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Locking Radial Plate Systemfor Radial Reconstruction andfor Radial and Ulnar Shortening
Hand Surgery
FAROS Recon
Our core competence is hand surgery, a field where we can offer youmuch more than just standard treatment solutions for, say, distalradial fractures. Many of our products are intended to help you toachieve outstanding results in difficult, non-everyday situations aswell. Products such as our ulnar head prosthesis (UHP) or the FlowerPlate for mediocarpal partial arthrodesis (4-corner fusion) are excellentexamples of this.
Our objective is to simplify hand surgery interventions through intelli-gent system solutions, helping you to achieve the best possible results inthe interest of the patient. Working in close cooperation with well-knownauthors and their teams, we have translated new ideas into innovativeproducts that are consistently being developed further in an ongoingprocess. The result is a wide range of high-quality systems that impresswith their clever design along with easy and safe handling.
And what’s more, we have never lost sight of the economic perspectiveand service needs of our customers.
We consider ourselves as a true partner – to be relied upon for routinetasks and special challenges alike.
3
INNOVAT ION: s imple , fa s t and user- f r i end ly
Table of Contents –FAROS Recon
System presentation Pages: 4 – 5
Form, advantage, benefit
FAROS C surgical technique Pages: 6 – 11
For radial displacement osteotomy
URS mini surgical technique Pages: 12 – 17
For radial and ulnar shortening
The product range Pages: 18 – 29
Standard sets and options
4
DES IGN: FAROS Recon
FAROS radial correction plates are innovative implants specially designed,in form as well as technique, for correcting the distal radius. Based on closecollaboration with renowned hand surgeons, a plate system has been createdthat covers almost all of the treatment options available for radial corrections.
Form, advantageand benefit
5
T-Drive screw head
Advantages Benefits
� All screws of the system featurea T-Drive socket of identical size
� Self-retaining
� Excellent force transmission
� Easy handling
� Safe screw implantation
� Reduced socket rounding risk
Standard and locking screws
� Ø 2.7-mm and 3.5-mmstandard screws
� Ø 2.7-mm and 3.5-mmmultidirectional locking screws
� A small, self-explanatory selectionof screws provides for safe bonestabilization in almost any situation
Faros C
URS mini
� Plate design specially matchedto radial correction needs
� Different holes to allow bothstandard screws and multidirec-tional locking screws to be used
� Secure repositioning and fixationof the distal fragment
� Highly stable system for correctbone position throughout thehealing process
� Atraumatic plate design
� Round holes allowing the useof multidirectional locking screws
� Premounted drill guidesand saw guides
� Less soft tissue irritation
� Extremely stable implant,despite its small size
� Easy handling of the systemthanks to exact orthogonal drillingand a parallel osteotomy creatingsmoothly cut surfaces
Dotize®: type II anodization� Increased strength,compared with titanium alloy
� Smooth surface
� Enables the use of plates witha relatively low profile
� Inhibits tissue adhesion andbone in-growth
� Supports easy removal of themetal implant
� Reduces rate of metalosis
Fati
gue
Str
engt
h
TI6AI4Vnon anodized
TI6AI4Vanodized type II
10721239(N) 1600
1400
1200
1000
800
600
400
200
0
6
SURGICAL TECHNIQUE : FAROS C
FAROS C – Step by stepto optimal fixation
Indications
Palmar corrective osteotomy of malunited radial fractures of
� types A2/A3 acc. to AO classification
� type A 3.2 acc. to AO classification
Preoperative planning
Preoperative planning of corrective osteotomies requires X-raystaken in the A/P and sagittal planes.
The sagittal X-rays are used to draw sketches of the plannedosteotomy (see next page).
7
Fig. 1:The dorsal tilt of the radial joint surface (here: 22°)is determined by way of a lateral X-ray. The resultis then compared with the palmar inclination(here: 10°) of the non-injured side to define thedesired joint position. The correction angle(here: 32°) is equivalent to the sum total of bothangles (dorsal tilt plus intended palmar inclination).
Advantageously, the osteotomy angle (here: 16°) isidentical with the bisector of the correction angle.
Fig. 2:Proximally, the distally fixed plate stands off fromthe shaft of the radius at the same angle as deter-mined for the malposition. This ensures that,following osteotomy, the shaft of the plate adaptssnugly to the shaft of the radius as soon as thedesired joint position is reached when openingthe osteotomy.
