Many fractures around the knee are caused by high energy trauma, such as falls from significant heights and motor vehicle collisions. Yaw Boachie-Adjei, MD, is a board-certified, double-fellowship Orthopedic Surgeon. It forms the upper part of the elbow and is the spool around which the forearm bends and straightens. Structure Region. The distal humerus is the lower end of the humerus. Proximally, the femur articulates with the pelvic bone. It also provides attachment for the tendon of adductor magnus muscle as well as the tibial collateral ligament (supporting structure connecting the tibia to the femur). [12] There is little scarring, and all of the surgery takes places inside of the mouth. Depending on the exact location, a proximal tibial fracture may affect the stability of the knee as well as the growth plate. The procedure can delay the need for a total knee replacement for up to ten years. under the distal end of the thigh to cushion it. REPLACE PROXIMAL AND DISTAL UPRIGHT FOR KAFO L4080 REPLACE METAL BANDS KAFO, PROXIMAL THIGH L4090 REPLACE METAL BANDS KAFO-AFO, CALF OR DISTAL THIGH L4100 REPLACE LEATHER CUFF KAFO, PROXIMAL Removing just a small wedge of bone can "swing" the knee open, pressing the healthy tissue together as space opens up between the femur and tibia on the damaged side so that the arthritic surfaces do not rub against each other. The ankle joint, also known as talocrural joint, is made up of three bony structures: the distal ends of the tibia (shinbone) and fibula, proximally and the talus, distally. Gross anatomy. Over time, the malalignment can result in the destruction of the joint surfaces and the progression of osteoarthritis. Due to the serious nature of this procedure, recovery may be extensive. The layers of tissue in the knee are stitched together, usually with absorbable sutures. This disorder is more commonly encountered in pre-adolescent to adolescent males but can also be seen in females. Kenhub. Biceps tendon injuries are generally repaired in younger, more active patients, or in patients with injuries to the dominant extremity. Mayo Clinic is a not-for-profit organization. Depending on the exact location, a proximal tibial fracture may affect the stability of the knee as well as the growth plate. A bone fracture may be the result of high force impact or stress, or a minimal trauma injury as a result of certain When the door is shut, the hinges are flush against the wall. Please see the table below that summarizes the ligaments associated with each joint. The ankle region is found at the junction of the leg and the foot.It extends downwards from the narrowest point of the lower leg and includes the parts of the foot closer to the body (proximal) to the heel and upper surface of the foot. Patient is then asked to extend the knee. Both walls bare indentations that accommodate the attachment of the cruciate ligament arising from the opposite side of the tibial plateau. Use this page to view details for the Local Coverage Determination for Ankle-Foot/Knee-Ankle-Foot Orthosis. There is often some deformity to the shape of the muscle, but usually, the loss of strength is much less than many expect. Surfaces. Conveniently the Salter-Harris types can be remembered by the mnemonic SALTR.. type I. slipped; 5-7%; fracture plane passes all the way through the growth Posteriorly, the oblique popliteal ligament (which is a continuation of the tendon of the semimembranosus muscle) supports the joint capsule. Inserts on the tibial tuberosity. The distal humerus is the lower end of the humerus. The Deep medial ligament (dMCL) is divided into two, the meniscofemoral and meniscotibial ligaments. The neck itself is anteverted (rotated laterally) at a variable angle between 10 15o (angle of torsion). Femur anatomy is so unique that it makes the bone suitable for supporting the numerous muscular and ligamentous attachments within this region, in addition to maximally extending the limb during ambulation. The joints of the foot are the ankle and subtalar joint and the interphalangeal joints of the foot.An anthropometric study of 1197 North American adult Caucasian males (mean age 35.5 years) Sciatic nerve injury. There are four bursae anterior to the knee joint: suprapatellar bursa: located between the femur and quadriceps femoris, it is attached to the articularis genu muscle and usually communicates with the synovial cavity; subcutaneous prepatellar bursa: between the skin and patella; subcutaneous infrapatellar bursa: between the skin and tibial The biceps tendon is also important in its contribution to shoulder stability. The oval fibular articular facet is found on the head of fibula, facing anteriorly, superiorly and medially. The tibia and fibula have specific parts that make up the ankle: Medial malleolus - inside part of the tibia; Posterior malleolus - back part of the tibia The goal is to shift the patient's body weight off the damaged area to the other side of the knee, where the cartilage is still healthy. Gently strengthen thigh and lower leg muscles to help protect the bones and cartilage in the knee. In more severe cases, the bone may be broken into several fragments, known as a comminuted fracture. Also known as the Y ligament of Bigelow and the ligament of Bertin. This article will review the gross anatomy of the femur. Retrieved from https://www.rch.org.au/clinicalguide/guideline_index/fractures/sufe_emergency/, Gaillard, F., & Bell, D. Shenton line | Radiology Reference Article | Radiopaedia.org. The Deep medial ligament (dMCL) is divided into two, the meniscofemoral and meniscotibial ligaments. As stated above, proximal biceps tendon injuries almost always occur to the long head of the biceps tendon. 2010 May 1;18(5):557-69. It functions as the point of insertion for the superior and inferior bands of the iliofemoral ligament which is attached to the tubercle proximally and distally respectively. Topics covered include: trauma systems and management; surgical procedures; epidemiological studies; surgery (of all The medial wall of the fossa is formed by the lateral surface of the medial condyle, while the lateral wall is formed by the medial surface of the lateral condyle. Injuries to the short head of the biceps are essentially unheard of. Topics covered include: trauma systems and management; surgical procedures; epidemiological studies; surgery (of all While the cruciate and meniscofemoral ligaments provide support within the synovial joint capsule, more robust ligaments are situated outside the capsule to keep the bones in line. The proximal attachment of the muscle, often considered the anchor of movement. Make a donation. Avoid heavy impact on the knees during everyday and athletic activities. This is usually an injury that occurs with heavy lifting or sports in middle-aged men. 5.0 5.1 Ebraheim NA, Taser F, Shafiq Q, Yeasting RA. Patients may present with an acute onset of pain and inability to ambulate or chronic hip pain with pain being referred to the knees. On the other hand, the anterior surface is flattened, located within the joint capsule, and meets the proximal end of the femoral shaft at the intertrochanteric line. All of the above arteries and branches can get extremely confusing, very fast! Classification. All rights reserved. Some acetabular procedures are named after the surgeons who first described them as Salter (R. Salter), Dega (W. Dega), Sutherland (D.H. Sutherland), Chiari (K. Chiari): other names one may encounter are Ludlov, P. Pemberton, and James B. Steele. Light, daily exercise is much better for an arthritic knee than occasional, heavy exercise.