Keywords: A Jones fracture is often mistaken for a sprain or an avulsion fracture. After a Jones fracture and wearing a cast on your foot and ankle, your ankle and foot joints may have become tight. An avulsion fracture occurs when a tendon or ligament pulls a small fragment of bone from the main bone. Foot Ankle Spec. Epub 2016 Jun 11. Following the doctors recommendations and guidelines will increase the chance of a successful recovery. They may also take pain killers to help with any pain. There are three types of fifth metatarsal fractures that doctors classify into three zones. However, the area of the bone that is fractured has a relatively poor blood supply, so bone healing may be slowed. Operative treatment with intramedullary screw fixation has become the ideal accepted care for the fifth metatarsal Jones fracture in the athlete 5 (Fig. Overall, patients with avulsion fractures have excellent outcomes and weight bearing as pain allows with a supportive device is usually recommended. Limit unnecessary walking or standing for the first week to control swelling and pain. This can either be a stress fracture, which is a tiny hairline break that occurs overtime, or an acute break that is caused due to a sudden traumatic impact. If the fracture does not appear to be healing, then a doctor may recommend surgery. A Jones fracture is often caused by a forceful blow to the bottom or outside part of your foot. Copyright 2021 Elsevier Ltd. All rights reserved. view and guidelines on treatment of base of 5th metatarsal fractures [6, 14, 21, 25, 33] but to date, to the authors knowledge, there has never been a systematic review detailing treatment in different types of Jones fracture in the modern literature. 2020 Nov;41(11):1325-1334. doi: 10.1177/1071100720938317. The fracture occurs especially in highly active individuals. People should also seek urgent medical attention if any of the following symptoms occur: A medical professional can determine whether a person has a Jones fracture or another type of metatarsal fracture and can provide appropriate treatment. If you have injured your foot or if you have developed these symptoms, it is important that you visit your healthcare provider or emergency department immediately. For instance, you can use the RICE method to reduce pain and swelling. A retrospective review of 55 adult patients who sustained acute, closed Jones fractures was conducted. They may prescribe exercises to be done as part of a home exercise program. Doctors classify Jones fracture as zone 2. Hypertension: Can 15 minutes of yoga a day help control blood pressure? Fractures here are a painful experience and can limit your ability to walk normally and engage in work, recreation, and athletic activity. Return to play and performance after Jones fracture in National Basketball Association athletes. Conclusion. The screw crosses the site of the fracture and squeezes the ends of it together. A Jones fracture can occur when the foot twists. Diagnosis is made with plain radiographs of the foot. Alsobrook J, Hatch RL. Proximal fifth metatarsal stress fractures; screening and treatment for incomplete fractures. Physical Therapy for Iliotibial Band Friction Syndrome, Ankle Strengthening Exercises for Ankle Injuries, Causes of Heel Pain and Treatment Options, The Causes and Treatment of Foot and Ankle Stress Fractures, Walking gait before and after chiropractic care following fifth metatarsal fractures: a single case kinetic and kinematic study, Return to play and performance after Jones fracture in National Basketball Association athletes, Proximal fifth metatarsal stress fractures; screening and treatment for incomplete fractures, Fifth metatarsal fractures and current treatment, Early weightbearing protocol in operative fixation of acute Jones fractures, Diagnosis and management of common foot fractures, Wolff's law in action: a mechanism for early knee osteoarthritis, A multidisciplinary approach to scars: a narrative review, Swelling on the outside part of your foot, Difficulty walking or bearing weight on your foot, Ankle range of motion and stretching exercises, Foot mobility exercises, like towel grabs with your toes. Anyone who suspects they have a fracture should talk with a foot and ankle specialist as soon as possible. Biz C, Zamperetti M, Gasparella A, Dalmau-Pastor M, Corradin M, de Guttry G, Ruggieri P. Muscles Ligaments Tendons J. Merck Manual. During the procedure, the surgeon uses X-rays to ensure proper screw placement. Often, a person will wear a boot or cast and initially attempt to keep their weight off the foot. Osteomyelitis occurs when bacteria or fungi enter tissue from the bloodstream, usually following injury or surgery. Once your physical therapist has gathered information about your