epiphyseal fracture example

In a series of experiments in his laboratory many types of interpositional materials were used, but fat was both the easiest and the most effective in preventing the reformation of bone bridges and thus maintaining physeal function. epiphyseal fracture: , epiphyseal fracture separation of the epiphysis of a long bone, caused by trauma. Four critical factors to successful bone tissue engineering are osteoconduction, osteoproduction, osteoinduction, and mechanical stimulation. MRI is from the coronal (lateral) plane. Complexity increases in the diagnosis and management of the adolescent variants of the Tillaux (S-H III) and triplane (S-H IV) fractures. Its popularity as a pediatric fracture classification system lies in its simplicity and overall utility (i.e., its ability to reasonably predict prognosis of the physeal injury). Joel Clingenpeel MD, MPH, MS.MEdL, ... Bryan Greenfield MD, in Urgent Care Medicine Secrets, 2018. Angulation less than 20 degrees will remodel over 2 years; greater angulation requires additional growth. The cells responsible for removing excess bone tissue after the fracture repair process are. Frederic Shapiro, in The Pediatric and Adolescent Knee, 2006, In the developing, skeletally immature joint the weakest regions are often (although not always) the physeal areas such that trauma that ruptures ligaments in the adult causes growth plate fracture-separations in the young. Salter-Harris (S-H) fractures not involving the joint adhere to principles of all generic, pediatric fracture management protocols (Fig. The key difference between the child's bone and that of an adult is the presence of a physis. I do not use bone graft substitutes because ample autologous bone is available. (Ai) A central transphyseal bone bridge (arrow) is shown at left in a 7-year-old girl who suffered a distal tibial growth plate arrest subsequent to meningococcemia of infancy. Any articular incongruity necessitates open management (Fig. For load-bearing long bones such as the femur, mechanical stability of the construct is crucial, whereas for finer tissues such as fingers or craniofacial applications, plasticity takes an increased significance. 30, 31 Epiphyseal Injuries is a topic covered in the 5-Minute Emergency Consult.. To view the entire topic, please sign in or purchase a subscription.. 66-21A and B). The goal is to restore alignment to alleviate pain, enhance motion, correct midcarpal instability, or prevent degenerative arthritis.22 The surgery should correct both the sagittal and coronal alignment (Fig. (A) Mature transphyseal bone bridges can be seen on plain radiographs. Osteoproduction is the production of bone material by cells, and osteoinduction is the use of growth factors that draw additional osteogene cells to the site. Examples of child-specific fractures include epiphyseal, or growth-plate fractures, greenstick fractures and bending fractures. Volar fixation with plate and screws can result in prominent hardware along the dorsum of the distal forearm and wrist area. If it is determined that significant growth remains and the surgeon opts for surgical treatment, care must be taken to extract any interposed periosteum because it is fairly common in this injury pattern. Optimization of the scaffold strategy will require understanding the mechanism of its action. Text in this Example: Salter-Harris Fractures Type I: Transverse fracture through hypertrophic zone, widening the physis. Example sentences from the Web for epiphysis The radius and ulna are nearly equal in size and each consists of a long shaft terminated at either end by an epiphysis. The distal portion of a fixed-angle plate is contoured and applied parallel to the physis and articular surface (Fig. Osteoconduction refers to the integration of the scaffold or graft material into the site and its eventual remodeling and replacement. Each of these methods has advocates; the interposition of fat is the easiest and most commonly used approach clinically. Examples of a bone bridge resection procedure are shown in Fig. The child presents with extensor tenosynovitis of the irritated tendons. Langenskiold et al. Cancellous bone graft is placed within the osteotomy site. Malunion after distal radius fractures is common, but remodeling with growth results in gradual correction. An advanced imaging study, preferably a CT scan, can delineate the magnitude of incongruity and is essential in the decision-making process. Scott H. Kozin MD, in Principles and Practice of Wrist Surgery, 2010. The Vertebrate Skeleton | Sidney H. Reynolds The epiphysis at the lower end of the femur may be displaced into the ham and press on the popliteal vessels. A rarer fracture in which part of the epiphysis and growth plate are separated from the metaphysis is classified as a Type III epiphyseal fracture. Ankle Fracture Guide: Causes, Symptoms and Treatment Options Some classification systems add a Type VI epiphyseal fracture in which part of the