Long-Term Results of Nail Correction with Distal Phalanx Osteotomy for Pincer Nail Deformity: A Retrospective Cohort Study

Abstract Background: Pincer nail deformity (PND) is characterized by excessive transverse curvature of the nail plate, often causing pain, functional impairment, and poor cosmesis. Existing treatments focusing on the soft tissue correction frequently result in recurrence. Aims and Objectives: To evaluate the long-term efficacy and safety of a novel distal phalanx osteotomy technique in correcting the anatomical basis of PND and alleviating associated symptoms. Materials and Methods: A retrospective cohort study was conducted on 51 cases (39 patients) with PND, who underwent inverted V-shaped distal phalanx osteotomy between May 2013 and January 2022. Nail morphology indices, pain levels, and satisfaction scores were assessed pre- and post-operatively. Statistical analysis was performed using paired t -tests. Institutional review board (IRB) approval was obtained. Results: Postoperative assessments showed significant morphological improvement: the width index increased from 69.1% to 95.9% and the height index decreased from 64.5% to 13.8% ( P < 0.001 for both). Pain visual analogue scale (VAS) decreased from 7.5 to 1.8, while satisfaction VAS improved from 1.4 to 9.0 ( P < 0.001). No recurrences, nail growth arrest, or complications were observed during a mean follow-up of 3.3 years. Conclusion: Distal phalanx osteotomy offers a durable, anatomically corrective approach to treating PND. By remodelling both the osseous and soft tissue structures, it effectively prevents recurrence and restores functional nail architecture.