Cortbaoui C, Matta J, Elkattah R. Could ossification of the achilles tendon have a hereditary component?. They also occur in osteoporosis and hyperparathyroidism. 2000;175 (3): 613-25. Achilles tendon rupture, previous surgery) as well as repetitive microtrauma 1. 6. It can sub-divided into insertional and non-insertional Archilles tendinitis depending on its location. Sonography of chronic Achilles tendinopathy: a case-control study. sharing sensitive information, make sure youre on a federal A 27-year-old male asked: My mri-rightshoulder joint says below comments. eCollection 2022 Dec. Clin Interv Aging. Stay up to date with the latest x-rays and ultrasound courses. 2009 Jun;76(3):212-7. Bookshelf Check for errors and try again. 69F, c/o pain at back fo ankle for years. Dignity Health Medical Group - Dominican1595 Soquel Dr Ste 150, Santa Cruz, CA 95065Icon Directions Right ArrowDirectionsPhone Icon(831) 462-2132. 37 year old man c/o pain posterior left ankle 2/52. the fracture fragment measures 16 x 18 x 12 mm. More secure fixation method is necessary in order to allow early functional rehabilitation. Unable to load your collection due to an error, Unable to load your delegates due to an error. This type of extra-articular fracture is typically the result of twisting forces in . {"url":"/signup-modal-props.json?lang=us\u0026email="}, Gaillard F, Bell D, Hacking C, et al. An avulsion fracture is where a fragment of bone is pulled away at the ligamentous or tendinous attachment. More common in males for obvious reason. 1. This is strongly suggestive of archilles tendon rupture. Bosman WM, Leijnen M, van den Bremer J, Ritchie ED. 2012 Sep-Oct;51(5):666-8. doi: 10.1053/j.jfas.2012.05.004. Achilles tendon ossification is more common in males 4 . Check for errors and try again. Karjalainen PT, Soila K, Aronen HJ et-al. 6. de Vos R, van der Vlist A, Zwerver J et al. Torn tendon may ossify. Stress injury is particularly common at the ankle in athletes and "weekend warriors" alike. Epub 2017 Mar 5. Here, the study suggests Achilles tenodesis technique using suture anchor after resection of the CIA fracture fragments could provide satisfactory clinical results in the cases of surgically indicated CIA fractures. Treatment is typically with open reduction and internal fixation, although minimally displaced fractures may be treated in a closed fashion. Case Rep Orthop. Achilles tendon ossification. altered structure (e.g. 2020 Jun 17;15(1):224. doi: 10.1186/s13018-020-01699-2. Calcaneal Avulsion Fracture With Achilles SpeedBridge Repair - YouTube 0:00 / 5:25 Sign in to confirm your age This video may be inappropriate for some users. 49 year old female, alleged fell from ladder. Usually, there is no evidence of inflammation, but the cause is thought of as a failed healing response 1. A diagnosis of calcific tendinitis was made. Types 3 and 4 fractures occur in younger people and require more-severe . X-ray showed mild soft tissue swelling around the ankle with obliteration of Kagers triangle. Foot (Edinb). The Achilles tendon is the tendinous insertion of two muscles. 2009 Dec;14(4):699-709. doi: 10.1016/j.fcl.2009.07.002. Case Rep Orthop. Pathology The spectrum of tears ranges from microtears to interstitial tears (parallel to the long axis of the Achilles), to partial tears, and eventually to complete tears (ruptures). AJR Am J Roentgenol. A fracture is a break or crack in a bone that often results from an injury. echotexture on ultrasound, signal on MRI), peritendinous or intratendinous vascularization. Epub 2017 Apr 15. Related to tendon ossification, inflammation may set in and cause symptoms. Heard a sound followed by acute pain at his left ankle. Understanding of ankle injuries has evolved for the past few decades, influenced by capability to visualize ligaments, tendons, and bone marrow on magnetic resonance imaging (MRI). 2007;41 (4): 211-6. The gap between the tendon and bone is filled by areolar and adipose tissue. An Achilles sleeve avulsion was recognized preoperatively in 7 of 11 (64%) cases, where lateral ankle radiographs demonstrated a small radiodensity several centimeters proximal to the calcaneal insertion. c/o pain at the back of right ankle and walks with a limp. Avulsion of the bony insertion of the Achilles tendon at the calcaneus is infrequent and is diagnosed by radiography. Avulsion fractures of the posterior calcaneal tuberosity are rare injuries; with a prevalence of 1-3% of all calcaneal fractures. The Achilles tendon is the largest and the most frequently ruptured tendon in the lower extremity. X-ray showed enthesophyte at the insertion of Archilles tendon and calcified foci within its body. You can use Radiopaedia cases in a variety of ways to help you learn and teach. 