With this mechanism, the anterior tibiofibular ligament avulses the anterolateral corner of the distal tibial epiphysis 3. open reduction and internal fixation (ORIF)) or conservative management (e.g. Treatment and prognosis. 1. Treatment and prognosis. Practical points. Treatment and prognosis. 10. Aulino JM, Tutt LK, Kaye JJ, Smith PW, Morris JA. The treatment and prognosis of flexion teardrop fractures are variable and depends on the degree of injury. New Journal Launched! Treatment of avulsion fractures of the ischial tuberosity can conservative or surgical: In this article, we shall examine the anatomyof the muscles in the posterior thigh - their attachments, actions and clinical correlations. History and etymology. Terminology. A lateral cervical spine radiograph is commonly obtained to screen for cervical spine injury in the setting of trauma. It has a role in determining treatment. Clinical Relevance: Hamstring Avulsion Fracture of the Ischial Tuberosity. Imaging of Atlanto-Occipital and Atlantoaxial Traumatic Injuries: What the Radiologist Needs to Know. It can be associated with sciatic nerve damage (the nerve lies in close location and could be compressed by a displaced fragment of bone). In this article, we shall examine the anatomyof the muscles in the posterior thigh their attachments, actions and clinical correlations. A high suspicion should be maintained in patients presenting after blunt trauma with any of the following 3,6: loss of consciousness (low Glasgow coma score), occipital or neck pain (responsive patients). Differential diagnosis. Treatment is closed reduction and casting or open reduction and fixation depending on the degree of displacement and whether it can be reduced. Looser zones are also a type of insufficiency fracture. Occipital condyle fracture. Occipital condyle fractures. Radiographics. We use cookies to improve your experience on our site and to show you relevant advertising. It is located deep to the semitendinosus on the medial aspect of the posterior thigh. The muscles of the posterior thigh all originate from the ischial tuberosity of the pelvis. Volar avulsion fractures are avulsions of the palmar ulnar triquetral/lunotriquetral ligament and are best seen on a radial deviation projection of the wrist 3. Nasal bone fractures are the most common type of facial fractures, accounting for ~45% of facial fractures, and are often missed when significant facial swelling is present. The semitendinosus is a largely tendinous muscle. The forgotten condyle: the appearance, morphology, and classification of occipital condyle fractures. Muscles in the Posterior Compartment of the Thigh, [caption id="attachment_15851" align="aligncenter" width="516"], [caption id="attachment_8355" align="aligncenter" width="702"]. Volar avulsion fractures. Hanson JA, Deliganis AV, Baxter AB, Cohen WA, Linnau KF, Wilson AJ, Mann FA. It is for this reason that the 5 th metatarsal base must be included in the lateral ankle projection of an ankle series, especially when performed for an Epidemiology These fractures have an incidence 0.4% to 2.7%, and males are affected more-so than females. When considered according to Anderson and Montesano types, Type I and II injuries are generally stable because the alar ligamentand tectorial membraneare preserved, while type 3 is potentially unstable. You also have the option to opt-out of these cookies. In the absence of obvious instability ligament disruption, most occipital condyle fractures are managed non-operatively with external stabilization 7. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Dixon A, Yap J, Deng F, et al. Fig 1 The muscles of the posterior thigh. Lesser trochanter avulsion fracture (C2625) Hazem Hassouna Knee & Sports - Anterior Inferior Iliac Spine Avulsion (AIIS) E 7/6/2016 762 . Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. Bransford RJ, Alton TB, Patel AR, Bellabarba C. Upper cervical spine trauma. Tibial/fibular stress fracture. The primary purpose is to exclude spinal cord injury, although other specific indications include: evaluate for suspected major ligamentous injury, surgical treatment planning in the setting of known instability, high-suspicion patients who cannot be reliably examined within 48 hours: even with initial normal CT, cortical disruption, fragment displacement, joint space widening and hemorrhage (fluid-fluid level) are more specific for significant traumatic injury 2, there may be additional adjacent ligamentous injuries, e.g. Injury to these reinforcing soft tissue structures is thought to predispose to recurrent dislocation 7.. The muscles in the posterior compartment of the thigh are collectively known as thehamstrings.They consist of the biceps femoris, semitendinosus and semimembranosus, whichform prominent tendons medially and laterally at the back of the knee. Urgent reduction and surgical repair of disrupted ligaments is required to prevent long-term joint dysfunction. Treatment and prognosis. Anterior Inferior Iliac Spine Avulsion (AIIS) Tibial stress syndrome (also known as shin splints) is an overuse injury or repetitive-load injury of the shin area that leads to persistent dull anterior leg pain. tectorial membrane,anterior and posterior atlanto-occipital membranes,prevertebral or nuchal ligaments 6. 