Tuberculous dactylitis is a distinctly uncommon, yet well recognized form of tuberculosis involving the small bones of the hand or foot. It occurs in young children in endemic areas under 5 years of age. Tuberculosis of the short tubular bones like phalanges, metacarpals or metatarsals is quite uncommon beyond 6 years of age, once the epiphyseal centers are well established. The radiographic features of cystic expansion have led to the name “Spina Ventosa” for tuberculous dactylitis of the short bones. Scrofuloderma is a mycobacterial infection affecting children and young adults, representing direct extension of tuberculosis into the skin from underlying structures e.g. lymph nodes. An 8-year-old malnourished girl had multiple axillary ulcers with lymphadenopathy. Tuberculous dactylitis with ipsilateral axillary scrofuloderma was suspected on clinical and radiological grounds. The suspicion was confirmed by histology and bacteriology. The patient responded to antitubercular drugs with progressive healing of the lesions without surgery. Concomitant presence of these dual lesions suggesting active disseminated tuberculosis in immune-competent child over 6 years is very rare and hardly reported.

Generally, skeletal peripheral metastases below the elbow and the knee are rare. Skeletal metastases to the hand or foot are very rare; but when they do it may be a revealing clinical finding. Purely lytic lesions are commonly seen in metastases from lung, renal, and thyroid tumors, but they are also known to occur in primary myeloma, brown tumor and lymphomas. A 70-year-old man was brought to the emergency department with acute painful swelling involving his right hand and the right knee. Due to significant accompanying soft tissue swellings cellulitis, acute osteomyelitis and gouty arthropathy were included in the initial differential diagnosis. Radiographs showed pure lytic bony lesion with complete disappearance of lower two third of the second metacarpal, trapezium and trapezoid bones of the right hand along with a lytic subarticular lesion of medial condyle of ipsilateral femur. Chest X-ray (CXR) was normal but sonography of the abdomen readily demonstrated a large renal mass, later confirmed at biopsy as renal cell carcinoma (RCC). Clinicians should be cognizant of the strong association between digital acrometastases and renal cell carcinoma in male patients with normal CXR findings. In suspected hand acrometastasis associated with a soft tissue component outside the contours of normal bone, screening the abdomen by sonography should be done prior to bone biopsy and before costly or time-consuming investigations are offered. Metastatic RCC should be included in the differential diagnosis of all unilateral expansile bony lesions of the digit. It is particularly important if such lesion/lesions are accompanied by local inflammation. Screening the abdomen by sonography may be of particular value in such elderly male patient when Chest X-ray shows no abnormality.

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A trauma system is a chain of arrangements and preparedness to provide quality response to injured from the site of injury to the appropriate hospital for the full range of care. Israel has a unique trauma system developed from the experience gained in peace and in war. The system is designed to fit the state's current health system, which is different from the European and American systems. An effective trauma system may potentially manage mass casualty incidence better. The aim of this paper is to discuss learning points to develop a trauma system based on the Israeli trauma model. After participating in a course on developing a trauma system organized by a top Israeli trauma center, a literature search on the topic on the Internet was done using relevant key words like trauma system and disaster management in Israel using the Google search engine in the pubmed, open access journals and websites of trauma organizations. Israel has a unique trauma system of organizing and managing an emergency event, characterized by a central national organization responsible for management, coordination and ongoing quality control. Because of its unique geopolitical situation, the armed forces has a significant role in the system. Investing adequate resources on continuous education, manpower training, motivation, team-work and creation of public volunteers through advocacy is important for capacity building to develop a trauma system. Wisdom, motivation and pragmatism of the Israeli model may be useful to streamline work in skeletal trauma services of developing countries having fewer resources to bring consistency and acceptable standards in trauma care.

<p class="abstract"><strong>Background:</strong> The 12^th<strong> </strong>South Asian Games (SAG) was held from February 5-16, 2016 in Guwahati and Shillong. International level mega-events bring people of different background to a single geographic location after extensive travel. Surveillance and measures for primary and secondary prevention of injuries and illnesses by the organizers and host country is highly desirable. There is no such previous published report on South Asian games. The study was conducted with the aim<strong> </strong>to analyse the medical arrangements and report injuries and illnesses in athletes and games officials during the South Asian Games-2016 at Shillong venue.</p><p class="abstract"><strong>Methods:</strong> <strong>:</strong> It is a retrospective study from all daily records of injuries and illnesses reported to the principal referral hospital designated to treat all significant injuries and illnesses for games officials and athletes from all eight participating countries staying in Shillong.<strong></strong></p><p class="abstract"><strong>Results:</strong> Eight major sports were conducted in Shillong that included Badminton, Boxing, Football, Judo, Taekwondo and Wushu. The average age of the injured athletes or ill officials combined was 27.5 years. Male to female ratio was approximately 7:3. There were a total of 65 injuries (59.6%) out of 109 hospital visits including six dislocations involving the upper limbs, but only one athlete required hospitalization. Athletes from three major contact sports namely taekwondo, football and wushu dominated the injured list. A significant number of games officials had injuries and medical illnesses, some requiring hospitalization.</p><p><strong>Conclusions:</strong> Thorough planning for be<em>fitting </em>medical care <em>arrangements</em><em> </em>is indispensable for successful conduct of any major sports event.<strong> </strong>Significant training, sensitization, preparedness, knowledge-based manpower and infrastructure are needed for adequate medical coverage before, during and after the schedule of any major sports events. </p>