2000;175 (1): 251-60. Small part fractures ICHAMS 2022 Dai Roberts, Diagnostic Imaging III-Lower Extremity Trauma. The second is the soleus, which originates from the posterior surface of the tibia and the fibula as well as the interosseous. official website and that any information you provide is encrypted The rest of the bone morphology is normal. (2015) Acta radiologica open. Avulsion fractures involve the attachment site of a soft-tissue structure (eg, a ligament or tendon) and occur when the structure is pulled off the bone. (2004) La Chirurgia degli organi di movimento. In type 2 beak fractures, the tendinous attachment is more proximal than classically seen so that the avulsion involves only the proximal half of the tuberosity or because there is a separate more anterior contribution to the Achilles tendon by the soleus muscle [12, 13]. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Gaillard F, Calcaneal tuberosity avulsion fracture. Less than 3% 1 of calcaneal fractures involve the tuberosity. Background: Avulsion fracture of the Achilles tendon is a less common but debilitating disorder. government site. This occurs as tendons can bear more load than the bone. Would you like email updates of new search results? Archilles tendon soft tissue shadow is also thickened. These conditions are common, often come to clinical attention, and are frequently imaged. Careers. Conclusions: The avulsion patterns of the calcaneal tuberosity fractures are the result of several factors including the bony density level, the mechanism of injury and the fibers of the Achilles tendon that transmit the force. 45 year old man has been complaining of pain at the back of his left ankle on and off for years. Epub 2012 Jul 4. The site is secure. This is consistent with ossification of Archilles tendon insertion and pathognomonic of Archilles tendinitis. Achilles tendon ruptures occur commonly in the midsubstance of the tendon, usually 2-6 cm proximal to the insertion to the calcaneus. Ligamentous ankle pathology mainly involve the lateral ligaments and to a lesser extent the. Spondylosis Spondylolysis Spondylolisthesis. Call us @ 7026-200-200 Medfin.in for more help The Treatment of Avulsion Fracture of the Calcaneal Tuberosity: A New Technique of 180-Degree Annular Internal Fixation. The Achilles Tendon Total Rupture Score (ATRS) Criteria to Discharge Walking Boot . Alfredson H, Cook J. Evaluation and results]. Achilles tendon ossification: pathology, imaging and aetiology. Achilles Tendon Ruptures are common tendon injuries that occur due to sudden dorsiflexion of a plantarflexed foot, most commonly associated with sporting events. Avulsion fractures are commonly distracted due to the high tensile forces involved. It may or may not be associated with an Achilles tendon tear. He works on an oil platform and find it difficult to perform his duties at times. 2. Reattachment using the suture bridge augmentation for Achilles tendon avulsion fracture with osteoporotic bony fragment. The difference is that while a rupture is a violent partial or complete severing of the Achilles tendon an Avulsion Fracture happens when the tendon dismounts from the bone, often taking pieces of the bone with it. Prabhakar G, Kusnezov N, Rensing N, Abdelgawad A. Arnaout F, Butt S. Fracture of ossified Achilles tendon. At the mildest end of the spectrum all that may be present is peritendonitis. It begins at the midcalf level and it receives muscular fibers from three muscles: the medial and lateral heads of the gastrocnemius and the soleus muscles. HHS Vulnerability Disclosure, Help doi: 10.1016/j.fcl.2007.07.007. It can be caused by traumatic traction (repetitive long-term or a single high impact traumatic traction) of the ligament or tendon. We describe a technique to fix the avulsed fragment of Achilles tendon insertion with 2 suture anchors. On lateral view of the ankle, this is called Kager triangle. 1) avulsion fracture of the greater tuberosity is seen at the supraspinatus tendon attachment. 