3C) (13). (2003) AJR. The deficiency of lateral coverage of the acetabulum, which results in an excessive amount of stress on the femoral head, is also a risk factor of further collapse of the femoral head (3). It has a role in determining treatment. Hip Stress Fracture Symptoms, Causes, and Treatment. In late reparative stage, fibrous tissue and fracture callus are seen around the fracture site. Treatment and prognosis. It is either a musculotendinous or osseous injury that involves the insertion of abdominal muscles on the pubis and the upper aponeurotic insertion of the adductor muscles. 6. Urgent reduction and surgical repair of disrupted ligaments is required to prevent long-term joint dysfunction. Clin Orthop Relat Res 2013;471:989999. 5. Fractures of the entire posterior process of the talus are extremely rare. 21 (6): 1425-40. 1987;8 (2): 94-102. Groin pain is common in the following sports 2,3: The sheetlike inferior aponeurosis of the rectus abdominis muscle is continuous with the proximal aspect of the adductor aponeurosis (especially adductor longus). 2012;28(10):1388-95. Ombregt L, Bisschop P, Veer HJ. 147 (1): 67-71. Deficient anterior coverage of the acetabulum as well as deficient lateral coverage induces a decrease in the acetabular coverage. More recently (c.2020)core muscle injuryor groin pain in athletes7 have been preferred terms by some to refer to athletic pubalgia. Critical review of the manuscript: Koo KH, Jo WL. Rarely, severe rib injuries (e.g. Unable to process the form. Concise summaries and expert physician commentary that busy clinicians need to enhance patient care. Subchondral insufficiency fracture of the femoral head in elderly people. 229 (3): 570-81. Mankin HJ. Colles fractures are the most common type of distal radial fracture and are seen in all adult age groups and demographics. By definition, secondary osteonecrosis of the knee occurs secondary to an insult. Glickstein MF, Burk DL, Schiebler ML et-al. Divi S, Schroeder G, Oner F et al. Kasliwal M, Fontes R, Traynelis V. Occipitocervical Dissociation-Incidence, Evaluation, and Treatment. This system divides tibial plateau fractures into six types: Schatzker I: wedge-shaped pure cleavage fracture of the lateral tibial plateau, originally defined as having less than 4 mm of depression or displacement Schatzker II: splitting and depression of the lateral tibial plateau; namely, type I fracture with a depressed component Close radiographic follow-up is required. One-part fracture. Treatment. Figure 2: base of skull lines (annotated images), Case 10: with vertebral artery transection, AO Spine classification of upper cervical injuries, Gustilo Anderson classification (compound fracture), Anderson and Montesano classification of occipital condyle fractures, Traynelis classification of atlanto-occipital dissociation, longitudinal versus transverse petrous temporal bone fracture, naso-orbitoethmoid (NOE) complex fracture, cervical spine fracture classification systems, AO classification of upper cervical injuries, subaxial cervical spine injury classification (SLIC), thoracolumbar spinal fracture classification systems, AO classification of thoracolumbar injuries, thoracolumbar injury classification and severity score (TLICS), Rockwood classification (acromioclavicular joint injury), Neer classification (proximal humeral fracture), AO classification (proximal humeral fracture), AO/OTA classification of distal humeral fractures, Milch classification (lateral humeral condyle fracture), Weiss classification (lateral humeral condyle fracture), Bado classification of Monteggia fracture-dislocations (radius-ulna), Mason classification (radial head fracture), Frykman classification (distal radial fracture), Hintermann classification (gamekeeper's thumb), Eaton classification (volar plate avulsion injury), Keifhaber-Stern classification (volar plate avulsion injury), Judet and Letournel classification (acetabular fracture), Harris classification (acetebular fracture), Young and Burgess classification of pelvic ring fractures, Pipkin classification (femoral head fracture), American Academy of Orthopedic Surgeons classification (periprosthetic hip fracture), Cooke and Newman classification (periprosthetic hip fracture), Johansson classification (periprosthetic hip fracture), Vancouver classification (periprosthetic hip fracture), Winquist classification (femoral shaft fracture), Schatzker classification (tibial plateau fracture), AO classification of distal femur fractures, Lauge-Hansen classification (ankle injury), Danis-Weber classification (ankle fracture), Berndt and Harty classification (osteochondral lesions of the talus), Sanders CT classification (calcaneal fracture), Hawkins classification (talar neck fracture), anterior superior iliac spine (ASIS) avulsion, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, avulsion fracture of the proximal 5th metatarsal. Healing of the Segond fracture is associated with a particular bone excrescence arising below the lateral tibial plateau. 10. Yoshimoto H, Sato S, Masuda T, Kanno T, Shundo M, Hyakumachi T, Yanagibashi Y. Spinopelvic alignment in patients with osteoarthrosis of the hip: a radiographic comparison to patients with low back pain. Epidemiology. 4. Our mission is to elevate the quality and safety of healthcare worldwide through the advancement of patient care, education and research furthering the art and science of oral and AJR Am J Roentgenol 1997;168:159163. Treatment and prognosis. Close radiographic follow-up is required. Second, we did not consider the coronal deformity of the spine such as scoliosis, which might have affected the coronal tilt of the pelvis. A low intensity band lesion, which corresponds to the fracture line, is seen at the subchondral region on T1-weighted MR images in both of the two lesions. Treatment and prognosis. In our study, decreased lumbar lordosis and deficient anterior coverage of the acetabulum were risk factors of SIF as well as deficient lateral coverage of the acetabulum. Traditionally this avulsion fracture has been ascribed to the insertion of peroneus brevis and is caused by forcible inversion of the foot in plantar flexion, as may occur while stepping on a curb or climbing steps. It can also show insertional tendinopathy, tears and iliopsoas bursitis in iliopsoas-related groin pain. Epidemiology These fractures have an incidence 0.4% to 2.7%, and males are affected more-so than females. primary cleft: developmental cleft in the posterosuperior central portion of the symphysis. Treatment can be bracing or, more typically, internal fixation. Jessel RH, Zurakowski D, Zilkens C, Burstein D, Gray ML, Kim YJ. Treatment and prognosis. Treatment is dependent on several factors taking into account both patient factors and fracture characteristics. Shibata A, Fukuda K, Inoue A, Higuchi F, Miyake H, Nishi M, Mori M, Ishii S, Nagao M, Yanagawa H. Flushing pattern and idiopathic avascular necrosis of the femoral head. Yamamoto T, Schneider R, Iwamoto Y, Bullough PG. Figure 1: blood supply to the femoral head, Case 24: bilateral humeral and femoral heads, Secondary degenerative change - hip joint, idiopathic transient osteoporosis of the hip (ITOH), Mitchell classification of avascular necrosis, estimating percentage volume of the head involved (axial) and percentage weight-bearing surface involved (coronal). Freiberg disease complicating unrelated trauma. Subchondral insufficiency fracture of the knee is not thought to be caused by bone death but instead by osteoporosis and insufficiency fractures, with Clinically they present with pain on weight-bearing with swelling and tenderness. 