A boxer's fracture, or metacarpal fracture, is a bone fracture that affects knuckles in the hand. There are three main types of metacarpal fracture: Any of the metacarpal bones in the hand can fracture. 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 boxers fracture is when you break a bone at the base of your finger, near the knuckle or neck of the bone. Symptoms will depend on which type of fracture you have. Complications may include damage to the median nerve.. 141 0 obj <>stream 0000045113 00000 n Treatment of broken fingers depends on the type of fracture and the particular bone in the finger that is injured. Dr. Knight welcomes you to any of our Dallas Fort-Worth accessible hand and wrist offices. The diagnosis may be confirmed via X Practical Fracture Treatment 5th edition, page 187. As the bone heals, excess bone often forms at the location of the fracture, therefore feeling that extra bone is common. Symptoms typically include pain at the site of the break and a decreased ability to move the affected arm. An ankle fracture is a break of one or more of the bones that make up the ankle joint. This common hand fracture can cause the knuckle on the affected finger to appear sunken in or angulated. 0000008875 00000 n On the other hand, a boxers fracture that is quickly diagnosed and treated will usually heal with little to no long term effects. Occasionally it is used to refer to fractures of the 4th metacarpal as well. Classically, it occurs after a person hits an object with a closed fist. Treatment for acute paronychia involves having a medical provider clean the wounded nail and drain any infection, and sometimes provide a course of antibiotics. Here we explain the different hand fractures and how they are treated. Common specific locations are at the base of the thumb and on the outside (little finger side) of the hand. A Colles' fracture is a type of fracture of the distal forearm in which the broken end of the radius is bent backwards. All rights reserved. Medical treatment will also include pain control. 0000003088 00000 n It is the most common reason for a broken bone among the elderly. Occasionally it is used to refer to fractures of the 4th metacarpal as well. A boxer's fracture, or metacarpal fracture, is a bone fracture that affects knuckles in the hand. The most common type of hematoma is due to trauma. 0000005455 00000 n 0000202220 00000 n This common hand fracture can cause the knuckle on the affected finger to appear sunken in or angulated. The three aforementioned parts of bone articulate with the talus bone of the foot. It is usually caused by a hard impact, for example punching a wall or similar. J Spinal Disord Tech. Treatment for acute paronychia involves having a medical provider clean the wounded nail and drain any infection, and sometimes provide a course of antibiotics. Put slight pressure on each bone to determine where the break is. [2] Sternal fracture can interfere with breathing by making it more painful; however, its primary significance is that it can indicate the presence of serious associated internal injuries, especially to the heart and lungs. Complications may include injury to an artery or nerve, and compartment syndrome.. That bone is known as a metacarpal. Angulation occurs when a part of the metacarpal bone moves out of its normal alignment. It typically occurs as a result of a fall on an outstretched hand. 24(3): 177-82, Jul 2011. Surgery is only necessary if the break is so severe that the doctor has to go inside to reset the bone. The three aforementioned parts of bone articulate with the talus bone of the foot. Less commonly, this fracture may also occur from getting the hand crushed. 0000023680 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). [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. Increase treatment plan adherence and help your patients to understand their disease or condition with Patient Education handouts provided by Lexicomp. 24(3): 177-82, Jul 2011. A laceration from the outside could result from striking an opponent in the mouth, or from punching though a window, door, or wall. Dr. Knight is a Board Certified Orthopedic Surgeon and Fellowship trained. Such a fracture seen in the 5th (or rarely, the 4th) metacarpal neck is called a "boxers fracture" (Figure 4). [10], The injury can also occur when the chest suddenly flexes, in the absence of an impact. After diagnosis, home care will often include cast or splint care, pain management, and checking for signs of infection. Cardiopulmonary resuscitation (CPR), has also been known to cause thoracic injury, including sternum and rib fractures. Symptoms may include pain, swelling, bruising, and an inability to walk on the injured leg. Treatment of any underlying disease, such as chemotherapy if indicated for bone cancer, may help to improve the pain of a sternal fracture. A scaphoid fracture is a break of the scaphoid bone in the wrist. Medically reviewed by William Morrison, M.D. Hypertension: Can 15 minutes of yoga a day help control blood pressure? 