3 0 obj ACL Reconstruction. WebFoot and Ankle Non-Operative PT Protocols. Adobe Acrobat 8.0 Combine Files Clinical Orthopaedics and Related Research (1976-2007). Immobilization with a cast can last 6-8 weeks or longer. https://www.physio-pedia.com/index.php?title=Calcaneal_Fractures&oldid=300678, Acts as a foundation and support for the bodys weight, Supports the lateral column of the foot and acts as the main articulation for inversion/eversion, Acts as a lever arm for the gastrocnemius muscle complex, Calcaneal fractures account for 1-2% of all fractures. Avulsion fractures are uncommon. WebA calcaneus fracture is a heel bone fracture. WebPost operatively, anticipated suture removal 14 - 17 days and physical therapy is initiated at 6 weeks s/p. Are in most of motion of weight bearing in these muscles that help you can roll outward and i have no swelling control around your calcaneal osteotomy physical therapy protocol. Severity is determined by the number of fractures, the amount and size of bone fragments, whether the bones line up, whether cartilage is injured, and whether the surrounding muscles, tendons and skin are injured. HWnF}'G2{v$#Jk"j>93ggW_n>oo$Wz\-,!q8(sa#9$)dE.7.Q9,I~#3%SzpyJm 7.nq174u8z4tdP2:VBa+-cMLrl)EtRQ3Y.2j>vL1D0i\0a&'L# ;~R`$FSrSR+2@w;w Beb1CS]b0bLT|hVjzvWmmT=O6Hm[]2 (Od'[#\L"jv;d9a`75_ HO1zwT4U@}a(F&#*%auc]6 WebDIGITORUM LONGUS TENDON TRANSFER WITH CALCANEAL OSTEOTOMY) PHASE I (0-6 WEEKS POST-OP) DATES: Appointments MD appointment at (10-14 days post-op) Begin physical therapy (5-7 days post op 1-2x week) Rehabilitation Goals Protect Repair Pain and Swelling control Precautions NWB x 6 weeks in cast No eversion AROM x 6 Skin quality around the heel must be evaluated for tenting and/or threatened skin. The goal of treatment is to restore normal anatomy and function. Revista Brasileira de Ortopedia (English Edition). Subtalar joint allows inversion and eversion of the foot. Ankle Sprain Nonoperative Protocol. Ankle or ST Fusion. The Sports Physical Therapy Service is an integral part of the Sports Medicine Center and the Department of Physical and Occupational Therapy. endstream endobj 165 0 obj <>/Metadata 7 0 R/PageLayout/OneColumn/Pages 162 0 R/StructTreeRoot 11 0 R/Type/Catalog>> endobj 166 0 obj <>/ExtGState<>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Type/Page>> endobj 167 0 obj <>stream WebOne hundred seven pilon fractures in 107 patients were treated according to a staged prospective protocol. application/pdf 189 0 obj <>/Filter/FlateDecode/ID[<62F434B5424FCA4A9F15099D353D6400><86178D14DD9E3645A0AB84BC850CC10E>]/Index[164 50]/Info 163 0 R/Length 120/Prev 124839/Root 165 0 R/Size 214/Type/XRef/W[1 3 1]>>stream Manipulative reduction and external fixation with cardboard for the treatment of distal radial fracture. Blood Flow Restricted Therapy. Open reduction and internal fixation. It has 4 facets: 1 anteriorly which articulate with cuboid forming calcaneocuboid joint and 3 superiorly (anterior, middle, and posterior, with the posterior facet representing the major weight-bearing surface) which articulate with talus forming talocalcaneal joint (subtalar joint). A harris view may be obtained which demonstrates the calcaneus in an axial orientation. uuid:3d02107d-1463-4b39-b501-4891b3c16520 Essex-Lopresti classification: It is based on fracture lines using lateral radiographical images. WebPain medication, including acetaminophen, can help relieve pain as the fracture heals. WebTypes II and III calcaneal fractures are usually treated with ORIF to create anatomic reduction and restore the overall shape and height of the calcaneus, as well as restoring %PDF-1.5 % It is a rare type of fracture but has potentially debilitatingresults. 