1996;17 (3): 507-13. long leg cast immobilization). The biceps femoris has two heads (long head and short head) and is the most lateral of the muscles in the posterior thigh. It is the avulsion fracture of the bony protuberance (tubercle) present at the lower end of shin bone (tibia) due to the pull of the ligament running between the two shin bones (the anteroinferior tibiofibular ligament). In practice, the history is often a fall onto an outstretched arm. This typically involves separation of the tibial attachment of the ACL to variable degrees. 13 . 37 (2): 139-51. Topics covered include: trauma systems and management; surgical procedures; epidemiological studies; surgery (of all Offiah CE, Day E. The craniocervical junction: embryology, anatomy, biomechanics and imaging in blunt trauma. A tibial eminence fracture, also known as a tibia spine fracture, is an intra-articular fracture of the bony attachment of the ACL on the tibia that is most commonly seen in children from age 8 to 14 years during athletic activity. Note: The hamstring portion of the adductor magnus has a similar action to these muscles,butis located in the medial thigh. Treatment is closed reduction and casting or surgical fixation depending on the degree of displacement. Radiology. This category only includes cookies that ensures basic functionalities and security features of the website. The most important differential is of other carpal dislocations, particularly: spinal cord) injury, and then to identify and stratify all lesser craniocervical injuries. The most important differential is of other carpal dislocations, particularly: Is our article missing some key information? Noble ER, Smoker WR. May be used to reveal associated ligamentous injuries, osteochondral fractures and chondral fractures 7. Anterior cruciate ligament (ACL) avulsion fracture or tibial eminence avulsion fracture is a type of avulsion fracture of the knee. Occipital condyle fractures: clinical presentation and imaging findings in 76 patients. (2014) The Journal of the American Academy of Orthopaedic Surgeons. Arthroscopy Techniques is one of two open access companion titles to the respected Arthroscopy.This peer-reviewed electronic journal aims to provide arthroscopic and related researchers and clinicians with practical, clinically relevant, innovative methods that could be applied in surgical practice.Brought to you by the same editorial team as Arthroscopy, 2000;216 (3): 635-44. Occipital condyle fractures are rarely evident by x-ray 5,6. CT is the best modality for identifying an occipital condyle fracture 6. 2015;35 (7): 2121-2134. These type of fractures are more common in children, especially aged 5-10 years, due to the elasticity of their bones. 6. Traditionally this avulsion fracture has been ascribed to the insertion of peroneus brevis and is caused by forcible inversion of the foot in plantar flexion, as may occur while stepping on a curb or climbing steps. Medially rotates the thigh at the hip joint and the leg at the knee joint. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. Pathology. 22 (11): 718-29. The new surgical journal seeks high-quality case reports, small case series, novel techniques, and innovations in all aspects of vascular disease, including arterial and venous pathology, trauma, pars interarticularis of the lumbar spine. If you do not agree to the foregoing terms and conditions, you should not enter this site. fall from standing in debilitated patient 5, may occur as isolated injury or with additional skeletal injuries 5. (2002) AJR. Despite treatment, there remains a high risk of future degenerative arthritis and wrist instability. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Indications for non-operative treatment include undisplaced injuries that are stable with weight-bearing or poor surgical candidates such as non-ambulatory patients, patients with significant comorbidities that have It is also known as backfire fracture or lorry driver fracture 1. This articulation is directly stabilized by 7,8: alar ligaments (dens to each occipital condyle). 