condition, they will then work with you to develop an appropriate treatment plan. Epub 2019 Nov 28. J Multidiscip Healthc. We report the clinical results of patients treated without weightbearing restriction. A Jones fracture can be a painful injury and can limit your ability to move around normally. It usually occurs after jumping up and landing forcefully on your foot. Sometimes, the simple act of running can cause microtrauma to the fifth metatarsal, and a Jones fracture may occur. PMID: 25666689, Lutter LD, Mizel MS, Pfeffer GB, Orthopaedic Knowledge Update: Foot and Ankle. The answer is that the area that usually breaks is where the bone changes from dense bone to spongy . A bone will break or fracture when a stress placed on the bone exceeds its ability to withstand stress. It is one of the most common fractures of the . Or it is from chronic overuse in most cases. Philadelphia, PA: Lipincott: 2004, Your email address will not be published. PMID: Dameron TB. In contrast to avulsion fractures, Jones fractures are prone to non-union (with rates as high as 30-50%) and almost always take longer than two months to heal 2 . However, some arduous tasks may cause discomfort. Rehabilitation Protocol for Ankle Fracture with ORIF This protocol is intended to guide clinicians through the post-operative course for an ankle fracture with ORIF. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Use a jones fracture depends on a foot fracture treatment. A doctor may initially recommend nonsurgical options, which may take 68 weeks to heal. 8600 Rockville Pike Fractures of the corpus ossis metatarsalis are generally fatigue fractures and are related to chronic stress. Of the 27 patients, 24 (89%) had achieved clinical union at a mean of 8.0 2.6 weeks. If massage, exercise, and other remedies do not work, surgery is an, Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. - 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; - frx stiffness and pull-out strengths were measured for either screw type and relationships with bone density and canal diameter were determined; This protocol results in rapid clinical union and a low rate of nonunion. 2018;17(2):106-116. doi:10.1016/j.jcm.2018.02.002, Begly JP, Guss M, Ramme AJ, Karia R, Meislin RJ. Specific to fracture is high forces acting on precise location of jones fracture treatment protocol and wearing a standardized protocol. Open reduction and internal fixation with the use of an intramedullary screw and supplemental calcaneal autograft is a successful treatment option for the management of Jones fracture nonunions. A Jones fracture is caused by a specific stressful or traumatic event. Conservative treatment requires immobilization in order to avoid motion across the fracture and keeping your foot non-weight bearing Our physicians and orthopedic surgeons vary in their preference of cast versus immobilization boot. Clipboard, Search History, and several other advanced features are temporarily unavailable. 2006;27:172-174. So what makes a Jones fracture different from other types of foot fractures? The patients were distributed into two groups according to the type of treatment: the group treated by a below-knee walking cast (CG) and the group managed by functional elasticated bandaging (FG) with the support of a flat hard-soled shoe. Content is reviewed before publication and upon substantial updates. A person with a Jones fracture may know they have injured their foot right away if the injury is sudden and causes immediate symptoms. A Jones fracture occurs when the bone known as your fifth metatarsal breaks. Mulcahey, M. K. (2021). The fracture may be a complete break in the bone, or it may be a thin crack in the bone. MeSH 2004-2022 Healthline Media UK Ltd, Brighton, UK, a Red Ventures Company. Supplements for heart health: Which ones are beneficial and which ones are not? A Jones fracture is a break in the fifth metatarsal, a bone of your foot that connects your pinky toe to the rest of your foot. Fifth metatarsal fractures and current treatment. Jones fractures can be treated either conservatively or with surgery. 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 Jones fracture: symptoms and diagnosis. 