Numbness around the foot Numbness, or pins and needles, around the foot raises concern about nerve injury or excessive swelling within the leg. Fibula Fracture: Symptoms, Causes, Treatments, Surgery and Recovery. The fractures of the proximal part of the tibia may be closed (meaning that the bone does not come into contact with the environment) or open. A rehabilitation program specifically designed for muscular strength, flexibility and range of motion of the joint will be designed. Although much less common, the proximal medial tibial condyle has been cited as an area subject to stress fracture. These fracture occurs in approximately 10% to. The numbers in the parentheses (1, 2, 3) are clickable links to peer-reviewed scientific papers. In this case, external osteosynthesis can be used not only temporarily, but also definitively. Wauwatosa, Wisconsin 53226 When a foot or ankle injury occurs, it can be difficult to get around, let alone perform your daily activities. If the damage continues or the force applied to the bone continues then it leads to a tibial stress fracture. Wisconsin Bone & Joint knee care experts offer comprehensive Symptoms of Proximal Tibia Fracture The symptoms of a proximal tibia fracture can include: Pain with movement or weight bearing Tenderness or tenseness in the knee Limited ability to bend the knee Deformity of the knee joint or just below it A pale and/or cool foot (which may suggest that the blood supply has been affected) Medical concerns or pre-existing limb problems might make it unlikely that the individual will benefit from surgery. 4,5 Compressive forces account for the transverse, often subchondral, stress fractures in the proximal tibia. Halloween is an exciting time filled with candy and costumes. What Are The Symptoms of Fractures of the Proximal Tibia? In this case, the fractured bone pieces are anchored and stabilized by means of plates and screws in the correct bone-healing position. Your doctor will examine the soft tissue surrounding the knee joint. If the fracture is comminuted, bone grafts may be used, always according to the physicians judgment and the intraoperative medical assessment. This article on Epainassist.com has been reviewed by a medical professional, as well as checked for facts, to assure the readers the best possible accuracy. MAKE AN APPOINTMENT WITH AN ORTHOINDY SPECIALIST. Open fractures often involve much more damage to the surrounding muscles, tendons, and ligaments. When planning treatment, your doctor will consider several things, including your expectations, lifestyle, and medical condition. It is the main weight-bearing bone of the two. Preview / Show more . Fredericson M, Bergman AG, Hoffman KL, Dillingham MS. Tibial stress reaction in runners. Fractures that involve the tibial plateau occur when a force drives the lower end of the thighbone (femur) into the soft bone of the tibial plateau, similar to a die punch. All fractures went on to . The plate is applied to the surface of the bone. This damage to the surface of the bone may result in improper limb alignment, and over time may contribute to arthritis, instability, and loss of motion. Open fractures often involve much more damage to the surrounding muscles, tendons and ligaments. The preferred treatment is accordingly based on the type of injury and the general needs of the patient. We and our partners use cookies to Store and/or access information on a device.We and our partners use data for Personalised ads and content, ad and content measurement, audience insights and product development.An example of data being processed may be a unique identifier stored in a cookie. Other joints and bones involved, such as the tibia, may also have symptoms. If your injury or condition is recent, you can walk right into one of ourOrthoIndy Urgent Care locationsfor immediate care. Both the broken bone and any soft-tissue injuries must be treated together. The lower leg is made up of the tibia and the fibula. It includes a splint and immobilization, as well as avoidance of charging the affected leg. See Also: Proximal tibia stress fracture symptoms Show details The impact often causes the cancellous bone to compress and remain sunken, as if it were a piece of styrofoam that has been stepped on. The pain is usually localized, but can extend . The proximal part of the tibia is that segment of the tibia bone, which extends to the knee to form the knee joint. Rapid mobilization is most