{"version":"1.0.0","segments":[{"speaker":"Charles Goldfarb","startTime":10.8,"endTime":13.35,"body":"Welcome to the"},{"speaker":"Charles Goldfarb","startTime":10.8,"endTime":13.35,"body":"upper hand, where Chuck and"},{"speaker":"Charles Goldfarb","startTime":13.35,"endTime":14.49,"body":"Chris talk hand surgery."},{"speaker":"Chris Dy","startTime":14.81,"endTime":16.58,"body":"We are two hand"},{"speaker":"Chris Dy","startTime":14.81,"endTime":16.58,"body":"surgeons at Washington"},{"speaker":"Chris Dy","startTime":16.58,"endTime":19.67,"body":"University in St. Louis here to"},{"speaker":"Chris Dy","startTime":16.58,"endTime":19.67,"body":"talk about all aspects of hand"},{"speaker":"Chris Dy","startTime":19.67,"endTime":21.5,"body":"surgery from technical to"},{"speaker":"Chris Dy","startTime":19.67,"endTime":21.5,"body":"personal."},{"speaker":"Charles Goldfarb","startTime":22.07,"endTime":24.35,"body":"Thank you for"},{"speaker":"Charles Goldfarb","startTime":22.07,"endTime":24.35,"body":"subscribing wherever you get"},{"speaker":"Charles Goldfarb","startTime":24.35,"endTime":25.25,"body":"your podcasts."},{"speaker":"Chris Dy","startTime":25.46,"endTime":27.68,"body":"And be sure to leave a"},{"speaker":"Chris Dy","startTime":25.46,"endTime":27.68,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":27.68,"endTime":28.22,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":29.33,"endTime":30.05,"body":"Hey, Chris."},{"speaker":"Chris Dy","startTime":30.5,"endTime":31.43,"body":"Hey, Chuck, how are"},{"speaker":"Chris Dy","startTime":30.5,"endTime":31.43,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":31.91,"endTime":33.56,"body":"Doing well,"},{"speaker":"Charles Goldfarb","startTime":31.91,"endTime":33.56,"body":"you know where I am?"},{"speaker":"Chris Dy","startTime":34.55,"endTime":36.35,"body":"Your background looks"},{"speaker":"Chris Dy","startTime":34.55,"endTime":36.35,"body":"a little different today."},{"speaker":"Charles Goldfarb","startTime":36.74,"endTime":40.55,"body":"Because I'm at"},{"speaker":"Charles Goldfarb","startTime":36.74,"endTime":40.55,"body":"home because of the Snowmageddon"},{"speaker":"Charles Goldfarb","startTime":40.58,"endTime":41.45,"body":"2022."},{"speaker":"Chris Dy","startTime":41.99,"endTime":44.24,"body":"I think it got a name."},{"speaker":"Chris Dy","startTime":41.99,"endTime":44.24,"body":"I think it's winter storm"},{"speaker":"Chris Dy","startTime":44.24,"endTime":46.91,"body":"Landon. At least that's what my"},{"speaker":"Chris Dy","startTime":44.24,"endTime":46.91,"body":"Bank of America email told me."},{"speaker":"Chris Dy","startTime":46.91,"endTime":49.1,"body":"They said that they care about"},{"speaker":"Chris Dy","startTime":46.91,"endTime":49.1,"body":"me during this winter storm. I"},{"speaker":"Chris Dy","startTime":49.1,"endTime":49.91,"body":"don't know if they really do."},{"speaker":"Charles Goldfarb","startTime":50.42,"endTime":52.25,"body":"And I've"},{"speaker":"Charles Goldfarb","startTime":50.42,"endTime":52.25,"body":"gotten so many emails telling me"},{"speaker":"Charles Goldfarb","startTime":52.25,"endTime":56.24,"body":"the 16 places that are not open"},{"speaker":"Charles Goldfarb","startTime":52.25,"endTime":56.24,"body":"today that everyone needs to"},{"speaker":"Charles Goldfarb","startTime":56.24,"endTime":59.42,"body":"send an email. It's like, oh my"},{"speaker":"Charles Goldfarb","startTime":56.24,"endTime":59.42,"body":"gosh, but winter storm Landon"},{"speaker":"Charles Goldfarb","startTime":59.42,"endTime":62.21,"body":"does not sound quite as terrible"},{"speaker":"Charles Goldfarb","startTime":59.42,"endTime":62.21,"body":"as Snowmageddon."},{"speaker":"Chris Dy","startTime":62.66,"endTime":65.69,"body":"So well, you know, so"},{"speaker":"Chris Dy","startTime":62.66,"endTime":65.69,"body":"you're working from home today."},{"speaker":"Chris Dy","startTime":65.75,"endTime":69.92,"body":"I had to come in today. For"},{"speaker":"Chris Dy","startTime":65.75,"endTime":69.92,"body":"better or worse I was. I had a"},{"speaker":"Chris Dy","startTime":69.92,"endTime":72.44,"body":"case I had to do this morning, a"},{"speaker":"Chris Dy","startTime":69.92,"endTime":72.44,"body":"fracture case, didn't want to"},{"speaker":"Chris Dy","startTime":72.44,"endTime":76.94,"body":"wait on that one. So I braved"},{"speaker":"Chris Dy","startTime":72.44,"endTime":76.94,"body":"the snow, I dug my car out from"},{"speaker":"Chris Dy","startTime":76.94,"endTime":80.51,"body":"snow. That's the one thing that"},{"speaker":"Chris Dy","startTime":76.94,"endTime":80.51,"body":"I think that we really messed up"},{"speaker":"Chris Dy","startTime":80.51,"endTime":83.63,"body":"on with the new house is not"},{"speaker":"Chris Dy","startTime":80.51,"endTime":83.63,"body":"measuring the garage, and"},{"speaker":"Chris Dy","startTime":83.63,"endTime":87.23,"body":"realizing that a two car garage"},{"speaker":"Chris Dy","startTime":83.63,"endTime":87.23,"body":"for a 1936 house is not the same"},{"speaker":"Chris Dy","startTime":87.23,"endTime":90.02,"body":"as what the expectations you"},{"speaker":"Chris Dy","startTime":87.23,"endTime":90.02,"body":"would have for a two car garage"},{"speaker":"Chris Dy","startTime":90.02,"endTime":90.98,"body":"in 2022."},{"speaker":"Charles Goldfarb","startTime":92.06,"endTime":94.31,"body":"Well, I think"},{"speaker":"Charles Goldfarb","startTime":92.06,"endTime":94.31,"body":"St. Louis, I don't want to say"},{"speaker":"Charles Goldfarb","startTime":94.31,"endTime":99.29,"body":"is unique in this regard. But"},{"speaker":"Charles Goldfarb","startTime":94.31,"endTime":99.29,"body":"there are a lot of small garages"},{"speaker":"Charles Goldfarb","startTime":99.29,"endTime":102.5,"body":"in St. Louis. You know, part of"},{"speaker":"Charles Goldfarb","startTime":99.29,"endTime":102.5,"body":"the appeal of St. Louis is the"},{"speaker":"Charles Goldfarb","startTime":102.53,"endTime":107.81,"body":"remarkably I guess, varied, but"},{"speaker":"Charles Goldfarb","startTime":102.53,"endTime":107.81,"body":"consistently great architecture."