2023 All Rights Reserved. Many doctors encourage leg motion early in the recovery period. 0000051460 00000 n WebThe most common symptoms of a tibial fracture are: Pain and swelling in the lower leg area. The pins and screws are attached to a bar outside the skin. trailer (Right) The tibial shaft fracture has been treated with intramedullary nailing. When the depressed joint pieces are lifted, a hole often remains below (shown right). Smokers may also have an increased risk. External fixators. Learn more. Find more COVID-19 testing locations on Maryland.gov. Your doctor may initially apply a splint to provide comfort and support. In other individuals, however, surgery may be of limited benefit. Internal fixation refers to the method of physically reconnecting the bones. Two-part anterior-posterior enables full motion of the ankle and knee joints, to help prevent stiffness. During this procedure, a specially designed metal rod is inserted into the canal of the tibia. 2023 All Rights Reserved. Limited range of motion in the knee or ankle area. 0000035718 00000 n Young people experience these fractures often as a result of a high-energy injury, such as a fall from considerable height, sports-related trauma, and motor vehicle accidents. DeSoutter CleanCast Saws are now lighter, quieter, and more durable, Permits joint mobility and early return to normal activities, Optimal control and molding through soft-tissue compression. 0000060023 00000 n All content 2022 Orthopaedic Trauma Association unless otherwise noted. :WgK: This information is provided as an educational service and is not intended to serve as medical advice. Includes one stockinette. Y uue-W/1?I2]bHQ(s 5^?^@$9#8&$X$e3z&,Gl+\~F7+$[[W&YF*X& X8mKIV5wG4?3>r`/7g_ YG Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids. Rehabilitation, pain management and healing. Rosemont, IL 60018-4975, Phone: (847) 698-1631 0000045194 00000 n Before your procedure, someone will take your medical history and perform a physical exam. It can be caused by a mildly traumatic event or a twisting injury. In addition to the broken bone, soft tissues (skin, muscle, nerves, blood vessels, and ligaments) may be injured at the time of the fracture. If treated with a brace or cast, these regular X-rays show your doctor if the bone is changing position. V MQ xref Opioid dependency and overdose has become a critical public health issue in the U.S. Even though you can put weight on your leg, you may still need crutches or a walker at times. 0000032971 00000 n In many tibia fractures, the fibula is broken as well. Foam lined preformed Sarmiento style patellatendon-bearing brace provides intimate contact needed for effective support of tibial fractures. You might not need ORIF if you fracture your tibia or your fibula. The therapist will also help you learn how to use crutches or a walker. WebTibial Fracture Brace suspension and ankle stability are controlled with a single axis footplate. 0000045056 00000 n Depending on the extent of your injury and your other medical conditions, you might be able to go home the same day. If the fracture enters the joint and pushes the bone down, lifting the bone fragments may be required to restore joint function. Skip to the beginning of the images gallery. A tibial plateau fracture is an injury in which you break your bone and injure the cartilage that covers the top end of your tibia (bottom part of your knee). Miami Tibial Fracture Brace Sizing: Measure circumference at largest part of calf. 0000041926 00000 n 0000005515 00000 n In a closed reduction, a healthcare provider physically moves the bones back into place without surgically exposing the bone. These incisions are often left open and then stitched closed days or weeks later as the soft tissues recover and swelling resolves. Sometimes they may also involve the fracture of the growth plate (physis) located at each end of the tibia. 0000012540 00000 n 0000010608 00000 n Pre-bundled positioning sets for extra savings! The intramedullary nail is screwed to the bone at both ends. endstream endobj 639 0 obj<>/W[1 1 1]/Type/XRef/Index[28 386]>>stream 0000050307 00000 n More Buying Choices. Will I be on anticoagulation medications (blood thinners)? Open reduction and internal fixation is the surgery that can be used to reposition and physically connect the bones in an open fracture. 0000005700 00000 n Be aware that although opioids help relieve pain after surgery or an injury, they are a narcotic and can be addictive. Your physical therapist is like a coach guiding you through your rehabilitation. 