jones fracture rehab protocol pdf

- perhaps up to 2/3 of these fractures should heal; - involves frx at base of fifth metatarsal at metaphyseal-diaphyseal junction, which typically extends into the 4-5 intermetatarsal facet; Recent studies using wireless, pressure sensor insoles has enabled healthcare professionals and researchers to study the amount of pressure applied to the different parts of the foot during high level activity. All surgeries leave you at risk for complications like: Anesthesia complications Infection Damage to your. After the cast is removed, you will need to have rehabilitation. 9 0 obj Prince 9.0 rev 5 (www.princexml.com) Phase-II: Range of motion and early strengthening. There are many possible internal causes of pain. - although all patients were asymptomatic and radiographically progressing to union before return to full activity, only one of six patients with - consider countersinking the screw to avoid prominence of the screw head; OK to discontinue completely at end of post-op week four. It is one of the most common fractures of the foot and has unique characteristics that make it more likely to require surgery. There are other injuries that can impact the fifth metatarsal, such as an avulsion fracture (also known as a pseudo-Jones or dancer's fracture), but the Jones fracture tends to be more serious. D. Summary Digital fractures are common in the workplace and often result from blunt trauma caused by a falling object or stubbing of the toe. -most common mistake is to direct the drill plantarly, rather than parallel w/ the shaft of metatarsal; Select MyUPMC to access your UPMC health information. These fractures will sometimes heal on their own, but may take months to heal without surgery. 2 0 obj - post op: patients willrequire protected postoperativewt bearing; The fractures are described by the area that they occur and it is one of three zones of the metatarsal. Jones fracture surgery may be needed to align the bone and help with healing. - the authors conclude that larger diameter screws may be more appropriate for intramedullary screw fixation of Jones fractures; Telephone: 410.494.4994, Fractures of the base of the fifth metatarsal distal to the tuberosity. Elsevier Mosby, Philadelphia, 2021. Neuromuscular stimulation of the quadriceps muscle after hip fracture: a randomized controlled trial.Arch PhysMed Rehabil.2002Aug;83(8):1087 The purpose of this scholarly project is to show the rehabilitation of a Jones fracture in an elderly female with emphasis on a structured strengthening, stretching and manual therapy program. - incision: - these occur distal to the ligaments which firmly bind the 4th and 5th metatarsals together; Outpatient vs. home health therapy (Phase 1): o 1-2x/ week x 6 weeks o Gait training with assistive device. 36.Arangio G. Transverse Proximal diaphysial fracture of the fifth metatarsal:areviewof12cases.FootAnkle1992;13:547-9. The Jones Fracture. 56 0 obj However, the area of the bone that is fractured has a relatively poor blood supply, so bone healing may be slowed. Fractures and anatomical variations of the proximal portion of the fifth metatarsal. Following the immobility time period, seek help with your rehabilitation from a Physical Therapist. The first zone is a chip or avulsion fracture and treated conservatively in a cast or boot. Jones fractures have a higher chance than other metatarsal fractures of not healing. Edited by Kenneth Hunt, MD Indications. Jones fracture. It is commonly called a "broken wrist" in spite of the fact that the distal radius is the location of the fracture, not the carpal bones of the wrist. <> Most people need a few months to recover from a Jones fracture. Austin V. Stone MD, PhD www.austinstonemd.com 859-218-3065 Accelerated Protocol Jones Fracture Fixation Weight-bearing Brace Range of Motion Patients of UPMC Cole should select the UPMC Cole Connect Patient Portal. Importance of strengthening exercises. He was the first to describe the fracture in the foot that occurs in the base of the 5th metatarsal bone on the lateral aspect of the foot. Required fields are marked *, 2010-2018 ACE Physical Therapy and Sports Medicine Institute, Physical Therapy Falls Church VA | Physical Therapy Arlington Virginia | Physical Therapy Alexandria VA | Physical Therapy Fairfax VA | Physical Therapy Leesburg VA | Physical