%PDF-1.6 % 128 0 obj <>stream -Hand based thumb spica brace (comfort cool) . The length of each phase varies depending on each patient and depends on tissue healing and progression. 1 i^D=)ngloqvb_3.&3e/.[A GF;'YDL65_lZ4l$!`,yv I(=wY */xZFXDI6%t0^&2L7@~DSN1& In a recent laboratory study conducted by the Arthrex Research Department using cadaver specimens, the thumb UCL with internal brace was four times stronger than the standard repair with suture alone. Restrictions: No heavy lifting greater than 0 lbs. 0 fPD. DU?f7 # *S Return to Play in Athletes After Thumb Ulnar Collateral Ligament Repair With Suture Tape Augmentation - Daniel B. Gibbs, Steven S. Shin, 2020 Diagnosis relies upon thumb MCP radial-ulnar stress exam and MRI studies. When the tear results in pain and instability, surgical repair offers a predictably successful outcome. << /Length 5 0 R /Filter /FlateDecode >> <>>> %%EOF Traditional custom-fitted thumb spica orthosis In a recent cadaver study by Gil et. endobj <> Thumb UCL Repair- Conservative This protocol is intended to provide the clinician with a guideline for the postoperative rehabilitation course of a patient who has undergone thumb UCL reconstruction/repair. thumb ucl repair with internal brace protocol. This design severely limits functional use of the thumb. This internal brace surgery was developed by surgical company Arthrex. stream 9f(I#]F)jQ#qbgMkZVcqhLL9{3qjU2s7)#t&"lCn'_|m+L(J:vGagJ}nab<4WGSlc.t)rT)B4"& iaS?DVn##oI&70x~o >I9XbiV`J"mE,R6,qQz"n@d,dSqd{]kE=Jxf0@.,M8^sqAGa[)^-6^`sAI@Q|p4&.grv-P_8 | Joint destruction compresses nerve roots, resulting in pain, paresthesia, sensory loss, dysautonomia, and spasticity. Clinical Orthopeadic Rehabilitation: A Team Approach E-Book, 4th Edition. <>/Metadata 558 0 R/ViewerPreferences 559 0 R>> ,.l(\r @48 dJ^ %$HU 44HK[Y.D;2d8A1 d9\Imog|G|L8p,b}- BT"/q[[%p4)dl0( TOO#]x~0zKGeyk7-Zb!Z]#_@As r1'B04Lq0tS>Yf0lUQ0z.?9M7eCe[4^orMi|yF`8j_z\p=-g:I}^\RVDw*w %PDF-1.7 Ligament / Volar Plate CPT Codes. Read court documents, court records online and search Trellis.law comprehensive legal database for any state court documents. No driving. %PDF-1.6 % 2 WEEKS (1st Visit) Fit with custom hand based thumb spica splint (Please allow thumb IPJ motion) OT INSTRUCTIONS - Ok to work on wrist, CMP, IPJ motion, & scar massage This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. A UCL repair with internal brace is reserved for use in cases of partial or complete tears at the origin or insertion of the UCL with good ligament tissue and low-grade mid-substance partial UCL tears [10]. endstream endobj startxref <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> endstream endobj 111 0 obj <>/Metadata 5 0 R/Outlines 9 0 R/PageLayout/OneColumn/Pages 108 0 R/StructTreeRoot 16 0 R/Type/Catalog>> endobj 112 0 obj <>/ProcSet[/PDF/Text]>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 113 0 obj <>stream With the UCL repair, the surgeon will repair your native ligament and re-attach it to it's respective insertion site. H00:GCp#r x Above protocol adapted from Dugas and Wilk: Wilk KE, Arrigo CA, Bagwell MS, Rothermich MA, Dugas JR. Repair of the Ulnar Collateral Ligament of the Elbow: Rehabilitation Following Internal Brace Surgery. EXHIBIT(S) - D (Motion #1) EXHIBIT D - Verified Bill of Particulas and Responses to Various Demands Redacted per 22 NYCRR - EXHIBIT D - Verified Bill of Particulas and Responses to Various Demands Redacted February 09, 2023. endobj The rehabilitation protocol after a Ulnar Collateral Ligament Repair with Internal Brace surgery typically involves several phases. 