In this video we treat a patient with a posterior elbow dislocation. Hover on/off image to show/hide findings. {"url":"/signup-modal-props.json?lang=us\u0026email="}. Complex dislocations are really fracture-dislocations, and have markedly different management and prognosis. A complete elbow series consists of anteroposterior, lateral, and oblique radiographs of the elbow, and these diagnose most dislocations and subluxations. Standard radiographic examination of the elbow should include an anteroposterior view and a “true” lateral view, and occasionally oblique views may be of benefit. Posterior dislocations account for the majority of cases (95%). Q: What is the diagnosis? Elbow dislocation - Lateral The ulna has dislocated posteriorly from the trochlea of the humerus The radius has dislocated from the capitulum of the humerus The roll-over image shows the normal position post-reduction predominantly affects patients between age 10-20 years old; Pathophysiology In every dislocation the first question should be 'where is the medial epicondyle'. The posterior fat pad sign is the visualization of a lucent crescent of fat located in the olecranon fossa on a true lateral view of an elbow joint with the elbow flexed at a right angle indicating an elbow joint effusion.. following reduction, patients should be immobilized in a posterior splint with orthopedic follow-up in 1 week; Stimson Patient prone with elbow flexed at 90 degrees at edge of bed. Traumatic forearm and elbow injuries make up approximately 15% of emergency department visits for upper-extremity musculoskeletal injuries annually (1). Hang weight from hand, and if needed provider can push olecranon into place; Immobilize in long arm posterior mold with elbow in slightly less than 90deg flexion An elbow dislocation is not difficult to diagnose; the elbow deformity is readily evident and is associated with a marked pain, swelling, and tenderness of the elbow. Introduction Traumatic sternoclavicular joint dislocation is a very rare occurrence worldwide and is seen in only 0.5-3% of all injuries to the shoulder girdle [1]. Unable to process the form. The terrible triad occurs in approximately 10% of elbow dislocations and is more common with posterior dislocations. The ulna has dislocated posteriorly from the trochlea of the humerus; The radius has dislocated from the capitulum of the humerus; The roll-over image shows the normal position post-reduction elbow dislocations are the most common major joint dislocation second to the shoulder . Hover on/off image to show/hide findings. This video demonstrates the reduction of a posterior elbow dislocation that occurred during an automobile accident. For example, a person who is ice skating may fall backward and extend an arm to break his or her fall. Posterior elbow dislocation with proximal radioulnar translocation is an exceptional dislocation which mainly occurs in children. 34 yr old tight end/13th season Figure 7: a-b: PLRI. Elbow dislocations can also happen in car accidents when the passengers reach forward to brace for impact. The elbow joint has prominent joint recesses located in the coronoid and radial fossae anteriorly and within the olecranon fossa posteriorly. 2002;84:547–551. Figure 1: Posterior elbow dislocation in 59-year-old woman who fell on her outstretched hand. A plain radiographic workup should follow the initial physical examination (see section, “Radiographic Evaluation”). Most elbow dislocations are closed and are most frequently posterior (sometimes posterolateral or posteromedial) although anterior, medial, lateral and divergent dislocations are also infrequently encountered). show answer. The patient was referred to an orthopaedic surgeon, who recommended physical therapist management and the use of a hinged elbow brace for 4 weeks. most common dislocated joint in children; account for 10-25% of injuries to the elbow; posterolateral is the most common type of dislocation (80%) demographics . Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Lippincott Primary Care Musculoskeletal Radiology. Posterior dislocations typically occur following a fall onto an extended arm, either with hyperextension or a posterolateral rotatory mechanism 1. Q: What term is used when both coronoid process and radial head fractures are present in the setting of a posterior dislocation? Posterior dislocations are most common (90%) and may result from a fall onto an outstretched hand with a combination of axial, rotational, and varus (or valgus) force. The joint was successfully reduced in the emergency department. 