often initiated with passive mobilization performed by the physiotherapist to obtain full range of motion, always in line with the pre-operative bone injury. Diagnosis of Tibial Plateau Fracture Physical examination plays a vital role in the diagnosis of tibial plateau fractures. stress fracture, a hairline fracture due to repetitive injury; shaft fracture, . A fracture of the proximal tibia may cause: Pain that is worse when weight is placed on the affected leg Swelling around the knee and limited bending of the joint Deformity the knee may look "out of place" Pale, cool foot. Open fractures usually involve greater damage to adjacent soft molecules such as tendons, muscles and ligaments. An open fracture occurs when the bone breaks in such a way that the bones penetrate the skin or when the wound reaches such a depth that it contacts the bone. Electrotherapy such as ultrasound can be done. Once it is verified that there is no real risk for the fracture, the physician will permit gradual loading of the leg. Call 911 or go to your nearest emergency room. Correlation of clinical symptoms and scintigraphy . Risk factors for stress fractures can be divided into two basic categories: extrinsic and intrinsic. Three bones form the knee joint: The femur, the tibia and the patella. Anterior tibial stress . associated with a significant number of distal tibia and fibular. Julius Wolff (1836-1902) was a German surgeon who proposed bones will remodel and adapt to the loads . Learn more about Halloween safety tips. The most common proximal tibia fracture symptoms include: Pale and cold feet A cold sensation and/or paleness in the foot may be a sign that an impairment in the blood supply is being caused by a bone fracture in the lower limbs. MINIMALLY INVASIVE METHOD, TOTAL KNEE ARTHROPLASTY SURGICAL TREATMENT, QUESTIONS AND ANSWERS ON HIP ARTHROPLASTY, ENDOSCOPIC DISCECTOMY FREQUENTLY ASKED QUESTIONS, Miltiadou 7 & Xenophanous, PC 13344, Ano Liosia - Zofria, PR Pjeter Bogdani,NR 14, (Ishu blloku) Tirana, Albania, Pain that gets worse when the patient tries to charge the lower extremity with weight, Swelling around the knee and reduced joint flexion, Pale-cold foot. Map It! An X-ray will also depict the morphology of the fracture and its complexity. Patients present unable to weight bear with a swollen, tender knee and a marked decrease in range of movement. Our team of physicians are committed to providing you with the best treatment options to alleviate your knee pain. Signs and symptoms of a Proximal Tibia Fracture include Sharp and sudden pain in the leg, immediately after the injury occurs Swelling, tenderness, and possible bruising around the injury site Noticeable deformity of the leg Reduced range of motion of the knee or ankle Inability to put weight or pressure on the injured leg Difficulty walking This is because the nerves and blood vessels near the bone may . The lower leg is made up of the tibia and the fibula. The site of the fracture will have swelling. Reveal. Read more: First aid for broken bones . [1] Stress or fatigue fractures occur in normal bone when it is subjected to abnormal forces like military training. MRI revealed a severe proximal tibial metaphysis stress fracture. On initial history, he did not have any apparent risk factors for stress . . Your doctor will often prescribe medications for pain-relief for a short period of time after the injury or surgery. WHAT DISEASES ARE TREATED WITH SHOULDER ARTHROSCOPY? Fax: 414-961-2061 Stress fractures were first reported in military personnel as "march foot" in the mid-19th century. When there is too much weight bearing and excessive pressure to the tibia, it causes compressive force through the tibia resulting in damage to the bone. Despite being a tropical country, vitamin D deficiency is common in Singapore. When a tibia fracture has occurred, the signs might include: Tenderness directly over the shin bone Deformity of the leg Swelling and bruising around the injured bone Inability to put weight on the leg If you have a suspicion that you, or someone you are helping to care for, has a tibia fracture, it is important to seek immediate medical care. Of course it undertakes the treatment and rehabilitation of the whole spectrum of orthopedic diseases. Medical Videos Privacy Policy, Images and Text Policy Editorial Policy, Information Policy Advertising Policy, Financial Disclosure Policy Cookie Policy, About Us Contact Us. On occasion, a CT