A trimalleolar fracture is a fracture of the ankle that involves the lateral malleolus, the medial malleolus, and the distal posterior aspect of the tibia, which can be termed the posterior malleolus.The trauma is sometimes accompanied by ligament damage and dislocation.. 0000023680 00000 n Right: Reproduced from Johnson TR, Steinbach LS (eds): Essentials of Musculoskeletal Imaging. Treatment varies depending on how far out of place the bone is located. This joint commonly is injured in closed-fist activities and is commonly known as a boxer's fracture. Boxers fracture should not be confused with boxers knuckle, which is caused by repeated damage to the ligaments over time. How can I tell if I have a Boxers fracture? This fracture is likely caused by the lateral band of the plantar aponeurosis (tendon). According to some studies, patients with bimalleolar fractures had significantly worse function in the ankle 0000008875 00000 n Complications may include nonunion of the fracture, avascular necrosis of the proximal part of the bone, and arthritis.. Scaphoid fractures are most The the 1st metacarpal under the base of the thumb is the most commonly injured. Complications may include injury to an artery or nerve, and compartment syndrome.. The vast majority of Boxers Fractures will not need surgical intervention. Classically, it occurs after a person hits an object with a closed fist. Another commin broken hand injury is a Boxers fracture to the outside of the hand. 0000000016 00000 n Treatment. Dr. Knight may be able to help you virtually with an online virtual consultation. trailer In this type of procedure, an incision is made in the skin overlying the fracture, and rods, pins, or screws are implanted in the bones to keep them in place. The skin overlying the affected area may be broken in multiple ways. The anatomic snuffbox is generally tender and swelling may occur. They may also be named after an activity with which they are associated. %%EOF The wound is closed, and a splint is placed. People who have non-surgical treatment of a metacarpal fracture may notice a bump on the back of their hand, even if the fracture is lined up perfectly. Here we explain the different hand fractures and how they are treated. Boxers fracture seems simple and straightforward. If it is out of place too far, the doctor or provider may offer to push it back into place The cause of a humerus fracture is usually physical trauma such as According to some studies, patients with bimalleolar fractures had significantly worse function in the ankle There may be snapping or popping felt when a fist is made. Symptoms may include pain, swelling, deformity, and bruising. Cardiopulmonary resuscitation (CPR), has also been known to 0000006657 00000 n Items such as hand putty and therapy balls can be great for doing this. [4] Sternal fracture is commonly associated with injuries to the heart and lungs; if a person is injured with enough force to fracture the sternum, injuries such as myocardial and pulmonary contusions are likely. A trimalleolar fracture is a fracture of the ankle that involves the lateral malleolus, the medial malleolus, and the distal posterior aspect of the tibia, which can be termed the posterior malleolus.The trauma is sometimes accompanied by ligament damage and dislocation.. DOI: 10.1016/J.JHSE.2007.07.011; Share this article. Do I have to have surgery to repair a Boxers fracture? In laymans terms, the head of the metacarpal, that is the bone that makes up the palm of the hand just below the finger, is effectively snapped off from the main shaft of the bone, which causes the sunken appearance of the knuckles that is a diagnostic symptom of the condition. [7], There is controversy over the question of whether the presence of sternal fracture is an indication of cardiac injuries. Angulation occurs when a part of the metacarpal bone moves out of its normal alignment. 0000202494 00000 n The cause of a humerus fracture is usually physical trauma such as [1], Because of the high frequency of associated injuries, clinicians are taught to suspect that a patient has multiple severe injuries if a sternal fracture is present. Treatment of broken fingers depends on the type of fracture and the particular bone in the finger that is injured. [3] It was common enough for the sternum to be injured by the seatbelt that it was included in the 'safety belt syndrome',[9] a pattern of injuries caused by seat belts in vehicle accidents. Boxer's fracture is a term for a fracture of one of the fingers and generally occurs after a closed fist makes contact with a hard object. Browse Hay Shop Books by category Updated 08 of 12, 2022 . After diagnosis, home care will often include cast or splint care, pain management, and checking for signs of infection. It is most likely an overuse injury, more common in runners, A TFCC tear is an injury to the triangular fibrocartilage complex found in the wrist. An ankle fracture is a break of one or more of the bones that make up the ankle joint. fracture of the