1995;3(2):1104. Complete radiographic union was noted in 13 (48%) patients, and 13 (48%) others had made significant progress toward radiographic union but had not yet reached it. Return to Weightbearing and High-Impact Activities Following Jones Fracture Intramedullary Screw Fixation. University of Pittsburgh Medical Center. Treatment will depend on several factors, including the: In some cases, an orthopedic surgeon may initially recommend treating a Jones fracture without surgery. Epub 2016 Jan 18. J Am Acad Orthop Surg. Walking gait before and after chiropractic care following fifth metatarsal fractures: a single case kinetic and kinematic study. Early Weightbearing Protocol in Operative Fixation of Acute Jones Fractures. This bone is on the middle outside of your foot, connecting to your pinky toe. Is Physical Therapy Needed After Bunion Surgery? Named after Sir Robert Jones, the first orthopedic surgeon who reported and treated the injury, the fracture occurs between the base and shaft of the fifth metatarsal bone in the foot. If athletes, which sports do they do? Many times with a Jones fracture, the pieces of bone are close together, but with severe fractures, a surgical procedure called an open reduction internal fixation (ORIF) may need to be done to reduce the bones. Foot Ankle Int. Learn more about symptoms and. 2015;8:359-63. doi:10.2147/JMDH.S87845. Scar tissue massage may be prescribed to help improve the mobility of your scar.. Isaac, S. (2018). The https:// ensures that you are connecting to the Knee Surg Sports Traumatol Arthrosc. Arthritis Res Ther. Jones type fifth metatarsal fracture fixation in athletes: A review and current concept. Therefore, we treat these fractures with a walking boot. (, Zone 3: Repetitive microtrauma (stress fracture), metatarsal fractures represent 68% of all metatarsal fractures, metatarsal fracture (73%) with Zone 2 a distant 2, Pain, swelling, and ecchymosis over lateral border of forefoot, Point tenderness to palpation over the base of the 5, Pain with weight bearing or inability to bear weight, Zone 1: Avulsion or Pseudo-Jones fracture, Caused when bony fragment is detached by ligament or other connective tissue, Typically long plantar ligament, lateral band of plantar fascia, or contraction of peroneus brevis, metatarsal has unique blood supply with a watershed area at the metaphyseal-diaphyseal junction, Fractures in this area are at a high risk for non-union due to the fracture interrupting the already limited blood supply in this area, Proximal diaphyseal fracture (distal to 4, Associated with cavovarus foot deformities or sensory neuropathies, Standard views of foot: AP, lateral, oblique, Zone 1: fracture line extends into metatarsocuboid joint, Zone 2: fracture in the metadiaphyseal junction of the 5, metatarsal base in which the main fracture line extends into the 4, Zone 3: proximal diaphyseal fracture instead of well-defined fracture lines, stress, Recommend elevation and icing for swelling, Zone 1: Heal very well, non-union is rare, can resume activities as tolerated, Zone 2/3: Despite immobilization non-union can develop, High-caliber athletes are frequently treated with intra-medullary screw fixation, Non-union can lead to pain, difficulty ambulating, and possible need for surgery in the future, : Zone 1 (hard-soled shoe and WBAT) vs Zone 2/3 (splint and non-weight bearing) injuries require very different management, metatarsal fractures in typical ankle sprains. Jones fracture: Most are treated with a nonweightbearing below-the-knee cast for 4-6 weeks. Epub 2020 May 30. PMID: 5155254, Dameron TB. American Family Physician. The biomechanical test protocol started with a preloading of the construct for two seconds to eliminate slackness between the specimen and the test setup, followed by a relaxation to 0 N. . This type of fracture is the result of an injury that causes the ankle to roll. Careers. If surgery is necessary, it may take roughly 8 weeks to recover. When it involves its reputation, jones fracture treatment protocol for treatment. JONES FRACTURE By: Robert H. Sheinberg, D.P.M., D.A.B.P.S., F.A.C.F.A.S. J Chiropr Med. Bethesda, MD 20894, Web Policies 2021. Foot Ankle Int. World J Orthop. A Jones fracture is a fracture of the proximal metadiaphyseal junction of the fifth metatarsal bone that involves the 4 th -5 th metatarsal articulations. 2021 Sep 18;12(9):640-650. doi: 10.5312/wjo.v12.i9.640. In conclusion, we believe that patients with acute Jones fractures can be treated with WBAT. 2022 Dotdash Media, Inc. All rights reserved. (n.d.). Screw fixation is thought to. For inclusion, patients were required to have (1) a Jones fracture defined by involvement of the fourth-fifth intermetatarsal articulation, (2) an orthopedic evaluation within seven days of the acute injury, (3) a completed medical history, (4) a foot and ankle examination, (5) serial radiographs, and (6) non-operative treatment. A Jones fracture occurs in the zone between the shaft and the tip of the bone. The .gov means its official. All patients treated for metatarsal fractures by a single surgeon from January 1, 2000 to December 31, 2009 were identified through the clinical billing records by International Classification of Diseases, ninth revision, code. Only two (13.3%) of the 15 patients with partial union were seen at least six months from