Fracture or Not: An Easily Mistaken Benign Finding in a Tuberous Sclerosis Patient

Tuberous sclerosis (TSC) is a rare autosomal dominant disorder that can affect multiple organ systems, including the brain, heart, lungs, and skin. Cutaneous manifestations are common, including ungual fibromas, however, these may be mistaken for other pathologies. Here, we present the case of a 14-year-old with TSC complaining of traumatic left little finger pain. Radiographic evaluation revealed cortical scalloping of the nailbed, concerning for a non-displaced fracture. Given the history of TSC, however, this defect may have also represented a periungual fibroma. The patient subsequently underwent conservative management and an eight-month radiographic follow-up showed no osseous remodeling, supporting the diagnosis of periungual fibroma. It is imperative for clinicians to understand the cutaneous manifestations of TSC to aid in proper diagnosis and avoidance of unnecessary treatment. In this case, interval follow-up confirmed the diagnosis and excluded fracture.

Subungual Hematoma

The authors present the case of a 64-year-old male who presented to the emergency department due to foot trauma. He sustained a large subungual hematoma, which was drained. Following the procedure, the patient achieved complete resolution of his pain. He also reported no complications at two-week phone follow-up. The management of subungual hematoma, including the trephination procedure, is discussed. Potential complications, although rare, are reviewed.

Treatment of Distal Phalanx Fracture Using Figure-of-Eight Suturing of the Nail

Nail bed avulsion injuries associated with a distal phalanx fracture are very common injuries occurring in industrial workers dealing with heavy machines. Often patients come with an open wound that needs a thorough wash and reduction of fracture with manipulation and traction along with suturing of the nail bed. The study was conducted on 20 patients with nail bed avulsion injuries associated with distal phalanx fracture. Patients were treated by a vertical figure-of-eight suturing of the nail plate with the nail bed after a reduction of the distal phalanx fracture. Patients were followed up periodically at a weekly interval for up to three months. This approach maintains excellent contact between the nail plate and matrix, limiting additional displacement of the nail plate. The vertical figure-of-eight suturing technique takes sutures and secures the nail by using the nail plate and the nail bed. It's simple, dependable, and easily taught to surgeons of any specialty. This procedure may be used even if the eponychium is not intact. It's a useful approach for anybody dealing with a nail bed avulsion injury that includes or excludes distal phalanx damage. This method of repair is straightforward, secure, and reproducible. It does not necessitate either the formal repair of damaged nail bed structures or the removal of the nail bed. This procedure can be performed in an outpatient setting with a local ring block, and the patient can return home the same day. Additionally, the patient can regain finger function within three months.

The Diagnosis and Management of Mallet Finger Injuries

BACKGROUND

Mallet finger is a common injury of the extensor tendon insertion causing an extension lag of the distal interphalangeal joint.

METHODS

We reviewed the most current literature on the epidemiology, diagnosis, and management of mallet finger injuries focusing on the indications and outcomes of surgical intervention.

RESULTS

Nonoperative management has been advocated for almost all mallet finger injuries; however, complex injuries are usually treated surgically. There is still controversy regarding the absolute indications for surgical intervention.

CONCLUSIONS

Although surgery is generally indicated in the case of mallet fractures involving more than one-third of the articular surface as well as in all patients who develop volar subluxation of the distal phalanx, a significant advantage of surgical management even in those complicated cases has yet to be clearly proven.