Nail disorders associated with cast immobilization of the forearm and wrist: report of two cases and review of the literature<sup>,</sup>

Sayar, Sıla Kılıç; Sayar, Yasin

doi:10.1016/j.abd.2020.07.024

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CASE REPORT • An. Bras. Dermatol. 96 (6) • Nov-Dec 2021 • https://doi.org/10.1016/j.abd.2020.07.024 copy

Nail disorders associated with cast immobilization of the forearm and wrist: report of two cases and review of the literature^☆ ☆ How to cite this article: Kılıç Sayar S, Sayar Y Nail disorders associated with cast immobilization of the forearm and wrist: report of two cases and review of the literature. An Bras Dermatol. 2021;96:721–5. ^,^☆☆ ☆☆ Study conducted at the Department of Dermatology and Venereology, Bahcesehir University Faculty of Medicine and Department of Orthopedics and Traumatology, Health Sciences University, Istanbul, Turkey.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Cast immobilization is used in the management of various injuries of joints and/or limbs. A variety of nail disorders have been reported in association with cast immobilization of the forearm and wrist among a limited number of patients so far. The mechanism was not clearly identified in some of these cases. Here, the authors report two patients with nail disorders appeared after the removal of immobilization cast of forearm and wrist and review the literature.

KEYWORDS
Immobilization; Neoplasms; Pyogenic granuloma; Reflex sympathetic dystrophy

Author (year)/Number of patients	Sex	Age (y)	Cause of the immobilization	Immobilization cast type and application details	Duration^a a The time between the removal of cast and the appearance of nail findings.	Nail findings/Fingers of the affected nails	Neurological signs and/or symptoms	Neurological examination/EMG results	Treatment	Course
Present authors (2021)/2 patients	M	28	Zone 2 flexor tendon laceration (first finger of the right hand)	Circumferential plaster cast (extending to 2^nd–5^th fingers)	2 weeks	Nail fold edema, oncyhomadesis/3^rd–4^th	None	Normal/Normal	Systemic steroids, topical emolients	Complete healing
	M	15	Fracture of the 4^th and 5^th metacarpals (right hand)	Plaster cast in intrinsic plus position (entending to 4^th–5^th fingers)	3 weeks	Nail fold edema, oncyhomadesis/3^rd–4^th	Local pain (during the immobilization)	Normal/Normal	Topical steroids	Complete healing
Baykal²2 Baykal C, Kılıç S, Sezer S. Periungual pyogenic granuloma-like lesions following plaster cast immobilization: a case managed with symptomatic therapy. J Dtsch Dermatol. 2018;16:74–5. (2018)/1 patient	M	25	Fracture of the middle phalanx of the left 3^rd finger	Circumferencial plaster cast of forearm + wrist (extending to 2^nd–5^th fingers)	3 weeks	PG, nail fold edema, oncy-homadesis/ 2^nd–4^th	None	Normal/Normal	Systemic steroid and antibiotics, topical antibiotics	Complete healing
Thakur³3 Thakur BK, Verma S, Mishra J. Pyogenic granuloma with onychomadesis following plaster cast immobilization. Indian J Dermatol Venereol Leprol. 2016;82:239. (2016)/1 patient	M	14	Left distal radio-ulnar joint dislocation	Plaster cast from above the elbow up to the metacarpal bones	6 weeks	PG, oncy-homadesis/ 1^st–2^nd	Local increased sweating	Normal/Normal	Curettage	NA
Whitelaw⁴4 Pampín A, Sanz-Robles H, Feltes RA, López-Estebaranz JL. Onychomadesis and pyogenic granulomas after postoperative upper-limb immobilization. Actas Dermosifiliogr. 2014;105:528–9. (2014)/1 patient	F	10	Fracture of the proximal phalanx of left 1^st finger	Plaster cast extending to the hand and wrist (fingers mobile)	NA	Nail fold edema and oncyhomadesis/1^st–3^rd	None	NA	None	Complete healing
Pampin⁵5 Whitelaw ST, Bourke G, Whitelaw DC. Focal nail dystrophy in a cutaneous nerve distribution after trauma. J Am Acad Dermatol. 2014;70:e46–7. (2014)/1 patient	M	35	Distal detachment of the biceps brachii tendon	Plaster cast from halfway up the arm to metacarpal joint	2 weeks	PG and oncyhomadesis/2^nd–4^th and 2^nd–5^th, respectively	None	Normal/Normal	None	Complete healing
Piraccini⁶6 Piraccini BM, Bellavista S, Misciali C, Tosti A, de Berker D, Richert B. Periungual and subungual pyogenic granuloma. Br J Dermatol. 2010;163:941–53. (2010)/3 patients	M	43/42/45	Wrist or other bone fracture of the limb	Plaster cast (non-detailed)	3 months^b b The time between the injury and the appearance of nail findings.	PG/ NA	Severe pain, hyperhidrosis in one patient	Normal/Normal	Surgical removal in 1, silver nitrate treatment in 2 patients	Complete healing in two patients
Pucevich⁷7 Pucevich B, Spencer L, English JC. Unilateral trachyonychia in a patient with reflex sympathetic dystrophy. J Am Acad Dermatol. 2008;58:320–2. (2008)/1 patient	F	48	Fracture in the right 3rd finger	Plaster cast of forearm + wrist (non-detailed)	NA	Trachyonychia/All fingers of a single hand	Pain, motor loss and dysesthesia of the arm	NA	Moisturizer, alpha-acetoxyacid, oral biotin	NA
Tosti⁸8 Tosti A, Piraccini BM, Camacho-Martinez F. Onychomadesis and pyogenic granuloma following cast immobilization. Arch Dermatol. 2001;137:231–2. (2001)/9 patients	M	15–42	Fracture of a phalanx in 3, a metacarpal bone in 2, and the wrist in 4 patients	Cast of forearm + wrist (non-detailed)	7–30 days	PG in all, oncyhomadesis in 3 patients/Not detailed	Moderate paresthesia and pain (during the immobilization)	Normal/Normal	NA	Complete healing
Tosti⁹9 Tosti A, Baran R, Peluso AM, Fanti PA, Liguori R. Reflex sympathetic dystrophy with prominent involvement of the nail apparatus. J Am Acad Dermatol. 1993;29:865–8. (1993)/1 patient	M	17	Ulnar-carpal joint fracture and ulnar collateral ligament damage	Plaster cast of forearm + wrist (non-detailed)	A few days	Nail fold edema/3^rd–4^th	Tingling, burning pain, hyperhidrosis and coldness	Normal/Normal	Antibiotic creams and systemic antiinflammatoires	NA

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[1] ⁎ Corresponding author. s_kilic@windowslive.com (S. Kılıc¸ Sayar).