Subungual (Dupuytren's) exostosis

Dupuytren's subungual exostosis is an uncommon osteochondral lesion affecting the distal phalanx of adolescents. Lack of awareness of this unusual lesion causes many to be initially misdiagnosed. Accurate diagnosis based on clinical findings and radiographs and appropriate treatment methods are outlined. We report retrospectively on the cases of six children treated for subungual exostosis over a 3-year period. Diagnosis was made based on clinical findings of a painful subungual or periungual mass associated with an exostosis on radiographs. Complete excision of the lesion, including the overlying nailbed, was curative in the five patients who opted for surgical treatment. Two of our patients had been previously treated with an incomplete excision and had a recurrence within 3 months of the original procedure. Failure to recognize and treat this condition appropriately may lead to morbidity due to overtreatment or recurrence. We hope this report will improve awareness of subungual exostosis and the appropriate operative treatment method.