[11]. The Weber ankle fracture classification (or Danis-Weber classification) is a simple system for classification of lateral malleolar fractures, relating to the level of the fracture in relation to the ankle joint, specifically the distal tibiofibular syndesmosis. The proximal attachment 1. blends into semimembranosus tendon and 2. distal attachment is at the posteromedial crest of the tibia. and grab your free ultimate anatomy study guide! Chin osteotomies (cutting the bone and moving it) are done through an incision inside the mouth. A standard oscillating saw is run along the guide wires, removing most of the bone wedge from underneath the outside of the knee, below the healthy cartilage. One of the tendons by the shoulder (the proximal biceps) is called the long head of the biceps, and the other is called the short head of the biceps. The biceps muscle helps bend the elbow joint, but it also has other functions. A femoral neck fracture associated with low-velocity injuries often occurs on a background of osteopenia (decreased bone density); which may either be age or diet related. The mechanism of injury is typically a high velocity from the distal end of the bone that is transmitted proximally. Dr. Tom Forbes Editor-in-Chief. This facilitates attachment of the ligament of the head of the femur (also called the ligamentum fovea or ligamentum teres). Episode 181: Athletes Undergoing Concomitant Hip Arthroscopy and Periacetabular Osteotomy Demonstrate Greater Than 80% Return-to-Sport Rate at 2-Year Minimum Follow-Up However, extreme variation of the angle of inclination could change this relationship and increase the amount of stress across the neck of the femur. The length of the fibres increase from proximal to distal One of the primary stabilisers Anatomy of the ankle ligaments: a pictorial essay. The new surgical journal seeks high-quality case reports, small case series, novel techniques, and innovations in all aspects of vascular disease, including arterial and venous pathology, trauma, When the bicep is flexed, the radius or forearm moves towards the upper arm. The femoral head forms the ball in the ball and socket joint of the hip. It forms the upper part of the elbow and is the spool around which the forearm bends and straightens. Use this page to view details for the Local Coverage Determination for Ankle-Foot/Knee-Ankle-Foot Orthosis. A bone fracture may be the result of high force impact or stress, or a minimal trauma injury as a result of certain The distal biceps tendon is injured around the elbow joint. The ends of the femur and tibia where they meet to form the knee joint can also be fractured. Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. Reviewer: resists valgus forces through all degrees of knee flexion. The tibial articular facet is located on the lateral tibial condyle and it faces posteriorly, inferiorly and laterally.. PubMed comprises more than 34 million citations for biomedical literature from MEDLINE, life science journals, and online books. usually self-resolving. doi:10.5812/traumamon.7146, Sutton KM, Dodds SD, Ahmad CS, Sethi PM. distal end usually accessible through laceration, proximal end may retract ~3cm if less then 5 degrees of ankle dorsiflexion with the knee extended perform gastrocnemius recession prior to tensioning repair. Supports the knee joint posteriorly. The tibial plateau also serves as the point of attachment for the anterior and posterior cruciate ligaments that insert on the contralateral wall of the intercondylar fossa. Sciatic nerve injury. The journal publishes original contributions that demonstrate a novel application of an existing ultrasound technology in clinical diagnostic, interventional and therapeutic applications, new and improved clinical techniques, the physics, Verywell Health's content is for informational and educational purposes only. The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician.JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency Integrates with the joint capsule. However he is still having persistent anterior shoulder/arm pain that worsens with most activities. The most superomedial part is the subcapital portion; this is wider than the midcervical part but narrower than the basicervical segment. The joints of the foot are the ankle and subtalar joint and the interphalangeal joints of the foot.An anthropometric study of 1197 North American adult Caucasian males (mean age 35.5 years) Toward the middle of the shaft, there are three surfaces and three borders. : 768 Ankle joint. 2. So a finger is distal to the wrist, which is distal to the elbow, which is distal to the shoulder. It is associated with a small conical protuberance known as the adductor tubercle, which provides a point of attachment for the large adductor magnus (powerful medial thigh musclethat moves the thigh medially). The Weber ankle fracture classification (or Danis-Weber classification) is a simple system for classification of lateral malleolar fractures, relating to the level of the fracture in relation to the ankle joint, specifically the distal tibiofibular syndesmosis. It is also located within the joint capsule and is covered by a synovial membrane. Firstly, the neck of the femur is angled superomedially in order to fit into the acetabulum. The middle segment is also referred to as the midcervical part and is the narrowest part of the femoral neck. New Journal Launched! The Salter-Harris classification was proposed by Salter and Harris in 1963 1 and at the time of writing (June 2016) remains the most widely used system for describing physeal fractures.. Arises below the adductor tubercle of the medial femoral condyle to the medial epicondyle of the tibia. The superficial layer has variable attachments and crosses two joints while the deep layer has talar attachments and crosses one joint: The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician.JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency Dr. Thomas L. Forbes is the Surgeon-in-Chief and James Wallace McCutcheon Chair of the Sprott Department of Surgery at the University Health Network, and Professor of Surgery in the Temerty Faculty of Medicine at the University of Toronto. Citations may include links to full text content from PubMed Central and publisher web sites. Annals of Vascular Surgery: Brief Reports and Innovations is a gold open access journal launched by Annals of Vascular Surgery. Jonathan Cluett, MD, is board-certified in orthopedic surgery. 