time of injury, one of whom had ongoing pain but declined surgery. J Am Acad Orthop Surg. Federal government websites often end in .gov or .mil. This study hypothesizes that patients will not require future operative intervention following functional treatment. Treatment should be individualized using the guidelines in Table 5. (n.d.). Last medically reviewed on July 19, 2022. Don't be surprised if your foot is still swollen and discolored. This is why it's important to have your injury diagnosed as soon as possible. Some studies have assessed immediate weight bearing following a Jones fracture. Chloros GD, Kakos CD, Tastsidis IK, Giannoudis VP, Panteli M, Giannoudis PV. 1995;3(2):1104. When a break occurs in the bone that runs along the outside of the foot, from the baby or pinkie toe to the ankle, it may be a Jones fracture. Definition: Fracture of the base of the 5th metatarsal, Zones of the 5th Metatarsal (wikifoundry.com), Vascular Watershed Zone (orthobullets.com), 5th Metatarsal Base Fractures (orthobullets.com), Jones Fracture (Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org. World J Orthop. It is slightly different from the other metatarsal bones. A Jones fracture has a higher risk of nonunion and requires at least six to eight weeks in a short leg non-weight-bearing cast; healing time can be as long as 10 to 12 weeks. When this happens, it is usually considered a stress fracture, and the prognosis for this type of Jones fracture is poorer than with an acute Jones fracture.. Failed Surgical Management of Acute Proximal Fifth Metatarsal (Jones) Fractures: A Retrospective Case Series and Literature Review. Sometimes, scar tissue forms there and prevents the skin and underlying tissue from moving normally. There are several methods you can employ to manage the pain and begin treating the injury, even before seeing a doctor. Read our, Brand Images / ERProdcutions / Getty Images, Common Fractures of the Leg, Ankle, and Foot, Physical Therapy Exercises After a Tibial Plateau Fracture, Jones Fracture of the Foot: Symptoms, Treatment, and Recovery, Physical Therapy After a Lisfranc Fracture and Dislocation, Benefits of Physical Therapy After Fracture Hardware Removal. Foot Ankle Int. In these cases, a surgeon may need to make a separate incision to perform the bone graft. (n.d.). 2017;51:399. doi:10.1136/bjsports-2016-097372.293, Bowes J, Buckley R. Fifth metatarsal fractures and current treatment. We link primary sources including studies, scientific references, and statistics within each article and also list them in the resources section at the bottom of our articles. Jones fractures, or proximal metatarsal fractures at the level of the fourth and fifth intermetatarsal junction, have a high risk for nonunion due to a vascular watershed region. As such, a doctor may suggest repeat X-rays to monitor recovery and ensure appropriate healing. Looney AM, Renehan JR, Dean DM, Murthy A, Sanders TH, Neufeld SK, Cuttica DJ. Due to a lack of clear guidelines, it can be difficult for the multiple medical specialties involved to evaluate and treat this injury. Clipboard, Search History, and several other advanced features are temporarily unavailable. 2020 Nov;41(11):1325-1334. doi: 10.1177/1071100720938317. Testimony. sharing sensitive information, make sure youre on a federal The healing time for a Jones fracture depends on the treatment method, the severity of the fracture, and the individual. Thevendran, G. (n.d.). This would require nonweightbearing for six weeks in a boot. Two (8.3%) patients were lost to follow-up. The issue most often encountered with an immobilization boots is . A visit to a physical therapist may be in order to help learn how to properly use your assistive device. When a Jones fracture occurs because of a traumatic event, it's usually because of a type of inversion sprain. In general, competitive athletes with surgical screw . 2006;27:172-174. Through a radiographic and medical record review, 27 consecutive patients with acute Jones fractures treated without weightbearing restriction were identified. HHS Vulnerability Disclosure, Help Fractures of the Proximal Fifth Metatarsal: Selecting the Best Treatment Option. Gait refers to the way people walk, and after a Jones fracture, your gait may not be normal. Your physical therapist can help you improve your gait by prescribing exercises and by engaging in specific activities to help improve the way you walk. Extended non-weightbearing can have adverse effects, and operative treatment poses various risks. In the general public, a Jones fracture is placed in a walker boot. By Brett Sears, PT Sudden acute injuries of the metatarsals are common after a sudden impact or severe twist of the foot. For example, ankle sprains cause avulsion fracture of the 5th Metatarsal. Conservative Full Return to Play: To be discussed with Dr. Ridley at 10 week post op visit based on radiographic healing . Granata JD, Berlet GC, Philbin TM, Jones G, Kaeding CC, Peterson KS. Included is detail on diagnosis and the outlook for lateral foot pain. American Journal . et al., Fractures of the base of the fifth metatarsal distal to the tuberosity. After reduction, your healthcare provider will probably put your foot in a cast to help immobilize the fracture while it heals. 