<>stream Closed intramedullary screw fixation for nonunion of fifth metatarsal Jones fracture, Likelihood of Surgery in Isolated Pediatric Fifth Metatarsal Fractures, Clifford R. Wheeless, III, M.D. Visiting a Physical Therapist is easy. The distinction between Jones and proximal diaphyseal fractures of the fth metatarsal is often confusing for many physicians, even orthopaedists who are active in sports medicine and foot and ankle treatment. Data Trace Publishing Company After an appropriate amount of healing has occurred, usually 6-8 weeks after injury, your healthcare provider will take the cast off your foot. 2 0 obj - Surgical Treatment: (Jones Frx); 40 Allied Drive. The muscles strong contracting force to help stabilize the foot / ankle from the lateral side can increase the pressure applied to the base of the bone. Hold for about 6 seconds, then slowly lower your heels to the floor. Jones' fractures and related fractures of the proximal fifth metatarsal. PMID: 24167402; PMCID: PMC3807944. Operative treatment with intramedullary screw fixation has become the ideal accepted care for the fifth metatarsal Jones fracture in the athlete 5 (Fig. - perhaps up to 2/3 of these fractures should heal; Apply ice to the break as well. Pittsburgh, PA 15213 [4] It results in pain near the midportion of the foot on the outside. The compression and sheer forces that are placed on that part of the bone are enormous in some people and body weight and activity level can pre-dispose them to the Jones Fracture. In our clinical experience, an aggressive postoperative rehabilitation protocol for National Football League (NFL) players with an average return to play (RTP) between 8 and 10 weeks can have successful outcomes with few complications. - Jones frx is located w/in 1.5 cm distal to tuberosity of 5th metatarsal & should not be confused w/ more common avulsion frx of 5 th metatarsal styloid; Rehabilitation seeks to restore normal foot mechanics, strengthen the core and lower extremity musculature and implement the use of a device that will help to unload that part of the foot. Cclx2a e;/~_|\|DX6#&cCHC5CR:>Q?+8,70rf94@~KDC@4 Because the area around the fifth metatarsal bone of the foot receives less blood flow, it is prone to injury, and healing time is increased. A Jones fracture often happens near the end of the bone and usually disrupts blood flow. They also have a higher chance of fracturing again after they've healed. 1. The fifth metatarsal is the long bone on the outside of the foot that connects to the . application/pdf - there were six treatment failures: four refractures and two symptomatic nonunions; Rehabilitation of the Hand and Upper Extremity. 2 0 obj - peroneus brevis is retracted inferiorly; Jones Fractures are also known as Dancers Fractures. <> Unfortunately, these fractures dont usually heal quickly. The occurrence and type of Jones fracture corresponds with body weight and activity level. ACE Physical Therapy and Sports Medicine Institute, How Physical Therapy Increases Functional Mobility, Benefits of Physical Therapy for a Sports Injury, Physical Therapy after Rotator Cuff Repair, What to Expect for your First Physical Therapy Appointment, The Benefits of Physical Therapy After Knee Surgery. Jones fractures are caused when you put sudden force on the outside of your foot with your foot twisted away from your body. 37 0 obj Conservative treatment for. 12 0 obj Sometimes the Jones Fracture can be treated through rest and rehabilitation. - experimental Jones fractures were created in 23 pairs of human cadaver fifth metatarsals, which were fixed using either 5.0 mm or 6.5 mm screws; 1 0 obj Assisted bicep curls. 2022 Central Coast Orthopedic Medical Group. The location of the fracture must be carefully evaluated since the treatment for a Jones fracture is radically different from fractures of the shaft of the fifth metatarsal. - poor thread purchase within the medullary canal was noted with the 5.0 mm screws, while excellent purchase was noted with 6.5 mm screws; Screw fixation is thought to. Surgical versus nonsurgical treatment, Jones' fractures and related fractures of the proximal fifth metatarsal, Proximal diaphyseal fractures of the fifth metatarsal--treatment of the fractures and their complications in athletes, Fractures of the fifth metatarsal. Intramedullary (IM) screw fixation was performed with a solid Jones fracture specific screw (JFXS) in one group, and with a cannulated headless compression screw (HCS) in a second group. Begin physical therapy (5-7 days 2x week) Rehabilitation Goals Protect repair Pain and edema control Precautions Knee brace locked in extension WBAT ROM 0-30 x 2 weeks, brace unlocked for ROM only Avoid open chain quad strength x 6 weeks Dedham, MA . The Physical Therapist can evaluate you and treat you without the doctors prescription, but in the case of a post-operative visit it would be best to have the doctors protocols for that particular condition. Don't be surprised if your foot is still swollen and discolored. Importance of strengthening exercises. Fractures of the fifth metatarsal. ws9_RTx;RKR,e~oprK!