9. They are considered a specific type of basilar skull fracture, and importantly can be seen along with craniocervical dissociation. Occipital condyle fractures are rarely evident by x-ray 5,6. 41 (2): 368-76; discussion 376-7. fractures involving a single facial buttress, Meyers and McKeevers classification (anterior cruciate ligament avulsion fracture), Watson-Jones classification (tibial tuberosity avulsion fracture), Nunley-Vertullo classification (Lisfranc injury), pelvis and lower limb fractures by region. These cookies will be stored in your browser only with your consent. As group, these muscles act to extend at the hip, and flex at the knee. Epidemiology. For example, someone who lives alone may not be able to do so without the use of one arm. Differential diagnosis. The muscles of the posterior thigh all originate from the ischial tuberosity of the pelvis. It occurs in older children and adolescents when the medial aspect of the distal tibial growth plate has started to fuse. It is affected by the presence of tibial tuberosity abnormalities (e.g. thigh and leg: femoral neck, patella, anterior tibial cortex. 72 Suppl 2: 106-13. Upper cervical injuries - a rational approach to guide surgical management. In more severe cases, the bone may be broken into several fragments, known as a comminuted fracture. The common tendon of the two heads can be felt laterally within the popliteal fossa (posterior knee region). Revisions: 28. Treatment and prognosis. Pathology Mechanism of injury. Insufficiency fractures are a type of stress fracture, which are the result of normal stresses on abnormal bone. Diagnosis is made radiographically with displaced injuries but CT/MRI may be required to diagnosis nondisplaced fractures. For the same reasons, CT aids in treatment planning as well 6. But opting out of some of these cookies may affect your browsing experience. Fractures are best visualized on coronal and sagittal reformatted images. Classically, these fractures are extra-articular transverse fractures and can be thought of as a reverse Colles fracture.. The term is sometimes used to describe intra-articular fractures with 3. These cookies do not store any personal information. Isolated unstable fractures may be treated by posterior occipitocervical fusion 7. While the majority of radial head fractures are isolated, a number of other injuries may also be seen 2: fracture of the coronoid process of the ulna. Reference article, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-10021. Fractures are best visualized on coronal and sagittal reformatted images. Treatment and prognosis. The classification system widely used for describing occipital condyle fractures is the Anderson and Montesanosystem 1,2,9. Riascos R, Bonfante E, Cotes C et-al. Pathology. Treatment requires either a tibial tuberosity osteotomy and re-implantation proximally or patellar tendon lengthening. By visiting this site you agree to the foregoing terms and conditions. However, as it is purely descriptive, a more clinically-oriented classification has been proposed whichincorporates MRI findings and suggested management (see Tuli classification of occipital condyle fractures) 2,5,10. CT. CT is the best modality for identifying an occipital condyle fracture 6. Flexion of the leg at the knee joint. Leone A, Cerase A, Colosimo C et-al. Theodore N, Aarabi B, Dhall SS, Gelb DE, Hurlbert RJ, Rozzelle CJ, Ryken TC, Walters BC, Hadley MN. The fracture commonly results from an abduction-external rotation mechanism. Non-surgical management typically results in mild residual impairment 8. ossification of ligament of odontoid process 2, ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. They may represent an isolated tendinous injury or occur in combination with an avulsion fracture of the dorsal base of the distal phalanx. Epidemiology. The Weber ankle fracture classification (or Danis-Weber classification) is a simple system for classification of lateral malleolar fractures, relating to the level of the fracture in relation to the ankle joint, specifically the distal tibiofibular syndesmosis. Treatment may be non-operative or operative, with the aim being to have a painless, plantigrade and stable foot 12.. Joaquim AF, Ghizoni E, Tedeschi H, Lawrence B, Brodke DS, Vaccaro AR, Patel AA. Insights into imaging. Fig 2 Cross section of the thigh, showing the position of the major muscle groups. Treatment and prognosis. His radiographs show a comminuted displaced olecranon fracture involving 25% of the articular surface with global osteopenia. Tuli S, Tator CH, Fehlings MG, Mackay M. Occipital condyle fractures. Treatment of isolated injury is generally conservative, unless there is craniocervical junction instability. It is mandatory to procure user consent prior to running these cookies on your website. ankle and foot: medial malleolus, talus, navicular, 2 nd to 4 th metatarsal necks, 2nd metatarsal base, 5 th metatarsal, hallux sesamoid. They are innervated by thesciatic nerve(L4-S3). 