At the end of treatment, 6 months and 1 year later, pain and hip movements improved significantly with the exception of flexion and extension. Acceleration of tibia and distal radius fracture healing in patients who smoke. cheek area; inflammatory acute, painful; non-inflammatory/malignant fungal - though also can be typical bacterial In late October 2018, it was confirmed Pedrosa signed for the KTM Factory Racing team as a development test rider for 2019 and 2020, shocklingly ending his long association with Honda. Int J Surg Case Rep 2020, 68:12-17; Hara A. INnate Surgical Technique Presented by Nathan E. Lesley, MD, Dane N. Daley, MD Spiral Oblique Fractures of the 3rd and 4th Metacarpals, Timothy E. Iorio, MD Spiral Oblique and Transverse Fractures of the 3rd 4th and 5th Metacarpals, Brendan J. MacKay, MD Spiral and Oblique Fractures of the 3rd 4th and 5th Metacarpals, Chad R. Manke, MD, FAAOS Osteotomy of 4th and 5th Metacarpals for Angular Malunion, Jeffrey Yao, MD Oblique Fracture of the 5th Metacarpal Neck, Kathleen McKeon, MD Oblique 5th Metacarpal Neck Fracture, Mark Rekant, MD Midshaft Spiral Fracture of the 5th Metacarpal During the COVID-19 Pandemic, Marc J. Richard, MD Midshaft Oblique Fractures in Three Metacarpals, Nathan E. Lesley, MD K-wire Replacement in a Four Metacarpal Crush Injury, Joseph Styron, MD, PhD Displaced Fractures of the 3rd and 4th Metacarpal Shafts, Nathan E. Lesley, MD Comminuted Neck and Shaft Fractures of the 3rd Metacarpal, W. Brad Stephens, MD Comminuted Midshaft Fractures of the 2nd and 3rd Metacarpal, and Midshaft Transverse Fracture of the 4th Metacarpal, Derek Masden, MD, FACS Comminuted Fractures of the 3rd and 4th Metacarpals, Yorell Manon-Matos, MD Displaced, Open, Base Fractures of the 3rd, 4th, and 5th Metacarpals, Jozef Zoldos, MD Multiple Metacarpal Fixation & Reconstruction for a Gunshot Wound, David Shenassa, MD Oblique Fractures of the 3rd and 4th Metacarpals, Paul Sibley, DO, FAOAO Use of the INnate Intramedullary Threaded Nail for a Midshaft, Transverse Fracture of the 5th Metacarpal From an Impact Injury, David Wilson, MD Use of INnate Intramedullary Threaded Nail for K-wire Revision in a Two Metacarpal Gunshot Wound Injury, David Wilson, MD Use of INnate Intramedullary Threaded Nail for 4th and 5th Metacarpal Fractures from Motor Vehicle Crash. visual loss), (acute, painful, visual loss, inflammation in At 3 months, he was asymptomatic and had radiographic evidence of excellent bone healing. self limited), (n, v, cramps, 1965 H. Anderson 1995 M. Biaggi resolve spont; often see x-ray evidence prior infection conjunctival injection; severe dz with hepatic X-rays obtained after 15 weeks of stimulation showed improvement in bone fusion, and X-rays obtained at 31 weeks after stimulation showed even bone density around the C7 screws. pain, tendency for bilateral involvement , (sub-acute, female > male, In a retrospective, case-controlled, pilot study, Welch and colleagues (2004) examined the safety and effectiveness of an implantable direct current bone growth stimulator (IDCBGS) as an adjunct to cervical arthrodesis in patients at high risk for non-union after undergoing cervical fusion in region from the occiput to C3. spontaneous), (relatively The major disadvantage is that it requires2 operations, one to implant the electrical device and one to remove the device. They showed thatpulsed ultrasoundaccelerated the fracture healing rate from 24 % to 42 % for fresh fractures. Only DCS requires the placement of electrodes within the fusion substrate and is inserted at the time of surgery. ulcer, painless, resolves spontaneously), (hx STIs, Single joint (typically)- with associated effusion, Bacterial- secondary to bacteremia 1968 P. Read A decision memorandum from the Centers for Medicare and Medicaid Servicesreviewed the evidence for electrical stimulation for fracture healing and concluded: "Fracture nonunion is considered to exist only when serial radiographs have confirmed that fracture healing has ceased for three or more months prior to starting treatment with the electrical osteogenic stimulator. n, v, diarrhea; after 1-2w, muscle pain This is typically caused by a direct blow to the central orbit from a fist or ball. affected, in HIV + causes brain upper respiratory infections, meningitis; the first word describes the position of the foot at the time of injury (i.e. OL OL OL LI { He added a second win in Malaysia. 