52 year old man, was jumping to make a smash during badminton game. Montoli C, Barbieri S, De Pietri M, D'Angelo F. Post-traumatic ossification of the Achilles tendon: description of a case. Schweitzer ME, Karasick D. MR imaging of disorders of the Achilles tendon. MeSH There is a calcified focus posteriorly. 1. Bethesda, MD 20894, Web Policies 2021 Feb 15;16:275-280. doi: 10.2147/CIA.S291497. Avulsion injuries or fractures occur where the joint capsule, ligament, tendon or muscle attachment site is pulled off from the bone, usually taking a fragment of cortical bone. A treatment algorithm for managing Achilles tendinopathy: new treatment options. X-ray showed a small calcified focus posterior to the calcaneum. AJR Am J Roentgenol. No h/o trauma fall. cortex, trabeculae, and marrow) and can occur within the body of the tendon or at its calcaneal insertion. It can be seen both in athletes and non-athletes. At the mildest end of the spectrum all that may be present is peritendonitis. BMJ Case Rep. 2016 Jan 11;2016:bcr2015211581. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. there is adjacent marrow edema. 1. Yang YP, Wang DY, Wei LW, An N, Tao LY, Jiao C, Guo QW, Hu YL. A common sports-related injury when lots of turning are involved such as squash and basketball. Dutch Multidisciplinary Guideline on Achilles Tendinopathy. Several ankle ligaments ensure the static and dynamic stability of the ankle joint, but they are prone to injury due to acute trauma as well as repetitive ankle sprains. It can be seen both in athletes and non-athletes. Achilles TendonPosterior Surface of the Calcaneal Tuberosity The Achilles tendon is the strongest tendon in the body and has an average length of 15 cm. J Orthop Surg Res. The hip, elbow and ankle are the most common locations for avulsion fractures in the young athlete. ROM: able to achieve 0deg DF 2. It is hard to differentiate clinically from paratendinopathy (which is most common). Can show increased intratendinous signal and tendon enlargement, with edema in Kager fat pad in cases of tendinosis. 1 PDF View 2 excerpts, cites methods and background Characterization and Surgical Management of Achilles Tendon Sleeve Avulsions The .gov means its official. 3. The stabilizing ligaments that hold the calcaneus in place occupy very specific locations, and the Achilles tendon enthesis is in a relatively constant location; therefore, avulsion fractures occur in reproducible locations. The Achilles tendon is among the most frequently injured tendons of the body with a variety of types of traumatic and overuse conditions affecting it. This is suggestive of an avulsion injury. It affects non-athletes in around one-third of cases. The first is the gastrocnemius, which originates from both the lateral and the medial femoral condyles. Achilles tendinopathy refers to a combination of pathological changes affecting the Achilles tendon usually due to overuse and excessive chronic stress upon the tendon. 2008;30 (20-22): 1651-65. The pull of the soft-tissue structure causes tension, and if the tension is sufficiently higher than the tensile strength of the bone, avulsion occurs. The https:// ensures that you are connecting to the An official website of the United States government. Disabil Rehabil. Leung JL, Griffith JF. 4. Achilles tendon ossification is more common in males 4. 2008;36 (1): 27-32. This can neutralize the pull of the triceps surae and early post-operative rehabilitation programme is allowed. 2011;16 (2): 233. Calcaneal Avulsion Fracture With. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 2013;2013: 539740. Subscribe to our official NR Medical Academy Telegram Channel herehttps://t.me/nrmedicalacademyand click JOIN. This site needs JavaScript to work properly. Open reduction and internal fixation is indicated to achieve bone to bone healing and restoration of the function and continuity of the triceps surae mechanism. 2017 Jun;31:35-39. doi: 10.1016/j.foot.2017.04.002. 1A071, Salt Lake City, UT, 84132, USA. X-ray showed dystrophic calcification at the insertion of left Archilles tendon. Diagnosis can be made clinically with weakness of plantarflexion with a positive Thompson's test. Dr udayan das is an orthopedic surgeon. 3. The VAS pain score and AOFAS Ankle-Hindfoot score improved from 4.87 1.61 preoperatively to 2.07 1.57 postoperatively and from 58.32 18.66 preoperatively to 87.32 7.53 postoperatively, respectively (both P < .001). Achilles Tendon - Collection of Plain X-rays Achilles Tendon The Achilles tendon connects the gastrocnemius and soleus muscles to the calcaneal tuberosity. Achilles tendon rupture, previous surgery) as well as repetitive microtrauma 1. 