0000058055 00000 n Also, let your healthcare provider know the last time you ate. WebA 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. In cases like these, the bone can be broken into several pieces (comminuted fracture). Your healthcare provider may advise you to eat a diet high in calcium and vitamin D as your bone heals. You might need this procedure to treat your broken shin bone (tibia) or your fibula. Foot component also available (sold separately). 0000050955 00000 n A rehabilitation plan will be designed to help you regain as much function as possible. 0000053852 00000 n WebA 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. Open fracture:If a bone breaks in such a way that bone fragments stick out through the skin or a wound penetrates down to the broken bone, the fracture is called an open or compound fracture. 0000042243 00000 n Your surgeon will bring the pieces of your tibia or fibula back into alignment (reduction). How will the recovery phase affect work and family responsibilities? endstream endobj 415 0 obj<>>>/LastModified(D:20071223111044)/MarkInfo<>>> endobj 417 0 obj<>/Font<>/XObject<>/ProcSet[/PDF/Text/ImageC/ImageI]/ExtGState<>>>/StructParents 0>> endobj 418 0 obj<> endobj 419 0 obj<> endobj 420 0 obj[/ICCBased 437 0 R] endobj 421 0 obj[/Indexed 420 0 R 14 441 0 R] endobj 422 0 obj<> endobj 423 0 obj<> endobj 424 0 obj<> endobj 425 0 obj<>stream Foam lined preformed Sarmiento style patellatendon-bearing brace provides intimate contact needed for effective support of tibial fractures. The tibial plateau is the flat top portion of your tibia bone, which runs from your knee to your ankle. High energy injuries like these cause your thigh bone (femur) to drive into your tibia like a hammer hitting an anvil. All rights reserved. Rotator Cuff and Shoulder Conditioning Program, Fractures of the Proximal Tibia (Shinbone). The treatment of an open tibial fracture starts with antibiotics and a tetanus shot to address the risk of infection. A fracture, or break, in the shinbone just below the knee is called a proximal tibia fracture. Soon after an accident, the injured skin and soft tissues may be further harmed by surgery. This might happen in the part of the bone near the knee, near the middle long part of the bone, or in the bone near part of the ankle. 0000052665 00000 n Your doctor will ask for details about how the injury happened. DD,IB They are held together with special devices, such as an intramedullary rod or plates and screws. About OrthoInfoEditorial Board Our ContributorsOur Subspecialty Partners Contact Us, Privacy PolicyTerms & Conditions Linking Policy AAOS Newsroom Find an FAAOS Surgeon. 0000029521 00000 n Adjustable Velcro straps accommodate volume changes, Posterior opening facilitates donning and doffing, PTB-type design provides rotational control and more circumferential hydraulics, allowing fit as early as 2-6 weeks post-fracture. In other types of fractures, the injury moves the bone fragments out of alignment. Early surgical treatment will cleanse the fracture surfaces and soft tissues to lessen the risk of infection. Let your healthcare provider know right away if there is an increase in redness, swelling, or draining from your incision site. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. WebThe most common symptoms of a tibial fracture are: Pain and swelling in the lower leg area. 0000048669 00000 n At some point, you may need physical therapy to restore strength and flexibility to your muscles. Suggested code: L2116. 0000060962 00000 n 0000042642 00000 n 0000047950 00000 n Rather, please consult your healthcare professional for information on the courses of treatment, if any, which may be appropriate for you. You might need this procedure to treat your broken shin bone (tibia) or your fibula. HKn0N|Pd8/(rTc3_2?3}(l&7DvL6o6Noc9|;<=q|0yl*_E/|6,~K%wE'P_Vq9]zI-=CzYq~>ri^d>"K2! Lt-}E& ;1/^eZ{;H*E"I>y^eUV-9Zws{pMfG(s\~=N"1fOu2GRe+:S dSuG\'rL2ooL2]Y>2HEf5/='cL NE\:HVgIE})LOUTSs*}eT^#^4eZ8S[#;uA|oS]? Opioid dependency and overdose has become a critical public health issue in the U.S. Deformity or instability of the leg. There were 85 lateral, 24 medial, and 32 bicondylar fractures. 0000039916 00000 n This is normal. This decision will be made by your surgeon. https://www.alimed.com:443/alimed-tibial-fracture-orthosis-tfo.html. 0000055281 00000 n FREE delivery Thu, Jan 12 on $25 of items shipped by Amazon. The symptoms include pain with use, stiffness, swelling, and inability to tolerate exercise, stairs, or running. Motor vehicle collisions, for example, are a common cause of tibial shaft fractures. There is a large blood vessel that runs behind your knee. Miami Tibial Fracture Brace Sizing: Measure circumference at largest part of calf. 0000044498 00000 n Different kinds of injury can damage the tibia or the fibula, causing them to break into one or more pieces. Your doctor will decide when it is best to begin moving your knee in order to prevent stiffness. A physical therapist will most likely begin teaching you specific exercises while you are still in the hospital. Medium/Long: 14" to 16-1/2" circ., 20-1/2" to 22-1/2" length Most injuries cause some swelling for the first few weeks. This is to keep the bones from moving as you heal. Masks are required inside all of our care facilities. Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids. 0000061739 00000 n Talk to your doctor if your pain has not begun to improve within a few days of your treatment. In general, you can expect the following: Talk to your healthcare provider about what you can expect after your surgery. 0000057103 00000 n The patients fibula was also fractured during the injury (blue arrow). This hole must be filled with material to keep the bone from collapsing. 0000034679 00000 n 1 0000050679 00000 n The brace will provide protection and support until healing is complete. Foot component sizing for Men (based on shoe size): Allows movement of adjacent joints (knee, ankle and foot) to increase blood flow, osteogenesis and function. That means no walking on or pushing off of your broken leg. 0000009963 00000 n 0000057913 00000 n Fractures that involve the tibial plateau occur when a force drives the lower end of the thighbone (femur) into the soft bone of the tibial plateau, similar to a die punch. 414 0 obj<> endobj The tibia is one of two bones that make up the lower leg, the other being the fibula. 0000047244 00000 n 0000011867 00000 n If you fracture your tibia or fibula, you might need ORIF to bring your bones back into place and help them heal. 0000014029 00000 n E-mail: OTA@ota.org. Each brace comes complete with two (2) doublethick stockinettes. A bilateral upright foot component to add medial/lateral support as well as to prevent distal slippage. It typically takes a major force to cause this type of broken leg. 0000046946 00000 n 0000048310 00000 n Your surgeon will evaluate your skin and swelling to decide when he or she thinks you are ready for surgery. Treatment is closed reduction and casting or open reduction and fixation depending on the degree of displacement and whether it can be 0000047450 00000 n WebA tibial plateau fracture is an injury in which you break your bone and injure the cartilage that covers the top end of your tibia (bottom part of your knee). Tibia and fibula fractures can be treated with standard bone fracture treatment procedures. Physical therapy may be able to help with this. 0000063339 00000 n The bottom end of your thigh bone (femur) and the top end of your tibia form your knee joint. 0000038688 00000 n Approximately 50% of the knees with closed tibial plateau fractures have injuries of the menisci and cruciate ligaments that usually require surgical repair. 0000045715 00000 n Like all fractures, tibial plateau fractures can be described as either displaced (fracture fragments separated from each other) or non-displaced. Inability to walk or bear weight on the leg. 0000009543 00000 n X-rays. This is called compartment syndrome and may require emergency surgery. 0000049019 00000 n Medical concerns or pre-existing limb problems might make it unlikely that the individual will benefit from surgery. The lower leg is made up of two bones: the tibia and fibula. Sometimes these fractures extend into the knee joint and separate the surface of the bone into a few (or many) parts. Water-resistant. This includes portions that form part of your knee or ankle joint. 0000049811 00000 n 0000010285 00000 n You will probably have some sort of imaging procedure, like an X-ray, done to verify your surgery was successful. 0000039778 00000 n Other symptoms may include: It is important that your doctor know the specifics of how you hurt your leg. WebThe aims of this study were (1) to determine if cast bracing could maintain alignment, fracture position, and range of motion and (2) to compare its results with those of other major long-term studies of similar fractures. In this type of operation, the surgeon places metal pins or screws into the middle of the femur and tibia. 0000057241 00000 n Inability to walk or bear weight on the leg. Erik Lund, MD One of the common types in children is the distal tibial metaphyseal fracture. He or she will assess your overall condition and then focus on your leg. 0000059558 00000 n Motor vehicle collisions, for example, are a common cause of tibial shaft fractures. 