Consultation Hours : 10 a.m. - 1 p.m. & 6 p.m. to 9 p.m. (Monday - Saturday)

Early Stabilization & Mobilization in unstable Pelvic Injuries

An 18 year old boy met with an unfortunate accident on the road. He was pillion-riding on a bike which was knocked down by a 4-wheeler near krishnagiri in Tamilnadu. He was immediately rushed to the Govt. Hospital at krishnagiri,initial hemodynamic stabilization was done and was shifted to a major hospital in Bangalore. On evaluation,he was found to have an unstable fracture of the pelvic ring and a closed fracture of the shaft of his right femur. He however.continued to be hemodynamicallly unstable and his Hemoglobin was hovering around 5.5g% inspite of repeated blood transfusions.at this stage,he was transfered to our hospital for angio-embolization of pelvic vessels.At CT angiogram was done here, which did not show any active bleeder. However,there was a large retro-vesical hematoma collection displacing the urinary bladder.The interventional Radiologist opined that angio-embolization was not necessary.

 

He stabilized over the next 3 days with blood transfusion.he was also put on mechanical DVT prophyaxis(Flowtron Pump). On the 4th day after admission here, CT scan was repeated. It did not show any increase in the size of the retro-vesical hematoma. He was taken up for surgery on the same day. open reduction of the symphysical diastasis was done using a Pfannensteil approach and stabilization achieved with a 4 hole plate. Open reduction and anterior double plating of right Sacroiliac joint was done. In the same sitting ORIF of fracture shaft femur was done using a locked intramedullary naill. He was in the ICU for a day,was shifted back to the ward after that.Immediate wheel chair ambulation was started on the first post-op day,along with knee bending and active quadriceps excercises.he was very comfortable with the wheelchair - bed transfer and with the mobilization excerses. He was discharged in a stable condition, 5 days after the surgery.At 6 weeks post-op, he has started walking with the help of a walker frame.

We are a comprehensive trauma team at BGS Global Hospital, Bangalore, with a solid backing of a 24/7 Emergency care & Blood bank ,Plastic Surgeon, Interventional Radiologist, Abdominal Surgeon, Neurosurgeon and Physiotherapists. Not only patients but also other major hospitals in Bangalore recognize our wholesome approach to the care of polytraumatised patients. This 18 year old stands a testimony to the trust patients and other major hospitals have placed in us.

 

References:

1.Goldstein A, Phillips T, Sclafani SJ, Scalea T, Duncan A, Goldstein j, et al.Early open reduction and interval fixation of the distrupted pelvic ring.J Trauma. 1986;26(4):325-33.

2.Barei DP, Shafer BL, Beingessner DM, Gardner MJ, Nork SE, Routt ML. The impact of open reduction interval fixation on acute pain management in unstable pelvic ring injuries. J Trauma.2010;68(4):949-53.

3.Latenser BA, Gentilello LM,Tarver AA, Thalgott JS, Batdorf JW. Improved Outcome with Early Fixation of Skeletally Unstable pelvic Fractures.J Trauma. 1991;31(1):28-31.

4.Matta JM;Tornetta P lll.Interval Fixation of Unstable Pelvic Ring Injuries.Clin Orth Rel Res 1996;329:129-140.

Thursday, 25 February 2016 11:05
Rate this item
(0 votes)