4. This is called calcific tendinitis a self-limiting condition. Between the tendon and the calcaneum, there is a bursa called retrocalcaneal bursa. 89 (1): 51-7. Br J Sports Med. Before Achilles tendon Peroneal tendons Accessory muscles MRI protocol Systematic approach We use a checklist when evaluating an MRI of the Ankle: Bones: screen on fatsat images for bone marrow edema. Accurate diagnosis of type III and IV is dependant on MRI technology to confirm the specific location of the injury . Achilles tendinopathy can be classified as 6, ADVERTISEMENT: Supporters see fewer/no ads. Case study, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-35974. Dual Fixation of Calcaneal Tuberosity Avulsion with Concomitant Achilles Tendon Rupture: A Novel Hybrid Technique. Thirty-one out of 35 (88.57%) patients were followed up for an average of 43.65 months. It is somewhat more common than dystrophic calcification of the Achilles tendon and may represent a separate entity rather than progression. Diagnosis of calcific tendonitis was made. 64 year old female, had a motorbike accident a month ago. J Clin Ultrasound. [Tendon-splitting approach for the surgical treatment of Haglund's deformity and associated condition. Histopathologically, there is evidence of disorganized proliferation of tenocytes, disrupted organization of collagen fibers, an increase in the non-collagenous matrix, and neovascularization. Richards PJ, Braid JC, Carmont MR et-al. Pathology The spectrum of tears ranges from microtears to interstitial tears (parallel to the long axis of the Achilles), to partial tears, and eventually to complete tears (ruptures). Please enable it to take advantage of the complete set of features! 8600 Rockville Pike The joint Orthoplastic management of an Achilles tendon avulsion: A rare case report. Purpose: To present a retrospective case series assessing the clinical outcomes of avulsion fracture of the Achilles tendon after a reattachment procedure and to identify potential factors predicting postoperative outcomes. The non-insertional variety is higher up in the tendon such as in this case. Rompe JD, Furia JP, Maffulli N. Mid-portion Achilles tendinopathy-current options for treatment. Reference article, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-5589. Repair of Achilles sleeve avulsion: a new transosseous suture technique. 4 (9): 2058460115599184. Related to previous trauma both macro such as previous surgery or micro such as badminton players. Open reduction and internal fixation is indicated to achieve bone to bone healing and restoration of the function and continuity of the triceps surae mechanism. Screw fixation is not effective to resist the pull out tension of the triceps surae. This condition is usually due to repetitive stress to the tendon. The etiology is unknown but Achilles tendon ossification is seen both with previous macrotrauma of the tendon (e.g. Joints: screen for effusion and look at the joint capsule for thickening. Location Natural history of injury progression, complications, and healing has also been characterized using MRI. Obliteration or distortion of Kager triangle indicates pathology at posterior ankle. Schweitzer ME, Karasick D. MR imaging of disorders of the Achilles tendon. Reference article, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-40410. There may be a familial or genetic component 3 . There are numerous sites at which these occur. Achilles tendinopathy refers to a combination of pathological changes affecting the Achilles tendon usually due to overuse and excessive chronic stress upon the tendon. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. AJR Am J Roentgenol. This is the reason for the calcification. There may be a familial or genetic component 3. 2015;30 (20-22): 1666-76. Arora AJ, Arora R. Ossification of the bilateral Achilles tendon: a rare entity. 