neck of the metacarpal bone, Dallas Fort-Worth accessible hand and wrist offices. Complications may include damage to the median nerve.. The burst fracture is categorized by the "severity of the deformity, the severity of Treatment varies depending on how far out of place the bone is located. Any of these bones can be broken or fractured. Treatment. Figure 2 - A sign of a boxers fracture, with the small finger crossing over another finger Treatment To determine if you have a fracture, your doctor will likely take an x-ray. Surgical Treatment of Patients with Cervical Myeloradiculopathy and Co-Existent Multiple Sclerosis: Report of 15 Patients with Long-Term Follow-up. Altizer, L. (2006, July-August). The three aims of treatment are preserving alignment, mobility and proper finger length. 0000003551 00000 n Occasionally it is used to refer to fractures of the 4th metacarpal as well. The information presented here is offered for informational purposes only. It typically occurs as a result of a fall on an outstretched hand. 0000009793 00000 n There are several types of hematomas, which are often described by their location (for example, under the fingernail, in the liver, spine, and ear). Diagnosis is generally suspected based on 2018American Society for Surgery of the Hand. 0000009567 00000 n Causes include punching or smacking with the hand, or dropping something on the hand. Complications can include a collection of air in the pleural space surrounding the lung (pneumothorax), injury to the nerves or blood vessels in the area, and an unpleasant https://en.wikipedia.org/w/index.php?title=List_of_eponymous_fractures&oldid=1113291984, Short description is different from Wikidata, Creative Commons Attribution-ShareAlike License 3.0, Fracture of anterior glenoid associated with anterior, External rotation and abduction of shoulder, axial load along metacarpal in a partially flexed thumb, fracture of distal fibula with posterior dislocation of the proximal fibula behind the tibia, fracture at the neck of the fifth metacarpal, compression fracture of lateral tibial plateau, forced valgus of knee when struck from side by car bumper, intra-articular fracture of radial styloid, forced ulnar deviation of the wrist causing avulsion of the radial styloid, foot dislocation through talonavicular and calcaneocuboid joints with associated fractures, usually after ankle twisting.treated in a non weight bearing cast for 68 weeks, V-shaped distal tibia fracture extending into the tibial plafond, impacted posterior humeral head fracture occurring during anterior shoulder dislocation, fracture of the distal third of the humerus resulting in entrapment of the radial nerve, unstable spinal fracture-dislocation at the thoracolumbar junction, fracture of base of 5th metatarsal extending into intermetatarsal joint, forced plantar flexion of foot or dropping heavy weight on foot, high energy impact to pelvis (front to back), posterior dislocation of hip with avulsion fracture of fragment of femoral head by the, impact to the knee with the hip flexed (dashboard injury), intra articular comminuted fracture of base of first metacarpal, axial load along the metacarpal causing splitting of the proximal articular surface, lateral tibial plateau avulsion fracture with anterior cruciate ligament tear, fracture of the lateral tubercle of the posterior process of the talus, fall on outstretched hand with wrist in flexed position, avulsion fracture of the medial femoral condyle at the origin of the medial collateral ligament, This page was last edited on 30 September 2022, at 19:23. Can I deal with a Boxer's Fracture at home? Boxer's Fracture Discharge Instructions Boxers fracture is a common term for a break that occurs in one of the five metacarpals, or knuckles. Complications may include an associated high ankle sprain, compartment syndrome, stiffness, malunion, and post-traumatic arthritis.. Ankle fractures may result from excessive stress on the joint such as from J Spinal Disord Tech. A humerus fracture is a break of the humerus bone in the upper arm. 24(3): 177-82, Jul 2011. They gained their name because they are exceedingly common among professional boxers and other pugilists, and even non-professionals that present with these injuries often got them from punching something, whether a person or a wall or an upright post. 0000009514 00000 n All rights reserved. How long does a Boxers fracture take to heal? Symptoms may include pain, swelling, and bruising. 0000054210 00000 n In all cases of boxers fractures, people will be asked to follow up with an orthopedic surgeon. Treatment will depend on your specific injury, how bad it is and whether there is any associated soft tissue damage. Wrist sprains are common in sports., Achilles tendontis is an overuse injury causing pain at the back of the ankle. 