HighlightsGiant digital fibrokeratoma, nail like changes, benign growth, surgical excision.

A 25 year old Afro-Carribean presented to the accident and emergency department with a painful swelling of the little finger. Radiology revealed periosteal elevation and a bone scan showed a hot spot in the proximal phalanx, suggestive of a tumour or an infection. He gave a history of recurrent chest infections in the past, the chest radiograph revealed apical lesions and loculated pleural eVusion. Bronchoscopy washings were positive for acid fast bacillus suggestive of pulmonary tuberculosis with tuberculous dactylitis. A detailed history and high index of suspicion is important as delay in diagnosis can have serious consequences for the patient.

The re-audit shows that, although there is an improvement in the situation, we are still below the standards of secondary prevention of fragility fractures with 60% of femoral fragility fracture patients not being referred for DEXA scan. A pathway lead by a fracture liaison nurse dedicated to osteoporotic fracture patients should improve the situation.

No abstract

Angioleiomyomas are relatively rare benign soft tissue tumors which often occur in the extremities. The true etiology is largely unknown and is seldom associated with pain. They are rarely diagnosed preoperatively as the clinical and radiological examinations are often nonspecific and inconclusive. The patients may face a considerable delay before a specialist treatment is sought due to the varied presentation/missed diagnosis preoperatively. This delay highlights the need for better characterizing the diagnosis and treatment of angioleiomyomas in clinical setting to expand awareness of this pathology, the differential diagnosis of lower extremity soft tissue tumors and the need for ongoing publication of such case reports. We wish to present two patients who came in with foot and ankle swellings and heel pain. Post-excision, these swellings were histologically diagnosed as benign angioleiomyomas.