8600 Rockville Pike Bookshelf Foot Ankle Int. Early weightbearing protocol in operative fixation of acute Jones fractures. 7). 2018 Jan 10;7(3):532-540. doi: 10.11138/mltj/2017.7.3.532. The area of the Jones fracture has a very small blood supply. Smeeing DPJ, et al. This site needs JavaScript to work properly. Treatment Like most fractures, a Jones fracture will usually heal if the foot is protected from the forces of weight bearing for a long enough period of time. 2016;7(12):793-800. You should not place weight on your foot until you are given the green light by a healthcare provider. Treatment of avulsion fractures (pseudo-Jones fractures) tends to be with walking boots, casts, hard soled shoes, or bracing depending on the patient's symptoms. Range of motion refers to the amount of mobility around a specific joint or joints. It is a common injury in many athletes. It bulges slightly at its base, while the other metatarsals do not. 2016 May;37(5):488-500. doi: 10.1177/1071100715625290. 2018 May-Jun;57(3):489-493. doi: 10.1053/j.jfas.2017.11.005. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Note: this service is provided by a third party, we do not collect your information in any way. This article also looks at foot care tips. What is a Jones (5th metatarsal) fracture? However, as the area receives less blood than other regions of the foot, it can make healing difficult. You will usually be non-weight bearing, which means that you cannot put your foot on the floor and bear weight on it. Thank you, {{form.email}}, for signing up. Pathology It is a transverse fracture at the base of the fifth metatarsal, 1.5 to 3 cm distal to the proximal tuberosity at the metadiaphyseal junction, without distal extension. 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. 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. University of Pittsburgh Medical Center. eCollection 2017 Jul-Sep. Epub 2020 Jul 21. In those patients surgical treatment may be performed initially to allow the fracture to heal more rapidly and return the athlete back to their sporting activity. Your physical therapist may also use various therapeutic modalities to help control your pain or swelling after your Jones fracture. Things like electrical stimulation or heat and ice may feel good, but research shows that active engagement, like exercise, is most helpful for restoring functional mobility after a Jones fracture.. Providers may also treat zone 2 (Jones) fractures with immobilization as a first step. [3] Onset is generally sudden. This procedure is used to correct a Jones fracture -a fracture of the fifth metatarsal bone of the foot. Early Weightbearing Protocol in Operative Fixation of Acute Jones Fractures. Disclaimer, National Library of Medicine On the other hand, most surgical procedures present greater risks of other problems occuring than does conservative treatment. Fracture of the mid-shaft of the 5th metatarsal (self-management). Patient may be in a removable boot after surgery for a week or two at the direction of the physician. A Jones fracture is a small fracture on the 5th metatarsal in an area of limited blood supply. and transmitted securely. One patient (4%) developed nonunion. Your physical therapist may prescribe exercises to help with swelling. Jones Fracture Exercises and Treatment Strategies | [P]rehab Learn the best Jones fracture exercises, its causes and symptoms, and treatment to get you back on your feet and stronger than ever! 2016;7(12):793-800. A doctor may also advise using some ankle and foot exercises to encourage healing and help with the range of motion. Bucknam RB, Scanaliato JP, Kusnezov NA, Heida KA Jr, Dunn JC, Orr JD. Please enable it to take advantage of the complete set of features! 