Correction in the sagittal planeActual situation: -22° Target: +10°� Correction angle: 32°� Bisector: 16°
22°
16°
10°10°
16°
16°
dorsal palmardorsal palmar
Osteotomy
32°
32°
10°
Intended joint position
Osteotomy
8
SURGICAL TECHNIQUE : FAROS C
Surgical technique: Dr. Prommersberger (M.D., P.D.), Bad Neustadt (Germany)
Fig. 3:Ulnar inclination correction:Actual situation: +16°Target: +25°� Correction angle: 9.0°� Bisector: 4.5°
To determine the correction andosteotomy angles for ulnar inclination,a sketch is drawn as well. The APX-ray of the non-injured side providesthe reference value for the intendedulnar inclination (here: 25°).The correction angle (here: 9°) is thencalculated as the difference betweenthe targeted ulnar inclination and theflattened ulnar inclination (here: 16°)of the injured side. Convenientlyagain in this case, the osteotomyangle (here: 4.5°) corresponds tothe bisector of the correction angle.
Fig. 5:X-ray example of a shortened anddorsally tilted radius. The erosion ofthe lunate caused by the traumaticulnar impaction syndrome is clearlyvisible.
Fig. 4:The required ulnar height of thebone block depends on ulnar feed.
16°
25°
4.5°4.5°4.5°
9°
3.5 mm
3.5 mm16°
25°
3.5 mm
9
Fig. 7:The first extensor tendon compart-ment is opened.
Fig. 8:After opening the third extensortendon compartment, the extensorpollicis longus tendon is lifted.
Fig.6:Radiopalmar approach:A Y-shaped skin incision approx. 7 cmlong is made on the distal radius.
10
SURGICAL TECHNIQUE : FAROS C
This step requires:
Non-cannulateddepth gauge
T-Drivescrewdriver
Drill bit,2.0 mm
Fig. 9:The brachioradial muscle is partiallydetached at the point of insertion.Thereafter, the quadrate pronatormuscle is pushed off the radiustowards ulnar together with the longflexor muscle of the thumb and theradial artery.
To provide a smooth contact surfacefor the plate, it is usually necessaryto ablate the palmar edge of the firstextensor tendon compartment.
Fig. 11:Once all distal screws have beenplaced, the planned osteotomy ismarked out and the plate removed.
The osteotomy site is located proxi-mally to the distal, locking screwholes, in the bisector of the plannedcorrection angle in both planes.
The osteotomy is performed assketched, using an oscillating saw.
Fig. 10:A radial plate of correct size isselected. To facilitate plate positio-ning, the drill-bit centering sleeve(26-276-03-07) can be mountedin advance to serve as a joystick.
The plate is now attached to theradius. Using the centering sleeve,the holes for the 2.7-mm lockingscrews (26-502-xx-09) are drilledwith the 2.0-mm bit (26-937-20-07).Each screw is inserted with thescrewdriver before drilling the nexthole.
Centeringsleeve, 2.0 mm
11
This step requires:
Fig. 13:The bone chip is inserted into theosteotomy gap. A 3.5-mm lag screwcan be used to fix it securely in place.
Notice:To harvest the bicortical bone chipfrom the iliac crest, for example, thelarge iliac crest mill (23-190-06-07)can be used.
Fig. 14:After irrigating and cleaning thewound, the capsule and the ligamentstructures are carefully restored.A final X-ray is then taken.
Finally, the patient is provided with asterile dressing and a dorsal forearmplaster splint.
Fig. 12:Upon completion of the osteotomy,the plate is again fitted to the radiusdistally. Subsequently, the osteotomygap is widened to cause the plateshaft to attach to the shaft of theradius. If necessary, plate-holdingforceps can be used for provisionalfixation of the plate in the proximalregion.
The length of the osteotomy gap isnow correctly adjusted under X-raycontrol and the plate fixed in placein the proximal region using 3.5-mmscrews.