2010 May 1;18(5):557-69. The tibia and fibula have specific parts that make up the ankle: Medial malleolus - inside part of the tibia; Posterior malleolus - back part of the tibia I would honestly say that Kenhub cut my study time in half. A femoral derotation osteotomy can be performed to correct version abnormalities such as excessive anteversion or retroversion of the hip joint. So a finger is distal to the wrist, which is distal to the elbow, which is distal to the shoulder. Origin. Staff skilled in dozens of specialties work together to ensure quality care and successful recovery. Gross anatomy. The complex of the medial collateral ligaments of the ankle joint is collectively called deltoid ligament.It attaches the medial malleolus to multiple tarsal bones. The intertrochanteric line is found anteriorly, while the intertrochanteric crest is found posteriorly. Two main types of osteotomies are used in the correction of hip dysplasias and deformities to improve alignment/interaction of acetabulum (socket) and femoral head (femur head) (ball), innominate osteotomies and femoral osteotomies. Surfaces. Most often, a snap or pop is both felt and heard, and pain occurs around the shoulder or elbow, depending on which part of the biceps tendon is torn. A bone fracture (abbreviated FRX or Fx, F x, or #) is a medical condition in which there is a partial or complete break in the continuity of any bone in the body. Proximally inserted between the anterior superior iliac spine and the acetabular rim; distally attached at the intertrochanteric line. While it is not a true tuberosity, it may be large enough to be considered as such. The information we provide is grounded on academic literature and peer-reviewed research. Ultrasound in Medicine and Biology is the official journal of the World Federation for Ultrasound in Medicine and Biology. A Meta-Analysis of Radiological Outcomes", Anterior cruciate ligament reconstruction, https://en.wikipedia.org/w/index.php?title=Osteotomy&oldid=1125479503, Articles lacking in-text citations from January 2016, Creative Commons Attribution-ShareAlike License 3.0. The top of the shinbone is then lowered on the outside and attached with surgical staples or screws, depending on the size of the wedge that was removed. The fibular collateral ligament (supporting structure that attaches the fibula to the femur) also has an insertion on the lateral condyle. Patient is then asked to extend the knee. The most common type of osteotomy performed on arthritic knees is a high tibial osteotomy, which addresses cartilage damage on the inside (medial) portion of the knee. This is usually an injury that occurs with heavy lifting or sports in middle-aged men. Even if there are no auto-suggestions within the search field, hit "Search" anyway, as you may still get results. Following a biceps tendon rupture, the muscle cannot pull on the bone, and certain movements may be weakened and painful. An osteotomy is a surgical operation whereby a bone is cut to shorten or lengthen it or to change its alignment. The convex anterior surface is bound by medial and lateral rounded borders. This feature contributes to the difference in gait between the two sexes. The linea aspera then diverges toward the distal third of the femur where the medial and lateral lips become continuous with their respective ipsilateral supracondylar line (medial and lateral supracondylar lines). Runs from the lateral femoral condyle to the head of the fibula. The problem arises if there is damage to the neck of the femur; this could compromise the blood supply to the femoral head and lead to avascular necrosis. Injury was founded in 1969 and is an international journal dealing with all aspects of trauma care and accident surgery.Our primary aim is to facilitate the exchange of ideas, techniques and information among all members of the trauma team. Excessive anteversion of the femur results in anterior instability of the hip joint while excessive retroversion results in femoroacetabular hip impingement.[5]. Non-contact activities keep joints and bones healthy and maintain fitness over time. Femoroacetabular impingement is a mechanical disorder characterized by hip pain with active and passive movements (particularly flexion and rotation) as a result of contact between the femoral head and the acetabulum. The distal attachment of a muscle. Emerging from the posterior intercondylar area to insert on the lateral wall of the medial condyle. The tibial plateau leveling osteotomy and tibial tuberosity advancement are two of the most common osteotomy procedures performed in the United States. It is sometimes performed to correct a hallux valgus, or to straighten a bone that has healed crookedly following a fracture.It is also used to correct a coxa vara, genu valgum, and genu varum.The operation is done under a general anaesthetic. In more severe cases, the bone may be broken into several fragments, known as a comminuted fracture. Symptoms may include pain, swelling, bruising, and an inability to walk on the injured leg. Grounded on academic literature and research, validated by experts, and trusted by more than 2 million users. The distal biceps tendon is injured around the elbow joint. The journal publishes original contributions that demonstrate a novel application of an existing ultrasound technology in clinical diagnostic, interventional and therapeutic applications, new and improved clinical techniques, the physics, Dr. Tom Forbes Editor-in-Chief. Apply resistance just proximal to the ankle. REPLACE PROXIMAL AND DISTAL UPRIGHT FOR KAFO L4080 REPLACE METAL BANDS KAFO, PROXIMAL THIGH L4090 REPLACE METAL BANDS KAFO-AFO, CALF OR DISTAL THIGH L4100 REPLACE LEATHER CUFF KAFO, PROXIMAL Learn more about common fractures of the knee: Patellar (Kneecap) Fractures Distal Femur (Thighbone) Fractures of the Knee If you want to learn them in an engaging way, take a look at our study unit: Humans are bipedal organismsmeaning that they are able to walk on two legs. The lateral and larger of the two apophyses is the greater trochanter; its proximal edge is roughly a hands breadth inferior to the pubic tubercle on the pubis. 2. The length of the fibres increase from proximal to distal One of the primary stabilisers Anatomy of the ankle ligaments: a pictorial essay. It is a rough area with numerous vascular foramina to accommodate traversing vessels. The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician.JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency 1998-2022 Mayo Foundation for Medical Education and Research (MFMER). On the other hand, the intertrochanteric crest is more pronounced than the intertrochanteric line. In other cases, patients are known to have the disorder with an acute worsening of the slippage (acute on chronic). Anterior Tibialis Tendon Ruptures are traumatic anterior ankle injuries that can present with foot drop and impaired gait. A four- to five-inch incision is made down the front and outside of the knee, starting below the kneecap and extending below the top of the shinbone. For instance, the bicep inserts along the radial tuberosity. However, results of non-surgical treatment are not as bad as many people think. Technique and preliminary results", "Orthognathic surgery and temporomandibular joint symptoms", "Systematic review of the incidence of inferior alveolar nerve injury in bilateral sagittal split osteotomy and the assessment of neurosensory disturbances", "Is Bone Grafting Necessary in Opening Wedge High Tibial Osteotomy? Evaluation of Proposed Protocol Changing Statistical Significance From 0.05 to 0.005 in Foot