scan and MRI may be needed. . A subset of fractures that happen in an individual's hip region are called proximal femur fractures, otherwise known as hip fractures. Synthetic or naturally occurring products which stimulate bone healing can also be used. In some cases, the condition of the soft tissue is so poor that the use of a plate or rod might threaten it further. Pain will usually have developed gradually over time, rather than at a specific point in time that the athlete can recognise as when the injury occurred. Finally he will assess the nerve function and blood flow to the injured leg. This article may contains scientific references. Stress fractures occur in military recruits, and risk factors include a sudden increase in physical activity and vitamin D deficiency. This injury can occur in both low-impact and high-impact trauma. Tibia and fibula fractures are characterized as either low-energy or high-energy. Whether or not a fracture of the proximal end of the tibia will be treated surgically is a complex decision that will be made jointly by the physician and the patient, taking into account all the facts and circumstances. We follow a strict editorial policy and we have a zero-tolerance policy regarding any level of plagiarism. External Osteosynthesis: In cases where the soft tissues (muscles, skin) around the fracture are severely injured, or if further time is required for surgery due to other concomitant problems, then the Orthopedic surgeon may place an external osteosynthesis device. Elderly patients and those with osteoporosis can suffer from this injury during low-impact trauma while younger patients . Tibial Impacted Fractures. It may even travel down into the knee. In order to avoid problems it is necessary to comply with the medical instructions on charging the injured leg. You can have a stress fracture in any bone, but it tends to affect the weight bearing bones in runners. They have a longer healing period and are usually accompanied by more complications. There are a few different methods that a surgeon may use to obtain alignment of the broken bone fragments and keep them in place while they heal. He or she will also talk to you about your symptoms and any other medical problems you may have, such as diabetes. Diagnosis can be confirmed with plain radiographs. They act like strong straps (bands) that hold the bones together and stabilize the knee. Crutches can be used to avoid complete weight-bearing. This is especially frequent in the bones that support your weight. The upper surface of the tibia is made of spongy bone, which is softer than the compact bone of the lower tibia. If you have these symptoms after an injury, go to the nearest hospital emergency room for an evaluation. working out on a different type of surface than usual . Your doctor will schedule X-rays to assess bone healing at regular intervals. A proximal tibia fracture is when the shinbone specifically breaks just below the knee. . hbspt.cta.load(3468789, 'eb9c5819-3814-4c84-8167-7eed92032fc4', {}); To determine whether you have a proximal tibia fracture, your physician will ask you for a complete medical history, ask questions about the injury and how it occurred, and conduct a physical examination. The tibia (shinbone) is the most commonly fractured long bone in the body. Gradual return to the training and sports. Tibial stress fractures are not rare--they have been extensively studied in young athletes and soldiers and in elderly people with rheumatoid arthritis, osteoporosis, Paget's disease, pyrophosphate arthropathy, and hyperparathyroidism--but they seldom occur in patients with severe primary degenerati Other tests. . To diagnose this type of injury, your doctor will do a. Additionally, the tibia is an important part of the knee and ankle joint. The doctor will ask how the injury happened. Fifty percent of the tender areas in the proximal . Shin splints develop from repeated stress to the shin bone by the pulling and tugging of the muscles and connective tissues in the lower leg . The examination is performed with a series of radiographs at regular intervals to be chosen by the treating physician to control the course of healing. The tibia is the larger of the two bones and supports over 80 percent of your weight. Symptoms include: Pain that is worse when weight is placed on the affected leg Swelling around the knee and limited bending of the joint Deformity The knee may look "out of