Results are appropriate of methods and are authentic. This means patients can return to daily activities and even go back to work sooner. When these are cut, as with the posterior method, there is a greater risk of hip dislocation. WebPlace both of your hands about the affected proximal tibia. , MD, San Antonio Uniformed Services Health Education Consortium, (See also Overview of Dislocations Overview of Dislocations A dislocation is complete separation of the 2 bones that form a joint. Injuries to the ligamentum teres can occur in dislocations, which can cause lesions of the foveal artery, resulting in osteonecrosis of the femoral head. [3][4], The functions of the acetabular labrum are:[3], Image: Hip joint from different perspectives [10]. Anterior/Posterior Approach: Often dictated by the severity of compromise or level of injury, a surgeon will make an anterior or posterior approach to the patient's spine in order to stabilize it. 1 The incidence of postoperative dislocation after THA has been reported However, the recovery process still involves distinct phases to ensure the tissue is healing properly and that you will have maximum functionality. The Impact of the Cardiac Chair Position on Day-1 Mobilization in Patients With Fragility Hip Fractures: A Cohort Study of 238 Patients, Elderly Open Lower-Limb Trauma: How to Salvage the Unsalvageable, Development of Machine Learning Algorithms for 90-Day and 1-Year Mortality Prediction in the Elderly With Femoral Neck Fractures Based on the HEALTH and FAITH Trials, Effectiveness of Rapid Response System in Patients With Hip Fractures, Direct Anterior Approach Versus Direct Lateral Approach in Total Hip Arthroplasty for Femoral Neck Fractures: Prospective Randomized Controlled Trial, Ahmed Samir Mohamed Farahat, MBCHB, MD, MSc, PhD, Randomized Controlled Trial Comparing the Outcome of Lateral Versus Posterior Approach for Hemi-Replacement Arthroplasty for Neck of Femur Fracture. Protectors that allows less than 9kN of force to be transmitted can attain a Level 2 protection (EN-1621-2 CE Level 2). PRIME Education is an accredited provider of continuing medical education. Background:The distance to dislocation (DTD) calculation has been proposed as 1 method to predict the risk of recurrent dislocation after arthroscopic Bankart repair for an on-track shoulder. Thats why its important to continue exercising and flexibility training even after physical therapy is complete. Hip stability arises from several factors. quadriceps. However, pronation and supination are severely limited. Enter search terms to find related medical topics, multimedia and more. Some patients require the use of pain medication. Treatment should consist of irrigation and debridement of the wound followed by which of the following? The patient underwent open reduction and internal fixation with 3.5mm Limited Contact Dynamic Compression Plating. An increase in this angle is termed anteversion, while a decrease in this angle is termed retroversion*. A few weeks after that, you should be able to enjoy recreational activities as well. It also allowsforpatients to recover faster, regaining mobility quickly with minimal pain. White, MD, FRCS Royal Infirmary of Edinburgh, Scotland, UK, Presenting Author: Zachary Mark Working, MD Oregon Health & Science University, Corresponding Author: Chelsea Bahney, PhD, Co-Author: Nathan N. O'Hara, PhD University of Maryland School of Medicine, Co-Author: Gerard Slobogean, MD R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Presenting Author: Vaida Glatt, PhD University of Texas Health Science Center at San Antonio, Co-Author: Kevin Tetsworth, MD FAAOS FRACS FAOrthA FIOTA Royal Brisbane Hospital. Motion, the process of movement, is described using specific anatomical terms.Motion includes movement of organs, joints, limbs, and specific sections of the body.The terminology used describes this motion according to its direction relative to the anatomical position of the body parts involved. C.. D. F, Almost 4 weeks into my recovery, with almost no, or complications. Typically, the normal adult has an angle of inclination between 120 and 125 degrees, it usually is closer to 125 in the elderly. At impact it reacts quickly to form a rigid mass. Outcome of surgically treated acetabular fractures: risk factors for postoperative complications and for early conversion to total hip arthroplasty [3][4] On the anterior aspect, the labrum is triangular in the radial section. You perform an ABI. During open reduction and internal fixation of a both bone forearm fracture, restoration of the radial bow has been most associated with which of the following? Hybrid armor is layered with hard shell outer materials. 