Castle Orthopaedics & Sports Medicine Services

Orthopedic Services

Providing the highest level of advanced medicine and compassionate care from diagnosis through post-rehabilitation

Providing the highest level of advanced medicine and compassionate care from diagnosis through post-rehabilitation

Areas of Care

Castle Orthopedics & Sports Medicine offers expert diagnosis and treatment for a full range of injuries and conditions, plus a variety of convenient on-site services, from imaging tests to state-of-the-art rehab facilities. Our goal is to help you achieve the best possible outcomes so you can get back to leading a full, active life.

Back and Neck

One of the most common complaints made to any physician is low back and/or neck pain. At Castle Orthopaedics, we strive to treat all disorders pertaining to the spine with compassion and appropriate urgency. The majority of spine complaints can be treated effectively by our excellent staff of physical therapists, along with the use of medications when needed. Sometimes, however, surgical expertise is required. One of the most common conditions we see is a herniated disc in the lumbar spine. The disc is the shock absorber to the spine, and over the years it may become more brittle and susceptible to rupture. Every effort is made to treat this condition without surgery, but often all conservative efforts fail, and microsurgery may be indicated. During microsurgery an operative microscope is utilized which allows for a smaller skin incision, which also leads to less trauma to the surrounding soft tissues of the spine. This and other newer minimally invasive surgical techniques allow for shorter hospital stays and less postoperative pain.

Another common complaint is chronic low back pain due to degenerative disc disease. Normally a condition of an aging spine, sometimes disc degeneration may result from an episode of trauma that occurred many years earlier. Occasionally, this disorder may require surgical management. In this setting surgery may involve fusion of the spine, or even disc replacement. Fusion of the spine limits the movement of a painful disc segment, and is currently the standard method of surgical treatment for disorders such as spondylolisthesis (slipped spine) and fractures, in addition to its occasional use in degenerative disc disease. Disc replacement is currently an option for single segment degenerative disc disease. A disc replacement is a mechanical device implanted in the disc space that helps the disc segments to maintain motion. It currently has FDA approval, however not all insurance plans approve and cover this procedure.

Shoulder and Elbow

Shoulder pain is one of the most common reasons why patients see an orthopedic physician. When your doctor at Castle evaluates your shoulder, he will determine the source of pain, which can be due to several factors. The shoulder joint is made up of the humeral head or ball at the top of the bone of the upper arm, the glenoid or socket of the shoulder joint, the acromion or upper part of the shoulder blade, and the clavicle or collar bone. The muscles that power movement of the shoulder include the muscles of the rotator cuff and the large deltoid muscle, which provides the rounded contour of the shoulder. The ligaments of the shoulder provide stability to the joint and keep the humeral head from dislocating from the glenoid. Any one of these bones, ligaments or muscle groups can potentially be a source of shoulder pain or disability. Some common sources of shoulder pain that your Castle physician will evaluate you for include rotator cuff tendonitis, a rotator cuff tear, rotator cuff impingement, torn ligaments of the shoulder, biceps tendon injuries, and arthritis involving the shoulder joint. All of these injuries among others can be diagnosed and treated at Castle Orthopaedics & Sports Medicine to help restore your shoulder function and decrease your pain.

In fact, Castle Orthopaedics & Sports Medicine is on the leading edge of treatment for complex shoulder problems. Dr Saleem, our shoulder and elbow subspecialist, was the first surgeon to perform a "Reverse" shoulder replacement in the Fox Valley area. This innovative procedure gives new hope to patients with un-repairable rotator cuff tears and shoulder arthritis. In addition, our physicians are performing advanced arthroscopic shoulder surgery in order to provide you with the least invasive procedure available. Along with our highly trained physicians, the physical therapy team at Castle has expertise in dealing with shoulder rehabilitation and they can provide the best hands-on care available, ultimately giving you a speedy and full recovery.

The elbow is a very complex joint that involves the articulation of three bones. The end of the humerus articulates with the radius and ulna bones of the forearm to allow for the extension and rotation of your elbow. Several muscles surround the elbow joint including the biceps, triceps, forearm extensor and forearm flexor muscles. Similar to the ligaments of the shoulder, ligaments in the elbow provide stability to the joint. The most common elbow problems include lateral epicondylitis (tennis elbow), medial epicondylitis (golfer's elbow), biceps tendon tears, triceps tears, ligament injuries and elbow fractures.