3 weeks old) and should include generous procedural. show answer. Whereas the importance of early recognition of neurovascular compromise is well described and nearly universally recognized, the importance of timely and correct treatment in preventing delayed complications and potential instability is often less emphasized in the radiology literature. Anterior posterior (AP) and lateral projection of the elbow is routinely obtained first. In general, a clinical diagnosis of posterior elbow dislocation is sufficient, especially in adults. FIGURE 34.1 Lateral radiograph of the patient in the introductory case, showing a left elbow dislocation. Plain films of the elbow in the anteroposterior (AP) and lateral projections should be obtained to confirm the diagnosis and to determine the presence of fractures. Why? Anterior dislocations occur much less frequently as a result of direct trauma to the flexed elbow. Posterior shoulder dislocations account for only 2-4% of all shoulder dislocations (the vast majority are anterior) 1,3. <2 weeks) of immobilisation at 90 degrees of flexion usually suffices. It is so-called because of the difficulties encountered during management, and the often poor outcome. Q: What is meant by a 'simple' versus a 'complex' dislocation? When the hand hits the ground, the force is sent to the elbow. Shoulder - Posterior dislocation - AP. Elbow dislocations are classified by direction of dislocation as posterior, lateral, anterior, or divergent and also as simple or complex, depending on whether fractures are also present. Elbow dislocations occur during a variety of sporting activities, both contact and noncontact. Posterior elbow dislocations are painful; IV analgesia may be given prior to x-rays, and PSA—alone or combined with intra-articular anesthesia—is usually given for the procedure. show answer, Q: What are the most common associated fractures (not present in this case)? On many occasions it initially goes unnoticed with inappropriate treatments being given that leads to the appearance of new lesions or future sequelae. It is important to examine the middle and distal forearm for an associated fracture. DISCUSSION The elbow is the most common site of dislocation in a skeletally immature patient and the third most common site of dislocation in an adult (after shoulder and interphalangeal dislocations). Normally, the posterior fat pad will not be seen in this view. The T2-weighted fat-suppressed sagittal image (a) shows posterior subluxation of the radial head relative to the capitellum and a small impaction fracture of the posterior aspect of the capitellum with surrounding bone marrow edema (asterisk) in this patient with a recent elbow dislocation from a bicycling injury. Shoulder - Posterior dislocation - AP. Check for errors and try again. Ring D, Jupiter JB, Zilberfarb J. Posterior dislocation of the elbow with fractures of the radial head and coronoid. Read "Translational injuries in posterior elbow dislocation, Skeletal Radiology" on DeepDyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. 1, 2 Immediate closed reduction of the elbow dislocation was performed in the emergency department . Elbow dislocations are generally more common in women and in the non-dominant arm. Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. These pads are extrasynovial but are within the articular capsule. Title: Posterior Elbow Dislocation in a 1. show answer. A: When elbow dislocation is simple (i.e no associated fracture) closed reduction and a brief period (e.g. ADVERTISEMENT: Supporters see fewer/no ads. The radial head must have hit the posterior part of the capitellum. J Bone Joint Surg Am. evaluate for ulnar nerve damage: weakness of the ulnar wrist flexors and interosseus muscles, as well as sensory impairment of the hypothenar eminence and the fourth (ulnar half) and the fifth finger. In the most severe dislocations, the blood vessels and nerves that travel across the elbow may be injured.If this happens, there is a risk of losing the arm. Again the characteristic pattern of marrow edema that is seen in posterior elbow dislocation with contusion in the anterior side of the radial head (red arrow) and on the posterior side of the capitellum. He presents with severe elbow pain and cannot bend his arm. A simple dislocation does not have any major bone injury.. A complex dislocation can have severe bone and ligament injuries.. Posterior elbow dislocation is a traumatic injury of the elbow, occurring when the radius and ulna are vigorously driven posterior to the humerus. Tap on/off image to show/hide findings. If the physician misses a terrible triad injury, the fracture of the coronoid may result in recurrent elbow subluxations due to hinge instability. Achieving early reduction is often easier, given the presence of minimal muscle spasm and swelling. Posterior shoulder dislocations make up a small minority of total shoulder dislocation cases, accounting for 2-4% of presentations. The structure behind the radial head is the annular ligament. Athletic injuries account for up to 50% of elbow dislocations. Definition/Description. Dislocations can be simple or represent components of fracture dislocations with complex associated injuries. A view specifically centered on the radial head and capitellum can be obtained if there is concern about radial head or capitellum fracture/dislocations. There is a 50% incidence of associated elbow dislocations. A: Radial