0000004009 00000 n 0000314585 00000 n Boxer's fracture. The fracture typically occurs in the neck of the metacarpal, which connects the main shaft of the bone to the head. How can Dr. Knight help you with Boxers Fracture? hbbbd`b`` Yet the injury can vary greatly in severity and may include one or more other broken bones. This content is written, edited and updated by hand surgeon members of the American Society for Surgery of the Hand.Find a hand surgeon near you. A Boxers fracture is a break to either the 4th or the 5th Metacarpals. More specifically, it is a fracture of the neck of the fifth metacarpal (a bone in the pinky finger") (Figure 1). A fracture occurs when the continuity of a bone is broken, and there are many different types. PMID: 20634728 Practical Fracture Treatment 5th edition, page 187. The tuberosity avulsion fracture (also known as pseudo-Jones fracture or dancer's fracture is a common fracture of the fifth metatarsal (the bone on the outside edge of the foot extending to the little toe). Medical treatment will also include pain control. Injuries involving the epiphyseal plate. Will a Boxer's Fracture be permanent or does treatment cur it? Treatment varies depending on how far out of place the bone is located. 0000001615 00000 n While certain fractures, such as hairline fractures, may be able to successfully knit together without much in the way of medical intervention, a Boxers fracture, due to the nature of the break and the position of the injury that typifies the condition, cannot simply be left to heal without any intervention. Read about the symptoms, signs, causes, diagnosis, treatment, and prevention of hematomas. document.getElementById( "ak_js_2" ).setAttribute( "value", ( new Date() ).getTime() ); Not sure what service you need or what injury or syndrome you may have? xref Sternal fractures may also occur as a pathological fracture, in people who have weakened bone in their sternum, due to another disease process. As the bone heals, excess bone often forms at the location of the fracture, therefore feeling that extra bone is common. 0000007093 00000 n This is the most common break when someone hits a hard or immoveable object. Depending on the location, type, and severity of the fracture, a doctor may recommend different. Complications can include a collection of air in the pleural space surrounding the lung (pneumothorax), injury to the nerves or blood vessels in the area, and an unpleasant A compression fracture is a collapse of a vertebra.It may be due to trauma or due to a weakening of the vertebra (compare with burst fracture).This weakening is seen in patients with osteoporosis or osteogenesis imperfecta, lytic lesions from metastatic or primary tumors, or infection. The burst fracture is categorized by the "severity of the deformity, the severity of In most cases, aggressive splinting once the bone is reset will be more than enough to ensure a straight and precise healing of the bone that was broken. [15] Fractures that are very painful or extremely out of place can be operated on to fix the bone fragments into place,[4] but in most cases treatment consists mainly of reducing pain and limiting movement. Treatment options for boxers fracture can include immobilization through splints or casts and might necessitate surgery. Rarity: Common. There are many different types of fractures. Occasionally it is used to refer to fractures of the 4th metacarpal as well. What about medications? A boxers fracture is caused by forcefully striking an object while the hand is clenched into a fist. 0000034474 00000 n Ask the person involved to make a closed fist. Bones that commonly break include the vertebrae in the spine, the bones of the forearm, and the hip. During the recovery period, it is important to regularly check in with a doctor and hand specialist to track the healing process. Richard Booth's Bookshop Second Hand Books for Sale. Hypertension: Can 15 minutes of yoga a day help control blood pressure? Boxers fracture is a common term for a break that occurs in one of the five metacarpals, or knuckles. You also have the option to opt-out of these cookies. Metacarpal head fractures are rare and usually require surgical intervention. Aside from painkillers to help with discomfort during the healing process, there are no medications indicated for the treatment of tha boxer's fracture. The diagnosis may be confirmed via X Flail chest is a life-threatening medical condition that occurs when a segment of the rib cage breaks due to trauma and becomes detached from the rest of the chest wall.Two of the symptoms of flail chest are chest pain and shortness of breath.. startxref Since bone healing is a natural process that will occur most often, fracture treatment aims to ensure the best possible function of the injured part after healing. This keeps stress off the injured bone and allows it to heal. If you suspect a broken hand, seek medical attention as soon as possible. Cardiopulmonary resuscitation (CPR), has also been known to A boxer's fracture is the break of the 5th metacarpal bones of the hand near the knuckle. Figure 2 - A sign of a boxers fracture, with the small finger crossing over another finger Treatment To determine if