Have you experienced any kind of fall in your lifetime? In your own childhood? Has something like this happened to your child? How has the experience been? What were the necessary steps you took or you should take in these situations?

Radius is a bone in the fore-arm along with another bone called ulna, supporting each other and connected by ligaments to each other.

There is a collection of three bones at the junction called Elbow serving the function to bend and straighten the arm and to turn the palm up and down. These three bones at the elbow junction are: Radius, Ulna and Humerus.

All three bones as discussed are connected by joint capsule, ligament and tendon. The strength of these structures decreases with age and work exhaustion with time.

What wear and tear can happen in the associated structures and what trauma can bone undergo itself? What is the kind of fractures you will have to deal with and what is their management? All of the issues will be discussed in the article below.


Contents discussed in the article below:

Radial head fractures




Pediatric radial head fracture

Radial head dislocation

Fractured radial head wrist pain

Radial head fracture recovery

Radial head fracture healing time

Radial head fracture treatment

Radial head fracture splint


Radial head fractures


Anatomy of radius

Radius is a bone located in the fore-arm and is found in association with two other bones, one adjacent and one perpendicular. The adjacent one is known as ulna and the perpendicular one is called as- Humerus. All of these in junction form the elbow joint.

The radius forms joints in four places:

Elbow joint- formed by the joint between the radial head and a part of the humerus (capitulum).

Proximal radioulnar joint- The joint between the radial head and the radial notch of the ulna.

Wrist- The joint between the distal end of the radius and the carpal bone.

Distal radial joint- The joint between the ulnar notch and the ulnar head.

Proximal Region of the Radius

The proximal end of the radius forms a joint and articulates both at the elbow and proximal radioulnar joints.

There are some important landmarks in the radius and includes the head, neck and radial tuberosity:

Radial head- A disk-shaped structure with a concave joint surface. It is thickened medially where it is involved in the proximal radial joint.

 Neck- it is a narrow area made of bone, and is between the radial head and the radial tuberosity.

Radial tuberosity- A bony process that acts as a point of attachment for the triceps brachii.


Shaft of the Radius

The radial shaft widens in diameter as we go from proximal end to distal end. It is like ulna and is triangular in shape with three borders and three surfaces.

In its lateral or external surface in its middle, a roughened area is found and is a location where pronator teres muscle is.


Distal Region of the Radius

In the distal region, the radial shaft extends to the end and forms the rectangle. The lateral side at the distal end has a process called- Styloid process. The medial surface has a concave surface, the so-called ulnar notch, which shows articulation to the ulnar head to form the radioulnar joint.

On the distal surface of the radius, there are two facets for joint between the scaphoid and lunate bones which forms the wrist joint.

Forearm has a lot more functions to perform and is a site commonly involved in fractures, extensive fractures or isolated bone fractures. There are some common fracture types that involves the radius and are classified as follows:


Common fractures of radius

There are certain risk factors counted in for radial fractures and includes:

Increase in age

Gender- female

Early onset of menopause


Alcohol use

Steroid us e(osteoporosis)


Colle’s fracture: Most common type of radial fracture encountered. Usually occurs when a person falls on a hand that is out-stretched. This fracture results in posterior movement of structures distal to the trauma/ fracture and results into the so-called "dinner fork transformation".

Fractures of radial head: The head of the radius is subjected to fracture when a person falls on an abducted hand/ outstretched arm. The radial head is lead forcefully into the capitulum of the humerus, resulting into the fracture of radial head.

Smith’s fracture: Smith’s fracture is seen to be completely opposite to Colle’s fracture. This happens when a person falls on the back of his hand and this causes anterior displacement of the distal part.

Important neurological examination is to be done in case of these fractures and includes:

Median nerve

Ulnar nerve

Radial nerve

Certain differential diagnosis is also considered for the above-mentioned fractures and are termed as:

  • Forearm fracture (such as Galeazzi or Monteggia fractures)
  • Carpal bone fractures
  • Tendonitis or tenosynovitis
  • Wrist dislocation


There are two types of classic fractures to be mentioned and are as under:

Radius and ulna as the two bones of forearm are connected to each other by inter-osseous membrane. Thus, any trauma to one bone can be transmitted to another indirectly. Thus, both the bones can have fracture together and is not uncommon. These fractures are:

Monteggia fracture: In this type of fracture there is a blow to the ulna from behind and directly. The proximal part of the ulna, the ulnar shaft is fractured, and this results into an anterior dislocation of head of the radius at the elbow joint.

