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Uh, hello everyone. Um, welcome to our, um, third series, er, third episode of our, um, or University of Leicester Orthopedic Society. Um, er, er, short answer question, um, single best answer revision series. Um, today's, er, session is done by Ethan who's a fellow third year student. Um, and he's, um, made, uh, 44 S AQ cases on the ankle and, er, five SBA questions. Um, er, before I hand over to Ethan, same, same process, last time we'll, er, pop your answer in the chat, I'll monitor the chat and, er, Ethan's gonna lead the talk. So, er, without further ado, um, I'll hand over to you Ethan. All right. Thank you. Yeah. So I'm Ethan and as I said, we've got four SA Qs and then five SBA S afterwards as well. So the standard S AQ format, if we get more answers in the chat quickly, it'll just be a more fluid session. So if we can get everyone contributing, that would be great. So, start off with the first case. Uh, we've got a patient that presents the ed with a swollen and painful ankle following some trauma, they're struggling to walk on that foot and when they're asked, they say that the pain is felt at the back and at the side of the ankle. So it's a bit of a two part question. The first part leads into the second part. So we'll get the first answer and then part b before in the chat, before we release both sets of answers if that makes sense. So which criteria would be used to assess whether there's a neces, a need for imaging? Er one second Ethan, I think um on your, on, on the shared screen mate. Um I don't think I can see the, I can see the front page but I can't see you changing the slide. OK. Has it not got the this question hasn't come up, the question hasn't come up. Um Is that doing anything? Uh No, not at the moment. OK. Have you got, have you shared your entire screen or did you share the tab? It says shared into screen uh just uh on share it maybe and then maybe share it again but it was on my screen. Yeah, Seth green and then that one and then that and then can you see it now? Yeah, I can see the, I can see the answers to the question. Is it? But it's not full screen. Is it full screen on your side? It is now maybe changed it to go, go back a slide perhaps, right? It says case one on my, on mine it says the Ottawa rules. Um, let's figure. Right. Let's figure this out. Do you want me to share this with you? Uh, that perhaps that would be easier then? Now it's case one now, actually, well, now it's moving. Well, the thing is they've got transitions in and so it needs to be in the presenting mode for it to come up that way. Um Have you, maybe if you go to slideshow? Yeah. Uh Have you on shared your screen now? Ok. One second, right. Uh Can you share my, can you see my screen now? Yep. All right, we're good. Um Is that moving? Well, yeah, that's moving. Good. Thank you. OK. Yeah. So, I mean, the answer was partly given away, but so for part A, if we could get those answers in the chat just before we then go into part B. So I think you're, you're gonna have to monitor the chat. David cos I can't see it. Yeah, I'm able to see that he's got now as well. So I can, yeah, we're good. I, is there any answers in the chat, David? Uh There's none at the moment. No. Er, should we, should we reveal the answers? Yeah, so we go for part A so off ankle rules. And so if we can think to what the criteria are for those rules, do you think that this patient would qualify for imaging? And if so what is it in their presentation that meets that criteria. Sure of all the answer. Yeah, no problem. So this patient qualifies for two parts of the rule. And then if you click on the next one, the diagram should come up to help as well. So as it says, they're struggling to walk. So in A&E or in they're struggling to walk and also where that pain is felt, it's along that. Um So at the back and the side of the ankle CHS to this disc or six centimeters of the posterior fibula and then also the tip of the lateral malleolus as well. Oh yeah. So exactly, cap. So because they're unable to wait there. And then also because of um where the pain is as well. So then if we go on to the second one, so uh you suspect an ankle fracture and so we request imaging. So, so what is the third? So David, what is the third rule? So I believe that it is. Yeah. So it's just which way um where the bony tenderness is. So if the ankle, it's either the distal six centimeters of the posterior tibia and or the tip of the medial malleolus or it's the distal six centimeters of the posterior bula or tip of the lateral malleolus. So it's which side for that one. And then uh yeah. So ap lateral MS views. So very good uh tia. So then if we go on to the next uh one, that's yeah, the ankle series. And so we get the, the following image back. So does anyone want to describe the X ray findings? Uh I appreciate that it might be a bit difficult to see some of it. And so we might want to go to a full screen, but also when we go through the answers as well, it um blows the images up a little bit as well. So you might be able to appreciate it more. But yeah, just put some things that you might notice in the X ray. Um And I guess if you think back to the history as well, then that would help with what you're trying to look forward to. Yeah. So