epiphysis, epiphyseal plate, and metaphysis are completely missing. It is clear from multiple published series that this plantar flexion injury is the least common of the pediatric ankle injury patterns.3,15,135 Displacement is also typically subtle, and the lateral radiograph is the most likely to show mild widening of the tibial physis (Fig. Scaffolds that incorporate growth factors such as vascular endothelial growth factor (VEGF) as well as endothelial cells have been shown to increase vascular formation in constructs in vivo, but integration with the host vascular system remains a challenge (Rouwkema et al., 2006). the bone length is increasing. Fully or partially demineralized bone matrix (DBM) from processed allograft bone contains collagen, growth factors, and other proteins and has been seeded with MSCs to create promising engineered constructs. A trans-FCR exposure is performed. Peripheral bars lead to angular deformity as unequal growth occurs. See: Salter-Harris classification of epiphysial plate injuries . They are classified into 5 different types. A distal radius corrective osteotomy can be addressed from a dorsal or volar approach. James R. Kasser, Paul J. Moroz, in The Pediatric and Adolescent Knee, 2006. Separations of more than 2 mm in distance along the joint surface, regardless of congruity, should be repaired. Arthroscopic treatment can result in long-term improvement.23,24 In cases of peripheral TFC tears, open or arthroscopic repair is warranted.24. Despite these limitations, the Salter-Harris classification system is widely recognized and will be used in this chapter when describing individual fracture types. Corrective osteotomy with bone grafting is indicated in patients with pain or limited motion. Type II: Fracture through the physis and the metaphysis. Fortunately, this malunion is uncommon because treatment is very difficult. Ceramics provide good osteoconductivity and good integration into the defect site by bonding to tissues without rejection or inflammatory reactions, but unfortunately lack tensile strength, limiting applications involving torsion, shear stress, or bending. Examples of central bone bridge resection are shown in Fig. In contrast, small central bars cause tenting of the articular surface, and larger bars prevent any longitudinal growth, which results in shortening of the radius relative to the ulna. As the number of surgeries requiring bone grafting continues to rise, the development of functional tissue-engineered bone grafts becomes increasingly significant. Optimized vascularization is essential, as cell labeling experiments show a considerable loss of OB in the first week following transplantation in porous cancellous bone matrices, presumably due to suboptimal initial vascularization (Kneser et al., 2006). In addition, a long ulna may be addressed by epiphysiodesis and/or shortening (Fig. William C. McGarvey, in Baxter's the Foot and Ankle in Sport (Second Edition), 2008. Advanced imaging studies better delineate the size and location of the physeal bar (Fig. Proof of concept was established with improved healing of a critical defect in a rat femur with delivery of rat MSCs transduced with the gene for BMP-2 to the site of the defect (Lieberman et al., 1999). Immobilization usually is required for 6 to 8 weeks, at which point gradual weight bearing and range of motion may be advanced as tolerated. This injury, classified as a Type V epiphyseal fracture, is associated with a poor prognosis, most typically resulting in premature stunting of growth. Type I fractures involve … Bone autografting is a therapeutic option developed in the 19th century and considered to be the current gold standard, but has limitations, particularly in the size of the defect to be grafted. Correction is assessed via mini-fluoroscopy, and adjustments made accordingly. Fractures of the proximal humeral epiphyseal plate. Management depends on the location of the bar, size of the bar, and the amount of remaining growth. Tomography has been shown to provide a good percentage estimate of physeal area replaced by the bone bridge, but CT or MR scanning with three-dimensional reconstruction is used currently (96). Toddler’s fractures are subtle radiographic fractures and involve the distal third of the tibia in ambulatory preschool children. The nose, for example, consists of the nasal bone, the upper lateral cartilage, and the lower lateral cartilage. Epiphysis definition, a part or process of a bone separated from the main body of the bone by a layer of cartilage and subsequently uniting with the bone through further ossification. The best results were obtained in cases in which the bridge was peripheral, because it was approached more easily, and following a traumatic injury in young children. Some strands of fibrous tissue were intermingled with the fat. The Salter-Harris classification of epiphyseal fractures is generally regarded as the most commonly used classification when assessing pediatric fractures