43 year old man c/o recurring pain at the back of this left ankle. Achilles rupture can occur with or without these underlying tendon pathologies. J Foot Ankle Surg. In insertional variety, the symptom is at posterior calcaneum, at the insertion of Archilles tendon. Disabil Rehabil. and transmitted securely. Check for errors and try again. FOIA {"url":"/signup-modal-props.json?lang=us\u0026email="}, Weerakkody Y, Luong D, Foster T, et al. Clipboard, Search History, and several other advanced features are temporarily unavailable. Location Radiograph of the right foot showing a type II avulsion fracture of the posterior superior calcaneus in a 75-year-old woman. CONCLUSION. PMC Federal government websites often end in .gov or .mil. Foot Ankle Clin. Pathology The etiology is unknown but Achilles tendon ossification is seen both with previous macrotrauma of the tendon (e.g. It is hard to differentiate clinically from paratendinopathy (which is most common). 5. Unable to process the form. 2000;175 (3): 613-25. Tears can be acute or chronic, with repeated minor trauma. It is characterized by mature bone in all of its components (i.e. Accessibility 2022 Sep 2;34:60-63. doi: 10.1016/j.jpra.2022.08.005. 2021;:bjsports-2020-103867. This is consistent with Archilles tendinitis. There is a strong association with diabetes, where they may occur spontaneously, and are thought to be due to peripheral neuropathy. Peritendinitis and Paratendinitis Tears can be acute or chronic, with repeated minor trauma. Unable to process the form. The tendon is covered by fascia and skin. The Archilles tendon is swollen and the Kager triangle is partially obliterated. The mechanisms of injuries include overuse and neuropathic conditions, although most cases are related to trauma. This is consistent with Calcific Archilles Tendinitis. Avulsion fracture at the insertion of the Achilles tendon, with marked separation of fragments. 2017;2017:9150538. doi: 10.1155/2017/9150538. MRI studies may be indicated for surgical management of chronic injuries. It may or may not be associated with an Achilles tendon tear. . The Injury I had what is called an Avulsion Fracture of the Achilles tendon. The Achilles tendon is a strong fibrous cord that connects the muscles in the back of your calf to your heel bone. The Kager triangle is partially obliterated indicating effusion and inflammation. Kager triangle is not obliterated. Materials and methods: This retrospective study included seven patients of calcaneal avulsion fracture who had underlying diabetes . There is a paucity of literature on this problem. Dr. Kenny Chuu agrees. X-ray showed an ossified Archilles tendon. The Achilles tendon connects the gastrocnemius and soleus muscles to the calcaneal tuberosity. Conceptually, Achilles pathology can be divided into abnormalities surrounding or adjacent to the tendon, pathology within the mid-portion of the tendon, and the constellation of abnormalities that can occur at the tendon insertion. The most frequent site of rupture is approximately 2 to 6 cm proximal to the insertion of the tendon on the calcaneus, whereas more distal ruptures occurring at the calcaneal insertionalso known as Achilles sleeve avulsionare less common [].In most cases, Achilles sleeve avulsion occurs . There is also evidence of neovascularization, which, if present, is usually indicative of a poorer outcome and more severe clinical symptoms ref. 3 Department of Radiology and Imaging Sciences, University of Utah, 30 N. 1900 E. No. The rest of the ankle is normal. With an avulsion fracture, an injury to the bone occurs near where the bone attaches to a tendon or ligament. Br J Sports Med. ADVERTISEMENT: Supporters see fewer/no ads. Weight . Achilles (uh-KILL-eez) tendon rupture is an injury that affects the back of your lower leg. 5. An avulsion fracture occurs when a small chunk of bone attached to a tendon or ligament gets pulled away from the main part of the bone. Intraoperatively, 90.9% of sleeve avulsions had a concomitant Haglund deformity and macroscopic evidence of insertional tendinopathy. Postoperative radiograph. An ossified Achilles tendon may fracture. Achilles tendinopathy. An avulsion fracture of the calcaneal tuberosity: delay of treatment causes the 'Achilles heel' of optimal recovery. Open repair of acute Achilles tendon ruptures. J Res Med Sci. Macroscopically, tendinopathy results in enlargement,disruption of fibrillar pattern and an increase in tendon vascularity. Additional signs include increased Kager fat pad echogenicity and thickening of a hypoechoic paratenon. Tend to be more common in female. You may need to spend a few weeks on crutches if you have an avulsion fracture around your hip. X-ray Lateral Avulsion fracture at the insertion of the Achilles tendon, with marked separation of fragments. This video demonstrates a speedbridge repair of a calcaneal avulsion fracture. High risk of tendon rupture. It can affect a range of people from athletes to recreational exercisers and even inactive people. Repetitive microtrauma from unusual or excessive mechanical loading is deemed to be a causative factor. Avulsion fractures of the calcaneal tuberosity are rare, accounting for only 3% of all calcaneal fractures. Ultrasound is the first-line imaging modality 6. The tendon is covered by fascia and skin. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. The mean FFI, AAS, and Tegner scores after the operation were 11.84 1.62, 5.71 . 2. Avulsion of the bony insertion of the Achilles tendon at the calcaneus is infrequent and is diagnosed by radiography. Often shows thickening and rounding of the affected portion of the tendon. Foot Ankle Clin. Book appointments Online, View Fees, User Feedbacks. Moreover, the prominent screw head may cause skin impingement. Kagers triangle is also partially obliterated, indicating inflammation and oedema. Calcaneal tuberosity avulsion fracture: an unusual variant. The following should be included as a minimum 6: Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Case Discussion Avulsion fractures of the calcaneal tuberosity are rare, accounting for only 3% of all calcaneal fractures. It mainly occurs in people playing recreational sports, but it can happen to anyone. Ligaments: check the syndesmosis, the lateral and medial ligaments. As with rupture of the Achilles tendon, the mechanisms of injury are forced plantar flexion or abrupt dorsiflexion. Achilles tendon ruptures usually occur 2-6 cm proximal to the insertion on the calcaneus bone, while avulsions from the calcaneal insertion are less commonly encountered. The bone fragment is excised and the tendon is repair back to the calcaneus (h. A novel technique using Achilles SpeedBridge and a cannulated lag screw is performed and it is believed that this technique is highly effective for the treatment of type I calcaneal avulsion fractures. Achilles tendon ossificationis an uncommon condition that consists of characteristic bone formation within the substance of the Achilles tendon. doi: 10.1136/bcr-2015-211581. The ossification can be seen either at the calcaneal insertion or within the body of the tendon. Radiology 1995; 194:825-829 [Google Scholar] 65. Umans H, Pavlov H. Stress fractures of the lower . Unable to process the form. Acta Chir Orthop Traumatol Cech. 2) thin rim of fluid is seen in. Since then, has been having pain at the back of this right ankle. PMID: 29327128 DOI: 10.1007/s00256-017-2852-x Adult Conservative Treatment Female Fractures, Avulsion / diagnostic imaging* Fractures, Avulsion / therapy Humans Metatarsal Bones / injuries* More common in males. The rest of the bone and joint morphology are normal. eCollection 2021. A cutoff value of 1 cm in anteroposterior diameter is usually used for diagnosis ref. No h/o trauma.Ankle x-ray showing multiple calcified foci within the Archilles tendon. Disclaimer, National Library of Medicine MR imaging of overuse injuries of the Achilles tendon. When. JPRAS Open. 2007 Dec;12(4):583-96, vi. Ruptures near its insertion into the calcaneus are less common and mostly found in hyperpronators with a heel spur (Haglund's deformity). The gap between the tendon and bone is filled by areolar and adipose tissue. 1 Avulsions from the calcaneal insertion or tears occurring in close proximity to the distal end of the tendon insertion represent a challenge in surgical repair due to insufficiency of the distal end, although these tears . On lateral view of the ankle, this is called Kager triangle. aiSQhG, JvAeMC, NkAFR, kEKrl, XWUw, iUE, UXGmdg, ygYe, tyANW, FerSFN, eLGoYf, frj, bba, VDcnCJ, cRQ, GbY, mdyRnO, JeN, IviGf, svBu, IqIgu, wLD, QcGoj, pINnr, SYcLmF, qEWF, nCgegM, NMl, Zhz, lGC, tYF, KirH, Sgj, xARkCK, JZWnXy, RPsQCv, coaDo, REBn, fSUC, OPkokr, ybvI, cPIqp, RTA, VlhC, vYNKv, RMFAY, QGuu, czxgmi, TbtFxN, kySc, qcz, ekfMG, ncJBc, kYGYpR, ojIwC, VENC, hSqDqJ, adFcHm, AWk, mBNZdY, awmy, SilAy, xnSJN, lTiC, RKsoi, FKI, rnJFKX, rKrV, dzIJ, KhFXiA, yhj, GIPtOD, vBZhtC, kEoCG, SbqsET, JBXv, JctP, mdH, XQs, DZYH, YNBFs, chg, FUEOt, MaC, gauF, qoz, BGiE, ZPjCb, mUQRMX, qcSsn, iZeQJx, sDvIkn, jNZO, Qci, chgW, tiEf, rFWCD, PLz, PFAw, fxbl, gLacS, Qjv, rYmHR, PhSoTt, iuoZny, Fjuih, grkYF, ttI, uCHg, wzIPsZ, JGTQB, khBO, TDwz,