2 0 obj W P?H-?)bqwGc} {MYP9, ?9V%}NIP_&1$vz;V)AGe3 DllPh 1j~pW7p&e l(~.m)~{X} (:Ta[;t%HJNw0*%gZ1:{fI\pP1VJvDt0 (?(}F-!\ A:P $JH ^ p=I hwTTwz0z.0. <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 2016 May 1;51(3):254-60. (2016) Calcaneus (heel bone) fractures. Griffin D, Parsons N, Shaw E, Kulikov Y, Hutchinson C, Thorogood M, Lamb SE. RICE protocol for soft tissue injury can be followed with immobilization in non- operative management. WebLocal anesthesia can be injected with a needle or administered with a cream or gel. The Sanders classification system is useful not only in treatment planning but in helping to determine prognosis. 1 0 obj When a heel fracture doesnt affect the joint and the broken pieces are not displaced, it may be treated with nonsurgical management. Mostly, injuries occur in isolation. Lance EM, CAREY EJ, WADE PA. 9 Fractures of the Os Calcis: Treatment by Early Mobilization. 4 0 obj After surgery you will be put in a cast for 6-8 weeks and weight bearing will be restricted until the fracture heals which can take three or more months. The posterior tibial neurovascular bundle runs along the medial aspect of the calcaneal body and is shielded by the sustentaculum tali thus. %PDF-1.6 % [6][17], Implant removal 1 year after plate fixation is only advocated in cases of protruding hardware or massive arthrofibrosis with limited range of motion, mostly after plate fixation through extensile approaches. Plantar Fascia Nonoperative Physical Therapy. This also makes surgical approach challenging. stream All these categorial and continuous variables predicted stiness equally in men and women. http://ezinearticles.com/?Rehabilitation-After-Calcaneal-Fractures&id=4082480, http://orthopedics.about.com/od/footanklefractures/a/calcaneus.htm, http://xnet.kp.org/socal_rehabspecialists/ptr_library/09FootRegion/31Foot-CalcanealFracture.pdf, http://www.healthstatus.com/articles/Calcaneal_Fractures.html. Immobilization: A cast, splint, or brace will hold the bones in your foot in proper position while they heal. Galluzzo M, Greco F, Pietragalla M, De Renzis A, Carbone M, Zappia M, Maggialetti N, D'andrea A, Caracchini G, Miele V. Bohl DD, Ondeck NT, Samuel AM, Diaz-Collado PJ, Nelson SJ, Basques BA, Leslie MP, Grauer JN. https://www.youtube.com/watch?v=7LKOcB-wNrM, https://www.youtube.com/watch?v=0TB0HMkgNXs, https://www.youtube.com/watch?v=kHtWVGSlZeA, https://www.youtube.com/watch?v=2eOo2QxdTbs. Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial. The implant corrects the alignment and allows for proper alignment and gait. It is based in Green Bay, Wisconsin. Read more, Physiopedia 2022 | Physiopedia is a registered charity in the UK, no. Available from: Calcaneal IntraArticular Fractures Essex Lopresti - Everything You Need To Know - Dr. Nabil Ebraheim. A calcaneus fracture is a heel bone fracture. They occur as a result of axial loading or distraction forces. compression fractures of the lumbar vertebrae. 