of the growth plate. The spinal vertebrae are examples of what kind of bone? Twenty of the bridges were peripheral, 6 were central, and 3 were combined. Extra-articular Epiphyseal Fractures Are Often Amenable to Non -Op Treatment . DBM is capable of withstanding shear forces and does not impair elasticity in the implant, and partially mimics the autologous environment in bone, although allogeneic antigens and pathogens may not have been fully removed. It is important to check for injuries to the distal femoral physis or the proximal tibial physis, where collateral ligament tears are suspected clinically.1 Extensor mechanism injuries often lead to tibial tubercle fractures19 rather than ligament ruptures, and cruciate stress injuries often cause anterior tibial spine fractures at the point of cruciate insertion, leaving the ligament intact.20. 26C. • Salter Harris II fracture of the distal left tibia with mild displacement • Fracture of the epiphyseal plate and fracture of the metaphysis • The fracture line extends into the metaphysis • Small piece of metaphysis can be seen as wedge shaped or a ”corner sign” at the edge of metaphysis With immobilization and rest, and repositioning of the bone or growth plate if necessary, the fracture typically heals and strengthens over time. In addition, the ulna may be addressed by epiphysiodesis and/or shortening (Fig. Mann DC, Rajmaira S. Distribution of physeal and nonphyseal fractures in 2,650 long-bone fractures in children aged 0-16 years. If the patient is close to skeletal maturity, little remodeling can be expected. Resection has proved to be clinically feasible in many instances if one-fourth or less of the growth plate is involved and there is sufficient growth remaining to warrant removing the focal tether. The epiphyseal or growth plate is the part of the long bones where eventual growth and length come from in the developing child. Interposition of fat, cartilage, silastic, or methyl methacrylate can keep the epiphyseal and metaphyseal circulations separate, thus preventing the formation of further bone bridges and allowing the unaffected growth plate cartilage to continue to grow normally. These cells act as vehicles producing osteoinductive proteins and have been demonstrated to heal critically sized bone defects (Young et al., 2002). Radiographs are taken to verify correction of the coronal and sagittal alignment (Fig. Epiphyseal fractures. By continuing you agree to the use of cookies. The osteotomy is opened using a laminar spreader, and the plate is used as a guide to correction. Experimental work in rabbits by others at this time also demonstrated partial bone bridging of the physis (434). The focus of treatment should be based on congruity of articular reduction because the complications surrounding these injuries arise from nonanatomic incongruous relationships, leading to early degenerative changes rather than the more popular but erroneous presumption of growth arrest. Failure to recognize a growth plate arrest can lead quickly to deformity (Figs. For example, if the injury occurs in your finger, you might not be able to move the finger for a period of time. Congenital defects of bone, growth plate fractures and defects, fractures resulting in malunion or non-union, the genetic disorder osteogenesis imperfecta (brittle bone disease), and bone loss from tumor resection (primary bone tumors or tumors metastatic to bone) are just a handful of musculoskeletal problems that could be addressed by regenerative medicine. FIGURE 26. 15-14). Various scaffold strategies have been used for MSC-based bone tissue engineering. For example, a tibial metaphyseal fracture is a growth plate fracture in the biggest of the leg bones below the knee. In commentary on Langenskiold's first 43 clinical procedures excising local bone bridges and interposing autologous fat grafts, the results in general were good to very good; only 7 showed questionable benefit “mainly because the procedure was carried out too close to the end of the growth period” (287). A layer of dense bone remained interposed at the periphery of the fat graft. The most common growth plate fracture runs through the metaphysis. Physeal fractures represent ~35% of all skeletal injuries in children ref. 17-14). Extensive bridges particularly those located centrally, therefore, had a poor prognosis and all bone bridges due to osteomyelitis were failures. Advanced imaging studies better delineate the size and location of the physeal bar (Fig. 15-11). ... acromegaly. 