochondromas, which are underreported in subungual locations, and to rule out malignant transformation. We present a 13-year-old girl with an isolated subungual nonprotruding exostosis of the great toe that was treated by excisional biopsy. The histopathologic examination confirmed it as osteochondroma, which is underreported.

Subungal exostosis: Differentiating from the closest mimic with an X‐ray

Subungal exostosis: Differentiating from the closest mimic with an X‐ray

The Influence of Clinical Factors on Treatment Outcome and a Recurrence of Surgically Removed Protruded Subungual Osteochondroma and Subungual Exostosis.

Subungual exostosis (SE) and subungual osteochondroma (SO) are benign solitary lesions that grow from the distal phalanx. The mass itself is typically painless, but pressure on the nail plate can result in pain and deformity of the involved digit. Tumors can be correctly diagnosed based on clinical, histological and radiographic appearance alone. Surgical resection of SE/SO is typically curative, with a small risk of recurrence. The study was retrospective and observational, involving 74 patients with subungual SE/SO. The surgical procedure consisted of the removal of the tumor from the dorsal approach under digital anesthesia. The procedure was assessed using a questionnaire and photo documentation after a minimum of 6 months after surgery. A total of 85% of respondents were satisfied with the procedure. Nearly 80% of patients rated the cosmetic effect as good or very good. Young age and pain intensity after surgery showed statistically significant associations with worse satisfaction. Age < 18 was associated with recurrence. Worse satisfaction is strongly associated with recurrence. Gender, duration of symptoms, pain before surgery and tumor size and destruction of the nail plate had no significant effect on recurrence. The technique using burr appeared to be a more effective treatment.

Surgical treatment of benign subungual tumours—a systematic review and case series

**Background**: Proper surgical technique is critical in the excision of benign subungual tumours to ensure complete tumour removal and prevent nail deformities. A systematic literature review was performed to identify approaches to excision and their clinical outcome. We present a series of rare benign subungual tumours to highlight different approaches and their outcomes.**Methods**: A systematic review of English language literature was conducted using the PubMed database between 1 January 1962 and 31 December 2021 for studies describing surgical approaches to benign subungual tumours. Search terms include ‘glomus tumour’, ‘subungual exostosis’, ‘osteoid osteoma’, ‘fibro-osseous pseudotumour of the digit’, ‘enchondroma’ and ‘implantation dermoid tumour’. We performed a retrospective review of patient records from our institute from 2021–2022. Six patients with subungual tumours were selected.**Results**: Twenty-one studies (with a total of 228 participants) described various techniques for excision of benign subungual tumours. The majority of the studies (n = 18) described the transungual approach, which allows maximum tumour exposure but with risk of nail deformity postoperatively. Other approaches described include lateral subperiosteal (n = 3), periungual (n = 2), nail bed margin (n = 1) and fish mouth (n = 2). Outcomes were measured using the rate of postoperative nail deformity and rate of tumour recurrence. Our series of patients were treated with excision using the transungual (5 of 6) and periungual approach (1 of 6), with good results. **Conclusion**: The available literature demonstrates that the transungual approach is the most widely used technique for removal of subungual tumours. This technique provides excellent tumour exposure; however, it is associated with damage to the nail bed. Our case series suggests that risk of nail dystrophy can be minimised by meticulous nail bed repair.

Subungual Exostosis of the Second Finger

Subungual Exostosis of the Second Finger

The interest of a hydrocolloid graft in the healing accompaniment of a subungual exostosis

Background: Subungual exostosis is a relatively uncommon, slow-growing benign bone tumor that most often affects the toes of young people and has a significant impact on quality of life. The treatment of which is essentially based on surgical excision with meticulous closure of the wound while avoiding the causes of nail dystrophy.

Clinical diagnosis and treatment of subungual exostosis in children.