0000023953 00000 n 0000009514 00000 n If your hand injury is serious, you should seek treatment right away. There may be a decreased ability to move the arm and the person may present holding their elbow. If your hand injury is serious, you should seek treatment right away. Treatment of this fracture usually is conservative casting. The surgeon will check if the healing is progressing well and help decide if surgery is needed to mend the bones. Indications for surgical treatment include the need for surgical debridement of an open wound, damage to a ligament, tendon, blood vessel, or nerve, and large degrees of joint displacement. Surgical treatment will often be required, usually an Open Reduction Internal Fixation.This involves the surgical reduction, or realignment, of the fracture followed by the implementation of surgical implants to aid in the healing of the fracture.. Prognosis. [4] However, because it is common for cardiac injuries to accompany sternal fracture, heart function is monitored with electrocardiogram. [1] Other associated injuries that may occur include damage to blood vessels in the chest, myocardial rupture, head and abdominal injuries, flail chest,[1] and vertebral fracture. 0000199702 00000 n 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. A bone fragment could puncture the skin from within. 24(3): 177-82, Jul 2011. Cardiopulmonary resuscitation (CPR), has also been known to Existing patients, click here. 0000054824 00000 n This website uses cookies to improve your experience. Dr. Knight is a renowned hand, wrist and upper extremity surgeon with over 25 years of experience. [8] The chest of a driver who is not wearing a seat belt may strike the steering wheel, and the shoulder component of a seatbelt may injure the chest if it is worn without the lap component. Metacarpal head fractures are rare and usually require surgical intervention. 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. [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. How can Dr. Knight help you with Boxers Fracture? Eponymous fractures and fracture-dislocations are most commonly named after the doctor who first described them. Wrist sprains are common in sports., Achilles tendontis is an overuse injury causing pain at the back of the ankle. Sternal fractures may also occur as a pathological fracture, in people who have weakened bone in their sternum, due to another disease process. If it is out of place too far, the doctor or provider may offer to push it back into place It is referred to as a boxers fracture because, most commonly, it occurs when people punch something. A boxers fracture is a fracture (broken bone) of the hand. A. Paulius K, Maguina P, Mejia A. Ultrasound-guided management of hand fractures. Treatment varies depending on how far out of place the bone is located. [14], Management involves treating associated injuries; people with sternal fractures but no other injuries do not need to be hospitalized. This is known as a displaced fracture. The recovery time will vary based on how severe the injury is. Occasionally, a fall onto an outstretched arm with the hand clenched into a fist can cause this type of fracture. 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. Hematomas are a collection of blood outside of a blood vessel. What about medications? A boxer's fracture is the break of the 5th metacarpal bones of the hand near the knuckle. Cardiopulmonary resuscitation (CPR), has also been known to Yet the injury can vary greatly in severity and may include one or more other broken bones. X rays can show glass shards, metal splinters, or gravel which may be present in the wound. A Colles' fracture is a type of fracture of the distal forearm in which the broken end of the radius is bent backwards. 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. 0000009681 00000 n [citation needed], Vehicle collisions are the usual cause of sternal fracture;[3] the injury is estimated to occur in about 3% of auto accidents. Classically, it occurs after a person hits an object with a closed fist. Treatment varies depending on how far out of place the bone is located. Surgical Treatment of Patients with Cervical Myeloradiculopathy and Co-Existent Multiple Sclerosis: Report of 15 Patients with Long-Term Follow-up. 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. 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. 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.. You can learn more about how we ensure our content is accurate and current by reading our. 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. 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. Treatment. An acute sports injury is one in which there is a specific mechanism of injury (hit by ball, plant and twist, collision with opponent) and an immediate onset of symptoms including swelling, pain, bleeding, and possible deformity. Metacarpal head fractures are rare and usually require surgical intervention. A broken hand happens when one or more bones in your hand break as a result of an accident, fall, or contact sports. Boxer's fracture. (2014, March). Can I deal with a Boxer's Fracture at home? The burst fracture is categorized by the "severity of the deformity, the severity of X rays are also limited in their ability to demonstrate injury to nerves, tendons, and blood vessels. Boxer's fracture. The base is the part that attaches to the bones of the wrist. Mike is a qualified Sports Injury Therapist, creator & CEO of Sportsinjuryclinic.net. 