Subungual Exostosis Research Articles

Nail changes and disorders among the elderly

Nail disorders are frequent among the geriatric population. This is due in part to the impaired circulation and in particular, susceptibility of the senile nail to fungal infections, faulty biomechanics, neoplasms, concurrent dermatological or systemic diseases, and related treatments. With aging, the rate of growth, color, contour, surface, thickness, chemical composition and histology of the nail unit change. Age associated disorders include brittle nails, trachyonychia, onychauxis, pachyonychia, onychogryphosis, onychophosis, onychoclavus, onychocryptosis, onycholysis, infections, infestations, splinter hemorrhages, subungual hematoma, subungual exostosis and malignancies. Awareness of the symptoms, signs and treatment options for these changes and disorders will enable us to assess and manage the conditions involving the nails of this large and growing segment of the population in a better way.

Solitary asymptomatic nodule of the great toe

Subungual exostosis is a benign osteocartilaginous tumor of the ungual apparatus, particularly of the toes. It affects both sexes equally, more frequently in the second and third decades of life. We describe a 6-year-old girl who came to our attention because of the enlargement of a pinkish nodule in the distal part of the nail bed of the first toe, progressively elevating the nail plate. History, X-ray imaging and histopathologic examination led us to confirm our clinical suspicion, excluding any other possible cause of the subungual mass. The peculiar features of this clinical entity, and the possibility of effective treatment by practical surgical techniques, are discussed.

Subungual exostosis following toe nail removal - case report

Removal of toe nail is a minor procedure that can be under ring block with no significant complications. We report the case of a young lady who developed a rapidly growing subungual exostosis on her right great toe following nail removal. Inadvertent iatrogenic injury to the nail bed and underlying phalangeal periosteum during nail removal might have triggered off rapid bone growth resulting in the large exostosis. To our knowledge, this aetiology for subungual exostosis formation has not been reported before.

Distinct chromosomal rearrangements in subungual (Dupuytren) exostosis and bizarre parosteal osteochondromatous proliferation (Nora lesion).

Proliferative lesions of the bone surface, such as subungual (Dupuytren) exostosis and bizarre parosteal osteochondromatous proliferation (BPOP, Nora lesion) are currently classified as reactive, proliferative processes that mimic primary neoplasms of bone. Cytogenetic analysis was performed on 3 subungual exostoses of the great toe and 2 BPOP lesions of the radius and ulna. A balanced translocation t(X;6) was identified in all cases of subungual exostoses. The chromosomal rearrangements observed in 1 case of BPOP differed from those seen in subungual exostosis. The presence of chromosomal abnormalities in subungual exostosis and BPOP suggests that these lesions are neoplastic, with a different molecular pathogenesis, and that each is a distinct clinicopathologic entity.

Subungual exostosis of the third toe

Subungual exostosis is a variant of osteochondroma that appears as a pinkish nodule under the free end of the nail plate. It becomes symptomatic when large enough to disrupt the overlying nail on the digit or through mechanical irritation of the exostosis from physical activity. Appropriate workup of such a lesion is important, because many cases of subungual exostosis are initially misdiagnosed by a variety of specialists, including dermatologists. With the use of history and roentgenography, subungual exostosis can be effectively diagnosed or excluded. Appropriate treatment of subungual exostosis can be selected— surgical excision of the lesion with significant cure rates achieved. Although most cases of subungual exostosis are localized to the great toe, we describe a 32-year-old woman who developed a subungual exostosis on her right third toe. Appropriate diagnostic workup and surgical treatment of the right third-toe exostosis has resulted in complete relief of symptoms with no signs of recurrence 7 months after surgery. (J Am Acad Dermatol 2001;45:S200-1.)

A giant subungual exostosis perforating through skin of the toe

Subungual exostosis is typically an uncommon, benign, bony tumor of cartilaginous bone that usually occurs as a solitary, solid lesion under the nail of the first toe or the fingernail. It may be difficult to diagnose subungual exostosis from a clinical presentation and it should be confirmed by radiographic examination. The treatment is surgical excision. It is essential to see normally cancellous bone under the area of excision to ensure that the tumor does not recur. In this article, our goal is to present a subungual exostosis case of the first toe, detailing diagnosis, pathologic findings and surgical management.