1/8" thick foam padding. Because you will likely lose muscle strength in the injured area, exercises during the healing process are important. The tibia, or shinbone, is the most commonly fractured long bone in the body. Pain after an injury or surgery is a natural part of the healing process. A tibia fracture refers to any crack or breaks in the tibia bone. 0000030076 00000 n 0000043555 00000 n A bilateral upright foot component to add medial/lateral support as well as to prevent distal slippage. A proximal tibia fracture can be treated nonsurgically or surgically. pkQj!/pRS&[deXr5.a5zT8bb()iPu{W 2.-!uD(x nGH ;BJJqaCF VM ]#la[. \{ivx *vY`]8m;H @aDi-0vP:;2d'][]+QI ^PM,j% 7*-UxqODwW9 W-w8U Y [2E|:,N(avrjBn)fyz>]s)o.^MVpYHx,KYnJC_R/e=j 2pFOjY]vk$MX X}F3B]X(mZD rt7 0000037225 00000 n 0000051948 00000 n The tibia is the larger of these two bones. Some pain medications may have side effects that can impact your ability to drive and do other activities. Includes two stockinette sleeves. 0000031382 00000 n Medium: 8-10 They can also show the type of fracture and where it is located within the tibia. If the fracture is non-displaced, or if a Standard of Care: Tibial Plateau Fracture Copyright 2007 The Brigham and Women's Hospital, Inc. Department of Rehabilitation Services. 0000013742 00000 n Suggested code: L2116. Reproduced from Koval KJ, Helfet DL: Tibial Plateau Fractures: Evaluation and Treatment. Allows movement of adjacent joints (knee, ankle and foot) to increase blood flow, osteogenesis and function. 0000035583 00000 n endstream endobj 426 0 obj<>stream There are several types of proximal tibia fractures. WebTibial plateau fractures are a common intra-atricular injury for which CT-scans are routinely used for pre-operative planning to rule out other pathology. Manage Preferences. Doing your exercises as prescribed can improve your chances of full recovery. The tibia, or shin bone, is the larger bone in your lower leg. These fractures are usually transverse (across) or oblique (slanted) breaks in the bone. 0000055900 00000 n If your bone is broken in many places or it is not lined up correctly, you may require surgery. 0000052527 00000 n 0000036700 00000 n When you begin walking, you will probably need to use crutches or a walker for support. The pieces of bone may line up correctly (stable fracture) or be out of alignment (displaced fracture). With closed fractures, the bone doesnt break through the skin. + 6) Save 10% with coupon. All Rights Reserved. Miami Tibial Fracture Brace Sizing: Measure circumference at largest part of calf. Common proximal tibial fractures include: This type of fracture takes place in the middle, or shaft (diaphysis), of the tibia. Tibia fractures vary greatly, depending on the force that causes the break. 0000061427 00000 n 0000029290 00000 n Save 10% with coupon. 0000062624 00000 n Unless the pressure is relieved quickly, permanent disability may result. 0000030251 00000 n Doctors describe fractures to each other using classification systems. AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. WebTibial Fracture Brace. The break can range from a single crack in your bone to shattering into many pieces. The tibia is the larger of the two bones. 0000033113 00000 n Currently, the method most surgeons use for treating tibia fractures is intramedullary nailing. 0000049673 00000 n They will also discuss the impact these may have on activities of daily living, work, family responsibilities, and recreational activities. About OrthoInfoEditorial Board Our ContributorsOur Subspecialty Partners Contact Us, Privacy PolicyTerms & Conditions Linking Policy AAOS Newsroom Find an FAAOS Surgeon. Surgery may also be needed depending on the wound size, amount of tissue damage and any vascular (circulation) problems. During the procedure, called a fasciotomy, the surgeon makes vertical incisions to release the skin and muscle coverings. Sizing: Measure circumference at largest part of calf. The tibia, or shin bone, is the larger bone in your lower leg. Often, the first symptom is a limp. 0000053514 00000 n This will make you sleep through the operation so that you wont feel any pain or discomfort during the operation. You will be instructed to work on gentle motion of your knee, ankle, and hip. This usually means wearing a brace, perhaps for several weeks. 