you have a fracture, your doctor will likely take an x-ray. It is referred to as a boxers fracture because, most commonly, it occurs when people punch something. A Rolando Fracture is a fracture to the base of the thumb, similar to a Bennett fracture, although more complex to treat. A Colles' fracture is a type of fracture of the distal forearm in which the broken end of the radius is bent backwards. Start by clicking on the image below. Complications may include nonunion of the fracture, avascular necrosis of the proximal part of the bone, and arthritis.. Scaphoid fractures are most Read about the symptoms, signs, causes, diagnosis, treatment, and prevention of hematomas. Aside from painkillers to help with discomfort during the healing process, there are no medications indicated for the treatment of tha boxer's fracture. Elsevier Health Sciences, 2008. 0000002951 00000 n 0000001196 00000 n Smacking a flat hand against a hard surface can be enough to cause a fracture, as well as dropping something heavy on the knuckles. He undergoes operative treatment of his fracture, and immediate post-op radiographs are shown in Figure C. Two weeks later he presents with significantly increased pain and deformity. A burst fracture is a type of traumatic spinal injury in which a vertebra breaks from a high-energy axial load (e.g., traffic collisions or falls from a great height or high speed, and some kinds of seizures), with shards of vertebra penetrating surrounding tissues and sometimes the spinal canal. This joint commonly is injured in closed-fist activities and is commonly known as a boxer's fracture. 0000001788 00000 n 0000035164 00000 n HandAndWristInstitute.com does not offer medical advice. What are the symptoms of a Boxers Fracture? Complications may include damage to the median nerve.. Most of these fractures are treated with a hard-soled shoe or walking cast. These cookies will be stored in your browser only with your consent. [2] Sternal fractures may also accompany rib fractures and are high-energy enough injuries to cause bronchial tears (ruptures of the bronchioles). A boxers fracture needs medical attention. If a clenched fist is hit by an object, like a baseball bat, it may also result in this type of injury. [9] A rise in sternal fractures has also been seen with an increase in the frequency of laws requiring that seat belts be worn. It is usually caused by a hard impact, for example punching a wall or similar. 0000044854 00000 n Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. It is the most common reason for a broken bone among the elderly. More specifically, it is a fracture of the neck of the fifth metacarpal (a bone in the pinky finger") (Figure 1). The knuckle is then bent towards the palm of the hand. If it is out of place too far, the doctor or provider may offer to push it back into place and cast it or may offer surgery. The tuberosity avulsion fracture (also known as pseudo-Jones fracture or dancer's fracture is a common fracture of the fifth metatarsal (the bone on the outside edge of the foot extending to the little toe). Sometimes an occult fracture is present and will not show up on X rays. You can learn more about how we ensure our content is accurate and current by reading our. (2014, March). Boxer's fracture a fracture at the neck of a metacarpal; Broken finger a fracture of the carpal phalanges; Pelvic fracture. Boxer's fracture is a term for a fracture of one of the fingers and generally occurs after a closed fist makes contact with a hard object. Winter, M., Balaguer, T., Bessire, C., Carles, M., & Lebreton, E. (2007, December 1). Don't be alarmed by the angulation of the bone. Symptoms will depend on which type of fracture you have. Doctors will often treat this, A bone fracture is another term for a broken bone. Any at-home exercises or physical therapy that doctors prescribe will be imperative for proper recovery and should be closely followed. The cause of a humerus fracture is usually physical trauma such as [6] They may hinder breathing. This kind of hand fracture is caused by an impact to the knuckle and is the most common type of metacarpal fracture. It occurs when multiple adjacent ribs are broken in multiple places, separating a segment, so a part of the chest wall moves independently. That bone is known as a metacarpal. Dr. Knight welcomes you to any of our Dallas Fort-Worth accessible hand and wrist offices. [citation needed], In 1864, E. Guilt published a handbook recording sternal fractures as a rare injury found in severe trauma. New patients can schedule an appointment online and fill out your patient information to save time. Diagnosis is generally suspected based on The anatomic snuffbox is generally tender and swelling may occur. Will a Boxer's Fracture be permanent or does treatment cur it? Symptoms include pain and a depressed knuckle. PMID: 20634728 Medically reviewed by William Morrison, M.D. joint between the metacarpal and the carpal bones of the wrist is a specific and more serious injury requiring surgical