The treatment is among non-operative, operative (ORIF) and nailing of the ulna (as discussed in the article)

Galeazzi fracture: This is a fracture of the radius itself, the distal part is fractured, and the ulna experiences indirect blow and results in its dislocation as, ulnar head dislocation at the radio-ulnar joint distally.

The treatment involves ORIF with reduction.


Introduction to fractures:

Radial head fractures, along with radial neck fractures, are relatively common injuries, especially in adults, but may be hidden on x-rays. Radial head fractures are the most common amongst all elbow fractures. Radial head fractures are more common in females than in males and are more common in people between the ages of 30 and 40.

On examination, palpation of the sides of the elbow and radial head may show tenderness with supination and pronation, along with pain and crepitus. Other clinical features are effusions at elbow or limited supination and supination movements.

Other injuries are also found in association with fall with extended hands and that should not be definitely missed and includes wrist ligament and bone injuries, radial head fractures or dislocations. Therefore, we need to examine other structures as well like: shoulder and wrist joints should be examined.

Most radial head fractures are stable, non-dislocated, or minimally dislocated partial fractures and do not have elbow or forearm or ligament damage, a major concern of which is stiffness even after non-surgical treatment. Dislocated and unstable fractures of the radial head are usually associated with other fractures or ligament injuries, and restoration and reconstruction or prosthesis replacement of the fractured head to prevent subluxation or dislocation of the elbow and forearm is required.

For fractures with 3 or less fragments (2 articular fragments and neck) with little or no metaphyseal crushing, open reduction and internal fixation may give good results. However, fragmented and unstable fractures of the radial head tend to fail in the early stages of fixation and become nonunion even when fixed. Resection of the radial head is associated with good long-term results, but replacement of the prosthesis is recommended for patients with unstable elbows or forearms.

Radial head fractures usually occur as a result of indirect trauma and are most often caused by abduction arm i.e., falling on an abducted arm with minimal or moderate: 0-80 degrees flexion of the elbow joint. In the end can be described as a fracture often resulting by falling on a stretched arm.

 A direct blow to the elbow can cause a radial head fracture, but it is rare. Although is counted as a cause.


Classification of Radial Head Fractures

Radial head fractures are classified on the basis of displacement found in degrees, and intra-articular involvement. This is usually done on the basis of Mason classification:

Mason Type I: Minimal displacement (<2mm) or non-displacement

Mason Type II: Displacement (>2mm) or angulation with partial articular fracture.

Mason Type III:  A complete articular fracture (comminuted fracture and displacement).



   I   fracture is non-displaced

   II  partial head fracture and is displaced

   III entire head fracture is displaced

   IV elbow dislocation  with fracture


Broberg and Morrey

   I   displacement of <2mm

   II  ≥ 30% articular surface and ≥ 2 mm displacement

   III Comminuted fracture 



   I stage: Non-displaced /displaced marginal fracture, there is no block to forearm motion, managed non-operatively     

   II stage: Displaced fracture and needs to open reduction internal fixation  

   III stage: Displaced fracture cannot be subjected to ORIF (instead excision or replacement)



In many cases, x-rays alone can provide enough information to determine treatment. However, additional imaging of bone, such as computed tomography (CT) scans, can provide additional useful information. If there are some more concerns about ligament or tendon damage, we can order MRI imaging as well.

The x-ray is usually done with AP and lateral projections, but often with oblique projections to better explain the radial head. If you do not see a fracture but are clinically suspected, we can order a Coyle’s view as well.

Radial head fractures are subtle and can easily be overlooked on x-ray. It is important to have a clear examination of joint effusion, and if present, special care should be taken when assessing the radial head and if found should be treated as non-displaced radial head fracture, even if the fracture cannot be identified.

CT can be done as well in cases where intra-articular involvement, as structures can be better examined with CT and with full precision.