As with shoulder injuries, the physicians at Castle can readily diagnose your elbow problem and initiate appropriate treatment. Our skilled surgeons at Castle have performed advanced elbow procedures including ulnar collateral ligament reconstruction (i.e. "Tommy John procedure"), lateral ulnar collateral ligament reconstruction, complex fracture repair, elbow arthroscopy, and elbow replacement. In addition, we do employ a dedicated hand therapist who specializes in the treatment of difficult hand and elbow problems.

Hand and Wrist

The orthopaedic specialty of Hand Surgery involves the care of patients with injuries and disorders of the upper extremity below the elbow, including the hand, fingers, wrist, and forearm. At Castle Orthopaedics &  Sports Medicine, commonly treated injuries include tendon and nerve lacerations (cuts), broken bones, dislocated joints, and torn ligaments or tendons. Chronic disorders are often diagnosed, and include tendonitis and other overuse syndromes. We also evaluate, diagnose and treat conditions such as carpal tunnel syndrome, ganglion cysts, trigger fingers, cubital tunnel syndrome, and arthritis of the hand, wrist and fingers. We treat a wide variety of patients with occupational or industrial injuries due to work-related accidents. Our practice includes patients of all ages, including geriatric and pediatric hand disorders.

Not all patients require surgery for management of their hand and wrist problems. In fact, most patients are treated with a combination of various non-operative methods, including education and modification of activities, physical and/or hand therapy, cortisone injections, splinting, and orthotic fabrication. Our goal is to achieve maximum pain relief and the return of our patients to the highest possible functional level.

Many patients come back to Castle Orthopaedics & Sports Medicine for hand care after being treated by one of our physicians for another orthopaedic problem. New patients are frequently referred to our practice by friends or neighbors, or upon referral by their personal physician or the emergency room. We are pleased to provide the services necessary for excellence in hand care all under one roof - including the availability of our diagnostic facilities, hand therapy services, and outpatient surgery center.

Hip and Knee

The hip and knee joints are found at the opposite ends of the body’s largest bone, the thigh bone or femur. The hip joint, a ball and socket joint that allows movement in a number of directions, is formed by the ball at the top of the femur and the socket, which is part of the pelvic bone. The knee joint, a hinge joint that allows movement in only one plane, is formed between the lower end of the femur and the upper end of the tibia or shin bone. The surface of each bone at the level of the joint is covered by a layer of smooth cartilage which allows an undamaged joint to move smoothly with little friction. In the knee there is an additional kind of cartilage called meniscus that is a rubbery cartilage that serves as an actual cushion between the bone ends. Ligaments, thick bands of tissue around the joints, support the joints and prohibit excessive movements, such as a knee moving side-to-side instead of just up and down. Tendons are the parts of muscles that attach to bones adjacent to joints and it is the muscles that make a joint move.

Considering the complex anatomy of joints it’s no wonder that a wide variety of maladies can effect them. Tendonitis, such as jumper’s knee, is inflammation of a tendon and is generally the result of chronic overuse. Tendonitis usually responds to treatment by some combination of rest, medication or therapy. A strain is an injury to a tendon that is overstressed in a single injury and can include such force that the tendon is actually torn completely requiring surgical repair. Sprains are injuries to ligaments that are stretched beyond their limits and can vary in severity from a mild stretch to a complete tear which may require surgery, such as a torn anterior cruciate ligament (ACL) in the knee. A torn meniscus in the knee is usually treated by arthroscopic surgery. Wearing of the cartilage surfaces in joints is called arthritis. Mild cases may respond to activity modification, medication, bracing or injections while more severe cases may necessitate joint replacement.

At Castle Orthopaedics & Sports Medicine, our physicians have the expertise to treat the entire range of hip and knee problems from simple to complex.

Foot and Ankle

The foot is a complex structure involved in the support and locomotion of the human body. With 26 bones in each foot, the feet account for nearly 25% of the bones in the human skeleton. These bones are positioned and maintained in alignment by ligaments, tendons, and muscles, including some muscles in the lower leg which have tendons that cross the ankle and insert into bones in the feet.