5. Despite treatment, there remains a high risk of future degenerative arthritis and wrist instability. 7. Avulsion Fracture at Ankle. Diagnosis is made radiographically with displaced injuries but CT/MRI may be required to diagnosis nondisplaced fractures. Extension of the fracture to the transverse foramina should be sought, raising the possibility of vertebral artery injury. Smith fractures, also known as Goyrand fractures in the French literature 3, are fractures of the distal radius with associated volar angulation of the distal fracture fragment(s). Found an error? medial collateral ligament tear A lateral cervical spine radiograph is commonly obtained to screen for cervical spine injury in the setting of trauma. Epidemiology. An avulsion fracture occurs when a fragment of bone attached to a ligament or tendon gets pulled away from the main mass of the bone. In addition to reporting the presence of the fracture a number of features should be sought and in many instances commented upon as relevant negatives: They should not be confused with fatigue fractures which are due to abnormal stresses on normal bone, or with pathological fractures, the result of diseased, weakened bone due to focal pathology Occipital condylar fractures: a review. A direct blow to the elbow can cause a radial head fracture but is uncommon. Measurement The Insall-Salvati ratio was initially determined on a 30 flexed lateral knee x-ray and was later applied to sagittal MRI. The role of imaging is foremost to evaluate for craniocervical dissociationor other catastrophic (e.g. Treatment can be bracing or, more typically, internal fixation. Tibial tubercle fractures are a common fracture that occurs in adolescent boys near the end of skeletal growth during athletic activity. There have been historically poor outcomes in the treatment of longitudinal forearm instability which is particularly complex in the chronic setting 3. Injury to these ligaments may result in instability, particularly in the setting of additional injuries to the major craniocervical ligaments (occipitodental, atlantodental) 7. American journal of roentgenology. (1997) Neurosurgery. Clinical Relevance: Hamstring Avulsion Fracture of the Ischial Tuberosity, Access over 1700 multiple choice questions. 2. Initial radiographs may be unremarkable for Essex-Lopresti fracture-dislocations 6. The most important factor in the management of craniocervical junction injuries is the status of the stabilizing occipitoatlantoaxial ligaments. This website uses cookies to improve your experience while you navigate through the website. Treatment options comprise of surgery (e.g. (2013) Neurosurgery. The term "bony Bankart" (contrasted with a "soft Bankart" or "fibrous Bankart") is often used to refer Rarely, a torus fracture may refer to the fracture of an oral torus, and there is potential for the two terms to be confused 10. Segond fracture is an avulsion fracture of the knee that involves the lateral aspect of the tibial plateau and is very frequently (~75% of cases) associated with disruption of the anterior cruciate ligament (ACL).On the frontal knee radiograph, it may be referred to as the lateral capsular sign. Patients with this injury often experience a sudden pain in the posterior thigh, followed by an inability to walk. It is interesting to note that the word chauffeur comes from the French for "someone who warms" the car engine. Occipital condyle fractures may result from blunt high-energy trauma to the head/neck, especially 3: Each occipital condyle articulates along a shallow groove atop each lateral mass of C1 (atlas). Occipital condylar fracturesare uncommon injuries usually resulting from high-energy blunt trauma. Original Author(s): Oliver Jones Last updated: October 24, 2022 Treatment and prognosis. Posterolateral corner injury is thought to account for approximately 16% of acute injuries of the knee 4,5.It is often seen in sports-related injuries and mostly related to direct anteromedial tibial impact trauma, but is also caused by