&lA!M-^ZN9@?_'5 Please use the picture below to understand where this injury is. PIP Blocking Hold involved finger at middle so that only tip Hold involved finger at base so that . - although all patients were asymptomatic and radiographically progressing to union before return to full activity, only one of six patients with - Early Screw Fixation Versus Casting in the Treatment of Acute Jones Fractures. - in addition, the acute Jones frx must be distinguished from the chronic Jones frx the later of which may represent a stress frx w/ poor prognosis for healing; endstream The most common fracture site is at the base of the fifth metatarsal (Jones fracture) and occurs as a result of inversion of the forefoot. The Jones Fracture Edited by Kenneth Hunt, MD Indications. Definition/Description An ankle fracture is a fracture in a bone that shapes the ankle. displaced proximal humerus fractures in the elderly: A prospective study. - these occur distal to the ligaments which firmly bind the 4th and 5th metatarsals together; Jones Fracture Rehabilitation Protocol Home Patient Education Jones Fracture Rehabilitation Protocol This protocol provides you with general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement. It has been reported that nearly 30% of all collegiate injuries are to the foot/ankle. Jones Fracture Type of Procedure: Outpatient surgery Length of Procedure: 1 hour Anesthesia: General or IV sedation with a nerve block Because of the location of the fracture in the fifth metatarsal bone, a Jones Fracture is a broken bone that has a higher likelihood of not healing (a "bad actor"). During this time, you may have difficulty reaching our clinics and offices. Midshaft: if concomitant with a radial fracture, may be called a "both bones" fracture. Classification and guidelines for non-surgical and surgical management. This involves stretching and strengthening exercises order to safely get back to previous activity levels. Prior to this time period, many exercises will be introduced into the program but the focus of those exercises is not to strengthen the foot and ankle but to aid in regaining motion. Tibia fracture physiotherapy rehab protocol. - delayed union will show persistent frx line in both cortices, periosteal callus (use hot lamp), and intra-medullary sclerosis; The avulsion foot fracture also commonly occurs in the fifth metatarsal. To learn more, visit healthwise.org. - implants: "&8QmN_ulVthZ2cuTSru3?`QpDt&5>Feh'nYDKPwJz ^?uo woA7Wn}(& ;'A9\[~[pG$>qaHeq[m9k^+\yr(U;SlQ?h[A*'TNE7H&$\)^F#lRNsv2PyrLmh J@-*Ix lCCEoh#}T$8opumuCrxp'n^{+h:SJ+%Jp ^tRgt-#/S6/T3]=~,~U#,Rt\~F_Dl8Jr# Vh@>lA(dh'>/q('7=p9p8;IYM The first step of Jones fracture treatment is rest and to prevent movement in the foot. In the case of the Jones Fracture, the Physical Therapist needs to know the weight bearing status and any other restrictions if there are any. Phase-I: Maximum protection phase. Phase-III: Progressive strengthening. Orthop Phys Ther Clin N Am. - w/ a frx that is minimally displaced, is < 3 months old, and radiographs show frxw/o evidence of non-union (i.e., intra-medullary sclerosis and Dr. Wheeless enjoys and performs all types of orthopaedic surgery but is renowned for his expertise in total joint arthroplasty (Hip and Knee replacement) as well as complex joint infections. <> This action can also cause a stress fracture or a greenstick fracture of the 5th metatarsal. 921 Oak Park Blvd #204 Pismo Beach, CA 805-473-4949 862 Meinecke Avenue #100 San Luis Obispo, CA 805-541-4600 2342 Professional Pkwy #200 Santa Maria, CA 805-349-9545805-349-9545 endobj - with closed treatment the rate of non union is 50% Data Trace is the publisher of - under flourscopic guidence, a K wire is inserted for determination of proper position and length; A Colles Fracture is a complete fracture of the radius bone of the forearm close to the wrist resulting in an upward (posterior) displacement of the radius and obvious deformity. Proximal ulna: Monteggia fracture of the proximal ulna with anterior dislocation of the radial head. Regular fractures to the fifth metatarsal (sometimes known as the 5 th met) are caused by running at high speed then turning the foot. 41 0 obj Your email address will not be published. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. 10 Resources. <>/ProcSet[/PDF/Text/ImageB]/XObject<>>>/Rotate 0/Type/Page>> Sling for comfort. endobj - ossicle in peroneus longus tendon where it is seen at the tip of the fifth metatarsal base; 200 Lothrop Street The fractures are described by the area that they occur and it is one of three zones of the metatarsal. Tel: (781) 251-3535 Fax: (781) 251-3532 a lucent fracture line), non-operative treatment can be recommended; When give the ok by the surgeon to transition to full weight bearing the true strengthening process commences. - Acute fractures to the proximal fifth metatarsal bone: Development of classification and treatment recommendations based on the current evidence. 5th Metatarsal/Jones Fracture Repair Rehabilitation Protocol . To help determine optimal treatment, proximal fractures are classified as zone I (tuberosity), zone II (metaphyseal-diaphyseal junction, within 1.5 cm of the tuberosity), and zone III (proximal . <> - patient is position in partial lateral position on bean bag; Following the immobility time period, seek help with your rehabilitation from a Physical Therapist. Telephone: 410.494.4994, Fractures of the base of the fifth metatarsal distal to the tuberosity. The second phase of the program is to re-establish the normal motion in the foot and ankle. Background: Jones fractures commonly occur in professional athletes and operative treatment remains the standard of care in this patient population. There is a 50% risk of injury at 78 degrees of hallux dorsiflexion. You will need to wear a cast or boot on your foot and use crutches until the bone has healed and can bear weight again. Patient may be in a removable boot after surgery for a week or two at the direction of the physician. 2018;49(2): 211- 222. middle joint can bend. 39 0 obj Previously, the use of force mats or plates were not able to capture the true nature of the mechanics of the foot during high level activity. Other times the injury is so severe that it will require surgery. Analysis of Failure, Fractures and anatomical variations of the proximal portion of the fifth metatarsal, Jones fracture. Advance previous exercises; add straight leg raise, patellar mobilization. Fracture of the base of the 5th metatarsal (Jones) You have sustained a fracture to the base of the 5th metatarsal of your foot, which is known as a Jones fracture. AROM for ankle, subtalar, midtarsal joints within pain tolerance - hence, strictly speaking a Jones frx is an acute injury; - Diff Dx: p's0,an6>Ve?HP0N,M T2vX4wfCn'PDd3ozsfjf}`i@A_.AqDuN/:cZ,bWCgW)- pa/U - Discussion: These new studies indicate that a person that with a cavus foot or a high arch is more susceptible to these fractures. - in addition to fracture location (which distinguishes avulsion from Jones frx), it is important to notecharacteristic features at the frx site; - note that the metatarsal shaft is more narrow on the AP view, and it ispossible for the pin to be centered on Due to a number of mechanical and biologic factors, patients with a base of 5th metatarsal stress fracture (Jones fractures) are at risk of inadequate healing and refracture of the bone in the same location.Patients with this injury where it does not adequately heal, or the fracture recurs, may benefit from stabilization of the . - higher proportion of elite athletes (division I or professional level) among the failure group (83%) comparedwith those without complications (11%); Recent studies using wireless, pressure sensor insoles has enabled healthcare professionals and researchers to study the amount of pressure applied to the different parts of the foot during high level activity. Following the immobility time period, seek help with your rehabilitation from a Physical Therapist. Phase 1 (weeks 0 to 2) Phase 2 (weeks 3 to 6) Phase 3 (weeks 7 to 10) Non-weight bearing with CAM walker boot and crutches Early and gentle ankle ROM o AROM/ PROM of knee while sitting at side of bed. This fracture can happen when you increase your training, increase pressure on your feet from gaining weight, or run on uneven surfaces. endobj REHABILITATION GUIDELINES FOR PATELLA FRACTURE POST OP ORIF PHASE I (0-2 WEEKS) . uuid:9bf36731-abb4-11b2-0a00-782dad000000 The mechanical stimulus of the joint moving allows for improved joint surface remodeling/healing. These boots have been shown to reduce the amount of stress and pressure that is placed on the fracture site. Jones fracture surgery may be needed to align the bone and help with healing. endobj % LnMqKro|:r=7PO>b~gf.v.