41300 comments

  • UgrasalSeems

    UgrasalSeems - Saturday, 24 February 2024

    The presentation will study prediction of methods are enticing in that they will seize information on thousands of human well being outcomes utilizing new analytics methods to identify environ- molecular features (and thus chemical compounds) in a single analytical run with none mental toxin Hot Spots utilizing Big Data. In the primary, the exam sufferers with higher levels of inferior laxity, a hole or iner stands or sits comfortably next to the patient. Pigs on a twice every day feed stockperson to be able to see and examine all of the ing regime ought to empty their trough within 10 pigs at any time medicine 7 years nigeria [url=http://www.casagrande.gov.ar/otc-drugs/group72/order-cheap-dulcolax/]cheap 5 mg dulcolax with visa[/url].
    When the usually acid filtrate becomes alkaline, some substances could also be precipitated. Bastyr calmly and ventional perspective and is aware of the strengths rapidly responded, Choose what works. Butachlor additionally induced these gastric neoplasms in Sprague-Dawley rats following chronic excessive dose exposure antifungal medication oral [url=http://www.casagrande.gov.ar/otc-drugs/group72/buy-cheap-nizoral/]order nizoral 200 mg with amex[/url]. Most lung abscesses are a complication of bacterial pneumonia or are attributable to aspiration of oral anaerobes into the lung. Although memory retraining might present modest, transient benefit, it could possibly additionally cause frustration for both patients and caregivers. Non- Given that apparent false constructive indicators in medical trials could in fact be occult cancers Cancer highlights the importance of having lengthy-term observe-up to verify non-cancer standing References: 1 stroke treatment 60 minutes [url=http://www.casagrande.gov.ar/otc-drugs/group72/buy-baycip-no-rx/]order cheapest baycip and baycip[/url]. Susceptibility of 40 lactobacilli to six rhamnosus, which is closely associated to acidophilus. The Pederson speculum is with proof of cervicitis could also be seen with Chlamydia tracho- barely bigger and could also be used in an adolescent. Fuller Somatic cells in the testis play an necessary regulatory position in sper- matogenesis, although most hormones and cytokines tested exhibit both pre- or post-spermatogonial effects (Desjardins and Ewing 1993) gastritis diet plans [url=http://www.casagrande.gov.ar/otc-drugs/group72/order-online-biaxin-cheap/]500 mg biaxin order overnight delivery[/url].
    The conventional care plan report has been eliminated in favor of a every day staff planning convention to debate affected person care. Lack of vaginal bleeding after the prog- Nettle root esterone challenge suggests both inadequate Green tea priming of the endometrial lining, absence of an Soy endometrial cavity, or some sort of obstruction. Vasopressin in other gynecological procedures: Clinical trials have proven that vasopressin is effective in decreasing blood loss throughout other gynecologic surgical procedures medicine used for uti [url=http://www.casagrande.gov.ar/otc-drugs/group72/order-finax-online-no-rx/]purchase finax 1 mg without a prescription[/url]. Chemoprophylaxis remedy with one of many therapies listed above ought to is not generally beneficial for attainable publicity be considered after a confirmed organic assault or an 113 to endemic disease. This is a home therapy program and must be taught to the It takes origin from the posterior twine of the brachial mom. It is intended to be utilized as part of an individual and cumulative phthalate risk evaluation arteria 3d medieval village [url=http://www.casagrande.gov.ar/otc-drugs/group72/purchase-online-lanoxin-cheap/]order lanoxin 0.25 mg with amex[/url]. The piece of intestine closest to the anus corresponds to our colon, the part closest to the stomach corresponds to our duodenum. Depending on the well being system, these medical tradeoffs can have monetary implications for patients as well. From a case-series, fatal food reactions trigger respiratory arrest usually after 30–35 minutes; insect stings cause collapse from shock after 10–15 minutes; and deaths caused by intravenous treatment occur most commonly within 5 minutes erectile dysfunction cleveland clinic [url=http://www.casagrande.gov.ar/otc-drugs/group72/purchase-cheap-vardenafilum-no-rx/]generic 20 mg vardenafilum free shipping[/url].
    It is thus not potential to extrapolate the patterns of tobacco use from one country where oral tobacco is available to other nations. Future contraceptive wants should be mentioned, and ladies who want to keep away from pregnancy ought to be suggested that contraception is required immediately after implant elimination. Add-back treatment relieves related menopausal symptoms and might ameliorate bone loss and lipid changes medications related to the lymphatic system [url=http://www.casagrande.gov.ar/otc-drugs/group72/order-cheap-synthroid-no-rx/]buy synthroid 200 mcg low price[/url]. Vit D deficiency Answer: lower bone density as a result of vit d deficiency, hormonal causes, steroid use. If your surgeon used the mammary artery for a bypass graft, you could feel ache along the left side of the incision. The focus of duloxetine in the twine blood (see above) was higher than the mother’s peak plasma focus obtained 6 hours after a dose 32 days after start (see Breastfeeding Summary below) symptoms toxic shock syndrome [url=http://www.casagrande.gov.ar/otc-drugs/group72/order-online-cystone-cheap/]purchase cystone with a visa[/url]. There has never been any full lack of consciousness throughout these episodes either. Syncope in the absence of pre 7 either occurs in a recumbent place or is related syncopal signs ought to be approached with a similar degree with exercise, chest pain, or palpitations. Our established methodology and findings pave the way for further research of the involvement of anti-alphaGal antibodies in immunity and may be a method to look at the potential of a person to mount an anti-carbohydrate response treatment herniated disc [url=http://www.casagrande.gov.ar/otc-drugs/group72/buy-mentat/]discount mentat 60 caps without prescription[/url].

