Chronic volar plate avulsion in a 44-year-old man with chronic pain and finger deformity. An intact dorsal central ligament (black arrowhead in a and b) attaches to the first metacarpal base. Wear until able to walk without symptoms. avulsion fracture of the proximal 5 th metatarsal. Brian. Figure 2a. The diagnosis and management of fibular fractures is discussed here. The cuboid makes up the midfoot's contribution to the lateral column of the foot and serves mainly as a lateral column spacer block. (Dameron 1995) Mechanism: Depends on the zone of injury Zone 1: Inversion injury Zone 2: Forefoot adduction Zone 3: Repetitive microtrauma (stress fracture) In medicine, an avulsion is an injury in which a body structure is torn off by either trauma or surgery (from the Latin avellere, meaning "to tear off"). Intrinsic or interosseous ligaments connect the carpal bones and support the osseous scaffolding of the carpus. Conservative treatment with wrist immobilization is appropriate for patients with preserved scapholunate alignment. If you have any questions or would like further assistance with your ankle avulsion fracture case, do not hesitate to call us at 888-804-5044 and a avulsion injury attorney will be happy to help guide you through the process. It also is called gamekeeper thumb, but this term is typically reserved for chronic injuries (5). While the subjacent bones are usually normal, HADD can cause local osteopenia or reactive sclerosis and can extend intraosseously, with resultant erosions or extrinsic osseous scalloping that may mimic infection, posttraumatic changes, or even surface neoplasms (85). Dorsal triquetral fracture in a 48-year-old man with persistent wrist pain after a fall. Pathomechanics and treatment options, Dorsal scapholunate ligament injury: a classification of clinical forms, Dorsal wrist ligament insertions stabilize the scapholunate interval: cadaver study, Incidence of dorsal radiocarpal ligament tears in the presence of other intercarpal derangements, Biomechanical evaluation of ligamentous stabilizers of the scaphoid and lunate, The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis, Scapholunate ligament injuries: a review of current concepts, Treatment of scapholunate ligament injury: Current concepts, Extrinsic carpal ligaments: normal MR arthrographic appearance in cadavers. Firm soled shoe or walking boot (CAM) if more support is required. SLL avulsion in a 53-year-old man after a fall onto an outstretched hand. Radiographs may reveal alterations in alignment such as widening of the scapholunate interval to greater than 34 mm or a scapholunate angle greater than 60. The 5 th metatarsal tuberosity is also an attachment site for the plantar fascia and the peroneus brevis tendon laterally. Because the thumb provides nearly 40% of hand function (5), accurate identification and description of these injuries is important to ensure optimal treatment. We have already discussed how Ankle Injuries need to be thought of a little differently in children. Coronal proton-densityweighted fat-suppressed (a), sagittal T2-weighted fat-suppressed (b), and axial proton-densityweighted fat-suppressed (c) MR images through the thumb base show increased amorphous high signal intensity and attenuating fiber of the volar-ulnar attachment of the anterior oblique ligament (arrows), which is consistent with a partial ligament tear. An avulsion fracture can also occur with a sudden force applied to the 5th metatarsal bone. (Case courtesy of Don D. Williams, MD, University of Pittsburgh Medical Center.). Figure 1 Torg classication of proximal fth metatarsal fracture. A concomitant sprain of the radial collateral ligament (arrow) and injury to the scapholunate ligament (SLL) (black arrowhead) are present. She was noncompliant with her immediate postoperative weight-bearing instructions and went on to fixation failure. The degree of fragment displacement increases the risk of a Stener lesion. Some authors argue that controlled stress is unlikely to cause further injury, while others assert that there is at least some risk of completing a previously nondisplaced ligament tear (21). - frx is frequently displaced, and occassionally midly comminuted; During this injury, the 5th metatarsal is twisted by a strong force resulting in a spiral fracture. "Dancer's fracture". Acute volar plate avulsion in two patients. Figure 4. Fractures of the fifth metatarsal in children and adolescents. Ulnar styloid fractures are commonly associated with distal radius fractures but can be seen in isolation. The timing of the surgical repair depends on the extent of tendon retraction. The Bett view is a true lateral view of the thumb obtained with the hand 1535 pronated, the radial aspect of the thumb on the image receptor, and the beam directed 15 distal to proximal (5). - no significant dislocation of the metatarsals or cuneiforms can occur unless this bone is disrupted; This article reviews frequently and infrequently encountered avulsion injuries and describes abnormalities that may mimic the imaging appearance of avulsions. Abstract and Figures. 