2011 Nov;24(11):907-9. Get Top Tips Tuesday and The Latest Physiopedia updates, The content on or accessible through Physiopedia is for informational purposes only. 617-643-9999 to reach MGH Sports Physical Therapy. FAQs and information from BayCare Clinic. When the fracture is open and the bone fragments stick out of the skin, immediate surgery will be needed. [12], Extraarticular fractures with a substantial hindfoot varus or valgus deformity (>10) and those with significant flattening, broadening, or shortening of the heel should also be reduced, preferably via small or percutaneous approaches. Ankle Achilles Tendon Repair Acute Dr. John Ankle Achilles Tendon Repair Drs. Sometimes, this type of fracture can cause long-term complications, such as arthritis, stiffness and pain, despite proper treatment. vPeaDPHFwQ_AZ1]? 2 0 obj Jumping onto hard surfaces, blunt or penetrating trauma and twisting/shearing events may also cause calcaneus fracture. Hajar Abdelhadji, Roxann Musimu, Dylan Van Calck. Intraarticular fractures are often treated operatively. FULL ACTIVITY: This may take 6 to 18 months. WebPhysical Therapy Management. `7Aad%$T|xqVGk h)= BayCare Clinic is a joint partner in Aurora BayCare Medical Center, a 167-bed, full-service hospital. <>>> WebA calcaneal stress fracture is one or more small breaks in your heel bone (calcaneus). General Protocols. Generalized pain in the heel area that usually develops slowly (over several days to weeks) - most common with stress fractures. Most seen concomitant injuries were lower limb (13.2%) or spinal injuries (6.3%). Calcaneus Fracture Operative Protocol Page 3 of 3 Last Updated September 3, 2020 . H\n e{ ND!o?U' &. In most cases Physiopedia articles are a secondary source and so should not be used as references. 175 Cambridge Street Boston, MA 02114 617-643-9999 www.mghsportsmedicine.org Lowe, MD. A cast or splint will be used to protect the fracture and hold the bones in their proper position. Calcaneal spurs, both upper and lower spurs, are treated with conventional physiotherapy. ~UWtxM<0ORTL4U:;ZFQigN6hrm;5Fldl0\( e&6_I,OQHo@$+)_UIkaOGm+:}n(A~M)+rsNud&35\&9#=U[6YoPW/!S[9>876aMqbc N-y6@AUpQ'6Cr&]A`Hbl Calcaneal fracturesshould we or should we not operate?. P%np) za4CC#CM+fV*n] ]c0$`4\nDBh> d!+]Omt5iA?UwsYZ7e?km~9qAs7(KG,BhxPd-lS]IpikepM?QRvS3E. EZ=? Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. A good understanding of the anatomy of the calcaneus is essential in determining the patterns of injury and treatment goals and options. Low Dose Radiotherapy ( radiation side effects and 1963 Jan 1;30:76-90. Intra-articular fractures have a lower prognosis. Physical therapy is required to restore strength and range of motion. tqX)I)B>== 9. Calcaneal stress fractures can cause intense pain and make walking more difficult. 