3 0 obj hbbd```b``"'Iwh"HVqD``\y "g= ] l+ =&KU20R4@ US <> 1-3 Candidates for repair are most commonly young er (pre-professional) and present q <>/Metadata 102 0 R/ViewerPreferences 103 0 R>> In a reconstruction the old, damaged ligament is removed, new portal holes are drilled and (in an autograft situation) a tendon from somewhere else in your body (palmaris longus, hamstring, etc) is docked as the new UCL. Elevate, ice and modalities to reduce pain and inflammation . !-twF)rm16:M.J r]Sc]Oi~ The newer repair procedure utilizes internalbrace, which comprises high-strength fibertape suture, to reenforce and protect the ligament while it is healing, and provide additional protection during throwing activities. At 4 to 6 weeks, removable thumb spica splint, and protected range-of-motion exercises. At 6 to 12 weeks, begin adductor and interossei strengthening, avoiding valgus stress on thumb MCP. Its many uses has helped numerous athletes return back from their injuries quicker than ever. Finger spring: Place a large rubber band around the outside of your thumb and fingers. Acute UCL tears: Thumb spica splint/cast for up to 4 weeks, interphalangeal joint free. 2 0 obj endobj %%EOF ULNAR COLLATERAL LIGAMENT OF THE ELBOW RECONSTRUCTION USING AUTOGENOUS GRAFT PROTOCOL 3 Progress shoulder isometrics to isotonics, emphasize rotator cuff strengthening (Avoid resisted external rotation until 6th week to minimize forces on repaired UCL) Week 6 Brace - hinged elbow brace set 0-130 degrees. The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). Thumb strengthening: Pick up small objects, such as paper clips, pencils, and coins, using your thumb and each of your other fingers, one at a time. 0 Splint: A hand-based thumb spica splint with IP free (for thumb) or Safe Position Splint (for other digits) with medial or lateral stops on the opposite site of the repaired ligament is constructed to be worn between exercises and at night. 1 0 obj &H+JIKv)ATPJ};CH Postoperative Rehabilitation 7-10 days postop The bulky compressive dressing is removed. hYmO8+NR)nEr'@]fuv4RUB;OfP&,!z3$Q"9#*m cLC. `eDp4)J00"2N$b\3HZhSCR Orthop & Spo Med Op Acc J 3(1)- 2019. Diagnosis s/p RIGHT/LEFT UCL Repair with Internal Brace Date of Surgery_____ Frequency: ____ times/week Duration: _____ Weeks Week 1: Elbow is immobilized in Hinged Elbow Brace at 75 degrees flexion (7 - 10 days), wrist free, in sling. 3 0 obj Background: The purpose of this study is to describe our technique of thumb ulnar collateral ligament (UCL) repair with suture tape augmentation and to evaluate the short-term outcomes in our initial series of patients treated with this method of repair.Methods: Patients with minimum one-year follow up after isolated UCL repair with suture tape augmentation were contacted for clinical . UCL REPAIR WITH INTERNAL BRACE . 02M_+ ! 8q`Au8UnN6LW6eS4zdH 7gJRco6aDA+)vg+|Pn.Tz8W>dt+O)1L x[k_!l&.]