To analyze and summarize the clinical characteristics and treatment effects for subungual exostosis in children. Clinical data for children with subungual exostosis treated in our department from January 2008 to September 2022 were evaluated. Forty children with subungual exostosis were evaluated, comprising 31 boys (77.5%) and 9 girls (22.5%) with a median age of 9 years (4-17 years). The median disease course was 6 months (1-48 months). Seven patients (17.5%) had definite trauma history and 5 (12.5%) had infection. The toe or finger nail appearance was abnormal in 36 patients and normal in 4 patients. Twenty-seven patients (67.5%) had pain when wearing shoes and walking, and 25 (62.5%) had toenail tenderness. The lesions were located in the distal phalanxes of the toes in 37 patients (92.5%), with 14 patients affected on the left side and 23 on the right side. Twenty-two patients had lesions in the great toe, 6 in the second toe, 6 in the third toe, and 3 in the fourth toe. The lesions in the other 3 patients (7.5%) were located in the distal phalanxes of the fingers, with 2 patients affected in the second finger and 1 in the third finger. Regarding the relationship between lesion location and nail bed, 4 patients were type I, 21 were type II, and 15 were type III. All 40 patients received surgical treatment, with nail removal in 15. The median maximum lesion diameter was 1.0 cm (0.8-2 cm), median operation time was 25 min (20-45 min), median blood loss was 1 ml (1-2 ml), and median postoperative hospital stay was 2 days (1-4 days). All cases were histopathologically confirmed as subungual exostosis. The median follow-up time was 24 months (3-60 months), with normal appearance of the toe or finger nail. There were no complications in 38 patients (95.0%). Two patients (5.0%) relapsed at 3 months postoperatively and underwent a secondary operation, with no subsequent recurrence during 12 months of follow-up. Subungual exostosis in children is a rare benign disease that often occurs in the toes. Selection of the appropriate incision and nail bed treatment based on the relationship between lesion location and nail bed is helpful for improving the treatment effect.

Dupytren’s exostosis of the great toe with the bearing of tight shoes: A case Report

Our work’s aim is to talk about a case of subungual exostosis of the great toe, benign tumor which is rare among patients above 50 years associated with bearing of tight shoes and to bring our therapeutic experience through observation of a 51 years old patient. It surgical management has consisted in completing the excision of the lesion and histopathology are mandatory for the diagnosis. The post-surgical follow up have been simple. The clinical and para clinical controls that have been done within 6 to 12 months didn t show any relapse.

Benign skin neoplasms in children

There are many different types of skin neoplasms in children and most are benign. Dermatologists should be able to differentiate between the various types of benign skin neoplasms and be able to recommend optimal treatment to concerned patients. Surgical removal of benign skin neoplasms is often the only treatment option. The aim of this paper is to provide a general overview of epidermal lesions (e.g., inflammatory linear verrucous epidermal nevus [ILVEN], nevus sebaceous), tumors of the epidermal appendages (e.g. pilomatrixoma), cutaneous neoplasms (e.g. angiofibroma), fibromatoses (e.g., knuckle pads), tumors comprised of fat, muscle, or bone tissue (e.g., osteoma cutis, subungual exostosis), epidermal cysts and pseudocysts, and pathologic fibrosis reactions after dermal injury (keloid). Scientific data are scarce and only in the last decade has it been possible to perform histopathological examinations and genetic studies together with detailed phenotyping to gain new understanding of the pathogenetic mechanisms.

Subungual exostosis in a 7-year-old boy

Subungual growths are frequently encountered in paediatric dermatological practice. Majority of them are viral warts. Here we report a case of subungual exostosis (SE) in a 7-year-old boy for its rarity and usually the diagnosis is delayed in most cases.

Pediatric Subungual Exostosis.

Exostosis is a type of benign bone tumor in which trabecular (spongy) bone overgrows its normal border in a nodular pattern. When the growth occurs under the nail bed, it is termed subungual exostosis or Dupuytren exostosis. This condition may mimic other bony abnormalities such as an osteochondroma and may present with nail deformities with or without pain. For this reason, a biopsy of the lesion is necessary to rule out a precancerous growth. In rare cases, pediatric patients may have subungual exostosis, as demonstrated in our case.

Some Reactive Lesions of Bone Are Probably Neoplasms.