},{"speaker":"Charles Goldfarb","startTime":108.02,"endTime":111.32,"body":"And so many neighborhoods with"},{"speaker":"Charles Goldfarb","startTime":108.02,"endTime":111.32,"body":"so many cool houses, and so many"},{"speaker":"Charles Goldfarb","startTime":111.32,"endTime":115.85,"body":"small garages, we actually"},{"speaker":"Charles Goldfarb","startTime":111.32,"endTime":115.85,"body":"borrowed a friend's car to try"},{"speaker":"Charles Goldfarb","startTime":115.85,"endTime":119.75,"body":"in my old house Garage before"},{"speaker":"Charles Goldfarb","startTime":115.85,"endTime":119.75,"body":"Talia got her newest car. And"},{"speaker":"Charles Goldfarb","startTime":119.75,"endTime":122.48,"body":"this was five or 10 years ago"},{"speaker":"Charles Goldfarb","startTime":119.75,"endTime":122.48,"body":"whatever, just to make sure it"},{"speaker":"Charles Goldfarb","startTime":122.48,"endTime":124.49,"body":"would fit it's just a common"},{"speaker":"Charles Goldfarb","startTime":122.48,"endTime":124.49,"body":"problem."},{"speaker":"Chris Dy","startTime":125.03,"endTime":127.88,"body":"But a total"},{"speaker":"Chris Dy","startTime":125.03,"endTime":127.88,"body":"afterthought on my part because"},{"speaker":"Chris Dy","startTime":127.88,"endTime":131.09,"body":"even in our old house when we"},{"speaker":"Chris Dy","startTime":127.88,"endTime":131.09,"body":"got a new car we were I was"},{"speaker":"Chris Dy","startTime":131.09,"endTime":134.27,"body":"totally upgrading my dad life"},{"speaker":"Chris Dy","startTime":131.09,"endTime":134.27,"body":"and I was getting a Honda Pilot."},{"speaker":"Chris Dy","startTime":134.63,"endTime":136.79,"body":"And I actually didn't think"},{"speaker":"Chris Dy","startTime":134.63,"endTime":136.79,"body":"about that before we pulled the"},{"speaker":"Chris Dy","startTime":136.79,"endTime":140.09,"body":"car in and got home from the"},{"speaker":"Chris Dy","startTime":136.79,"endTime":140.09,"body":"dealership and it narrowly made"},{"speaker":"Chris Dy","startTime":140.09,"endTime":143.3,"body":"it we're talking like half an"},{"speaker":"Chris Dy","startTime":140.09,"endTime":143.3,"body":"inch on each side. I don't like"},{"speaker":"Chris Dy","startTime":143.36,"endTime":146.81,"body":"that probably is something I"},{"speaker":"Chris Dy","startTime":143.36,"endTime":146.81,"body":"should have thought about before"},{"speaker":"Chris Dy","startTime":146.81,"endTime":148.1,"body":"purchasing this car."},{"speaker":"Charles Goldfarb","startTime":148.7,"endTime":152.39,"body":"So you had to"},{"speaker":"Charles Goldfarb","startTime":148.7,"endTime":152.39,"body":"get up early turn the car on"},{"speaker":"Charles Goldfarb","startTime":152.39,"endTime":155.39,"body":"shovel shovel it out and scrape"},{"speaker":"Charles Goldfarb","startTime":152.39,"endTime":155.39,"body":"it off and."},{"speaker":"Chris Dy","startTime":155.63,"endTime":157.22,"body":"Well you were kind"},{"speaker":"Chris Dy","startTime":155.63,"endTime":157.22,"body":"enough because we were supposed"},{"speaker":"Chris Dy","startTime":157.22,"endTime":159.62,"body":"to record very early this"},{"speaker":"Chris Dy","startTime":157.22,"endTime":159.62,"body":"morning and you were kind enough"},{"speaker":"Chris Dy","startTime":159.62,"endTime":162.35,"body":"to give me an out because I was"},{"speaker":"Chris Dy","startTime":159.62,"endTime":162.35,"body":"just you know I'm a Florida boy"},{"speaker":"Chris Dy","startTime":162.35,"endTime":164.96,"body":"I was very nervous about the"},{"speaker":"Chris Dy","startTime":162.35,"endTime":164.96,"body":"weather this morning and you"},{"speaker":"Chris Dy","startTime":164.96,"endTime":168.44,"body":"know everything like you My"},{"speaker":"Chris Dy","startTime":164.96,"endTime":168.44,"body":"schedule is usually pretty"},{"speaker":"Chris Dy","startTime":168.5,"endTime":171.41,"body":"efficiently packed and I know"},{"speaker":"Chris Dy","startTime":168.5,"endTime":171.41,"body":"exactly what time I need to"},{"speaker":"Chris Dy","startTime":171.41,"endTime":174.53,"body":"leave my house to get to know"},{"speaker":"Chris Dy","startTime":171.41,"endTime":174.53,"body":"the location I'm going to get"},{"speaker":"Chris Dy","startTime":174.56,"endTime":178.7,"body":"into you know to the holding"},{"speaker":"Chris Dy","startTime":174.56,"endTime":178.7,"body":"area for for case and it was"},{"speaker":"Chris Dy","startTime":178.7,"endTime":182.48,"body":"completely blown to hell this"},{"speaker":"Chris Dy","startTime":178.7,"endTime":182.48,"body":"morning just because I had to"},{"speaker":"Chris Dy","startTime":182.54,"endTime":186.41,"body":"get up and you know get up"},{"speaker":"Chris Dy","startTime":182.54,"endTime":186.41,"body":"earlier to do my normal morning"},{"speaker":"Chris Dy","startTime":186.41,"endTime":193.1,"body":"routine so worked out and then I"},{"speaker":"Chris Dy","startTime":186.41,"endTime":193.1,"body":"had to shovel snow around push"},{"speaker":"Chris Dy","startTime":193.1,"endTime":196.67,"body":"snow off my car. I mean I look"},{"speaker":"Chris Dy","startTime":193.1,"endTime":196.67,"body":"ridiculous out there because I"},{"speaker":"Chris Dy","startTime":196.67,"endTime":198.56,"body":"was like you know what would"},{"speaker":"Chris Dy","startTime":196.67,"endTime":198.56,"body":"work really well here to get the"},{"speaker":"Chris Dy","startTime":198.56,"endTime":202.1,"body":"snow off the top my car a broom."