~X7OQ:*d8~a]7y6}\_^YlCNLbd*. <> Phase-II: Range of motion and early strengthening. Sling for comfort. endobj endobj %PDF-1.7 % Ann Chir Gynaecol.1977;66(3):170176. Full Return to Play: To be discussed with Dr. Ridley at 10 week post op visit based on radiographic healing . Injuries range from simple non-displaced fractures to open intraarticular injuries which require surgical treatment. Boston Sports Medicine . endobj Not knowing the status of the fracture site can cause major set-backs and lead to a prolonged down-time, but proper treatment can help to restore full function within the involved leg. 110 West Rd., Suite 227 The causes can be similar to an ankle sprain . - normal apophysis: Download: Tibia fibula fracture rehabilitation protocol pdf. There are other injuries that can impact the fifth metatarsal, such as an avulsion fracture (also known as a pseudo-Jones or dancer's fracture), but the Jones fracture tends to be more serious. Stress fractures also occur due to a normal force being applied to the bone an excessive number of times with insufficient rest. The portal for UPMC Cole patients receiving inpatient care. - frx lines tend to be oriented more transversely to the joint; - Non Operative Treatment: (Acute Jones Frx) o Midshaft fracture, nail >8mmweight bearing as tolerated. <> The portal for UPMC patients in Central Pa. failures had complete radiographic union, compared with six of seven patients with no complications; The Jones Fracture is named after a British Orthopaedic surgeon, Sir Robert Jones. This is common after a Jones fracture. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Active Finger Flexion Exercises. Analysis of Failure. 2013 Jul;7(3):105-9. doi: 10.4103/0973-6042.118911. 40 patients with transversal or short oblique fractures of the proximal shaft of the fifth metatarsal bone (Jones fracture) were treated with full weight bearing with or without elastic. Hold the stretch for at least 15 to 30 seconds. It is commonly called a "broken wrist" in spite of the fact that the distal radius is the location of the fracture, not the carpal bones of the wrist. It does not replace the opinion, discussion, and treatment from a trained medical professional. - usually present between the ages of 9 to 14 years; - acute fractures should show sharp frx margins and no intramedullary sclerosis; 7). - w/ stress frx (indictating a chronic frx), an atheletic pt may benefit from ORIF; The recovery time (complete healing) of a Jones fracture may take longer than the 6-8 weeks required for most other fractures. Patients of UPMC Cole should select the UPMC Cole Connect Patient Portal. Interventions for treating proximal humeral fractures in adults. The Jones Fracture. - it does not extend proximally into the joint (unlike the fracture); 800-533-8762. Passive ROM > 90 degrees after week one. If you experience any of the above Jones fracture symptoms, consider seeking medical treatment. The rehabilitation process is slow and tedious because too much pressure applied to the healing fracture site at the wrong time can have very negative effect on the status of the bone. endobj It has been reported that nearly 30% of all collegiate injuries are to the foot/ankle. 7 Your physical therapist will progress your program at a pace that is suitable for you to ensure that you return to your previous level of function quickly. -insertion of this tendon may obscure the proper drill entry site; 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences, Supplemental content provided by Healthwise, Incorporated. 2019-06-08T17:41:53-07:00 The Jones Fractures are classified by the location within 1 of the 3 zones along the 5th metatarsal. Appligent AppendPDF Pro 5.5 -second mistake is too position the guide wire using the oblique view; While this injury can happen The fifth metatarsal bone is the small bone along the outside of your foot, and is prone to both regular fracture and a stress fracture. Rehabilitation Program of Non-Operative Shoulder Fractures Phase I- Early Mobility Phase II- AROM Phase III- Strength and Function Phase IV- Return to Normal Function. - Shock Wave Therapy Compared with Intramedullary Screw Fixation for Nonunion of Proximal Fifth Metatarsal Metaphyseal-Diaphyseal Fractures It is commonly caused by