and Ankle Randomized Controlled Trials In 2018, a group of 72 methodologists suggested shifting the p value threshold from the commonly accepted .05 convention to .005, and p values between .05 and .005 would be labeled suggestive (1). The ankle AP view is part of a three view series, and visualizes the distal tibia, distal fibula, proximal talus and proximal fifth metatarsal. The inferior margin is more oblique in orientation and projects posteroinferiorly and laterally toward the lesser trochanter. hamstring origin on ischial tuberosity is ~6 cm proximal to inferior border of overlying gluteus maximus. The extracapsular fractures are also called basicervical fractures, while intracapsular fractures are transcervical and subcapital. Joint replacement surgery, Reverse shoulder replacement surgery, Shoulder replacement revision, Revision of previous tr auma surgery, Humerus fracture fixation, Clavicle fracture fixation, Superior capsule reconstruction, Tendon transfer, Shoulder ligament reconstruction, Shoulder replacement surgery, Rotator cuff surgery, Shoulder tendon transfer, Consolidate your knowledge on the knee joint with the following quiz! This is performed to realign the mandible (lower jaw) or maxilla (upper jaw) with the rest of the skull and/or teeth. The femoral condyles rest on very shallow, complementary depressions on the proximal tibial plateau known as facets. (OBQ18.141) A 48-year-old male returns to your office 8 months after sustaining a proximal humerus fracture that was successfully treated nonoperatively. The patient's weight is transferred to the outside (lateral) portion of the knee, where the cartilage is still healthy.[10]. These fractures can be classified as intracapsular or extracapsular. A single copy of these materials may be reprinted for noncommercial personal use only. 4. It is especially important to avoid any serious knee injuries, such as torn ligaments or fractured bones, because arthritis can complicate knee injury treatment. The short head of the proximal biceps attaches to a spur of bone in front of the shoulder called the coracoid process. 6. Not only is the distal femur the widest part of the bone, but it also interacts with both the proximal tibiaand the patella. As the door swings open, one side of the door remains pressed against the wall as space opens up on the other side. Many patients with a distal biceps rupture will have surgery to repair the torn tendon. Many patients with a distal biceps rupture will have surgery to repair the torn tendon.. 6. The femoral apophyses are prominent protrusions found on the proximal aspect of the femur. There are two lines that connect the greater and lesser trochanters on the anterior and posterior aspect of the proximal femur. The medial apophysis is smaller, more conical, and extends in the posteromedial plane. distal non-insertional hamstring injuries. The inferior articular surface is quadrilateral, and smooth for articulation with the talus. Chevron, Wedge) or the way the bones are aligned (Dial=old style rotary dial phone). It has a role in determining treatment. It is associated with a crescent-shaped, rough, depression known as the trochanteric fossa, found on the medial surface of the apophysis. Complications may include an associated high ankle sprain, compartment syndrome, stiffness, malunion, and post-traumatic arthritis.. Ankle fractures may result from excessive stress on the joint such as from These vessels are not as vulnerable as those at the neck of the femur. While most cases only affect one side (the left more often than the right), it is not uncommon to see bilateral pathology. Clinicians may also want to entertain fractures of the neck of the femur or primary knee pathologies as possible differential diagnoses. Learn more about common fractures of the knee: Patellar (Kneecap) Fractures Distal Femur (Thighbone) Fractures of the Knee Anterior Tibialis Tendon Ruptures are traumatic anterior ankle injuries that can present with foot drop and impaired gait. J Am Acad Orthop Surg. An ankle fracture is a break of one or more of the bones that make up the ankle joint. hip and knee are maximally flexed and then the knee is rapidly fully extended. Making the diagnosis of a torn biceps tendon is typically straightforward, but the decision for how to best treat these injuries may be more complicated. Attached to the obturator crest and membrane, the iliopubic eminence, and the superior pubic ramus; blends with the iliofemoral ligament distally. Annals of Vascular Surgery: Brief Reports and Innovations is a gold open access journal launched by Annals of Vascular Surgery. Maintaining aerobic cardiovascular fitness has been an effective method for preventing the progression of osteoarthritis. Our engaging videos, interactive quizzes, in-depth articles and HD atlas are here to get you top results faster. This site complies with the HONcode standard for trustworthy health information: verify here. An anteroposterior plain radiograph of the pelvis will demonstrate loss of Shentons curve, Kleins line, and obvious slippage of the capital epiphysis. 2. New Journal Launched! The Weber ankle fracture classification (or Danis-Weber classification) is a simple system for classification of lateral malleolar fractures, relating to the level of the fracture in relation to the ankle joint, specifically the distal tibiofibular syndesmosis. Many patients with a distal biceps rupture will have surgery to repair the torn tendon. Citations may include links to full text content from PubMed Central and publisher web sites. The radial head is the knobby end of the radius where it meets the elbow. Both femurs naturally converge towards the knee. The caudal aspect of the surface forms part of the floor of the popliteal fossa. Place the knee in 20 of flexion from full extension to avoid mechanical locking of the joint. hip and knee are maximally flexed and then the knee is rapidly fully extended. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. The radial head is the knobby end of the radius where it meets the elbow. Complications may include an associated high ankle sprain, compartment syndrome, stiffness, malunion, and post-traumatic arthritis.. Ankle fractures may result from excessive stress on the joint such as from The interaction of these three bones requires numerous ligaments to prevent disarticulation (separation of the bones that interact at their joint). Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. 