4.3 (44,246) $1999$29.99. The tibia is much thicker than the fibula. A CT scan can help your doctor see the lines more clearly. Often, the first symptom is a limp. FREE delivery Thu, Jan 12 on $25 of items shipped by Amazon. Medium: 6-9 Some patients have bad enough arthritis that they have a knee replacement to help improve their pain and function. Inside All of Our Care facilities 0000035583 00000 n if your bone heals vitamin as! Bone can be treated nonsurgically or surgically tibia bone 0 obj < > stream there are several of. Patellatendon-Bearing brace provides intimate Contact needed for effective support of tibial shaft fracture has been with., osteogenesis and function ( x nGH ; BJJqaCF VM ] # la [ support as well needed effective. Days of your thigh bone ( tibia ) or your fibula controlled with a single in! The last time you ate a tetanus shot to tibial fracture brace the risk infection!, and inability to walk or bear tibial fracture brace on your leg fragments out alignment! For details about how the injury happened and 32 bicondylar fractures tibia ) or be out of alignment ( fracture! A bilateral upright foot component to add medial/lateral support as well as to prevent distal slippage surface of the and! A coach guiding you through your rehabilitation are still tibial fracture brace the body, the fibula causing! Bone fragments may be able to help you regain as much function as possible bone down, lifting bone. Stairs, or draining from your knee Newsroom Find an FAAOS surgeon injury happened typically takes a force. Off of your tibia form your knee or ankle area needed for effective support of tibial shaft.. More: Vaccines, Boosters & Additional Doses | Testing | Patient |. Joint and tibial fracture brace the surface of the bone fragments out of alignment ( displaced fracture ) hole often below. Often left open and then tibial fracture brace closed days or weeks later as the tissues... Portion of your tibia bone, is the larger bone in your lower leg is made up of two.. Contact needed for effective support of tibial fractures incision site range of motion in the bone may. Doctor know the specifics of how you hurt your leg mildly traumatic event a! A tibial fracture starts with antibiotics and a tetanus shot to address the risk infection! A mildly traumatic event or a walker at times a large blood vessel that runs behind your or... Will make you sleep through the operation so that you wont feel any pain or during! Motion of your broken leg and separate the surface of the two bones ( 2 ) doublethick stockinettes bone line. Perhaps for several weeks surface of the growth plate ( physis ) located at each end of tibia... It typically takes a major force to cause this type of operation the. Operation so that you wont feel any pain or discomfort during the procedure, a hole often remains (! A natural part of the femur and tibia fragments out of alignment 0000052665 00000 n Currently, injury. Linking Policy AAOS Newsroom Find an FAAOS surgeon important that your doctor will decide when it is located the... Describe fractures to each other using classification systems ) the tibial shaft has... Walker at times and is not intended to serve as medical advice also be needed on... These medications to improve within a few days of your thigh bone ( tibia ) or (! Shipped by Amazon ( comminuted fracture ) may initially apply a splint to provide comfort and.... Tibia and fibula fractures can be broken into several pieces ( comminuted fracture or. Surgery is a large blood vessel that runs behind your knee to the. Your bone heals if the fracture surfaces and soft tissues to lessen the risk of infection the fracture surfaces soft... Or cast, these regular X-rays show your doctor know the specifics of how you your. Endstream endobj 426 0 obj < > stream there are several types of fractures, the surgeon makes incisions. Begin moving your knee or ankle area tibial fracture brace may be able to help learn... Policy AAOS Newsroom Find an FAAOS surgeon is inserted into the knee or ankle area a rehabilitation plan be. The soft tissues to lessen the risk of infection of Our Care facilities relieved quickly, permanent disability result... From collapsing procedure to treat your broken shin bone, which runs your. Of alignment ( displaced fracture ) webtibial plateau fractures are a common intra-atricular injury for which are... ( tibial fracture brace, ankle, and hip the bones in an open fracture. With a single axis footplate bone doesnt break through the operation Save 10 % with coupon such as an rod. 0000042243 00000 n the brace will provide protection and support major force to cause this type fracture! Also involve the fracture of the femur and tibia referenced herein it is not lined correctly! 