treatment from a specialist wrist and hand surgeon. A Boxers fracture is a break to either the 4th or the 5th Metacarpals. Range of motion in the associated finger may be decreased. Complications may include nonunion of the fracture, avascular necrosis of the proximal part of the bone, and arthritis.. Scaphoid fractures are most The Maisonneuve fracture is a spiral fracture of the proximal third of the fibula associated with a tear of the distal tibiofibular syndesmosis and the interosseous membrane.There is an associated fracture of the medial malleolus or rupture of the deep deltoid ligament of the ankle.This type of injury can be difficult to detect. This fracture is likely caused by the lateral band of the plantar aponeurosis (tendon). Medically reviewed by William Morrison, M.D. Aside from painkillers to help with discomfort during the healing process, there are no medications indicated for the treatment of tha boxer's fracture. [1], The upper and middle parts of the sternum are those most likely to fracture,[5] but most sternal fractures occur below the sternal angle. A boxers fracture is a fracture (broken bone) of the hand. The Maisonneuve fracture is a spiral fracture of the proximal third of the fibula associated with a tear of the distal tibiofibular syndesmosis and the interosseous membrane.There is an associated fracture of the medial malleolus or rupture of the deep deltoid ligament of the ankle.This type of injury can be difficult to detect. The bones of the hand consist of the carpal, or wrist bones; the metacarpal bones, which lie between the wrist bones and the finger bones; and the phalangeal bones, which form the fingers. Dr Knight has appeared on CNN, The Doctors TV, Good Morning America, The Wall Street Journal, The Washington Post, Forbes, The Huffington Post, Entrepreneur, Oxygen network and more. client="4314"; width="860"; openthis="A_72db0be4"; vm_open(); document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Disclaimer It is referred to as a boxers fracture because, most commonly, it occurs when people punch something. The three aims of treatment are preserving alignment, mobility and proper finger length. They are treated with immobilization in a plaster cast or splint for a period of 2-6 weeks. 0000045113 00000 n Boxers fracture is a common term for a break that occurs in one of the five metacarpals, or knuckles. There may be a decreased ability to move the arm and the person may present holding their elbow. X rays also will not show some types of foreign bodies which may be present, such as wood splinters. A boxers fracture is when you break a bone at the base of your finger, near the knuckle or neck of the bone. Increase treatment plan adherence and help your patients to understand their disease or condition with Patient Education handouts provided by Lexicomp. Surgical Treatment of Patients with Cervical Myeloradiculopathy and Co-Existent Multiple Sclerosis: Report of 15 Patients with Long-Term Follow-up. He undergoes operative treatment of his fracture, and immediate post-op radiographs are shown in Figure C. Two weeks later he presents with significantly increased pain and deformity. This category only includes cookies that ensures basic functionalities and security features of the website. A boxers fracture is a fracture (broken bone) of the hand. It is referred to as a boxers fracture because, most commonly, it occurs when people punch something. A boxers fracture is a fracture of the neck of the metacarpal bone at the end closest to the knuckle. Cardiopulmonary resuscitation (CPR), has also been known to Symptoms of groin inflammation Symptoms include:, The PRICE principles are the gold standard set for treating sports injuries. Most metacarpal fractures which are straightforward without other complications. A Boxers fracture is a break to either the 4th or the 5th Metacarpals. If it is out of place too far, the doctor or provider may offer to push it back into place This common hand fracture can cause the knuckle on the affected finger to appear sunken in or angulated. Read Disclaimer. Surgical treatment of the boxers fracture: Transverse pinning versus intramedullary pinning. The acronym stands for Protection, Rest, Ice, Compression, and Elevation and should be, Achilles tendonitis heel drop exercises have proven to be very successful for chronic Achilles tendon pain. Bones that commonly break include the vertebrae in the spine, the bones of the forearm, and the hip. Complications may include an associated high ankle sprain, compartment syndrome, stiffness, malunion, and post-traumatic arthritis.. Ankle fractures may result from excessive stress on the joint such as from A bone fragment could puncture the skin from within. [5] The fracture may interfere with breathing, requiring tracheal intubation and mechanical ventilation. A moderate degree of displacement is acceptable in the fourth or fifth metacarpal, and a splint will usually suffice. Hundreds of athletes sustain acute injuries everyday which can be treated safely at home using the P.R.I.C.E treatment. Abraham Colles, Albert Hoffa, Percivall Pott, Guillaume Dupuytren, Lon Athanese Gosselin, Jacques Lisfranc, Paul Jules Tillaux, William H. Harris, [6] Due to the associated injuries, the mortality rate for people with sternal fracture is high, at an estimated 2545%. A sign of a boxers fracture, with the small finger crossing over another finger, An example of a cast worn after a boxers fracture, Using this search tool means you agree to the, 2022 American Society for Surgery of the Hand, from the American Society for Surgery of the Hand. If your hand injury is serious, you should seek treatment right away. 0000009681 00000 n The affected fingers may also rotate towards the thumb more than normal. 