place" Pale, cool foot A pale appearance or cool feeling to the foot may suggest that the blood supply is in some way impaired. What Are Signs of A Non-Displaced Tibial Plateau Fracture? Pain may even be present at night or at rest. Because fractures of the proximal end of the tibia include a loaded joint, there are some medium and long-term parameters to consider. Stress fractures of the tibia, metatarsals, and fibula are the most frequently reported sites. Learn more about trauma care at OrthoIndy. The most common location, on the tibia bone, is two to three inches above the bony bit on the . This may imply nerve damage or increased leg edema. A tibial shaft fracture is when the tibia bone fractures anywhere below the knee and above the ankle. The amount of time it takes to return to daily activities varies with different types of fractures. lower leg swelling. This commitment to a dedicated continuum-of-care model has made us one of the most trusted and respected practices in Southeast Wisconsin and greater Milwaukee area. The damage to the bone surface results in deformity of the knee joint, which, in turn, can lead to arthritis development, instability and loss of range of motion. What kind of help will be needed for recovery? The x-rays show a stress fracture of the lower tibia. Background Tibial stress injuries are frequent injuries of the lower extremity and the most common causes of exercise-induced leg pain among athletes and military recruits. Tibial physeal fractures are most common between the ages of 8 and 15. years, and fibular fractures are most common between 8 and 14 years of. For a young patient, surgical treatment is most appropriate because it will restore the anatomical integrity of the joint, provide stability and minimize the risk of developing post-traumatic arthritis in the future. When the upper 1/3 of the tibia is fractured, but the fracture is not extended to the articular surface, an intramedullary nail or osteosynthesis plate is used for stabilization purposes. KNEE ARTHROPLASTY KNEE JOINT REPLACEMENT, TOTAL KNEE ARTHROPLASTY (M.I.S.) 5 - 7, 10 pain is a common presenting. What can a patient expect from post-traumatic arthritis and what are their options? As mentioned above, this method of treating and repairing fractures can also be used successfully. During surgery (compartment release), vertical incisions are made to release the skin and muscles. The tibia is the larger and thicker of the two bones, and its function is load-bearing. During this type of procedure, the bone fragments are first repositioned (reduced) into their normal position. For rehabilitation and physical therapy, no referral is needed tosee one of our physical therapists. Although not a screening test for fractures of the upper tibia, the doctor may order this test to assess the condition of the surrounding tissues. It's commonly seen in runners and military recruits. The external fixator is removed when the injury has healed. Symptoms of a fracture in your tibia can range from bruising to intense pain in your lower leg, based on the extent of your injury. Last Update: October 15, 2022. . . Excessive weight-bearing on the bone due to continuous muscle contractions as seen in running. Symptoms usually have a gradual onset, with complaints that include isolated pain along the shaft of the bone and during activity, decreased muscular strength and cramping. These causes of a high-energy Tibia Fracture tend to be: Call Now To Schedule Your Same-Day Appointment and Diagnosis. They are also at greater risk of becoming . And it becomes stronger or sharper with more strenuous movement . It widens near the knee to help form the knee joint. Some proximal tibia fractures heal within four months, yet many may take six months or longer to heal. Various other tests to rule out concomitant injury to other parts of the body (head, abdomen, chest, spine or even the other lower extremity) may be performed. All rights reserved. Wisconsin Bone and Joint, S. C. What are the risks and benefits? These fractures are the result of bone that is deficient in strength that is loaded under normal physiologic conditions. There are benefits and risks associated with both forms of treatment. increasing training or weight-bearing exercises too quickly. If so, for how long. Fax: 414-257-1772 An open fracture is when a bone breaks in such a way that bone fragments stick out through the skin or a wound penetrates down to the broken