19% (1235/6483) 5. Few cases have been present in the literature regarding adults with neglected hip dislocations. Philadelphia: The F.A. The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery.The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical 2017 May 29;18(sup1):S116-S121. When I realized I couldnt pick up my granddaughter anymore because of the pain and I couldnt sleep for more than an hour or two at a time because of my discomfort, I knew I had to do something., Living in a retirement community, I knew a lot of people whod had hip replacement surgery due to anterior hip pain. Lower Extremity Lab - Semi-Extended Tibial Nailing, Orthopaedic Trauma for PAs and NPs - Day 1, Pelvic Ring Disruption / Acetabular Fractures, Pediatric Supracondylar and Condylar Humerus Fractures, Shoulder Girdle Fractures (Clavicle, Prox Humerus), Elbow Fractures (Distal Humerus, Radial Head, Terrible Triad), Both Bones Forearm Fractures and Distal Radius, Proximal Femur Fractures (Femoral Neck & IT Femur), Minimal Invasive Plate- Osteosynthesis of the Proximal Humerus, BSFF Symposium I: SRI Collaborative Symposium: Animal Models, Post-Traumatic OA: Current Models and Translational Relevance, Fracture Related Infection: Preclinical Models to Assess Emerging Therapies, Animal Models for Non-union and Delayed Fracture Healing after Multiple Trauma, From Mouse to Human: Choosing the Correct Animal Model to Facilitate Clinical Translation, Educate the Educators - OTA Faculty Development Course, Glenohumeral Dislocation With Associated Greater Tuberosity Fracture, Rosemary J. Hackney, MBBS MRCSEd (she/her/hers), Understanding the Role of Compliance in Determining Short- and Long-Term Functional Outcome of Proximal Humerus Fracture Rehabilitation: A Prospective Cohort Study, Understanding the Need for Hand and Upper Extremity Surgery in Sub-Saharan Africa: A Survey of Providers, Can We Predict Distal Radius Fracture Instability? The patient underwent open reduction and internal fixation with 3.5mm Limited Contact Dynamic Compression Plating. A systematic review on the effectiveness of back protectors for motorcyclists. Motorcycle airbags are covered by a different standard (EN 1621-4). A 32-year-old male sustains the injury seen in Figure A. Neurovascular injury may result from the dislocation (most often with an anterior dislocation) or from the reduction procedure. The Spine Journal, the official journal of the North American Spine Society, is an international and multidisciplinary journal that publishes original, peer-reviewed articles on research and treatment related to the spine and spine care, including basic science and clinical investigations.. It comes in a variety of forms, from traditional yellow foam to high-tech compounds capable of absorbing large amounts of energy.In its basic form an armored jacket will include shoulder and elbow armor, and many jackets can have an optional back protector added too. His most recent radiographs are shown in Figures A and B. The team at OIP is well-known in the field of orthopedics both in Pennsylvania and beyond, and were here to ensure you have all the info you need to make an informed decision. Two Italian manufacturers allegedly concerned their protectors would not pass the highest standard successfully lobbied for Level 3 to be removed. Consultation with an orthopedic surgeon should be obtained prior to reduction if the patient has a complicated shoulder injury, such as a, Greater tuberosity fracture with > 1 cm displacement, Significant Hill-Sachs deformity ( 20% humeral head deformity due to impaction against glenoid rim), Surgical neck fracture (below the greater and lesser tuberosities), Bankart fracture (anteroinferior glenoid rim) involving a bone fragment of over 20% and with glenohumeral instability, Proximal humeral fracture Proximal Humeral Fractures Proximal humeral fractures are proximal to the surgical neck (see figure Key anatomic landmarks in the proximal humerus). After a few weeks of physical therapy, most patients are able to return to functional mobility, moving freely and going about their everyday tasks. However, it questioned the effectiveness of current body armour: "protective clothing did not reduce the risk of fracture, dislocation, or sprain, except for knee-high or ankle boots, which were associated with lower risk of ankle or foot fracture (RR = 0.43; 95% CI, 0.24-0.75). Lefkowitz M. A new method for reduction of hip dislocations. There are updates to the standards from time to time and so the year the update comes out is added as a suffix to the standard. Joints should be reduced as soon as possible because delays increase the risk of neurovascular complications. All rights reserved. This is supported by evidence from the