Non-cannulateddepth gauge
2.0-mmdrill bit
Centeringsleeve, 2.0 mm
2.5-mmdrill bit
3.5-mmgliding hole bit
12
SURGICAL TECHNIQUE : URS min i
URS mini – Step by stepto optimal fixation
Indications
� Ulnar impaction syndrome
� Radial impaction syndrome
Notice:
When shortening the radius, the plate is preferably inserted byusing a radiopalmar (alternatively: dorsal) approach. The osteo-tomy is performed orthogonally to the plate. As no lag screw isrequired in this case, the 6-hole plate version (26-163-06-09)is sufficient. No saw guide is used in this procedure.
13
Preoperative planning
Preoperative planning is carried out by X-rays taken in the A/Pand lateral beam paths.
Positioning
The patient is placed on the back with the upper arm exsanguinated.The arm is placed on a hand table, with the forearm in full supinationposition.
14
SURGICAL TECHNIQUE : URS min i
Fig. 1:X-ray example of an ulnar impactionsyndrome.
Fig. 3:The incision is then continued betweenthe flexor and extensor musclesthrough the intermuscular septum.This is followed by exposure of theulna, with the quadrate pronatormuscle being carefully pushed off thebone in the distal section of the ulna.
Fig. 2:Ulnopalmar approach:A skin incision approx. 8 cm longis made over the distal ulna.
Such ulnopalmar access providesfor secure soft-tissue coverage ofthe plate.
Surgical technique: Prof. Krimmer, Ravensburg (Germany)
15
Fig. 5:Using the premounted drill sleeves,the holes for the 2.7-mm screwsare now drilled with the 2.0-mm bit(26-937-20-07).
Note that the three distal holes areto be filled with locking (fixed-angle)screws (26-502-xx-09), whereas the(elongated) proximal holes are intendedfor standard screws (26-901-xx-09).
Fig. 6:After the holes have been drilled,the sleeves are removed with thescrewdriver. This is followed by lengthmeasurement using the universaldepth gauge (26-945-60-07).
Thereafter, the screws are inserted inthe sequence shown above, startingmonocortically.
Fig. 4:Once the ulna has been completelyexposed, the shortening plate is putin place along the inner edge on thepalmar side, approx. 3 cm awayproximally from the distal end.
Notice:If the plate does not rest flatly on thebone in this area, precise adaptationto the ulnar surface will be necessaryin order to prevent plate tilting afterthe osteotomy.Plate adaptation is done with thebending pliers (25-229-25-07).
1 3 4 2
This step requires:
Non-cannulateddepth gauge
Bending pliers 2.0-mm drill bit
16
SURGICAL TECHNIQUE : URS min i
This step requires:
2.5-mmdrill bit
Hooklet,blunt
Fig. 7:Depending on the width of the inten-ded osteotomy, the appropriate sawguide (3 mm, 4 mm or 6 mm) isselected and placed underneath theplate as shown above. As this requireslifting the plate slightly, it may benecessary to loosen the screws alittle.
Notice:The fixing grooves of the saw guideare placed in the 3rd distal hole andon the distal edge of the central elon-gated hole.
To assure stable fixation of the sawguide during the sawing process,the screws must be retightened.
max. 15
mm
max.0,5 mm
ca. 4
0m
m
Fig. 9:Upon removing the parallel, cortico-cancellous bone chip, the 3rd distal,2.7-mm locking screw (26-502-xx-09)is inserted as well and screwed inplace bicortically together with theother distal screws.
Thereafter, the osteotomy gap isclosed by pulling the plate with theblunt hooklet (15-075-01-07).
To assure complete closure of theosteotomy gap, ulnar duction of thewrist may be necessary in addition.
Fig. 8:The saw guide enables you to performa parallel osteotomy directly below the4th distal hole.
To make sure that the finely toothedsaw blade can oscillate freely withinthe guide slots, it should be dimen-sioned as follows:
� Thickness: max. 0.5 mm� Width: max. 15 mm� Length: approx. 40 mm
Upon completion of the osteotomy,the screws are loosened a little againto remove the saw guide.
17
This step requires:
Fig. 11:The remaining elongated hole abovethe osteotomy is filled with a 2.7-mmstandard screw for additional stability,using the lag screw technique.The required hole is created with the2.0-mm drill bit (26-937-20-07) andthe 2.7-mm drill bit (26-937-27-07).
Fig. 12:After irrigating and cleaning thewound, the capsule and the ligamentstructures are carefully restored.A final X-ray is then taken.
