Subungual exostosis and osteomyelitis: a case series

Subungual exostosis (SE) is a rare benign osteocartilaginous tumor, most often affecting the great toe. While complications such as nail deformity and recurrence are known, the coexistence of osteomyelitis within SE has not previously been reported. We describe three adolescent patients with SE complicated by osteomyelitis at the same anatomical site. Diagnosis was established by clinical examination, magnetic resonance imaging (MRI), and intraoperative bone cultures. All patients underwent surgical excision with debridement, application of intramedullary antibiotic-loaded bone void filler, and a 6-week systemic antibiotic regimen. At follow-up, all patients showed complete resolution of infection with no recurrence or postoperative complications. This case series introduces a novel association between SE and osteomyelitis. MRI should be considered in SE cases to assess for underlying infection, and management should integrate surgical debridement, intraoperative cultures, and targeted antibiotic therapy to ensure optimal outcomes.