The vertical forces placed on the foot during normal gait exceed total body weight by at least 20%. This number increases significantly with jogging or running. Any abnormalities in foot alignment or body position can also increase these forces. Increased forces can cause significant trauma to the foot by exceeding the structural tolerances of the soft tissues. This, in turn, can lead to further imbalances between the bones and muscles of the foot. These malalignments may cause many problems, including pronation (flat feet), bunions, hammertoes, corns, calluses, repeated ankle sprains, and even back and neck pain.

At Castle Orthopaedics & Sports Medicine, your ankle pain can be treated by any of our board certified orthopaedic surgeons or sports medicine physicians. If you or a member of your family has foot pain, we have a board certified podiatrist whose entire practice is dedicated to the diagnosis and treatment of diseases, injuries and abnormalities of the foot. He is available to discuss surgical and conservative treatment of all foot ailments from toenail problems to heel pain, bunions to skin lesions, and prescription orthotics to shoe modifications.

Fractures and Dislocations

Orthopedic surgeons treat millions of fractures each year in the United States. Treatment methods are variable, and depend on various factors such as patient age, bone quality, fracture pattern and location, and surgeon preference. Traditional methods of surgical fracture repair developed over the past century have provided reliable results with regards to fracture union and functional recovery. Recent innovations in fracture care have been developed that have the potential to increase healing rates. The physicians and staff at Castle Orthopaedics & Sports Medicine will provide you with comprehensive treatment of your fracture or dislocation, using the most reliable and up-to-date methods available.

Fractures are classified and treated according to the amount of displacement or separation of the bone ends of the fracture site. Most fractures are nondisplaced, and require only splint or cast immobilization until the bone is healed. Many fractures require reduction, in which he fractured bone ends are realigned appropriately. Closed reduction involves obtaining bony alignment via manipulation without incising the skin, and is usually done with anesthesia. Other fractures have enough separation at the bone ends or misalignment of the bone fragments to require a surgical procedure in which an incision is used to properly expose and subsequently align the fracture. Often pins, screws, plates, rods, nails, or wires are used to hold the reduced fragments in place until bony union occurs.

Fractures are unfortunate but fairly common occurrences. Proper exercise and a diet with adequate calcium and vitamin D content can help increase bone mass and significantly decrease the risk of fracture. We have a bone density scanner (DEXA) which can help identify those at increased risk of fracture due to osteopenia or osteoporosis.

Sports Injuries

An increasing number of people are becoming more physically active due to the many health benefits that exercise has to offer. For some, these benefits can come with a price: sports injuries. Fortunately, most sports injuries can be treated, and most people are able to return back to their activities. Some of the most common sports injuries are sprains, strains, fractures and dislocations.

A sprain is a stretch or tear of a ligament. A ligament is a band of connective tissue that joins the end of one bone to another. The severity of a sprain can range from a mild stretch to a full tear. Signs of a sprain include pain, swelling, bruising, and joint looseness or instability.

A strain is a twist, pull, or tear of a muscle or tendon. A tendon is a cord of tissue connecting a muscle to a bone. Some signs of a strain include pain, muscle spasms, and loss of strength or function.

A fracture is a break of a bone. A fracture can occur suddenly or develop over time. Sudden or acute fractures usually cause pain, swelling, bruising, and loss of function. If a break of the skin occurs with a fracture, it is a medical emergency. A stress fracture is a type of broken bone that can develop over time. The most common symptom of a stress fracture is pain at the site of the fracture with weight bearing activity. This type of fracture is usually associated with repetitive activities.

A dislocation occurs when two bones that come together to form a joint separate. It is usually caused by a sudden traumatic collision. A joint dislocation is an emergency and requires urgent medical treatment.

Whether an injury is acute or chronic, there is never a good reason to try to “play through” the pain. Continuing the activity can cause further harm. You should seek medical care if:

  • the injury causes severe pain, swelling, or numbness;
  • you cannot tolerate weight on the area;
  • the pain or dull ache of an old injury is accompanied by increased swelling or instability.

Often, the initial treatment of a sports injury should include the use of the RICE method. These four steps should be started as soon as possible after the injury and continue for at least 48 hours.