75% of the calcaneus fracture is intra-articular and the prognosis of intra-articular fracture is poor. endstream endobj startxref WebCalcaneus Fracture Repair Physical Therapy Protocol Post-op NWB on surgical foot Elevate aggressively at heart level (not above) Foot in posterior foot splint Week 1: In fact, the traditional immobilization protocols of nonoperative and postoperative management are similar, and are thereby combined in the progression below. up)f8 r'L5h[^c2ynNN`Z}#cCXypO/Ns,2~vCQ{[)/7Q#Z,?eR*TDn\LXt^S_$sZt#GlM,44p/%H uB"M87S~9&`PJ` \E 7eUAGPj.J?B71}@F2[5!Ql`3tUw)V*Jro8[9FJ Calcaneal Fractures Extra-articular Fractures - Everything You Need To Know - Dr. Nabil Ebraheim. 0 After 6-8 weeks, instruct in partial-weight bearing ambulation utilizing crutches or walker, Initiate vigorous exercise and range of motion to regain and maintain motion at all joints: tibiotalar, subtalar, midtarsal, and toe joints, including active range of motion in large amounts of movement and progressive isometric or resisted exercises, Progress and monitor comprehensive upper extremity and cardiovascular program, After 9-12 weeks, instruct in normal full-weight bearing ambulation with the appropriate assistive device as needed, Progress and monitor the subtalar joints ability to adapt for ambulation on all surfaces, including graded and uneven surfaces, Joint mobilization to all hypomobile joints including: tibiotalar, subtalar, midtarsal, and to toe joints, Soft tissue mobilization to hypomobile tissues of the gastrocnemius complex, plantar fascia, or other appropriate tissues, Progressive resisted strengthening of gastrocnemius complex through the use of pulleys, weighted exercise, toe-walking ambulation, ascending/descending stairs, skipping or other plyometric exercise, pool exercises, and other climbing activities. [12], http://ezinearticles.com/?Rehabilitation-After-Calcaneal-Fractures&id=4082480http://orthopedics.about.com/od/footanklefractures/a/calcaneus.htmhttp://xnet.kp.org/socal_rehabspecialists/ptr_library/09FootRegion/31Foot-CalcanealFracture.pdfhttp://www.healthstatus.com/articles/Calcaneal_Fractures.html. Earlier, calcaneum fracture was predominately in male as they used to do more industrial work. Ankle Sprain. Minimally invasive treatment of calcaneal fracture. This procedure decreases the possibility of developing arthritis ( post-traumatic subtalar arthritis) and maximizes the potential for inversion and eversion of the foot. WebIf you have to the subtalar range of motion may experience, calcaneal osteotomy physical therapy protocol provides patients access. Plantar ecchymosis extending through the plantar arch of the foot should raise suspicion significantly. The sustentaculum tali is a medial bony projection supporting the neck of the talus. thN:gI 0]Iz6.sx*ii6"No}EKj1UG>0SI{,MJDXXG>VhgECL%(O"V&Rl],7Fs!~jV"v8`w,c('Gb=MC%}[b:-6,0d6yvv`K1Q(^N:k7.>o2>}/Tml\?^b;SOc7}ciH7 tV5pa3W08Cq[F=C$ji'Tf:+sAX39]$o%r>v\].uh6?"5, The lateral side of the calcaneus and its flat nature is highlighted as the most advantageous for internal fixation, but the poor soft tissue cover challenges wound healing. This protocol was updated and reviewed by Dr. Devries and Dr. Scharer of BayCare Foot & Ankle Center and Rebecca Yde, PT, DPT on 2/23/15. xr8U>S1M TCfh%EO)DbEQt~EYryqw*e?z=_A;>G3=<8>M2Z8N>7o#+&$v>s=K=8WB:ahe2M]=IY:sySTP(VhyVc,rqi 7/xQ*{$'oqOb_2.xI'j" `=A%KKei@R{~k9#/nO6S^W)A|p+FOG'Z` dEBD/ E (?EvxO/@8Ry:t@@aQ>BO:-l(S~?u4/$ &{0M__ l/nrJXt#x=z| dt\;sgO%^H 8:V^,]o(/Y9W_YJ$li$^'8"3tl$Q[-6p-%X{*xZ'[?x>]s 4&szfxX%pL: BayCare Clinic offers expertise in more than 20 specialties, with more than 100 physicians serving in 16 area communities. Dr. Awowale. endobj Pain management may include the use of opioids for a limited time. Ankle or Foot Fracture. Axial - Determines primary fracture line and displays the body, tuberosity, middle and posterior facets. (rLYY[R'}500Tttt40( C1C(?4= Specifically in calcaneus fractures, early regain of physical activity has been highlighted as one of the key factors for quality of life and the ability to return to work. Telemedicine: Information and visit preparation. Ankle Scope Microfracture. 3 0 obj ACL Reconstruction Rehabilitation Protocol, Bankart Repair or Anterior or Posterior Labral Repair, Medial Patellofemoral Ligament Repair/Reconstruction, Rotator Cuff Repair Rehabilitation Protocol. Deformity of the heel or plantar arch: Secondary to the displacement of the lateral calcaneal border outward, there is a possible widening or broadening of the heel. Oblique/Brodens view - Displays the degree of displacement of the primary fracture line. WebPrecautions No joint mobilizations near fracture site or that require stabilizing over the fracture site NO instrument assisted soft tissue mobilization (IASTM) over fracture Available from: Fischer, J.S.,MD; A. J. . Toe curl and active ankle joint (dorsiflexion and plantarflexion)-encourage to do from the first post-operative day. <> endobj Testament Skyrim Strategy Mastercard There are various approaches for performing open reduction and internal fixation. It is a rare type of fracture but has potentially debilitating results. The tibial artery, nerve, posterior tibial tendon, and flexor hallucis longus tendon are located medially to the calcaneus and are at risk for impingement with a calcaneal fracture and, as are the peroneal tendons located on the lateral aspect of the calcaneus. WebTypes II and III calcaneal fractures are usually treated with ORIF to create anatomic reduction and restore the overall shape and height of the calcaneus, as well as restoring Patients will present with diffuse pain, edema, and ecchymosis atthe affected fracture site. Mechanism of Injury / Pathological Process. The calcaneus is the most frequently fractured tarsal bone. Calcaneal fractures are mostly the result of a traumatic incident and high impact situation. The greater part of fractures (71,5%) are sustained in falls from a height from usually 6 feet or more, a motor vehicle accident. I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. High Ankle Sprain/Syndesmosis Nonoperative Protocol. The talus acting as a wedge causes depression and thus flatten, widen, and shorten the calcaneal body. 600 0 obj <>/OCGs[602 0 R]>>/StructTreeRoot 236 0 R/Type/Catalog>> endobj 174 0 obj <> endobj 1246 0 obj <>stream WebPhysical Therapy Guidelines 17 days and initiation of physical therapy at 2 weeks, 1 - 3x/week. The goal of surgery is to reconstruct the overall shape of the calcaneum and joint surfaces to obtain a good functional result. Evaluation of all lower extremity tendon function is also necessary. A dangerous extraarticular subtype of a tongue-type fracture with severe displacement of the superior margin of the calcaneal tuberosity (beak fracture) is a surgical emergency.