• 1

    Dupuytren GF. On the Injuries and Diseases of Bones, translated and edited by F Le Gros Clark, pp 408-411, Sydenham Society, London, 1847.

    • Search Google Scholar
    • Export Citation
  • 2

    Kilpatrick SC, Koplyay P, Pope TL Jr, et al: Clinical, radiologic, and pathologic spectrum of myositis ossificans and related lesions: a unifying concept. Adv Anat Pathol 5: 277, 1997.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3

    Letts M, Davidson D, Nizalik E: Subungual exostosis: diagnosis and treatment in children. J Trauma Acute Care Surg 44: 346, 1998.

  • 4

    Apfelberg DB, Druker D, Maser MR, et al: Subungual osteochondroma: differential diagnosis and treatment. Arch Dermatol 115: 472, 1979.

  • 5

    Ilyas W, Geskin L, Joseph AK, et al: Subungual exostosis of the third toe. J Am Acad Dermatol 45: 200, 2001.

  • 6

    Murphey MD, Choi JJ, Kransdorf MJ, et al: Imaging of osteochondroma: variants and complications with radiologic-pathologic correlation. Radiographics 20: 1407, 2000.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Grifasi PJ, Lomabardi CM, Sciarrino AL, et al: Three select subungual pathologies: subungual exostosis, subungual osteocondroma, and subungual hematoma. Clin Podiatr Med Surg 6: 355, 1989.

    • Search Google Scholar
    • Export Citation
  • 8

    Kim SW, Moon SE, Kim JA: A case of subungual osteochondroma. J Dermatol 25: 60, 1998.

  • 9

    Salasche SJ, Garland LD: Tumors of the nail. Dermatol Clin 3: 521, 1985.

  • 10

    Bovée Jlucas DR, Sciot R, Mertens F : WHO Classification of Tumours of Soft Tissue and Bone, IARC, Lyon, 2013.

  • 11

    Miller-Breslow A, Dorfman H: Dupuytren's (subungual) exostosis. Am J Surg Pathol 12: 368, 1988.

  • 12

    De Palma L, Gigante A, Specchia N: Subungual exostosis of the foot. Foot Ankle Int 17: 758, 1996.

  • 13

    Ippolito E, Falez F, Tudisco C, et al: Subungual exostosis. Histological and clinical considerations on 30 cases. Ital J Orthop Traumatol 13: 81, 1987.

  • 14

    Dal Cin P, Pauwels P, Poldermans LJ, et al: Clonal chromosome abnormalities in a so-called Dupuytren's subungual exostosis. Genes Chromosomes Cancer 24: 162, 1999.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15

    Lee SK, Jung MS, Lee YH, et al: Two distinctive subungual pathologies: subungual exostosis and subungual osteochondroma. Foot Ankle Int 28: 595, 2007.

  • 16

    Mertens F, Moüller E, Mandahl N, et al: The t(X;6) in subungual exostosis results in transcriptional deregulation of the gene for insulin receptor substrate 4. Int J Cancer 128: 487, 2011.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17

    Nora FE, Dahlin DC, Beabout JW: Bizarre parosteal osteochondromatous proliferations of the hands and feet. Am J Surg Pathol 7: 245, 1983.

  • 18

    Kim SW, Suh JH, Shin SM, et al: Bizarre parosteal osteochondromatous proliferation (Nora's lesion) of the big toe. (A report of two cases and review). J Korean Foot Ankle Soc 17: 68, 2013.

    • Search Google Scholar
    • Export Citation
  • 19

    Wissinger HA, McClain EJ, Boyes JH: Turret exostosis. Ossifying hematoma of the phalanges. J Bone Joint Surg Am 48: 105, 1966.

  • 20

    Mallory TB: A group of metaplastic and neoplastic bone and cartilage containing tumors of soft parts. Am J Pathol 9: 765, 1933.

  • 21

    DaCambra MP, Gupta SK, Ferri-de-Barros F: Subungual exostosis of the toes: a systematic review. Clin Orthop Relat Res 472: 1251, 2014.

  • 22

    Davis D, Cohen P: Subungual exostosis: case report and review of the literature. Pediatr Dermatol 13: 212, 1996.

  • 23

    Unlu S, Demirkale I, Kalkan T, et al: Large subungual exostosis of the great toe: a case report. JAPMA 100: 296, 2010.

  • 24

    Gavillero A, Arxé D, de Planell E, et al: Estudio estadístico en cirugía ungueal. El Peu 25: 20, 2005.

  • 25

    Hidalgo Ruiz S : “Patologías del Aparato Ungueal,” in Podología: Atlas de Cirugía Ungueal, edited by Martínez Nova, Ap 15, Panamericana, Madrid, 2006.