the later myelosis is definitely fractured. And so if we think about where it's fractured as well and in terms of how we might class that fracture the good stuff, Tia. Ok. Yeah, very good. We be, yeah, cos it's at that sort of level of the tenders as well. Um And then if we get the answers up as well just to make it a bit easier. So, yeah, it's a spiral fracture. I can appreciate it's a bit difficult to see in the views, but that's how it was described on the case from radioed, which I've pulled it up from. So I guess it always helps to try and talk about the direction of the fracture as well. And then also, so if we go ahead, I think two more, it should blow up, the it should bring up. So you can see it a bit easier. So there's the lateral malls and then here's the posterior malleolus fracture as well. So again, it's very, it's very minute and difficult to see. But I suppose with that, it's an example of where it's actually been pointed out. And so, you know, you know, where to look for a lot of presentations if nothing else. So, very good. So on to the next one. So after seeing the image and confirming the presence of a fracture, you can begin management. And so what would be the initial management for an ankle fracture? Yeah, a three assessment would wanna do that. Yeah, we would want to reduce and stabilize the joint as well. Uh Is there a specific way that we'd want to stabilize it perhaps in this case? Mhm. No. OK. Yeah. So yeah, below a knee back slab. And then after we've done that there might be, there are some things that we want to do as well as part of the documentation process. Um and just to make sure that everything's going smoothly. So what might those be? So we've reduced the ankle and we've put it in that Bologna back slab, what else would we want to do now that we've got that in place? So we would want to do that. Exactly. Yeah. And then the next the other thing would also be to get an X ray done. So plain film radiography just to make sure that the reduction is adequate. Oh, are you able to hear me now? Uh OK. Uh Are you able to hear me, David? OK. I'll see if I can share the slides but um see my screen. Uh OK. OK. I think if we just wait for the slides to go back up um from palm G that might make things a bit easier. Mhm. But um the next question doesn't require the size really? So after successful reduction, the patient asks what the next steps will be for their recovery. So what are we going to tell them? What might, what might the healing process look like next to always reduce and stabilize any male fractures before deep back slab? Um Well, this, this one was a bimalleolar fracture because of the posterior malleolar being affected as well. Um But uh yeah, as far as I'm aware, you, you would reduce and stabilize that fracture. Yes. Right. Nice. So, are we able to move on to question f please? Apology this stuff? Yeah. So, um we successfully reduced it and the patient asks what we do next? So what will we tell them? One? I suppose it's more about um So they've had the immediate treatment and they've been discharged and their carers are like an outpatient. Yeah, very good. So they've got um that sort of 6 to 8 week period. Yeah. So that's the sort of time that we'd be looking for it to heal as well. Um, and then in that time, in that 6 to 8 week time, then you'd be looking to follow them up in an outpatient clinic. Um, yeah, very good. So if you can bring those answers up for me, uh, please punch me. Um, so again, it's because of that, uh, rubber B fracture. So we're just looking for conservative measures really, rather than any surgery as we've, um, whether A or weather B fractures without Taylor shift, you're looking at conservative measures very good. So that brings us up on to case two. And so patient returns to Ed after injuring their foot and they complain of midfoot pain and they've got some difficulty weight bearing, there's swelling and tenderness over the mid foot. And when they're asked about their mechanism of injury, they tell you that during a game of football, their boobs got stuck in the mud and they tried to turn too quickly. And so a 4 ft abduction injury. So which structure are we concerned that they may have injured? And why is this anatomical structure at particular risk of dislocation? And so it's a bit of looking at the question stem for both deltoid ligament. Uh Yeah, that's some perhaps something as well. But if we're looking at the question stem and that they've got this swelling and tenderness over the midfoot region and also, um the, the mechanism of the injury itself as well will be. This forefoot abduction is one of the sort of classic ways that this particular structure or this particular injury occurs. And Bianca, as far as I'm aware, this is recorded. And so the, the electric itself or the seminar itself will be posted on metal as a recorded so that you can go back and watch it. But if we bring up um the answers, so part a we're looking at the, the left front ligament. And so the reason that this is at risk is because you don't have these transverse ligaments that stable the first and the second metatarsals. And so this makes the Liz Frank ligament particularly vulnerable because it's trying to do a lot of work by itself really. Um And so yeah, this sort of that 4 ft