Duplicidad ungueala propósito de un caso

Abstract

The intention of this article is to show the adopted therapeutic option in a clinical case of a congenital malformation of a duplication of the nail, with a revision of the affections, that like in the duplication of the nail, attends with the appearance of two complete nails in a same finger. In order to make a diagnosis differential between polysyndactyly, polyonychia and the duplication of the nail the examination of the bony structure turns out essential, the appearance of duplicated bony elements in all the finger, would characterize polysyndactyly; the bifid or bipartite distales phalange existence would be characteristic of polyonychia, and the absence of supernumerary bony elements the determinant of the duplication of the nail. Nevertheless, many authors denominate the appearance of supernumerary nails, polyonychia, without making any differentiation. Because of this, we include the radiological analysis made in the clinical case, that they were conclusive for the definitive diagnosis. The appearance of two complete nail units, with a lateral deviation towards the medial and lateral edges of the second right toe, it produced a deformity in the finger from the birth. Although the patient was diagnosed at the age of 15 months, we took the choice of waiting for 6 months to analyze if some of the two nail units, assumed a dorsal position and a greater size to make the biomechanic functions of the nail. The satisfactory results in a previously treated case, in which existed the same deformity, was determining to make a total resection of the nail located in the lateral edge and, at the same time, to make a resection of the surrounding tissues, that provide the finger a greater volume in the distal zone. The objectives of the surgery were to restore the biomechanic function of the nail, to make possible the use of normal footwear, to improve the aesthetic of the foot, and to prevent future affections. The result of the surgery was satisfactory, nevertheless lateral deviation towards the medial line, of the only existing nail and the absence of ossification of the distal phalange, make us foresee the necessity of orthotics and chiropody treatments in the future.