    • Search Google Scholar
    • Export Citation
  • 26

    Munuera Martínez PV : Exostosis-condroma: diagnóstico diferencial y tratamiento. Rev Esp de Podol XI: 515, 2000.

  • 27

    García Carmona FJ, Pascual Huerta J, Fernández Morato D: A proposed subungual exostosis clinical classification and treatment plan. JAPMA 99: 519, 2009.

    • Search Google Scholar
    • Export Citation
  • 28

    García Carmona J, Padín M, Fernández Morato D: Cirugía de la exostosis subungueal. Piel 19: 522, 2004.

  • 29

    García Carmona FJ, Fidalgo Rodríguez A : Tratamiento quirúrgico de la onicocriptosis asociada a exostosis. Piel 23: 96, 2008.

  • 30

    Pérez L: Cirugía en la exostosis periungueal. A propósito de un caso clínic. El Peu 25: 200, 2005.

  • 31

    Liberati A, Altman DG, Tetzlaff J, et al: The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339: b2700, 2009.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Moher D, Liberati A, Tetzlaff J, et al: The PRISMA group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement. PLoS Med 6: e1000097, 2009.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33

    Stewart LA, Clarke M, Rovers M, et al: Preferred Reporting Items for Systematic Review and Meta-Analyses of individual participant data: the PRISMA-IPD statement. JAMA 313: 1657, 2015.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Wright JG, Swiontkowski MF, Heckman JD: Introducing levels of evidence to the journal. J Bone Joint Surg Am 85: 1, 2003.

  • 35

    Page MJ, Shamseer L, Altman DG, et al: Epidemiology and reporting characteristics of systematic reviews of biomedical research: a cross-sectional study. PLoS Med 13: e1002028, 2016.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36

    Redondo I: En busca de la evidencia. El meta-análisis como herramienta de investigación. NURE Investigación 12: 1, 2015.

  • 37

    Sousa MR, Ribeiro AL: Systematic review and meta-analysis of diagnostic and prognostic studies: a tutorial. Arq Bras Cardiol 92: 229, 2009.

  • 38

    Ferreira C, Avidos L. Prevalência da exostose subungueal nas onicodistrofias de hallux e seu tratamento. Rev Saúde em pé 41: 16, 2015.

    • Search Google Scholar
    • Export Citation
  • 39

    García Carmona FJ, Orejana García AM, Morato DF : Abordaje Quirúgico de la Patología Subungueal, Grupo, Aula Médica, Madrid, 2005.

    • Search Google Scholar
    • Export Citation
  • 40

    Gragera GS, Pérez PL : Incidencia de Cirugías de Exostosis y Condroma Subungueal en el Hospital Podológico en los Ultimos 5 Años (tesis fin de grado), Universidad de Barcelona, Barcelona, 2016.

    • Search Google Scholar
    • Export Citation
  • 41

    Valinsky MS, Hettinger DF, Gennet PM: Subungual exostosis removal utilizing a minimal incision technique. Curr Podiatr Med 40: 10, 1991.

    • Search Google Scholar
    • Export Citation
  • 42

    Yagüe de Paz J: Onicocriptosis y exostosis subungueales. Relaciones e incidencias entre ambas patologías. Casos clínicos. Rev Esp de Podol II: 11, 1991.

    • Search Google Scholar
    • Export Citation
  • 43

    Başar H, İnanmaz ME, Başar B, et al: Protruded and nonprotruded subungual exostosis: differences in surgical approach. Indian J Orthop 48: 49, 2014.

  • 44

    Fikry T, Dkhissi M, Harfaoui A, et al: Subungual exostoses. A retrospective study of a series of 28 cases. Acta Orthop Belg 64: 35, 1998.

  • 45

    Landon GC, Johnson KA, Dahlin DC: Subungual exostoses. J Bone Joint Surg Am 61: 256, 1979.

  • 46

    De Berker D, Langtry J: Treatment of subungual exostoses by elective day case surgery. Br J Dermatol 140: 915, 1999.

  • 47

    Moreno-Collado CA: Análisis clinopatológico y terapéutico en 30 casos de exostosis subungueal. Cir Ciruj 68: 101, 2000.

  • 48

    Oliveira AS, Picoto AS, Verde SF, et al: Subungual exostosis: treatment as an office procedure. J Dermatol Surg Oncol 6: 555, 1980.

  • 49

    Ortega ORM, Sanchez HG: 23 observations of subungual exostosis. Med Cut ILA 16: 11, 1988.

  • 50

    Rodríguez-Castellanos MA, Minjares-Padilla LM, Hernández-Torres MM, et al: Osteocondroma y exostosis subungueal. Características clínico-epidemiológicas e histológicas en pacientes mexicanos. Dermatol Rev Mex 56: 236, 2012.