Finally, the patient is provided with asterile dressing and a dorsal forearmplaster splint.
Fig. 10:To fix the osteotomy closure, the twoproximal screws are now tightenedin their elongated holes. Then thecentral proximal hole is drilled withthe 2.0-mm bit (26-937-20-07) andfilled with a 2.7-mm locking screw(26-502-xx-09).
Non-cannu-lated depthgauge
2.0-mmdrill bit
Non-cannu-lated depthgauge
2.0-mmdrill bit
2.7-mmdrill bit
T-Drivescrew-driver
L R
RL Screw positionin plate
Screw positionin plate
18
PRODUCT RANGE: s tandard se t s and opt ions
FAROS Recon implantsFAROS C radial plates
Palmar radial platesThe bold-type item numbersare recommended for inclusion in set.
26-172-10-09
right side
26-172-11-09
left side
26-173-10-09
right side
26-173-11-09
left side
1⁄1 1⁄1 1⁄1 1⁄1
Dotize® unit(s)1
Dotize® unit(s)1
Dotize® unit(s)1
Dotize® unit(s)1
R Screw positionin plate
L
with tab26-171-11-09
left side
19
with tab26-171-10-09
right side
Icon explanations
Titanium, Dotize®
Items/pack
Multidirectionallocking holes
Plate profile
unit(s)1
Dotize®
1⁄1 1⁄1
Dotize® unit(s)1
Dotize® unit(s)1
20
PRODUCT RANGE: s tandard se t s and opt ions
FAROS Recon implantsURS miniUlnar and radial shortening plates
Ulnar shortening plate, small26-163-07-09
= 1.9 / 3.2 mm
Radial shortening plate, small26-163-06-09
= 1.9 / 3.2 mm
1⁄11⁄1
Palmar platesThe bold-type item numbersare recommended for inclusion in set.
Dotize® unit(s)1
Dotize® unit(s)1
21
1⁄1
for drill bitmax. Ø 2.0 mm
Screws Ø 2.7 mm
Icon explanations
Titanium, Dotize®
Items/pack
Multidirectionallocking holes
Plate profile
unit(s)1
Dotize®
max. Ø 2.0 mm
22
PRODUCT RANGE: s c rews
FAROS Recon implantsScrews
Length Item No. Item No.8 mm10 mm12 mm 26-502-12-09 26-504-12-0914 mm 26-502-14-09 26-504-14-0916 mm 26-502-16-09 26-504-16-0918 mm 26-502-18-09 26-504-18-0920 mm 26-502-20-09 26-504-20-0922 mm 26-502-22-09 26-504-22-0924 mm 26-502-24-09 26-504-24-0926 mm 26-502-26-09 26-504-26-0928 mm 26-502-28-09 26-504-28-0930 mm 26-502-30-09 26-504-30-0932 mm 26-502-32-09 26-504-32-0934 mm 26-502-34-09 26-504-34-0936 mm 26-502-36-09 26-504-36-0938 mm 26-502-38-09 26-504-38-0940 mm 26-502-40-09 26-504-40-09
Screws Multidirectional,locking cortical screws
Ø 2.7 mm
Multidirectional,locking cortical screws,
Ø 3.5 mm
unit(s)1
set2
set2
set4
set4
set4
set4
set2
set2
set2
set2
set2
set2
set2
set2
set2
set2
set2
set2
set2
set2
The bold-type item numbersare recommended for inclusion in set.
Icon explanations
Items/set
Items/pack
Titanium
T-Drive, non-cannulated
Multidirectionallocking holes
Ø 2.7 mm
Ø 3.5 mm
set1
unit(s)1
Length Item No. Item No.8 mm 26-901-08-09 26-903-08-0910 mm 26-901-10-09 26-903-10-0912 mm 26-901-12-09 26-903-12-0914 mm 26-901-14-09 26-903-14-0916 mm 26-901-16-09 26-903-16-0918 mm 26-901-18-09 26-903-18-0920 mm 26-901-20-09 26-903-20-0922 mm 26-901-22-09 26-903-22-0924 mm 26-901-24-09 26-903-24-0926 mm 26-901-26-09 26-903-26-0928 mm 26-901-28-09 26-903-28-0930 mm 26-901-30-09 26-903-30-0932 mm 26-901-32-09 26-903-32-0934 mm 26-901-34-09 26-903-34-0936 mm 26-901-36-09 26-903-36-0938 mm 26-901-38-09 26-903-38-0940 mm 26-901-40-09 26-903-40-09
Screws Standard corticalscrews
Ø 2.7 mm
Standard corticalscrews
Ø 3.5 mm
unit(s)1
set4
set2
set2
set4
set4
set4
set4
set4
set2
set2
set2
set2
set2
set2
set2
set2
set2
set2
set2
set2
set2
set2
set2
set2
The bold-type item numbersare recommended for inclusion in set.