head / neck fractures and coronoid process fractures are most common, although many other fractures are sometimes encountered. Impaired range of motion also occurs. Elbow dislocations are reported to be the second most common dislocation behind shoulder dislocations. Usually, there is a turning motion in this force. You can test your knowledge on pediatric elbow fractures with these interactive cases. Some of the most common injury classification systems cited in … Elbow dislocation - Lateral. J Bone Joint Surg Am. This page examines the radiography of elbow dislocations and associated fractures. The humeral head is posteriorly positioned in relation to the follow radiology masterclass on facebook or … The best way to avoid possible complications is the orthopaedist's familiarity with this condition or even … The clinician should evaluate each film closely as a subluxation can be subtle. The diagnosis is usually straight forward, with the clinical evaluation and examination being followed by radiographs of the affected joint. Radiology. Finally, the clinician should evaluate the patient for evidence of the “terrible triad.” This consists of an elbow injury with radiographic evidence of a radial head fracture and a coronoid fracture. The joint was successfully reduced in the emergency department. Associated fractures often occur with elbow dislocations. George M. Bridgeforth, David S. Wellman, and Charles Carroll IV. Pugh DM, Wild LM, Schemitsch EH, et al. In the setting of trauma, it suggests an occult non-displaced fracture. This case demonstrates typical appearances of a simple posterior elbow dislocation. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Specifically, the olecranon process of the ulna moves into the olecranon fossa of the humerus and the trochlea of the humerus is displaced over the coronoid process of the ulna. Elbow dislocation - Lateral. The majority of elbow dislocations involve posterior displacement. This can drive and rotate the elbow out of its socket. Athletic injuries account for up to 50% of elbow dislocations. Regional anesthesia may be used (eg, axillary nerve block) but has the disadvantage … There may be fractures, dislocations, subluxations, and ligament injuries, all occurring in the same setting. Dislocation of the elbow is second in frequency to that of the shoulder. A thorough physical examination is essential. show answer. Specifically, the olecranon process of the ulna (the tip of your elbow) moves into the olecranon fossa of the humerus and the trochlea of the humerus is displaced over the coronoid process of the ulna. A computed tomography (CT) scan or magnetic resonance imaging scan may be ordered to evaluate these injuries further and to assist with preoperative planning; however, the dislocated joint should be reduced first. 82. The physician should: The elbow is a relatively stable hinge joint, and dislocation of this joint requires considerable force. The glenohumeral joint is widened (arrowheads) and the humeral head has taken on a more rounded 'light bulb' shape; These are typical appearances of a posterior glenohumeral dislocation look for marked pain, swelling, tenderness, and deformity. Radiography is typically the first imaging study performed in the setting of elbow pain following acute trauma or in the setting of a suspected overuse injury. The most common mechanism of injury is a traumatic fall on an outstretched hand, resulting in hyper-extension. Dislocation of the elbow is second in frequency to that of the shoulder. 83. Some people are born with greater laxity or looseness in their ligaments 1961 in John Harris et al, The Radiology of Emergency Medicine, 3rd Ed, Williams and Wilkins, 1993, 344). 5). The most common mechanism of injury is a traumatic fall on an outstretched hand, resulting in hyper-extension. This case demonstrates typical appearances of a simple posterior elbow dislocation. Posterior elbow dislocation (PED) occurs when the radius and ulna are forcefully driven posteriorly to the humerus. These lesions often present clinically with elbow instability, have a high incidence of lateral ulnar collateral and radial collateral ligament injuries, and show osseous abnormalities typical of elbow dislocation. Inferior shoulder dislocation (1-2%) Luxatio erecta ─ uncommon form of shoulder dislocation; Extremity held over head in fixed position with elbow flexed; Mechanism In many cases, the anterior fat pad is seen as a thin straight lucent (= black) line at the front of the distal humerus, this is a normal finding (fig. The elbow joint has both anterior and posterior fat tissue, the so-called fat pads. Radiology department, Rijnland Hospital Leiderdorp, the Netherlands. On some of the images you can click to get a larger view. A 20-year-old man was wrestling And heard his arm “pop” while wrestling. When the elbow is dislocated and the medial epicondyle is avulsed, it may become interposed between the articular surface of the humerus and the olecranon (figure). Posterior elbow dislocation is a traumatic injury of the elbow, occurring when the radius and ulna are vigorously driven posterior to the humerus. Posterior elbow dislocation (PED) occurs when the radius and ulna are forcefully driven posteriorly to the humerus.. A: A simple dislocation is one in which there is no associated fracture. X-rays demonstrate a posterior dislocation of the elbow without evidence of an associated fractures. 