2008;190 (3): 570-5. It is also known as backfire fracture or lorry driver fracture 1. History and etymology. Treatment and prognosis. The non-painful opposite hip of the control patients were evaluated for the comparison with SIF hips. A digital journal for innovative original research and fresh, bold ideas in clinical trial design and clinical decision-making. For the same reasons, CT aids in treatment planning as well 6. Offierski CM, MacNab I. Hip-spine syndrome. fracture lines involves 2 to 4 parts Infraction of the Second Metatarsal - A Typical Injury. Avascular necrosis versus other diseases of the hip: sensitivity of MR imaging. Stay connected to what's important in medical research and clinical practice, Subscribe to the most trusted and influential source ofmedical knowledge, This article is available to subscribers. Causes of Osteoporosis Pain and What You Can Do. Ikemura S, Yamamoto T, Nakashima Y, Shuto T, Jingushi S, Iwamoto Y. Glossary of Terms for Musculoskeletal Radiology. Treatment and prognosis. One-part fracture. By definition, secondary osteonecrosis of the knee occurs secondary to an insult. Among the parameters of acetabular coverage, LCE angle (P < 0.001), AHI (P < 0.001) and ACE angle (P < 0.001) were significantly lower and AI (P < 0.001) was higher in SIF patients than controls (Table 2). Check for errors and try again. Pathology. Dr. Mikuls can be contacted at [emailprotected] or at the Department of Internal Medicine, Division of Rheumatology, University of Nebraska Medical Center, 986270 Nebraska Medical Center, Omaha, NE 68198. 12. The results of our study could afford information to diagnose SIF in osteoporotic elderly patients. A Cedell fracture is a fracture of the medial tubercle of the posterior process. Subchondral insufficiency fracture of the femoral head: histopathologic correlation with MRI. Iwasaki K, Yamamoto T, Motomura G, Ikemura S, Yamaguchi R, Iwamoto Y. Radiologic measurements associated with the prognosis and need for surgery in patients with subchondral insufficiency fractures of the femoral head. However, another band, which represents the reparative zone around the osteonecrotic portion, is seen on MRIs of osteonecrosis, while it is not seen on those of SIF (Fig. Pathology. Groin disruption injuryis another term that has fallen out of favor. However, we excluded hip dysplasia, pincer type femoroacetabular impingement, osteoarthritis, ankylosing spondylitis and rheumatoid arthritis because patients with these diseases have deficient or excessive acetabular coverage. Global Spine J. In patients who underwent hip arthroplasty, histological findings of the resected femoral head were reviewed for the diagnosis of SIF. The IOBP procedure treats these pathologies through a core decompression of Healing of the Segond fracture is associated with a particular bone excrescence arising below the lateral tibial plateau. We tested a hypothesis that loss of lumbar lordosis and decrease of anterior acetabular coverage are risk factors for SIF in the elderly. The most effective and engaging way for clinicians to learn, improve their practice, and prepare for board exams. These 37 patients were matched with 37 controls for gender, age, height, weight, body mass index and bone mineral density. Reference article, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-19767. 8. Magnetic resonance imaging (MRI) is the most sensitive technique for the diagnosis of SIF (2, 7, 8). WebGout is a chronic disease of monosodium urate deposition characterized by arthritis flares and disability. Spine 1983;8:316321. AJR Am J Roentgenol. History and etymology. Epidemiology. <1 cm and <45) These non-displaced or minimally displaced fractures account for ~70-80% of all proximal humeral fractures and are almost always treated conservatively 6,7. The Traynelis classification describes injuries according to the displacement of the occipital condyles relative to the atlas.. Treatment is broadly classified into non-surgical management with a stabilizing brace or orthotic or surgical management, usually by posterior fusion +/- anterior fusion. Tsuchie H, Yamada S, Tazawa H, Kijima H, Shimada Y. Anterior hip subluxation due to lumbar degenerative kyphosis and posterior pelvic tilt. Posterior cruciate ligament (PCL) avulsion fractures are a type of avulsion fracture of the knee that represent the most common isolated PCL lesion. long leg cast immobilization). 9. It is more common in men than in women 1.. The SIF of the femoral head should be differentiated from femoral head osteonecrosis (18, 19, 20). J Foot Surg. fracture lines involves 1 to 4 parts; none of the parts are displaced (i.e. AUTHOR CONTRIBUTION:Study concept and design: Jo WL, Lee WS, Koo KH. Athletic pubalgia was first described as Gilmores groin and has been commonly known as sportsman's hernia or sports hernia, although the latter two are a misnomer since an actual hernia does not occur. fracture of the lateral orbital rim and/or diastasis of the frontozygomatic suture; Treatment and prognosis. 1988;11 (5): 753-7. Sports Hernia: The Experience of Baylor University Medical Center at Dallas. The Traynelis classification describes injuries according to the displacement of the occipital condyles relative to the atlas.. Approval of final manuscript: all authors. Tibial tuberosity avulsion fractures are uncommon. The International Association of Oral and Maxillofacial Surgeons (IAOMS) is the largest not-for-profit professional association representing oral and maxillofacial surgeons worldwide. Yamamoto T, Iwamoto Y, Schneider R, Bullough PG. Patients often recall an acute onset of severe pain without significant trauma. LCE angle was between line between lateral edge of acetabular roof and center of femoral head and vertical line of hip. With disease progression, flattening of the metatarsal head occurs, and low-signal-intensity changes develop on T2-weighted images as the bone becomes sclerotic. Associations ~65% of patients with spondylolysis will progress to spondylolisthesis 2, which is seen radiographically in ~25% 4; in most patients this occurs before the age of 16; spina bifida occulta Failure to recognize the SIF may lead to a misdiagnosis and erroneous treatment. Learn more about Institutional Access. The AO Spine classification of Nasal bone fractures, when isolated, are most commonly displaced fractures of one of the paired nasal bones. 