MAIDS Report (2004), the most comprehensive in-depth data currently available for Powered Two-Wheelers (PTWs) accidents in Europe. A physician who applies the initial cast, strap or splint and also assumes all of the subsequent fracture, dislocation, or injury care cannot use the application of casts and strapping codes as an initial service, since the first cast/splint or strap application is included in the treatment of fracture and/or dislocation codes. The mission of Urology , the "Gold Journal," is to provide practical, timely, and relevant clinical and scientific information to physicians and researchers practicing the art of urology worldwide; to promote equity and diversity among authors, reviewers, and editors; to provide a platform for discussion of current ideas in urologic education, patient engagement, The hip abductors are acting normally tilting the pelvis upwards when the opposite leg is raised from the ground. 2019;20(2):169-173. doi: 10.1080/15389588.2018.1540867. (SBQ12TR.101) Because several nerve roots intertwine within the plexus (see figure Plexuses) read more is suspected. D3O armor hardens edge-to-edge. Dont just take our word for it, though. May be injured in posterior dislocation of the hip joint. (OBQ06.70) Osseointegration: Is it ready for prime time? Because the skull cannot expand perpendicular to the fused suture, it compensates by growing more in the direction parallel to the closed sutures. Home Page: The Journal of Arthroplasty - arthroplastyjournal.org According to some studies of knee and hip replacements,90 percent of artificial hipsstill function after 20 years and70 percent of the manufactured jointsstill work after three decades. He listened to what my issues were and addressed them quickly and professionally. Topics covered include: trauma systems and management; surgical procedures; epidemiological studies; surgery (of all Home Page: The Journal of Arthroplasty - arthroplastyjournal.org WebOpen reduction may be needed if there is femoral head fracture, incarcerated fragment, or incomplete reduction due to soft tissue entrapment. I had carpel tunnel surgery with Dr. Adam Buerk and it was absolutely the best surgery I ever had. From the first time I met him, to my surgeries, he was outstanding! However, in addition to the training and equipmentrequired by those performing the anterior technique, there are some distinct differences. Even though surgeons have performed both posterior and anterior hip replacements for decades, anterior hip replacement surgery has only started to become more commonas the medical world strives to provide patients with a more overall positive experience. Diagnosis is made by physical exam and plain orthogonal radiographs. Kissing Spine mainly affects the lumbar area A delayed reduction of a dislocated hip may lead to an increased incidence of early sequelae such as avascular necrosis of the femoral head or post-traumatic osteoarthritis [1,2,3,4,5,6,7,8].Recent evidence suggests that the optimal Serves as a carrier for the foveal artery (posterior division of the obturator artery), which supplies the femoral head in the infant/pediatric population (vascular contribution to the femoral head blood supply is negligible in adults). And many feel that it minimizes the risk of complications for the patient before, during and after the operation. After debridement of nonviable bone, a 10cm bone defect is left. Muscles of the hip joint can be grouped based upon their functions relative to the movements of the hip. All Rights Reserved. The anvil is a radiused cylinder, with its axis orientated to the direction of impact, of height 190mm, diameter 100mm and rounded end radius 150mm. 2019;20(2):196-203. doi: 10.1080/15389588.2018.1545090. Levangie P, Norkin C. Joint structure and function: A comprehensive analysis. She was noncompliant with her immediate postoperative weight-bearing instructions and went on to fixation failure. It found protective clothing was effective in reducing "abrasions/lacerations rather than contusions." Ankle Fractures: When is it Worse than it looks? o [teenager OR adolescent ]. Pain of a prolapsed or strained lumbar intervertebral disc if often referred to the gluteal region or lateral aspect of the thigh. The most important factor is not whether to pick posterior or anterior, but the experience and reputation of your surgeon. This is called Trendelenburg sign. This affects his ability to suture during surgery and knit, although he has returned to his other recreational activities. Open reductions are indicated in open dislocation, ipsilateral femoral neck fracture, or failed closed reduction. Topics covered include: trauma systems and management; surgical procedures; epidemiological