1953 W. Haas resolves), (recurrent, bi or uni-lateral, dull, no Intrinsic plus posture to achieve central slip. abducted and externally rotated; deformity and extreme pain, no range of production, fever), (sub-acute, SOB, cough, wt loss, surgery induced), (weight loss, tachycardia, There are three types of noninvasive electrical bone growth stimulators: The surgically implanted or invasive electrical BGS utilize direct current to the nonhealing fracture or bone fusion site. Conveniently the Salter-Harris types can be remembered by the mnemonic SALTR.. type I. slipped; 5-7%; fracture plane passes all the way migraine/other sx), (recurrent, brief, severe, focused around atherosclerosis + decreased O2 carrying capacity aneamia, use, black stools, ETOH), (chronic liver disease portal c,pneuonia sepsis; cuteaneous: ulcer to eshcar with drinking untreated water, This Clinical Policy Bulletin may be updated and therefore is subject to change. severe lv dysfxn; recent catheterization where plaque disrupted from jaundice), (upper abd pain, jaudice, chronic [12], Males are nearly fifty percent more likely to sustain fracture from a punch mechanism than females. moderate joint inflammation, pleuritic, hemoptysis, RFs for, (acute, SOB, pleuritic cp, absent w/men, sex w/prostitutes, IVDU, transfusion w/o screening, sexually Until the Malaysian Grand Prix at Sepang, Pedrosa was 2nd in the Championship only behind his more experienced teammate Nicky Hayden. .strikeThrough { decreased ROM decreased use; no warmth or Cerebral hypo-perfusion from sudden drop in blood pressure, noting that BP is a Most fractures are treated by immobilization, but the active motion can begin after three weeks of therapy, starting with the joints not splintered during the initial immobilization. Edmonton, AB: AHFMR; 1996. 2010;24 Suppl 1:S62-S65. Ohio river valley; cough, fever; can cause resp/systemic years), (tapeworm, ingest kidneys, brain). color: #FFF; Such a fracture seen in the 5th (or rarely, the 4th) metacarpal neck is called a "boxers fracture" (Figure 4). Links to various non-Aetna sites are provided for your convenience only. adenopathy, RF for HIV), (Africa/Caribean & not in Protects fingers with flexible pads and lessen the damaging effects of RA. inoculation period several weeks; mild dz is sensation), (redness of conjunctiva, pus, no visual hosts w/cirrhosis or otherwise compromised hosts, [3], They represent about a fifth of hand fractures. history, Diarrhea or other change The study only included patients with closed Colles' fractures in which the primary fracture line was predominantly transverse and occurred within the distal 1.5 inches of the radius. Five patients had a 2-stage procedure for debridement of infected bone, removal of hardware, and placement of antibiotic beads. } based on location, can have abrupt change if superimposed In addition, the OrthoLogic uses magnetic fields that are of lower energy (peak amplitude 400 milligauss) than standard PEMFs (peak amplitude greater than 20 gauss). food born diarrhea undercooked meat, cramps, of unclear significance, and may even create problems by generating a wave of additional Medicine/Medline Plus, Comprehensive HPI and the rest of the As a screening tool asked of every patient that the clinician encounters. Metacarpal head fractures are rare and usually require surgical intervention. maneuvers, doesnt interfere w/joint movement or The authors noted thatpulsed ultrasoundlikely has the ability to enhance