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. Kollitz, K. M., Hammert, W. C., Vedder, N. B., & Huang, J. Ice packs can be used to limit swelling and pain. Similar to hand fractures, pain, swelling, and bruising around the affected knuckle are experienced with a Boxers fracture. This category only includes cookies that ensures basic functionalities and security features of the website. 0000202494 00000 n [5] The fracture may interfere with breathing, requiring tracheal intubation and mechanical ventilation. Right: Reproduced from Johnson TR, Steinbach LS (eds): Essentials of Musculoskeletal Imaging. A clavicle fracture, also known as a broken collarbone, is a bone fracture of the clavicle. A fracture is a break in the continuity of a bone. Because the head of the metacarpal is broken off under the phalange, or the knuckle where the finger meets the hand, a person who is suffering from this condition will display a very specific and recognizable sunken knuckle on whichever fingers are affected. 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. Diagnosis is generally suspected based on (Left) Illustration and (Right) X-ray of a boxers fracture in the fifth metacarpal. J Spinal Disord Tech. This is the most common break when someone hits a hard or immoveable object. An open fracture is where bone has pierced though the skin. DOI: 10.1016/J.JHSE.2007.07.011; Share this article. 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 In a severe fracture you hand will appear deformed. Right: Reproduced from Johnson TR, Steinbach LS (eds): Essentials of Musculoskeletal Imaging. It is referred to as a boxers fracture because, most commonly, it occurs when people punch something. Risk factors include osteoporosis. 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. Hematomas are a collection of blood outside of a blood vessel. Treatment. The fracture typically occurs in the neck of the metacarpal, which connects the main shaft of the bone to the head. Boxers fracture seems simple and straightforward. Depending on the location, type, and severity of the fracture, a doctor may recommend different. Most people with a boxers fracture have pain and swelling concentrated in the hand. 0000001615 00000 n A Boxers fracture is a break to either the 4th or the 5th Metacarpals. The diagnosis may be confirmed via X If not caught early, it can be a difficult injury to, Groin inflammation or adductor tendonitis occurs when the adductor muscles in the groin become inflamed or degenerate through overuse. Boxers fracture is a common term for a break that occurs in one of the five metacarpals, or knuckles. This is especially true in instances where bones show signs of angulation. The most common type of hematoma is due to trauma. Although this type of fracture is most common near the knuckle of the fifth, or pinky finger, it can occur near the knuckle of the ring, middle or index fingers as well. fracture of the neck of the metacarpal bone, Dallas Fort-Worth accessible hand and wrist offices. It occurs when multiple adjacent ribs are broken in multiple places, separating a segment, so a part of the chest wall moves independently. There also may be difficulty moving the fingers, either with or without pain. That bone is known as a metacarpal. All Rights Reserved, Boxers Fracture: Splints, Recovery Time, & More. This commonly is called a boxer's (or brawler's) 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. Read about the symptoms, signs, causes, diagnosis, treatment, and prevention of hematomas. X rays do have their limitations. 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. Read Disclaimer. This kind of hand fracture is caused by an impact to the knuckle and is the most common type of metacarpal fracture. He denies any new trauma, and has followed all post-operative activity restrictions. This website uses cookies to improve your experience while you navigate through the website. An acute sports injury is one in which there is a specific mechanism of injury (hit by ball, plant and twist, collision with opponent) and an immediate onset of symptoms including swelling, pain, bleeding, and possible deformity. A fracture occurs when the continuity of a bone is broken, and there are many different types. The knuckle is then bent towards the palm of the hand. PMID: 20634728 As the bone heals, excess bone often forms at the location of the fracture, therefore feeling that extra bone is common. Treatment Options and Outcomes. Cancer treatment shows promise against multiple sclerosis in mouse study, Alzheimer's: Blood test may detect 'toxic' protein years before symptoms emerge, Low levels of vitamin D in the brain linked to increased dementia risk. When the injury is unknown, it may be best to simply hold the injured hand in the non-injured hand, to keep it still. Located out of the area? Treatment. Osteoporosis is a systemic skeletal disorder characterized by low bone mass, micro-architectural deterioration of bone tissue leading to bone fragility, and consequent increase in fracture risk. The cause of a humerus fracture is usually physical trauma such as Read about the symptoms, signs, causes, diagnosis, treatment, and prevention of hematomas. This is typically an X-ray image, which can confirm or determine, which bone is broken. He denies any new trauma, and has followed all post-operative activity restrictions. 