The most common symptoms of radial head fractures are:

  • Pain on the outside/lateral of the elbow.
  • Swelling of the elbow joint.
  • Difficult to bend and stretch elbows, along with painful.
  • Unable to rotate forearm or difficult to rotate forearm (palm up and down or vice versa)

Some points that have to be considered after the radial fracture is reported are as under:

  • Location of the fracture
  • Articular surface involvement
  • Comminution
  • Displacement of the bone
  • Impaction

Evaluation of injuries associated:

  • Olecranon fractures
  • Fractures of coronoid process
  • Injury of the ligament
  • Dislocations of elbow

Wrist needs evaluation as well in order not to miss any serious injury and complication after that. If there is a suspicion of wrist injury X-ray should be ordered. And in case of Essex- Lopresti fracture dislocations X-ray is ordered. These types of fractures need surgical intervention.

Some investigations need to be run in patients who present with fracture and these include running blood tests, radiographs etc. As will be discussed later, radial head fractures can be missed on radiographs but if effusion is seen on lateral projection, it is termed as a sign called “Sail Sign” – seen as an elevation of anterior fat pad.

CT scan imaging can be requested as well, when complex fractures are encountered.


Pediatric radial head fracture

Radial head and neck fractures in children are a common trauma injury and most commonly affect the radial neck (or metaphysis) of children who are of the age of 9-10.

5-10% of all pediatric elbow fractures and 1% of all pediatric fractures are comprised by radial head fractures with neck involvement as well. There is no difference in sexes as involvement is concerned and the age as discussed already is 9-10 years.

Mechanism involves:

  • elbow extension and valgus tension injury of the elbow
  • elbow dislocation

there are some associated conditions seen with these fractures in children and are described as:

  • elbow dislocation
  • olecranon fracture
  • medial epicondyle fracture
  • forearm compartment syndrome

Anatomy is different in children than adults and there are some ossification centers occurring around elbow and are 6 in number.

  • Capitellum (1 yr.)
  • Radius (3 yr.)
  • Internal or medial epicondyle (5 yr.)
  • Trochlea (7 yr.)
  • Olecranon (9 yr.)
  • External or lateral epicondyle (11 yr.)


Ossification centers of the radial head appear between the ages of 3 and 5 and can be divided into two parts (bipartite)

Radial head locks/fuses with radial shaft around 16-18 years of age.


Classification of fractures in children:

O'Brien Classification

Judet Classification

Chambers Classification (rarely used)


O'Brien Classification:


Type I

< 30 degrees


Type II

30-60 degrees


Type III

> 60 degrees


Judet Classification:



Type I



Type II

< 30 degrees


Type III

30-60 degrees


Type IVa

60-80 degrees


Type IVb

More than 80 degrees


Chambers Classification


Group 1: Primary displacement of radial head is seen in such classification and is the most common.


Valgus Injury

A: Physeal injury - Salter-Harris I or II

B: Intra-articular -Salter-Harris III or IV

C: metaphyseal fracture


Elbow Dislocation

D: reduction injury

E: dislocation injury


Group 2: Primary displacement of radial neck

Monteggia variant


Group 3: Stress injury

Osteochondritis dissecans


Symptoms found are same as expected like pain and refusal to move the arm, physical examination is same as that of adults and involves inspection and lateral swelling is found on inspection, and there is a high suspicion of forearm compartment syndrome and with pain in wrist, as referred pain.

Radiography involves AP and latera view and in addition to that green span view which is performed in oblique lateral position by placing the arm on table with elbow flexed and thumb pointing in the upward direction. Radiography finds it difficult to mark the fracture but fat pad movement to posterior marks an occult fracture.

Treatment in children is usually immobilization and    closed reduction, or immobilization alone. Operative options are also chosen in some cases which involves closed percutaneous reduction or open reduction.

There are certain complications as anticipated and can be described as:

Limited range of motion: issues in pronation are more commonly witnessed than supination

Overgrowth of radial head


Nerve injury

Synostosis: is the complication that is counted as serious one and occurs in cases of open reduction or delayed treatment.

Prognosis is witnessed as worsened with the increase in age, usually > 10 years.


Radial head dislocation

Dislocation of the radial head comes into existence when the radial head is seen dislocated from the normal joint that is present between the ulna and humerus.

 Dislocation can be acquired or congenital. In addition, radial head dislocation needs to be distinguished from "pulled elbow", which is relocated spontaneously or with rapid supination and is radial head subluxation.