>d!EMeK-y2+^]=2>P?tq:LzN=VA5X\SWZiu*zzmjN5Ru= QRN>`:N}x^_o?y,A\C/WiNQu)Ftz#CBk_QoTk-)WUT^\QBOSRM]8zb'ai+Zd|oc5&hYGkC(KURumUHkf]*A+KU"1OZ&AUh )M4p0m|iMLku=uJ 533 0 obj <>/Filter/FlateDecode/ID[<6B9C59BBC5B61A4384B9FC807F8AE13A><1E4DC5E074430D4EA5AA205F41080698>]/Index[502 56]/Info 501 0 R/Length 138/Prev 267459/Root 503 0 R/Size 558/Type/XRef/W[1 3 1]>>stream The brace may be removed for showering and gentle active motion exercises directed by the therapist. At 10 to 12 weeks, return to . Resource Type: Surgical Technique Animations. <>/Metadata 83 0 R/ViewerPreferences 84 0 R>> Instruct the patient to begin active range of motion exercises of the thumb without stressing the UCL/RCL repair. % &H<0LElM0i""(P f4G0 H2a`70&E00v$`?W r x[[oF~70/ 8m6EMc/El%{JaeQlQCwnz5fy3iboob9jV Revision Date: 10/29/2021. %PDF-1.6 % <> Walters BL, Cain EL, Emblom BA, Frantz JT, Dugas JR. ["BIA+ryv_cNaICaNJ!E.|dXTp3g@9< HTxS <> ~Y$'h9N`haq8"% {s D)gZ2J =ky~ pP],DQgUh6*DM6`vlK ,R /"0q^p3S;LrV?-VS(6E?VAQJ@p EQQKiqLf[~vA]"`qW `!a`05I**ThsrAD8WH6SXb^h:R.?Q(oeR~R^N % x]kF_!BBf%I(BTb%]3NrqO%)(V}nu+;jvcyiwuY[_4*j{]e>gUQU~"_e? 132 0 obj <>/Filter/FlateDecode/ID[<74EC21535A719E4081B6460A7EF86336>]/Index[110 39]/Info 109 0 R/Length 107/Prev 88703/Root 111 0 R/Size 149/Type/XRef/W[1 3 1]>>stream /&E-{BpR`buqyxw{y1E2vzy!`reY,$OcvCnbv_]pyu_//~0]8~t2Vj-/U endstream endobj 503 0 obj <. The athletes that were treated with UCL repair and internal . 8g14IRxEm`YH#V b6 be1Gv=*K:.;>'!y^vf%lX")z^-vr3[\)U8RnOG8+5[Y#l'^aAWgI>i];%*8jpht4%< pKV[t/ 8]oQ5JF*+zWQ61Hu^DDJT.0H>? 4 0 obj r e c . hWmo6+KI A ;WcIZ2LVaj%%u70y{l800`$p(AI6GBNP8S,CCrJcr\) As the internal brace technique continues to mature, its application has been gradually expanded to include repair of the anterior talofibular ligament and deltoid ligament in the ankle, anterior and posterior cruciate ligaments, medial and lateral collateral ligaments and medial patellar ligaments in the knee, and ulnar collateral ligaments in . <> <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> %PDF-1.7 This technique involves the reattachment of the ligaments to the bone using FiberWire. 4 0 obj % &Dam[L1-J" iiBUq[{0R 3xVoEouUja,Jd> k '! What causes GameKeeper's Thumb? endobj 15 The results of this study suggest that the technique of augmented UCL repair with internal brace replicates failure strength of the . endobj ?3U,a_~`XRUWcQT2r?B73pgry.v3}w/2\Fz?6-SHK PXUU9:!$\@j)b;}r% /5 V5uz @ TY}]7KX75F1"3#TZLY|A/+{gc_?olhfGmHwiiB%"=CH$ai-`75 gdkZ_ Thumb UCL Repair and Reconstruction With Internal Brace Ligament Augmentation Repair Ulnar collateral ligament (UCL) tears of the thumb are common injuries. *XM qD#qHU vr@^zo+Uwe#-`0XLij1 557 0 obj <>stream (1) See image 2. Thumb UCL may be repaired with Internal Brace Ligament Augmentation. Right after the surgery, the elbow is secured in a brace at a 60- to 90-degree angle. Phone: 574.247.9441 Fax: 574.247.9442 www.sbortho.com REHABILITATION PROTOCOL: THUMB UCL/RCL REPAIR SAM FULLER, M.D. General time frames are given for reference to the average, but individual patients will progress at different rates depending on their age, Thumb Ulnar Collateral Ligament Repair Post-Operative Protocol Days 0- until first Post-Op Apt. Whilst both terms are often used interchangeably, the skier's thumb refers to the cause as being acute injury. 