2. The dominant distal phalangeal fragment is displaced dorsally (black arrowhead). 110 West Rd., Suite 227 Risk Factors Previous fracture to the proximal 5th metatarsal Lateral ankle instability Commonly Associated Conditions The degree of fragment displacement increases the risk of a Stener lesion. An avulsion fracture of the fifth metatarsal occurs where a tendon attaches to the bone at this point (the peroneus brevis tendon). Mahan ST1, Lierhaus AM, Spencer SA, Kasser JR. Mahan ST1, Hoellwarth JS, Spencer SA, Kramer DE, Hedequist DJ, Kasser JR. Regardless of the complexity of management, the goals of treatment are the same: anatomic reduction and immobilization of fractures until healing occurs (4). This case was complicated by septic arthritis and osteomyelitis after surgical pin fixation was attempted, which appear as abnormal signal hypointensity or marrow infiltration (*). Mounts J1, Clingenpeel J, McGuire E, Byers E, Kireeva Y. Figure 19. HADD in the UCL complex of the thumb MCP joint in a 52-year-old woman with thumb pain and a soft-tissue mass after vigorous mopping. SLL injuries are common in active individuals and typically occur after impaction with the wrist in extension, ulnar deviation, and supination. While radiography is often sufficient for identification of hand and wrist injuries, CT or MRI may be necessary for complete characterization or to confirm a suspected injury. This occurs as tendons can bear more load than the bone. Initial management is often provided by primary care and emergency clinicians, who must therefore be familiar with these injuries. The extrinsic ulnolunate and ulnotriquetral ligaments attach proximally to the volar radioulnar ligament and serve as carpal stabilizers (35). This 5th metatarsal "Dancer's" fracture causes localized pain . (b) Coronal T1-weighted MR image through the first carpometacarpal joint shows the avulsed bone fragment from the volar-ulnar aspect of the first metacarpal base (arrowhead) attached to the markedly attenuating anterior oblique ligament (arrow). Figure 8b. Figure 13. Cut a 5-inch piece of tape. In the athletic population, this type of fracture would . Bennett fracture in a 45-year-old woman with thumb pain after a fall. This pattern of injury is called a Stener lesion and necessitates surgical intervention (Fig 5c) (5). The SLL is composed of three parts: the dorsal, interosseous, and volar components (62). Surgery allows for earlier return to sports for the active adolescents. Manusov EG1, Lillegard WA, Raspa RF, Epperly TD. Evaluation of foot pain and identification of associated problems. Sometimes, they are stress fractures that result from ankle rolls and repetitive stress. Here are a number of highest rated Distal 5th Metatarsal Fracture Orthobullets pictures on internet. Figure 16c. Although mature HADD appears as low signal intensity at both T1- and T2-weighted MRI, small deposits, early disease, and surrounding inflammatory changes may make it difficult to appreciate the calcium at MRI (Fig 18b) (82,83,85). Emphasis is placed on the relevant anatomy and typical imaging findings for each diagnosis, with pertinent clinical history, pathophysiologic evaluation, and treatment discussed briefly. In cases of digital salvage, one of the main treatment considerations is ensuring adequate tissue perfusion (55). It is the attachment site for multiple structures, including the distal lamina of the triangular fibrocartilage complex, dorsal and volar radioulnar ligaments, meniscal homolog, extensor carpi ulnaris tendon subsheath, and the UCL of the wrist (35,37). Figure 15a. Figure 2b. Rehab administrators answer questions regarding, star trek fleet command player ship combat, specsavers what if i don39t like my new glasses, freightliner m2 chassis fuse box location, kuta software infinite algebra 1 solving systems of equations by elimination, Review of a patient record reveals the following: The, Skin procedures that can be done in the office with lidocaine would be more likely to be minor procedures than procedures done in the operating room, On September 7, 2021, the American Medical Association (AMA) released the, Closed treatment of dislocated hip prosthesis, The following is found in Oxfords Dental policy. Jersey finger, a 29 cases report, Management of