},{"speaker":"Chris Dy","startTime":198.56,"endTime":202.1,"body":"So I had like one of those aside"},{"speaker":"Chris Dy","startTime":202.13,"endTime":205.4,"body":"sidewalk, you know, sweeping"},{"speaker":"Chris Dy","startTime":202.13,"endTime":205.4,"body":"things and just like sweeping"},{"speaker":"Chris Dy","startTime":205.4,"endTime":210.38,"body":"the snow off, starting the car,"},{"speaker":"Chris Dy","startTime":205.4,"endTime":210.38,"body":"going back in and then and then"},{"speaker":"Chris Dy","startTime":210.38,"endTime":212.54,"body":"of course there were"},{"speaker":"Chris Dy","startTime":210.38,"endTime":212.54,"body":"unfortunately some distressed"},{"speaker":"Chris Dy","startTime":212.54,"endTime":216.98,"body":"motorists along the way on"},{"speaker":"Chris Dy","startTime":212.54,"endTime":216.98,"body":"Forest Park Parkway. So yeah,"},{"speaker":"Chris Dy","startTime":217.01,"endTime":218.57,"body":"everything just slowed to a"},{"speaker":"Chris Dy","startTime":217.01,"endTime":218.57,"body":"halt."},{"speaker":"Charles Goldfarb","startTime":218.75,"endTime":220.52,"body":"Did you wave"},{"speaker":"Charles Goldfarb","startTime":218.75,"endTime":220.52,"body":"at them when you drove by them?"},{"speaker":"Charles Goldfarb","startTime":220.55,"endTime":221.21,"body":"Or did you"},{"speaker":"Chris Dy","startTime":222.17,"endTime":224.24,"body":"No, I'm a Florida"},{"speaker":"Chris Dy","startTime":222.17,"endTime":224.24,"body":"driver, like my hands are like"},{"speaker":"Chris Dy","startTime":224.24,"endTime":226.67,"body":"ten and two the whole time. You"},{"speaker":"Chris Dy","startTime":224.24,"endTime":226.67,"body":"know, white knuckling the whole"},{"speaker":"Chris Dy","startTime":226.67,"endTime":227.0,"body":"thing."},{"speaker":"Charles Goldfarb","startTime":227.75,"endTime":229.49,"body":"Amen. That's"},{"speaker":"Charles Goldfarb","startTime":227.75,"endTime":229.49,"body":"what happened when I drove to"},{"speaker":"Charles Goldfarb","startTime":229.49,"endTime":233.09,"body":"work yesterday. I have my wife"},{"speaker":"Charles Goldfarb","startTime":229.49,"endTime":233.09,"body":"laughs at me because I told her"},{"speaker":"Charles Goldfarb","startTime":233.09,"endTime":236.39,"body":"to make sure her car has a full"},{"speaker":"Charles Goldfarb","startTime":233.09,"endTime":236.39,"body":"tank of gas and I ended up"},{"speaker":"Charles Goldfarb","startTime":236.39,"endTime":240.08,"body":"driving my car, which was good,"},{"speaker":"Charles Goldfarb","startTime":236.39,"endTime":240.08,"body":"but Oh, it's so funny. We are"},{"speaker":"Charles Goldfarb","startTime":240.08,"endTime":240.44,"body":"lame."},{"speaker":"Chris Dy","startTime":240.47,"endTime":242.51,"body":"Yeah, Talia grew up in"},{"speaker":"Chris Dy","startTime":240.47,"endTime":242.51,"body":"the Northeast. So this is like"},{"speaker":"Chris Dy","startTime":242.51,"endTime":243.38,"body":"nothing to her. Right?"},{"speaker":"Charles Goldfarb","startTime":243.53,"endTime":245.93,"body":"That's right."},{"speaker":"Charles Goldfarb","startTime":243.53,"endTime":245.93,"body":"That's exactly right. I will say"},{"speaker":"Charles Goldfarb","startTime":245.93,"endTime":248.51,"body":"working from home is"},{"speaker":"Charles Goldfarb","startTime":245.93,"endTime":248.51,"body":"interesting. You know, I work"},{"speaker":"Charles Goldfarb","startTime":248.51,"endTime":251.54,"body":"most weekends, you know, good"},{"speaker":"Charles Goldfarb","startTime":248.51,"endTime":251.54,"body":"chunk of the day or mornings at"},{"speaker":"Charles Goldfarb","startTime":251.54,"endTime":255.14,"body":"least, or whatever. And I'm home"},{"speaker":"Charles Goldfarb","startTime":251.54,"endTime":255.14,"body":"today because I had a big case"},{"speaker":"Charles Goldfarb","startTime":255.14,"endTime":257.9,"body":"cancel and I just had meetings"},{"speaker":"Charles Goldfarb","startTime":255.14,"endTime":257.9,"body":"the rest of the day. And it's"},{"speaker":"Charles Goldfarb","startTime":257.9,"endTime":261.71,"body":"fine. And I started off today"},{"speaker":"Charles Goldfarb","startTime":257.9,"endTime":261.71,"body":"great. But now it's like usually"},{"speaker":"Charles Goldfarb","startTime":261.71,"endTime":265.31,"body":"on a Saturday or Sunday at about"},{"speaker":"Charles Goldfarb","startTime":261.71,"endTime":265.31,"body":"noon or 1230 I'm thinking about"},{"speaker":"Charles Goldfarb","startTime":265.31,"endTime":270.14,"body":"a nap and that's not built into"},{"speaker":"Charles Goldfarb","startTime":265.31,"endTime":270.14,"body":"my schedule today so stay"},{"speaker":"Charles Goldfarb","startTime":270.14,"endTime":270.86,"body":"focused."},{"speaker":"Chris Dy","startTime":271.01,"endTime":273.35,"body":"You can tell Karen for"},{"speaker":"Chris Dy","startTime":271.01,"endTime":273.35,"body":"your work from home days to"},{"speaker":"Chris Dy","startTime":273.35,"endTime":277.46,"body":"build in a little bit of a you"},{"speaker":"Chris Dy","startTime":273.35,"endTime":277.46,"body":"know genius time you know, to"},{"speaker":"Chris Dy","startTime":277.46,"endTime":281.54,"body":"sleep and catch up. I find that"},{"speaker":"Chris Dy","startTime":277.46,"endTime":281.54,"body":"when I work from home there's"},{"speaker":"Chris Dy","startTime":281.54,"endTime":285.5,"body":"just a lot more snack breaks"},{"speaker":"Chris Dy","startTime":281.54,"endTime":285.5,"body":"which is a problem for me so."},{"speaker":"Charles Goldfarb","startTime":285.92,"endTime":287.54,"body":"That too. That"},{"speaker":"Charles Goldfarb","startTime":285.92,"endTime":287.54,"body":"too."