  • Rest: Reduce regular exercise or activities of daily living as needed. Support the injured area to avoid weight bearing and/or further injury.
  • Ice: Apply an ice pack to the injured area for 20 minutes at a time, four to eight times per day. To avoid cold injury or frostbite, do not apply the ice for more than 20 minutes at a time every two hours.
  • Compression: Compression of the area may help reduce swelling. A simple elastic wrap or compression splint may be required. Applying the wrap or splint too tightly could result in decreased circulation and numbness, or more severe injury.
  • Elevation: If possible, keep the injured area elevated on a pillow, above the heart, to help decrease swelling.

Although RICE can be helpful, sometimes further treatment is necessary. For example, medications such as non-steroidal anti-inflammatories drugs (NSAIDs) can reduce pain and swelling. Immobilization in a sling, splint, brace or cast can reduce movement, which may reduce pain and facilitate healing. Physical therapy or home exercises are sometimes recommended to increase the speed of recovery and to help the patient return to sports. Surgery also may be needed to stabilize or repair the injured area. Fortunately, most sports injuries do not need surgery.

At Castle Orthopaedics & Sports Medicine, our physicians will fully assess your sports injury and organize your treatment plan. Our professional services also include X-ray, MRI, physical therapy, hand therapy, and surgery.

Concussions

Sports-related concussion or mild traumatic brain injury (MTBI) occurs at all levels of sports participation and at epidemic proportions. The Centers for Disease Control estimates that at least 1.6 to 3.8 million sports-related and recreation-related concussions occur each year. Participation in competitive sports, especially full contact sports, increases an individual's risk for MTBI. High risk sports include football, ice hockey, wrestling, soccer, and lacrosse.

A concussion occurs as a result of a bump, blow, or jolt to the head or body which causes the brain to move rapidly and crash into the skull. This does not result in a structural injury of the brain, but causes an impairment of brain function. Since CT and MRI scans only show structural or bleeding injuries of the brain, they are always normal and not helpful in excluding the diagnosis of concussion.

The signs and symptoms of concussion are quite varied. An athlete may exhibit only one symptom, or may demonstrate several. Signs include varying levels of consciousness, disorientation, balance problems, memory and concentration problems, change in personality, and inappropriate emotions. Symptoms may include headaches, nausea, ringing of the ears, feeling off balance or dizzy, visual difficulties, sensitivity to light and noise, and feeling “out of it” or “hazy”.

Treatment is directed at resting the injured brain. This includes restriction from participation in sports and other physical activities. On occasion a concussed athlete may be advised to remain home from school. Medications for headaches are not recommended in the initial time period following a concussion.

Current management of MTBI utilizes computer-based neurocognitive testing to confirm resolution of a concussive injury. This major advancement eliminates the sole reliance on the self-reporting of symptoms by the athlete.

ImPACT (Immediate Post concussion Assessment and Cognitive Testing) is a computer-based neurocognitive test. This test assesses brain function by measuring performance in verbal memory, visual memory, reaction time, and processing speed. These “test scores” are compared to the athlete's baseline or pre-injury test results. One can demonstrate depression of these scores following a concussive injury. The test scores return to baseline as the athlete recovers from the injury, reflecting the normalization of brain function.

A concussed athlete has resolved his or her injury when there is complete symptom resolution and normalization of his or her neurocognitive test scores. Under no circumstances should an athlete be returned to play if he or she is symptomatic.

Preinjury ImPACT baseline testing is recommended for all athletes, especially for those who participate in contact sports or for athletes with prior history of concussion. Baseline testing should also be considered for athletes with learning disabilities.

Joint Replacement

Human joints are typically formed at the junction of two or more bones. The ends of the bones are connected by thick tissues, such as the joint capsule and ligaments, and are often surrounded by muscles and tendons which aid in joint movement. For example, the knee joint is a hinge joint formed between the lower end of the femur, or thigh bone, and the upper end of the tibia, or shin bone. The hip is a ball and socket joint, formed by the upper end, or head, of the femur (the ball), and a part of the pelvis called the acetabulum (the socket).

The surface of each bone at the level of the joint is covered by a layer of smooth cartilage which allows an undamaged joint to move smoothly with little friction. Normally, the motion of our joints should occur relatively painlessly. When a joint becomes arthritic, which may occur for many different reasons, the cartilage becomes worn or damaged. This often leads to joints becoming stiff and painful. The capsule surrounding the joint is also frequently lined by tissue called synovium. The synovium produces fluid which provides nutrients to the joint and aids in reducing friction. The synovium frequently becomes inflamed in arthritic or damaged joints and can cause pain and swelling.