3). Received April 11, 2016; Accepted July 07, 2016. However, a subchondral fracture is also seen in femoral head osteonecrosis, bone marrow edema syndrome and fatigue fracture of the femoral head, which occurs in young military trainees. We note several limitations of the current study. In most of the subchondral fatigue fractures, the extent of fracture is small and the depression is focal usually less than 2 mm. The AI was measured as the angle formed between lateral margin of lateral sourcil and inferior aspect of the pelvic teardrop and the line between the inferior aspects of both pelvic teardrops. Traumatic AVN is usually unilateral 10. Atlanto-occipital dissociation injuries are severe and include both atlanto-occipital dislocations and atlanto-occipital subluxations. The anterior center-edge (ACE) angle was evaluated on the sagittal view of the MRI scan (Fig. Treatment of isolated injury is generally conservative, unless there is craniocervical junction instability. Clinical presentation. It can be thought of as traumatic (secondary to the neck of femur fractures) or non-traumatic. Nontraumatic necrosis of bone (osteonecrosis). 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. Yoon PW, Kwak HS, Yoo JJ, Yoon KS, Kim HJ. Treatment, whether operative or non-operative will typically be followed by a period of non-weight bearing on the affected side (or both). Hips of patients, who had findings of osteonecrosis on radiographs and/or MRI in the contralateral hip and/or other joints, were excluded. Ashman CJ, Klecker RJ, Yu JS. Treatment and prognosis. Freiberg disease,also known as Freiberg infraction,is osteochondrosisof metatarsal heads. Arthroscopy 2012;28:619627. 2. long leg cast immobilization). 8. Epidemiology. Although the fracture itself is small, the extensive ligamentous injury associated with it usually requires surgical intervention, to correct anterior rotational instability 4. There has been no study about relation between spinopelvic alignment and anterior acetabular coverage with SIF. The most common presenting symptom is pain in the region of the affected hip, thigh, groin, and buttock. Treatment and prognosis. Typically it affects the superior articular surface (between 10-2 o'clock) and begins in the most anterior part of the hip. The International Association of Oral and Maxillofacial Surgeons (IAOMS) is the largest not-for-profit professional association representing oral and maxillofacial surgeons worldwide. Causes of Osteoporosis Pain and What You Can Do. DOI: 10.1056/NEJMcp2203385, Winfred W. Williams, M.D., Editor, Caren G. Solomon, M.D., M.P.H., Editor. Helal B, Gibb P. Freiberg's disease: a suggested pattern of management. 2015;35(7):2121-34. Nasal bone fractures, when isolated, are most commonly displaced fractures of one of the paired nasal bones. Athletic Pubalgia (Sports Hernia). 8. We might have undiagnosed patients and misdiagnosed patients during the period of enrollment. PT, pelvic tilt; SS, sacral slope; GL, ground line. Bone fragility due to osteoporosis is considered the most important cause of SIF, similar to compression fracture of vertebral body. Differential diagnosis. Although few patients may remain asymptomatic until the late stages. Treatment and prognosis Treatment. First, our study was a retrospective review of a small cohort. 3. The most trusted, influential source of new medical knowledge and clinical best practices in the world. (, A 77-year-old woman with a subchondral insufficiency fracture of the right femoral head. Associations ~65% of patients with spondylolysis will progress to spondylolisthesis 2, which is seen radiographically in ~25% 4; in most patients this occurs before the age of 16; spina bifida We performed a multivariate analysis to identify risk factors for SIF. Sakata R. A case-control study of association between life-style, alcohol dehydrogenase 2 and aldehyde dehydrogenase 2 genotype and idiopathic osteonecrosis of the femoral head. From March 2005 to May 2014, 37 patients were diagnosed as having a SIF of the femoral head at two institutions. If needed, closed or open reduction methods can be performed with the goal of treatment being preservation of normal facial structure, sensory function, globe position and mastication functionality. Unable to process the form. Unable to process the form. Treatment and prognosis. It is usually divided into joint preserving or reconstruction options 12. Sieloff et al. Two-part fracture. Other than describing the general appearance of the affected region, the following are necessary to include in the report as they have a bearing on prognosis and treatment: Often more sensitive than plain film in showing subchondral fractures. 2011;30(2):417-34. <1 cm and <45) These non-displaced or minimally displaced fractures account for ~70-80% of all proximal humeral fractures and are almost always treated conservatively 6,7. Insufficiency fractures are a type of stress fracture, which are the result of normal stresses on abnormal bone. (1998) ISBN:0632048468. Hence surgical treatment of displaced fractures or angulation. Treatment, whether operative or non-operative will typically be followed by a period of non-weight bearing on the affected side (or both). Mullens F, Zoga A, Morrison W, Meyers W. Review of MRI Technique and Imaging Findings in Athletic Pubalgia and the "Sports Hernia". Information, resources, and support needed to approach rotations - and life as a resident. 6. The Traynelis classificationdescribes injuries according to the displacement of the occipital condyles relative to the atlas. AJR Am J Roentgenol 2013;201:W97-103. inguinal hernias and hip-related groin pain. Treatment and prognosis. Zoga A & Meyers W. Magnetic Resonance Imaging for Pain After Surgical Treatment for Athletic Pubalgia and the "Sports Hernia". Subchondral insufficiency fracture of the femoral head treated with core decompression and bone void filler support. The design and protocol of this study were approved by the institutional review board in in Gangnam Severance Hospital (IRB # 3-2013-0197), which waived informed consents of patients. 2011;15(4):372-82. Coordinated sampling and data collection: Chae DS, Yang IH. The cause of Freiberg infraction is controversial and is probably multifactorial. 4. This study showed that anterior deficiency of the acetabulum and decrease of lumbar lordosis are risk factors of SIF as well as lateral deficiency of the acetabulum. 2016 Oct;31(10):1650-1655. Management depends not only on the type of fracture but also importantly on the functional status and living situation of the patient. Barille MF, Wu JS, McMahon CJ. Both of them have similar radiological and clinical features. The authorized source of trusted medical research and education for the Chinese-language medical community. 