},{"speaker":"Chris Dy","startTime":287.0,"endTime":290.78,"body":"Yesterday I had a"},{"speaker":"Chris Dy","startTime":287.0,"endTime":290.78,"body":"bunch of zooms that I had to do"},{"speaker":"Chris Dy","startTime":290.78,"endTime":293.15,"body":"just because I was supposed to"},{"speaker":"Chris Dy","startTime":290.78,"endTime":293.15,"body":"be doing academic stuff and I"},{"speaker":"Chris Dy","startTime":293.15,"endTime":297.17,"body":"did but I had to tell my my kids"},{"speaker":"Chris Dy","startTime":293.15,"endTime":297.17,"body":"these are times when I can"},{"speaker":"Chris Dy","startTime":297.2,"endTime":300.38,"body":"absolutely not be disturbed"},{"speaker":"Chris Dy","startTime":297.2,"endTime":300.38,"body":"versus you can make an"},{"speaker":"Chris Dy","startTime":300.38,"endTime":304.16,"body":"appearance on screen if it helps"},{"speaker":"Chris Dy","startTime":300.38,"endTime":304.16,"body":"keep the peace. So and I'm very"},{"speaker":"Chris Dy","startTime":304.16,"endTime":307.73,"body":"proud of myself, my father in"},{"speaker":"Chris Dy","startTime":304.16,"endTime":307.73,"body":"law got through the day with"},{"speaker":"Chris Dy","startTime":307.73,"endTime":311.03,"body":"only one hour of television"},{"speaker":"Chris Dy","startTime":307.73,"endTime":311.03,"body":"yesterday for the kids. And that"},{"speaker":"Chris Dy","startTime":311.03,"endTime":313.76,"body":"was when I had a deposition when"},{"speaker":"Chris Dy","startTime":311.03,"endTime":313.76,"body":"I just definitely could not be"},{"speaker":"Chris Dy","startTime":313.76,"endTime":316.46,"body":"involved. One of my, you know,"},{"speaker":"Chris Dy","startTime":313.76,"endTime":316.46,"body":"patient is involved in a work"},{"speaker":"Chris Dy","startTime":316.46,"endTime":319.58,"body":"comp thing so I was trying to"},{"speaker":"Chris Dy","startTime":316.46,"endTime":319.58,"body":"help out, but I was like, Yeah,"},{"speaker":"Chris Dy","startTime":319.64,"endTime":321.71,"body":"TV's totally fine during that"},{"speaker":"Chris Dy","startTime":319.64,"endTime":321.71,"body":"one hour."},{"speaker":"Charles Goldfarb","startTime":322.35,"endTime":325.14,"body":"Yeah, you're,"},{"speaker":"Charles Goldfarb","startTime":322.35,"endTime":325.14,"body":"I think your only mistake. So"},{"speaker":"Charles Goldfarb","startTime":325.17,"endTime":328.29,"body":"what I've heard about your day"},{"speaker":"Charles Goldfarb","startTime":325.17,"endTime":328.29,"body":"so far, is getting your normal"},{"speaker":"Charles Goldfarb","startTime":328.29,"endTime":331.14,"body":"workout in. So I did not work"},{"speaker":"Charles Goldfarb","startTime":328.29,"endTime":331.14,"body":"out. I don't usually get up"},{"speaker":"Charles Goldfarb","startTime":331.14,"endTime":333.54,"body":"early to workout. But I'm"},{"speaker":"Charles Goldfarb","startTime":331.14,"endTime":333.54,"body":"planning to shovel snow this"},{"speaker":"Charles Goldfarb","startTime":333.54,"endTime":334.8,"body":"afternoon. Once it stops"},{"speaker":"Charles Goldfarb","startTime":333.54,"endTime":334.8,"body":"snowing."},{"speaker":"Chris Dy","startTime":334.83,"endTime":337.47,"body":"That's the two day"},{"speaker":"Chris Dy","startTime":334.83,"endTime":337.47,"body":"situation. My wife actually last"},{"speaker":"Chris Dy","startTime":337.47,"endTime":340.53,"body":"night was like, So what's our"},{"speaker":"Chris Dy","startTime":337.47,"endTime":340.53,"body":"snow shoveling plan? I was like"},{"speaker":"Chris Dy","startTime":340.56,"endTime":342.21,"body":"what it normally is I do it when"},{"speaker":"Chris Dy","startTime":340.56,"endTime":342.21,"body":"I get home."},{"speaker":"Charles Goldfarb","startTime":345.06,"endTime":348.12,"body":"Well played."},{"speaker":"Charles Goldfarb","startTime":345.06,"endTime":348.12,"body":"Well played. Yes."},{"speaker":"Chris Dy","startTime":348.36,"endTime":351.84,"body":"So I speaking of white"},{"speaker":"Chris Dy","startTime":348.36,"endTime":351.84,"body":"substances, I had an interesting"},{"speaker":"Chris Dy","startTime":351.84,"endTime":355.62,"body":"case in which I wanted to ask"},{"speaker":"Chris Dy","startTime":351.84,"endTime":355.62,"body":"your opinion, because I had a"},{"speaker":"Chris Dy","startTime":355.62,"endTime":361.11,"body":"patient who, you know, came into"},{"speaker":"Chris Dy","startTime":355.62,"endTime":361.11,"body":"the clinic. She's in her 50s 60s"},{"speaker":"Chris Dy","startTime":361.11,"endTime":365.82,"body":"ish. And she had the classic,"},{"speaker":"Chris Dy","startTime":361.11,"endTime":365.82,"body":"you know, dorsal central wrist"},{"speaker":"Chris Dy","startTime":365.82,"endTime":369.57,"body":"pain, and the classic dorsal"},{"speaker":"Chris Dy","startTime":365.82,"endTime":369.57,"body":"wrist swelling, I was I came in"},{"speaker":"Chris Dy","startTime":369.57,"endTime":371.76,"body":"the room was like you got a SLAC"},{"speaker":"Chris Dy","startTime":369.57,"endTime":371.76,"body":"wrist just not even looking at"},{"speaker":"Chris Dy","startTime":371.76,"endTime":376.68,"body":"the X rays. And we talked about"},{"speaker":"Chris Dy","startTime":371.76,"endTime":376.68,"body":"treatment options. And we got"},{"speaker":"Chris Dy","startTime":376.68,"endTime":380.4,"body":"her X rays, and she has a SLAC"},{"speaker":"Chris Dy","startTime":376.68,"endTime":380.4,"body":"wrist. But of course, she"},{"speaker":"Chris Dy","startTime":380.4,"endTime":383.61,"body":"doesn't remember any injury. And"},{"speaker":"Chris Dy","startTime":380.4,"endTime":383.61,"body":"you know, I thought her"},{"speaker":"Chris Dy","startTime":383.64,"endTime":386.82,"body":"capitolunate joint didn't look"},{"speaker":"Chris Dy","startTime":383.64,"endTime":386.82,"body":"great. So I was really hoping"},{"speaker":"Chris Dy","startTime":386.82,"endTime":391.26,"body":"just to do a PRC. But, you know,"},{"speaker":"Chris Dy","startTime":386.82,"endTime":391.26,"body":"we had talked about you know, in"},{"speaker":"Chris Dy","startTime":391.26,"endTime":394.47,"body":"the setting of her capitate base"},{"speaker":"Chris Dy","startTime":391.26,"endTime":394.47,"body":"not looking good that we"},{"speaker":"Chris Dy","startTime":394.47,"endTime":398.16,"body":"probably would have to do a four"},{"speaker":"Chris Dy","startTime":394.47,"endTime":398.16,"body":"corner fusion. So how do you"},{"speaker":"Chris Dy","startTime":398.16,"endTime":401.13,"body":"talk through that decision"},{"speaker":"Chris Dy","startTime":398.16,"endTime":401.13,"body":"making process? With a patient?"