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Tu DP, Cai LJ, Zhao HY, Huang LG, Nie J. Complicated Bosworth fracture-dislocation: A case report and review of the literature. Chin J Traumatol 2023; 26:344-350. [PMID: 37925272 PMCID: PMC10755783 DOI: 10.1016/j.cjtee.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 04/30/2023] [Accepted: 06/02/2023] [Indexed: 11/06/2023] Open
Abstract
Bosworth fracture and dislocation is relatively rare, accounting for about 1% of ankle fractures. It is characterized by the proximal fibula fracture embedded in the posterolateral distal tibia. Due to an insufficient understanding of this fracture, it is easy to cause missed diagnosis and misdiagnosis in clinical practice. Due to the insertion of the fracture, it is challenging to perform closed reduction, and improper treatment is easy to cause complications. Surgical treatment is recommended for this type of fracture. In order to improve the understanding of orthopedic surgeons about Bosworth fracture and dislocation, this paper reports the diagnosis and treatment of 2 cases of Bosworth fracture and dislocation, and reviews the literature on Bosworth fracture's mechanism, diagnosis, classification, complications, and treatment options in recent years.
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Affiliation(s)
- Dong-Peng Tu
- Department of Orthopaedics, Hangzhou Xiaoshan Orthopaedic Hospital of Traditional Chinese Medicine, Hangzhou, 311261, China.
| | - Li-Jun Cai
- Department of Orthopaedics, Hangzhou Xiaoshan Orthopaedic Hospital of Traditional Chinese Medicine, Hangzhou, 311261, China
| | - Hong-Yong Zhao
- Department of Orthopaedics, Hangzhou Xiaoshan Orthopaedic Hospital of Traditional Chinese Medicine, Hangzhou, 311261, China
| | - Li-Gang Huang
- Department of Orthopaedics, Hangzhou Xiaoshan Orthopaedic Hospital of Traditional Chinese Medicine, Hangzhou, 311261, China
| | - Jing Nie
- Department of Orthopaedics, Hangzhou Xiaoshan Orthopaedic Hospital of Traditional Chinese Medicine, Hangzhou, 311261, China
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2
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Lucenti L, Testa G, Nocera C, Culmone A, Dell'Agli E, Pavone V. Bosworth Fractures of the Ankle: A Systematic Literature Review. J Pers Med 2023; 13:jpm13050713. [PMID: 37240883 DOI: 10.3390/jpm13050713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/21/2023] [Accepted: 04/22/2023] [Indexed: 05/28/2023] Open
Abstract
Bosworth lesions are fracture-dislocations of the ankle and are characterized by entrapment of the proximal segment of the fibula behind the posterior tubercle of the distal tibia. Treatment is challenging, mainly due to failure of a closed reduction. The aim of this study was to review the literature concerning this type of injury. A total of 103 patients with Bosworth fractures were included in the study. The analyzed studies yielded a total of 103 cases, of which 68% (n = 70) were male and 32% (n = 33) were female. Bosworth fractures are mainly due to accidental trauma (58.2%), sports-related injuries (18.4%), and traffic accidents (18.4%). More than 76% of the patients presented a Danis-Weber B fracture, 8.7% a type C fracture, and only 0.97% presented a type A fracture. In 92.2% of the patients, the attempted closed reduction was unsuccessful. A definitive treatment with open reduction and internal fixation (ORIF) was used in 96 patients (93.2%). The most frequent complication was post-traumatic arthritis (10.7%). Bosworth fractures are challenging. The available literature lacks adequate information about this fracture, and an approved standardized algorithm for treating such fractures is not available.