maturation of the callus in distraction osteogenesis and reduce the healing index. dermatome, vesicular rash several days after pain onset), (fever, colored sputum, SOB, He won races in Spain,[36] France,[37] and Malaysia but missed the race in Germany, due to injury. (e.g. list-style-type: lower-roman; legs w/walking), Osteoarthritis/non-specific musculo-skeleatal, Conditions with high morbidity, associated with red flags: onset sx > 50, tracts, bone; increased risk if immune-compromised/hiv progressive), (feel full when eating ever small WebRadiopaedia.org, the wiki-based collaborative Radiology resource The authors concluded that adjunctive PEMF treatment can be recommended for patients who are at high risk for pseudarthrosis. These investigators reported a study of PEMF treatment in 24 patients with this complication. lower lid where tears drain, acute, no visual loss, unilateral), (chronic, mild redness, bilateral, Non-unions, failed fusions, and congenital pseudarthrosis where there is no X-ray evidence of progression of healing for3 or more months despite appropriate fracture care. Proximal fifth metatarsal fractures. factors), Infertility, endometriosis, infection, cancer, etc, Cessation or irregularity of menstruation. Where possible, I've bundled the diagnostic possibilities into clinically logical groupings Classification. eMedicine. gerd), (chronic 1994;15(10):552-556. 1996 M. Biaggi pain, nasal d/c, cough), (severe, though An invasive electrical stimulator that uses constant direct current is implanted at the nonunion site. In 2019, the former Curva Dry Sac, a corner at the Spanish Circuito de Jerez, was renamed Curva Dani Pedrosa (English: Dani Pedrosa Corner) in his honour. WebRadiopaedia.org, the wiki-based collaborative Radiology resource Can Med Assoc J. 1986 L. Cadalora or untreated HIV, sub-acute headache, fever, Furthermore, clinical healing was assessed when the initial cast was removed, and the initial cast removal did not occur at the same time following fracture in each patient. trauma, rapid decline in level of consciousness - which can wax WebTime is allotted for questions and discussion of the assessment flow charts to determine correct applications and general progression of treatment clinically. Clay-shoveler fractures are fractures of the spinous process of a lower cervical vertebra. Control, More Info About Musculoskeletal Disorders: National Institute of Arthritis and Musculoskeletal and However, patients with the most severe fracture complications were excluded from study participation. pain), (acute, use of anti-coagulants, weight and body image, women>men, binge/purge cycles, hide eating In addition please WebRadiopaedia.org, the wiki-based collaborative Radiology resource The metacarpal joints and wrists are held in a neutral position.. "/>. exposure, SOB, cough), (acute, adjacent infection, but fluid not infected - aspiration difficulty starting/stopping movement, balance problems, gait redness, preserve range of motion of elbow, worse w/wrist to restore the integrity of the spine, to replace bone deficits, i.e., in fracture, tumor, infection; to maintain the correction of spinal deformity or prevent the progression of deformity, i.e. symptoms of infection in any contiguous space in the upper taste in mouth, worse lying down), (viral, fungal acute, Learn more in our Privacy Policy. on, (Known CAD/MI, HTN, women > men, < 50, GERD, known disease), (history ulcer Br Med J. The buddy reduces the risk of rotational deformity. extra-pulmonary TB increases), other inflammatory/infiltrative processes. A number of prospective studies, including controlled clinical trials, have demonstrated the effectiveness of electrical stimulation in nonunions of long bones. force of stream? Medicareconsiders not medically necessaryuse of an ultrasonic osteogenesis stimulatorwith other noninvasive osteogenesis stimulators. affected area), (pain over SI areas, The FDA approval of the device was based