4. Attached to the posterior surface and the apex of the patellar. Each of these parts of the muscle belly has its own tendon attachment on top by the shoulder, and the two parts coalesce into one tendon attachment at the elbow. The ends of the femur and tibia where they meet to form the knee joint can also be fractured. Deciding whether to have the biceps tendon repair depends on a number of factors, including the age of the patient, the activity level of the patient, which arm the injury is on (dominant or non-dominant), and the expectations for future. Firstly, the neck of the femur is angled superomedially in order to fit into the acetabulum. [14], Learn how and when to remove this template message, "Valgus osteotomy by external fixation for treatment for developmental coxa vara", "Osteotomy for treating knee osteoarthritis", "Algorithm for Femoral and Periacetabular Osteotomies in Complex Hip Deformities", "Dega osteotomy for the management of developmental dysplasia of the hip in children aged 28 years: results of 58 consecutive osteotomies after 1325 years of follow-up", "Proximal femoral derotation osteotomy for idiopathic excessive femoral anteversion and intoeing gait", "Distal Femoral Osteotomy: Lateral Opening Wedge Technique", "The use of rapid prototyping jigs in the planning of knee osteotemies", "The young osteoarthritic knee: dilemmas in management", "High Tibial Osteotomy Knee Surgery and Realignment | HSS", "Post-operative rehabilitation and nutrition in osteoarthritis", "Surgical treatment to correct a bad bite", "Chin Ptosis: Classification, Anatomy, and Correction", "Tibial Plateau Leveling Following Tibial Tuberosity Advancement: A Case Series", "Proximal tibial osteotomy for osteoarthritis with varus deformity. distal end usually accessible through laceration, proximal end may retract ~3cm if less then 5 degrees of ankle dorsiflexion with the knee extended perform gastrocnemius recession prior to tensioning repair. The distal attachment of a muscle. It is bowed anteriorly, which contributes to the weight bearing capacity of the bone. While the fossa is located within the joint capsule, the majority of it sits outside of the synovial membrane. It is a pronounced ridge on the posterior surface of the femur, which begins at the intersection of the shaft and neck of the femur. Learning anatomy is a massive undertaking, and we're here to help you pass with flying colours. Although the medial condyle is smaller than the lateral condyle, it is more readily palpable. It lies deep to the iliotibial tract(fibrous continuation of the tensor fasciae latae), which also inserts on the lateral femoral condyle. This neck-shaft angle (angle of inclination) is larger in infants and gradually decreases to the previously stated angle. 3. Although it is described as being a cylindrical structure, the shaft of the femur has several surfaces and borders that blend seamlessly. You should discuss these treatment options with your orthopedic surgeon, who can help you determine the best option for your situation.. Knee Surgery, Sports Traumatology, Arthroscopy. Complete your understanding of the interaction between the femur, tibia, and patella by learning more about the latter two bones using the following resources! Anterior Tibialis Tendon Ruptures are traumatic anterior ankle injuries that can present with foot drop and impaired gait. (OBQ18.141) A 48-year-old male returns to your office 8 months after sustaining a proximal humerus fracture that was successfully treated nonoperatively. Arising from the medial tibial eminence and inserting posteromedially on the medial wall of the lateral condyle. The Archives of Physical Medicine and Rehabilitation publishes original, peer-reviewed research and clinical reports on important trends and developments in physical medicine and rehabilitation and related fields.This international journal brings researchers and clinicians authoritative information on the therapeutic utilization of physical, behavioral and Arising from the anastomotic ring are cervical arteries that pierce the joint capsule to become retinacular arteries. In more severe cases, the bone may be broken into several fragments, known as a comminuted fracture. It is important in the motion called supination of the forearm. 5.0 5.1 Ebraheim NA, Taser F, Shafiq Q, Yeasting RA. The ligament is composed of two layers. Place the knee in 20 of flexion from full extension to avoid mechanical locking of the joint. Read more. The relationship of the femur with its proximal and distal articulations is rather unique. It can also be used to lengthen the chin (which is more difficult with an implant) or to shorten or narrow a chin. The tendons of sartorius and gracilis muscles also pass over (but have no attachments) to the medial condyle of the femur. Orthopedic surgeons opt to rectify this problem by pinning the capital epiphysis in place without reducing the displacement. Patients may provide a history of trauma and associated pain from the injury. The main function of the groove is to stabilize the patella during ambulation. The ankle AP view is part of a three view series, and visualizes the distal tibia, distal fibula, proximal talus and proximal fifth metatarsal. Variation in the angle of convergence impacts the angle between the lateral aspects of the tibia and femur (the femoral-tibial angle, which is roughly 175 degrees). Attached to the free edges of the acetabular labrum. The human foot is a strong and complex mechanical structure containing 26 bones, 33 joints (20 of which are actively articulated), and more than a hundred muscles, tendons, and ligaments. As you can see, the femur can have a lot of anatomical landmarks. The popliteal surface of the femur is a triangular space found at the distal posterior surface of the femur. Mayo Clinic has one of the largest and most experienced practices in the United States, with campuses in Arizona, Florida and Minnesota. hamstring origin on ischial tuberosity is ~6 cm proximal to inferior border of overlying gluteus maximus. 6. Our femur quizzes and diagram labeling activities are not only fast, but fun and effective, too! The line then continues as the spiral line of the femur at the inferior aspect of the intertrochanteric line and continues into the medial lip of the linea aspera on the femoral shaft. On the anterior surface of the distal femur, toward the anterior apex of the intercondylar fossa is an area known as the patellar surface or trochlear groove. The posterior surface of the neck of the femur is directed posterosuperiorly. Sciatic nerve injury. It extends inferomedially from the greater trochanter to the lesser trochanter. Use this page to view details for the Local Coverage Determination for Ankle-Foot/Knee-Ankle-Foot Orthosis. Please note that the mechanical axis of the femur differs from the anatomical axis of the femur (a line running from the center of the greater trochanter, along the femoral shaft, and ending at the center of the knee joint line). The blood supply of the proximal femur is of particular medical interest because of its susceptibility to damage. Find out more about the anatomy of the hip and knee joints using the following study units: The patella articulates with the patellar surface of the distal femur. The free ends of each meniscus (the horns) are attached to the tibial plateau by ligaments. The Salter-Harris classification was proposed by Salter and Harris in 1963 1 and at the time of writing (June 2016) remains the most widely used system for describing physeal fractures.. The ligament is composed of two layers. The bones are cut, reshaped or partially removed to realign the load-bearing surfaces of the joint.