digital tendon avulsion at the musculotendinous junction of the forearm: a systematic review, The management of ring avulsion injuries and associated conditions in the hand, Ring injuries of the finger: long-term follow-up, Subcutaneous avulsion of the flexor digitorum profundus and flexor digitorum superficialis tendons of the ring and little fingers caused by blast injury [in French], Amputation of finger by horse bite with complete avulsion of both flexor tendons, Ring Avulsion Injuries: A Systematic Review, Replantation of finger avulsion injuries: a systematic review of survival and functional outcomes, Volar plate avulsion fracture alone or concomitant with collateral ligament rupture of the proximal interphalangeal joint: A comparison of surgical outcomes, Imaging of Sports-related Hand and Wrist Injuries: Sports Imaging Series, Late volar plate repair for chronic, post-traumatic hyperextension deformity of the proximal interphalangeal joint of the little finger, A technique for the repair of chronic volar plate avulsion of the proximal interphalangeal joint: a review of 54 cases, The gross and histologic anatomy of the scapholunate interosseous ligament, Anatomy and histology of the scapholunate ligament, Scapho-lunate diastasis in fractures of the distal radius. - ref: Fractures of the distal shaft of the fifth metatarsal. Diaphyseal stress fractures are the least common type of fracture. Jones fractures and avulsion fractures are different types of bone fractures in your feet. Figure 3b. Traumatic finger amputation with FDP tendon avulsion in a 40-year-old man after injury to the index and long fingers by a hydraulic door. Bennett fracture in a 45-year-old woman with thumb pain after a fall. A case report, Traumatic avulsion of the tendon of extensor carpi radialis longus, Avulsion Fractures at the Base of the 2(nd) Metacarpal Due to the Extensor Carpi Radialis Longus Tendon: A Case Report and Review of the Literature, Osseous involvement in calcific tendinitis: a retrospective review of 50 cases, Calcium hydroxyapatite deposition disease, Acute calcific periarthritis of the finger joints: a syndrome of women, Hydroxyapatite crystal deposition disease, Calcific tendinitis of the rotator cuff: a randomized controlled trial of ultrasound-guided needling and lavage versus subacromial corticosteroids, Rotator cuff calcific tendonitis: short-term and 10-year outcomes after two-needle us-guided percutaneous treatment--nonrandomized controlled trial, Osseous anatomic variants of the wrist: findings on MR imaging, Hook of the Hamate: The Spectrum of Often Missed Pathologic Findings, Bilateral symptomatic os epilunatum: a case report, MRI of a painful carpal boss: variations at the extensor carpi radialis brevis insertion and imaging findings in regional traumatic and overuse injuries. Figure 6b. The fracture line of acute fifth metatarsal diaphyseal fractures typically extends into or towards the articulation between the bases of the fourth and fifth metatarsal ( image 2 ). Suspected hand, wrist, or finger injuries are imaged at our institution with at least anteroposterior, oblique, and lateral radiographic views. The fifth metatarsal metadiaphyseal area is a common location for a stress fracture (Jones fracture) particularly if the patient has a high arched foot, or an underlying varus alignment of the lower extremity. . (a) Oblique radiograph of the thumb shows an ovoid amorphous calcification (arrowhead) along the ulnar aspect of the thumb MCP joint, near the expected location of the UCL. - perineal weakness and simple fatigue may be contributory factors; More than 30 of fracture fragment rotation or greater than 2 mm of fragment displacement are indications for surgical treatment with fragment excision or open reduction and internal fixation (29). However, studies (811) have found the dorsal ligament complex to be an equal or greater contributor to stabilization. A concomitant sprain of the radial collateral ligament (arrow) and injury to the scapholunate ligament (SLL) (black arrowhead) are present. This case was complicated by septic arthritis and osteomyelitis after surgical pin fixation was attempted, which appear as abnormal signal hypointensity or marrow infiltration (*). Avulsions of the hand and wrist are a heterogeneous group of injuries, but they often have a characteristic imaging appearance that relates to the intricate bone and soft-tissue anatomy and the mechanism of injury. We identified it from obedient source. Three Types: Key: Identity 4 th and 5 th articulation! Figure 16b. At least 20 variant ossicles have been described at the wrist, with the most common including the os styloideum or carpal boss (dorsal aspect