Post-traumatic double fingernail deformity

Posttraumatic onychoheterotopia: A case and review of the pediatric literature

BACKGROUND

Onychoheterotopia, or ectopic nail, is a rare nail condition in which nail growth occurs in areas other than the distal phalanges. The majority of cases in the literature are noted to be congenital; however, acquired cases have less commonly been described following either acute or chronic trauma.

METHODS

We present a case of acquired onychoheterotopia in a child, with a corresponding literature review of acquired pediatric onychoheterotopia cases for comparison.

RESULTS

There were a total of 10 cases of acquired onychoheterotopia in pediatric patients in the literature. Including our patient, 81.8% (9/11) developed an ectopic nail on the fingers. Crush injury preceded the ectopic nails in 45.5 % (5/11) of cases. Infection occurred in 27.3% (3/11).

CONCLUSIONS

Although the incidence and prevalence of acquired onychoheterotopia are unknown, it seems to be an uncommon phenomenon. From our case and others from the literature, there may be associations with crush injury specifically. Further research will be needed to fully elucidate the pathophysiology and risk factors for ectopic nail growth.

Surgical Management of Onychoheterotopia

Onychoheterotopia (ectopic nail) is a rare condition characterized by the development of nail tissue, distinct from the normal nail unit. It is usually acquired following traumatic inoculation of nail matrix; the congenital variety being less common. The exact pathogenesis of the disease is not clear. It affects the dorsal aspect of fingers and toes mostly. Herein, we report a case of a 35-year-old man with post-traumatic onychoheterotopia of left middle finger, who was treated with surgical avulsion of the ectopic nail along with chemical matricectomy of the well-formed ectopic matrix. The patient had a satisfactory cosmetic outcome with normal growth of the nail unit and no recurrence. The report serves to highlight clinical presentation of acquired onychoheterotopia along with its surgical management.

Current Topics in Nail Surgery

Background:

Nail surgery can be performed in an office-based dermatology practice with a limited amount of specialized equipment and training. Several excellent reviews have been published in recent years that detail the techniques of nail surgery for both the novice and the experienced practitioner.

Objective:

In this article recent developments in nail surgery are discussed. Topics that are treated include the general principles of nail surgery, including epidemiologic issues, studies of nail anatomy, instrumentation, and anesthesia. The reconstruction of injuries and congenital defects involving the nail is explained, and the role of the hand surgeon clarified. Appropriate removal of tumours and cysts is considered, with special attention to the management of malignant lesions. The controversy regarding more or less conservative management of melanonychia striata is addressed, and the need for early diagnosis of subungual melanoma is emphasized. Other topics are surgical management of ingrown nails and onychomycosis. Newer areas of nail surgery, such as laser surgery of the nail, psycho-dermatology of the nail, and the role of primary care physicians in simple nail surgery are also examined.

Ectopic Nail Formation in the Hand

This paper reports an unusual case of ectopic nail formation, reviews the literature and proposes a simple classification of this anomaly.

Posttraumatic ectopic nail: case report

Ectopic nail, also known as onychoheterotopia or onychoheterotropia, is an extremely rare disorder. It is characterized by the growth of nail-like tissue in a different location other than the nail bed. Congenital and acquired deformities have been reported. We describe a case of posttraumatic ectopic nail and review the literature on this unusual condition.