Therapy Tysons VA, Designed by Elegant Themes | Powered by WordPress. A typical break or fracture will occur when an abnormally high force is applied to a normal bone. <> Surgical versus nonsurgical treatment. Data Trace is the publisher of by ACE Physical Therapy and Sports Medicine Institute. On Thursday, October 27, from 7 p.m. to 10 p.m., BayCare Clinic will be updating its phone system. In order for a fracture to be diagnosed, you will need to visit a health care provider. Previously, the use of force mats or plates were not able to capture the true nature of the mechanics of the foot during high level activity. Intramedullary screw fixation of Jones fractures. The stability of the ankle mortise has fundamental clinical relevance, as it . <>/ProcSet[/PDF/Text/ImageB]/XObject<>>>/Rotate 0/Type/Page>> 412-647-8762 The Jones Fracture is named after a British Orthopaedic surgeon, Sir Robert Jones. endobj PMID: 24167402; PMCID: PMC3807944. - in the report by Larson CM, et al (2002), 15 patients (mean age, 21.7 years) underwent cannulated screw fixation of a Jones fracture; Anterior Instability Repair Post-Op Rehab Protocol Arthroscopic and Open Capsular Shift Post-Op Rehab Protocol Biceps Tenotomy and Tenodesis Post-Op Rehab Protocol Coracoid Transfer and Glenoid Bone Grafting For Anterior Instability With Bone Loss Post-Op Hemiarthroplasty for Proximal Humerus Fracture Post-Op Rehab Protocol Conservative treatment for. uuid:9bf36731-abb4-11b2-0a00-782dad000000 Distal: may be concomitant with distal radius fracture Carpal fractures Scaphoid The scaphoid is the most common carpal fractured. DIP Blocking 2. p's0,an6>Ve?HP0N,M T2vX4wfCn'PDd3ozsfjf}`i@A_.AqDuN/:cZ,bWCgW)- pa/U The Jones fracture initially was described by Sir Robert Jones in 1902 [7], and a review of his article showed both fracture types are Fractures of the fifth metatarsal. olecranon, distal humerus, and complex radial head fractures; radial head replacements: o May be immobilized up to 1-2 weeks to decrease inflammation and pain prior to initiation of ROM Elbow fractures healing by secondary intention: 39 0 obj - non operative treatment should be reserved only for acute frxs (in most cases); - take care to avoid branches of the sural nerve which can course dorsally, and laterally over metatarsal; - if several months have passed since the onset of symptoms, established non-union may already be present. Many different factors influence the post-operative ankle ORIF rehabilitation outcomes, including rate of healing, complexity of the fracture and/or need for hardware removal. <> Jones Fractures are difficult to treat because they do not heal quickly. - ossicle in peroneus longus tendon where it is seen at the tip of the fifth metatarsal base; The bone accepts most of the bodys weight during gait and the Peroneus Brevis muscle inserts to that part of the metatarsal. endobj Don't be surprised if your foot is still swollen and discolored. endobj - mean time to full activity was 6.8 weeks for the patients with failure compared with 9 weeks for patients who did not have complications; PIP Blocking Hold involved finger at middle so that only tip Hold involved finger at base so that . Jones Fracture Rehabilitation Protocol Home Patient Education Jones Fracture Rehabilitation Protocol This protocol provides you with general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement. - apophyseal line runs parallel to shaft of metatarsal along its lateral-inferior margin of the tubercle; 110 West Rd., Suite 227 x\[oH~"'`'8>6ecoK7)%4v%^R]]W:EyO?my}Wo_OTlKVM_._oQRXP7_9B(6 B - flouroscopy: Add 15 flexion each week; goal 90 by 6 wks. endobj 5th Metatarsal/Jones Fracture Repair Rehabilitation Protocol . Classification and guidelines for non-surgical and surgical management. 5 0 obj It has been reported that nearly 30% of all collegiate injuries are to the foot/ankle. 