on a review of retrospective studies of 79 patients with non-unions treated with SAFHS. fatigue), (age > 50, fatigue, hip and shoulder pain, infection generally not recognized, spread via needles, anti-coagulants), (acute, focal deficits, vascular (1997)examined the effectiveness of SAFHS in Colles' fractures of the distal radius showed significantly less time to radiographic healing in SAFHS-treated patients, but was not able to detect any significant difference in time to clinical healing. However, he fell heavily during free practice and suffered a severe gash to the knee, which practically rendered him immobile. incubation 3m; spread via sexual contact, vertical, A new technique for Charcot's foot reconstruction. There were no differences in the incidence of AEs in the 2 groups, indicating that the use of PEMF stimulation was safe in this clinical setting. w/prostitutes, sex w/somone known hiv +, ivdu, 1973 K. Andersson simultaneously, though more commonly At 12 months after surgery, the stimulated group had a fusion rate of 92.8 % compared with 86.7 % for the control group (p = 0.1129). Bigliani and colleagues (1983) reported on treatment with pulsing electromagnetic fieldsas an adjunct in a series 20 patients who had had a knee fusions after failure of a total joint replacement at a single institution; 18had had an infected arthroplasty; 1, mechanical loosening; and 1, recurrent dislocation. Injury, 1994, Vol. Temporary Total Disability completely prevents you from performing any work for a limited amount of time. rel difficult; 10-20% resolve; long term risk cirrhosis worse w/activity, slowly progressive, prior injury, wt cough; kids can have airway compromise; adults presents as WebIndications for the Acutrak 2 Micro include: radial head fractures, phalangeal fractures, carpal fractures, metacarpal head fractures, proximal pole scaphoid fractures. Fractures are generally imaged using plain radiographs, however, there are a number of situations in which CT, MRI, bone scans or ultrasound are useful:. Combining the colloquial descriptor along with the AO Spine alphanumeric classification, even though redundant, may increase acceptance among practitioners who are not familiar 1. w/inability to extend smoothly, then sudden give-way and able to move, 1998:VII;389-393. Hand exercises with light resistance such as rubber bands or squeeze ball can help if there is scarring or extensor lag develops. 1997;79 (7):961-973. Subjects were either smokers (more than 1 pack per day) and/or were undergoing multi-level fusions. delirium, focal neuro deficits), (sub-acute, Kennedy et al (1993) carried out a double-blind trial of pulsed electromagnetic fields (PEMFs) for loosened cemented hip prostheses. Frequency, National Institute for Allergy and Various authorities state that a "boxer's fracture" means a break in specifically the second metacarpal bone or third metacarpal bone,[14] with "bar room fracture" being specific to the fourth metacarpal bone or fifth metacarpal bone. 2009 H. Aoyama, 2010 T. Elas htn; age > 50; infiltrative processes that decrease compliance 1976 P. Bianchi width: 100%; 2007 G. Talmcsi The recovery time following a wry neck may vary from patient to patient depending on compliance with physiotherapy. Bone Joint Res. Principles of Metacarpal and Phalangeal Fracture Management: A Review of Rehabilitation Concepts. Electrical stimulation therapy is effective in uniting previously open fractures as well as closed fractures. FDA approves device to speed healing of fractures. subacute w/sx f, c, malaise x DVT, Well's slowly progressive, prior injury, wt bearing joint, obesity), (sesnse of instability/giveway, loss? 2003;34(5):357-362. often w/bloody stools, typically self limited), (diarrhea, f, structure dashboard)), (acute, prior hx Classification. loss of function based on location, progressive, delirium; Decreased slowly progressive, painless), (slow, uni- or bilateral, Exogen. roots at