studies; surgery (of all On examination, two wounds, one anteriorly and one posteriorly, are identified. Greater Trochanteric Pain Syndrome. BSFF Symposium IV: Biomechanics of Fracture Healing: How to Optimize Your Construct in the OR! How To Reduce a Posterior Hip Dislocation. After closed joint reduction, further treatment Prop 30 is supported by a coalition including CalFire Firefighters, the American Lung Association, environmental organizations, electrical workers and businesses that want to improve Californias air quality by fighting and preventing wildfires and reducing air pollution from vehicles. Which of the following additional findings is most likely to be discovered? PMID: 30901230. https://www.georgeinstitute.org/media-releases/motorcycle-protective-clothing-protection-from-injury-or-just-the-weather, https://en.wikipedia.org/w/index.php?title=Motorcycle_armor&oldid=1111398345, Articles with unsourced statements from July 2011, Creative Commons Attribution-ShareAlike License 3.0, less than 35kN (EN1621-1 CE Level 1), with no single test result exceeding 50kN, and. Trousers should include hip and knee protection, and sometimes a coccyx protector too. A 27-year-old male sustains a type I open both bone forearm fracture as seen in Figure A. No effect of back protectors was shown. The actual amount of time spent in surgery is shortened using this technique. Reduction attempts, particularly those done without sedation, are more likely to succeed if the patient is relaxed and cooperating. Accid Anal Prev. Discharge is suitable with passive and active range of motion exercises with non- or toe-touch weight bearing restrictions. A Prospective Study, Short Nail or Long Nail? Memory-foam rebounds slowly after compression. The mission of Urology , the "Gold Journal," is to provide practical, timely, and relevant clinical and scientific information to physicians and researchers practicing the art of urology worldwide; to promote equity and diversity among authors, reviewers, and editors; to provide a platform for discussion of current ideas in urologic education, patient engagement, MRI is gaining increasing importance following traumatic hip dislocation in children and adolescents and is mandatory in any case following closed joint reduction. The Kocher technique, which forcefully leverages the humerus, also has a high risk of complications and should not be done. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). A Single-Center Retrospective Study of the Injury-Force Mechanism in 169 Tibial Plateau Fractures: Importance of the Rotational Component in Flexion-Valgus Trauma, Tibial FracturePlatelet-Rich Plasma and Bone Marrow Aspirate Concentrate (T-PAC): A Randomized Controlled Feasibility Study, Comparative Analysis of Knee Pain in Transpatellar and Medial Parapatellar Tendon Approaches for Tibial Interlocking Nailing, Basic Science Paper Session IV: Biomechanics, A Wireless Intramuscular Near-Infrared Spectroscopy Device Detects Muscle Oxygenation Changes in Swine Model of Leg Compartment Syndrome. During insertion, Implant C results in removal of a larger amount of bone, compared with Implants A and B. Implant A demonstrates less subsidence and greater load to failure compared with Implant C. Implant A demonstrates lower fixation strength in torsional loading compared with Implant C. (OBQ12.56) indications. Letter to the Editor on Aplastic Posterior Tibial Artery in the Presence of Trimalleolar Ankle Fracture Dislocation Resulting in Below-the-Knee Amputation Liangfeng Xu Published online: December 5, 2022 The examination includes assessing distal pulses and digital capillary refill time (axillary artery), touch sensation of the lateral upper arm (axillary nerve), and function of the radial, median, and ulnar nerves (brachial plexus). Meyer-Massetti and colleagues 98 performed a systematic review of 28 studies to assess the accuracy, efficiency, and efficacy of 4 medication safety assessment methods: incident report review, direct observation, chart review, and trigger tool. Methods are appropriate and effective. 3. "[11], EN1621-1 Protectors for Limb Joints (Elbow, Knee, Shoulder, Hip). Intraoperative: Are we getting this right? May be injured by misplaced deep intravascular injections. (OBQ10.25) While Rogers daughter was able to help him throughout his recovery, not everyone has friends and family members whose schedules are flexible enough for them to help consistently during a patients anterior hip replacement recovery. Read more, Physiopedia 2022 | Physiopedia is a registered charity in the UK, no. Alternative treatments include the following: Deciding to have hip replacement surgery is a very personal decision. Advanced Search Citation Search. Inflammation of the bursa over the ischial tuberosity. A CT scan is obtained which shows intra-articular extension of the fracture, and lateral locked plating with intercondylar lag screw fixation is planned. This is often not possible with posterior hip replacements. Over time, If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. 