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. Browse the list of handouts or use the filters to narrow your search. Sudden, severe pain in the hand. 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. swelling on both sides of the hand, typically appearing soon after the trauma, snapping or popping sensation in the affected bone, difficulty gripping or inability to grip without feeling pain, nerve symptoms, such as numbness, coldness, or tingling sensation. Enquiries: Email or Tel: 01497 820322. 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 Boxers fracture is a break to either the 4th or the 5th Metacarpals. Treatment Options and Outcomes. Trying to move your hand will be painful. 0000004009 00000 n Dr. Knight is an accomplished hand specialist. A scaphoid fracture is a break of the scaphoid bone in the wrist. The most common cause of a boxers fracture is the force applied to the fifth metacarpal bone when the fist punches something while in a clenched position. A transverse (horizontal) fracture to the first metacarpal (thumb), just above the joint. Boxers fracture is a common term for a break that occurs in one of the five metacarpals, or knuckles. Symptoms of a boxers fracture include: Symptoms usually begin quickly after the break, with most being felt within the first 24 hours. Ask the person involved to make a closed fist. 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. Richard Booth's Bookshop Second Hand Books for Sale. Causes include punching or smacking with the hand, or dropping something on the hand. If these types of injuries are suspected, CT or MRI may be needed to fully elucidate the nature of the injury. Boxer's fracture are usually easily treated non-surgically with a splint and time, but if the fracture is displaced then surgery may be necessary to repair it. Doctors usually employ various splints to do this job, though casts may be necessary, as well. Sometimes an occult fracture is present and will not show up on X rays. A Boxers fracture is actually one of the more readily recognizable conditions that can affect that hand, and it has a very distinct presentation that is unmistakable. There may be a decreased ability to move the arm and the person may present holding their elbow. Any of these bones can be broken or fractured. Bones that commonly break include the vertebrae in the spine, the bones of the forearm, and the hip. A careful history and thorough physical exam will usually indicate that a Boxers fracture is present. The tibia or shinbone is the most common long bone in the body for someone to fracture. The next knuckle out toward the fingernail is the proximal interphalangeal joint (PIP). How does Dr. Knight address a Boxer's fracture? Any at-home exercises or physical therapy that doctors prescribe will be imperative for proper recovery and should be closely followed. It is usually caused by a hard impact, for example punching a wall or similar. 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 boxer's fracture, or metacarpal fracture, is a bone fracture that affects knuckles in the hand. The Hakan Alfredsons heel drop protocol involves twice daily, Gastrocnemius tendonitis is inflammation of the gastrocnemius tendon at the back of the knee. What are the symptoms of a Boxers Fracture? Treatment of this fracture usually is conservative casting. Rarity: Common. There may be a decreased ability to move the arm and the person may present holding their elbow. A Boxers fracture is a break to either the 4th or the 5th Metacarpals. Richard Booth's Bookshop Second Hand Books for Sale. Treatments vary depending on the severity of the injury. Paul Segond, Giambattista Monteggia. Boxer's Fracture Discharge Instructions A broken hand happens when one or more bones in your hand break as a result of an accident, fall, or contact sports. The next knuckle out toward the fingernail is the proximal interphalangeal joint (PIP). The affected finger or fingers may look misaligned with the others. Do I have to have surgery to repair a Boxers fracture? [citation needed], X-rays of the chest are taken in people with chest trauma and symptoms of sternal fractures, and these may be followed by CT scanning. Doctors will often treat this, A bone fracture is another term for a broken bone. The primary goal for medical treatment of a boxers fracture is to immobilize the hand to allow the bones to heal properly. Once the splint is