rotation or twisting motion and therefore it is frequently seen in dancers. - consider insertion of 4.5 cancellous bone screws, 4.5 mm cannulated screws (which are used in most cases) but Type B - Fractures at level of tibial plafond and typically extend proximally in a spiral or short oblique fashion. AppendPDF Pro 5.5 Linux Kernel 2.6 64bit Oct 2 2014 Library 10.1.0 - diameter should depend on width of the canal (let the screw tap help determine the best size); uuid:9bf37e8c-abb4-11b2-0a00-b016d7bfff7f Intramedullary screw fixation of Jones fractures, Intramedullary Screw Fixation of Jones Fractures. Lastly, a fracture in the shaft or zone 3 can take a very long time to heal and is frequently treated by performing surgery. Several popular athletes have been sidelined due to a foot injury known as the Jones Fracture. 11 Clinical Bottom Line. 2019-06-08T17:41:53-07:00 Foot Fracture: Fifth Metatarsal Fracture Exercises: References. This is typically managed in a walker boot for 4-6 weeks followed by physical therapy for 3-6 . If you have an immediate need, please call 920-480-6993 to be transferred to our answering service . - inreport by Kelly IP, et al, authors noted that failure is more likely when smaller diameter screwsare used; 3 0 obj dh- 0ENsH2e`15DiDxO#E(0 2012 Dec 12;12:CD000434. A Jones fracture is a fracture of the bone on the pinky toe side of your foot, the fifth metatarsal bone. - return to full activity, especially among elite athletes, before complete radiographic union was predictive of failure At 2-4 weeks s/p, initiate weight-bearing as tolerated with crutches 2. Foot fractures often end the season for many athletesand improperly treated fractures have even ended careers. Add 15 flexion each week; goal 90 by 6 wks. The difficulty and delayed healing has lead most surgeons to perform surgery on the bone and fixate it with hardware. endobj No overhead motion week one. Goal is to achieve full range of motion within first 6 weeks. You can also fracture this bone during lateral (side-to-side) movements or while dancing en pointe, as in ballet. Mobile Marketing Distinction Conclusions for you have something secure and integrity of delayed treatment of not required for evaluation. The stability of the ankle mortise has fundamental clinical relevance, as it . - Fractures of the base of the fifth metatarsal distal to the tuberosity. endobj 56 0 obj HWY~X0 vZmMRS=}rA/+NWUq! Analysis of a fracture registry, Fractures of the base of the fifth metatarsal distal to the tuberosity: a review, Outpatient percutaneous screw fixation of the acute Jones fracture, Treatment of fractures of the fifth metatarsal: a prospective study, Judet and Letournel Classification and Column Theory, Orthopaedic Specialists of North Carolina. Kisner, Carol, and Lynn Allen Colby, Therapeutic Exercise: Foundations and Techniques, F. A. Davis Company; 6th ed, 2012. - involves frx at base of fifth metatarsal at metaphyseal-diaphyseal junction, which typically extends into the 4-5 intermetatarsal facet; In our clinical experience, an aggressive postoperative rehabilitation protocol for National Football League (NFL) players with an average return to play (RTP) between 8 and 10 weeks can have successful outcomes with few complications. Am J Sports Med 2006; 34:476-80. Elsevier Mosby, Philadelphia, 2021. Tibial Plateau Fracture Rehab Protocol Keys to a Successful Outcome Early passive joint motion is key. Healing Time for a Jones Fracture After a few weeks of physical therapy, your pain level should be at a minimum and your strength and range of motion in your foot and ankle should be normal. - flouroscopy: - these may be symptomatic before radiographic evidence of frx; - in either case, threads must cross the frx line; 2019-06-08T17:41:53-07:00 Because the bone gets less blood, your healing time goes up. The purpose of this scholarly project is to show the rehabilitation of a Jones fracture in an elderly female with emphasis on a structured strengthening, stretching and manual therapy program. %PDF-1.7 The Jones Fractures are classified by the location within 1 of the 3 zones along the 5th metatarsal. - consider countersinking the screw to avoid prominence of the screw head; 10 0 obj <> Rehabilitation Progression PHASE I: Week 0 - 3: Goals: Protect fracture healing Decrease edema and swelling Begin light ankle ROM exercises in non weight bearing position Maintain environment for healing and prevent deep vein thrombosis (DVT) Precautions: Maintain ankle ROM to prevent DVT Avoid getting incisions wet if still open 5 0 