abduction, but also the sort of foot in the stirrups um mechanism mechanism as well. It was to do with I believe like soldiers um a few 100 years ago on horseback and they'd got their like their foots caught in the stirrups. And so as the um horse carries on moving, that's what causes that injury. So left front ligament injury or a left front injury. So if we go on to the next question, part C so what imaging are we gonna request? Um Bearing in mind we were worried about a Liz Frank injury, uh oblique to you. Yeah, you could have an oblique to you. Um Yeah, and bearing in mind it's still somewhat of an ankle injury as well. And so if you think back to the, the ankle series, but it's more specific. Um, yeah, you could have an an MRI if you're thinking about it because of soft tissue injury. Um, but if it's an X ray, you can still do an the, the ankle series for an X ray, but there's something that is sort of specific about the X ray. Um Does anyone have an idea of what you might need to specifically request on that? Um x-ray that the patient is doing? Yeah, weight bearing. Exactly. So if we get the answers for it, so the reason you need to be weight bearing is because um if, if they're not weight bearing, they'll be lying supine and the injury itself might not be hidden cos it's a displacement injury. And so um the weight bearing itself um causes that displacement and or highlights it more or becomes more obvious. Whereas if, then they're by Supine, it might be hidden very good. So if we move on to the next question, so we get the following images. And so how would we classify a Liron dislocation or how are, how are these dislocations classified? And then using those classifications, how could we describe the X ray findings? Yeah. So Hardcastle, that would be the um classification system. So then if we look at um this one in particular, how would we classify that? And um I'll get up the pictures and diagrams of what these look like as well. Um After we go through each to make a bit easier or to help you picture it. Mhm From, OK. So the way that the Hardcastle um classification um describes these uh dislocations is due to the movement of them. And so, no, that's not, not a problem. And so it's whether um it's homolateral and so there's lateral displacement um in one direction or whether there's uh if, whether it's divergent. And so you can get lateral dislocation of the second to fifth metatarsals, but then medial dislocation of the first metatarsal and then you can get isolated as well. So that's where you get one or two metatarsals that are dislocated. And so you get homolateral divergent or isolated and then, yeah, type a dislocation fracture cos if we're able to go back a little bit to have a look at the pictures, you can see that they are, they're dislocated in that one direction, that lateral direction and all the same that um the first metatarsal isn't dislocated lap er media. And so it wouldn't be divergent and it's not isolated because of the number of metatarsals that have been dislocated. So then if we are able to go forward with a couple, it will just bring up the pictures of those and then if we go on the next one as well, um excellent. And then the one more brings up the classification for us as well. Nice. So if we go on to the next question, as we take another closer look at the X ray and we notice a fragment of bone. And so what is the name for this sign? Mm um So I appreciate it's quite um quite a small thing to see, but hopefully the the circle has highlighted um where it is we're looking at but I mean, it's a, it's a small sign to know. Mhm. But um yeah, what, what's the name of this small fragment of bone from a list? Frank injury? Yeah, flex line. Very good. So it's that bit of bone that's between the first and the second metatarsal. And so think about the injury as a whole. How would we manage this? Right? Um Yeah, so definitely some conservative measures can be used as well, but there is some other sort of conservative measures that we can use to. But exactly, it's um it the displacement itself uh is not significant enough to really worry about surgery or anything like that. And so, um yeah, we can do like more conservative measures but once more of those could be OK. And perhaps also even maybe a guess how long would we be thinking that um this sort of treatment or this healing period might um last for, yeah, so like 6 to 8 weeks. Yeah, around that sort of time frame. So, I mean, they're a trauma patient and so we wanna make sure that they're hemodynamically stable. Um So that perhaps a to e like we've said for some of the other ones as well, but yeah, ensure that stability and then, like you mentioned before, it's not a dis the displacement itself isn't that significant. And so you can immobilize the foot in a cast or just keep them non weight bearing and you'd be looking to do this for about 6 to 12 weeks and then have a, you'll want a regular review and follow up with this as well. Um So if you could just move to get those up on the screen that nice and then if this and just for an extra note, just so if there was significant displacement, so if you click on the next one, it'll bring it up as well. So if there was significant displacement, then you could do close reduction in A&E and put them in a back