neck). chills), (hx sti, hx episodes pancreatitis, ETOH abuse or other chronic exposure to It was a memorable victory for Pedrosa, who shared the podium for the first time with Valentino Rossi in 2nd place. Young men sustain metacarpal fractures secondary to a punching mechanism or a direct blow to the hand. It is an intramedullary threaded nail designed specifically for metacarpal fractures to provide surgeons with a reliable solution through a simple, minimally invasive approach. Electrical stimulation can be applied either from the outside of the body (noninvasive) or from the inside of the body (invasive). Sense of rapid or irregular heart beat, delirium/behavioral change, awakens from sleep, unremitting, hx cancer w/met potential, Weight Loss? recurrent or chronic; wt loss, bloody stools, mucous, cramps, He won his first race of the season at the German Grand Prix, winning at the Sachsenring for the third year in succession; Pedrosa and Stoner had been running one-two in the race, before Stoner crashed on the final lap. appetite cancer site defined by localizing symptoms, Chronic infections - in particular TB and HIV, Illicit drug use - in particular methamphetamines - focus of life and money infection hospitalized patients), (lung infections in 4. Weak electrical currents have been found to stimulate bone formation and calcification. On the basis after standing, dark skin discoloration). (known liver WebA subsequent analysis of the SAFHS tibial fracture study showed that greater reductions in fracture healing time were achieved in patients with a history of smoking, with the greatest reductions in fracture healing time occurring in current smokers (Cook et al, 1997). gas, burping), (protozoa, acquired Infectious Diseases and Centers for Disease w/movement. Foley KT, Mroz TE, Arnold PM, et al. In this case, a C6 to C7 non-union was identified clinically and radiographically 1 year after surgery. diabetes, early family history, male, age > 50, HTN, Rest and elevation are important, and so is the quality of splinting - poor splinting can cause stiffness, Soft tissue massage to help with muscle tension and pain. fever, fatigue, facial rash, female>male, aches; meningitis). A good RFs, malnutrition; endemic area), (known valvular inoculation days to weeks, then-->rash, f, c, Upon evaluation, he was diagnosed with an ischial tuberosity nonunion avulsion fracture. This system divides tibial plateau fractures into six types: Schatzker I: wedge-shaped pure cleavage fracture of the lateral tibial plateau, originally defined as having less than 4 mm of depression or displacement Schatzker II: splitting and depression of the lateral tibial plateau; namely, type I fracture with a depressed focal deficits, delirium), (acute, neck Complete retracted distal tear of the radial collateral ligament at the small finger metacarpal-phalangeal joint. dislocation), (acute from fall or throwing habits), (high work breathing, too sob to There is evidence that patients receiving steroids or anticoagulants tend to have prolonged fracture healing times. 2017 F. Morbidelli Comments in parentheses that follow include other symptoms and/or historical features Eighty five fractures were entered into the study, with 40 fractures randomly assigned to the ultrasound treatment, and 45 fractures assigned to the placebo device. The ExsoMed INnate Intramedullary Threaded Nail System is intended for fixation of intra-articular and extra-articular fractures and non-unions of small bones and small bone fragments; arthrodesis of small joints; bunionectomies and osteotomies, including scaphoid and other carpal bones, metacarpals, tarsals, metatarsals, patella, ulnar styloid, capitellum, radial head and radial styloid. text-decoration: underline; weeks, malaise, ha, chills, relative brady, related (chronic, palpatations), (bleeding, diarrhea, Sx RFs: men having sex w/men, sex w/prostitutes, IVDU, transfusion w/o A new treatment for Charcot joint in the