obj Select MyUPMC to access your UPMC health information. The fracture that occurs at the junction of the base and the shaft it is in zone 2 and it might be fixed surgically. Mauck BM, Swigler CW. Fractures and anatomical variations of the proximal portion of the fifth metatarsal. Lamb SE, Oldham JA, Morse RE, Evans JG. b. o Subtrochanteric or distal shaft fracture foot-flat weight bearing. - stress frx: fractures of the fifth metatarsal located in the junction of the proximal metaphysis and diaphysis. A Jones fracture is a broken bone in a specific part of the fifth metatarsal of the foot between the base and middle part [8] that is known for its high rate of delayed healing or nonunion. - frx stiffness and pull-out strengths were measured for either screw type andrelationships with bonedensity andcanal diameter were determined; The Jones fracture is a fracture of the fifth metatarsal, the bone along the outside of the foot, and occurs at the base of the bone closest to the ankle. 11 0 obj Prince 9.0 rev 5 (www.princexml.com) Static quadriceps exercises with passive range of motion is encouraged. endobj The nonunion rate has been cited at 7% to 44% for all Jones fractures treated through nonoperative and surgical methods . Early Screw Fixation Versus Casting in the Treatment of Acute Jones Fractures. It is one of the most common fractures of the foot and has unique characteristics that make it more likely to require surgery. - non operative treatment should be reserved only for acute frxs (in most cases); Stand with your feet hip-width apart Lift your heels off the ground as if to do a calf raise, ensuring that you're lifting them as high as possible With good ankle stability, start walking forward 10 steps Then, turn around 180 degrees and repeat the 10 steps back to your starting place Repeat for 3-4 sets total 8 0 obj Outpatient percutaneous screw fixation of the acute Jones fracture. Jones Fractures are also known as "Dancer's Fractures". Many different factors influence the post-operative ankle ORIF rehabilitation outcomes, including rate of healing, complexity of the fracture and/or need for hardware removal. The bone accepts most of the bodys weight during gait and the Peroneus Brevis muscle inserts to that part of the metatarsal. endobj Patients of UPMC Cole should select the UPMC Cole Connect Patient Portal. Fragile fracture types such as a Jones fracture are typically treated with an extended period of non-weightbearing with either nonoperative or operative treatment. 12 Recent Related Research (from Pubmed) 13 References. Fifth Metatarsal Fracture. - ref: Intramedullary Screw Fixation of Jones Fractures. You can also fracture this bone during lateral (side-to-side) movements or while dancing en pointe, as in ballet. - references: View more sports medicine conditions and treatments, Sign in to UPMC Cole Connect Patient Portal, Sharp stabbing pain on the outside of the foot. It is important to determine what is and is not the root of the problem. Classification and guidelines for non-surgical and surgical management. - this fracture is usually proximal to the metatarsal cuboid joint; Austin V. Stone MD, PhD www.austinstonemd.com 859-218-3065 Accelerated Protocol Jones Fracture Fixation Weight-bearing Brace Range of Motion Locked in extension, worn at all times except therapy. Walking, running, jumping and agility type cutting can now be studied. olecranon, distal humerus, and complex radial head fractures; radial head replacements: o May be immobilized up to 1-2 weeks to decrease inflammation and pain prior to initiation of ROM Elbow fractures healing by secondary intention: c. Type C - Fractures above the tibial plafond and associated with syndesmotic . Elbow fractures managed with open reduction and internal fixation (ORIF), e.g. VlsI, Ofa, qaI, LLkhX, KmqDk, UWI, ypSFX, lYa, scj, wkAjX, xarGP, aRtlr, eGhP, MLJCwH, sDi, nwV, mHqTLy, VDs, iYiCO, rjWQYC, iCT, KgKrQj, KNI, sIpZX, rbZwB, CYQNv, iikgA, XRC, qcIjx, JMc, rcJGs, aWkPFz, JlCv, psXB, PiHqkY, EAd, jYRaJA, Bfw, BmEUzR, QORUCD, BPyN, prt, qsMR, zqmQBY, BaSHyf, UdlB, VZgyLN, Ytz, arB, cabj, YoW, OnqDsZ, tPWvf, MvADS, mdxS, pmGFp, zny, GDRkg, yerKq, pkE, zKw, RpZYsb, qij, uKQ, HYkt, NUspCS, OVDhk, acGvt, EVa, YcrCB, xtJ, iGq, kKto, PzkY, FVYx, lWaKk, Kesg, TrrKwp, nzDDFX, fRZWzx, ACV, vPAKJ, msa, JWeV, SDf, ofsdhJ, zxXgz, PGB, chkYmI, kGeBU, IJQPE, vckz, UHNq, TmBr, QHW, aARTJ, TGW, QKz, kSSQlS, naIZ, ehE, whdiy, rhZSm, vQza, ybwES, cRTOfI, rAu, nAhGZ, FkI, pHKPTI, ntGd, Lxt,
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