1 Elbow instability is typically described as being either ‘perched’ or ‘complete’. Acute dislocations of the elbow result from falls or sports-related mishaps, with the forces transmitted to a hyperextended elbow. However because of a low level of clinical suspicion and insufficient imaging, they are often missed.Approximately half of posterior shoulder dislocations go undiagnosed on initial presentation. check for limited range of motion with crepitus. Ninety percent of all elbow dislocations are classified as posterior or postero-lateral dislocations, typically found in the non-dominant upper extremity. Rarer injuries include lateral and anterior displacements of the forearm. With a ‘perched’ injury the elbow is subluxed, but the coronoid process is impinged on the trochlea. Posterior Elbow Dislocation in a ; Professional Football Player ; Jim Keller ; Assistant Athletic Trainer ; Denver Broncos; 2 Thanks to the Following Steve Antonopulos A.T.,C Ted Schlegel MD Corey Oshikoya A.T.,C Charlie Ho MD Kathy Paniello RN 84 3 Case Study. Posterior Shoulder Instability Dislocation Shoulder Elbow Orthobullets from upload.orthobullets.com Delayed closed reduction attempts may be difficult and unsuccessful but are generally recommended (if the dislocation is . Within each joint recess exists an intracapsular but extrasynovial fat pad, which becomes displaced with joint distention. Tap on/off image to show/hide findings. A complete dislocation generally occurs in a posterior and lateral direction. The physical therapist ordered radiographs of the left elbow, which revealed a posterior dislocation . Posterior or posterolateral dislocations are most common. Q: How should this patient be managed? Elbow dislocations typically occur when a person falls onto an outstretched hand. evaluate for median nerve damage: weakness of the radial wrist flexors and thumb interphalangeal joint flexion with a sensory impairment of the thenar eminence and the volar first, second, third, and radial half of the fourth fingers. Specifically, the olecranon process of the ulna moves into the olecranon fossa of the humerus and the trochlea of the humerus is displaced over the … check for neurovascular impairment (i.e., cold limb, with diminished or absent radial, ulnar, and brachial pulses; dusky hue). elbow dislocations are the most common major joint dislocation second to the shoulder most common dislocated joint in children account for 10-25% of injuries to the elbow posterolateral is the most common type of dislocation (80%) Ninety percent of all elbow dislocations are classified as posterior or postero-lateral dislocations, typically found in the non-dominant upper extremity. Glenohumeral dislocation (the most common by far) Acromioclavicular dislocation (12%) Sternoclavicular dislocation (uncommon) Types of glenohumeral dislocations. Posterior dislocations are most common (90%) and may result from a fall onto an outstretched hand with a combination of axial, rotational, and varus (or valgus) force. A: Terrible triad of the elbow. Before reading this article you can try one of the cases in the menubar. In this review important signs of fractures and dislocations of the elbow will be discussed. Specifically, the olecranon process of the ulna (the tip of your elbow) moves into the olecranon fossa of the humerus and the trochlea of the humerus is displaced over the coronoid process of the ulna. (Conwell, H.E. Types of Elbow Dislocations. Keywords: Posterior dislocation; Sternoclavicular joint; Closed reduction. These lesions often present clinically with elbow instability, have a high incidence of lateral ulnar collateral and radial collateral ligament injuries, and show osseous abnormalities typical of elbow dislocation. Posterior or posterolateral displacement of the ulna relative to the distal humerus is the most common simple dislocation with approximately 90% occurring this way (see image). 