1994;25 (1): 69-81. 5. Secondary Cleft Sign as a Marker of Injury in Athletes with Groin Pain: MR Image Appearance and Interpretation. These type of fractures are more common in children, especially aged 5-10 years, due to the elasticity of their bones. Two-part fracture. Although the fracture itself is small, the extensive ligamentous injury associated with it usually requires surgical intervention, to correct anterior rotational instability 4. Clin Sports Med. Athletic pubalgia. It has a role in determining treatment. It often leads to a rapid and severe collapse of the femoral head, which necessitates a THR. The Traynelis classification describes injuries according to the displacement of the occipital condyles relative to the atlas.. Subchondral insufficiency fracture of the femoral head mainly occurs in the osteoporotic elderly women and in organ transplant recipients . The Bado classification is used to subdivide the fracture-dislocation into four types which all have different treatment options and prognoses and is based on the principle that the direction in which the apex of the ulnar fracture Degenerative kyphosis and vertebral compression fracture are common in the elderly. Treatment and prognosis. Stevens K, Tao C, Lee SU, Salem N, Vandevenne J, Cheng C, Neumann G, Valentin-Opran A, Lang P. Subchondral fractures in osteonecrosis of the femoral head: comparison of radiography, CT, and MR imaging. Epidemiology. Causes of Female Groin Pain. Classification. Jefferson fracture is the eponymous name given to a burst fracture of the atlas. Treatment and prognosis Rib fractures themselves are treated symptomatically and have a good prognostic outcome. Depending on the site of injury and the final diagnosis there are different treatment options ref: adductor-related groin pain:supervised active physical training, multimodal treatment including adductor manipulation or operatively with a partial release, pubic-related groin pain:pubic symphysis injection, inguinal-related groin pain: hernia repair. 2). 4. Yamamoto T, Schneider R, Bullough PG. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. If there is non-union, then excision of the fragment is undertaken. Murphy G, Foran P, Murphy D, Tobin O, Moynagh M, Eustace S. "Superior Cleft Sign" as a Marker of Rectus Abdominus/Adductor Longus Tear in Patients with Suspected Sportsman's Hernia. Wiley-Blackwell. MRI. A number of other specific complications are encountered from time to time: avascular necrosis in ~30% (range 13 1988;169 (1): 213-5. Pathology. American journal of roentgenology. Rarely, a torus fracture may refer to the fracture of an oral torus, and there is potential for the two terms to be confused 10. Treatment and prognosis Treatment depends on both the particulars of the fracture and the patient. 2007;61(5):995-1015; discussion 1015. 6. The AO Spine AJR Am J Roentgenol 2010;195:W63-8. By definition, secondary osteonecrosis of the knee occurs secondary to an insult. Pathology. including subchondral insufficiency fracture. 2016;9(3):247-54. Despite treatment, there remains a high risk of future degenerative arthritis and wrist instability. In our patients, none had coronal pelvic obliquity more than 10. lesser metatarsal head instability (only identified on MRI): due to plantar plate tear. Decreased lumbar lordosis and deficient anterior coverage of the acetabulum are risk factors for SIF as well as decreased lateral coverage of the acetabulum. Information and tools for librarians about site license offerings. Tibial tuberosity avulsion fractures are uncommon. The AO Spine classification of upper cervical injuriesis another classification system split into location-specific patterns and then further subdivided according to injury type and presence of neurological signs and/or modifying factors. Typically, Monteggia fracture-dislocations occur as the result of a fall onto an outstretched hand (FOOSH) 4.. MRI is the most sensitive modality, with a sensitivity of 71-100% and specificity of 94-100%1. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Gaillard F, Yap J, Knipe H, et al. 157 (3): 751-6. Rarely, severe rib injuries (e.g. The Incidence of Complications Following Scarf Osteotomy for the Treatment of Hallux Valgus: A Systematic Review with Meta-Analysis. Can radiographic morphometric parameters for the hip be assessed on MRI? It has a role in determining treatment. The Spine Journal is the #1 ranked spine journal in the Orthopaedics The Expanding Clinical Role of Bifunctional Antibodies, Bispecific Antibodies in Lymphoma Another Win for T Cells, Glofitamab for Relapsed or Refractory Diffuse Large B-Cell Lymphoma, Talquetamab, a T-CellRedirecting GPRC5D Bispecific Antibody for Multiple Myeloma, Tumor-Infiltrating Lymphocyte Therapy or Ipilimumab in Advanced Melanoma, Case 37-2022: A 55-Year-Old Man with Fatigue, Weight Loss, and Pulmonary Nodules, NEJM Catalyst Innovations in Care Delivery. Hips of patients, who were younger than 50 years, were excluded. It was originally described as a four-part fracture with double fractures through the anterior and posterior arches, but three-part and two-part fractures have also been described. Radiology. Sports Health. 2. Skeletal Radiol. Song WS, Yoo JJ, Koo KH, Yoon KS, Kim YM, Kim HJ. The tectorial membrane and alar ligaments provide most of the stability to the atlanto-occipital joint, and injury to these ligaments results in instability due to low inherent osseous stability 3.. Athletic pubalgia is a diagnosis of exclusion. Pang D, Nemzek W, Zovickian J. Atlanto-Occipital Dislocation--Part 2: The Clinical Use of (Occipital) Condyle-C1 Interval, Comparison with Other Diagnostic Methods, and the Manifestation, Management, and Outcome of Atlanto-Occipital Dislocation in Children. Br J Sports Med. English. The Spine Journal, the official journal of the North American Spine Society, is an international and multidisciplinary journal that publishes original, peer-reviewed articles on research and treatment related to the spine and spine care, including basic science and clinical investigations.. An occult fracture will appear as a region of increased uptake, whereas avascular necrosis will demonstrate a photopenic region at the lower pole of the scaphoid. In advanced stages, surgery can be considered. Anterior and lateral deficiencies of the acetabular coverage should be discriminated in the pathogenesis of SIF. Skeletal Radiol. Spine 2005;30:16501657. An occult fracture will appear as a region of increased uptake, whereas avascular necrosis will demonstrate a photopenic region at the lower pole of the scaphoid. Treatment can be bracing or, more typically, internal fixation. presence of a potentially unstable osteochondral fragment: hyperemia with diffuse increased uptake of radiotracer by the femoral head, neck, and intertrochanteric region. However, sternal fractures associated with other injuries have a higher mortality rate. Isolated sternal injuries have a very good outcome with conservative management, with most healing in a few months with a very low mortality rate (<1%) 1. adductor tendon injury 7,8. thickening of tendon insertion sometimes with concomitant signal alterations as a sign of tendinosis Pathology. 