Subungual exostosis explained
| Subungual exostosis |
| Synonyms: | Dupuytren subungual exostosis[1] |
| Field: | orthopedics |
Subungual exostosis is a type of non-cancerous bone tumor of the chondrogenic type, and consists of bone and cartilage.[2] It usually projects from the upper surface of the big toe underlying the nailbed, giving rise to a painful swelling that destroys the nail. Subsequent ulceration and infection may occur.[3]
There is an association with trauma and infection. Diagnosis involves medical imaging to exclude other similar conditions, particularly osteochondroma. X-ray appearance may reveal a bony protuberance attached to the top or side surface of a toe bone.
Treatment is by surgical excision and is effective.
More than half are under the age of 18 years and males are affected equally to females.[3] Combined with bizarre parosteal osteochondromatous proliferation, they comprise <5% of cartilage tumors.
Signs and symptoms
They tend to be painful due to the pressure applied to the nail bed and plate. They can involve destruction of the nail bed.[4] These lesions are not true osteochondromas, rather it is a reactive cartilage metaplasia. The reason it occurs on the dorsal aspect is because the periosteum is loose dorsally but very tightly adherent volarly.[5]
Diagnosis
Diagnosis involves medical imaging.[6]
Differential diagnosis includes mainly bizarre parosteal osteochondromatous proliferation (BPOP), which is more irregular and tends to involve the middle of the finger or toe rather than the end near the nail.[7] They are distinct from subungual osteochondroma.[8]
Treatment
Treatment is by surgical excision and is effective.[7]
Epidemiology
It tends to occur in children and adolescents. Combined with BPOP, they account for less than 5% of cartilage tumors.[9]
See also
Notes and References
- Web site: Dupuytren subungual exostosis Genetic and Rare Diseases Information Center (GARD) – an NCATS Program. rarediseases.info.nih.gov. 11 October 2017. en.
- Book: Soft Tissue and Bone Tumours: WHO Classification of Tumours. 2020. WHO Classification of Tumours Editorial Board. International Agency for Research on Cancer. Lyon (France). 5th. 3. 978-92-832-4503-2. Bone tumors. 338.
- Book: Soft Tissue and Bone Tumours: WHO Classification of Tumours. 2020. WHO Classification of Tumours Editorial Board. International Agency for Research on Cancer. Lyon (France). 5th. 3. 978-92-832-4503-2. Subungual exostosis. 345–347.
- Suga H, Mukouda M . Subungual exostosis: a review of 16 cases focusing on postoperative deformity of the nail . Annals of Plastic Surgery . 55 . 3 . 272–5 . 2005 . 16106166 . 10.1097/01.sap.0000174356.70048.b8. 5813472 .
- Murphey MD, Choi JJ, Kransdorf MJ, et al: Imaging of osteochondroma: variants and complications with radiologic-pathologic correlation. Radiographics 20:1407-1434, 2000
- DaCambra . Mark P. . Gupta . Sumit K. . Ferri-de-Barros . Fabio . Subungual Exostosis of the Toes: A Systematic Review . Clinical Orthopaedics and Related Research . April 2014 . 472 . 4 . 1251–1259 . 10.1007/s11999-013-3345-4 . 24146360 . 0009-921X. 3940761 .
- Book: Bocklage . Therese J. . Quinn . Robert . Verschraegen . Claire . Schmit . Berndt . Bone and Soft Tissue Tumors: A Multidisciplinary Review with Case Presentations . 2014 . JP Medical Ltd . London . 978-1-907816-22-2 . 379 . https://books.google.com/books?id=468iAwAAQBAJ&pg=PA379 . en . 16. Cartilaginous tumours of bones and joints.
- Lee SK, Jung MS, Lee YH, Gong HS, Kim JK, Baek GH . Two distinctive subungual pathologies: subungual exostosis and subungual osteochondroma . Foot & Ankle International . 28 . 5 . 595–601 . 2007 . 17559767 . 10.3113/FAI.2007.0595. 41309941 .
- Engel . Hannes . Herget . Georg W. . Füllgraf . Hannah . Sutter . Reto . Benndorf . Matthias . Bamberg . Fabian . Jungmann . Pia M. . Chondrogenic Bone Tumors: The Importance of Imaging Characteristics . RöFo: Fortschritte auf dem Gebiete der Röntgenstrahlen und der Nuklearmedizin . March 2021 . 193 . 3 . 262–275 . 10.1055/a-1288-1209 . 33152784 . 1438-9010. free .