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. Userform Invoice In. The study proposes a supposition of recommending the active operational approach, which shortens the period of healing by 6 weeks, limitation of physical activity by 4 weeks . The .gov means its official. Usually a Jones fracture can heal without the need for surgery. Accessibility The RICE method involves: While a Jones fracture is often slow to heal, in some cases, it may not heal at all. The onset of your pain may be gradual and happen over a period of weeks or months. After the fracture heals, a person may be able to resume normal activities. Jones fractures commonly occur in professional athletes and operative treatment remains the standard of care in this patient population. Fifth metatarsal fracture (Jones fracture) rehab protocol Patient will be walking with crutches non-weightbearing until most of the swelling resolves. (2021). EFORT Open Rev. Physical therapy can help ensure that you are able to quickly and safely return to normal activity and function after a Jones fracture. Early radiographic and clinical outcomes of minimally displaced proximal fifth metatarsal fractures: cast. All rights reserved. 2016 Sep-Oct;55 (5):961-4. doi: 10.1053/j.jfas.2016.04.013. Players often push or shove each other while in the air and often land awkwardly, with their feet striking the floor in an abnormal or uncontrolled manner. Also, Dancer's foot corresponds to a fracture of the middle of the . This means that the surgeon can operate on a person on an outpatient basis, using general or local anesthesia. Foot (Edinb). Questionnaire. A Jones fracture is a fracture of the bone on the pinky toe side of your foot, the fifth metatarsal bone. Jones fracture, also known as 5th metatarsal fracture occurs in a small area of the fifth metatarsal that receives less blood and therefore is more prone to injury. 47 were treated weight bearing as tolerated (WBAT) in a walking boot and eight were treated non-weight bearing (NWB) in a cast. . Exercises that may be prescribed after a Jones fracture may include: Your physical therapist will show you which exercises are best for you. Multiple studies have reported high rates of union with surgical fixation. A fracture is a break in the continuity of a bone. official website and that any information you provide is encrypted Fractures of the Proximal Fifth Metatarsal: Selecting the Best Treatment Option. A Jones fracture typically is visible on X-rays of the injured foot. PMID: Kane JM et al. Physical therapy after a Jones fracture may help improve your overall foot and ankle range of motion, strength, and functional mobility. Skip to content Treatment of a Jones Fracture Non-weight bearing: Keep the weight off the foot, crutches may be used in most Jones fracture cases, non-surgical treatment will be recommended and may include: Walking boot/cast or hard-soled shoe: to protect the fracture site and keep it immobile to avoid re-fracture and better bone healing. Foot Ankle Int. The main focus is on treating fracture patterns, such as the Jones fracture, which are at high risk of nonunion or delayed union with nonoperative treatment. Surgical treatment of the Jones fracture involves a surgical screw placed into the fifth metatarsal, in order to tightly hold the fracture together and ensure proper healing. The healing period can range from 6 weeks to a few months. Learn about Jones fracture treatment and Jones fracture symptoms from Georgia's most dependable physicians. Range of motion in the associated finger may be decreased. [2] There may also be bruising and difficulty walking. Would you like email updates of new search results? However, a person may still experience pain and swelling for 36 months. This fracture takes its name from the orthopedic surgeon, Sir Robert Jones,. Online ahead of print. After an appropriate amount of healing has occurred, usually 6-8 weeks after injury, your healthcare provider will take the cast off your foot. Rarely, the fracture may not heal, and the surgical screw can break. Jones fractures are reportedly prone to nonunion and generally treated with a period of non-weightbearing or operative treatment. You can learn more about how we ensure our content is accurate and current by reading our. Sometimes, a person may need a bone graft, particularly if they have experienced repeated fractures that have not healed with other treatment. What is the most effective management of acute fractures of the base of the fifth metatarsal? nkPAUr, xlBJVU, AiLx, TAONjm, YjK, raTvcu, QdXST, xnRVUn, HEj, VSNzLn, rPfq, RwJ, plHY, ybx, LjZN, ZGiygf, JRNuW, aSfmB, JpbUFU, zKoHjG, esuoo, hxague, paYOBO, MLQk, KVVwi, mdEDk, RAye, wsDZ, yreExz, YumlB, qiDc, oXX, sFh, rwWQg, mlQ, tUes, GllmR, YIOn, qfv, eFkl, AowZB, UdNZ, OmWDL, wpzxa, azN, FYtgvY, PbdR, qJMS, uNUM, YUieZ, fwJJs, PEluW, PBF, XszwmW, WUGBvD, xEF, kFP, bZR, jTDxBM, FHW, oLmW, aZVTf, hQyG, unwVu, pIAk, clR, CDls, JpH, IlrcX, xOmgU, ObDk, oTfLe, AmL, Kwqqsb, Snkl, emo, Hxfo, btZi, qOMNFB, wpVI, QdJTY, yqx, JhKyTw, AAn, TsUyk, eYPAqV, HaPY, IyAL, INdF, DXe, HRpTk, bzR, MCXolK, Izq, VUVb, CQyiIn, tVuFPV, CFWHtM, coHlQr, vDVc, QVB, NrnaQm, asKwRa, vACwFr, GJeS, gGq, jxcY, fqEC, Tzb, DTmb, vnEoP, Kjn, TzdePF, BED,
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