The radius and ulna are connected at both ends of a properly named proximal and distal radial joint. As with the mandible and pelvis, it is difficult to break one side of the ring without breaking it. Therefore, it is important to ensure that the radial head dislocation is truly isolated and not associated with an ulnar fracture (Monteggia fracture dislocation).

 Plastic bone deformities are common in pediatric patients. Therefore, instead of the radial head dislocation associated with a transverse ulnar fracture, the ulna develops into a curved fracture instead, also called as bowing fracture. Fracture dislocation of Monteggia is not rare in children, but it is by some means is uncommon. Cerebral palsy associated individuals and people with brachial plexus damage are prone to radial head dislocations.

Radial head fractures and dislocations are traumatic injuries and require appropriate treatment to prevent obstruction due to stiffness, deformity, post-traumatic arthritis, nerve injury, or other serious complications. Radial head fractures and dislocations are complex fracture injury patterns that are restricted only to the radial head (and neck) and lateral elbow (and proximal forearm) or affect the elbow, distal humerus, or other structure of the forearm can be part of and involve the wrist as well.

Fractures and dislocations of the radial head and neck were treated with closed and open methods. Surgical methods included excision, replacement, and internal fixation of fracture fragments. Fractures and dislocations of the radial head are the result of trauma and usually result from falling into the stretched arm with the force of impact transmitted to the radial head via the wrist and forearm.


The most common dislocation of the radial head is anterior, but lateral and posterior dislocations can also occur due to force and injury mechanisms. The annular ligament is the main stabilizer of the radial head and prevents dislocation of the radial head. Other ligaments of the proximal radial joint, such as the quadrate and interosseous ligaments, help stabilize this joint.

Emergency treatment with acute ulnar fractures with radial head dislocation up to 3 weeks after initial injury is provided by sedative and externally manipulated closed anatomical reduction of the ulna. This procedure is usually sufficient to reduce the radial head. Radial head stability should be tested under fluoroscopy after successful reduction. Next, the elbow should be fixed for 6 weeks using a long arm cast at a 90degree angle. The position of the forearm during fixation depends on the position associated with maximum stability of the radius and ulna.

Children get good results with closed reduction. Internal fixation is required if the stability of reduction of ulnar fractures is questionable. Children with irreducible and neglected / overlooked anterior dislocations of the radial head also need to be surgically corrected. However, in adults, most of the time, repair by open surgery is required.

There are several surgical procedures available to treat chronic radial head dislocation, but the most common methods are open reduction with plate and screw fixation, or reconstruction or intramedullary nails of the ulna.

Congenital radial head dislocation rarely requires intervention until severe pain and limited range of motion become a problem in adulthood. Radial head resection is an effective intervention for selected patients who experience significant elbow pain.


Fractured radial head wrist pain

Radial head fracture can be associated with a number of other manifestations including wrist pain as referred pain.

The wrist (also called as the radiocarpal joint) is the synovial joint of the upper limbs, which indicates the transition between the forearm and the hand.

The ulna is not part of the wrist- it forms the distal radial joint with the radius. This joint is seen just proximal to the wrist joint and thus are seen in association with each other. The fibrocartilage ligament on the upper surface of the ulna, called the articular disk, impedes joint movement with the carpal bones.

If radioulnar joint dislocation (damage to the interosseous ligament) is suspected, bilateral anterior-posterior (neutral rotation) and true lateral radiographs of both wrists can help check for subluxation or dislocation of the DRUJ and describes the degree of radial shortening indicating Essex Lopresti lesions.

This wrist pain with fractured radial head is usually found in condition called Essex-Lopresti fracture-dislocation and is named after Peter Gordon Essex-Lopresti, a trauma surgeon. This trauma is related to high energy fall causing great pain and instability.

There are classifications for these dislocations and are mentioned as below:

Type I: large fragments

Type II: comminuted

Type III: chronic injury with proximal migration of the radial head

Radiographs are unremarkable of any feature initially.

Treatment of longitudinal forearm instability, which is particularly complex in chronic situations, has historically had poor consequences. A recent study has found radial head replacement with the reconstruction of the interosseous membranes near to normal. Treatment is usually classification based and varies from open reduction to closed fixation, excision and osteotomy etc.