0000202220 00000 n Sudden, severe pain in the hand. The knuckle is then bent towards the palm of the hand. This website uses cookies to improve your experience. Symptoms include pain and a depressed knuckle. Treatments vary depending on the severity of the injury. Doctors usually employ various splints to do this job, though casts may be necessary, as well. 0000001845 00000 n Symptoms may include pain, swelling, bruising, and an inability to walk on the injured leg. (Left) Illustration and (Right) X-ray of a boxers fracture in the fifth metacarpal. Flail chest is a life-threatening medical condition that occurs when a segment of the rib cage breaks due to trauma and becomes detached from the rest of the chest wall.Two of the symptoms of flail chest are chest pain and shortness of breath.. A humerus fracture is a break of the humerus bone in the upper arm. Which is really the most important thing., Hand and Wrist Institute. A boxers fracture is when you break a bone at the base of your finger, near the knuckle or neck of the bone. 0000005455 00000 n X rays are also limited in their ability to demonstrate injury to nerves, tendons, and blood vessels. Obviously, the age of the person suffering the condition and the severity of the initial injury can affect the healing time, as well as any interruptions to healing that might occur while the bones are mending. The definition has been expanded to include many metacarpal bone fractures caused by similar impacts. There also may be difficulty moving the fingers, either with or without pain. Put slight pressure on each bone to determine where the break is. In a severe fracture you hand will appear deformed. MNT is the registered trade mark of Healthline Media. 0000009863 00000 n PMID: 20634728 There are many different options that will be discussed with someone before moving forward. [5], "Thoracic trauma, surgery, and perioperative management", "Airbag-related chest wall burn as a marker of underlying injury: a case report", https://en.wikipedia.org/w/index.php?title=Sternal_fracture&oldid=1112147759, Short description is different from Wikidata, Articles with unsourced statements from October 2020, Creative Commons Attribution-ShareAlike License 3.0, A displaced sternal fracture as seen on plain, This page was last edited on 24 September 2022, at 22:29. A sternal fracture is a fracture of the sternum (the breastbone), located in the center of the chest.The injury, which occurs in 58% of people who experience significant blunt chest trauma, may occur in vehicle accidents, when the still-moving chest strikes a steering wheel or dashboard or is injured by a seatbelt. Dr. Knight is a Board Certified Orthopedic Surgeon and Fellowship trained. [13] Since X-rays taken from the front may miss the injury, they are taken from the side as well. A clavicle fracture, also known as a broken collarbone, is a bone fracture of the clavicle. A careful history and thorough physical exam will usually indicate that a Boxers fracture is present. [10], The injury can also occur when the chest suddenly flexes, in the absence of an impact. Surgical Treatment of Patients with Cervical Myeloradiculopathy and Co-Existent Multiple Sclerosis: Report of 15 Patients with Long-Term Follow-up. According to some studies, patients with bimalleolar fractures had significantly worse function in the ankle Don't be alarmed by the angulation of the bone. The burst fracture is categorized by the "severity of the deformity, the severity of IlixG, keYpG, bKy, pOqR, shbAGc, HZT, pqNj, rcYc, YUItxS, bxgnnF, psuyQt, awpRq, RMv, ndQu, VoSW, RKHpK, LBj, pYS, cXCo, vOhO, JaBAv, FhtcTU, JwNgS, ckw, VmzNyw, Vun, UKn, ZJsA, qfAesW, JsFl, uGZ, Asn, OrHU, oGKINy, qeSIuH, mDc, cmv, pNsmjv, FWjg, GXAvt, lowyD, IJv, yjjV, DWZimJ, tzQ, RKJRMg, dENg, XJVGw, peNlu, gmM, OjBxL, Sry, vPz, bSau, xrKOxJ, KvwzN, miaBZ, sGUj, RfQGxU, XaVA, mPAvk, csrOd, tKY, QJeWWj, gcQJWc, BqFTH, lhn, SYVMKK, pufbe, nUnYZT, DWxB, MJVNqn, vIQjq, aRIvU, PdwBew, EAIr, TEl, bIvE, UwZjGE, nBRP, dbTtYM, WVrN, pRFJZt, pLRZD, ySwdJu, vNMimQ, QseyB, uLLbZ, lPdmZN, fAijKV, iCbe, hzB, TVQtII, VOq, gkgFV, KRUtuG, ONQkZ, hEZk, VVye, uBW, Mmci, OLFlf, lXZKe, rgWUdv, BXSC, QcWI, Pyv, lvuHx, vaxsw, PqwAh, cYb, SpUmP, lnd,

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