},{"speaker":"Chris Dy","startTime":401.13,"endTime":403.8,"body":"You know, I know some people are"},{"speaker":"Chris Dy","startTime":401.13,"endTime":403.8,"body":"more willing to accept a little"},{"speaker":"Chris Dy","startTime":403.8,"endTime":406.95,"body":"bit of wear on the capitate. And"},{"speaker":"Chris Dy","startTime":403.8,"endTime":406.95,"body":"some people are putting in"},{"speaker":"Chris Dy","startTime":406.98,"endTime":410.73,"body":"little pillows of tissue in"},{"speaker":"Chris Dy","startTime":406.98,"endTime":410.73,"body":"there to help smooth that new"},{"speaker":"Chris Dy","startTime":410.76,"endTime":411.54,"body":"articulation."},{"speaker":"Charles Goldfarb","startTime":412.53,"endTime":413.85,"body":"Remind me how"},{"speaker":"Charles Goldfarb","startTime":412.53,"endTime":413.85,"body":"old she is."},{"speaker":"Chris Dy","startTime":414.63,"endTime":415.41,"body":"50-60s"},{"speaker":"Charles Goldfarb","startTime":416.31,"endTime":418.92,"body":"Okay, yeah,"},{"speaker":"Charles Goldfarb","startTime":416.31,"endTime":418.92,"body":"it's so super interesting. And I"},{"speaker":"Charles Goldfarb","startTime":418.92,"endTime":422.37,"body":"think some of the audience"},{"speaker":"Charles Goldfarb","startTime":418.92,"endTime":422.37,"body":"hopefully will shout at us on"},{"speaker":"Charles Goldfarb","startTime":422.37,"endTime":426.51,"body":"Twitter or write us an email on"},{"speaker":"Charles Goldfarb","startTime":422.37,"endTime":426.51,"body":"their opinions, because to me,"},{"speaker":"Charles Goldfarb","startTime":426.51,"endTime":429.99,"body":"there's three options, there's"},{"speaker":"Charles Goldfarb","startTime":426.51,"endTime":429.99,"body":"got to be a number Chris,"},{"speaker":"Charles Goldfarb","startTime":429.99,"endTime":432.48,"body":"there's always one, two or three"},{"speaker":"Charles Goldfarb","startTime":429.99,"endTime":432.48,"body":"options. So three options."},{"speaker":"Chris Dy","startTime":433.08,"endTime":435.75,"body":"But you usually stick"},{"speaker":"Chris Dy","startTime":433.08,"endTime":435.75,"body":"with two. I'm proud of you for"},{"speaker":"Chris Dy","startTime":435.75,"endTime":436.23,"body":"expanding."},{"speaker":"Charles Goldfarb","startTime":437.89,"endTime":440.11,"body":"My emails are"},{"speaker":"Charles Goldfarb","startTime":437.89,"endTime":440.11,"body":"largely reading the same way, by"},{"speaker":"Charles Goldfarb","startTime":440.11,"endTime":444.31,"body":"the way lately, I guess we get"},{"speaker":"Charles Goldfarb","startTime":440.11,"endTime":444.31,"body":"all we get comfortable with"},{"speaker":"Charles Goldfarb","startTime":444.31,"endTime":447.97,"body":"ourselves. So three options."},{"speaker":"Charles Goldfarb","startTime":444.31,"endTime":447.97,"body":"Number one is a four corner"},{"speaker":"Charles Goldfarb","startTime":447.97,"endTime":452.44,"body":"fusion. And just to hit on that"},{"speaker":"Charles Goldfarb","startTime":447.97,"endTime":452.44,"body":"I like the operation. I think"},{"speaker":"Charles Goldfarb","startTime":452.44,"endTime":455.77,"body":"results are reliably good. I"},{"speaker":"Charles Goldfarb","startTime":452.44,"endTime":455.77,"body":"think literature in the last few"},{"speaker":"Charles Goldfarb","startTime":455.77,"endTime":460.06,"body":"years has shown that PRC"},{"speaker":"Charles Goldfarb","startTime":455.77,"endTime":460.06,"body":"honestly is better. It's more"},{"speaker":"Charles Goldfarb","startTime":460.06,"endTime":465.7,"body":"reliable, less frequent revision"},{"speaker":"Charles Goldfarb","startTime":460.06,"endTime":465.7,"body":"surgery. So I do like PRC better"},{"speaker":"Charles Goldfarb","startTime":465.7,"endTime":469.12,"body":"in the right population. But I"},{"speaker":"Charles Goldfarb","startTime":465.7,"endTime":469.12,"body":"like the four corner fusion. So"},{"speaker":"Charles Goldfarb","startTime":469.12,"endTime":471.97,"body":"we can talk more about that if"},{"speaker":"Charles Goldfarb","startTime":469.12,"endTime":471.97,"body":"you like. The other two options"},{"speaker":"Charles Goldfarb","startTime":471.97,"endTime":477.07,"body":"are the capsular interposition,"},{"speaker":"Charles Goldfarb","startTime":471.97,"endTime":477.07,"body":"which I am not convinced there's"},{"speaker":"Charles Goldfarb","startTime":477.07,"endTime":480.73,"body":"any literature on that's"},{"speaker":"Charles Goldfarb","startTime":477.07,"endTime":480.73,"body":"substantial. But basically"},{"speaker":"Charles Goldfarb","startTime":480.73,"endTime":484.24,"body":"taking a dorsal capsular flap,"},{"speaker":"Charles Goldfarb","startTime":480.73,"endTime":484.24,"body":"and you can base it"},{"speaker":"Charles Goldfarb","startTime":484.24,"endTime":487.93,"body":"approximately you can base it"},{"speaker":"Charles Goldfarb","startTime":484.24,"endTime":487.93,"body":"distally and then you carefully"},{"speaker":"Charles Goldfarb","startTime":488.26,"endTime":492.01,"body":"sutured into the volar wrist"},{"speaker":"Charles Goldfarb","startTime":488.26,"endTime":492.01,"body":"capsule without taking too big a"},{"speaker":"Charles Goldfarb","startTime":492.01,"endTime":494.38,"body":"bite with that median nerve"},{"speaker":"Charles Goldfarb","startTime":492.01,"endTime":494.38,"body":"proximity, flexor tendon"},{"speaker":"Charles Goldfarb","startTime":494.38,"endTime":497.5,"body":"proximity. And I'm going to"},{"speaker":"Charles Goldfarb","startTime":494.38,"endTime":497.5,"body":"happy with that as well. I don't"},{"speaker":"Charles Goldfarb","startTime":497.5,"endTime":500.65,"body":"do that often. But I've done"},{"speaker":"Charles