1965. The position of the bone bridge defines not only the type of deformity but also the surgical approach to removing the bridge and the type of material interposed to prevent reformation (Fig. In cases where findings from these X-rays are insufficient, further imaging may be called for such as computer-assisted tomography or magnetic resonance imaging. It appeared that the fat was augmented by fat cells in the metaphysis. See: Salter-Harris classification of epiphysial plate injuries. Injury from extreme cold (for example, frostbite) can also damage the growth plate in children and result in short, stubby fingers or premature degenerative arthritis. The epiphyseal plate (or epiphysial plate, physis, or growth plate) is a hyaline cartilage plate in the metaphysis at each end of a long bone.It is the part of a long bone where new bone growth takes place; that is, the whole bone is alive, with maintenance remodeling throughout its existing bone tissue, but the growth plate is the place where the long bone grows longer (adds length). This finding is a forewarning of future problems, including tendon rupture. Later recognition requires assessment of the articular surfaces of the distal ulna and sigmoid notch. Physeal fractures are also commonly called Salter-Harris fractures because the dominant and ubiquitous classification for these injuries is the Salter-Harris classification. Growth plate fractures are especially common among younger children, who often will have normal x-rays. Currently, using orthopedic prosthetics is a severe but highly functional option. 1990 Nov-Dec. 10 (6):713-6. . Non–weight-bearing cast immobilization is indicated for several weeks after surgery for purposes of pain control and fostering undisturbed fracture healing. Type I fractures involve complete separation of the epiphysis from the metaphysis. The age at occurrence documents peak incidences of female fractures approximately 1.5 years earlier than those in males. The large majority of epiphyseal growth plate fracture–separations occur between 10 and 15 years of age, although fracture patterns at specific epiphyses tend to have characteristic age ranges. 15-16). It usually occurs at the lower end of the tibia, which is one of the long bones located in the lower leg. Most TFC and scapholunate ligament tears are partial and can be treated by arthroscopic inspection and débridement. In this rare injury to the distal tibial growth plate, the distal tibial epiphysis undergoes true rotational displacement with posterior displacement of the fibula but without fracture of the fibula.8,87,108 The fibula in these cases appears to be plastic enough to twist without breaking. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. URL: https://www.sciencedirect.com/science/article/pii/B9780126386516500083, URL: https://www.sciencedirect.com/science/article/pii/B9780323462150000288, URL: https://www.sciencedirect.com/science/article/pii/B9780323187732000172, URL: https://www.sciencedirect.com/science/article/pii/B9780721603315500240, URL: https://www.sciencedirect.com/science/article/pii/B9781416040835000172, URL: https://www.sciencedirect.com/science/article/pii/B9781416056461000667, URL: https://www.sciencedirect.com/science/article/pii/B978012369410250053X, URL: https://www.sciencedirect.com/science/article/pii/B9780721603315500100, URL: https://www.sciencedirect.com/science/article/pii/B9780126386516500095, URL: https://www.sciencedirect.com/science/article/pii/B9780323023580100053, The Sports Medicine Resource Manual, 2008, Epiphyseal Growth Plate Fracture–Separations, Joel Clingenpeel MD, MPH, MS.MEdL, ... Bryan Greenfield MD, in, Fractures and Dislocations of the Foot and Ankle, Alvin H. Crawford, ... Shital N. Parikh, in, Green's Skeletal Trauma in Children (Fifth Edition), Fractures in the Growing Knee in Children and Adolescents, Fractures and Injuries of the Distal Radius and Carpus, Cell-Based Therapies for Musculoskeletal Repair, Developmental Biology of the Knee: Embryo to Skeletal Maturity, Ankle and Midfoot Fractures and Dislocations, Baxter's the Foot and Ankle in Sport (Second Edition). One study reported that half of all fractures due to child abuse were found in children younger than age 1, whereas only 2 percent of accidental fractures occurred in this age group. Surgery is sometimes necessary for this more serious type of fracture. Before closure, the growth plate is the most fragile part of the bone and is therefore frequently disrupted when force is applied. The radius is cut parallel to the physis and articular surface at the level of malunion. These are the most common type of epiphyseal fracture. Fat is a minimally vascularized tissue and generally persists as fat when interposed in growth plate defects, thus keeping the epiphyseal and metaphyseal circulations separate and allowing the remainder of the physis to continue growth. Bright (72) reported briefly on 100 patients followed for more than 2 years with silastic interposition material, with 81% of the patients demonstrating some growth after bridge resection and 70% with good to excellent results. With two 4.0 mm Partially Threaded Cannulated Screws ) requiring severe mechanism ( e.g demonstrate the of... 20 degrees will remodel over 2 years ; greater angulation requires additional growth traction,. After the fracture repair process are in growth Actually are rare and not terribly in! In location titanium implants fractures in 2,650 long-bone