A number of fibro-osseous and osteocartilaginous lesions, especially common in the small bones of the hand and feet, pose a diagnostic challenge and have historically been thought to be reactive lesions. However, modern molecular techniques when supplementing clinical, radiographic, and histologic evaluation suggest they may, in fact, be neoplasms. To review the clinical presentation and histopathologic, molecular, and radiologic features of selective bone lesions, focusing most specifically on subungual exostosis, florid reactive periostitis, and bizarre periosteal osteochondromatous proliferation. Literature review and personal experience are the sources of this review. Some lesions previously thought to be reactive are locally aggressive and demonstrate reproducible molecular abnormalities, and thus may be neoplasms. Although most common in the bones of the fingers and toes, these lesions also occur in long and other bones. The clinical presentations, radiologic appearances, and histopathologic features often overlap, making the diagnosis challenging, and these lesions may require molecular evaluation to maximize accurate prognostication.

A Comparative Study of Nail Fold Approach and Microscopic Nail Bed Approach in the Surgical Treatment of Subungual Exostosis.

Subungual exostosis is a benign tumor that occurs under the nail plate of the distal phalanx and causes nail deformity and pain. There are many reports of recurrence and postoperative nail deformity, and the surgical approach needs to be reassessed. Two typical surgical approaches are from the nail fold and the nail bed. Here, we compare 2 surgical approaches for subungual exostosis that were performed in our department. Twenty-three cases of subungual exostosis were treated between 2010 and 2019; 12 cases were treated by the nail fold approach and 11 by the microscopic nail bed approach. The nail fold approach resulted in not only scarring but also nail deformities, such as onychodystrophy. There were 2 (18.2%) cases of recurrence. In the microscopic nail bed approach, there was no case of recurrence. It was possible to preserve the thinned nail bed by dissecting under a microscope, and the thinned nail bed did not become necrotic in any cases. To solve postoperative nail deformity and a high recurrence rate, sufficient resection and meticulous surgical procedure on the nail bed and nail matrix are essential. The microscopic nail bed approach satisfied both of these criteria and was considered to be a useful method for subungual exostosis.

Subungual Exostosis: A Case of 10-year-old Boy

Subungual Exostosis: A Case of 10-year-old Boy

Subungual exostosis associated with an acquired digital fibrokeratoma of the thumb

Subungual exostosis associated with an acquired digital fibrokeratoma of the thumb

Intraoperative Dermatoscopic Features of Subungual Exostosis.

Subungual exostosis is a benign osteo-chondral overgrowth occurring on the distal phalanx beneath the nail plate. Dermatoscopic features of subungual exostosis have been described in a few studies, however, intraoperative dermatoscopic findings of the entity has not been described yet. Here we report intraoperative dermatoscopy of subungual exostosis in a young female patient.

Subungual exostosis of the great toe: A case report

Subungual exostosis is typically a rare benign, acquired tumor of cartilaginous bone occurring on the medial surface of the distal hallux of toes or fingers. These are usually associated with secondary changes such as elevation of the nail plate, ulceration or subungual hyperkeratosis and hyperpigmentation. On histological examination, the lesion consists of mature bone at the base with proliferating fibrocartilaginous cap. A 14-year-old male presented with a solitary firm swelling gradually increasing in size for three months on the distal part of the right great toe. On physical examination, a firm, non-tender, non-mobile, whitish nodule was noted in the distal dorsomedial aspect of the right great toe distorting the adjacent nail. Radiographs demonstrated a dorsal bony outgrowth that was continuous with the distal phalanx. Excisional biopsy was done and on histopathological examination, a characteristic trabecular pattern of mature bone covered with a hyaline and fibrocartilaginous cap was seen. There was lack of true anaplasia, thereby confirming the diagnosis of subungual exostosis. There was no recurrence over six months. This topic is underrepresented in the orthopaedic literature, because many of the important clinical series have been published in journals from other branches of medicine i.e. mainly by dermatologists and pathologists. This reflects the fact that the condition is treated by many kinds of non-orthopaedic providers. We, as orthopaedic surgeons, must be careful while evaluating lesions of distal phalanges, always keeping in mind the possibility of subungual exostosis. Radiographs are helpful in diagnosis but confirmation can be done by histopathological examination. En bloc excision with minimal nail plate deformation can help prevent recurrence or deformity.