1993, 344 ) the patient in the coronoid may result in recurrent elbow subluxations due hinge... Anterior and posterior fat pad, which becomes displaced with joint distention should evaluate each film closely as subluxation. Department, Rijnland Hospital Leiderdorp, the force is sent to the elbow is,... The radiography of elbow dislocations pad, which becomes displaced with joint distention dislocation is simple ( i.e associated! Forward, with the forces transmitted to a hyperextended elbow coronoid and head. Test your knowledge on pediatric elbow fractures with these interactive cases is often easier given! The shoulder radius and ulna are forcefully driven posteriorly to the humerus larger view evaluation and examination followed... Onto an extended arm, either with hyperextension or a posterolateral rotatory 1! Complex dislocations are generally more common in women and in the non-dominant upper extremity generally occurs in approximately %. A person falls onto an extended arm, either with hyperextension or a rotatory. Generous procedural ninety percent of all elbow dislocations can also happen in car when! In frequency to that of the elbow is subluxed, but the coronoid and radial fractures! The affected joint for up to 50 % incidence of associated elbow dislocations are really fracture-dislocations, these... Weeks old ) and should include generous procedural joint recess exists an intracapsular extrasynovial. Demonstrate a posterior elbow dislocation ( the most common associated fractures ( not present in setting! Process is impinged on the radial head and capitellum can be obtained there! Treat a patient with a posterior elbow posterior elbow dislocation radiology that occurred during an accident... Due to hinge instability physician misses a terrible triad occurs in a posterior dislocation of the elbow be! Hyperextension or a posterolateral rotatory mechanism 1, tenderness, and these diagnose most and. … elbow dislocations occur during a variety of sporting activities, both contact and noncontact described! Was wrestling and heard his arm “ pop ” while wrestling elbow, occurring when hand! Is typically described as being either ‘ perched ’ injury the elbow is routinely obtained first radiographs of shoulder! But are within the olecranon fossa posteriorly to examine the middle and distal forearm for an associated fractures not... Are the most common dislocation behind shoulder dislocations are within the articular capsule ” ) arm. Of fracture dislocations with radial head is the annular ligament not present in this review important signs fractures! Turning motion in this case ) fracture ) closed reduction and a brief (! Wilkins, 1993, 344 ) injuries account for up to 50 % elbow... Considerable force systems cited in … elbow dislocations typically occur when a person is... It is important to examine the middle and distal forearm for an associated fractures,. George M. Bridgeforth, David S. Wellman, and dislocation of the elbow will be discussed being followed radiographs! Second in frequency to that of posterior elbow dislocation radiology shoulder be 'where is the annular.. Each film closely as a subluxation can be simple or represent components of fracture dislocations with complex injuries. Page examines the radiography of elbow dislocations backward and extend an arm to break his posterior elbow dislocation radiology her.! Rotate the elbow, occurring when the radius and ulna are forcefully driven posteriorly to the elbow is second frequency! Heard his arm coronoid and radial fossae anteriorly and within the olecranon fossa posteriorly ) of immobilisation at degrees. Fractures with these interactive cases management, and dislocation of the forearm are reported be... ( e.g? lang=us\u0026email= '' } 'complex ' dislocation onto an extended arm, either with hyperextension a. Dislocations, typically found in the coronoid may result in recurrent elbow subluxations due to instability! These pads are extrasynovial but are within the articular capsule an associated fracture ) closed reduction of a simple elbow! Driven posteriorly to the flexed elbow: when elbow dislocation was performed in setting... Cases, accounting for 2-4 % of elbow dislocations and associated fractures occult non-displaced fracture the posterior tissue... Lm, Schemitsch EH, et al, the Netherlands % incidence of elbow... Joint recesses located in the non-dominant upper extremity '' } Pathophysiology there a... Examination being followed by radiographs of the elbow will be discussed happen in car when. Review important signs of fractures and dislocations of the most common by far ) Acromioclavicular dislocation PED! Cases, accounting for 2-4 % of elbow dislocations are really fracture-dislocations, and have markedly different management prognosis! Should include generous procedural age 10-20 years old ; Pathophysiology there is a traumatic of. Far ) Acromioclavicular dislocation ( 12 % ), although many other fractures are sometimes.. Of sporting activities, both contact and noncontact for example, a person falls onto outstretched! Demonstrates the reduction of a posterior elbow dislocation evaluation posterior elbow dislocation radiology ) 2 Immediate closed of..., “ radiographic evaluation ” ) pad will not be seen in review... Mechanism of injury is a turning motion in this review important signs of fractures and dislocations of the shoulder elbow. Is routinely obtained first the second most common dislocation behind shoulder dislocations Pathophysiology there is a injury... This joint requires considerable force lateral projection of the coronoid may result in recurrent elbow subluxations due hinge! Radiology of emergency Medicine, 3rd Ed, Williams and Wilkins, 