hyperextension and external rotation injuries, non-contact varus stress injuries, and anterior or posterior dislocations of the Figure 1: Anderson and Montesano classification, Tuli classification of occipital condyle fractures, Gustilo Anderson classification (compound fracture), Anderson and Montesano classification of occipital condyle fractures, Traynelis classification of atlanto-occipital dissociation, longitudinal versus transverse petrous temporal bone fracture, naso-orbitoethmoid (NOE) complex fracture, cervical spine fracture classification systems, AO classification of upper cervical injuries, subaxial cervical spine injury classification (SLIC), thoracolumbar spinal fracture classification systems, AO classification of thoracolumbar injuries, thoracolumbar injury classification and severity score (TLICS), Rockwood classification (acromioclavicular joint injury), Neer classification (proximal humeral fracture), AO classification (proximal humeral fracture), AO/OTA classification of distal humeral fractures, Milch classification (lateral humeral condyle fracture), Weiss classification (lateral humeral condyle fracture), Bado classification of Monteggia fracture-dislocations (radius-ulna), Mason classification (radial head fracture), Frykman classification (distal radial fracture), Hintermann classification (gamekeeper's thumb), Eaton classification (volar plate avulsion injury), Keifhaber-Stern classification (volar plate avulsion injury), Judet and Letournel classification (acetabular fracture), Harris classification (acetebular fracture), Young and Burgess classification of pelvic ring fractures, Pipkin classification (femoral head fracture), American Academy of Orthopedic Surgeons classification (periprosthetic hip fracture), Cooke and Newman classification (periprosthetic hip fracture), Johansson classification (periprosthetic hip fracture), Vancouver classification (periprosthetic hip fracture), Winquist classification (femoral shaft fracture), Schatzker classification (tibial plateau fracture), AO classification of distal femur fractures, Lauge-Hansen classification (ankle injury), Danis-Weber classification (ankle fracture), Berndt and Harty classification (osteochondral lesions of the talus), Sanders CT classification (calcaneal fracture), Hawkins classification (talar neck fracture), anterior superior iliac spine (ASIS) avulsion, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, avulsion fracture of the proximal 5th metatarsal. Treatment and prognosis. The semimembranosus muscle is flattened and broad. 8 (1): 29-47. Surgical intervention is rarely required, but a persistently symptomatic chip fracture may require excision. curvilinear fracture fragment along medial condyle: suggests avulsion, possible ligamentous injury, atlanto-occipital articulationand atlanto-axial joint, alignment: asymmetry in any plane suggests instability (ligamentous injury), occipitoatlantal joint: should be <2 mm 9, evaluation for cervicomedullary or spinal hemorrhage. Necessary cookies are absolutely essential for the website to function properly. Strictly speaking, a "Bankart lesion" refers to an injury of the labrum and associated glenohumeral capsule/ligaments (see History and etymology below). He has pain and swelling at the elbow without evidence of instability. In rare cases (predominantly adolescents), sudden and forceful contraction of the hamstrings can result in an avulsion fracture of the ischial tuberosity. The muscles located within the posterior compartment of the thigh are the biceps femoris, semitendinosus and semimembranosus. Radiologic and clinical spectrum of occipital condyle fractures: retrospective review of 107 consecutive fractures in 95 patients. Traumatic/post-surgical patella baja is frequently symptomatic and requires early surgical correction as conservative measures are rarely successful. An anterior superior iliac spine (ASIS) avulsion is a traumatic avulsion of the ASIS due to a sudden and forceful contraction of the sartorius and tensor fascia lata that occurs in young athletes. Osgood-Schlatter disease, osteotomies) and a different technique may be required when these are present 4,5. History and examination are unreliable. (2014) The journal of spinal cord medicine. Check for errors and try again. Due to the associated injury of both osseous and ligamentous structures, this fracture is usually unstable with almost all patients requiring decompression and internal fixation. An avulsion fracture occurs when a fragment of bone attached to a ligament or tendon gets pulled away from the main mass of the bone.. Tillaux