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Affiliation(s)
- Ludovico Lucenti
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico "Rodolico-San Marco", University of Catania, 95123 Catania, Italy
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico "Rodolico-San Marco", University of Catania, 95123 Catania, Italy
| | - Chiara Nocera
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico "Rodolico-San Marco", University of Catania, 95123 Catania, Italy
| | - Annalisa Culmone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico "Rodolico-San Marco", University of Catania, 95123 Catania, Italy
| | - Eleonora Dell'Agli
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico "Rodolico-San Marco", University of Catania, 95123 Catania, Italy
| | - Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico "Rodolico-San Marco", University of Catania, 95123 Catania, Italy
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Fang C, Tang ZH, Yeoh CS, Tan GM. A Case Series of Bosworth Fracture-Dislocations and Review of 129 Reported Cases. Malays Orthop J 2022; 16:76-85. [PMID: 36589382 PMCID: PMC9791907 DOI: 10.5704/moj.2211.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 01/12/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction Bosworth fracture dislocations of the ankle are rare injuries of the ankle caused by extreme external rotation of the supinated foot where the proximal fibula fracture fragment is posteriorly dislocated and entrapped behind the posterior-lateral ridge of the tibia. This case series aims to document three such cases treated in our institution over a nine year period. We also provide a review of 129 cases in the existing literature. Materials and methods Medical records and relevant radiographs for each patient were analysed and collected from the time of presentation till the point of latest follow-up. During each clinic visit, all physical exam findings as well as all complications were recorded. The American Foot and Ankle Society (AOFAS) Hindfoot score was also tabulated for each patient at the point of latest review. Results Closed reduction was unsuccessful in all three patients, and all required open reduction. One patient had an uncomplicated recovery whilst the remaining two suffered significant soft tissue complications. One patient suffered severe soft tissue swelling preventing primary closure at the time of surgery, whilst another suffered post-operative wound dehiscence and infection. Eventually all fractures healed, and all three patients obtained satisfactory AOFAS scores. Conclusion The diagnosis of Bosworth fracture dislocations of the ankle is often delayed or missed, due to its rare occurrence. Closed reduction is often unsuccessful, and early open reduction is required to avoid poor clinical outcomes due to severe soft tissue damage or even compartment syndrome.
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Affiliation(s)
- C Fang
- Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore,Corresponding Author: Christopher Fang, Department of Orthopaedic Surgery, National Healthcare Group, Singapore
| | - ZH Tang
- Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore
| | - CS Yeoh
- Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore
| | - GM Tan
- Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore
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Campbell ST, DeBaun MR, Githens MF. Frame-Assisted Reduction of a B-Type Pilon Fracture Dislocation: Talar Body Incarceration on an Intact Fibula: A Case Report. JBJS Case Connect 2021; 11:e20.00436. [PMID: 33577191 DOI: 10.2106/jbjs.cc.20.00436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We describe an irreducible anterolateral tibiotalar dislocation with an AO/OTA (Arbeitsgemeinschaft fur Osteosynthesefragen/Orthopaedic Trauma Association) B-type pilon fracture. The injury was initially treated with closed reduction, using a medializing force achieved with an external fixator to unhinge the talar body from the fibula, followed by temporary stabilization. Definitive fixation was performed once the soft tissues had recovered. CONCLUSION This unique irreducible pilon fracture dislocation pattern is important to recognize to prevent iatrogenic complications associated with multiple failed closed reduction attempts. Frame-assisted, percutaneous, or open maneuvers may be required to facilitate a reduction. Staged treatment with temporization in an external fixator may be required.
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Affiliation(s)
- Sean T Campbell
- Department of Orthoapedic Surgery, Harborview Medical Center, Seattle, Washington
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Han SJ, Kim JH, Yang DB, Kim BS, Ok HS. Bosworth-type fibular entrapment fracture of the ankle without dislocation: a rare case report and a review of the literature. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:178. [PMID: 33569480 PMCID: PMC7867949 DOI: 10.21037/atm-20-5112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Bosworth fracture-dislocation of ankle is a rare and irreducible type of ankle injury, with a high incidence of complication. This type of fracture was defined originally as entrapment of the proximal fragment of the fibula behind the posterior tubercle of the distal tibia. Recently, many variants of this type of fracture dislocation have been reported, but all of those reports included the syndesmosis ligament injury of ankle. Here, we report a case of a particularly rare variant of Bosworth fracture-dislocation without syndesmosis ligament injury of ankle. A 48-year-old male presented with a Bosworth fracture dislocation with entrapment of proximal fragment behind the tibia. After temporary treatment in emergency department was applied, emergency open reduction and internal fixation with a plate and screws was performed due to irreducibility of the fracture fragment. The fractured lateral malleolus was entrapped behind the tibia and rupture of the interosseous ligament was found intraoperatively. The anterior inferior tibiofibular ligament, a part of syndesmosis ligament of ankle, was grossly intact and no abnormal findings was seen by fluoroscopy with external rotational stress. Moreover, the deltoid ligament was found to be normal in ultrasonography. There were no complications after surgery and the patient showed full functional recovery at 2 years follow up. These fractures will frequently be irreducible and should be considered for open reduction and internal fixation with the careful evaluation of injury mechanisms with syndesmotic stability.