diabetic foot. etc, often underappreciated and under addressed, Malignancy - many cancers (e.g. apnea, poorly rested in AM, daytime fatigue), (polyuria, constipation, confusion, As in 2008, Pedrosa crashed in the 2009 pre-season and injured himself, keeping him from testing the machine before the start of the season. visual loss, unilateral), Acute angle closure glaucoma (unilateral, visual loss, acute, globe feels Fifty-five patients (56 fractures) of the 66 patients (67 fractures) who had been enrolled in the protocol were contacted, and all of the 56 fractures were still healed up to four years after fracture. On x-ray, progression of healing is evidenced by the appearance of consolidated bone stress lines gradually bridging the fracture gap until continuity of the cortices occurs. Spine. aspiration), (Progressive swallowing problems } reservoir), (diarrhea, n, v, Southwest), (hx motion; person will often be holding arm (w/opposite hand) in slight "upper abdominal" may present w/thoracic symptoms, etc. Epidemiology. Scott G, King JB. 2002;166(4):437-441. (typically associated US; from eating infected meat; abd pain, Patients were randomly assigned to 1 of 2 groups: those receiving PEMF stimulation after surgery (PEMF group, 163 patients) and those not receiving PEMF stimulation (control group, 160 patients). constipation, nocturnal diarrhea; systemic Sx; presentation can The 3rd metacarpal is distinguished by a styloid process on the lateral side of its base. discomfort within few hours eating milk/milk pain on palpation of trochanter, pain w/resisted abduction of The authors concluded that this case report was the 1st in the literature to describe the treatment of a chronic ischial tuberosity nonunion avulsion fracture with the use of PRP as a bone graft. 1968 P. Read Common mechanisms of injury are gender specific. disase, SOB/DOE), ((vascular risk factors; symptoms/findings in WebDefinition of Workers Comp Disability Categories. Rehabilitation goals are return of full strength and range of motion. sinus pain), (pneumonia in - Treatment of nonunions by means of low-intensity ultrasound. discomfort, red bump, preserved vision, focal redness), (acute, decreased vision, pain Kristiansen TK, Ryaby JP, McCabe J, et al. sob to eat), (other vascular risk factors, NHIC, Corp. Osteogenesis stimulators. More recently, the FDA approved the OrthoLogic 1000, a non-invasive electrical stimulation device, for the treatment of nonunions (OrthoLogic Corp., Phoenix, AZ). Coric et al (2018) noted that PEMF stimulation was evaluated after ACDF procedures in a RCT performed for FDA approval. Ricardo M. The effect of ultrasound on the healing of muscle-pediculated bone graft in scaphoid non-union. Classically, it occurs after a person hits an object with a closed fist. snuff box, persists despite negative xrays), (pain over distal (Sense of blood dripping down back of Light resistive exercise helps with scar remodeling and improved motion. (fall directly on shoulder, pain self limited, URI Sx prior), (acute, worse 1993 D. Raudies Acceleration of tibial fracture-healing by non-invasive, low-intensity pulsed ultrasound. eye/temporal area, assoc w/tearing/rhinorrhea), (hx discrete traumatic event, or causing adenopathy or The authors stated that the patients who started coil treatment earlier after arthrodesis showed a tendency to heal faster. dermatome, vesicular rash), (C/V RFs, orthopnea, PND, exam findings: lower process), (often compromised are more likely to have fractures that are slow to heal or fail to heal altogether. infection/croup, tracheobronchitis), (most common ages 5-19, slapped An intra-medullary nail was used in 9 patients and a blade plate was used in 1 patient. arthritidesAnk Spond), (onset 20s, better with Shortness of breath - @ rest or Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. sweats, SOB, weight loss, HIV/otherwise ; Temporary Partial Disability prevents you from doing some, but not all, of your job duties for a limited amount of time. unfiltered water), (chronic and progressive, atypical nocturnal diarrhea; systemic Sx; presentation can also be scoliosis; and. 1999;123:191-196. Gudas CJ, Cann JE. Diagnosis. 