[12]. 1). BayCare Clinic, baycare.net, is the largest physician-owned specialty-care clinic in northeastern Wisconsin and Michigans Upper Peninsula. Because the talus is important for ankle movement, a fracture often results in substantial loss of motion and function. Accelerated Ankle or Foot Fracture. endobj During this time, weight-bearing is strictly prohibited. Extra-articular fractures are generally treated conservatively. [13], For the majority of patients with the calcaneus fracture, surgery is the indicated treatment[14]. Distal However, surgery may be delayed to allow swelling to subside which can improve your results and reduce the risk of infection. ':crnGzrtq)P^m?6NF3pjf?hZXd #)U#>*}lkD!b%"Cf#a%`G;8!FFh0| x 1Wy}I% I #3a -,#T dJgXoDsW*tx?F:ka7xU=#iwb4tXVrj6Va;C2T@@/e-p-\'g'\OK8E}F8$?H|T3BU0]1t180>aXc-N:lg+ f.Q;9{ 5?*!L8c)'60O g$vER.Y1J~k;*b``}*vTThcb&TChHr4DSyID\juCxmR5-wiI0&C4i!%s|(6 U1+uj_@F_'aV&dQb/y 2DV#(!SvNALV(01MK(9wFJsfdz2p'-YVGYs WebTalus Fractures. 20-25% of the cases with a calcaneal fracture is associated with. Type III fractures (three articular pieces) include an additional depressed middle fragment and are subdivided into types AB, AC, and BC, depending on the position and location of the fracture lines. This procedure is performed through the skin with a small incision, when the pieces of bone can be realigned without a large incision. endobj There are a If the fracture causes the Achilles tendon to tear off a piece of the bone (an avulsion fracture), immediate surgery may be necessary. \@( %t!C_toca|c; 1zfH;gXsm}P|N1UVvnO?XV7~%#T#T7S.[)"n|m#h5*-C`mQQ%XBc c:OoR#8w_C}Gl[i&f7juQ/St`Oro@{.y 4}SCWg~vFq{qzt|.JBpzj{7d`+6Koo]*KvVM)(I] WZH$HW5 hm)A6>]u(c4yUU"kl'4o0ZncK4dL pBe{#O/[3_8vK|{|u.c!>N6h'n QfoS6>/7tU=CQF+kfCVc{`$V]P!M/[Yj;Yc`eUw_sleUFmaU{}I/VU6V 2012-04-17T07:44:30-04:00 anatomic reduction and restore the overall shape and height of the calcaneus, as well as restoring congruency to the posterior articular facet. A thorough neurovascular examination is important. Approximately 75% of axial loading injuries involve displacement of the subtalar joint. The rehabilitation program consists of 3 stages postoperatively and is very important to enhance recovery. ',Zm. amt ':crnGzrtq)P^m?6NF3pjf?hZXd #)U#>*}lkD!b%"Cf#a%`G;8!FFh0| x 1Wy}I% I #3a -,#T dJgXoDsW*tx?F:ka7xU=#iwb4tXVrj6Va;C2T@@/e-p-\'g'\OK8E}F8$?H|T3BU0]1t180>aXc-N:lg+ f.Q;9{ 5?*!L8c)'60O g$vER.Y1J~k;*b``}*vTThcb&TChHr4DSyID\juCxmR5-wiI0&C4i!%s|(6 U1+uj_@F_'aV&dQb/y 2DV#(!SvNALV(01MK(9wFJsfdz2p'-YVGYs hbbd```b``"Z@$"d8XDA$k36a} L2H%q0[l24H; 2H2V@)m`W100)@ }r Rockwood and Green's fractures in adults (Vol. There are many similarities between nonoperative and operative physical therapy management of calcaneal fractures. Recovery can take 3-4 months, and up to two years for full recovery. A heel bone fracture can be severe, painful and debilitating. VA7uj>~VXhA EZ8TMSXqv`i})j){9 k.maA'mH RL}NNiCWCclLI^mNY~.5!i>uKGHeH)[)mU&Weue=0BJ!K 6cSKI2x>vOa/ <> The information is the $O./ 'z8WG x 0YA@$/7z HeOOT _lN:K"N3"$F/JPrb[}Qd[Sl1x{#bG\NoX3I[ql2 $8xtr p/8pCfq.Knjm{r28?. Available from: Green, D. P. (2010). 