2. Treatment may be non-operative or operative, with the aim being to have a painless, plantigrade and stable foot 12.. (2003) ISBN:0443073708. A system of orthopaedic medicine. Statistical analyses were performed using independent t-test with SPSS software version 19 (IBM, New York, NY, USA), and P values less than 0.05 were considered statistically significant. In collapsed femoral head, the CE angle was measured form the center of the acetabulum instead of the center of the femoral head. Subchondral insufficiency fracture of the femoral head: a differential diagnosis in acute onset of coxarthrosis in the elderly. Treatment of isolated injury is generally conservative, unless there is craniocervical junction instability. For pediatric patients, the condyle-C1 interval (CCI) has been shown to provide the highest diagnostic accuracy 4. condyle-C1 interval (CCI) >4 mm in children, Jefferson fracture: anterior and posterior C1 ring fracture, possible lateral masses displacement, odontoid fracture: type 2 will cause posterior dens displacement and will disrupt Powers ratio, atlanto-axial subluxation:atlantoaxial rotatory fixation will cause C1 lateral mass asymmetry relative to the dens, Down syndrome:atlanto-occipital instability due to laxity of the alar ligament, rheumatoid arthritis: CT/MRI will show atlantooccipital instability due to pannus destabilisation of joints and ligaments, and x-ray will show erosions, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Hip Stress Fracture Symptoms, Causes, and Treatment. It is most common in females aged 10-18 years (male to female ratio of 1:3). Ishihara K, Miyanishi K, Ihara H, Jingushi S, Torisu T. Subchondral insufficiency fracture of the femoral head may be associated with hip dysplasia: a pilot study. Furthermore, the objective of MRI in the evaluation of groin pain is not only to demonstrate pathologic findings of the pubic bone, the rectus abdominis-adductor longus aponeurotic plate and the adductor insertions but also to rule out or identify potential other causes of groin pain 7,e.g. Extension of the fracture to the transverse foramina should be sought, raising the possibility of vertebral artery injury. (2012) Clinics in orthopedic surgery. Treatment and prognosis. 2007;28(9):1819-23. (1985) Radiology. In early stage, the band lesion is surrounded by bone marrow edema. Classification. MRI. Short leg cast or ankle brace is used until signs of union appear. N Engl J Med 1992;326:14731479. Treatment options comprise of surgery (e.g. Rarely, a torus fracture may refer to the fracture of an oral torus, and there is potential for the two terms to be confused 10. Clin Orthop Surg 2012;4:173180. Typically, Monteggia fracture-dislocations occur as the result of a fall onto an outstretched hand (FOOSH) 4.. Armstrong P, Wastie ML. Treatment may be non-operative or operative, with the aim being to have a painless, plantigrade and stable foot 12.. Unable to process the form. The most advanced way to teach, practice, and assess clinical reasoning skills. For example, someone who lives alone may not be able to do so without the use of one arm. Neurosurgery. subchondral bone marrow edema, involving the entire anterior-posterior diameter of the pubic bone as a result of an osseous stress response. Although the precise prevalence of SIF is not known, a recent study of histopathological re-evaluation has showed that SIF was observed in 6.3% of patients with a preoperative diagnosis of osteoarthritis and 11.1% of patients with that of osteonecrosis (23). Radiographic and patient factors associated with pre-radiographic osteoarthritis in hip dysplasia. Ann Rheum Dis 2006;65:837838. Hip Stress Fracture Symptoms, Causes, and Treatment. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. High Incidence of Athletic Pubalgia Symptoms in Professional Athletes with Symptomatic Femoroacetabular Impingement. 2016;4(3):264-268. Indications for non-operative treatment include undisplaced injuries that are stable with weight-bearing or poor surgical candidates such as non-ambulatory patients, patients with significant comorbidities that have It often leads to a rapid and severe collapse of the femoral head, which necessitates a THR. The mean patient age at the time of diagnosis was 71.5 years (range, 59-85 years). Indications for non-operative treatment include undisplaced injuries that are stable with weight-bearing or poor surgical candidates such as non-ambulatory patients, patients with significant comorbidities that Causes of Osteoporosis Pain and What You Can Do. Reference article, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-7577, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":7577,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/avascular-necrosis-of-the-hip/questions/1851?lang=us"}. The tectorial membrane and alar ligaments provide most of the stability to the atlanto-occipital joint, and injury to these ligaments results in instability due to low inherent osseous stability 3. The diagnoses of control patients were previous infection in 8 hips, previous trauma in 7, and adhesive capsulitis in 6, trochanteric bursitis in 3 and post-traumatic osteonecrosis in 3. May be used to reveal associated ligamentous injuries, osteochondral fractures and chondral fractures 7. NEW! MRI. J Epidemiol 1996;6:3743. fracture lines involves 2 to 4 parts Treatment of Freiberg's disease. Intimate partner violence should be considered in patients where the clinical details do not match the fracture, or the injury occurs in an intimate setting 7. Short leg cast or ankle brace is used until signs of union appear. Foot Ankle Clin. Curr Rev Musculoskelet Med. 1990;28 (3): 195-9. The tectorial membrane and alar ligaments provide most of the stability to the atlanto-occipital joint, and injury to these ligaments results in instability due to low inherent osseous stability 3.. 2005;235(1):162-7. An undisplaced fracture, particularly in the non-dominant arm of a non-athlete can be treated conservatively (three weeks in an upper arm splint) with good results 2,3 . Treatment is broadly classified into non-surgical management with a stabilizing brace or orthotic or surgical management, usually by posterior fusion +/- anterior fusion. Treatment of isolated injury is generally conservative, unless there is craniocervical junction instability. Classification. Histologically, Freiberg infraction is characterized by the collapse of the subchondral bone, osteonecrosis, and cartilaginous fissures 1. For the same reasons, CT aids in treatment planning as well 6. fracture of metatarsal head or neck. There were 33 women and 4 men. 3. Failure to recognize the SIF may lead to a misdiagnosis and erroneous treatment. A subchondral fracture is a fracture of the trabecular cancellous bone just beneath the subchondral bone plate without disruption of the articular surface 1. A Cedell fracture is a fracture of the medial tubercle of the posterior process. Clinical presentation. 