Joint pain may become so severe that a person will avoid using the joint. This process may lead to loss of motion (stiffness/contractures) and weakening the muscles around the joint making further motion even more difficult. A physical examination, X-rays, and possibly other tests performed by your surgeon, can show the extent of damage to the joint. When other treatment options will not adequately relieve the pain and disability, joint replacement, also called joint arthroplasty, may be considered.

Joint replacement involves removing the arthritic or damaged portions of a joint and replacing either part of, or the entire, joint or the surface of the joint, with an artificial one, called a prosthesis. The materials used for joint replacement are typically made from metal, polyethylene (plastic), or ceramic. The goals of joint replacement are to restore function and relieve the pain caused by the inflamed, worn, or damaged bone and cartilage.

At Castle Orthopaedics, our surgeons have vast expertise in joint replacement from your shoulder and elbow to your hip and knee. Our surgeons perform the latest in both total joint replacement, where the entire joint is replaced, and partial joint replacements, where only the damaged or arthritic portions of the joint are replaced. Castle surgeons were the first to perform the Birmingham Hip Resurfacing procedure at Rush Copley. Castle surgeons also frequently utilize advanced computer navigation for joint replacement depending upon your individual situation. Furthermore, Castle surgeons have expertise in ‘patient-specific’ joint replacement where, prior to surgery, the instruments used to perform the joint replacement are custom made for that individual patient based upon his or her unique anatomy. The surgeons at Castle Orthopaedics are also highly skilled at all forms of minimally-invasive joint replacement surgery, which can aid in initial recovery. Our surgeons can also revise, or re-do, a previously performed joint replacement that has failed or become painful. Each patient and each joint has unique characteristics that demand specialized attention.

Arthroscopic Surgery

Arthroscopic surgery ("arthroscopy") is a minimally invasive technique used to evaluate and treat joint disorders. By inserting a slender camera through a small incision, your surgeon can perform a multitude of diagnostic and therapeutic procedures. The knee, shoulder, elbow, wrist and ankle are the most commonly treated joints. Our Surgicenter is equipped with state of the art technology, including digital photography and high definition video displays.

Arthroscopic surgery offers many advantages. Smaller incisions lead to less post-operative pain, better cosmesis, quicker recovery time, and less scarring. Since the joint is continually lavaged with sterile irrigation, infection rates are very low. Most procedures allow the patient to go home on the same day as the surgical procedure.

Arthroscopic techniques continue to evolve. In the recent past, most standard shoulder surgery was done through a large incision, and sometimes required muscle detachment for exposure. Now most shoulder pathology can be addressed arthroscopically, which minimizes adjacent soft tissue damage Rotator cuff repair, shoulder stabilization, removal of bone spurs, and decompression are just a few of the shoulder procedures our surgeons are expert at treating.

Some of the most common arthroscopic knee procedures that we perform at Castle Orthopaedics, include anterior cruciate ligament reconstruction, treatment of meniscal pathology, removal of loose bodies, and limited or extensive joint debridement. Our expert physicians and Surgicenter staff along with our top of the line equipment make it possible to provide a multitude of arthroscopic procedures to get you well as quickly and painlessly as possible.

Ancillary Services

Osteoporsis Screening

Osteoporosis is a term that refers to the weakening of bones due to the loss of calcium. The subsequent loss of bone mass leads to bone weakness and an increased risk of fractures.

Osteoporosis occurs more commonly in women than in men. This is due to the fact that women have less bone mass than men, tend to live longer, take in less calcium, and need the female hormone estrogen to keep their bones strong. Total bone mass often peaks in the late 20s or early 30s, and then begins to decline slowly. In women, the rate of bone loss speeds up after menopause, when estrogen levels decline. Bone loss may also occur prematurely if a woman has her ovaries surgically removed.

Risk factors for osteoporosis include the following:

  • Menopause before age 48
  • Surgery to remove ovaries before menopause
  • Not getting enough dietary calcium and vitamin D
  • Not getting enough exercise
  • Smoking
  • Family history of osteoporosis
  • Alcohol abuse
  • Thin body and small bone frame
  • Fair skin (white or Asian race)
  • Hyperthyroidism
  • Long-term use of oral steroids
  • Prior bone fracture as an adult

Screening for osteoporosis in women starts at age 65. If a woman has several risk factors for osteoporosis, screening may occur earlier. Men should be screened if they have any of the risk factors listed above. Screening is usually done with a bone density test called a DEXA (dual energy x-ray absorptiometry) scan, which takes a "picture" of the bones. The DEXA scan can show thinning of the bones (osteopenia) as well as osteoporosis. Ask about scheduling your DEXA scan at our on-site scanner at Castle Orthopaedics.

