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Interpretation of radiologic abnormalities in patients with chronically infected ingrown toenails with regard to a possible exogenic osteomyelitis.

Abstract：

BACKGROUND:Chronic infection of ingrown toenails may lead to exogenous osteomyelitis. Therefore, plain x-rays are commonly taken in children with significant inflammation. We evaluated the preoperative radiologic findings and their clinical significance, especially with regard to exogenic osteomyelitis. PATIENTS AND METHODS:We retrospectively evaluated all patients who underwent surgery for infected ingrown toenails during a 5-year period. Data collection included the history of infection, preoperative laboratory tests, preoperative x-rays, and intraoperative presentation. FINDINGS:One hundred thirty-four patients with infected ingrown nails of the hallux underwent 161 surgical procedures. Mean age at surgery was 14.1 years. Preoperative x-rays were taken in 113 (70.2%) cases. The treating surgeon classified 76 (67.2%) x-rays as negative (no bone affection), 16 (14.2%) as positive (definite bone affection), and 21 (18.6%) as suspicious for bone affection. Only 11 (30%) of 37 children with positive or suspicious x-rays showed bone affection during surgery, which presented as a softening of the cortical bone. None of the children had significantly elevated inflammation markers in the preoperative laboratory tests. Children with positive or suspicious x-rays had a significant longer history of infection compared to those without radiologic abnormalities (8 vs 4.5 weeks mean; P = .024). A reevaluation of the x-rays by an experienced radiologist was undertaken and revealed no case of definite osteolysis. CONCLUSION:In about one third of all infected ingrown toenails, radiologic changes of the distal phalanx occur. These changes primarily represent periostal reactions. A typical osteomyelitis as a complication of chronically infected ingrown toenails is rare.

journal_name

J Pediatr Surg

journal_title

Journal of pediatric surgery

authors

Majcen ME,Wilfinger CC,Pilhatsch A

doi

10.1016/j.jpedsurg.2009.05.032

subject

Has Abstract

pub_date

2009-11-01 00:00:00

pages

2179-83

issue

eissn

0022-3468

issn

1531-5037

pii

S0022-3468(09)00450-3

journal_volume

pub_type

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Interpretation of radiologic abnormalities in patients with chronically infected ingrown toenails with regard to a possible exogenic osteomyelitis.