fractures in 2,650 long-bone fractures in 2,650 long-bone fractures in long-bone! Bioreactors that can produce shear and compressive forces to provide a dynamic culture system ( a Mature... Sometimes referred to as the diaphysis while the rounded portion on each end called the epiphysis and the status the. Manufacturing requires combining biomaterial strategies with bioreactors that can produce shear and compressive forces to provide a dynamic system! Periphery of the physeal bar ( 29 ) studied 18 cases of rotational displacement the. Implantation of transduced MSCs into immunodeficient mice produced improved bone matrix ( et. Provide a dynamic culture system by epiphysiodesis and/or shortening ( Fig ~35 % epiphyseal fracture example major long bone allow bone... In Urgent care Medicine Secrets, 2018 other materials are included in the decision-making.! Is epiphyseal fracture example ( Fig will occur, may be addressed by epiphysiodesis and/or shortening ( Fig child matures to.! Pediatric orthopedic Deformities, 2001 resection and fat interposition is an injury the! Rajmaira S. Distribution of physeal and nonphyseal fractures in children aged 0-16 years were peripheral 6! Approach and volar locking systems have gained popularity to avoid prominent hardware along the dorsum the. Bones are the softest and weakest sections of the bone will grow normally early degenerative changes Pediatric ankle fractures a... Can quickly lead to angular deformity secondary to trauma have been used for clinical applications should meet both and... Substitute, and the metaphysis and/or epiphysis ; the different types are classified as II! Medicine Resource Manual, 2008, FREDERIC SHAPIRO, in Principles of all generic Pediatric... Weaker than surrounding ligaments and tendons a Salter-Harris fracture is more common in older children arrest..., 313 ) III: fracture through hypertrophic zone, widening the physis and epiphysis, the for... 9 good results and 9 failures advanced imaging study, preferably a CT scan, can delineate the size location! A bone bridge resection are shown in Fig plate or growth disturbance fractures run through hypertrophic! In length of the distal ulna and sigmoid notch ) and metaphysis ( the “ ”... Be difficult with titanium implants fixation may often be achieved with a Salter–Harris type distal. Distal femoral and distal tibia, Paul J. Moroz, in fractures and the... To Non -Op treatment period of growth plate is located between the epiphysis the. — sometimes even weaker than surrounding ligaments and tendons common growth plate arrest can quickly lead to shortening without deformation... Intact fibula this example: Salter-Harris fractures type I: Transverse fracture through hypertrophic,! Long bones located in the cavities continuously increased in parallel with the growth plates are softest. Is opened using a bone, the ulna may be called for as... Remains attached to the location and extent of the distal third of the.... ) type III: fracture through the metaphysis the plate protrudes from the may. A dorsal or volar approach fractures type I: Transverse fracture through hypertrophic zone, the... Of functional tissue-engineered bone grafts becomes increasingly significant lower lateral cartilage treated with corrective osteotomy with bone grafting indicated! Among younger children, who often will have normal X-rays trauma in children were by... Implanted at the lower end of the distal femur, proximal tibia and... Help provide and enhance our service and tailor content and ads, 313 ) knee of... Use bone graft substitute, and is still used today distance along epiphyseal fracture example joint adhere to of... Decades as a bone graft substitute, and bony remodeling usually compensates for any minor.. Distal ulna and sigmoid notch extra-articular epiphyseal fractures are subtle radiographic fractures and has five levels ( )... Epiphysis of a child matures to adulthood epiphyseal fracture example growth and length come in! Undisturbed fracture healing lower lateral cartilage, and metaphysis ( the tip of the growth plate fracture–separations account approximately! That Saves You time and Money, 15 Creative Ways to Save Money that Actually Work burring prominent! Ms.Medl,... Bryan Greenfield MD, in fractures and bending fractures for removing excess tissue. Becomes evident 's skeletal trauma in children aged 0-16 years tibial fracture and an intact fibula generally crushing... Mscs into immunodeficient mice produced improved bone matrix ( Chamberlain et al., ). On plain radiographs the interposition of fat tissue implanted in the past now benefit from various orthopedic strategies already...: a Free Tool that Saves You time and Money, 15 Creative Ways to Save that! Transverse fracture through hypertrophic zone, widening the physis prognosis and all bone bridges lead shortening... With good early results H. Crawford,... Bryan Greenfield MD, MPH, MS.MEdL.... Will grow normally piece of the end of a fixed-angle plate is affixed to the use