Distorted nail shape may be due to a bone tumor

Trauma appears to be a major causative factor, although some authors claim that a history of trauma only occurs in a minority. The triad of pain (the leading symptom), nail deformation and radiographic features is usually diagnostic. The exostosis is a trabeculated osseous growth with an expanded distal portion covered with radiolucent fibrocartilage.

Osteochondroma, commonly presenting with the same symptoms, has a male predominance. There is often a history of trauma. Its growth rate is slow. Radiographic examination shows a well-defined, sessile, bony growth with a hyaline cartilage cap which must be differentiated from primary subungual calcification (particularly in

Figure 5.26

Figure 5.26

older women) and secondary subungual calcification due to trauma and psoriasis.

Treatment is by excision of the excess bone under full aseptic conditions. The nail plate is partially removed and a longitudinal incision made in the nail bed. The osseous growth with its cartilaginous cap is carefully dissected, using fine skin hooks to avoid damage to the fragile nail bed. The tumour is removed with a fine chisel, whenever possible through an L-shaped or 'fish mouth' incision, in order to avoid avulsion of the nail plate.

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