Pincer nails complicated by distal phalangeal osteomyelitis

Besides the known cosmetic implications, pincer nails are often complicated by pain, chronic inflammation and recurrent suppurative infections. We report two such cases of chronic paronychia of the thumb secondary to pincer nails. Both were complicated by osteomyelitis. Although both cases eventually healed after excisional debridement, one case required elective amputation because the significant loss of bony support resulted in a painful, floppy fingertip and poor pinch. Regular radiographic assessments may be useful in the management of patients with chronic inflammation or recurrent paronychias secondary to pincer nails to detect osteomyelitis.