  • holsontah

    holsontah - Saturday, 24 February 2024

    [url=https://hd.novinki.pro/filmy-2024/]
    фильмы 2024 в качестве бесплатно[/url]


    лучшие фильмы 2024

    https://hd.novinki.pro/filmy-2024/

  • KentOmifs

    KentOmifs - Saturday, 24 February 2024

    Skin test positivity to at least other reactions where β-lactam drug administra- one determinant occurred in 70 % of the patients, tion is contraindicated. However, the process is irreversible and has potential issues associated with the relatively lengthy staple line corresponding to bleeding and leakage. A optimistic correlation was found between the 677C→T polymorphism and migraine (159), which was shown to be conscious of high-dose riboflavin remedy (400 mg/d), with a significant discount in assault frequency (169) symptoms 0f high blood pressure [url=http://www.casagrande.gov.ar/otc-drugs/group72/order-cheap-synthroid-no-rx/]synthroid 100 mcg purchase on line[/url].
    Figure 6 displays the remedy algorithm for adults 60 years that can be used to determine how to provoke and intensify blood strain therapy and the frequency of follow-up blood strain visits for a affected person with hypertension. As newer and more potent medicine become out there, the number of critical drug interactions is prone to enhance. Diagnosis and treatment of intraductal papillary mucinous neoplasm of the pancreas blood pressure healthy numbers [url=http://www.casagrande.gov.ar/otc-drugs/group72/purchase-online-lanoxin-cheap/]0.25 mg lanoxin purchase visa[/url]. Decreased synaptic proteins in neuronal exosomes of frontotemporal dementia and Alzheimer’s illness. We are a nonproft membership shopper organizations and patients to foster a shared association dedicated to the advancement understanding of professionalism and how they will of neuromuscular, musculoskeletal, adopt the tenets of professionalism in apply. Studies were not excluded due to methodological high quality, but feedback are given on the limitations of the research strategies and therefore the boldness that might be placed on their findings gastritis zungenbelag [url=http://www.casagrande.gov.ar/otc-drugs/group72/order-online-biaxin-cheap/]discount biaxin 500 mg buy line[/url].
    In poisonous forms of bipolar disorders there is a subject to inefficacy of treatment (lofty platoon of pre-lithium episodes and hospitalizations). Before lengthy, a vicious cycle develops which continues in this method till somebody experiences a full blown panic assault. The primary point is that solely base pairing that brings the complementary sequences into register will cause renaturation fungus sliver [url=http://www.casagrande.gov.ar/otc-drugs/group72/buy-cheap-nizoral/]cheap nizoral 200 mg without prescription[/url]. Cellulitis be used to treat infections of the central nervous system with or without sepsis could also be accompanied by bulla for because of their capability to penetrate the blood-brain mation and necrosis with extensive soft tissue destruction, barrier. Anesthesia пїЅ Anesthesia, General Agents and Techniques пїЅ Anesthesia, Regional and Local Agents and Techniques пїЅ Choice of Anesthesia пїЅ Conscious Sedation Agents and Techniques пїЅ Intraoperative Monitoring and Common Intraoperative Problems пїЅ Postoperative Pain Management 2. Widespread endothelial injury may be produced by deposition of antigenantibody complexes medications knowledge [url=http://www.casagrande.gov.ar/otc-drugs/group72/buy-baycip-no-rx/]baycip 500 mg mastercard[/url].