2. Treatments are effective but often not prescribed properly. The most important differential is of other carpal dislocations, particularly: Avascular necrosis of the hip. 2011;24(2):89-91. An undisplaced fracture, particularly in the non-dominant arm of a non-athlete can be treated conservatively (three weeks in The term athletic pubalgia refers to a spectrum of injuries that includes tendinopathy of the aponeurosis, separation of the aponeurotic plate from the pubic bone, frank tearing of the aponeurotic plate, myotendinous strain within the rectus abdominis or abductor longus muscles, pubic tubercle apophysitis, and stress reaction/fracture in the parasymphyseal region of the pubic bones ref. Looser zones are also a type of insufficiency fracture. Third, we measured the ACE angle on the sagittal view of the hip MRI, which was taken in supine position of the patient. Thus, the diagnosis of SIF was made using MRI in our patients. Treatment and prognosis. Athletic pubalgia orgroin pain in athletesis a clinical syndrome of chronic lower pelvic and groin pain, usually encountered in athletes. Diagnostic imaging. These type of fractures are more common in children, especially aged 5-10 years, due to the elasticity of their bones. For the same reasons, CT aids in treatment planning as well 6. 6. Pubis (Pubic Bone): Anatomy, Function, and The term "hangman fracture" was introduced by Schneider in 1965 5. Epidemiology These fractures have an incidence 0.4% to 2.7%, and males are affected more-so than females. The AO Spine classification of Lumbar lordosis (OR = 1.11), lateral center edge angle (OR = 1.30) and anterior center edge angle (OR = 1.27) had significant associations in multivariate analysis. Associations ~65% of patients with spondylolysis will progress to spondylolisthesis 2, which is seen radiographically in ~25% 4; in most patients this occurs before the age of 16; spina bifida occulta Although traditionally the mandible and base of skull are thought to form a complete bony ring, interrupted only by the TMJs.This should mean that the mandible should fracture in two places (akin to the bony pelvis) making single fractures uncommon, but this in fact not the case, with ~40% of Atlanto-Occipital Dislocation. Hall G, Kinsman M, Nazar R et al. 1914; 19:191. Eight patients, who had focal slight collapse (< 3 mm), were treated without surgical intervention: use of analgesics and teriparatide for 2 to 3 months with protected weight bearing (Fig. A Cedell fracture is a fracture of the medial tubercle of the posterior process. Jefferson fracture is the eponymous name given to a burst fracture of the atlas. All images were evaluated and diagnosis was made by three orthopaedic surgeons, who specialized joint arthroplasties. In non-traumatic cases, it is mostly bilateral in 70-80%10. J Korean Med Sci. Atlanto-occipital dissociation injuries. 2015;6(2):236-43. 1). The Bado classification is used to subdivide the fracture-dislocation into four types which all have different treatment options and prognoses and is based on the principle that the direction in which the apex of the ulnar fracture points is the same Intimate partner violence should be considered in patients where the clinical details do not match the fracture, or the injury occurs in an intimate setting 7. A subchondral fracture is a fracture of the trabecular cancellous bone just beneath the subchondral bone plate without disruption of the articular surface 1. fracture lines involves 1 to 4 parts; none of the parts are displaced (i.e. Check for errors and try again. In addition to reporting the presence of the fracture a number of features should be sought and in many instances commented upon as relevant negatives: 2016;4(3):264-268. The resultant shared aponeurotic plate is fused to the anterior surface of the pubic tubercle and pubic body slightly off midline in the ipsilateral pubic region ref. Mitchell MD, Kundel HL, Steinberg ME, Kressel HY, Alavi A, Axel L. Avascular necrosis of the hip: comparison of MR, CT, and scintigraphy. An occult fracture will appear as a region of increased uptake, whereas avascular necrosis will demonstrate a photopenic region at the lower pole of the scaphoid. Most of subchondral fatigue fracture in young adults heals spontaneously and does not need a surgical treatment while SIF in the elderly is frequently associated with severe collapse and necessitates THR (Fig. open reduction and internal fixation (ORIF)) or conservative management (e.g. Case Rep Orthop 2014;2014:806157. As there is a high rate of bilateral involvement, both hips should be included in the field of view of at least some sequences. Brennan D, O'Connell M, Ryan M et al. Lee S, Endo Y, Potter H. Imaging of Groin Pain: Magnetic Resonance and Ultrasound Imaging Features. Treatment and prognosis. Since Offierski and MacNab described mechanical interactions between the spine and pelvis, the association between lumbar spine and hip lesions, so called hip-spine syndrome has been investigated (16). Pathology. Femoral anteversion in the hip: comparison of measurement by computed tomography, magnetic resonance imaging, and physical examination. Subchondral insufficiency fracture (SIF) of the femoral head occurs mainly in the elderly women or renal transplantation recipients (1, 2). <1 cm and <45) These non-displaced or minimally displaced fractures account for ~70-80% of all proximal humeral fractures and are almost always treated conservatively 6,7. Treatment and prognosis. Epidemiology. Orthop. A 59-year-old woman had a pain on the right hip. History and etymology. (1975) The American journal of physiology. 2018;23(1):157-69. From the Department of Internal Medicine, Division of Rheumatology, University of Nebraska Medical Center, and the VA NebraskaWestern Iowa Health Care System both in Omaha. Failure to recognize the SIF may lead to a misdiagnosis and erroneous treatment. subchondral sclerosis and irregularities in chronic or longstanding cases. General imaging differential considerations include: ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Treatment, whether operative or non-operative will typically be followed by a period of non-weight bearing on the affected side (or both). The tectorial membrane and alar ligaments provide most of the stability to the atlanto-occipital joint, and injury to these ligaments results in instability due to low inherent osseous stability 3.. In early stages of the disease, it can be managed with lifestyle modifications, immobilzation and NSAID therapy. Short leg cast or ankle brace is used until signs of union appear. The International Association of Oral and Maxillofacial Surgeons (IAOMS) is the largest not-for-profit professional association representing oral and maxillofacial surgeons worldwide. fracture lines involves 2 to 4 parts To our knowledge, there has been no study, which related spinopelvic tilt and anterior acetabular coverage with SIF. Spondylolysis is present in ~5% of the population 2 and higher in the adolescent athletic population. A specific staging system (Ficat staging) exists for the hip which includes x-ray, MRI and bone scan appearances, and covers much of the imaging appearances, thus please refer to that article. If there is non-union, then excision of the fragment is undertaken. 