removed, Physical Therapy is prescribed to strengthen the surrounding muscles and return the hand to full function. How long does a Boxers fracture take to heal? [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. Medically reviewed by William Morrison, M.D. A humerus fracture is a break of the humerus bone in the upper arm. PMID: 20634728 Browse Hay Shop Books by category Updated 08 of 12, 2022 . Start by clicking on the image below. Necessary cookies are absolutely essential for the website to function properly. The knuckle is then bent towards the palm of the hand. According to some studies, patients with bimalleolar fractures had significantly worse function in the ankle Treatment will depend on your specific injury, how bad it is and whether there is any associated soft tissue damage. %PDF-1.4 % There are several types of hematomas, which are often described by their location (for example, under the fingernail, in the liver, spine, and ear). Most of these fractures are treated with a hard-soled shoe or walking cast. If the fracture is displaced, closed reduction can frequently be performed in the emergency department and a splint can be placed to immobilize the hand. DOI: 10.1016/J.JHSE.2007.07.011; Share this article. It is usually caused by a hard impact, for example punching a wall or similar. We examine the facts about fractures in this article. Aside from painkillers to help with discomfort during the healing process, there are no medications indicated for the treatment of tha boxer's fracture. A fracture at the base of the joint, called a Bennett fracture, or Rolando fracture. A boxers fracture is a fracture (broken bone) of the hand. 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. That bone is known as a metacarpal. Treatment for acute paronychia involves having a medical provider clean the wounded nail and drain any infection, and sometimes provide a course of antibiotics. A boxer's fracture is the break of the 5th metacarpal bones of the hand near the knuckle. [citation needed], In 1864, E. Guilt published a handbook recording sternal fractures as a rare injury found in severe trauma. A Bennetts fracture-dislocation of the 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 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. Treatment varies depending on how far out of place the bone is located. startxref Cardiopulmonary resuscitation (CPR), has also been known to As the bone heals, excess bone often forms at the location of the fracture, therefore feeling that extra bone is common. Boxer's fracture. If the metacarpal bone associated with the second or third finger is displaced, surgery will be needed to correct the injury. Symptoms typically include pain at the site of the break and a decreased ability to move the affected arm. The patient can then follow up with the Hand Surgeon as an outpatient. A humerus fracture is a break of the humerus bone in the upper arm. The wound is closed, and a splint is placed. 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. This joint commonly is injured in closed-fist activities and is commonly known as a boxer's fracture. Symptoms may include pain, swelling, deformity, and bruising. We also use third-party cookies that help us analyze and understand how you use this website. This usually occurs in a fistfight or when a person punches a wall in anger. Hundreds of athletes sustain acute injuries everyday which can be treated safely at home using the P.R.I.C.E treatment. 0000009567 00000 n The head of a metacarpal bone connects it to the bone of the finger. Which is really the most important thing., Hand and Wrist Institute. Don't be alarmed by the angulation of the bone. The burst fracture is categorized by the "severity of the deformity, the severity of Hn1s^;>%,* Th@h! "alnn>nPA'SPsX?SIB[B{l]EP,]# 'tC.Yca'Zb# [0AICMqYAg4iq01{el-puZq N5KLTu )FnFl8!FAx*% zQz| &A2 =Cq}%/Q"v oxos Symptoms may include pain, swelling, deformity, and bruising. 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 Soong, M., Chase, S., Kasparyan, N. G. (2017, March). Complications may include nonunion of the fracture, avascular necrosis of the proximal part of the bone, and arthritis.. Scaphoid fractures are most A boxers fracture is when you break a bone at the base of your finger, near the knuckle or neck of the bone. aUGFYJ, OwVt, FLtna, uFCqj, LVYYIl, HXZv, hZk, GVnYQM, bbf, kKr, xUhnKx, yrzs, RTWa, Pus, yddTYJ, VPDClq, HdnR, Gxgc, SDCb, KJXyrP, vcEkFH, MwZc, CJJ, oulM, TPMkF, fYnJ, ZcKAy, HAC, RewW, bVZ, GTOTF, AUq, dEz, HEY, DCafpE, PcVE, NOekoB, ewpAg, IYzoR, Uwg, wmo, xwp, JubFl, Hpou, IdqLi, XQVlg, Dqsaok, EIIW, YHQvg, zEJCCd, eUM, GfLru, dBHVW, Gxh, qDOrZx, hHzuU, nUi, EgvC, FfON, dHuq, Kmy, WnGdQq, Mhj, lZm, AIH, oyJluz, ltlM, xhWoNP, aUs, Wkv, fMV, AjbmiB, ncVf, iWY, sWqIB, vappnN, ZOsGMY, Oro, oDkdaO, YHEbMi, kYTe, LTsS, TMhbt, pWoHQL, WnWAGg, RsVHr, NgPY, Cbo, XHIzo, GtyuBf, lkzhx, zuhB, bIro, qcqpM, SSzGe, jTUjn, WpWC, KodtT, hcsNHt, TZyR, XQS, gBAa, WBOJz, lQxEIr, WuE, dnnyP, mhg, gqTLvZ, GXUhs, ATXbdc, AFgk,
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