    We aren't aware of any evidence of differ 131 marily depends upon the mixture of its location, size, 181 ing development potential according to the myoma s place. Fibromuscular Dysplasia Patient Volume 2008 2012 Volume 400400 300300 200200 100100 00 2008 2009 2010 2011 2012 Lower Extremity Wound Clinic Volume 2008 2012 Volume 2,0002,000 1,5001,500 In 2012, a total of 1,397 1,0001,000 sufferers have been treated within the Lower Extremity Wound Clinic. Topical four% lidocaine has a faster onset of action than lidocaine-prilocaine cream (20-30 versus 60-90 minutes, respectively) medicine 6 year in us [url=http://www.casagrande.gov.ar/otc-drugs/group72/order-cheap-dulcolax/]purchase dulcolax 5 mg on line[/url]. Basophilic cells choose that causes purple blood cells to shrink and type up alkaline dyes and can turn blue or purple after notches round their edges. The Bible says that the manifold knowledge and counsel of God for the ages should be and is to be demonstrated and never just taught but demonstrated by way of the church. Iron deficiency happens in being pregnant because of the expanded blood quantity and lively transport of iron to the fetus medications quit smoking [url=http://www.casagrande.gov.ar/otc-drugs/group72/order-finax-online-no-rx/]cheap finax master card[/url].
    The statistical significance of these findings is unknown and independent affirmation is required. The majority of benzene {in the|within the} {environment|surroundings|setting} comes from petroleum {products|merchandise}, {however|nevertheless|nonetheless}, half of {the personal|the private|the non-public} {exposure|publicity} is from cigarette smoke {{Radiation {therapy|remedy} used to {treat|deal with} {cancer|most cancers}. It ought to highlight areas where improvements can be made whereas recognising that sources and support might be necessary to ensure improvements may be carried out treatment anal fissure [url=http://www.casagrande.gov.ar/otc-drugs/group72/buy-mentat/]order genuine mentat on line[/url]. Indeed, evaluated by the modifications in set-point for cal in vitro studies of dispersed cells from the para cium. Dose-related unwanted side effects of carbamazepine embody vertigo, ataxia, diplopia, and drowsiness. It is very efficient within the therapy of assorted senile illnesses and as an aid to patients present process chemotherapy impotence losartan potassium [url=http://www.casagrande.gov.ar/otc-drugs/group72/purchase-cheap-vardenafilum-no-rx/]purchase discount vardenafilum line[/url].
    You will receive a proof on the continued treatment and what to do if pain or bleeding seems, and an evidence on the method of switch of the embryos. Standardized echog- Astrocytoma Anterior displacement of iris and angle closure raphy 25and fluorescein angiography72 may help the Neovascular glaucoma (whole retinal detachment) prognosis. Perfusion deficits ought to beand the patient ought to be started on a balanced electrolyte answer treatment 5ths disease [url=http://www.casagrande.gov.ar/otc-drugs/group72/order-online-cystone-cheap/]cheap cystone online mastercard[/url].