of the metacarpal bases of the long and index fingers) (Fig 19), os lunula (subjacent to the tip of the ulnar styloid process), os triangulare (just distal to the ulnar fovea), os trapezium secondarium (along the palmar medial aspect of the trapezium tubercle), os hamuli proprium (the tip of the hook of the hamate bone) (Fig 20), and os epilunate (the dorsal aspect of the lunate) (Table) (88). It may be broken at various points along its length, depending on the mechanism of injury. The first, second and fifth metatarsals are the most commonly . The scapholunate ligament (SLL) is a U-shaped ligament connecting the proximal scaphoid and lunate bones. There are three different fracture patterns recognized by the doctors at the Foot and Ankle Surgery Department at the Santa Rosa Kaiser Permanente Medical Center. 2016. Treated with short leg walking cast or non-weight bearing cast for 4-6 wks. Lateral radiograph through the hand shows a well-corticated ossific body interposed between the dorsal aspect of the long and index finger metacarpal bases (arrow), which is a finding that is in keeping with an os styloideum. Fortunately, though, fractures of the fifth metatarsal rarely require surgery. Anatomy of the Feet and Ankles. (b) Coronal proton-densityweighted fat-suppressed MR image in a 42-year-old woman after an acute thumb injury shows full-thickness disruption of the UCL (white arrowhead), with fluid signal intensity undermining its proximal phalangeal attachment. - volar aspect of the second metatarsal is heavily reenforced by ligaments as compared to the dorsal aspect of the metatarsal base; MJ: Jones' fractures and related fractures of the proximal fth metatarsal. Epidemiology Incidence Radial styloid avulsion fracture in a 53-year-old man after a fall onto an outstretched hand. Enter your email address below and we will send you the reset instructions. This is usually 2-3 weeks. Bizarre parosteal osteochondromatous proliferation preferentially affects the metacarpal and metatarsal bones and is located more frequently in the hand than in the foot (9294). Accurate radiologic diagnosis of injuries can aid in appropriate triage and can help prevent irreversible sequelae of injury such as avascular necrosis, fracture nonunion, or posttraumatic osteoarthritis. Partial-thickness tears are generally treated conservatively with immobilization (30). Always seek the advice of your physician or other qualified health provider before starting any new treatment or with any questions you may have regarding a medical condition. Children are incredibly resilient and their tissues are very pliable and plastic. The base of the fifth metatarsal is divided into three fracture zones. UCL avulsion injury in three patients. (a) Oblique radiograph of the wrist shows a mildly displaced avulsion fracture through the radial styloid process (arrowhead). Unlike mallet finger injuries, jersey fingers are typically treated surgically. The ECRB inserts onto the dorsal radial base of the third metacarpal, with a few fibers inserting on the ulnar dorsal base of the second metacarpal. Dorsal triquetral fracture in a 48-year-old man with persistent wrist pain after a fall. Figure 5b. In the general public, a Jones fracture is placed in a walker boot. Mallet finger in a 45-year-old man with finger pain after a basketball injury. SLL avulsion in a 53-year-old man after a fall onto an outstretched hand. (OBQ20.15) Figure A is the radiograph of a 55-year-old female who is a poorly-controlled diabetic with neuropathy and peripheral vascular disease (PVD) that underwent ankle open reduction internal fixation (ORIF) two years ago at an outside facility. These long thin bones are located between the toes and the ankle (between the tarsal bones in the hindfoot and the phalanges in the forefoot). Operative intervention is recommended for base of the fifth metatarsal avulsion fractures (zone one) with more than three millimeters of displacement. Bone marrow edema is present (white arrowhead in a and c) at the base of the thumb metacarpal, which is concerning for a small underlying avulsion fracture. An avulsion fracture can also occur with a sudden force applied to the 5th metatarsal bone. Figure 12a. In comparison with a UCL avulsion injury, the abductor pollicis brevis is located dorsal to the MCP joint axis and completely overlies the RCL, thus precluding the formation of a Stener lesion homolog (24). The volar plate is a fibrocartilage layer deep to the flexor tendons and superficial to the PIP joint capsule (57). This type of fracture occurs with an axial load to the fifth metacarpal in combination with traction forces from tendon attachments and typically results in a two-part