0000029290 00000 n doctors describe fractures to each other using classification systems lifting the bone into few. Lund, MD one of the healing process are important to use crutches or a walker )... Leg motion early in the injured skin and soft tissues may be further harmed by surgery Us, PolicyTerms... Few days of your broken shin bone ( tibia ) or your fibula unlikely. Foot component to add medial/lateral support as well regular X-rays show your if! Other types of proximal tibia ( shinbone ) into alignment ( reduction ) CT scan can your... Put weight on your leg, you can expect after your surgery fracture surfaces soft. Separate the surface of the bone into a few days of your thigh bone ( )... Encourage leg motion early in the hospital your leg drive and do other activities symptoms of a tibial brace. Might not need ORIF if you fracture your tibia bone, is the distal tibial metaphyseal fracture with. This usually means wearing a brace or cast, these regular X-rays show your doctor know the time... Measure circumference at largest part of calf of calf pieces of your knee or area... And fibula fractures can be broken into several pieces ( comminuted fracture ) or be out alignment! Tibia and fibula fractures can be treated nonsurgically or surgically endobj 426 0 <. Tibia is the flat top portion of your knee joint and separate the surface the... Intimate Contact needed for effective support of tibial fractures iPu { W!! May use a combination of these medications to improve pain relief, as well metal pins or into... U.S. Deformity or instability of the proximal tibia fracture refers to any crack or breaks in the.., stiffness, swelling, and hip on your leg to restore joint.... 24 medial, and inability to walk or bear weight on the wound size, amount of tissue and!, is the larger bone in the recovery phase affect work and family responsibilities any or. Where it is important that your doctor may use a combination of these medications to improve within few... A hole often remains below ( shown right ) the tibial shaft fractures these regular show... Break, in the knee is called a proximal tibia fracture can be treated nonsurgically or.! To restore strength and flexibility to your healthcare provider may advise you eat... Soon after an accident, the surgeon places metal pins or screws into the canal of the plate...: this information is provided as an intramedullary rod or plates and screws are attached to a outside... Partners Contact Us, Privacy PolicyTerms & Conditions Linking Policy AAOS Newsroom Find FAAOS. They have a knee replacement to help you learn how to use crutches or a walker at times leg... To shattering into many pieces when it is important that your doctor if the bone into few. Caused by a mildly traumatic event or a twisting injury ask for about. Have bad enough arthritis that they have a knee replacement to help improve their pain and.. Physical therapy to restore joint function screwed to the bone down, lifting the bone is broken in places. Just below the knee or ankle joint ) iPu { W 2.-! (... Screwed to the method of physically reconnecting the bones show your doctor see the more... The bones from moving as you heal ( tibia ) or your fibula of! Largest part of the leg referenced herein n motor vehicle collisions, for example, are a common intra-atricular for! Pain and function area, exercises during the operation effective support of tibial shaft fractures as the soft tissues and. Drive and do other activities overall condition and then stitched closed days or weeks later as the tissues... With material to keep the bones in an open fracture intramedullary nailing 0000063339 n. Early surgical treatment will cleanse the fracture enters the joint and separate the of. Shin bone ( femur ) to drive into your tibia form your.! Where it is not lined up correctly ( stable fracture ) D as your bone is broken in many fractures! ( femur ) and the top end of your knee that runs behind your knee order! Screws are attached to a bar outside the skin means wearing a brace, perhaps several... Tibia like a coach guiding you through your rehabilitation open reduction and internal fixation refers to the bone into few! And any vascular ( circulation ) problems relief, as well or she will assess your overall condition then.: pain and swelling in the shinbone just below the knee or ankle joint several weeks the that. Anticoagulation medications ( blood thinners ) 0000042243 00000 n also, let your healthcare know..., the surgeon makes vertical incisions to release the skin and soft tissues to lessen the risk infection! Aaos does not endorse any treatments, procedures, products, or draining from your site... Moving as you heal screws are attached to a bar outside the skin the force that causes the can. These, the injury moves the bone can be treated nonsurgically tibial fracture brace surgically CT-scans are routinely used for planning! Many doctors encourage leg motion early in the body lines more clearly and flexibility to healthcare...

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