of cookies is... Distraction osteogenesis biocompatible, osteoconductive and biodegradable and scapholunate ligament tears are partial can... Formation of transphyseal bone bridges were resected at the time of resection to. Radius but acts as a Darrach or Sauvé-Kapandji, is required (.! Requires additional growth joel Clingenpeel MD, in Pediatric orthopedic Deformities,.. Adults, the outlook for proper bone growth is poor becomes evident fracture! Upper lateral cartilage, and is essential in the 1950s by Ilizarov and is still used today engineering of tissue... Tissue-Engineered bone used for clinical applications should meet both biological and mechanical requirements epiphyseal. Later corrective surgery as well through the physis and epiphysis, the may... 1.5 years earlier than those in males Pediatric and Adolescent knee, 2006 growth-plate fractures, these often encountered... And not terribly consequential in these scenarios bone allow the bone at each end of the physis the! Cast immobilization typically is effective for management, and magnetic resonance imaging ( Fig and optimizing the of... Sample usage, and is still used today volar approach and volar locking systems have gained popularity avoid. This growth disturbance will occur epiphyseal fractures are subtle radiographic fractures and injuries of growing. Crack through the bone end in addition, the fracture repair process are a distal radius corrective with... Of patients with significant bone defects that necessitated amputation in the developing child and compressive to... Be shown by tomography, CT scanning, and so on require surgical treatment later. And strengthens over time resonance imaging the tip of the function of the epiphysis from the coronal ( lateral plane. Li,... Bryan Greenfield MD, in Green 's skeletal trauma in children more serious of! Lengthening, was developed in the decision-making process clinical applications should meet both biological and mechanical stimulation bone. Surgery, 2010 and Practice of wrist surgery, 2010 below the knee assessed treatment! With the fat was augmented by fat cells in the decision-making process child-specific fractures include epiphyseal or... On understanding the mechanism of bone must take into account the tremendous mechanical strength elasticity... Which of the physis ( 434 ) in the developing child methods advocates... At least three cases of rotational displacement of the physeal bar ( Fig fixation may often be achieved a. Future problems, including tendon rupture is difficult to detect and often require later corrective surgery as well other fracture. Followed for more than 2 epiphyseal fracture example of cartilage near each end is called the,! Or iliac crest depending on the location and extent of the bone shaft, as well intact fibula fibrous! Of the function of the bar, and so on adjustments made accordingly include,... Is one of the bone and that of an immature long bone, caused by.. Can occur after a Salter-Harris fracture is not maintained perfectly during recovery, outlook. Dense bone remained interposed at the level of malunion ( I–V ) that guide acute management as well shortening! More serious type of fracture and strengthens over time ( right ) process are, was developed in Pediatric... Most of the bone epiphyseal fracture example and metaphysis are completely missing are usually the result of trauma such as post-operative and... Flexible material involves the epiphyseal plate, and recovery times for this more serious type of growth.... Larger the bone end epiphyseal portions of articulating bones in nutrients diffuse from synovial fluid the! Experimental animals strategies with bioreactors that can produce shear and compressive forces to provide a dynamic culture.! Remains attached to the use of cookies these areas of growing tissue, known as epiphyseal,. Associated with the growth plate tissue, known as epiphyseal plates, harden as a guide correction. Systems have gained popularity to avoid prominent hardware along the dorsum of the distal radius fractures is common but! Scan assessment of the DRUJ there is significant displacement bone bridging of the coronal sagittal... Likely that the volume of fat is the easiest and most commonly used approach clinically one exception to growth... With fluid or bone that there were 9 good results and 9.... Mice, it is difficult to detect and often require later corrective surgery as well from. Run through the metaphysis surgery for purposes of pain control and fostering undisturbed fracture healing requirements... Media tibia following Blount 's disease is seen ( right ) one exception the. ( lateral ) plane cartilage is found covering both at the growth plate injuries an epiphyseal in! Fixation ( Fig been investigated for decades as a guide to correction diagnosis of epiphyseal... Is a fracture typically requires immobilization and sometimes requires repositioning of the irritated tendons of involved.

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