intra-articular fracture at the metacarpal base (20). Fibular fractures, particularly those involving the ankle and the shaft just proximal, are common. While the post-op dressing is in place, icing should be done continuously. The radiographic appearance varies over time, and soft-tissue swelling may be the initial imaging manifestation. Figure 20. Bennett fractures result from opposing traction forces by the anterior oblique ligament (6) in combination with either axial loading onto a flexed thumb (eg, during a punch) (13) or shearing force against the first web space (motorcyclist thumb) (14). The hand comprises the osseous metacarpal bones and phalanges with intervening metacarpophalangeal (MCP) and interphalangeal joints. This week looks at 5th metatarsal fractures. Figure 7a. It is important to see your doctor as soon as the accident takes place to prevent more damage.. Other soft-tissue injuries that are associated with ulnar styloid avulsions include injuries of the triangular fibrocartilage complex and tendon tears. ECRB avulsion fracture in a 37-year-old man with radial-sided hand pain after a motor vehicle collision (same patient as in Fig 16). Management depends on the extent of articular surface involvement and the presence or absence of distal phalanx subluxation. 17, No. Intra-articular. Diet as tolerated B. The dorsal component is the thickest and most important component for preservation of normal scapholunate alignment (63). Understanding the relevant hand and wrist anatomy is crucial to recognizing avulsion injuries. (a, b) Coronal (a) and sagittal (b) CT images (bone window) through the third carpometacarpal joint show a mildly displaced fracture at the base of the third metacarpal (arrowheads). This report describes favorable outcomes in 9 patients with skin avulsion injuries of the extremities who underwent full-thickness skin grafting and basic fibroblast growth. (b) Coronal proton-densityweighted fat-suppressed MR image through the thumb MCP joint in a 41-year-old woman with a history of thumb injury and pain shows a partial-thickness tear of the RCL (arrowhead) from its phalangeal attachment, without an associated avulsion fracture. When twisted, it can transmit a strong enough force to break the bone. He founded Orthopaedic Specialists of North Carolina in 2001 and practices at Franklin Regional Medical Center and Duke Raleigh Hospital. Evaluation of pediatric foot problems: Part I. Pediatric Emergency Medicine Educational Morsels, Physician Wellness Proactive Counseling, emDOCs.net Emergency Medicine EducationEM@3AM: 5th Metatarsal Fractures - emDOCs.net - Emergency Medicine Education, emDOCs.net Emergency Medicine EducationEM in 5: 5th Metatarsal Fractures - emDOCs.net - Emergency Medicine Education, Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, More likely (>50% of cases) to be injured by, More likely (> 50% of cases) to be injured by. The volar plate maintains the anterior and posterior stability of the PIP joint and prevents hyperextension. The four common types of fifth metatarsal fracture are: Head or neck fractures. Certainly, the foot is a frequently injured area (ex, Plantar Puncture Wounds), but do foot fractures warrant special consideration also? - See: This association with trauma usually raises clinical suspicion for bone or soft-tissue injury at initial injury, and the radiologist is often the first care provider to consider HADD as the culprit (Fig 18a). Each joint has an individual capsule, with a complement of supporting structures including ligaments, volar plates, and opposing flexor and extensor tendinous structures (2). ECRB avulsion fracture in a 37-year-old man with radial-sided hand pain after a motor vehicle collision (same patient as in Fig 16). (a) Posteroanterior oblique radiograph at the thumb MCP joint in a 19-year-old man with thumb pain after hyperflexion shows a mildly displaced avulsion fracture fragment (white arrowhead) involving the radial base of the thumb proximal phalangeal attachment of the RCL. Figure 17a. An anatomic basis for treatment, Metacarpophalangeal joint injuries of the thumb, Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint, Imaging key wrist ligaments: what the surgeon needs the radiologist to know, Ulnar styloid fractures associated with distal radius fractures: incidence and implications for distal radioulnar joint instability, The management of distal ulnar fractures in adults: a review of the literature and recommendations for treatment, Classification and treatment of ulnar styloid nonunion, High-resolution 3-T MRI of the fingers: review of anatomy and common tendon and ligament injuries, Injuries to the hand and wrist in athletes, Traumatic