[3]. Conveniently the Salter-Harris types can be remembered by the mnemonic SALTR.. type I. slipped; 5-7%; fracture plane passes all the way through the growth After regional or general anesthesia is administered, the surgical team sterilizes the leg with antibacterial solution. PubMed comprises more than 34 million citations for biomedical literature from MEDLINE, life science journals, and online books. Common proximal tibial fractures include: Proximal Tibial Epiphyseal Fracture: This type of fracture affects the top portion of the bone (epiphysis) and the growth plate. Classification. He has not done any physical therapy nor received a corticosteroid injection. There is a posterolateral surface which is limited anteriorly by the lateral border and posteriorly by the linea aspera. New Journal Launched! Unlike its larger counterpart, the lesser trochanter cannot be palpated. Knee Surgery, Sports Traumatology, Arthroscopy. The medial supracondylar line continues to the adductor tubercle (on the medial condyle) and the lateral supracondylar line ends at the lateral condyle. The ends of the femur and tibia where they meet to form the knee joint can also be fractured. The ligament of the head of the femur is attached to the fovea (shallow depression on the superomedial part of the head of the femur) and to the center of the acetabulum. The neck of the femur is the most vulnerable site for a fracture to occur. Surgeons remove a wedge of the tibia from underneath the healthy side of the knee, which allows the tibia and femur to bend away from the damaged cartilage.[7]. The distal end of the tibia is much smaller than the proximal end and presents five surfaces; it is prolonged downward on its medial side as a strong pyramidal process, the medial malleolus.The lower extremity of the tibia together with the fibula and talus forms the ankle joint.. It will also discuss the blood supply of the femur and summarize the points of muscular and ligamentous attachment. For a grade of 3- patient should be abl e to actively extend the knee from 90 o of flexion He has not done any physical therapy nor received a corticosteroid injection. Genotypic females tend to have a wider angle of inclination than genotypic males do. The Deep medial ligament (dMCL) is divided into two, the meniscofemoral and meniscotibial ligaments. hamstring origin on ischial tuberosity is ~6 cm proximal to inferior border of overlying gluteus maximus. Guide wires are drilled into the top of the shinbone (tibia plateau) from the outside (lateral side) of the knee. (OBQ18.141) A 48-year-old male returns to your office 8 months after sustaining a proximal humerus fracture that was successfully treated nonoperatively. hip and knee are maximally flexed and then the knee is rapidly fully extended. A joint dislocation can cause damage to the surrounding ligaments, tendons, muscles, and nerves. 2022 Dotdash Media, Inc. All rights reserved. The tibia and fibula have specific parts that make up the ankle: Medial malleolus - inside part of the tibia; Posterior malleolus - back part of the tibia The shaft is relatively wide at the proximal end but becomes progressively narrow toward the middle. Avoid activities that causes pain which lasts over an hour. [1], Osteotomy is one method to relieve pain of arthritis, especially of the hip and knee. This is a raised longitudinal impression that runs along the long axis of the femur. A critical long-term study of eighty-seven cases", "A new periacetabular osteotomy for the treatment of hip dysplasias. distal end usually accessible through laceration, proximal end may retract ~3cm if less then 5 degrees of ankle dorsiflexion with the knee extended perform gastrocnemius recession prior to tensioning repair. sensitivity 0.89, specificity 0.91. A bone fracture (abbreviated FRX or Fx, F x, or #) is a medical condition in which there is a partial or complete break in the continuity of any bone in the body. For a grade of 3- patient should be abl e to actively extend the knee from 90 o of flexion It has a role in determining treatment. Osteotomy is also used as an alternative treatment to total knee replacement in younger and active patients. Symptoms may include pain, swelling, bruising, and an inability to walk on the injured leg. The oval fibular articular facet is found on the head of fibula, facing anteriorly, superiorly and medially. It is characterized by a longitudinal concavity and a transverse convexity, and the distal portion is located outside of the joint capsule. The relationship of the femur with its proximal and distal articulations is rather unique. For instance, the bicep inserts along the radial tuberosity. Many fractures around the knee are caused by high energy trauma, such as falls from significant heights and motor vehicle collisions. Biceps Tendon Rupture Types and Treatment. resists valgus forces through all degrees of knee flexion. A joint dislocation, also called luxation, occurs when there is an abnormal separation in the joint, where two or more bones meet. The complex of the medial collateral ligaments of the ankle joint is collectively called deltoid ligament.It attaches the medial malleolus to multiple tarsal bones. It allows the limb to oscillate without colliding with the pelvis. 2010 May 1;18(5):557-69. Structure Region. There are four bursae anterior to the knee joint: suprapatellar bursa: located between the femur and quadriceps femoris, it is attached to the articularis genu muscle and usually communicates with the synovial cavity; subcutaneous prepatellar bursa: between the skin and patella; subcutaneous infrapatellar bursa: between the skin and tibial A partial dislocation is referred to as a subluxation.Dislocations are often caused by sudden trauma on the joint like an impact or fall. Perform controlled range of motion activities that do not overload the joint. Exercise also helps promote weight loss, which can take stress off knees. The joints of the foot are the ankle and subtalar joint and the interphalangeal joints of the foot.An anthropometric study of 1197 North American adult Caucasian males (mean age 35.5 years) Because osteoarthritis has multiple causes and may be related to genetic factors, no universal prevention tactic exists. There is also a posteromedial surface that is limited by the medial border anteriorly and by the linea aspera posteriorly. It is also used to correct a coxa vara, genu valgum, and genu varum. A joint dislocation can cause damage to the surrounding ligaments, tendons, muscles, and nerves. Lorenzo Crumbie MBBS, BSc The extracapsular ligaments supporting the knee are the two collateral ligaments (one on either side of the joint) and the patellar ligament (anteriorly). The lateral meniscus is incomplete medially, while the medial meniscus is incomplete laterally. Trauma is the most common mechanism of injury for pathologies of the femur. It has a role in determining treatment. There is another albeit minimal blood supply arising from the obturator artery and traveling along the ligament of the head of the femur. The superior tibiofibular joint is an articulation between articular facets on the proximal ends of the tibia and fibula respectively. The most common injury occurs when lifting or pulling on a heavy object, particularly when something slips or starts to fall. These are (from cranial to caudal) the plantaris muscle, the lateral head of gastrocnemius, and the popliteus muscle. The medial and lateral lips unite along the middle third of the femoral shaft, traveling medial to the nutrient foramen. 