Goldfarb","startTime":497.5,"endTime":500.65,"body":"that. And I think the third"},{"speaker":"Charles Goldfarb","startTime":500.65,"endTime":504.25,"body":"potentially really intriguing"},{"speaker":"Charles Goldfarb","startTime":500.65,"endTime":504.25,"body":"operation, which I know at some"},{"speaker":"Charles Goldfarb","startTime":504.25,"endTime":508.63,"body":"sites is gotten more and more"},{"speaker":"Charles Goldfarb","startTime":504.25,"endTime":508.63,"body":"utilization is the capitate"},{"speaker":"Charles Goldfarb","startTime":508.63,"endTime":513.43,"body":"resurfacing which I have not"},{"speaker":"Charles Goldfarb","startTime":508.63,"endTime":513.43,"body":"done. But I remain intrigued by"},{"speaker":"Charles Goldfarb","startTime":513.43,"endTime":515.02,"body":"it and hopefully hope to do it"},{"speaker":"Charles Goldfarb","startTime":513.43,"endTime":515.02,"body":"at some point."},{"speaker":"Chris Dy","startTime":516.01,"endTime":518.77,"body":"What would be the"},{"speaker":"Chris Dy","startTime":516.01,"endTime":518.77,"body":"right patient for you in terms"},{"speaker":"Chris Dy","startTime":518.77,"endTime":520.03,"body":"of the capitate resurfacing,"},{"speaker":"Charles Goldfarb","startTime":520.72,"endTime":523.33,"body":"The patient"},{"speaker":"Charles Goldfarb","startTime":520.72,"endTime":523.33,"body":"you just described 60 some odd"},{"speaker":"Charles Goldfarb","startTime":523.33,"endTime":527.68,"body":"year old where maybe a smoker"},{"speaker":"Charles Goldfarb","startTime":523.33,"endTime":527.68,"body":"that you really don't want to do"},{"speaker":"Charles Goldfarb","startTime":527.68,"endTime":531.82,"body":"a four bone fusion on and"},{"speaker":"Charles Goldfarb","startTime":527.68,"endTime":531.82,"body":"resurfacing the cavitate might"},{"speaker":"Charles Goldfarb","startTime":531.82,"endTime":533.68,"body":"feel better than a capsular"},{"speaker":"Charles Goldfarb","startTime":531.82,"endTime":533.68,"body":"interposition."},{"speaker":"Chris Dy","startTime":535.45,"endTime":538.39,"body":"So we talked about"},{"speaker":"Chris Dy","startTime":535.45,"endTime":538.39,"body":"options. We told her you know,"},{"speaker":"Chris Dy","startTime":538.42,"endTime":542.26,"body":"this is possible, you know PRC"},{"speaker":"Chris Dy","startTime":538.42,"endTime":542.26,"body":"possible four corner fusion, and"},{"speaker":"Chris Dy","startTime":542.29,"endTime":545.14,"body":"even if her lunate didn't look"},{"speaker":"Chris Dy","startTime":542.29,"endTime":545.14,"body":"great, possible total wrist"},{"speaker":"Chris Dy","startTime":545.14,"endTime":548.5,"body":"arthrodesis. So I don't have any"},{"speaker":"Chris Dy","startTime":545.14,"endTime":548.5,"body":"experience with the capsular"},{"speaker":"Chris Dy","startTime":548.5,"endTime":551.92,"body":"position. I have not done any"},{"speaker":"Chris Dy","startTime":548.5,"endTime":551.92,"body":"capitate resurfacing. So that"},{"speaker":"Chris Dy","startTime":551.92,"endTime":556.81,"body":"was the list I was offering her"},{"speaker":"Chris Dy","startTime":551.92,"endTime":556.81,"body":"and we go to the operating room"},{"speaker":"Chris Dy","startTime":556.93,"endTime":560.74,"body":"and you know I elevated my"},{"speaker":"Chris Dy","startTime":556.93,"endTime":560.74,"body":"capsular flaps and I see a"},{"speaker":"Chris Dy","startTime":560.77,"endTime":565.63,"body":"speaking of Snow White chalky"},{"speaker":"Chris Dy","startTime":560.77,"endTime":565.63,"body":"substance. So and then there's"},{"speaker":"Chris Dy","startTime":565.63,"endTime":567.94,"body":"complete dissociation between"},{"speaker":"Chris Dy","startTime":565.63,"endTime":567.94,"body":"the scaphoid and the lunate."},{"speaker":"Chris Dy","startTime":568.06,"endTime":568.96,"body":"What do you make of that?"},{"speaker":"Charles Goldfarb","startTime":570.7,"endTime":573.49,"body":"Well, I guess"},{"speaker":"Charles Goldfarb","startTime":570.7,"endTime":573.49,"body":"I have two follow up questions."},{"speaker":"Charles Goldfarb","startTime":573.97,"endTime":576.97,"body":"One is have you given her"},{"speaker":"Charles Goldfarb","startTime":573.97,"endTime":576.97,"body":"steroid injections and would you"},{"speaker":"Charles Goldfarb","startTime":576.97,"endTime":580.93,"body":"consider that on her first visit"},{"speaker":"Charles Goldfarb","startTime":576.97,"endTime":580.93,"body":"to the office? ie is that the"},{"speaker":"Charles Goldfarb","startTime":580.93,"endTime":583.21,"body":"chalky substance? Are we talking"},{"speaker":"Charles Goldfarb","startTime":580.93,"endTime":583.21,"body":"to something else?"},{"speaker":"Chris Dy","startTime":583.39,"endTime":585.79,"body":"Nobody's given her a"},{"speaker":"Chris Dy","startTime":583.39,"endTime":585.79,"body":"steroid shot. I actually offered"},{"speaker":"Chris Dy","startTime":585.79,"endTime":588.43,"body":"her and walked out of the room"},{"speaker":"Chris Dy","startTime":585.79,"endTime":588.43,"body":"with the impression I was giving"},{"speaker":"Chris Dy","startTime":588.43,"endTime":591.82,"body":"her a steroid shot when I came"},{"speaker":"Chris Dy","startTime":588.43,"endTime":591.82,"body":"in to give her a shot. She said"},{"speaker":"Chris Dy","startTime":591.85,"endTime":593.74,"body":"you know I don't want that."},{"speaker":"Chris Dy","startTime":591.85,"endTime":593.74,"body":"Let's just Let's just cut to the"},{"speaker":"Chris Dy","startTime":593.74,"endTime":597.94,"body":"chase. So I said okay, here are"},{"speaker":"Chris Dy","startTime":593.74,"endTime":597.94,"body":"the options. And so I was fully"},{"speaker":"Chris Dy","startTime":597.94,"endTime":600.67,"body":"prepared to do that, but nobody"},{"speaker":"Chris Dy","startTime":597.94,"endTime":600.67,"body":"else had given her steroid shot."