Nail Unit Enchondromas and Osteochondromas: A Surgical Approach

The anatomic singularities of the nail unit explain why bony tumors and osseous outgrowths of the distal phalanx quickly interfere with the nail apparatus. Osteochondromas (or exostosis) are benign osteocartilaginous outgrowths most commonly located on the hallux. They are by far the most common bony lesions affecting the nail unit. While frequently considered benign tumors, subungual exostoses are better regarded as reactional osseous outgrowths rather than true tumors. Enchondromas (better named chondromas) are intraosseous tumors whose location at the distal phalanx is rare. Large tumors may be responsible for phalanx deformity.

A simple and efficient surgical technique for subungual exostosis.

Subungual exostosis is a benign osteochondral tumor usually involving the distal phalanx of the great toe. The lesion most frequently occurs in the second and third decades of life and is rare before the age of 10 years. There are few reports of its occurrence in children, and most of them advocate partial or complete nail excision to treat this lesion successfully. We report our experience with six children and adolescents using a simple surgical technique that involves approaching the exostosis under the nail to preserve nail coverage. Rapid recovery and excellent cosmetic appearance were achieved immediately after the operation.

A Simple and Efficient Surgical Technique for Subungual Exostosis

Subungual exostosis is a benign osteochondral tumor usually involving the distal phalanx of the great toe. The lesion most frequently occurs in the second and third decades of life and is rare before the age of 10 years. There are few reports of its occurrence in children, and most of them advocate partial or complete nail excision to treat this lesion successfully. We report our experience with six children and adolescents using a simple surgical technique that involves approaching the exostosis under the nail to preserve nail coverage. Rapid recovery and excellent cosmetic appearance were achieved immediately after the operation.

Operative method with nail reduction for subungual exostosis

Operative method with nail reduction for subungual exostosis

Imaging of osteochondroma: variants and complications with radiologic-pathologic correlation.

Osteochondroma represents the most common bone tumor and is a developmental lesion rather than a true neoplasm. It constitutes 20%-50% of all benign bone tumors and 10%-15% of all bone tumors. Its radiologic features are often pathognomonic and identically reflect its pathologic appearance. Osteochondromas are composed of cortical and medullary bone with an overlying hyaline cartilage cap and must demonstrate continuity with the underlying parent bone cortex and medullary canal. Osteochondromas may be solitary or multiple, the latter being associated with the autosomal dominant syndrome, hereditary multiple exostoses (HME). Complications associated with osteochondromas are more frequent with HME and include deformity (cosmetic and osseous), fracture, vascular compromise, neurologic sequelae, overlying bursa formation, and malignant transformation. Malignant transformation is seen in 1% of solitary osteochondromas and in 3%-5% of patients with HME. Continued lesion growth and a hyaline cartilage cap greater than 1.5 cm in thickness, after skeletal maturity, suggest malignant transformation. Variants of osteochondroma include subungual exostosis, dysplasia epiphysealis hemimelica, turret and traction exostoses, bizarre parosteal osteochondromatous proliferation, and florid reactive periostitis. Recognition of the radiologic spectrum of appearances of osteochondroma and its variants usually allows prospective diagnosis and differentiation of the numerous potential complications, thus helping guide therapy and improving patient management.

Treatment of subungual exostoses by elective day case surgery.

Twenty-one patients (11 female, 10 male: mean age 21.3 years) with subungual exostoses were treated with elective surgery under local anaesthetic in a dermatology day case theatre over a period of 8 years. Fifteen (71%) tumours affected the great toe, four (19%) affected other toes and two (10%) affected fingers. All received local excision with great care to remove all tumour residue from the terminal phalanx. Wounds were allowed to heal by secondary intention. Attention was paid to preoperative antiseptic procedure and postoperative analgesia. During follow-up of between 6 and 36 months (mean 17 months), there were two relapses (10%) in the first 12 months, seen in two of the younger subjects aged 9 and 13 years. One required further surgery. One further case suffered long-term dystrophy due to perioperative damage to nail matrix. Conservative and thorough treatment of this pathology can be achieved using the appropriate tools in a dermatology day case theatre.

Clonal chromosome abnormalities in a so-called Dupuytren's subungual exostosis

We report the first cytogenetic investigation of a Dupuytren's subungual exostosis. The clonal abnormalities found suggest that at least some of these heterotopic ossifications could be neoplastic in nature, instead of being a purely reactive process or exuberant growth in response to trauma.

