e-journal

Subungual Exostosis of the Finger with Nail Plate Induction

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Introduction:
Subungual exostosis (SE) is a solitary, commonly sessile, bony growth firmly attached to the tuft of the underlying distal phalanx. It is a benign osteocartilaginous tumor arising underneath or beside the nail bed and may disrupt nail growth. Initially described in the hand by Hutchinson
in 1857 [8], Dupuytren wrote about his experience with its manifestation in the foot a decade earlier [4]. The differential diagnosis of SE spans many possible nail, soft tissue, and bony pathologies. Onchomycosis, granuloma pyogenicum, epithelioma, verruca, keratoacanthoma [12], fibroma, glomus tumor [11], melanotic whitlow [3], osteochondroma [2], turret exostosis [13], juxtacortical chondroma, and myositis ossificans [1] have all been mentioned as potential diagnoses. The etiology and pathogenesis of SE is not clearly established. It is most commonly thought to reflect a
fibrocartilaginous metaplasia from trauma or chronic infection [5, 9]. Although the latter may be a secondary consequence, as SE can elevate the nail causing exposure of the underlying soft tissue. However, others have alluded to genetic etiology [6], supranumery digits, cartilaginous rests,
or a forme fruste of hereditary multiple exostoses [10]. SE is seen predominantly in females in a ratio of up to 2:1 [2, 5], though one series documented occurrence more often in males [8]. It occurs primarily in children and young adults in the second or third decades of life and more often
affects the great toe, up to 77% of the time [9]. SE is best diagnosed on lateral radiographic view. It is usually seen as a bony projection on the dorsal or dorsomedial aspect of the distal phalanx capped with fibrous tissue. Early lesions may have insufficient bony formation to show up on X-rays [7]. No surrounding destructive changes are seen, supporting this as a benign diagnosis. SE is treated surgically. The nail plate may be removed, and excision is either through the nail bed [11] or via a midlateral incision [2]. Complete resection of the fibrocartilaginous cap is compulsory as local recurrence rates of 11% have been reported [9]. On histology, SE is composed of a mature trabecular pattern of a cancellous bone base with a proliferating fibrocartilaginous cap. The growth, which can reach more than 2 cm in diameter, is always benign. Our case report is the first description of aberrant induced nail plate growth with SE in the literature.

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Ketersediaan

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Informasi Detail

Judul Seri

Hand Surgery

No. Panggil

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Penerbit

: Springer., 2010

Deskripsi Fisik

HAND (2010) 5:203–205

Bahasa

English

ISBN/ISSN

DOI 10.1007/s11552-0

Klasifikasi

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Tipe Isi

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Tipe Media

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Tipe Pembawa

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Edisi

(2010) 5

Subjek

Hand Surgery

Info Detail Spesifik

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Pernyataan Tanggungjawab

deliza

Versi lain/terkait

Lampiran Berkas

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