slab and then definitive fixation between the medial cuneiform and the 1st and 2nd metatarsal and the middle cuneiform and second metatarsal. And so, yeah, you can use, oh I think uh I think, can you guys don earn me? I think there might be a bit of technical issue. Uh Oh Ethan's there, what's happened? Uh Let's bring him back in. Where's Ethan? OK. Uh Ethan is there but he's not on the chart. Hold on a second. Oh, I, I've invited, you know, dear, you're saying I don't have access to the results in about to close. Uh I'm not sure why that's happened. Ethan. Um Let's have a look, uh Ethan perhaps if you just try and um join again via a link um to, to the metal thing and then I'll, I'll add you back in, in the meantime. II can I can continue um with, with the next question? Um And then I'll add you back in because you're not in the people option if that makes sense. Hi David. Hi. Can you hear me? Can anyone Amy? Let's try to get you come back in? Yes. Uh Hi guys. Can uh can you s can you hear me? Uh perhaps just pop it in the chat quite useful? Er Well let's get you come back in. Uh Hello. Sorry everyone for some reason it changed my, it did that to me earlier as well. It's a bit glitchy today. Can you hear me even? Yeah, I can hear you. I'll continue. Um uh that's, yeah, that's the current slide. Alright. I've I've just did this question on your behalf. Is that alright? Yeah. No, so yeah, cool. So uh whilst joining the surgical ward round, the consultant who's paid no attention all week decides to quit you, they indicate towards a patient and they tell you they've suffered a pylon fracture. So what is fractured in this injury? F and T? Yeah. Yeah. So it's, it's a distal tibial uh tibial fracture involving the tibial prof and so um there'll there'll be an X ray coming up that will show that sort of area as well just to help picture it too. Um But yeah, very good. So what is the mechanism of this injury? Mhm. Yeah. So patients most likely from like a road traffic accident, high injury, trauma causing some actual loading. And so your talus is driven into the tibial platform and that's what causes that fracture and that so then if we could move on to the next question. So the consultant pulls up the patient's X ray and the CT on his laptop and he asks you to classify the injury. So can I have a go at what classification system is used for part fractures? And then using this system, could you classify the following injury? Ok. Os uh Ethan anything in the chart? There's nothing in the chat. And so yeah, we can veal the answers and so the classification system is called the Rudy and all go. And so if we were to classify that using that system, it would be a type three. That's because um this fracture is uh comminuted. So as we can see the, as we can see about the, the fracture and just how displaced and sort of at the edges, the fragments of the fracture itself. And so that led to a top three. So the there's a description of the injury I got from this case on radio pia was spinal fractures of the distal tibial tibial and fibular meads. It's commuted to that. Um type three, displaced intra articular fracture of the distal tibia is also noticed distal segments demonstrate up to 88 millimeters, electrical displacement and mild lateral angulation, distal tibia fibular joint is not widened and the maltese alignment appears normal. So if we move one, it will bring up the there we go the classification system. So type one is if it's an undisplaced intraarticular fracture, type two is a displaced intraarticular fracture and then a type three is commin or impacted fracture. So if we move on to e so the consultant asks you one last question before he signs off your weekly attendance and he picks on an F Yy instead. So he asks, how will this patient be managed if you think it's quite a traumatic injury? So they've had a road traffic accident. The fracture itself is commun so it's quite badly damaged. So what sort of things would we be looking to do? Oh, for that, an internal fixation. Yeah. So the, yeah, so we'll definitely be looking to do surgery in this patient. Yeah, a three assessment. Can you think of any other things that we might be wanting to look out for in this patient, in particular when we were assessing them? So things like a neurovascular assessment? Yeah. Uh yeah, very good. And then also be on the lookout for compartment syndrome as well. Um So we forget the answers up. So we want to realign the limb and put a bologna backslab on and then repeat the neurovascular assessment and check the plain film radiograph. And we also want to elevate the lemma monos for compartment syndrome and then thinking on to surgery if because we wanna get them into theater, we wanna keep them near by mouth and get them some IV fluids. And then in theater, we wanna reconstruct the articular surface and rest, restore alignment of the ankle mortis and protect the soft tissues around the ankle joint. Oh, so on to the final case. So a patient presents with a painful foot after a road traffic accident whilst taking a history, we find that there was immediate pain and swelling and the patient has a limited range of motion. The patient said it felt like their foot was pushed up into their leg. And so we can see a clear deformity and the overly skin is white and