Surgical Treatment on Subungual Osteochondromas in Paediatric Feet: A Case Series Study

Abstract

Subungual osteochondroma (SO) is an infrequent and non-malignant bone tumour of the distal phalanx, especially prominent in paediatric populations. The aim of this research was to describe a case series of paediatric feet with SO which received surgical treatments. The secondary purpose was to compare these descriptive data by sex distribution. Methods: Twenty-three paediatric feet with SO confirmed by clinical or radiological features received surgical treatment. Socio-demographic (age, sex, height, weight and BMI) and clinical features (side, location, tumour or pain presence, and nail lift before surgery, as well as recurrence and adverse effects at one month after intervention) were reported. Results: Regarding clinical features before intervention, the most frequent locations of SO were the first toe (86.8%) and the right lower limb (56.5%). In addition, the presence of the tumour, pain and nail lift showed a prevalence of 91.3%, 69.5% and 47% of the study sample, respectively. Considering clinical features at one month after intervention, the most frequent adverse effect was the pain presence (69.5%). In addition, one case (4.4%) presented ulceration. Only one patient (4.4%) suffered from recurrence with a new tumour. There were not statistically significant differences by sex distribution (p > 0.05). Conclusions: This novel study showed that surgery treatment for SO in paediatric populations presented a very low recurrence degree with minor adverse effects and without differences by sex distribution. Thus, further randomized clinical trials should be carried out in order to determine the effectiveness of this intervention in this special population.

The Influence of Clinical Factors on Treatment Outcome and a Recurrence of Surgically Removed Protruded Subungual Osteochondroma and Subungual Exostosis

“…All studies showed a predominance of the defect in the big toe [7,27]. In children populations with SE, the defect was located in the big toe in 75% of the cases and the second toe in 20% of the cases [4].…”

“…In a pediatric population, SE was located in the big toe in 55% of cases, in the second or third toes in 30% of the cases and the distal phalanxes of the fingers in only 7.5% of the cases-twice as often on the right side [22]. The most frequent locations of SO in children were the first toe (86.8%) and the right lower limb (56.5%) [27].…”

“…There is a debate on whether SE and SO represent the same clinical entity but with histopathological variations. Based on previous research, we chose to treat the assessment of SO and SE as a single group, as done by other authors of recent studies on this subject, due to the absence of differences in therapeutic management and outcomes [1,13,27].…”

“…DaCambra et al reported a 25% pediatric population with SE but used the search terms "subungual exostoses/exostosis" and "subungual osteochondroma" [3]. In other pediatric patients with SO, the sex ratio was the same while the mean age was 11.13 years old [27]. In an SE population, the median age of the patients was 9 years (4-17 years), with a significantly higher proportion of boys (4:1) [22].…”

Neurofibromatosis type I-associated malignant peripheral nerve sheath tumors: a case report and literature review

“…So far, no single or combined drug treatment can cure MPNST and a complete surgical resection remains the only treatment option for MPNST patients [30]. The success rate of surgical resection of the low risk tumor located at the end of the limb is greatly increased [31]. However, in patients with high-risk soft tissue sarcoma of the trunk and limbs, neoadjuvant therapy is associated with recurrence-free survival and overall survival when the tumor is ≥ 10 cm [32].…”