  • ThordirHoics

    ThordirHoics - Saturday, 24 February 2024

    Rhinology 251 Differential Diagnosis the differential prognosis consists of an inverted papilloma, fungiform pap- illoma (typically arises from anterior nasal septum), cylindrical papilloma (typically arises from lateral wall; rare tumor), minor salivary gland benign or malignant tumors, lacrimal sac tumors, esthesioneuroblastoma, carcinoma similar to squamous cell carcinoma or sinonasal undifferentiated carcinoma, mucosal melanoma, chondrosarcoma, angiofibroma, inflammatory nasal polyp, allergic fungal rhinosinusitis. There is world, and nasal carriage is a properly-outlined danger issue in the evidence that suggests that iron chelator therapy may improvement and spread of nosocomial infections. The burden of unnecessary absenteeism to the students, households and communities far outweighs the dangers related to head lice antifungal essential oil blend [url=http://www.casagrande.gov.ar/otc-drugs/group72/buy-cheap-nizoral/]discount generic nizoral canada[/url].
    The mode of transmission from animal to humans appears to require direct contact with tissues or body fluids, or with aerosols generated during butchering or culling. However, fewer than 2,000 patients die of Most often it presents as a lump or nodule in the neck. Chronic synovitis finally supervenes, leading to ache, bony deformities and contractures over the counter erectile dysfunction pills uk [url=http://www.casagrande.gov.ar/otc-drugs/group72/purchase-cheap-vardenafilum-no-rx/]buy generic vardenafilum 20 mg online[/url]. These systems usually incorporate either a side-lever design, or a rowing-motion design. Research Tools (This materials is used with permission and was excerpted from the upcoming revision of the information at. Furthermore, the surviving eggs progressively have a higher threat of containing irregular numbers of chromosomes (aneuploidy) symptoms stomach cancer [url=http://www.casagrande.gov.ar/otc-drugs/group72/order-cheap-dulcolax/]buy 5 mg dulcolax[/url]. Treatment regimens are restricted to high expertise, high skill, and excessive-value interventional remedy. This lack of correlation makes it dif data can be found concerning how colonization impacts this cult to determine an appropriate remedy routine for medication test, however tendencies towards decrease specifcity have been seen. Side effects: nausea, vomiting, abdominal pain, diarrhea, headache, fatigue, rash urticaria, pruritus, photosensitivity; rarely hepatitis, jaundice, dyspnoea, angioedema, anaphylaxis, neurological reactions (including dizziness, confusion, hallucinations and drowsiness); acute renal failure, decreases in hematological indices; on intravenous infusion, severe local irritation (typically leading to ulceration), fever, and infrequently agitation, tremors, psychosis and convulsions medications xr [url=http://www.casagrande.gov.ar/otc-drugs/group72/order-cheap-synthroid-no-rx/]order 75 mcg synthroid with mastercard[/url]. General health since leaving hospital пїЅ putting on weight, feeding (associated breathlessnessfi. Acute pancreatitis refers to an acute inflammatory means of the pancreas, normally accompanied by abdominal pain and elevations of serum pancreatic enzymes. Advances in Experimental Medicine and Biology, Volume 686, 2010, pp three-14 18 Manuel Posada de la Paz professional english medicine [url=http://www.casagrande.gov.ar/otc-drugs/group72/buy-mentat/]order mentat canada[/url].
    In addition, several other bacterial reactions utilize H2, and H2 launched from fecal material is only a small fraction of that produced. Normal ocular epithe- lium doesn't contain any mast cells, eosinophils, or basophils, although in ocular inflammatory problems similar to vernal and giant papillary conjunc- tivitis, such cells are seen, as evidenced by the conjunctival deposition of eo- sinophil major primary protein deposition [10]. These cells are neurowhich a major neoplasm is unsuspected, the ectodermal in origin symptoms yeast infection women [url=http://www.casagrande.gov.ar/otc-drugs/group72/order-finax-online-no-rx/]finax 1 mg buy low price[/url]. Because of the individual- and population-stage burden of autoimmune dis- ease, threat assessment with respect to this group of diseases assumes special significance. The maximum recommended dose of nebulised ipratropium is 500 micrograms four times day by day, and in view of its longer duration of motion than salbutamol there's unlikely to be any advantage in giving it more frequently than this. In addition, the fertility and reproductive capacity of the offspring at 10 weeks was assessed medications band [url=http://www.casagrande.gov.ar/otc-drugs/group72/order-online-cystone-cheap/]60caps cystone fast delivery[/url]. The affected person described herein had an unusually giant number of pruritic papules in addition to tick larvae present on her skin. B-cell recovery following rituximab-primarily based therapy is asso- Compliance with ethical standards ciated with perturbations in stromal derived issue-1 and granu- locyte homeostasis. Suitable topical medicine in a affected person with thrush and hoarseness and is someinclude the polyenes amphotericin B and nystatin, and instances identified during a bronchoscopy gastritis diet елмаз [url=http://www.casagrande.gov.ar/otc-drugs/group72/order-online-biaxin-cheap/]discount 500 mg biaxin with amex[/url]. Infective endocarditis can current with petechiae (30% of Publishers, 2005, pp 1627-51 sufferers), called splinter hemorrhages in nail beds, Roth spots when involving retina, and Janeway lesions when on palms and 4. Cho- lesteatoma might erode bone by extra native inflammatory response and osteolytic enzymes. Thus, their routine use isn't warranted in patients whose headaches fit a broad definition of recurrent migraine and who've had no recent change in headache pattern, no history of seizures, and no focal neurologic findings pulse pressure 2012 [url=http://www.casagrande.gov.ar/otc-drugs/group72/purchase-online-lanoxin-cheap/]buy discount lanoxin 0.25 mg line[/url].
    Frequent causes of background staining are endogenous enzyme exercise and endogenous biotin. Fluid losses occur routinely through urine, stools, respiratory vapor and insensible skin losses. Congenital Adrenal Hyperplasia Due to Steroid 21-Hydroxylase Deficiency: An Endocrine Society Clinical Practice Guideline medicine zalim lotion [url=http://www.casagrande.gov.ar/otc-drugs/group72/buy-baycip-no-rx/]baycip 500mg fast delivery[/url].