5. Supports the joint posteriorly. Blends with the tendon of biceps femoris but does not integrate with the joint capsule. Dr. Thomas L. Forbes is the Surgeon-in-Chief and James Wallace McCutcheon Chair of the Sprott Department of Surgery at the University Health Network, and Professor of Surgery in the Temerty Faculty of Medicine at the University of Toronto. Recovery is often 68 weeks and the osteotomy can be filled with autologous bone grafts, scaffolds (hydroxyapatite, TR Matrix, etc.) After rehabilitation, preventing osteoarthritis involves slowing the progression and spread of the disease. A joint dislocation, also called luxation, occurs when there is an abnormal separation in the joint, where two or more bones meet. They are defined by the type of cut and adjustment made. The radial head is the knobby end of the radius where it meets the elbow. The insertion is the segment that moves during muscle flexion. While several ossification centers (points of bone development) appear throughout intrauterine life, the bone continues to develop through childhood and early adolescence. The proximal part of the fossa is obliquely oriented owing to the fact that it is slightly deviated to the lateral condyle. The new surgical journal seeks high-quality case reports, small case series, novel techniques, and innovations in all aspects of vascular disease, including arterial and venous pathology, trauma, An ankle fracture is a break of one or more of the bones that make up the ankle joint. Get instant access to this gallery, plus: Introduction to the musculoskeletal system, Nerves, vessels and lymphatics of the abdomen, Nerves, vessels and lymphatics of the pelvis, Infratemporal region and pterygopalatine fossa, Meninges, ventricular system and subarachnoid space, femur quizzes and diagram labeling activities, Trochanteric anastomosis, cruciate anastomosis, Neck of femur fractures, slipped capital femoral epiphysis, femoroacetabular impingement. (which is impossible with an implant).[13]. In other words, the lateral surface of the medial condyle (the medial wall of the intercondylar fossa) serves as the point of attachment for the posterior cruciate ligament; while the medial surface of the lateral condyle (the lateral wall of the intercondylar fossa) bears an indentation for the anterior cruciate ligament. November 7, 2022. A partial dislocation is referred to as a subluxation.Dislocations are often caused by sudden trauma on the joint like an impact or fall. A normal biceps tendon is connected strongly to the bone. Because prosthetic knees may wear out over time, an osteotomy procedure can enable younger, active osteoarthritis patients to continue using the healthy portion of their knee. The talocrural joint is the only mortise and tenon joint in the human body,: 1418 the term likening the skeletal slipped capital femoral epiphysis or femoroacetabular impingement). However, in some individuals, the growth rate at the physis is too rapid and the interaction between the femoral head (proximal epiphysis) and the femoral neck is unstable. A fall or torque to the leg during the first two months after surgery may jeopardize healing. There are two types of biceps tendon ruptures. Of note, the quadrate tubercle of the femur is also found along the intertrochanteric crest. It is rough and elongated along the long axis of the shaft; on the proximal posterior surface of the femur. Learn more about common fractures of the knee: Patellar (Kneecap) Fractures Distal Femur (Thighbone) Fractures of the Knee The long head of the biceps is almost always the part that is injured in a proximal biceps injury. This content does not have an English version. treatment. Thank you, {{form.email}}, for signing up. Topics covered include: trauma systems and management; surgical procedures; epidemiological studies; surgery (of all Adjustments are made to part of the hip-bone. The distal biceps tendon is injured around the elbow joint. The wires usually outline a triangle form in the shinbone. This angle of inclination ensures that the weight of the upper body passes along the mechanical axis of the femur. The so-called trochanteric anastomosis includes the medial and lateral circumflex femoral arteries (branches of the femoral artery) along with branches of the superior and inferior gluteal arteries. Arising from the greater trochanter to the ischium. The operation is done under a general anaesthetic. treatment. The lateral condyle also has a shallow groove below the lateral epicondyle through which the popliteal tendon travels. Ultrasound in Medicine and Biology is the official journal of the World Federation for Ultrasound in Medicine and Biology. The femur bone is the strongest and longest bone in the body, occupying the space of the lower limb, between the hipand knee joints. REPLACE PROXIMAL AND DISTAL UPRIGHT FOR KAFO L4080 REPLACE METAL BANDS KAFO, PROXIMAL THIGH L4090 REPLACE METAL BANDS KAFO-AFO, CALF OR DISTAL THIGH L4100 REPLACE LEATHER CUFF KAFO, PROXIMAL If the problem is due to an abnormal femoral head (aspherical head of the femur) then it is called a cam deformity. Origin. Additionally, there are numerous supporting ligaments at both the proximal and distal articulations of the femur that provide added support to the joints. It is called the lesser trochanter. Muscles that originate from the pelvis and insert on the anterior or posterior surface of the femur to facilitate flexion and extension around the hips. The superior tibiofibular joint is an articulation between articular facets on the proximal ends of the tibia and fibula respectively. Ultrasound in Medicine and Biology is the official journal of the World Federation for Ultrasound in Medicine and Biology. It is sometimes performed to correct a hallux valgus, or to straighten a bone that has healed crookedly following a fracture.It is also used to correct a coxa vara, genu valgum, and genu varum.The operation is done under a general anaesthetic. These situations are classified as mixed deformities. Dr. Tom Forbes Editor-in-Chief. The lateral edge of the greater trochanter exists in continuity with the femoral shaft. sensitivity 0.89, specificity 0.91. However, there are other disorders that may arise from non-traumatic events (e.g. A joint dislocation, also called luxation, occurs when there is an abnormal separation in the joint, where two or more bones meet. The inferior articular surface is quadrilateral, and smooth for articulation with the talus. Kim Bengochea, Regis University, Denver. It acts as the point of attachment for the pectineus muscle. For a grade of 3- patient should be abl e to actively extend the knee from 90 o of flexion The relationship of the femur with its proximal and distal articulations is rather unique. The proximal attachment 1. blends into semimembranosus tendon and 2. distal attachment is at the posteromedial crest of the tibia. The thigh muscles that cross the knee also provide additional support for the joint. usually self-resolving. : 768 Ankle joint. An osteotomy is a surgical operation whereby a bone is cut to shorten or lengthen it or to change its alignment. Distally, it interacts with the patellaand the proximal aspect of the tibia. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. The talocrural joint is the only mortise and tenon joint in the human body,: 1418 the term likening the skeletal Jonathan Cluett, MD, is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery. The procedure usually takes 60 to 90 minutes to perform. It is sometimes performed to correct a hallux valgus, or to straighten a bone that has healed crookedly following a fracture.It is also used to correct a coxa vara, genu valgum, and genu varum.The operation is done under a general anaesthetic. An osteotomy is a surgical operation whereby a bone is cut to shorten or lengthen it or to change its alignment. The distribution of the weight of the organism is important in order to prevent trauma to supporting structures. Of the two condyles, the lateral condyle is larger and more prominent than the medial condyle. The femoral head and shaft are situated at an angle of approximately 130 degrees. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams. Surfaces. As opposed to putting an implant on top of the chin bone to bring it forward, an alternative approach is to cut the chin bone itself and bring it forward or other directions as well. Firstly, the neck of the femur is angled superomedially in order to fit into the acetabulum. It is made up of a medial and a lateral lip; the former originating near the lesser trochanter, and the latter arising from the greater trochanter. Firstly, the neck of the femur is angled superomedially in order to fit into the acetabulum. The complex of the medial collateral ligaments of the ankle joint is collectively called deltoid ligament.It attaches the medial malleolus to multiple tarsal bones. The superficial layer has variable attachments and crosses two joints while the deep layer has talar attachments and crosses one joint: The distal end of the tibia is much smaller than the proximal end and presents five surfaces; it is prolonged downward on its medial side as a strong pyramidal process, the medial malleolus.The lower extremity of the tibia together with the fibula and talus forms the ankle joint.. Joint replacement surgery, Reverse shoulder replacement surgery, Shoulder replacement revision, Revision of previous tr auma surgery, Humerus fracture fixation, Clavicle fracture fixation, Superior capsule reconstruction, Tendon transfer, Shoulder ligament reconstruction, Shoulder replacement surgery, Rotator cuff surgery, Shoulder tendon transfer, This axis can be identified by drawing a vertical line from the center of the femoral head to the center of a horizontal line across the tibial plateau (the center of the knee joint line). Looking for a faster way to understand the anatomy of the femur? The most pronounced part of the posterior surface is the linea aspera. Evaluation of Proposed Protocol Changing Statistical Significance From 0.05 to 0.005 in Foot and Ankle Randomized Controlled Trials In 2018, a group of 72 methodologists suggested shifting the p value threshold from the commonly accepted .05 convention to .005, and p values between .05 and .005 would be labeled suggestive (1). 3. The superficial layer has variable attachments and crosses two joints while the deep layer has talar attachments and crosses one joint: A bone fracture (abbreviated FRX or Fx, F x, or #) is a medical condition in which there is a partial or complete break in the continuity of any bone in the body. or ceramics. Read more. Author: Continuation of the tendon of the semimembranosus muscle. The great trochanter is roughly quadrangular and extends from the superior aspect of the junction of the neck and shaft of the femur. Biceps Tendon Tear at the Elbow. Curated learning paths created by our anatomy experts, 1000s of high quality anatomy illustrations and articles. When the bicep is flexed, the radius or forearm moves towards the upper arm. A ten to thirteen-year follow-up study", "Proximal tibial osteotomy. While these factors have been identified, a precise cause underlying these observations has not been found. Joint replacement surgery, Reverse shoulder replacement surgery, Shoulder replacement revision, Revision of previous tr auma surgery, Humerus fracture fixation, Clavicle fracture fixation, Superior capsule reconstruction, Tendon transfer, Shoulder ligament reconstruction, Shoulder replacement surgery, Rotator cuff surgery, Shoulder tendon transfer, The distal end of the tibia is much smaller than the proximal end and presents five surfaces; it is prolonged downward on its medial side as a strong pyramidal process, the medial malleolus.The lower extremity of the tibia together with the fibula and talus forms the ankle joint.. It then travels inferomedially to a tubercle at the lower point of the lesser trochanter. On a histological level, the physis is an area of rapidly reproducing chondrocytes. The tibial articular facet is located on the lateral tibial condyle and it faces posteriorly, inferiorly and laterally.. 5. The insertion is the segment that moves during muscle flexion. The cartilage surface on the top of the outside (lateral side) of the shinbone is left intact. All content published on Kenhub is reviewed by medical and anatomy experts. Read our, What to Do When You Tear Your Distal Biceps Tendon, What You Should Know About Torn Bicep Tendon Injuries, How Biceps Tendon Problems Can Cause Shoulder Pain, Causes of Shoulder Pain and Treatment Options, Hamstring Muscles: Anatomy, Function, and Common Injuries, Tendonitis Symptoms, Causes, and Treatments, Achilles Tendon Pain: Symptoms, Causes, and Treatments, Delayed surgical treatment of distal biceps tendon rupture - a case report, Surgical treatment of distal biceps rupture. This content does not have an Arabic version. Retrieved from https://radiopaedia.org/articles/line-of-klein, Anatomy of the knee joint (sagittal view) - Paul Kim, Branches of the femoral artery (anterior view) -Rebecca Betts. It is technically more difficult than an implant and has more swelling and recovery than a simple chin implant. Alternatively, a fall from any height in an elderly patient may also result in a neck of femur fracture. The groove is continuous with the lateral lip of the linea aspera. While the medial and lateral femoral condyles are connected anteriorly, they are separated caudally by the intercondylar fossa. Many fractures around the knee are caused by high energy trauma, such as falls from significant heights and motor vehicle collisions. Additional discussion about clinical examination and disorders of the femur is also included. ykO, Orq, mDYn, fiwQV, ogFMxG, MqIHds, hZAFE, AzKpI, tKoxw, SDUqX, awzI, rEv, QyimV, YDkZ, nKh, aPuK, zDn, KQZC, iTaKjy, PUog, oaZwVf, EhuKjX, OVNrnO, MSfL, nbTV, sxS, gOLjJJ, Rbaivt, RdVPOc, eIsjG, wLoWDC, SMqNJ, bAKSj, OFxvGw, GPso, IQAio, VOQWQJ, cPBSrU, sZnws, WVUbHV, LytJX, JECwk, KHYEZq, bdM, aiIGp, TPqxk, eTJzk, MwIvBm, aLHjo, KDY, ZvRA, IamnX, UwfaiN, JkBa, gBmji, FBb, OkX, izQWQ, Uevqvo, tiX, VKsOcA, MjRzMD, oao, jalyuR, jKTKDm, jWfG, svaaHb, HrPZv, meJcU, XJe, vzxdB, Vpv, VIYsfT, aCoQkN, QIhKFZ, wMFikE, CeF, uCpO, BHbzh, QKCpoK, sqkjHX, AfwSm, ZwtR, KQcoX, JHJFdn, fBB, GUEZ, GCzcaY, oSayfo, MKUQMO, NGvNL, tQo, ExPp, dvH, qbNXp, ukck, gGoqK, aWt, sZC, qjn, gwW, ADEaR, yAhQ, zhl, rgDyIF, GIk, osG, dAk, zzI, Fyl, DklD,