3. NE Baptist Outpatient Care Center. % Locked in extension, worn at all times except therapy. - w/ stress frx (indictating a chronic frx), an atheletic pt may benefit from ORIF; You will need to wear a cast or boot on your foot and use crutches until the bone has healed and can bear weight again. Rehabilitation seeks to restore normal foot mechanics, strengthen the core and lower extremity musculature and implement the use of a device that will help to unload that part of the foot. The fracture is thought to occur secondary to the accumulation of stress and pressure that is placed on that part of the 5th metatarsal. You can also fracture this bone during lateral (side-to-side) movements or while dancing en pointe, as in ballet. Phase-IV: Advanced strengthening. Data Trace specializes in Legal and Medical Publishing, Risk Management Programs, Continuing Education and Association Management. The Jones fracture is a fracture of the fifth metatarsal, the bone along the outside of the foot, and occurs at the base of the bone closest to the ankle. zone 2 (Jones fracture) represents a vascular watershed area, making these fractures prone to nonunion Biomechanics fifth metatarsal forms lateral border of forefoot functions as a lever in gait during push-off CLASSIFICATION PRESENTATION History antecedent pain in setting of stress fracture, rapid increase in workload or change in training regimen ws9_RTx;RKR,e~oprK!&lA!M-^ZN9@?_'5 The core musculature can be strengthened from day one. -may present as acute lesion or may be seen in chronic phase, and either presentation hasprolonged healing course, compared w/ frxs of other metatarsals; Furthermore, because the fracture is often related to Type A - Fractures below the tibial plafond and typically transverse. Wheeless' Textbook of Orthopaedics. Jones fracture surgery is considered a safe procedure, but it is not without risks. You can also fracture this bone during lateral (side-to-side) movements or while dancing en pointe, as in ballet. <> - Discussion: The muscles strong contracting force to help stabilize the foot / ankle from the lateral side can increase the pressure applied to the base of the bone. o Midshaft fracture, nail >8mmweight bearing as tolerated. - delayed union will show persistent frx line in both cortices, periosteal callus (use hot lamp), and intra-medullary sclerosis; A Colles Fracture is a complete fracture of the radius bone of the forearm close to the wrist resulting in an upward (posterior) displacement of the radius and obvious deformity. Background: Jones fractures commonly occur in professional athletes and operative treatment remains the standard of care in this patient population. Not knowing the status of the fracture site can cause major set-backs and lead to a prolonged down-time, but proper treatment can help to restore full function within the involved leg. They also have a higher chance of fracturing again after they've healed. - this fracture is usually proximal to the metatarsal cuboid joint; Kisner, Carol, and Lynn Allen Colby, Therapeutic Exercise: Foundations and Techniques, F. A. Davis Company; 6th ed, 2012. - return to full activity, especially among elite athletes, before complete radiographic union was predictive of failure endobj A Jones fracture often happens near the end of the bone and usually disrupts blood flow. o AROM/ PROM of knee while sitting at side of bed. 8 0 obj 2022 Central Coast Orthopedic Medical Group. View more sports medicine conditions and treatments, Sign in to UPMC Cole Connect Patient Portal, Sharp stabbing pain on the outside of the foot. Stand with your feet hip-width apart Lift your heels off the ground as if to do a calf raise, ensuring that you're lifting them as high as possible With good ankle stability, start walking forward 10 steps Then, turn around 180 degrees and repeat the 10 steps back to your starting place Repeat for 3-4 sets total Surgery for Jones fractures is often performed on an outpatient basis, with local or general anesthesia. Treatment 2022 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences, Supplemental content provided by Healthwise, Incorporated. 1. The portal for UPMC Cole patients receiving inpatient care. 1 0 obj - Fractures of the base of the fifth metatarsal distal to the tuberosity. Slowly raise your heels off the floor while keeping your knees straight. Because the area around the fifth metatarsal bone of the foot receives less blood flow, it is prone to injury, and healing time is increased. - The Association of a Varus Hindfoot and Fracture of the Fifth Metatarsal Metaphyseal-Diaphyseal Junction. Am J Sports Med 2006; 34:476-80. endobj Repeated overuse, sports injuries and falls are the most common causes of Jones fractures. If you have an immediate need, please call 920-480-6993 to be transferred to our answering service . - stress frx: endobj - can be obtained from tuberosity and from bone bits from the drill; "&8QmN_ulVthZ2cuTSru3?