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Affiliation(s)
- Sang-Jin Han
- Departments of Orthopedic Surgery, Hyundae General Hospital, Chung-Ang University, Namyangju-Si, Kyunggi-Do, Korea
| | - Jong-Heon Kim
- Departments of Orthopedic Surgery, Hyundae General Hospital, Chung-Ang University, Namyangju-Si, Kyunggi-Do, Korea
| | - Du-Bin Yang
- Departments of Orthopedic Surgery, Hyundae General Hospital, Chung-Ang University, Namyangju-Si, Kyunggi-Do, Korea
| | - Boo-Seop Kim
- Departments of Orthopedic Surgery, Hyundae General Hospital, Chung-Ang University, Namyangju-Si, Kyunggi-Do, Korea
| | - Hyun-Soo Ok
- Departments of Orthopedic Surgery, Hyundae General Hospital, Chung-Ang University, Namyangju-Si, Kyunggi-Do, Korea
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Martin-Somoza FJ, Picazo DR, Cabezuelo JAM, González AV. Bosworth fracture. An atypical case of irreducible ankle fracture-dislocation. Trauma Case Rep 2020; 28:100322. [PMID: 32637534 PMCID: PMC7330149 DOI: 10.1016/j.tcr.2020.100322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2020] [Indexed: 10/30/2022] Open
Abstract
An irreducible ankle-fracture dislocation in which the proximal fibular shaft fragment locks behind the posterior tibial tubercle is defined as "The Bosworth injury". Characteristically, this fracture is generally not reducible using closed methods. A high number of attempts can be counterproductive to get a good final functional result and it may also lead to the appearance of future complications. Although it is a recognized and published cause of irreducible ankle dislocation, it is an unusual and rare injury. The initial radiological diagnosis is difficult, usually going unnoticed, and it is frequently diagnosed during the surgical act, appreciating the retrotibial position of the proximal fibular fragment. The present report is the first in the medical data to describe a case of Bosworth injury in a 32-week-old pregnant woman. The initial diagnosis went unnoticed. After unsuccessful closed reduction attempt, urgent surgical intervention was performed.
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Affiliation(s)
| | - David Ruiz Picazo
- Department of Orthopaedics Surgery and Traumatology, Complejo Hospitalario Universitario de Albacete, Spain
| | | | - Ana Verdejo González
- Department of Orthopaedics Surgery and Traumatology, Complejo Hospitalario Universitario de Albacete, Spain
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Posterior malleolus fractures in Bosworth fracture-dislocations. A combination not to be missed. Injury 2020; 51:537-541. [PMID: 31703958 DOI: 10.1016/j.injury.2019.10.088] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 10/29/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Posterior malleolar fractures (PM) have been linked to inferior outcome in malleolar fractures. This study aims to analyze the prevalence and pathoanatomy of PM fractures in Bosworth fracture-dislocations (BF). MATERIALS & METHODS Radiographs and computed tomography (CT) scans of 13 patients treated at our institution and 97 cases published between 1947 and 2018, identified in a systematic literature search, were evaluated with respect to the pathoanatomy of BF. In all 13 cases from the present study and in 10 cases from the literature, axial CT scans were performed. RESULTS All 13 patients (100%) with BF from the present series and 61 of 97 documented cases (63%) of BF from the literature were associated with a PM fracture. In patients with a complete CT analysis, dislocation of the fibula behind the posterior tibial rim was associated with extraincisural (Bartoníček / Rammelt type 1) PM fractures. Displacement of the fibula between the displaced PM fragment and the tibia was associated with Bartoníček / Rammelt types 2 and 3 PM fractures. CONCLUSIONS Seventy prevent of all reported BF are associated with a PM fracture. The true prevalence may be even higher because of the historically infrequent use of CT imaging. The pathoanatomy of the PM fragment is highly variable as is the kind of fibular displacement in BF. Therefore, CT scanning should be performed routinely in BF. Displaced PM fractures in BF involving the incisura should be treated operatively via a direct posterolateral approach.
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Abstract
A luxation fracture of the ankle characterized by a dislocation of the fibula posterior to the tibial tubercle is defined as a Bosworth injury. The Bosworth fracture is a frequently overlooked complex injury of the ankle joint. Associated injuries such as a pilon fracture and posterior malleolus fracture have rarely been reported. In the case of a closed irreducible ankle fracture dislocation, Bosworth injuries should be considered as a potential cause. This article reports the course, treatment and clinical outcome 12 months after trauma of a Bosworth fracture with associated impaction of the posteromedial pilon and fracture of the posterior malleolus. To date, there are only few reports of comparable injuries in the German language literature.