An ultrastructural study of subungual exostosis, with special reference to intranuclear inclusions

A 12-year-old Japanese boy noticed a red nodule on the distal portion of his right great toe about 2 months before entering our clinic. There was evidence of traumatic injury and infection before the appearance of the nodule. Histological examination showed the subcutaneous localization of bony spicules lined by osteoblasts. Haversian canals, which contained blood vessels and connective tissue, were also seen. Electron microscopic examination revealed normal bone structure, but, interestingly, mesenchymal cells that were localized around the tumor had intranuclear inclusions composed of filamentous bundles. From these findings, this case was diagnosed as subungual exostosis. It is suggested that the appearance of intranuclear inclusions, reported here for the first time, is related to the pathogenesis of subungual exostosis.

Subungual exostosis: diagnosis and treatment in children.

Subungual exostosis is a benign bone tumor of the distal phalanx occurring beneath or adjacent to the nail. The exostosis occurs most commonly in the toes, most frequently involving the distal phalanx of the hallux. The majority of the lesions occur in the second or third decade of life. From 1975 to 1995, 21 children were treated for subungual exostosis at the Children's Hospital of Eastern Ontario, 20 of whom underwent local excision. One patient required an amputation of the affected distal phalanx due to recurrence of the lesion. The subungual exostosis occurred on the hallux in 14 children, the second toe in three children, the third toe in two children, and the fourth toe in two children. No lesion was encountered in the little toe. The exostosis is very rare in patients under 7 years of age; the average age in this review being 12 years and 6 months. The lesion recurred in three children. Removal of the nail over the exostosis facilitates the mandatory entire removal of the lesion.

Subungual Exostosis: Case Report and Review of the Literature

Subungual exostosis is typically a benign, acquired tumor of cartilaginous bone occurring on the medial surface of the distal hallux. A 16-year-old boy with subungual exostosis of his left great toe is presented. We evaluated the English language literature on this topic from 1857 to 1994; including our patient, 312 cases have been described. The diagnostic characteristics (histologic and radiologic), etiologic features, and therapeutic management were reviewed. Subungual exostosis more commonly affects women than men in a ratio of 2:1. Most lesions occur in the early twenties; however, a minimum of 51 (16%) of the 312 cases of subungual exostoses appeared in children 18 years of age or younger. Seventy percent of lesions occurred on the first hallux. There was frequently an association with trauma. The diagnosis of subungual exostosis may be suspected from the clinical presentation and confirmed with radiographic examination. The treatment is surgical.

Subungual Exostosis: Case Report and Review of the Literature

Subungual exostosis is typically a benign, acquired tumor of cartilaginous bone occurring on the medial surface of the distal hallux. A 16-year-old boy with subungual exostosis of his left great toe is presented. We evaluated the English language literature on this topic from 1857 to 1994; including our patient, 312 cases have been described. The diagnostic characteristics (histologic and radiologic), etiologic features, and therapeutic management were reviewed. Subungual exostosis more commonly affects women than men in a ratio of 2:1. Most lesions occur in the early twenties; however, a minimum of 51 (16%) of the 312 cases of subungual exostoses appeared in children 18 years of age or younger. Seventy percent of lesions occurred on the first hallux. There was frequently an association with trauma. The diagnosis of subungual exostosis may be suspected from the clinical presentation and confirmed with radiographic examination. The treatment is surgical.

Subungual (Dupuytren's) exostosis.

Dupuytren's subungual exostosis is an uncommon osteochondral lesion affecting the distal phalanx of adolescents. Lack of awareness of this unusual lesion causes many to be initially misdiagnosed. Accurate diagnosis based on clinical findings and radiographs and appropriate treatment methods are outlined. We report retrospectively on the cases of six children treated for subungual exostosis over a 3-year period. Diagnosis was made based on clinical findings of a painful subungual or periungual mass associated with an exostosis on radiographs. Complete excision of the lesion, including the overlying nailbed, was curative in the five patients who opted for surgical treatment. Two of our patients had been previously treated with an incomplete excision and had a recurrence within 3 months of the original procedure. Failure to recognize and treat this condition appropriately may lead to morbidity due to overtreatment or recurrence. We hope this report will improve awareness of subungual exostosis and the appropriate operative treatment method.

Subungual Exostosis: A Simple Technique of Excision

Subungual or Dupuytren's exostosis is a benign lesion of the distal phalanx that is prone to recurrence if incompletely excised. We report on a series of five patients treated with our simple excision technique. Despite sacrifice of a portion of the nail bed, the cosmetic appearance of the nail was excellent in four patients and good in one patient. There were no recurrences.

末節骨病変が爪下外骨腫との鑑別を要した遺伝性多発性外骨腫症

末節骨病変が爪下外骨腫との鑑別を要した遺伝性多発性外骨腫症