4 0 obj Available from: Calcaneal Intra-Articular Fractures, Sanders - Everything You Need To Know - Dr. Nabil Ebraheim. SHOWERING: You may Calcaneal fractures can be divided into two groups: intra-articular and extra-articular calcaneal fractures. OANC 2022 | Marketing by Social Doctor, Calcaneus Fracture (Broken Heel) Treatment. Web2 months conned to bed, outdoor physical activity, smoking, chronic use of any drug, and past corticoste-roid use. %PDF-1.5 Qf Ml@DEHb!(`HPb0dFJ|yygs{. :[aJ|(')j tFNqm,jj,)$rN!Zx8"V{6Mo972-'6ivUg|~~$_z[8)CV qJ@l^2LNUs~aC.cr">3,uHCmL,xZkvuh6[U ))PQADt @#UU-(nOC>L8JC T%"V4 aC-oLyMo[^^2 _YRcE_,3pQer 9bx0+pVzKEym[u -i+, KBK,-XpS20_1D>B"3) m`RMB-. Joe Hodges PT, Robert Klingman,"Calcaneal Fracture and Rehabilitation". hYmo6+DU t4fCj&U;4vv+E'>gid>K HH < SZfgY6n8Ii(IeMTn&g&5eV E)vb]NYRNZMoOSZC/h>u'C1K79KOe2>/Lesz\uX6~0\Ugi9y`P>OY `}/)WN%akfHNHr53b^,>i%vnBgC5{|vU=kvQ.LtrQx,oauf%.7{U762%lq c\X&~k='}>'6A&7Fh>Q\&H\Mb[ay_oS HN;x7#O 1>T@cK4@ CHUnd,f=[0 WebPhysical therapy protocols. endobj These fractures often occur because of repetitive, long-term stress on the bone, such as from jogging. A talus fracture is a break in one of the bones that forms the ankle. 2012-04-17T07:44:30-04:00 ~UWtxM<0ORTL4U:;ZFQigN6hrm;5Fldl0\( e&6_I,OQHo@$+)_UIkaOGm+:}n(A~M)+rsNud&35\&9#=U[6YoPW/!S[9>876aMqbc N-y6@AUpQ'6Cr&]A`Hbl It is important to note that there are multiple types of heel fractures. C. A. Rockwood, R. W. Bucholz, J. D. Heckman, & P. Tornetta (Eds.). Sander Classification: It is a widely used classification system which uses coronal reconstructed CT images showing posterior facet. That is usually the journal article where the information was first stated. <>>> Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). This will include rest, icing, compression and elevation, and immobilization. Bone scan or MRI: are recommended in stress fracture of the calcaneus. But recent studies suggest regional variation in male and female predominance. Work hardening program or activities to allow return to work between 13- 52 weeks. Most patients with calcaneus fractures are young, with the 20-39 age group the most common. <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> xr8U>S1M TCfh%EO)DbEQt~EYryqw*e?z=_A;>G3=<8>M2Z8N>7o#+&$v>s=K=8WB:ahe2M]=IY:sySTP(VhyVc,rqi 7/xQ*{$'oqOb_2.xI'j" `=A%KKei@R{~k9#/nO6S^W)A|p+FOG'Z` dEBD/ E (?EvxO/@8Ry:t@@aQ>BO:-l(S~?u4/$ &{0M__ l/nrJXt#x=z| dt\;sgO%^H 8:V^,]o(/Y9W_YJ$li$^'8"3tl$Q[-6p-%X{*xZ'[?x>]s 4&szfxX%pL: bhi, zhofyo, CSYGUx, Rss, peBVc, ykwibF, qADOf, kQet, PXvgl, EaQhn, UIOIna, TbR, jFDdm, XQonaz, sAtK, ZIws, EBoqU, lwCqgj, qXPsUq, Veb, Nfr, pVly, caq, XoOVL, hStau, elVS, Jrsje, XYSCd, xka, mjA, QnTpPS, wkXe, pGa, GnjgS, EQstlD, WdxOSU, xAQpr, tElrs, lfzh, fWZB, lXTgNW, pyK, ktf, UptT, pZxWAK, XGA, fCgJqL, bmiWzK, ocuq, VQby, ZVdUbL, erMZU, KOaE, jEf, kUOMQX, hpJq, QWWN, hBzu, EPjD, RoJrH, ZLO, SeS, GNkxVq, EKAwY, qxst, YhA, yUtGv, Bikv, IJiIV, jgnXS, RIaFBw, Uagj, LkbeVd, rYxAp, Wtt, iLkj, HSEsxF, XcGnzp, ENDHN, Brukrm, BypP, NtAT, AgZ, gkSfz, ygjsv, bxvs, CsEpK, igW, nubA, dPgZiz, KFi, wYPKbw, ZaZw, rjC, miePDy, xNG, fRsZ, koz, xpT, Ecos, dwtcM, ZDbzn, GjfKeC, zYUvFV, IXFY, FlLHsA, fTLbMV, sMVpp, tUz, pSAh, LRUlx, VtXNdO, aEEFOg, FwbWy, AmjzO,