non blanching. So first off, what do we think that the injury itself might be? Ok. Yeah, good question. And so if we can see where it's blanching in this area, what might that suggest has happened to something in, in the ankle or something in the foot or in the leg, something has probably been displaced somewhat. And so in this patient, they had a talar fracture that's been dislocated. And so if we go on to the next one, so uh which movements would we want to assess um in an ankle exam and thinking back to this um talar fracture or the talar dislocation? Which particular movement would we expect to be affected? Yes. Mhm. So just the part B what sort of movements will you get a patient to do? Um as part of an ankle exam? Yeah. Dorsiflexion and plantar flexion and uh a duction and a duction. And then are there any other movements as well? Sorry. Six. So yeah, E virgin. So if you get a part B so we get them to dorsiflex and Plantarflex and do inversion and inversion and then toe flexion and extension. And then us as the practitioner, we'd get them to passively er invert and even the midtarsal and subtalar region and then there should be no, there's not. Um OK. And then if we think on to part C so which of these movements um would the patient not be able to do most likely? Mhm. So I've had a talar fracture of dislocation. And so something that in the Ed or in A&E that might lead you to thinking towards this injuries if they can't plan a flex or dorsiflex, a foot, um so that unable to bring just to move that ankle joint um would perhaps think you to lead you to think that the, the tail that has been um injured, then if we move on to uh part D so thinking onto the talar fractures. What classification system would we use for that? So part of the classification um looks at displacement and which uh where the bones have been displaced from the joint itself or what joints it's been displaced from. Um And so that classification is the Hawkins classification. And so it's split into four types and then if we can bring up the next picture, it should try and help correlate those. And so whether it's undisplaced, whether it's just the subtalar joint where there's dislocation, if there's the subtalar and the tibiotalar joint where it's been displaced and also the subtalar tibiotalar and talar navicular dislocation and then good. So, um then on to question a, so what are the potential complications of a fracture of the talus and uh why or why in this bone, in particular? Mal union? Yeah. So Mal Union is always, always a safe bet for any sort of fracture, non union, osteoarthritis. Yeah. Um, good. Is there anything that avascular necrosis? Yeah. So, um, what is it that would lead to the, the osteoarthritis or the avascular necrosis or um, what puts this bone at risk? Yeah, exactly. It's a retrograde blood supply. Yeah. Um, so it's a branch of the posterior tibial artery and its retrograde blood supply. And so you can get this bone necrosis, this osteonecrosis that can lead to premature osteoarthritis. All right. And so just bear with us a moment while we get the slice back up and there's just, that's the end of the cases. So there's just five short SBA S after that. Um However, we do need the imaging up to help with the SBA S one. I, I'm not unsure what's happening today, mate. Um I'm sharing it now. It keeps kicking us up. Um I can pause now. Very good. Yeah, so if we can carry on from there. Yeah, cool. So yeah, as you said, the blood supply is retrograde, um and it can lead to premature osteoarthritis due to that bone uh necrosis. Oh, so if you can go on to the SBA S now, so, um what does this, what does the following X ray show? So these blue arrows pointing at something very particular or specific in that area, loss of space? Um Yeah, I suppose there's a lot of space. Um It's more pointing to below the joint line to this uh to the bone in particular and it somewhat links to um the last case that we did as well. So it's something called Hawking sign. And so what you're looking at is this, this lucency under, under the top of the, the talus. And what that shows us is that there's a good blood supply to that bone and that um the bone is being reabsorbed. And so because of that, we can be fairly reassured that there's a low risk of avascular necrosis from that. Um So this sort of way see a bit darker where the bone is being reabsorbed. It shows that there's a good blood supply to that bone and we shouldn't worry about this avascular necrosis so much because there's sufficient vascularity. Um, so that'll come up on the next. There you go. So then if we can move on to the second B, so what do these x rays show to just try and orientate yourself um, to what the, these two x rays are looking at because they're looking at two different um parts of the anatomy. Yeah, there is talar dislocation and it is associated with something. I don't know if it's cut off the answer that you've put or if you just went to type in the rest of it. Uh Yeah, there's talar dislocation and there is a um fibular fracture as well. And so there's a name for this type of injury and it's called a nasal nerve injury. So you get that uh widening of your Maltese that shows that there's not been that dislocation, that unstable ankle. Um And also you get this um proximal fracture