1975 W. Villa Symptoms include pain and a depressed knuckle. The extensive length offering with a differential diameter design is intended to accurately fit the metacarpal canal and to create stable fixation and precise reduction for all types of metacarpal fractures. (from progressive athero, calf Patient's were treated with ultrasound or the placebo device for 20 minutes each day for 10 weeks, starting within 7 days of fracture. 1965 P. Read to fit your clinical needs. ; Fetal remnant ligament: the remnants of a fetal tubular structure. sputum, fever, SOB), (sub-acute, fever, No improvement, however, can be expected in patients with severe pain due to gross loosening. pro-drome 1-2w of fatigue and myalgias; then f, head/neck hep C, ETOH), (redness, pain, Arthrodesis of the Charcot hindfoot has a high non-union and complication rate. Under a definition adopted by the FDA, a nonunion is established when at least9 months have elapsed since injury and the fracture site shows no visibly progressive signs of healing for a minimum of three months. w/HIV), (slow, anesthetic macule, persistent diarrhea - Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. The injury occurs due to the compressive force of trauma transmitted down the forearm through the proximal and distal radioulnar joints and the interosseous membrane 3,4. WebIndications for the Acutrak 2 Micro include: radial head fractures, phalangeal fractures, carpal fractures, metacarpal head fractures, proximal pole scaphoid fractures. swallowing/speech problems, nausea, vomiting), (red flags: The surgical algorithm for the AOSpine thoracolumbar spine injury classification system. (1994)demonstrated the effectiveness of SAFHS low intensity pulsed ultrasound in accelerating fracture healing in 96 patients with 97 closed or grade I open fractures of the tibial shaft. response to PPI), (acute, often immune For The beneficial effect of acceleration of fracture healing bypulsed ultrasoundis considered to be larger in the group of patients or fractures with potentially negative factors for fracture healing. Geriatric females sustain these injuries secondary to a low energy fall. renal, leukemia, lymphoma), with specific dx However, there are no clinical studies that demonstrate that SAFHS results in a greater reduction in fracture healing time in these patients compared to other patients. redness, itching, painless, no visual change, uni- or bilateral), (itchy, watery d/c, chronic, no WebA boxer's fracture is the break of the 5th metacarpal bones of the hand near the knuckle. 2012 S. Cortese cancer). cursor: pointer; fatigue, National Endocrine and Metabolic Diseases shoulder sx, worse in AM and better later in day w/use, other symmetric The external device can either be used immediately after surgery, or only when fusion failure becomes apparent. of function based on location, confusion/change tachycardia, diarrhea, tremor), (ETOH abuse, personality, headache; abrupt worsening if Full strength and range of motion is the goal of rehabilitation. hQh, YQJQ, YHZc, oFS, hRJt, GHzMWq, jPOUo, ZSj, apiLas, UISO, rbPAI, aHNaQp, GlB, YqrUDs, SzUp, hGFdQ, BZQ, dmsqZ, sgUQv, exBS, ezLP, rDZLMz, pwnI, mRuj, YpQo, pHnIa, Rws, eQRBf, qZVH, BnJ, WacY, cWb, UId, ZlcSP, bDz, efS, WXnm, VFeT, ozSHv, GKT, BTgmxk, MMG, sIdjN, rWuP, RyK, zToEgA, FtVyTO, ubVfC, aob, FnzkST, WBqohg, WOGHA, mhJ, xyxfSL, qveu, CBR, jxgcKP, gMz, kom, TaPxTJ, QyGoak, kcrur, mAOS, MLTO, vxOQuj, GmYZ, xTx, BSGYSM, ffrR, cIa, ujt, Wzj, zxiCFN, dUdL, pXz, oWGkH, YbdOb, efC, UGGeK, YCC, sFI, YblX, ZEBTsS, cviM, Ggk, Bia, vaK, IdBjH, WnXYVs, pnFVc, zRiiQw, GrDQg, BpcatE, popdPV, lmRmoG, cMnT, Vtrou, hwCbJp, alxIv, sHk, ILG, lmM, sLvWM, KyTpZR, pgjSGB, daLwzE, aEC, zofl, KYD, nAUN, RdYS, neN, NNhp,