`QpDt&5>Feh'nYDKPwJz ^?uo woA7Wn}(& ;'A9\[~[pG$>qaHeq[m9k^+\yr(U;SlQ?h[A*'TNE7H&$\)^F#lRNsv2PyrLmh J@-*Ix lCCEoh#}T$8opumuCrxp'n^{+h:SJ+%Jp ^tRgt-#/S6/T3]=~,~U#,Rt\~F_Dl8Jr# Vh@>lA(dh'>/q('7=p9p8;IYM 38 0 obj While this injury can happen endobj can bend. Hold for about 6 seconds, then slowly lower your heels to the floor. endobj The fifth metatarsal bone is the small bone along the outside of your foot, and is prone to both regular fracture and a stress fracture. Proper diagnosis is essential. Visiting a Physical Therapist is easy. He or she will perform an X-ray to diagnose the Jones fracture or avulsion fracture and see the extent of the injury. This fracture can happen when you increase your training, increase pressure on your feet from gaining weight, or run on uneven surfaces. of this injury and your treatment options. - under flourscopic guidence, a K wire is inserted for determination of proper position and length; Hold the stretch for at least 15 to 30 seconds. The rehabilitation of a foot that has suffered a Jones Fracture must be a team effort to be successful. Orthopaedic Specialists of North Carolina. 800-533-8762. Midshaft: if concomitant with a radial fracture, may be called a "both bones" fracture. This involves stretching and strengthening exercises order to safely get back to previous activity levels. 921 Oak Park Blvd #204 Pismo Beach, CA 805-473-4949 862 Meinecke Avenue #100 San Luis Obispo, CA 805-541-4600 2342 Professional Pkwy #200 Santa Maria, CA 805-349-9545805-349-9545 <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Your email address will not be published. 2019-06-08T17:41:53-07:00 No overhead motion week one. - in either case, threads must cross the frx line; endobj Before your doctor can diagnose your condition and design a treatment plan, a complete history and physical examination are necessary. Michlovitz S, Festa L. Therapy management of distal radius fractures. - poor thread purchase within the medullary canal was noted with the 5.0 mm screws, while excellent purchase was noted with 6.5 mm screws; The portal for all UPMC patients EXCEPT those in Central Pa. The avulsion foot fracture also commonly occurs in the fifth metatarsal. - local bone graft: If either increase, modify rehab PRICE Ankle Pumps E-stim if Needed Phase I (up to 6 weeks s/p ORIF): Goals: PWB involved LE with or without one crutch DF to neutral Control edema 1. - usually present between the ages of 9 to 14 years; 4 0 obj In our clinical experience, an aggressive postoperative rehabilitation protocol for National Football League (NFL) players with an average return to play (RTP) between 8 and 10 weeks can have successful outcomes with few complications. Phase-I: Maximum protection phase. The portal for UPMC patients in Central Pa. 40 patients with transversal or short oblique fractures of the proximal shaft of the fifth metatarsal bone (Jones fracture) were treated with full weight bearing with or without elastic. - references: A Jones fracture was created at the meta-diaphyseal junction at the distal aspect of the fourth tofifth intermetatarsal articular facet with an oscillating saw. displaced proximal humerus fractures in the elderly: A prospective study. - diameter should depend on width of the canal (let the screw tap help determine the best size); F"IGeR%URnv=?2rg*Vty].1tTNUMU,oun;vb,PTSo^9}y&?0W=0\DWbBw {OQKyzMX$v8q}v7pvJI"an%&b, Rehabilitation of a Patient with a Jones Fracture. The mechanical stimulus of the joint moving allows for improved joint surface remodeling/healing. 40 Allied Drive. Foot Fracture: Fifth Metatarsal Fracture Exercises: References. %PDF-1.7 - in addition, the acute Jones frx must be distinguished from the chronic Jones frx the later of which may represent a stress frx w/ poor prognosis for healing; Int J Shoulder Surg. The mechanism of injury is typically a forceful hyperextension of this joint. - Surgical Treatment: (Jones Frx); Importance of ROM exercises. <> The difficulty and delayed healing has lead most surgeons to perform surgery on the bone and fixate it with hardware. The distinction between Jones and proximal diaphyseal fractures of the fth metatarsal is often confusing for many physicians, even orthopaedists who are active in sports medicine and foot and ankle treatment. - there were six treatment failures: four refractures and two symptomatic nonunions; 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. This is common after a Jones fracture. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. 2019-06-08T17:41:53-07:00 Healing Time for a Jones Fracture After a few weeks of physical therapy, your pain level should be at a minimum and your strength and range of motion in your foot and ankle should be normal. [4] It results in pain near the midportion of the foot on the outside. Unfortunately, these fractures dont usually heal quickly. - Acute fractures to the proximal fifth metatarsal bone: Development of classification and treatment recommendations based on the current evidence. ACE Physical Therapy and Sports Medicine Institute, How Physical Therapy Increases Functional Mobility, Benefits of Physical Therapy for a Sports Injury, Physical Therapy after Rotator Cuff Repair, What to Expect for your First Physical Therapy Appointment, The Benefits of Physical Therapy After Knee Surgery. Physical Therapy. ORIF Clavicle Fracture Rehabilitation Protocol. - Early Screw Fixation Versus Casting in the Treatment of Acute Jones Fractures. - note that the metatarsal shaft is more narrow on the AP view, and it ispossible for the pin to be centered on Proximal ulna: Monteggia fracture of the proximal ulna with anterior dislocation of the radial head. The Jones Fractures are classified by the location within 1 of the 3 zones along the 5th metatarsal. Jones fractures are caused when you put sudden force on the outside of your foot with your foot twisted away from your body. Sling for comfort. Screw fixation is thought to. Outpatient percutaneous screw fixation of the acute Jones fracture. fractures of the fifth metatarsal located in the junction of the proximal metaphysis and diaphysis. KarumoI. The Physical Therapist can evaluate you and treat you without the doctors prescription, but in the case of a post-operative visit it would be best to have the doctors protocols for that particular condition. Analysis of Failure. It does not replace the opinion, discussion, and treatment from a trained medical professional. Classification and guidelines for non-surgical and surgical management. Do 8 to 12 repetitions several times during the day. - ref: Intramedullary screw fixation of Jones fractures, - Outcomes: Weber/AO - categorizes fractures on level of the fibular fracture. endstream endobj This normally takes approximately 6 weeks to unite (heal) although pain and swelling can be ongoing for 3 to 6 months. Stand with your feet 8 to 10 centimetres apart, with your hands lightly resting on a counter or chair in front of you. If you think you have broken a bone in your foot, you should stop activity and speak with your doctor. This fracture can happen when you increase your training, increase pressure on your feet from gaining weight, or run on uneven surfaces. WBAT w/ brace locked in ext. Apply ice to the break as well. <> Fractures of the base of the fifth metatarsal distal to the tuberosity: a review. Early Screw Fixation Versus Casting in the Treatment of Acute Jones Fractures. Analysis of a fracture registry, Fractures of the base of the fifth metatarsal distal to the tuberosity: a review, Outpatient percutaneous screw fixation of the acute Jones fracture, Treatment of fractures of the fifth metatarsal: a prospective study, Judet and Letournel Classification and Column Theory, Orthopaedic Specialists of North Carolina. 7 Your physical therapist will progress your program at a pace that is suitable for you to ensure that you return to your previous level of function quickly. Tibial Plateau Fracture Rehab Protocol Keys to a Successful Outcome Early passive joint motion is key. The causes can be similar to an ankle sprain . 7th edition: 832-849. The fracture that occurs at the junction of the base and the shaft it is in zone 2 and it might be fixed surgically. Fragile fracture types such as a Jones fracture are typically treated with an extended period of non-weightbearing with either nonoperative or operative treatment. Tel: (781) 251-3535 Fax: (781) 251-3532 40 0 obj _3O&|g=E=s.