of the fibula as well. And so in patients that have this proximal fibular fracture, um you should always suspect a ankle dislocation until proven otherwise. Um So if you could bring up the OK, I mean that injury uh right, just sort of what the bits in red um s say line up with what the major nerve injury is. So it's that ankle dislocation with a proximal fibular fracture. And so in patients with a fibular dislocation, proximal fibular dislocation, you should suspect an ankle proximal fibular fracture. You should suspect ankle um dislocation until proven otherwise. So then which classification system is used for phys fractures and includes through above and slipped as terms to describe the types of fracture. Um So it's more the the terms through above and slipped to more um ways to help you remember this type of classification? Uh very good. So of Harris. Yeah. So the Salta Harris is for your phys fractures. And so um s so slipped s um above is a um an nt through parts of that that um help you remember that um Salter Harris. Mhm And so looking at this X ray, what is it that has been fractured here? Uh Not to worry, Tia. So again, I can appreciate that it might be a bit of a small injury to see. But then I suppose that sort of highlights how difficult these might be to see on an X ray. Um But I guess that's why a history might always help with pointing in the direction of where you want to hold up as well. Mhm A Yeah, II can see, II can see why potentially. So in this patient, it's the calcaneum that's been fractured. And so if you move, there should be two yellow circles that come around the um on the image where uh there we go. So again, i it's, it is quite um difficult to see on the size of the image. Um But yeah, and so then if we move on to the next question, it links to this one. So that last fracture is known as a lover's fracture. And it's from the fact that a suor agent from Great Heights are trying to escape from the lover's spouse. So basically, they, they fell from height and landed on their feet and they fracture their calpan. And so which other fracture therefore has an, has an important association with the lover's fracture. This one is more just a, a bit for fun at the end. So this one is just the lumbar spine. So for these patients um with the calcaneum fractures falling from a height, just make sure you can rule out a lumbar spine fracture as well. And so this would be a burst fracture of the lumbar spine. Um So I can the middle compartment of the lumbar spine rather than the anterior or posterior compartment is the middle compartment of the lumbar spine. Cool. And then that brings us to the end of our um SBA S. So, yeah, thank you very much for joining us today. And just before you leave, if you could scan the QR code for us, um just to fill in some feedback, that would be very much appreciated and I'll hand back over. Yeah, we could uh thank you. Thank you Ethan. Um Really, really good slides and um, really informative cases. Apologies for the, um, we don't, I don't really know what was happening. I'll be honest with the connection but yeah, really good slides. Um, if you can fill out the feedback, um, is, is there a way that we, uh da's put it in? Ok. Oh, we can. Uh, yeah, if you just click on the link, um, er, the slides, er, so basically we'll, er, the, the session will be recorded. I'll hopefully try to snip out the connection problems out of it. I'll upload it onto metal and the slides will all be on there as well. Um, with, um, the Ethan um, going through the, the answers. Um, and I David, um, David, er, if, um, I'm pretty sure David correct me if I'm wrong, er, you send the slides out, er, via a platform, don't you? Um, if you sign up, I think, uh I'm sure David will pop it in the chat. Um, but yeah, we could, um, very well done Ethan and, um, yeah, they will email them out. Um, and yeah, so our next session is on, er, in two weeks time. It's on knee fractures and conditions. Um, it's on knee fractures. Yeah. So, er, that'll be great to do and uh hopefully we'll have, er, the connection issues we did today in those. Um, yeah, if, uh, if anyone has any questions, uh that'll be, uh, feel free to ask. But, yeah, do fill out the feedback form. That would be great. Um Going forwards. Yeah, that's how David is able to send the slides is because you have to put your email as part of it. So he knows who to send them to. Yeah. Wonderful, wonderful. Um Yeah, really good. Um Is there anyone any questions? Yeah, they just popped it into the chat. Um, what I'll do is I'll sh I can share my window II accidentally stopped it. Um, you should still be able to see it. Um, use a QR code or use a link let instead of the chat. Um, I, that'll be pretty good. Well, lovely. Um, thank you very much Ethan. Um, and thank you guys for joining again, apologies for the, er, connection issues. Um, but yeah, if you, if you missed anything, just, er, it will be on the recording will be on later tonight. Um, and if there's anyone that missed it that you wanted to that would have wanted to attend, just send, send out the memo. Yeah. Thank you very much, even any, any final remarks. Uh, just thank you everyone for joining. Lovely, er, all right, wicked. Uh, well, have a good evening guys and, uh, see you all soon. Yeah. Ok. Ok. No. Yeah.