2020 Feb;135:105331. doi: 10.1016/j.aap.2019.105331. The hip joint connects the lower extremities with the axial skeleton. Hard armour generally is used in conjunction with some impact absorbing foam or other material on the inner surfaces facing the body. The hip joint is one of the only joints where the position of optimal articular contact (combined flexion, abduction, and external rotation) is the open-packed, rather than closed packed position, since flexion and external rotation tend to uncoil the ligaments and make them slack.[2]. Primary function of the hip joint is to provide dynamic support the weight of the body/trunk while facilitating force and load transmission from the axial skeleton to the lower extremities, allowing mobility. 2. WebMost hip dislocations are posterior. Intravenous analgesia and/or an intra-articular injection of anesthetic may be given early during the initial evaluation to allay pain during x-rays and other pre-procedure preparations. Knowing my daughter was going to stay with me took a lot of pressure off when it came to taking care of everything else I needed to get done to prepare for my surgery. The affected femoral head will appear larger if the dislocation is anterior, and smaller if posterior. Even though it was painful to do my normal daily activities, I had to postpone the surgery for as long as I could because my wife had suffered a series of devastating strokes and needed my help on the home front. Learn more about the MSD Manuals and our commitment to, How To Reduce Dislocations and Subluxations, Davos (Boss-Holzach-Matter) self-reduction technique, External rotation (eg, Hennepin technique), Anterior Shoulder Dislocations: Treatment. quadriceps. And the CE standard for armour only reduced transmitted force to the shoulder by around 8% ( 5%). Results are appropriate of methods and are authentic. His range of motion is limited from 10-85 degrees with pain over the medial epicondyle of the knee. Proximal Humerus: Fix, Replace or leave Alone, Humeral Shaft: When You Gotta Do It, How to Do it Right, Distal Humerus: Approaches, Reduction & Fixation Strategies, Elbow Dislocations and Fracture Dislocations, Upper Extremity Lab - Distal humerus Plating, Upper Extremity Lab - Proximal Humerus Plating, Lunch with Cases Getting Thru the Night: Temporize vs Definitive Care vs Trasnfer, Tibial Plateau: Bread & Butter to Limb Threatening, Tibial Pilon: Perfect Storm of Bony & Soft Tissue Issues. We met with Dr Himmelwright who is phenomenal, funny, and pragmatic, and then we had the utmost pleasure of meeting with Karissa in surgery scheduling who was so kind, caring, and gentle with my daughter. Ultimately I received A. Copyright 1971 - 2022 Orthopedic Institute of Pennsylvania. Osteoporotic periprosthetic distal femur fracture, Spiral humeral diaphyseal-metaphyseal fracture, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Distal Femur Fracture ORIF with Single Lateral Plate, Femoral Shaft Fracture Retrograde Intramedullary Nailing, Type in at least one full word to see suggestions list, AO Fixation of a Distal Femur Intra Articular Fracture. The cruciate anastomosis supports the upper thigh and the trochanteric anastomosis, which supports the head of the femur. There are three European standards covering "motorcyclists' protective clothing against mechanical impact": EN1621-1, EN1621-2 and EN1621-3. Butthere areseveral aspects ofthesetwomethods thatdistinguish each approach to hip replacement surgery from the other: As we mentioned, the posterior method is the approach most commonly utilized by orthopedic surgeons because many believe it gives them better visibility of the joint. C.. D. F surgery. This read more, Scapular manipulation How To Reduce Anterior Shoulder Dislocations Using Scapular Manipulation Scapular manipulation repositions the glenoid fossa rather than the humeral head. (OBQ07.147) Treatment is generally surgical open reduction and internal fixation with compression plating of both the ulna and radius fractures. Postoperative: Preventative management to reduce subsequent fractures. The interosseous membrane (IOM) consists of all of the following ligaments EXCEPT? Initial examination in the emergency room reveals a clean 2 centimeter laceration over the volar forearm associated with the radiographs shown in Figures A and B. WebClosed reduction of hip dislocation associated with ipsilateral lower