23
24
PRODUCT RANGE: s torage module and set l i s t
Suggested setInstruments
The selection of instruments described below represents abasic set needed for the implantation of FAROS C as well asURS mini plates.
Additional instruments are specifically required in each case.These are listed on the right and shown on page 28 for FAROS C.
The instruments and saw guides additionally required for URSmini plates are depicted on page 29.
FAROS instrument set
55-910-76-07 FAROS storage module, complete
26-276-03-07 FAROS A centering sleeve for 2-mm drill bits
26-931-27-07 Forefoot and hindfoot soft-tissue sleeve, 2.7 mm
26-931-35-07 Forefoot and hindfoot soft-tissue sleeve, 3.5 mm
26-937-20-07 Twist drill, Ø 2.0 mm
26-937-25-07 Twist drill, Ø 2.5 mm
26-937-35-07 Twist drill, Ø 3.5 mm
26-945-60-07 FAROS universal depth gauge, 60 mm
26-950-11-07 AO handle with silicone insert, black
26-952-00-07 T-Drive bit, T8, non-cannulated / AO attachment/coupling
25-229-25-07 Bending pliers for locking (fixed-angle) plates
Additionally required for FAROS C
26-937-35-07 Gliding hole drill, 3.5 mm
Additionally required for URS mini
26-166-03-07 Saw guide for parallel cut, 3 mm
26-166-04-07 Saw guide for parallel cut, 4 mm
26-166-06-07 Saw guide for parallel cut, 6 mm
15-075-01-07 Hooklet, blunt
26-937-27-07 Gliding hole drill, 2.7 mm
25
Icon explanations
Items/set
Items/pack
set1
unit(s)1
set1
unit(s)1
set2
unit(s)1
set1
unit(s)1
set1
unit(s)1
set1
unit(s)1
set1
unit(s)1
set1
unit(s)1
set1
unit(s)1
set1
unit(s)1
set1
unit(s)1
set2
unit(s)1
set1
unit(s)1
set1
unit(s)1
set1
unit(s)1
set1
unit(s)1
set1
unit(s)1
set1
unit(s)1
26
PRODUCT RANGE: FAROS basi c s e t
Instrument setFAROS
1⁄2 1⁄2
Soft-tissue sleeve
26-931-27-07
15 cm/6"
Ø 2.7 mm
Soft-tissue sleeve
26-931-35-07
15 cm/6"
Ø 3.5 mm
1⁄2
Bending pliersfor locking plates25-229-25-07
17 cm / 66⁄8"
unit(s)1
unit(s)1
unit(s)1
27
Icon explanations
Steel
Items/pack
Silicone
T-Drive, cannulated
T-Drive, non-cannulated
Ø 2.7 mm
Ø 3.5 mm
unit(s)1
Sic
110 mm
80 mm
115 mm
85 mm
1⁄21⁄2 1⁄2 1⁄2 1⁄2 1⁄2
Centering sleevefor drill bits,non-cannulated26-276-03-07
Ø 2.0 mm
Core hole drill
26-937-20-07
Ø 2.0 mm
Core hole drill
26-937-25-07
Ø 2.5 mm
Universaldepth gauge
26-945-60-07
18 cm/7"
Silicone handle
26-950-11-07
11.5 cm / 4 4⁄8"
Screwdriver bit,non-cannulated
26-952-00-07
unit(s)1
unit(s)1
unit(s)1
unit(s)1
unit(s)1 Sicunit(s)
1
28
PRODUCT RANGE: FAROS basi c s e t
Additionally required instrumentsFAROS Recon
Centering sleeve
26-185-35-07
Ø 3.5 mm
1⁄2
Cortical tap
26-938-35-07
11.5 cm / 4 4⁄8"
Ø 3.5 mm
1⁄2
Tamper
23-198-08-07
15.5 cm / 61⁄8"
Ø 3.5 mm
1⁄2
Drill bit
26-937-35-07
11.5 cm / 4 4⁄8"
Ø 3.5 mm
1⁄2
FAROS CThe bold-type item numbersare recommended for inclusion in set.