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Cho BK, Choi SM, Shin YD. Prognostic factors for intermediate-term clinical outcomes following Bosworth fractures of the ankle joint. Foot Ankle Surg 2019; 25:601-607. [PMID: 30321945 DOI: 10.1016/j.fas.2018.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 05/12/2018] [Accepted: 05/21/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND This retrospective comparative study was performed to evaluate the clinical outcomes after surgical treatment for Bosworth fracture-dislocation, and to analyse the prognostic factors related to postoperative outcomes. METHODS Fifteen patients were followed for ≥2 years after Bosworth fracture-dislocation. Twenty-five ankle fracture-dislocations as control group were enrolled to compare clinical outcomes. Clinical evaluation consisted of the AOFAS and Olerud-Molander scores. Patient and injury factors were analysed to identify the outcome predictors. RESULTS There were no significant differences in either clinical evaluation score as compared to control group (P=0.245, .302, respectively). The time interval to operation and number of manual reduction attempts were found to be predictive factors for poor outcomes (P=0.004, .038, respectively). CONCLUSION As compared to more common patterns of ankle fracture-dislocations, intermediate-term clinical outcomes after Bosworth fracture-dislocations were statistically comparable. Delayed surgical reduction and repeated attempts at closed reduction appear to be negative outcome predictors.
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Affiliation(s)
- Byung-Ki Cho
- Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea.
| | - Seung-Myung Choi
- Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Young-Duck Shin
- Department of Anesthesiology and Pain Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
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Ren W, Hu YC, Lu JK. Rare variants of Bosworth fracture-dislocation: Bosworth fracture-dislocation with medial malleolus adduction type fracture. Chin J Traumatol 2019; 22:120-124. [PMID: 30744942 PMCID: PMC6487462 DOI: 10.1016/j.cjtee.2018.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/06/2018] [Accepted: 12/14/2018] [Indexed: 02/04/2023] Open
Abstract
Bosworth ankle fracture-dislocation is rare, known to be an irreducible type of ankle injury, with a high incidence of complication. We present two cases of even rarer variants of Bosworth ankle fracture-dislocation. The first case is a type of supination external rotation adduction, and the second case is a type of supination external rotation adduction. These types have not been described before. In both of the cases we failed to achieve close reduction, and therefore proceeded with emergency surgeries, with open reduction and internal fixation. Both of the cases were performed with a postero-lateral approach to reduce the dislocations, and fix the fractures successfully. Unfortunately in one of the cases, acute compartment syndrome developed post-surgically. However, both cases showed good functional outcomes.
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Affiliation(s)
- Wei Ren
- Department of Orthopedic Surgery, United Family Hospital, Beijing 100015, China; Tianjin Medical University, Tianjin 300070, China
| | - Yong-Cheng Hu
- Department of Orthopedic, Tianjin Hospital, Tianjin 300211, China; Tianjin Medical University, Tianjin 300070, China
| | - Ji-Ke Lu
- Department of Orthopedic Surgery, United Family Hospital, Beijing 100015, China.
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Association of Bosworth, Pilon, and Open Talus Fractures: A Very Unusual Ankle Trauma. Case Rep Orthop 2019; 2019:6316137. [PMID: 30881715 PMCID: PMC6387697 DOI: 10.1155/2019/6316137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/18/2018] [Accepted: 01/17/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction A Bosworth fracture-dislocation is a rare lesion resulting in a fixed dislocation of the distal fibula behind the posterior tibial tubercle. Only few cases have been reported showing an associated consequent fracture, namely, a pilon or a medial malleolus fracture. Case Report We present a case report of a patient with an unusual combination of a Bosworth injury with a pilon fracture and an open multifragmentary talus fracture and our approach for open reduction and internal fixation. At one year postoperative, the patient developed an invalidating tibiotalar and subtalar arthrosis that eventually required an ankle-hindfoot arthrodesis. A Bosworth injury is an infrequent entity and is even rarer when associated with other fractures. Careful preoperative planning is necessary, as the combination of these fractures is a surgical challenge. Special care must be taken to preserve the neurovascular bundle. Discussion The present case highlights a Bosworth injury involving a severity that has never been described before and suggests adding an eighth stage to the classification presented by Perry et al.
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12
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Bosworth Dislocation without Associated Fracture. Case Rep Orthop 2018; 2018:7284643. [PMID: 29808144 PMCID: PMC5902103 DOI: 10.1155/2018/7284643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 03/07/2018] [Indexed: 11/17/2022] Open
Abstract
One of the rarest ankle injuries is the Bosworth fracture-dislocation, whereby the distal fibula fractures and is lodged behind the tibia and is often unable to be reduced in a closed fashion. Even more rarely, a Bosworth dislocation without any accompanying fractures may occur. In this case, a 19-year-old male presented with a Bosworth dislocation, with the ipsilateral tibia having previously undergone intramedullary nailing. After closed reduction was attempted, open reduction and fixation was performed, directly reducing the fibula and fixing the unstable syndesmosis with 2 quadricortical screws. Bosworth injuries are rare, yet severe, and should be treated in a timely manner. We were able to provide good reduction and fixation without requiring removal of the intramedullary nail, and we support the use of 2 quadricortical screws as a valid treatment option for the fixation of Bosworth dislocations.
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