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

Abstract

Subungual exostosis is a fairly rare benign cartilaginous tumor with bone-cartilaginous proliferation affecting the distal phalanges of the toes (more often the first toe (80%) or the hand, which is characterized by long growth. The presence of subungual exostosis significantly worsens the quality of life of patients due to a serious impact on wearing footwear, walking, and daily behavior The etiology and pathogenesis of subungual exostosis are not clearly defined, but the risk factors for the occurrence of pathology traditionally include traumatic injuries (reactive metaplasia), chronic infections, tumors, hereditary abnormalities, and cartilage cyst activation.

The aim is to highlight the peculiarities of the methods of diagnosis and treatment of the pathology of exostoses of the fingers in pediatric practice based on literature sources and own experience.

The described clinical case with exostosis of the first toe demonstratesa typical clinical picture of an exostosis with a typical histological structure. Radical solution to the problem of bone volume formation, which provoked a pain syndrome, with the imposition of separate nodal sutures on the wound, in our opinion, significantly shortens the wound healing period and creates a good cosmetic effect.

Conclusions. In contrast to clinical complaints, X-ray signs of subungual exostosis have inconspicuous data due to the presence of a distinct X-ray contrast layer in the form of a peculiar "cap". In order to detail the pathological formation, computer tomography scan or magnetic resonance imaging is sometimes recommended. Differential diagnosis of subungual exostosis is carried out with pyogenic granuloma, subungual viral wart, ingrown toenail, glomus tumor, Kenen's tumor (angiofibroma), keratoacanthoma, nail bed cancer, amelanotic tumor, melanoma, osteochondroma, which is covered with hyaline cartilage in contrast to subungual exostosis, for which inherent fibrocartilaginous coating, hemangiolymphangioma and glomus angioma (Barre-Masson tumor), Nora's disease, etc. Conservative treatment is ineffective. Surgical excision of subungual exostosis is today considered the method of choice and may be accompanied by reconstruction of the nail bed. The success rate of surgical resection is more than 95%, with a 5% recurrence rate.

The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies.No conflict of interests was declared by the authors.