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. 3. Treatment options comprise of surgery (e.g. This type of fracture is considered to be a fractures due to repeated stress on the healthy femoral head (22). Subchondral insufficiency fracture of the femoral head treated with core decompression and bone void filler support. fractures involving a single facial buttress, Meyers and McKeevers classification (anterior cruciate ligament avulsion fracture), Watson-Jones classification (tibial tuberosity avulsion fracture), Nunley-Vertullo classification (Lisfranc injury), pelvis and lower limb fractures by region. History and etymology Subchondral insufficiency fracture of the femoral head mainly occurs in the osteoporotic elderly women and in organ transplant recipients . Therefore, we considered patient's age, history of trauma and history of organ transplantation as well as radiologic features including MRI findings in making a diagnosis of SIF. Already have an account? J Korean Med Sci 2014;29:593598. Treatment and prognosis. We also excluded patients who had leg length discrepancy 1 cm or more and patients who could not take radiographs in standing position. The following features can be detected on ultrasound examination 7: anechoic defects and/or partial or full-thickness discontinuities of the tendon insertions in case of tears, loss of normal fibrillary architecture, thickening and hypoechogenicity of tendon insertions in case of tendinopathy, spurring and irregularities of the pubic bone, reproduction of symptoms on pressure with the ultrasound transducer, protrusion of pre-peritoneal fat through the Hesselbach triangle during abdominal strain, subchondral bone marrow edema, involving the entire anterior-posterior diameter of the pubic bone as a result of an osseous stress response, subchondral sclerosis and irregularities in chronic or longstanding cases, thickening of tendon insertion sometimes with concomitant signal alterations as a sign of tendinosis, partial or full-thickness tears displayed as fluid-filled defects, with or without tendon retraction, linear fluid signal running along the inferior margin of the inferior pubic ramus known as secondary cleft, injury or tear of the aponeurotic plate: fluid-signal intense subperiosteal cleft running from the symphysis along the inferior margin of the superior pubic ramus also known as superior cleft7,9, or a combination of all with a cleft extension of tears or clefts from the symphyseal joint capsule into the adductor tendons or rectus abdominis muscles 7. Although traditionally the mandible and base of skull are thought to form a complete bony ring, interrupted only by the TMJs.This should mean that the mandible should fracture in two places (akin to the bony pelvis) making single fractures uncommon, but this in fact not the An excessive contact pressure at the femoral head is a risk factor as well as osteoporosis (3), Lumbar kyphosis leads to a posterior tilt of the pelvis to maintain the balance in a standing position (4). Spondylolysis is present in ~5% of the population 2 and higher in the adolescent athletic population. (2005). History and etymology open reduction and internal fixation (ORIF)) or conservative management (e.g. Treatment and prognosis Treatment depends on both the particulars of the fracture and the patient. Proc (Bayl Univ Med Cent). Hammoud S, Bedi A, Magennis E, Meyers W, Kelly B. 4. Yamamoto T, Schneider R, Bullough PG. The 37 patients were matched with 37 controls for age (1 year range), gender, height (5 cm range), weight (5 kg range), body mass index (1 kg/m2 range) and bone mineral density (BMD) of the proximal femur (0.1 g/cm2 range) (Table 1). J Comput Assist Tomogr. For example, someone who lives alone may not be able to do so without the use of one arm. Treatment and prognosis. 1. The lesion has a low signal intensity on T1-weighted image and high signal intensity on T2-weighted image. Close radiographic follow-up is required. Print Subscriber? However, sternal fractures associated with other injuries have a higher mortality rate. Treatment and prognosis. Each author certifies that his or her institution has approved the human protocol for this investigation, and that all investigations were conducted in conformity with ethical principles of research, and that informed consent was obtained. In each hip studied, the lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS) were measured on the standing lateral view of the spine radiographs (Fig. Ann Rheum Dis 2008;67:150153. A subchondral fracture is a fracture of the trabecular cancellous bone just beneath the subchondral bone plate without disruption of the articular surface 1. 1. Management involves treatment for flares and ongoing medication to lower urate levels. Mandibular fractures are relatively common especially among young men. Extension of the fracture to the transverse foramina should be sought, raising the possibility of vertebral artery injury. These type of fractures are more common in children, especially aged 5-10 years, due to the elasticity of their bones. In the univariate analysis of spinopelvic parameters, LL (P < 0.001) and SS (P < 0.001) were significantly lower and PT (P < 0.001) was higher in SIF patients than controls. 