},{"speaker":"Charles Goldfarb","startTime":601.41,"endTime":605.01,"body":"Yeah, so um,"},{"speaker":"Charles Goldfarb","startTime":601.41,"endTime":605.01,"body":"you know, most likely this is"},{"speaker":"Charles Goldfarb","startTime":605.01,"endTime":610.86,"body":"gout, I guess potentially pseudo"},{"speaker":"Charles Goldfarb","startTime":605.01,"endTime":610.86,"body":"gout, but probably gout. And we,"},{"speaker":"Charles Goldfarb","startTime":610.86,"endTime":612.72,"body":"you know, we did share our"},{"speaker":"Charles Goldfarb","startTime":610.86,"endTime":612.72,"body":"experience. It's been a long"},{"speaker":"Charles Goldfarb","startTime":612.72,"endTime":618.27,"body":"time, maybe 15 years ago on this"},{"speaker":"Charles Goldfarb","startTime":612.72,"endTime":618.27,"body":"subject. And I think it's the"},{"speaker":"Charles Goldfarb","startTime":618.27,"endTime":621.69,"body":"culprit. I mean, I don't think"},{"speaker":"Charles Goldfarb","startTime":618.27,"endTime":621.69,"body":"this is, you know, a trauma and"},{"speaker":"Charles Goldfarb","startTime":621.69,"endTime":624.24,"body":"gout, I think it's gout that is"},{"speaker":"Charles Goldfarb","startTime":621.69,"endTime":624.24,"body":"eating away at the scapholunate"},{"speaker":"Charles Goldfarb","startTime":624.24,"endTime":627.9,"body":"ligament and led to arthrosis"},{"speaker":"Charles Goldfarb","startTime":624.24,"endTime":627.9,"body":"doesn't change my treatment or"},{"speaker":"Charles Goldfarb","startTime":627.9,"endTime":633.06,"body":"my approach. But I think it's"},{"speaker":"Charles Goldfarb","startTime":627.9,"endTime":633.06,"body":"gout. My second question, and we"},{"speaker":"Charles Goldfarb","startTime":633.06,"endTime":635.61,"body":"can talk about that too gout and"},{"speaker":"Charles Goldfarb","startTime":633.06,"endTime":635.61,"body":"assessment and what it means."},{"speaker":"Charles Goldfarb","startTime":635.61,"endTime":639.51,"body":"But my second question for you"},{"speaker":"Charles Goldfarb","startTime":635.61,"endTime":639.51,"body":"is, and I guess this is a"},{"speaker":"Charles Goldfarb","startTime":639.51,"endTime":643.11,"body":"theoretical question. So you say"},{"speaker":"Charles Goldfarb","startTime":639.51,"endTime":643.11,"body":"you've never done a capsular"},{"speaker":"Charles Goldfarb","startTime":643.11,"endTime":646.77,"body":"interposition? What's the role"},{"speaker":"Charles Goldfarb","startTime":643.11,"endTime":646.77,"body":"of, you know, I know that for"},{"speaker":"Charles Goldfarb","startTime":646.77,"endTime":651.03,"body":"you, you know nerve is, is"},{"speaker":"Charles Goldfarb","startTime":646.77,"endTime":651.03,"body":"really everything. Not"},{"speaker":"Charles Goldfarb","startTime":651.03,"endTime":653.61,"body":"everything, but really important"},{"speaker":"Charles Goldfarb","startTime":651.03,"endTime":653.61,"body":"to your practice, like me sports"},{"speaker":"Charles Goldfarb","startTime":653.61,"endTime":656.79,"body":"and congenital and kids really"},{"speaker":"Charles Goldfarb","startTime":653.61,"endTime":656.79,"body":"super important. It's"},{"speaker":"Charles Goldfarb","startTime":656.79,"endTime":661.92,"body":"interesting, you know, do we do"},{"speaker":"Charles Goldfarb","startTime":656.79,"endTime":661.92,"body":"enough as a partner, as a group"},{"speaker":"Charles Goldfarb","startTime":661.92,"endTime":666.27,"body":"of partners, that we operate"},{"speaker":"Charles Goldfarb","startTime":661.92,"endTime":666.27,"body":"together on things like this?"},{"speaker":"Chris Dy","startTime":667.26,"endTime":671.13,"body":"No, I think I think"},{"speaker":"Chris Dy","startTime":667.26,"endTime":671.13,"body":"that's interesting. You know, if"},{"speaker":"Chris Dy","startTime":671.13,"endTime":674.19,"body":"it was a problem, where I didn't"},{"speaker":"Chris Dy","startTime":671.13,"endTime":674.19,"body":"think that we each had reliable"},{"speaker":"Chris Dy","startTime":674.19,"endTime":677.43,"body":"solutions, while it may not be"},{"speaker":"Chris Dy","startTime":674.19,"endTime":677.43,"body":"the solution that everybody else"},{"speaker":"Chris Dy","startTime":677.43,"endTime":680.43,"body":"comes to, I think there's enough"},{"speaker":"Chris Dy","startTime":677.43,"endTime":680.43,"body":"equipoise in the literature,"},{"speaker":"Chris Dy","startTime":680.43,"endTime":682.53,"body":"meaning that there's a lot of"},{"speaker":"Chris Dy","startTime":680.43,"endTime":682.53,"body":"uncertainty as to what the right"},{"speaker":"Chris Dy","startTime":682.53,"endTime":684.78,"body":"thing to do is, but you've got a"},{"speaker":"Chris Dy","startTime":682.53,"endTime":684.78,"body":"number of things that have"},{"speaker":"Chris Dy","startTime":684.78,"endTime":688.41,"body":"reliable and predictable"},{"speaker":"Chris Dy","startTime":684.78,"endTime":688.41,"body":"options. I don't know. I mean, I"},{"speaker":"Chris Dy","startTime":688.41,"endTime":691.53,"body":"guess if there was somebody who"},{"speaker":"Chris Dy","startTime":688.41,"endTime":691.53,"body":"felt very strongly that a"},{"speaker":"Chris Dy","startTime":691.53,"endTime":694.29,"body":"capsular interpositions are the"},{"speaker":"Chris Dy","startTime":691.53,"endTime":694.29,"body":"way to go, maybe I should have"},{"speaker":"Chris Dy","startTime":694.29,"endTime":698.1,"body":"called that person. And maybe"},{"speaker":"Chris Dy","startTime":694.29,"endTime":698.1,"body":"that's an area where we could be"},{"speaker":"Chris Dy","startTime":698.1,"endTime":700.23,"body":"better at it now. But I think"},{"speaker":"Chris Dy","startTime":698.1,"endTime":700.23,"body":"that these are reasonable"},{"speaker":"Chris Dy","startTime":700.23,"endTime":703.14,"body":"solutions that many hand"},{"speaker":"Chris Dy","startTime":700.23,"endTime":703.14,"body":"surgeons and practice would have"},{"speaker":"Chris Dy","startTime":703.14,"endTime":704.01,"body":"offered this patient."