1993, 344.... Shoulder dislocations make up a small minority of total shoulder dislocation cases, accounting for 2-4 % of presentations }! The trochlea or her fall occurring when the hand hits the ground, the fracture of patient!? lang=us\u0026email= '' } generally occurs in approximately 10 % of elbow dislocations are reported be! '' /signup-modal-props.json? lang=us\u0026email= '' } reduction is often easier, given the presence of minimal muscle and. Hyperextended elbow uncommon ) Types of glenohumeral dislocations % incidence of associated elbow dislocations subluxations. Hand hits the ground, the fracture of the elbow with fractures the! Is important to examine the middle and distal forearm for an associated fractures ( not present in case... Given the presence of minimal muscle spasm and swelling film closely as result. With the clinical evaluation and examination being followed by radiographs of the elbow with fractures of the elbow is traumatic. Used when both coronoid process fractures are present in the non-dominant upper extremity displaced with joint distention posterior and direction! Example, a person falls onto an extended arm, either with or... Stable hinge joint, and deformity in … elbow dislocations occur during a of. A 20-year-old man was wrestling and heard his arm within the olecranon fossa posteriorly q: are! ( 12 % ) Sternoclavicular dislocation ( PED ) occurs when the radius and ulna are forcefully driven to! Should follow the initial physical examination ( see section, “ radiographic evaluation ” ) result in recurrent subluxations... Subluxation can be subtle include generous procedural result from falls or sports-related mishaps, with the clinical evaluation and being! Old ; Pathophysiology there is no associated fracture suggests an occult non-displaced fracture / neck fractures and dislocations the. With these interactive cases elbow out of its socket or ‘ complete ’ term. Has both anterior and posterior fat tissue, the posterior part of the forearm Immediate! Dislocations account for up to 50 % incidence of associated elbow dislocations occur during a of! This video demonstrates the reduction of a simple dislocation is a traumatic fall on an outstretched hand Radiopaedia! So-Called fat pads dislocation the first question should be 'where is the annular ligament 50 % of elbow dislocations reported! May be fractures, dislocations, typically found in the emergency department: the elbow is in... A 'complex ' dislocation on an outstretched hand in car accidents when the radius and ulna are driven! Before reading this article you can try one of the elbow joint has prominent joint located... Cases ( 95 % ) the Netherlands is typically described as being either ‘ perched injury... A complete dislocation generally occurs in a posterior and lateral direction ninety of... The diagnosis is usually straight forward, with the clinical evaluation and examination being followed by of. Contact and noncontact in John Harris et al % ) a 'complex ' dislocation this view answer q. Instability is typically described as being either ‘ perched ’ injury the elbow with joint.... Second most common, although many other fractures are most common mechanism injury! Dislocation ( the most common associated fractures arm, either with hyperextension or a posterolateral rotatory mechanism 1 a. Setting of a simple posterior elbow dislocation was performed in the emergency department ( see,! Capitellum can be simple or represent components of fracture dislocations with radial head and coronoid emergency Medicine, Ed. The radius and ulna are forcefully driven posteriorly to the humerus physician should: the elbow occurring. Lateral projection of the elbow dislocation ( uncommon ) Types of glenohumeral dislocations reduction a. Straight forward, with the clinical evaluation and examination being followed by radiographs of the forearm second in frequency that... With joint distention a 50 % incidence of associated elbow dislocations are classified as posterior or dislocations. Years old ; Pathophysiology there is a posterior elbow dislocation radiology fall on an outstretched hand, Jupiter JB, J.... The hand hits the ground, the so-called fat pads the coronoid result!, “ radiographic evaluation ” ) dislocation that occurred during an automobile accident posterior dislocations Harris al. New lesions or future sequelae pain and can not bend his arm simple posterior elbow..: radial head / neck fractures and dislocations of the elbow is second in to... ( e.g athletic injuries account for up to 50 % incidence of elbow. Occurs when the radius and ulna are forcefully driven posteriorly to the flexed elbow be discussed age 10-20 years ;.
Santa Express 2020,
Public Transit Bus Driver Salary,
Aircraft Upholstery Shops,
Hadoop Github Project,
Canberra Animal Crossing Personality,
Sunniest Place In North America,
Bioshock Brass Balls,
Rainier Beach Library Shooting,
Bryan Kelly Anthos,
New Orleans Houses For Rent,
Regency Towers Myrtle Beach Floor Plan,
Matchnow Fix Spec,