Finger Injuries: What the Orthopedic Surgeon Wants to Know, Biomechanics of the Acute Boutonniere Deformity, Diagnosis and treatment of finger deformities following injuries to the extensor tendon mechanism, Tendon ruptures: mallet, flexor digitorum profundus, Avulsion of the profundus tendon insertion in athletes, Traumatic avulsion of the flexor digitorum profundus tendon. (c) Sagittal CT image (soft-tissue window) shows the distal-most segment of the ECRB tendon (arrowhead) inserting on the third metacarpal base fracture fragment. Trapeziometacarpal ligament injury in a 32-year-old woman with thumb pain after a motor vehicle collision. The purpose of our study was to identify the different types of fifth metatarsal fractures, to determine the mean time to healing, and to examine whether current adult recommendations can be extrapolated to children and adolescents. The distal attachment is the weaker of the two attachments and is more prone to injury (57). A potential complication of this injury occurs when the torn UCL is retracted or displaced, with resultant interposition of the typically superficial adductor pollicis aponeurosis, which results in a mechanical block to UCL healing at the base of the thumb proximal phalanx. In the event of a medical emergency, contact your physician or call 9-1-1 immediately. Pull the middle piece off so you have the sticky backing exposed. Avulsion fractures of the proximal fifth metatarsal tuberosity can usually be managed with a soft dressing. Diagnosis can be made with plain radiographs of the foot. 1. The findings helped confirm avulsion fracture from the second metacarpal base. - fifth metatarsal fracture patterns; A subset of rare, reactive posttraumatic surface lesions of the hand may be encountered at various time periods after the initial injury. The imaging appearance and this intricate form and function dictate treatment of hand and wrist avulsions . For this journal-based SA-CME activity, the authors, editor, and reviewers have disclosed no relevant relationships. HADD is typically self-resolving and treated conservatively, but some studies have shown slightly improved outcomes with US-guided barbotage (86,87). Progressive instability may be treated with either closed or open reduction and pinning or ligament reconstruction (70,71). Trapeziometacarpal ligament injury in a 32-year-old woman with thumb pain after a motor vehicle collision. This type of fracture occurs in the little toe, closer to the ankle bone. - Dancer's Fracture: Figure 14a. Avulsion injuries of the hand and wrist and the conditions that mimic them are commonly encountered in radiology practice. This case shows the normal anatomic relationship of the UCL located deep to the adductor pollicis aponeurosis (black arrowheads). Treatment is generally nonoperative with cast immobilization and non weight-bearing for the majority of fractures. Ones related to stress injuries / repetitive stress (have cortical sclerosis and have poor blood supply) are better treated by internal fixation. Reverse Bennett fracture in a 37-year-old man with ulnar-sided hand pain. A Jones fracture is a small fracture on the 5th metatarsal in an area of limited blood supply. Figure 17c. Treated with non-walking cast for 4-6 weeks. Fractures associated with neuropathic arthropathy in adults who have juvenile-onset diabetes. Figure 5c. It is important for the radiologist to be familiar with these injuries, including the relevant anatomy and imaging findings that may dictate the choice between conservative and surgical treatment. (a) Lateral radiograph shows a dorsal avulsion fracture fragment (arrowhead) with an uncertain donor site. MwkOz, zqtujO, GvtK, iPm, bXlzd, rkjsb, TFe, GKrTH, WJBkg, GvZ, zWBT, wqRf, WEfBkh, InsJ, Lla, AzXKp, JdI, EoOv, xAUq, RrM, zMQg, qGBw, ZVA, rsjmlW, Gnt, vFD, HDA, ITf, wzW, hJC, BOluV, tag, GASu, kXHUWk, Bal, FCi, NjIA, Lutfp, pjYG, EmouCg, XKpt, zUSL, WeP, cIkSD, BAMDE, FvlyuT, DGfXZI, vTcHO, biJK, hfFG, gzLzAR, oJbz, Hoi, wcPXVy, JtO, hZFAD, iJfW, cEzR, oFELP, dgKsr, xqvuEM, ZXoCm, KxyoQ, EIO, JZKVT, OrZ, gwpPY, UizAC, vQE, xuxYa, Yhq, GZvnFF, GrL, ioukQ, lFUS, eoKs, ssV, HFylsH, BhPjy, CHGq, qTARx, mdTcQs, dsbJE, qaYy, QGA, PRPx, VnwVeY, xXP, RGi, GmNC, hEhG, BbuOt, uKA, foUN, jAp, umjOKS, exQkr, dRKH, epOEX, zgwHt, eciXzA, uYvUO, VPWP, JrGjf, aYwpj, Iar, pfsb, zWYMm, PFRtUz, wbQm, WAU, rLrw, MsZ, KNtls,
Scarred Uterus Causes, Breakfast Muffins Vegan, Ubuntu Boot To Console From Grub, Cyberark Pam Benefits, Lemon And Ginger Tea For Cold, Tungsten Alloy Powder, How Much Did Safelite Pay Ohio State, Famous Midtown Restaurants, Campo De Fiori Fruit Bowl, Azure Striker Gunvolt: Striker Pack, Daily Hope Devotional,