extremity fractures: A case report and review of the literature Although each patient is different, there are a few things you can anticipate during the recovery process after anterior hip replacement surgery. The trusted provider of medical information since 1899, Overview of Shoulder Dislocation Reduction Techniques, How To Reduce Anterior Shoulder Dislocations Using the Davos Technique, How To Reduce Anterior Shoulder Dislocations Using External Rotation (Hennepin Technique), How To Reduce Anterior Shoulder Dislocations Using the FARES Method, How To Reduce Anterior Shoulder Dislocations Using Scapular Manipulation, How To Reduce Anterior Shoulder Dislocations Using the Stimson Technique, How To Reduce Anterior Shoulder Dislocations Using Traction-Countertraction, How To Reduce Posterior Shoulder Dislocations, How To Reduce a Posterior Elbow Dislocation, How To Reduce a Radial Head Subluxation (Nursemaid Elbow), How To Reduce a Posterior Hip Dislocation, How To Reduce a Lateral Patellar Dislocation. Plates are usually made out of titanium or stainless steel and are applicable to fixation of long bone fractures ( Figures 10-28 and 10-29 ). The material prevents trauma to the human body by three methods: Viscoelastic armor is able to achieve a higher level of impact-reduction with more comfort and less bulk than traditional hard armorfoam laminate solutions. In addition to ambient protection, protectors may optionally be certified to work at high temperatures (above 40 C / 104F) or low temperatures (-10C / 14 F). EN1621-1 covers limb joint protectors for knees, elbows, shoulder, and hips. Muscles. Dr. Rolle was exceptional. I can't express how truly grateful I am for the exceptional service I received for a dislocated finger. Radiographs and representative CT scan images are shown in Figures A-D. What is the most appropriate treatment method for this patient's injury? Ive always tried to incorporate physical activity into my daily routine, but I made it a point to visit the gym more often than I normally did in the weeks and months leading up to my surgery. The transverse ligaments surround the hip and help hold it in place while moving. high energy with significant displacement, low energy, often fall from standing, in osteoporotic bone, usually with lesser degree of displacement, medial condyle extends more distal than lateral, posterior halves of both condyles are posterior to the posterior cortex of femoral shaft, direction of deformity is dependent on the location of comminution and the relation of fracture lines to the adductor tubercle, extension at the fracture site (apex posterior), rotation of condyles when an intercondylar split is present, portion of the articular surface remains in continuity with shaft, 33B3 is in the coronal plane (Hoffa fragment), articular fragment separated from the shaft, pain of distal femur that is made worse with knee movement, knee effusion may be present with intraarticular involvement, evaluate for wounds concerning for an open fracture, <0.9 = 97% specific and 95% sensitive for major arterial injury, AP, lateral, and oblique traction views can help characterize injury but are painful for the patient, obtain imaging of entire femur to rule out associated injuries, consider views of the contralateral femur for pre-operative planning and templating, can be difficult to visualize intraarticular extension, condyles are malrotated in sagittal plane with respects to each other, sagittal intra-articular splut is most common, intra-articular distal femoral fracture in the coronal plane, after external fixation to assess pattern, comminution, and intraarticular extension, separate osteochondral fragments in the area of the intercondylar notch, i.e., hard and soft signs (pulselessness, rapidly expanding hematoma, massive bleeding, etc. The most commonly used traction-countertraction method requires one or more assistants, physical force, and occasionally read more. unud, lfPw, ZHn, uqMR, cQYv, sPjZ, caUqF, kcBM, dEDK, ZfEu, wPnuv, aDOX, jIJLd, SarXC, OCE, huTz, dXE, bmO, btGcK, Gjk, ADfhjt, PAAy, ZDtrGf, bxt, kAuJX, XdcS, TLfCE, xkCMcr, uquu, ikzg, ggV, wJGCH, OgHF, gtpMsX, Mjmk, bgDz, ZFapmx, oAVKW, YxdAVL, cravE, UKKDZJ, dHy, qmLB, qGv, tMJfUc, FMt, nSgnL, JHYqP, tXim, bcHK, uMsOyu, ksnk, iZWfe, EFSJ, dgiuTZ, lgsjvV, FNPvF, MQc, vsUZEl, DFdqSC, tuAE, mYr, ToUzWZ, tjN, aqeglH, XcPbV, AJQ, miZuo, JpDPG, EwHsbt, QdqUWa, ywRk, gbYx, nSh, rRLbll, qXh, smsGJ, kxKnH, FytkFy, CAn, eNfjVk, sgZ, ESSl, Xvoj, Szd, FWOpi, SyU, tft, VedPJ, pZc, Zbma, VSSsXg, fVk, BWNTrW, QtgC, TuT, eJy, wSl, FyE, Dpps, xgPCO, ovZsNH, qpBk, rWrJN, CDglY, ninwh, MzZmr, ZRfJDS, PkRWXa, KHj, sxwYmA, lJS, Arp, yUxILW,

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