bone. Pain thats present throughout the activity and does not go away after the activity has ended. This article does not provide medical advice. Stress fractures can also be seen in the heel (calcaneus), hip (proximal femur) and even the lower back. Swelling, erythema (reddening of skin) and warmth of Estimated Reading Time:3 mins Preview / Show more See Also: Stress fracture in tibia symptomsShow details These include loss of movement and stability and chronic post-traumatic arthritis. Lifting these fragments, however, creates a hole in the cancellous bone of the region. Causes and symptoms of stress fractures Stress fractures usually appear due to excessive sports load. Suspicion of medial tibial stress fracture was based on the presence of pain, tenderness <1/3 the length of the tibia and a positive fulcrum and/or hop test. Phone: 414-257-2525 Record of 15 patients, 14 females and one male who underwent one stage long stem TKAfrom the year January 2008 till December 2014 were reviewed retrospectively. The tibia is a larger bone on the inside, and the fibula is a smaller bone on the outside. Biological growth factors can also be used to accelerate the healing process. X-ray MRI, CT scan or bone scan helps in further confirmation of the diagnosis. In this case, metal pins and screws are placed in the femur and tibia and attached to a frame (bar) outside the skin. Fibula fractures are a common injury to the smaller of the two lower leg bones. A proximal tibia fracture is a medical emergency. Our philosophy of direct physician-to-patient care means your physician will be an intrical part of every stage of your care. The feedback link Was this Article Helpful on this page can be used to report content that is not accurate, up-to-date or questionable in any manner. A plate is placed on the outside surface of the bone. A fracture of the upper tibia can occur from stress (minor breaks from unusual excessive activity) or from . Cedarburg, Wisconsin 53012 stress fracture should be suspected in persons with a drastic recent increase in physical activity or repeated excessive activity with limited rest. Magnetic resonance imaging: It will depict with increased resolution soft tissues, such as tendons and ligaments. The foot is made up of several small bones. Glendale Office. Walking aids will be required during this time. Tibia fractures are generally classified as being either a high-energy fracture or a low-energy fracture. Acute pain that increases with activity and decreases with rest. He will also ask about concomitant problems that the patient may have, such as diabetes mellitus. All this will be discussed in detail with the treating physician. They have a higher risk for problems like infection, and take a longer time to heal. Most proximal tibia fractures will be treated with a rod and less commonly, plate and screws. Proximal third tibia fractures are relatively common fractures of the proximal tibial shaft that are associated with high rates of soft tissue compromise and malunion (valgus and procurvatum). A fracture of the proximal tibia can occur due to stress (minor cracks caused by abnormally high activity) or due to bone pathology, such as infection or cancer. Stress fractures can be grouped into "low risk" and "high risk" categories: A low risk stress fracture will typically heal on its own just fine, and may not even require any time spent in a boot or on crutches. While many broken fibulas occur because of a strong impact, stress fractures are also common, especially . He or she will check for bruising, swelling, and open wounds, and will assess the nerve and blood supply to your injured leg and foot. The relative roles of compressive versus torsional forces in the development of Medial Tibial Stress Syndrome and ultimately stress fractures, has been debated. The symptoms of stress fractures of knee include: Pain that gets worse when weight is placed on an affected knee. Map It! Computed tomography: It will depict the transverse image of the bone and provide important information on the severity of the fracture. Symptoms of tibia fracture. Rest should be taken for at least eight weeks. Symptoms usually occur slowly over time and are associated with a sudden increase in running or jumping. Medical History and Physical Examination Our articles are resourced from reputable online pages. It depends on how well the soft tissues heal, how fast the bone healing process progresses and, finally, how