    • Search Google Scholar
    • Export Citation
  • 51

    Bakotic B, Huvos AG: Tumors of the bones of the feet: the clinicopathologic features of 150 cases. J Foot Ankle Surg 40: 277, 2001.

  • 52

    Suga H, Mukuoda M: Subungual exostosis: a review of 16 cases focusing on postoperative deformity of the nail. Ann Plast Surg 55: 272, 2005.

  • 53

    Li Y, Yue T, Han Y: Subungual exostosis. Chin Med Sci J 6: 169, 1991.

  • 54

    Evison G, Price CH: Subungual exostosis. Br J Radiol 39: 451, 1966.

  • 55

    Tuzuner T, Kavak A, Parlak AH, et al: Subungual osteochondroma: a diagnostic dilemma. JAPMA 96: 154, 2006.

  • 56

    Dhondt E, Oudenhoven L, Khan S, et al: Nora's lesion, a distinct radiological entity? Skeletal Radiol 35: 497, 2006.

  • 57

    Gruber G, Giessauf C, Leithner A, et al: Bizarre parosteal osteochondromatous proliferation (Nora lesion): a report of 3 cases and a review of the literature. Can J Surg 51: 486, 2008.

    • Search Google Scholar
    • Export Citation
  • 58

    Joseph J, Ritchie D, MacDuff E, et al: Bizarre parosteal osteochondromatous proliferation: a locally aggressive benign tumor. Clin Orthop Relat Res 469: 2019, 2011.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 59

    Cañueto J, Santos-Briz A, Yuste-Chaves M, et al: Turret exostosis or acquired osteochondroma. Actas Dermosifiliogr 102: 474, 2011.

  • 60

    LeClere LE, Riccio AI, Helmers SW, et al: Turret exostosis of the talus. Orthopedics 33: 517, 2010.

  • 61

    Kandzierski G, Matuszewski L: Florid-reactive periostitis of the phalanges: a 2-case report. J Pediatr Orthop 32: 179, 2012.

  • 62

    Yuen M, Friedman L, Orr W, et al: Proliferative periosteal processes of phalanges: a unitary hypothesis. Skelet Radiol 21: 301, 1999.

  • 63

    James SL, Davies AM: Surface lesions of the bones of the hand. Eur Radiol 16: 108, 2006.

  • 64

    Lemont H, Christman RA: “Subungual Exostosis and Nail Disease and Radiologic Aspects,” in Nails: Therapy, Diagnosis, Surgery , edited by RK Scher, CR Daniel III , p 250, Saunders, Philadelphia, 1990.

    • Search Google Scholar
    • Export Citation
  • 65

    Higuchi K, Oiso N, Yoshida M, et al. Preoperative assessment using magnetic resonance imaging for subungual exostosis beneath the proximal region of the nail plate. Case Rep Dermatol 3: 155, 2011.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 66

    Dumontier CA, Abimelec P: Nail unit enchondromas and osteochondromas: a surgical approach. Dermatol Surg 27: 274, 2001.

  • 67

    Giralt de Veciana E, Planell i Mas E, Bonilla E, et al: Estudio clínico del tratamiento de las exóstosis digitales mediante la implantación de un gel biocompatible. Rev Int Cienc Podol 23: 216, 2012.

    • Search Google Scholar
    • Export Citation
  • 68

    Gómez Martín B, Sánchez Gómez R, Álvarez Carderón-Iglesias O . Exóstosis subungueales vs osteocondroma: importancia del diagnóstico diferencial. Rev Int Cienc Podol 1: 101, 2007.

    • Search Google Scholar
    • Export Citation
  • 69

    Mahon DJ, Holland DM: The hallucal distal phalanx and transverse convexity of the nail plate: the relationship. Foot 10: 59, 2000.

  • 70

    Kosaka M, Kusuhara H, Mochizuki Y, et al: Morphologic study of normal, ingrown, and pincer nails. Dermatol Surg 36: 31, 2010.

  • 71

    Bonnevialle P, Gauzy D, Sales J, et al: “Exostose Solitaire et Maladie des Exostoses Multiples,” in Appareil Locomoteur, edited by EMC, p 14, Elsevier Masson SAS, Paris, 2011.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 72

    Tuzuner T, Kavak A, Ustundag N, et al: A painful subungual nodule: subungual exostosis. Acta Orthop Traumatol Turc 38: 71, 2004.

  • 73

    Holmes C, Choksi P, Wrobel JS: Bizarre parosteal osteochondromatous proliferation: a novel case report of recurrence in the toe. JAPMA 105: 80, 2015.