unit(s)1
unit(s)1
unit(s)1
unit(s)1
Gliding hole drill
26-937-27-07
Ø 2.7 mm
29
Saw guidefor parallel cut26-166-03-07
Distance: 3 mm
Saw guidefor parallel cut26-166-04-07
Distance: 4 mm
Saw guidefor parallel cut26-166-06-07
Distance: 6 mm
Hooklet, blunt
15-075-01-07
17 cm / 66⁄8"
URS miniThe bold-type item numbersare recommended for inclusion in set.
Icon explanations
Steel
Items/pack
T-Drive, cannulated
T-Drive, non-cannulated
Ø 2.3 mm
Ø 3.5 mm
unit(s)1
max. 15
mm
max.0,5 mm
110 mm
80 mm
1⁄21⁄2 1⁄2 1⁄2 1⁄2
unit(s)1
unit(s)1
unit(s)1
unit(s)1
unit(s)1
30
Should any more questions remain …… just contact us!
Apart from our range of products specially tailored to the requirementsposed by traumatological and reconstructive interventions in hand surgery,we also offer you a wide selection of different systems for use in classicaltraumatology.
Please do not hesitate to order our Special Catalog for the Upperand Lower Extremities, which is available in printed and digital form (CD).To facilitate the ordering process for you, we have created a specialOrder Form that is available on request at any time.
Of course, you can reach us personally at your convenience,either by e-mail – [email protected] –or telephone (customer hotline): +49-7461-706-109.
SERV ICE : in format ion mater ia l and cata log s
31
FAROS Recon references
Prommersberger K.-J., Lanz U.Die Korrekturosteotomie der fehlverheilten distalen Radiusfrakturvom ExtensionstypOperative Orthopädie und Traumatologie 1998;10:77-89
Prommersberger K.-J., Moossavi S., Lanz U.Ergebnisse der Korrekturosteotomie fehlverheilterExtensionsfrakturen der Speiche an typischer StelleHandchir. Mikrochir. Plast. Chir. 1999;31:234-240
Prommersberger K.-J., van Schoonhoven J.Korrektureingriffe nach distaler RadiusfrakturUnfallchirurg 2007; 110:617-630
Prommersberger K.-J., van Schoonhoven J.Fehlverheilte Extensionsfraktur des distalen RadiusUnfallchirurg 2007; 110:631-636
Prommersberger K.-J., van Schoonhoven J.Störungen des distalen Radioulnargelenkes nach distalerRadiusfrakturUnfallchirurg 2008; 111:6173-186
Prommersberger K.-J., Lanz U.B.Corrective osteotomy of the distal radius through a volar approachTechniques of Hand and Upper Extremity Surgery 2004;8:70-77
Prommersberger K.-J., van Schoonhoven J., Lanz U.B.Outcome after corrective osteotomy for malunitedfractures of the distal end of the radiusJ Hand Surg (Br.) 2002; 27: 55-60
Prommersberger K.-J., van Schoonhoven J.,Laubach S., Lanz U.Corrective Osteotomy for Malunited, Palmarly DisplacedFractures of the Distal RadiusEur J Trauma 2001; 27:16-24
Prommersberger K.-J., Fernandez D.L.Nonunion of Distal Radius FracturesClinical Orthopaedics and Related Research2004;419:51-56
FAROS C videoDVD90-167-31-04
URS videoDVD90-738-39-04
Special Catalogfor the Upper andLower Extremities
Printed version90-851-48-06
CD version90-851-38-06
11.09 . 90-601-02-04 . Printed in Germany · Copyright by Gebrüder Martin GmbH & Co. KG · Alle Rechte vorbehalten · Technische Änderungen vorbehaltenWe reserve the right to make alterations · Cambios técnicos reservados · Sous réserve de modifications techniques · Ci riserviamo il diritto di modifiche tecniche
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KLS Martin Group
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