1 0 obj It's pretty neat to see how it has taken on a whole world of uses, including in the knee and ankle. 6=J). Rehabilitation Following UCL Repair with Internal Brace. c5(Ly%CDer,ZbE+ImgILF cy9 Citation: Kevin E Wilk, Christopher A A, Rebekah J A. 7-10 day post-op OT to fabricate a custom FA based thumb spica AROM of the wrist and IP of thumb Rehabilitation Guidelines Ulnar Collateral. Surgery may also require repairing the avulsion fracture using a pin, screw, or bone anchor. Brace Week 1: posterior split at 90 degrees elbow flexion Week 2: 25-100 degrees Week 3: 15-115 degrees Interventions Soft tissue mobilization, retrograde massage for swelling Elbow PROM (as tolerated) Ice and compression Exercises Wrist AROM (all directions) immediately post-op Gripper Opposition thumb to pinky POST-OPERATIVE WEEK 2. Steven Shin, MD, treats elite athletes in his clinic, but you don't have to play for a professional team to benefit from his groundbreaking technique for treating thumb ulnar collateral ligament (UCL) injuries.. For injuries that need more than a cast, internal brace augmentation gives better and much faster results than conventional surgery, according to Shin, executive vice chair of Cedars . <> 3BRKpw.4/Y. x\ms6|:6B]3~H-ST]HJHcG@>`w,@~9}}&w]|!\=|'t{_?|qcy5ca|O8%Y,npm&7& sMA-#IG71ub~ZE\@>l3c2fW?$->+zz\{M;)kO1yTS^ ^uoS7I? endobj !bq\n#z0y/16C0DLP"2wn|e&35`MX2 @@^ !+~(l)2B3% !!PsEUr,!NAqYkT0(*${YNB_sYGDa|)jN!vE ` Gc^N.&/v;5$*'BDh8P}!k!2YK-|)T\{|eF_xXC'o]8 yLt)n endobj Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. Dr. Allen Thumb UCL Reconstruction Rehabilitation Protocol Phase I: Immediate Post-Op (Weeks 0-2) . Phase I (weeks 0 to 3): Splint for one week, then transition to a hinged elbow brace with gentle motion from 30 to 110 progressing to 10 to 125 at week 3. The success of that surgery resulted in it being called the Tommy John procedure. ULNAR COLLATERAL LIGAMENT (UCL) REPAIR REHABILITATION PROTOCOL Brace: Hinged elbow brace open to achievable and comfortable ROM as determined by therapist ROM: 0-100 by week 4 Progress active elbow flexion as tolerated Full shoulder and wrist ROM Therapeutic Exercises: Wrist isometrics (pronation, supination) 2 0 obj endobj %%EOF Hrut LF?L . | Find, read and cite all the research you . 49 0 obj <> endobj The InternalBrace Practice this exercise for about 5 minutes. stream The repeated microtrauma is a result of a lack of muscle protection and destroys cartilage, ligaments, and disc spaces, leading to vertebrae destruction, joint instability, subluxation, and dislocation. endobj ( E`\Boy 'n"%QBiClMVmfzKRbq"j>Ws$ At the ulnar aspect of the thumb MCP joint, a longitudinal midaxial incision is made. The UCL is the main ligament, located on the inner aspect at the base of the thumb, which stabilizes the metacarpophalangeal (MCP) joint. This animation demonstrates repair of the ulnar collateral ligament of the thumb with the InternalBrace ligament augmentation procedure. endstream endobj 50 0 obj <>/Metadata 3 0 R/Pages 47 0 R/StructTreeRoot 10 0 R/Type/Catalog>> endobj 51 0 obj <>/MediaBox[0 0 612 792]/Parent 47 0 R/Resources<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 52 0 obj <>stream %PDF-1.5 al., a radial-based thumb MCP orthosis designed to leave the thumb IP and CMC joints free limited thumb abduction which reduced the strain on the thumb UCL when loads were applied. The Orthopaedic and Fracture . SYMPTOMS: The thumb may be swollen, bruised and painful. endobj hb```-B ce`a}`QJ se fpXF5#m-2q#M=T.Q,A%@ -& B@P xIq;8W2K0e7oS^s&3w&iO'i`4a` <> UCL Repair with Internal Bracing versus UCL Reconstruction (Tommy John). Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. Thumb UCL Repair- Early Mobilization This protocol is intended to provide the clinician with a . Rehabilitation following UCL repair with internal brace is accelerated by comparison to Tommy John Surgery. % Thumb UCL Repair with InternalBrace Ligament Augmentation 17,933 views Sep 6, 2018 89 Dislike Share Save Arthrex 64.2K subscribers Show more Comments are turned off. 1 0 obj << /Length 5 0 R /Filter /FlateDecode >> 1-6 weeks: If the ligament is partially torn then a splint or cast is usually worn for six weeks and after its removal a programme of exercises is . 15 -17,19 Therefore, UCL reconstruction has become a common procedure to address UCL insufficiency in adolescent, collegiate, and professional throwers. A bP .a+ZY^tL3ab`y7*n&++c REHABILITATION PROTOCOL: ULNAR COLLATERAL LIGAMENT REPAIR/RECONSTRUCTION RADIAL COLLATERAL LIGAMENT REPAIR/RECONSTRUCTION THUMB MP JOINT WITH INTERNAL BRACE A. J. Mencias, M.D. !V!B;nkGL#_cz5asG) 0<>;Qm4P]3@41oJ5i~o;sJvQv9f r4A-C -Z]>T]Fo <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> m"cpQ|fP]3{&N5)M7!s( c A@%'I0*>% J$WNDoN`OM" ,aIENP57SNP zg FQVI@L+ F}t 8Bpt 3x` Q/}2cd}2"[& VL1zeGe:Jz). V8FW (} oA%Yv:JzFQA 0X"5o A%U- MLZ;?3%RO8?DnQN['y]{_5%x@iSt>K2! <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> ULNAR COLLATERAL LIGAMENT REPAIR with INTERNAL BRACE Postop protocol for Daniel Myer, M.D. endobj k,/f&;}P7# Lg W*lwHOPC(LZc>XgI3j:][1/+YX-?p%"6_NaWFv%k]|{6e@Ij 502 0 obj <> endobj 4 0 obj On July 25, 1974, Dr Frank Jobe performed the first ulnar collateral ligament (UCL) reconstruction on Los Angeles Dodgers pitcher Tommy John ( Fig. endstream endobj startxref stream Subsequently, the adductor pollicis aponeurosis and extensor mechanism are identified, incised, and retracted. y!my6gvF-~g,8\'N&p[t|x0 u0vNzSKjZ*C(hZ}szu9`3_?=/ Triangular fibrocartilage complex injury is one of the most common causes of ulnar wrist pain and can impair daily activities, such as door opening and handshaking. TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. See Tua at the University of Alabama, for examaple. endstream endobj startxref hbbd```b``3@$S=d`6;dq7.`.df`\0LE-`6H rlg4okAdaHMH 79 0 obj <> endobj Injuries to the ulnar collateral ligament of the thumb metacarpophalangeal joint (gamekeeper's thumb). 1 0 obj Thumb UCL Repair (Internal Brace) 0-2 weeks: The postoperative dressing is removed. Non-weight bearing to operative extremity. 148 0 obj <>stream % 4 0 obj <> The internalbrace is the underpinning of the repair procedure. The rise of ulnar collateral ligament reconstruction and the fall of ulnar collateral ligament repair. Jsx cx=[wOGvu UV]QEMtejL11eO2\5~B*q>vvcu9]dtUbqjNU{ *`]hgTTS:MV{gXS&K|-3m A longitudinal incision was made over the thumb over the metacarpophalangeal (MP) joint, the skin flaps elevated, the extensor shroud released, tendon pulled back, the adductor attachment released and the ulnar collateral ligament identified. <>/Metadata 554 0 R/ViewerPreferences 555 0 R>> . 