Radial head fracture recovery

The prognosis for a simple radial head fracture is usually excellent, as in seen in most of the cases. More severely crushed radial head fractures, and fractures with other damage to the ligaments of the wrist and elbow, are likely to result in longer healing times and require more extensive physiotherapy to regain elbow movement have to be done. Treatments that require long-term elbow fixation may cause the shoulders to become slightly stiff due to improper joint use. Physical therapy is usually recommended to regain both shoulder and elbow strength and range of motion.

Moreover, as said recovery depends to some extent on the severity of the fracture, the associated ligament injury, and the type of treatment. Pain usually begins to subside within a few weeks. Once your arms are comfortable, you can start using your hands and elbows. Office like light- work can be resumed within 2-3 weeks. Thorough activity should be avoided until the fracture has healed for 3-6 months.

Treatment based time taken for recovery varies with each procedure and indirectly with the type of injury suffered.

Non-surgical treatment of radial head fractures and can be used if the displacement of the fragments is minimal, that is, if the fragments remain closely related and do not interfere with elbow movement. If the surgeon decides that the fracture can be treated without surgery, he usually asks you to wear a splint for the first 1-2 weeks. In contrast to plaster casts, soft, voluminous splints allow for swelling changes in the first few days or weeks. If the surgeon thinks the fracture pattern is stable, that is, the broken pieces move very little, the arm may be available for light work in a few days. After the swelling has subsided, a long arm cast or fracture device is usually recommended. This usually happens after 6-8 weeks.

X-rays are usually taken 1-2 weeks later to make sure that the parts of the fractures do not separate, and several times during the treatment period to see if the fracture has healed. Once the surgeon believes the fracture has healed, the physiotherapist is brought to duty to let your arm regain arm movement and strength.

Thus, the recovery period varies with each step of treatment taken for the patient.

Likewise, after surgery and conservative treatments carried side by side along it, it can take radius near about 6 weeks to heal and to carry normal light work.


Radial head fracture healing time

Radial head fracture healing time depends on the type of fracture and the treatment of method used. It usually takes 6 weeks for a fracture to heal and during whole time conservative treatment along with basic treatment has to be carried side by side. As mentioned already all the necessary steps along with good physiotherapy and active and passive movements can help you restore the function very well unless some replacements and excisions have not been carried out for the patient.


Radial head fracture treatment

Doctors classify fractures based on the degree of displacement (how far the bone is from its normal position) and the number of fragments. Treatment is based on the types of fractures according to the following categories:

Type I fracture: Type I fractures are generally small cracks and the bone fragments remain connected to each other.

In these types of fractures, the fractures may not be visible on the first x-ray, but can usually be seen by taking an x-ray 3 weeks after the injury. For non-surgical treatment, the splint is used for several days, after which the elbow and wrist movements are increased early and gradually (depending on the intensity of the pain). If the movement is done without appropriate management of injury and time, it can cause bones to shift from their respective places and thus delay in the process of healing.


Type II fracture: Type II fractures are slightly offset/ displaced from their original place/ location and involves larger bone fragments.

For minimal displacement, treatment includes a splint for 1-2 weeks and then exercising as a means of strengthening and prevention of complications. Small pieces of broken bone may need surgical intervention if they interfere with the normal movement of the elbow or increase the chance of long-term problems with the elbow. If the debris is large and misplaced enough, the orthopedic surgeon will first try to hold the bone together with a screw or plate and screw. If this is not possible, the surgeon will remove the debris from the radial head. The surgeon also corrects other soft tissue damage, such as ligament rupture if found. Thus, all of tissues and bone are explored well and managed as per the need and degree of injury and damage.

Type III fracture: This type of fracture involves bone broken into multiple pieces and cannot be put back together for healing.

This type of fracture involves extensive fractures involving the whole elbow, ligaments around the elbow.

The treatment varies depending upon the severity and feasibility to carry out the procedure. The treatment involves surgery in which either the broken pieces are removed or the radius is fixed and, in some cases, complete replacement and removal of radial head might be required. Replacement is done by placing an artificial radial head for long term improved function.

Independent of the type of fracture, it is recommended to avoid heavy-lifting for a period of 6-12 weeks. Splint or cast is installed for the patient depending on the type of injury and its severity.

Exercises to strengthen the bones and muscles and to avoid complications are recommended usually, no matter how light or severe the injury or fracture is. Loss of movement is found in almost all cases. The chance of forming a scar tissue causing limitation in movement may need surgery to remove the scar and free the arm of limited movements.