Hand Therapy

Many therapy services for the upper extremity (especially the hand) are provided not by physical therapists but rather by specialists called occupational therapists. Our certified hand therapy specialist is an occupational therapist who has limited the scope of his work exclusively to the care of patients with various disorders of the hand, wrist, forearm and elbow and who has successfully passed a comprehensive test of advanced clinical skills and therapy in upper extremity rehabilitation.

The hand is such a specialized part of the body that even seemingly relatively minor impairments can have a substantial negative impact on an individual’s ability to perform the routine activities of daily living, from self-care to work to leisure activities and sports. Our certified hand therapist begins an evaluation not just with an evaluation of the patient’s injury or impairment but also with an assessment of the patient’s needs (a violinist and a truck driver, for instance, may have entirely different functional needs). His approach, then, is a holistic one creating a therapy program for each patient designed to optimize that individual’s recovery.

The mission of our hand therapy program is to provide accurate assessment, effective state-of-the-art treatment and excellent outcomes so that our patients can return successfully to the performance of their daily activities as soon as possible.

Physical Therapy

Physical Therapy is an essential part of the recovery for many patients who have had orthopaedic conditions, injuries or surgeries, and at Castle Orthopaedics & Sports Medicine, we have a team of experts to help guide you through your rehabilitation when it is needed. The physical therapists on staff have a combined experience of over 100 years. They are a very collegial group who have a variety of practice experiences allowing ideas and experiences to be freely exchanged for the benefit of the patients. There are a number of characteristics that set our physical therapy department apart from others:

Expertise – Your therapist is a specialist in outpatient orthopaedic rehabilitation. While his or her initial training included a wide range of treatments and conditions (stroke rehab, burn rehab, etc.) your therapist has chosen to professionally focus in one area. The therapists all routinely attend continuing education programs to keep their skill at the cutting edge of their specialization.

Individuality – Except in the case of illness or vacation, you’ll have one therapist working with you throughout your course of treatment. You won’t be bumped around from therapist to therapist.

Professionalism - We don’t have physical therapy aides or assistants so each time you attend therapy your care will be provided by a licensed, registered professional physical therapist.

Experience – After working with our orthopaedic patients for years, our therapists have a keen knowledge of the routines and preferences of each surgeon in the practice as well as how patients routinely progress through their course of treatment. Thus they can readily recognize deviations from routine expectations and adjust the therapy course accordingly or, if necessary, conveniently consult with the physician right on site.

Search far and wide but you will be hard-pressed to find a better group of professionals dedicated to helping you achieve your maximum rehabilitation potential than the group waiting to meet you at Castle Orthopaedics & Sports Medicine.

MRI

Magnetic resonance imaging (MRI) is a sophisticated diagnostic technology that creates detailed views of the body without the use of X-rays or radioactive agents. While it’s not the preferred diagnostic choice for every medical condition, it has proven to be extremely useful in orthopedics. But not all MRI scans are created equal.

MRI technologists are the individuals who actually perform the scans and they need to be experts in using that technology. Our two MRI technologists bring a combined 35 years of medical imaging experience to their work and they have each exclusively done orthopedic MRI imaging for the last eight years. They know what to look for and won’t complete a scan until they have produced a scan of the highest technical quality.

Our MRI equipment is state-of-the-art. MRI scans aren’t actual pictures that are taken, but rather images that are created by a computer using data that is created when magnetic fields are passed through the body. Software programs are at the heart of creating the images and our programs were developed (and are consistently upgraded) to optimize the quality of the images. Our MRI facility is accredited by the American College of Radiology, verifying that our facility adheres to the highest standards of imaging quality.

The radiologists who read our scans specialize only in advanced imaging of the musculoskeletal system. They don’t read chest X-rays one day, mammograms the next and ultrasounds after that. Our radiologists do nothing other than interpreting CT and MRI scans of the musculoskeletal system.