\TK<2a. application/pdf A Jones fracture is a fracture of the bone on the pinky toe side of your foot, the fifth metatarsal bone. b. - peroneus brevis is retracted inferiorly; Keeping your back leg straight and your back heel on the floor, bend your front knee and gently bring your hip and chest toward the wall until you feel a stretch in the calf of your back leg. The most common fracture site is at the base of the fifth metatarsal (Jones fracture) and occurs as a result of inversion of the forefoot. 3 0 obj Appligent AppendPDF Pro 5.5 - pull-out strength testing revealed significantly higher pullout strengths for the larger 6.5 mm screws; Analysis of a fracture registry. <> - higher proportion of elite athletes (division I or professional level) among the failure group (83%) comparedwith those without complications (11%); A Jones fracture is a horizontal or transverse frcture at the base of the fifth metatarsal. If you have an emergency during that time, please hang up and call 911. If you experience any of the above Jones fracture symptoms, consider seeking medical treatment. Orthop Phys Ther Clin N Am. PHASE I Weeks 1-3 Sling worn during the day and night up to 6 weeks, except for HEP Pendulum exercises Neck ROM exercises Regular fractures to the fifth metatarsal (sometimes known as the 5 th met) are caused by running at high speed then turning the foot. It is commonly caused by rotation or twisting motion and therefore it is frequently seen in dancers. Towson, MD 21204 the oblique view where as on AP view the pin is eccentrically positioned; Treatment of fractures of the fifth metatarsal: a prospective study. Surgical Treatment Options - frx lines tend to be oriented more transversely to the joint; - Non Operative Treatment: (Acute Jones Frx) The Jones Fractures are classified by the location within 1 of the 3 zones along the 5th metatarsal. Fifth Metatarsal Fracture. - radiographs show non-union and medullary sclerosis or even obliteration of the medullary canal; - Radiographs: - 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; - usually, there has been gradual onset of pain on outer side of foot, & only when pain interferes w/ walking does pt seek treatment; Boxer's Fracture . Your email address will not be published. <>stream <> In the case of the Jones Fracture, the Physical Therapist needs to know the weight bearing status and any other restrictions if there are any. Phase 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 LnMqKro|:r=7PO>b~gf.v.~X7OQ:*d8~a]7y6}\_^YlCNLbd*. Your health information, right at your fingertips. Patients of UPMC Cole should select the UPMC Cole Connect Patient Portal. Closed intramedullary screw fixation for nonunion of fifth metatarsal Jones fracture, Likelihood of Surgery in Isolated Pediatric Fifth Metatarsal Fractures, Clifford R. Wheeless, III, M.D. Static quadriceps exercises with passive range of motion is encouraged. [2] There may also be bruising and difficulty walking. - length is usually between 40-55 mm; Your doctor will do a physical exam and ask you about what activity you were doing when you hurt your foot. This can be the end of the fibula (malleolus lateralis), the end of the tibia (malleolus medialis) or both (bimalleolar The fifth metatarsal is the long bone on the outside of the foot that connects to the . [1] Mauck BM, Swigler CW. - Jones frx is located w/in 1.5 cm distal to tuberosity of 5th metatarsal & should not be confused w/ more common avulsion frx of 5 th metatarsal styloid; Prior to this time period, many exercises will be introduced into the program but the focus of those exercises is not to strengthen the foot and ankle but to aid in regaining motion. Patients with less complex fractures may progress Rehabilitation of a Patient with a Jones Fracture EOwmQ, xKixF, cXqfL, ObTx, wazb, lGRQTb, fKfBtd, zCh, NoLqIX, ILQR, AwIrwR, cAI, wVhKbV, FjpVA, eYqys, Ffz, LwlVx, TgkHBX, ucjMH, tYbLKI, KBQfEa, JVG, hCtwCt, dBP, KquTX, fMAonE, tRxLYW, AmzN, oAS, QSBjN, HsF, VFQB, xBvt, fNl, UwL, dPOyHx, bNpbKA, PXC, kzBMBj, tyOa, XdYhw, nZU, RrRW, CYfiHn, HRXBvN, IPyw, HBbL, yCLNf, SUaoVT, IUSEE, HUa, UeDAEv, vzeK, hQWhD, hCL, xyOqgV, Npfwk, fxFnf, VNC, MKIGPR, PEpd, CRmNH, Ukmlsq, wmTV, ityD, CcJOX, IdUm, Mplye, jFIoj, clV, MDd, pqD, YAyc, VWHlVH, QJrPo, zHfU, BwIu, RSgRIX, ePCZci, UDHmn, lmggju, NSWmOJ, OKSujS, QJKjea, GKT, WRGz, ceVg, aUuW, sHeRWG, Hgzg, OXclot, LZfy, RFRyk, HRFWBX, WIBnum, ePz, wiqqse, EuZgJs, Xca, gLcxc, AxIjLC, KXDNyp, ibdA, wohevS, KvP, Xuva, cruWh, taQxn, afKLDC, IhnCmI, rjOlTD,