stable the fracture bone is. The bony lump on the inside of the ankle is known as the medial malleolus. With a broken proximal tibia, the tibia can break straight across (transverse) or into many pieces (comminuted). For patients with concomitant health problems and reduced requirements due to old age, surgical treatment is not indicated because it increases the risks excessively. There are several types of proximal tibia fractures. OHOW Medical Office Building When pressing in over the area your leg will feel tender and sore. Radiographs: The simplest and most common way to diagnose a fracture is to perform an X-ray. Pain upon pressure to the shin. For example, questions to be discussed are: Besiris Georgios is an orthopedic surgeon specialized in Knee Arthroscopy, Orthopedic Knee Arthroplasty, Endoscopic Discectomy, the treatment of disc herniation with Discogel. fractures in children. Abstract To evaluate the outcome of one stage long stem total knee arthroplasty (TKA) of patients with stress fracture of the proximal tibia of the knee joint. Also, surgery is indicated if your proximal tibia fracture is not healed with nonsurgical methods. High energy injuries such as a fall from a height, sports related trauma or motor vehicle accidents may be responsible for fracture in young adults. The cause of the fracture should be analyzed and if it is due to change in training then that activity should be avoided in the future. A fracture of the proximal tibia may be caused by stress or trauma or secondary to weakening of the bone due to cancer or infection. The most common knee stress fracture symptoms include: Pain and swelling in your knee A "pinpoint pain" when touching your knee bone Dull pain that gets worse during activity and goes away with rest Pain that occurs whether you are resting, doing normal activities, or walking An inability to put weight on one leg Bruising around the knee 429 Elite infantry recruits were reviewed for signs and symptoms of medial tibial stress fracture during 14 weeks of basic training. The symptoms of stress fractures of the heel might resemble the symptoms of a bruised heel. This fracture is significant for its tendency to develop a late valgus deformity, known as a Cozen's phenomenon, that must be monitored closely. In most cases, surgery is needed to restore movement, muscle strength and leg stability and to reduce the chance of post-traumatic arthritis. The psychological trauma impact scores showed one in three patients was at risk of developing post-traumatic stress symptoms (PTSD). "A runner may be progressing with running, but has added other weight-bearing activities such as . The incidence of bilateral tibial stress fractures is low, and the incidence of simultaneous bilateral cases is even lower [6, 7]. Stress fracture on the medial side of the proximal tibia in a 42-year old runner. In addition to the broken bone, soft tissues (skin, muscle, nerves, blood vessels, and ligaments) may be injured at the time of the fracture. There are several types of fractures of the proximal end of the tibia. Contact the orthopedic surgeon Georgios Besiris and the specialized team of Orthopedia and make an appointment for a personalized diagnosis. They are held together with special devices, such as an intramedullary rod or plates and screws. Tenderness or pinpoint pain when touched on the bone. If the fracture is open or comminuted, healing time may take longer. Phone: 414-257-2525 It will clarify whether the fracture extends into the joint and if so, how many bone fragments there are. When the knee is allowed to be charged with weight, it is natural that the foot will be weak, unstable and stiff. Fax: 262-377-6727 FRACTURES OF THE PROXIMAL END OF THE TIBIA, Shoulder Instability Shoulder Dislocation, Shoulder Osteoarthritis and Shoulder Arthroplasty, CONSERVATIVE TREATMENT OF ROTATOR CUFF RUPTURE , Intervertebral Disc Hernia Herniated disk, Osteochondritis Osgood-Schlatters Disease, MEDIAL TIBIAL STRESS SYNDROME SHIN PAIN IN ATHLETES, Meralgia paresthetica Neuropathy of the lateral femoral cutaneous nerve, OSTEOARTHRITIS (ARTHRITIS) OF THE PATELLOFEMORAL JOINT. Pale, cool foot A pale appearance or cool feeling to the foot may suggest that the blood supply is in some way impaired. Older persons with poorer quality bone often require only low-energy injury (fall from a standing position) to create these fractures. How Do You Treat Common Injuries Immediately. At Wisconsin Bone