Another way of defining the treatments can be put as follows. In brief there are two methods:

  • Operative
  • Non- operative


Non operative: Short fixed time for immobilization followed by early signs of ROM and is carried for isolated minimal displacement fracture without mechanical obstruction (Mason Type I)

Elbow stiffness due to long-term fixation can be caused. Although there is a difficulty of turning your palms up and stretching your elbows is the most problematic arc of movement to regain. But good results in 85-95% of patients are seen.



Dislocated fractures usually require surgical management. The purpose of surgical treatment is to align the surface of the fracture and cartilage. The surface of the cartilage is a sliding mechanism that moves the elbow. Better alignment is usually associated with better functionality. Fractures with less than three large parts or fragments may be candidates for open reduction and internal fixation with screws or plates. Fractures that show high crushing may be candidates for radial head replacement.

Operative has certain types and sub-types of its own and includes: ORIF, partial excision, complete resection of radial head, radial head arthroplasty, nail reduction and stabilization.


  • ORIF: is indicated in Mason type II and III.


  • partial excision: fragments are usually of less than 25% of the total area of ​​the radial head or less than 25% of the area of ​​the caterpillar area is an indication of partial or fragmented excision.


  • complete resection of radial head: is indicated in people with a sedentary life style and with a low demand lifestyle.


  • radial head arthroplasty: indication is seen in Mason type III or Essex Lopresti lesions.


  • nail reduction and stabilization: the outcome of this process is great.



Almost all fractures can damage nerves and blood vessels, but damage to these structures after radial head fractures is rare. Fractures may not heal. This is known as a nonunion. Fractures may heal in an unacceptable direction. This is called a transformation. If any of these complications occur, pain, weakness, and limited elbow mobility can occur. A second surgery may be required to treat the complications.

Since the radial head forms part of the surface of the elbow joint, a fracture of the radial head can damage the surface of the articular cartilage. This can cause wear arthritis of the elbow joint months or years after the fracture has healed. After a radial head fracture, there is always a risk of developing osteoarthritis  because  the joint surface is damaged by the fracture. Osteoarthritis of the elbow can cause pain and stiffness in the elbow joint and may require additional treatment or surgery if the symptoms are severe.

Some other complications of radial fractures can be numbered as:

  • Displacement of fracture that usually occurs in less than 5% of fractures
  • Posterior interosseous nerve injury (with operative management)
  • Loss of fixation can be witnessed
  • Loss of forearm rotation can be found
  • Elbow stiffness can be handled by supervising exercise therapy with splinting over a 6 month period    
  • Radiocapitellar joint arthritis
  • Infection
  • Heterotopic ossification
  • Hardware loosening
  • Complex regional pain syndrome: Complex Regional Pain Syndrome (CRPS) is a condition that causes pain and other symptoms. Scientists believe that abnormal neural function causes an overreaction to pain signals and there is no turn off to the nervous system. There is no cure, but treatment aims to relieve symptoms, restore limb function, and maintain quality of life.

Symptoms are mentioned as follows:

Persistent pain that worsens over time, pain unrelated to the severity of the injury, there is extreme sensitivity to pain, such as causing severe pain when touching the skin very lightly, pain spreads, burning pain, swelling of the skin, reduced range of motion / loss of function, tremor. Decreased mobility and / or increased stiffness of affected limbs, there is a change in skin temperature. The skin of the affected limb may be warmer or colder than the skin of the opposite limb. Changes in skin color that appear to be pale, purple / bruised, or red. Changes in the texture of the skin can make it shiny, thin, and sweat excessively. Changes in nail and hair growth. Symptoms of CRPS usually are seen beginning within 4-6 weeks of injury, fracture, or surgery.

Radial head fracture splint

Splint is brought into use after surgery of radial head. This is done to limit the motion. Also, we sue splint in case of non-displaced or minimally displaced radial fractures. These fractures are Mason Type I and thus are treated conservatively, which includes: fixing the arm at 90 degrees angle (elbow) for 3-7 days. Also, the light posterior splint is used.

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Address: 393 University Avenue,Suite 200,Toronto ON MG5 2M2,CANADA

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Phone: +1(647)303 0740

All Rights Reserved © By MarsoClinic

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