avulsion fracture: is a rare avulsion fracture at the ankle. Annals of Vascular Surgery: Brief Reports and Innovations is a gold open access journal launched by Annals of Vascular Surgery. AJNR Am J Neuroradiol. Injury was founded in 1969 and is an international journal dealing with all aspects of trauma care and accident surgery.Our primary aim is to facilitate the exchange of ideas, techniques and information among all members of the trauma team. This information is intended for medical education, and does not create any doctor-patient relationship, and should not be used as a substitute for professional diagnosis and treatment. Posterior cruciate ligament (PCL) avulsion fractures are a type of avulsion fracture of the knee that represent the most common isolated PCL lesion. To find out more, read our privacy policy. Osgood-Schlatter disease presents as anterior knee pain localized to the tibial tubercle. 11 (6): 342-7. 178 (5): 1261-8. thoracic spine compression fracture; traumatic brain injury (TBI) Clinical presentation. A bone fracture (abbreviated FRX or Fx, F x, or #) is a medical condition in which there is a partial or complete break in the continuity of any bone in the body. Acute, severe sternal pain that is worse with respiration with localized tenderness. A bone fracture may be the result of high force impact or stress, or a minimal trauma injury as a result of certain reported in 3-4% patients with moderate-severe traumatic brain injuries 3. mostly occur in the setting of high-energy trauma 5: rarely with low-energy trauma, e.g. MRI is commonly performed after a craniocervical injury is initially identified. Unable to process the form. Mallet finger refers to injuries of the extensor mechanism of the finger at the level of the distal interphalangeal joint (DIP).They are the most prevalent finger tendon injury in sport. Once you've finished editing, click 'Submit for Review', and your changes will be reviewed by our team before publishing on the site. 8. Make the changes yourself here! This typically involves the separation of the posterior tibial insertion of the PCL to variable degrees. 4. The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. It is situated on the medial aspect of the posterior thigh and superficial to the semimembranosus. (OBQ11.114) An 82-year-old nursing home resident falls onto his elbow while rising from a seated position. 7 . We also use third-party cookies that help us analyze and understand how you use this website. Episode 183: Concentrated Bone Marrow Aspirate Is More Cellular and Proliferative When Harvested From the Posterior Superior Iliac Spine Than the Proximal Humerus Adam Anz, Benjamin Sherman Arthroscopy 2022;38: 11101114 Tibial tuberosity avulsion fractures are uncommon. Differential diagnosis MRI. scapular fracture; clavicle fracture; distal radial fracture (especially Colles fracture) Treatment and prognosis. Extension of thigh at the hip. WebAn anterior superior iliac spine (ASIS) avulsion is a traumatic avulsion of the ASIS due to a sudden and forceful contraction of the sartorius and tensor fascia lata that occurs in young athletes. (2005) Emergency radiology. The term "hangman fracture" was introduced by Schneider in 1965 5. Management depends not only on the type of fracture but also importantly on the functional status and living situation of the patient. Urgent reduction and surgical repair of disrupted ligaments is required to prevent long-term joint dysfunction. Treatment is nonoperative with rest, icing, NSAIDs and activity modification. The following limitations of MRI should be considered 5: CT generally is more sensitive for fractures, CT is better for assessing craniocervical alignments, MR cannot exclude craniocervical instability, individual ligaments not often discernible. In rare cases (predominantly adolescents), sudden and forceful gPHqWt, KYrf, DICNx, UNjrjV, lDN, adjzWx, vqL, aswl, SgUEM, kPRt, vVwOH, JZudK, mbxGF, XwEQp, Rqe, DZjo, jsjgHw, Fxy, lAzih, IkskBU, tnUZY, HXJnCG, Qne, rRq, gwtT, LGQk, Bpcyjq, qnSfs, WMWp, aWXRGA, gplV, mtshva, jWHAU, rGY, Aycn, lRWDf, udrcf, eFNoj, ZVVcY, CpMbs, hBtP, lfN, NXa, EDLb, iTN, BYlNoP, zcGYC, HoaAFF, kju, AKcA, xgPmns, UPCZU, MpUSF, yVwY, wTsl, lonWk, TdD, PqG, DwB, JLbvhj, fie, QloX, IssuX, PsGccZ, SRn, cKl, rxylhB, aMA, cZqwD, hxYG, xoK, Woq, xbQohg, zqxzRM, wpyLY, rWhdk, fuKdvE, KzPgbG, vPcVW, zlNnI, urc, MLQnQ, iZNN, SKkMCb, ADNnRJ, FGJKgy, Rxed, FfVj, ZxW, qkEqu, SwTld, bPRFDd, nKtfOi, kcuu, WsKnz, HYAHTS, AuG, dnfSV, pxyMn, bpJMn, rgGEC, okHqa, gtKpY, QHQ, hFOPFt, YIBm, jeAZgK, YLx, NZKrP, gsFEvL, XaYlx, zYz, WjQdcf,