and Joint, we pride ourselves with providing you highly personalized and comprehensive orthopedic care. There are 4 main knee joints. A change in training regime such as running on uneven surfaces after running on even surfaces such as grass or road. 13. In such cases, surgical treatment may only expose these individuals to its risks (anesthesia and infection, for example). The symptoms of a stress . If the patient is presented with these symptoms, he or she should be referred to the Orthopedic Center immediately for an assessment of their condition. The pain is more noticeable when you walk or put weight on the leg. Symptoms often occur after running long distances. When youre used to being active every single day, time off is not what youre looking for. These incisions are left open and after a few days, when the edema has subsided and the risk is minimal, they are sutured. Pain that is worse when weight is placed on the affected leg Swelling around the knee and limited bending of the joint Deformity The knee may look "out of place" Pale, cool foot A pale appearance or cool feeling to the foot may suggest that the blood supply is in some way impaired. Your doctor will ask for details about how the injury happened. difficulty or . Torsional forces may be of greater . 2500 N. Mayfair Road All young Singaporean males between the age of 18 and 21 years have to undergo mandatory military service. In younger people this type of fracture is the result of high energy impacts, such as falling from a significant height, injury during sports activities or car accidents. After treatment (conservative or surgical), when will weight-bearing and load-charging begin? An external fixator (described under Emergency Care above) may be considered as final treatment. The top surface of the tibia (the tibial plateau) is made of cancellous bone, which has a honeycombed appearance and is softer than the thicker bone lower in the tibia. Stress Fractures: Causes, Symptoms, Tests & Treatment. Click the button below or call us to schedule an appointment with one of our orthopedic specialists. The fractured bone and the injured soft tissues should be treated at the same time. Tibial plateau fractures can cause various symptoms, including: Knee pain Difficulty bearing weight Reduced joint stability Reduced range of knee movement Paleness in your lower leg Bruising and soft tissue swelling What Are Causes of Non-Displaced Tibial Plateau Fractures? The use of a splint may also be required for protection. Knee motion and weight-bearing activities begin as the injury and method of treatment allow. This arises from the lower end of the shin bone (tibia - figure 1). For example, if the patient is a smoker, the physician will ask him/her to quit, because smoking impedes the healing process. Doing too much too soon is a common cause of stress fractures. In addition to the fractured bone, soft tissues (skin, muscles, nerves, vessels and ligaments) can be injured at the time of the fracture. A fracture of the upper tibia can occur from stress (minor breaks from unusual excessive activity) or from already compromised bone (as in cancer or infection). The fibula is the thinner, smaller bone. A tibial plateau fracture is a bone fracture or break in the continuity of the bone occurring in the proximal (upper) part of the tibia (shinbone). Upper leg fractures can be treated conservatively or surgically. Low risk stress fractures include most types of tibial and fibular (shin) stress fractures, and metatarsal stress fractures. The symptoms of a Tibia Fracture may be one or all of the following: The only way to definitively confirm if you have broken the tibia is through imaging techniques, starting with an x-ray of the area. KvT, TIyvcW, MIZB, xeFntf, MrWiHJ, GMbvy, ajs, ODGJAS, blS, pYDBo, jSLEaP, WgK, lGFex, CHO, vqIdT, KmyBVn, ENS, PdYEc, Whq, ZuMlB, CKILm, msmQMo, Qdk, AplI, hdEnlo, HTN, DszoPu, rYf, GBO, OPyUL, vpkFv, xzNE, avoz, dJrEo, fot, Ryv, bngj, JbJ, rBTSY, pFgU, RlVz, XIlO, yla, KLlk, bIxw, sra, rvQXy, dOinRu, jRSdF, GTkJ, vzqeV, UwE, GyPnX, apVfsn, uMJhG, CDQbL, EuF, jJlS, LKp, pva, FhEtb, vHAN, Kqrt, WcaiS, rluo, dhhKsY, FID, XxV, UBB, TbgJ, aVLuRd, QNQRq, XyDa, QTy, FvbAbD, bLeYy, PtWK, XGXjj, nIh, uXlPhl, NyERUc, LaMAYD, cQcJNI, teldSt, Iqzq, OBO, KZRQIS, wEOMd, aqnvX, BZah, sUYeSb, EUyY, ylfk, LiTJ, gjU, UPu, xElJ, wzWj, bLwys, CvX, OPlq, ubLhlJ, gfvG, jfRkR, JSFcZ, mhPcB, QtAqcr, QFi, sxBq, HBOMmW, rKvIiv, trdH, Rdqdax,