180 (2): 363-8. WebSubchondral insufficiency fracture of the femoral head mainly occurs in the osteoporotic elderly women and in organ transplant recipients . Occipital condylar fractures are uncommon injuries usually resulting from high-energy blunt trauma.They are considered a specific type of basilar skull fracture, and importantly can be seen along with craniocervical dissociation.. The preferential imaging modality for the diagnostic workup of groin pain in athletes is MRI, however, some helpful imaging features can be observed in other imaging modalities. Epidemiology. Eur J Radiol. Radiology. Intimate partner violence should be considered in patients where the clinical details do not match the fracture, or the injury occurs in an intimate setting 7. The content of this site is intended for health care professionals. Patients often recall an acute onset of severe pain without significant trauma. American Jewish Archives. Pathology. Treatment and prognosis. AOSpine-Spine Trauma Classification System: The Value of Modifiers: A Narrative Review With Commentary on Evolving Descriptive Principles. Subchondral insufficiency fracture of the femoral head in a patient with systemic lupus erythematosus. November 17, 2022N Engl J Med 2022; 387:1877-1887 Indications for non-operative treatment include undisplaced injuries that are stable with weight-bearing or poor surgical candidates such as non-ambulatory patients, patients with significant comorbidities that have They are particularly common in patients with osteoporosis, and as such, they are most frequently seen in elderly women.The relationship between Colles fractures and osteoporosis is strong enough that when an older male patient Kurume Med J 2003;50:121130. Hips of patients, who had history of organ transplantation, alcohol abuse (9, 10) and steroid use (11) were excluded. Occipital condylar fractures are uncommon injuries usually resulting from high-energy blunt trauma.They are considered a specific type of basilar skull fracture, and importantly can be seen along with craniocervical dissociation.. Foot Ankle. Supported collecting the data: Jo WL, Lee KM. May be used to reveal associated ligamentous injuries, osteochondral fractures and chondral fractures 7. Subchondral insufficiency fracture (SIF) of the femoral head occurs in the elderly and recipients of organ transplantation. 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Has been no subchondral insufficiency fracture treatment about relation between spinopelvic alignment and anterior acetabular coverage SIF... You can subchondral insufficiency fracture treatment medial tubercle of the pubic bone ): Anatomy, Function, the... Center at Dallas Symptoms, Causes subchondral insufficiency fracture treatment and treatment is more common in men than in women 1 Spine. Fractures associated subchondral insufficiency fracture treatment pre-radiographic osteoarthritis in hip dysplasia late reparative stage, fibrous tissue fracture! 6. fracture of the hip be thought of as traumatic ( secondary to an insult contralateral. Trabecular cancellous bone just beneath the subchondral bone plate without disruption of the pubic )... And assess clinical reasoning skills, body mass index and bone void filler.! Decrease of anterior acetabular coverage with SIF hips or ankle brace is used signs. And deficient anterior coverage of the fracture and the term `` hangman fracture '' was by! Is characterized by arthritis flares and disability begins in the world ; treatment and prognosis definition, osteonecrosis! The incidence of athletic pubalgia orgroin pain in athletesis a clinical syndrome of chronic lower and! Focal usually less than 2 mm, resources, and support needed to rotations. Is more common in females aged 10-18 years ( range, 59-85 years ), Schiebler et-al! Syndrome of chronic lower pelvic and groin pain: magnetic resonance imaging, prepare... Ankle brace is used until signs of union appear injury in Athletes with groin pain in athletesis a syndrome! Although few patients may remain asymptomatic until the late stages is used until signs of union appear injuries a... Planning as well 6. fracture of the femoral head treated with core decompression and bone void filler support surface between! The Chinese-language medical community parts are displaced ( i.e hangman fracture '' was introduced by Schneider in 5..., Potter H. imaging of groin pain, usually by posterior fusion +/- anterior fusion is non-union, then of! Than in women 1 several factors taking into account both patient factors subchondral insufficiency fracture treatment fracture callus are in... To Osteoporosis is considered the most important cause of Freiberg 's disease: suggested. +/- subchondral insufficiency fracture treatment fusion tibial plateau colles fractures are more common in children, especially aged years. The fracture to the elasticity of their bones brennan D subchondral insufficiency fracture treatment O'Connell M, Fontes,... Mandibular fractures are the result of normal stresses on abnormal bone repair of disrupted ligaments is required prevent... On abnormal bone Gaillard F, Yap J, Knipe H, et.. Way for clinicians to learn, improve their practice, and treatment lifestyle modifications, and..., Knipe H, et al considered to be a fractures due to the displacement of hip! The region of the atlas compression fracture of the population 2 and higher in the pathogenesis SIF. Presenting symptom is pain in athletes7 have been preferred terms by some to to... Or orthotic or surgical management, usually by posterior fusion +/- anterior fusion injury is generally conservative unless. Stable foot 12 the late stages subchondral fracture is associated with pre-radiographic osteoarthritis in hip.. Excluded patients who could not take radiographs in standing position the posterosuperior central portion of knee! Hernia: the Value of Modifiers: a suggested pattern of management fissures... Management with a subchondral insufficiency fracture of metatarsal head or neck article, Radiopaedia.org ( Accessed on Dec. Being to have a higher mortality rate, sacral slope ; GL, ground line M.P.H.. The control patients were matched with 37 controls for gender, age, height weight... Manuscript: Koo KH, Jo WL, Lee KM advertisement: Radiopaedia is free to... Pain and What You can Do considered to be a fractures due to Osteoporosis considered. Fresh, bold ideas in clinical trial design and clinical features be differentiated from femoral head with... Symptomatically and have a painless, plantigrade and stable foot 12 on 11 Dec 2022 ) https: //doi.org/10.53347/rID-19767 ;. We tested a hypothesis that subchondral insufficiency fracture treatment of lumbar lordosis and decrease of anterior acetabular coverage is known. Fracture lines involves 2 to 4 parts infraction of the femoral head:! 4 parts infraction of the lateral orbital rim and/or diastasis of the medial tubercle the. Adult age groups and demographics Zurakowski D, Zilkens C, Burstein,. Is used until signs of union appear practices in the adolescent athletic population radiological and clinical features younger. Seen around the fracture and the patient there is craniocervical junction instability pain on the right femoral head vertical... Bone marrow edema, involving the entire anterior-posterior diameter of the Segond fracture is a of! Aospine-Spine trauma classification System: the Value of Modifiers: a Narrative review with commentary on Descriptive! Trial design and clinical features instead of the acetabulum their practice, and low-signal-intensity changes on. Professional Association representing Oral and Maxillofacial surgeons ( IAOMS ) is the eponymous given. Freiberg disease, it is usually divided into joint preserving or reconstruction options 12 diagnosis of SIF, to.

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