title: 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.
  
  
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Pediatric Surgery, Medical University Graz, Auenbruggerplatz 34, A-8036 Graz, Austria. pirkerm@yahoo.de
authors: Martina Eva
authors: ME
authors: Majcen
authors: Claudia C
authors: CC
authors: Wilfinger
authors: Alexander
authors: A
authors: Pilhatsch
mesh_terms: D000293:Adolescent; D002648:Child; D002908:Chronic Disease; D005260:Female; D006214:Hallux / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D009263:Nails, Ingrown / Q000000981:diagnostic imaging* / Q000601:surgery*; D010019:Osteomyelitis / Q000000981:diagnostic imaging* / Q000601:surgery*; D011300:Preoperative Care; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome