Spider Bite

OSTEOCHONDROMA
© 2008 by Seth A. Rubenstein, D.P.M.

 

An 18 year old female presented with a complaint of nail deformity on her right great toe of 8 months duration. An achy pain is noted. Prior treatment with Pen-lac nail lacquer did not resolve the deformity.

A discoloration was noted along the medial nail border consistent with elevation of the nail off the underlying nail bed. Once trimmed back, a well circumscribed firm mass was observed in the underlying skin (figure 1).

Fig. 1

 

X-ray exam revealed a boney projection off the medial-distal aspect of the distal phalanx. The mass did not appear to press through the skin on x-ray despite the clinical findings. (Figure 2 and Figure 3). The bone tumor is capped with cartilage which does not appear on x-ray.

 

 

Fig. 2

Fig. 3

 

Intra-operative photos show the extent of the mass as it grew through the nail bed. The mass is removed using an osteotome (Figure 4). Once removed, the extent of the tumor can be seen by the size of the defect (Figure 5).

Fig. 4

Fig. 5

 

 

The mass measures about 1.0 centimeter in width (Figure 6). Post operative X-ray demonstrating removal of tumor (Figure 7).

Fig. 6

Fig. 6

The wound is allowed to heal by secondary intention. After 6 weeks it is completely healed (Figure 8).

 

fig. 8