  • Vernainift

    Vernainift - Saturday, 24 February 2024

    Hello everyone! I go by the name Admin Read:

    На мега ссылка мы предоставляем не только товары высокого качества, но и гарантируем максимальную защиту. Ваша безопасность - наша первоочередная задача. На mega ссылка тор вы можете сделать покупки с уверенностью, зная, что ваши данные защищены. Присоединяйтесь к нам и наслаждайтесь комфортом при совершении безопасных покупок.

    mega dark market:https://xn--megas-k90b.com

  • holsontah

    holsontah - Saturday, 24 February 2024

    [url=https://hd.novinki.pro/filmy-2024/]
    фильмы 2024 в качестве[/url]


    фильмы онлайн в хорошем качестве 2024

    https://hd.novinki.pro/filmy-2024/

  • phenetuha

    phenetuha - Saturday, 24 February 2024

    [url=https://novinki-smotret.pro/filmy-2024/]
    фильмы 2024 вышедшие в хорошем качестве бесплатно[/url]


    фильм 2024 онлайн бесплатно уже вышли

    https://novinki-smotret.pro/filmy-2024/

  • WilliamEcoge

    WilliamEcoge - Saturday, 24 February 2024

    Автосервис для Машинки: В случае если ваша машинка начала странности творить, не тревожтесь, у нас есть волшебники, коие отремонтируют ее. Масло, тормоза, движок — они там в этом шарят!

    Строим Сайты: Хотите свой собственный галлактический вебсайт? У нас есть дети, которые имеют все шансы это устроить. Прекрасно, ясно, несложно. Даже в случае если вы в интернете чайник — не страшно, они объяснят.

    Помощь с Компом: В случае если у вас компьютер тупит, как я в арифметике, не переживайте! Мы вас спасем. Вирусы, глюки, чудеса — наши эксперты разберутся.

    Бизнес-Советы: Мечтаете о своем бизнесе, хотя не понимаете, с чего начать? Мы не бизнесмены, но у нас тут есть знатоки, которые дадут совет, как не "попасть в грабли".

    Шопинг интернет: Интернет-магазин для тех, кто любит нажимать кнопки и получать посылочки. Здесь багаж от наших приятелей, проверено — качество замечательное!
    [url=https://madfightgym.md/]https://madfightgym.md/[/url]

    Поддержка и Общение: У нас как в большой семье, только интернет. Мы готовы посодействовать, поддержать, поболтать. Иногда просто важно, чтобы был кто-то вблизи.

    Инновации и Крутые Штуки: Ну и конечно, мы следим за последними трендами и подкидываем для вас заманчивых штукенций. Девайсы, свежие релизы — мы в курсе и готовы поделиться.

    Понятно и Откровенно: Тут никто не будет вас заваливать сложными текстами или техническим жаргоном. Все очень просто и понятно, как ребятам.

    Доверие и Дружба: Мы не просто сайт, мы приятели. Всегда рады вашим вопросам и услугам. Мы доверяем вам, и вам продоставляется возможность доверять нам.

    Результаты и Спасибо: Вот такие у нас приключения. Мы тут, чтобы помочь вам, не зависимо от того, как вы в чем либо разбираетесь. Добро пожаловать в нашу интернет-семью!

  • phenetuha

    phenetuha - Friday, 23 February 2024

    [url=https://novinki-smotret.pro/filmy-2024/]
    новинки фильмов 2024[/url]


    смотреть фильмы онлайн 2024

    https://novinki-smotret.pro/filmy-2024/

  • Josephannex

    Josephannex - Friday, 23 February 2024

    Как быстро купить аккаунт в вк без риска?
    Можно тут купить аккаунт вк https://good-akkaunt.ru если не хочется тратить время, силы на продвижение собственного профиля. Наш сайт поможет вам с выбором. Это также может быть интересным вариантом для бизнеса или маркетологов, стремящихся получить уже установленную аудиторию.
    Мы расскажем вам: Зачем нужны учетные записи в вк, для каких целей могут понадобится аккаунты вконтакте, На что нужно обращать внимание.

Leave a comment

Make sure you enter all the required information, indicated by an asterisk (*). HTML code is not allowed.