    • Search Google Scholar
    • Export Citation
  • 74

    James A, Henderson S: Multiple recurrences of subungual exostosis in a child: a unique presentation of a Nora's lesion. Foot Ankle Int 34: 445, 2013.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 75

    Multhopp-Stephens H, Walling AK: Subungual exostosis: a simple technique of excision. Foot Ankle Int 16: 88, 1995.

  • 76

    Orejana García AM, Pascual Huerta J, Marín Muñoz MD, et al: Asociación entre hallux limitus-hallux rigidus y exóstosis subungueal: resultados preliminares. Podol Clin 6: 26, 2005.

    • Search Google Scholar
    • Export Citation
  • 77

    Zambrano E, Nosé V, Perez-Atayde AR, et al. Distinct chromosomal rearrangements in subungual (Dupuytren) exostosis and bizarre parosteal osteochondromatous proliferation (Nora lesion). Am J Surg Pathol 28: 1033, 2004.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 78

    Dave S, Carounanidy U, Thappa DM, et al. Subungual exostosis of the thumb. Dermatol Online J 10: 15, 2004.

  • 79

    Moreno Martín FJ: Exóstosis subungueal vs. osteocondroma: diagnóstico diferencial Reduca (Enfermeria, Fisioterapia y Podologia) 1: 18, 2009.

    • Search Google Scholar
    • Export Citation
  • 80

    Stănescu L, Popescu CF, Niculescu CE, et al: Subungual exostosis of the big toe. Rom J Morphol Embryol 50: 501, 2009.

  • 81

    Vázques-Flores H, Domínguez-Cherit J, Vega-Memije ME, et al: Subungual osteochondroma: clinical and radiologic features and treatment. Dermatol Surg 30: 1031, 2004.

    • Search Google Scholar
    • Export Citation
  • 82

    Dockery G, Butterworth R : Atlas a Color y Texto de Cirugía del Antepié, St. Louis, Mosby Year Book, 1992.

  • 83

    Carvajal L, Loayza M: Tumores del dedo grande. Podomorfos 6: 2004.

  • 84

    Duncan RL, Turner CH: Mechanotransduction and the functional response of bone to mechanical strain. Calcif Tissue Int 57: 344, 1995.

  • 85

    Singh G, Haneef NS, Uday A: Nail changes and disorders among the elderly. Indian J Dermatol Venereol Leprol 71: 386, 2005.

  • 86

    Albiol J, Blanco J, Giralt de Veciana E, et al: Extirpación de condroma subungueal por mínima incisión. Rev Esp de Podol 1: 38, 1991.

    • Search Google Scholar
    • Export Citation
  • 87

    Martinez Nova A. Podología: Atlas de Cirugía Ungueal , edited by A Martínez Nova, Panamericana, Madrid, 2006.

  • 88

    DuVries HL: Diseases and deformities of the toenails,” in Surgery of the Foot , edited by VT Inman, p 204, CV Mosby, St. Louis, 1959.

    • Search Google Scholar
    • Export Citation

Subungual Exostosis

Systematic Review and Meta-Analysis

View More View Less
  • 1 Department of Clinical Sciences, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
  • | 2 Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
Restricted access

Background:

The coexistence of deformity of the nail bed and subungual exostosis (SE) is a frequent finding in podiatric practice in the fourth and fifth decades of life. However, it has been described by other specialists as being an uncommon osteocartilaginous tumor most prevalent during the second and third decades of life. This study attempts to determine the causes of this discrepancy.

Methods:

Two authors independently conducted a systematic bibliographic review in multiple databases, podiatry sources and others, and key words were chosen to achieve a broad search strategy. Studies reporting on epidemiology and treatment of SE lesions in lower extremities in ten or more patients were selected. Initially, 197 articles were identified through database screening, with 23 meeting all inclusion and exclusion criteria. Seven articles with the ages of all of the patients were included in the analysis of age data. A comparison was then made between the diagnostic criteria for the selected 23 articles.

Results:

Model results reveal that, although there are some significant differences between individual studies, the main factor tested (patient's age) was clearly significant (F 1,5.2 = 78.12, P < .001), showing that studies coming from the podiatry speciality were conducted on individuals with a mean age of 37 years higher than in studies from other specialties. Clinical and radiologic characteristics and treatment described in the podiatry literature also contrast with those in other specialties.

Conclusions:

The SE described by podiatrists, in accordance with the parameters of true exostosis, is different from Dupuytren's SE and should be considered as a different pathologic entity. The authors are working on its histologic identification.

Corresonding author: Laura Pérez-Palma, PM, Department of Clinical Sciences, Faculty of Medicine and Health Sciences, University of Barcelona, C/ Feixa Llarga, s/n - Edifici de Govern, Hospitalet de Llobregat, Barcelona 08907, Spain. (E-mail: lperez@ub.edu)