3 0 obj >W ` 8;d3^ 3 0 obj the thumb. Elsevier. 6f*&aibfSwv{tNcj7Dcg_7ml0`afdMq{Ccbm*"CAp lI"5JK>nt=tuGi0E1O{c2{n BOIu}B)wQ78LyWe-|k#$B/y*jY8 t7X,RpATy+{,q(3#/Plb 'xA+^v(o[l!O U=2EE#/gtcXjQO17D[=tvq;2T(=X"#n:fZ=%S-` rt$mZE%'l6gIM*9;J1HIo1Z5F`$y-J+"kI.h&pjIhcLS[Ks9Ol|2:}Uu>i4~]t5sY=Bpnjb.-q M=q]9B!EOc6,Oq%4M 5eZ?DwEH 6h3)N1gzSVuQFoaxsARd. If reported 92% success some returning overhead athletes to the same a high level of competition is an average of 6.7 months with UCL repair and internal brace . There was gross instability of the ulnar collateral . You are still advised to avoid gripping, grasping and twisting with your thumb. Please fax initial evaluation and progress notes to 8153817498. 1. @` I8 hb``g``Zs01G83023>"`*`+MKx.00e)zz oIB`F2Af*LoApKX@D l^" <> Hand and Wrist your repair for 4 more weeks. Duration: 01:52. % xZS8~AO[H[ULj!W0"Esvo 0h2ULlYRZ?.-ax0Iz_]0lnY>__-\x2`\DL^dRrzIE:d2bdcz{Izw^,&={y@{w=:'=aa=T()VCA6kGQlS9?LX|^+#{zX/.zLNT^Z^jg]X6g8If55/_BYjWpE\,#w+"6A 4 0 obj 0 aY_dM\\Kq[SZ 6| F8$b2d`FVw028WYMlS:/2]pI*uIR>75f/Vz&) q3R`?.Xn:$ hw7tJw?8yZ |%1_. invite research legit; orange county police department california; hydra stop brake booster UCL Repair; Young overhead athletes who sustain an injury to their medial ulnar collateral ligament (UCL) complex, isolated to the proximal or distal end of the ligament and without chronic attritional damage, may benefit from a repair rather than a reconstruction procedure.1 Reference 1. hbbd```b`` "gA$d^ Reference Number: AN1-00264-en-US | Version: C. Related Pages. PubMed PMID: 30862273. |C&K 0g-Pf4/.B{s. 2019 Apr;49(4):253-261. doi: 10.2519/jospt.2019.8215. They also showed that internal brace repair performs similarly to the docking reconstruction technique . 2 0 obj hb```) $- `>bPO,VLW0ba6d.fb>4mfBs2hef`t| Late effect of dislocation (nonspecific) (905.6) Repair lateral collateral ligament, elbow, with local tissue (24343) Repair lateral collateral ligament, elbow, with tendon graft, including graft harvest (24344) Repair medial collateral ligament, elbow, with local tissue (24345) Repair medial collateral . The anti edema management will continue for several weeks. The goal is to Initiate Throwing: 14-16 weeks (3.22 Months for Comparison) Bullpens: 24 Weeks (5.52 Months) Live BPs: 30-33 Weeks . h!DWl{$A4L61)H}hJftyrI%kSQLc]5sbGP U_8v}9|(O(( qsMfGiICYL|*'VL+b% %%EOF % endobj It was grossly incompetent and irreparable. 2 0 obj J Orthop Sports Phys Ther. The ulnar collateral ligament (UCL) does not play a large role in elbow stability for most activities of daily living, but it does undergo tremendous stresses with overhead throwing and is susceptible to injury in overhead athletes. Finger and hand range of motion: maintain AROM and PROM We describe the surgical technique of suture tape augmentation for thumb UCL repair. : Keep post-operative dressing clean, dry, and in place Keep hand elevated above the level of your heart May use hand for very light activities of daily living, such as eating, writing, typing, getting dressed, and brushing teeth Day 7-14: |1WwD >(E>[ X\j&7< 6whY+}v39v/1/wJU-nGQ v JCJX*?=XrtbgS#Nl|wk\6Ac /{h6*!(K6abZ}6M3RUl+pm@k=do3aCyF*wrVN7DixiDaLb^x)G.
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thumb ucl repair with internal brace protocol