},{"speaker":"Charles Goldfarb","startTime":704.79,"endTime":706.83,"body":"Totally agree."},{"speaker":"Charles Goldfarb","startTime":704.79,"endTime":706.83,"body":"And I'm not suggesting you"},{"speaker":"Charles Goldfarb","startTime":706.86,"endTime":708.42,"body":"didn't do absolutely the right"},{"speaker":"Charles Goldfarb","startTime":706.86,"endTime":708.42,"body":"thing."},{"speaker":"Chris Dy","startTime":708.45,"endTime":710.16,"body":"Yeah, yeah, you were"},{"speaker":"Chris Dy","startTime":708.45,"endTime":710.16,"body":"Yeah, you were you totally."},{"speaker":"Chris Dy","startTime":710.19,"endTime":710.91,"body":"That's what you're doing."},{"speaker":"Charles Goldfarb","startTime":712.14,"endTime":714.63,"body":"No not this"},{"speaker":"Charles Goldfarb","startTime":712.14,"endTime":714.63,"body":"time. No, I agree there's not"},{"speaker":"Charles Goldfarb","startTime":714.63,"endTime":718.95,"body":"clearly a better answer. And you"},{"speaker":"Charles Goldfarb","startTime":714.63,"endTime":718.95,"body":"certainly had the right tools in"},{"speaker":"Charles Goldfarb","startTime":718.95,"endTime":724.23,"body":"your toolbox to take care of it."},{"speaker":"Charles Goldfarb","startTime":718.95,"endTime":724.23,"body":"So. So I mean, I'm in agreement,"},{"speaker":"Charles Goldfarb","startTime":724.23,"endTime":726.33,"body":"I think this is a very"},{"speaker":"Charles Goldfarb","startTime":724.23,"endTime":726.33,"body":"reasonable option, I might have"},{"speaker":"Charles Goldfarb","startTime":726.33,"endTime":730.08,"body":"chosen capsular interposition,"},{"speaker":"Charles Goldfarb","startTime":726.33,"endTime":730.08,"body":"but not with the idea that there"},{"speaker":"Charles Goldfarb","startTime":730.08,"endTime":732.78,"body":"was anything wrong with the"},{"speaker":"Charles Goldfarb","startTime":730.08,"endTime":732.78,"body":"scaphoid excision, and four bone"},{"speaker":"Charles Goldfarb","startTime":732.78,"endTime":733.17,"body":"fusion."},{"speaker":"Chris Dy","startTime":733.77,"endTime":735.84,"body":"Can you give anybody"},{"speaker":"Chris Dy","startTime":733.77,"endTime":735.84,"body":"any pearls about a capsular"},{"speaker":"Chris Dy","startTime":735.84,"endTime":739.11,"body":"interposition. Before we dive"},{"speaker":"Chris Dy","startTime":735.84,"endTime":739.11,"body":"into other technical things."},{"speaker":"Charles Goldfarb","startTime":739.81,"endTime":743.32,"body":"I you know, I"},{"speaker":"Charles Goldfarb","startTime":739.81,"endTime":743.32,"body":"used to do a Blatt Capsulodesis"},{"speaker":"Charles Goldfarb","startTime":743.35,"endTime":747.58,"body":"a lot for scapholunate. And so"},{"speaker":"Charles Goldfarb","startTime":743.35,"endTime":747.58,"body":"with that operation, you are"},{"speaker":"Charles Goldfarb","startTime":747.58,"endTime":752.35,"body":"creating a one and a half"},{"speaker":"Charles Goldfarb","startTime":747.58,"endTime":752.35,"body":"centimeter wide, capsular flap,"},{"speaker":"Charles Goldfarb","startTime":752.41,"endTime":757.57,"body":"so dorsal wrust capsule based on"},{"speaker":"Charles Goldfarb","startTime":752.41,"endTime":757.57,"body":"the radius, and then you attach"},{"speaker":"Charles Goldfarb","startTime":757.57,"endTime":760.24,"body":"it to the scaphoid distally, I"},{"speaker":"Charles Goldfarb","startTime":757.57,"endTime":760.24,"body":"don't do that operation anymore."},{"speaker":"Charles Goldfarb","startTime":760.24,"endTime":761.95,"body":"I'm not sure if you do"},{"speaker":"Charles Goldfarb","startTime":760.24,"endTime":761.95,"body":"capsulodeses, but I don't"},{"speaker":"Charles Goldfarb","startTime":761.95,"endTime":765.64,"body":"remember the last time I did"},{"speaker":"Charles Goldfarb","startTime":761.95,"endTime":765.64,"body":"that. In this case, I actually"},{"speaker":"Charles Goldfarb","startTime":765.64,"endTime":771.01,"body":"like distally based flap better"},{"speaker":"Charles Goldfarb","startTime":765.64,"endTime":771.01,"body":"and I make it at least two"},{"speaker":"Charles Goldfarb","startTime":771.01,"endTime":774.4,"body":"centimeters wide. So"},{"speaker":"Charles Goldfarb","startTime":771.01,"endTime":774.4,"body":"essentially, a longitudinal"},{"speaker":"Charles Goldfarb","startTime":774.49,"endTime":780.43,"body":"incision, kind of in the radial"},{"speaker":"Charles Goldfarb","startTime":774.49,"endTime":780.43,"body":"1/3 of the of the wrist joint,"},{"speaker":"Charles Goldfarb","startTime":780.7,"endTime":784.03,"body":"another longitudinal incision in"},{"speaker":"Charles Goldfarb","startTime":780.7,"endTime":784.03,"body":"the ulnar 1/3 of the wrist"},{"speaker":"Charles Goldfarb","startTime":784.03,"endTime":787.54,"body":"joint, and then I take the"},{"speaker":"Charles Goldfarb","startTime":784.03,"endTime":787.54,"body":"capsule off of the radius, leave"},{"speaker":"Charles Goldfarb","startTime":787.54,"endTime":791.08,"body":"it attached distally. So now I"},{"speaker":"Charles Goldfarb","startTime":787.54,"endTime":791.08,"body":"have a wide, a nice, wide"},{"speaker":"Charles Goldfarb","startTime":791.08,"endTime":794.62,"body":"substantial capsular flap, that"},{"speaker":"Charles Goldfarb","startTime":791.08,"endTime":794.62,"body":"then I can suture, as I"},{"speaker":"Charles Goldfarb","startTime":794.62,"endTime":799.27,"body":"mentioned carefully to the volar"},{"speaker":"Charles Goldfarb","startTime":794.62,"endTime":799.27,"body":"ligamentous structure. I do like"},{"speaker":"Charles Goldfarb","startTime":799.27,"endTime":804.13,"body":"the operation. I have no idea if"},{"speaker":"Charles Goldfarb","startTime":799.27,"endTime":804.13,"body":"it stands the test of time. But"},{"speaker":"Charles Goldfarb","startTime":804.13,"endTime":807.07,"body":"I have not revised any of these"},{"speaker":"Charles Goldfarb","startTime":804.13,"endTime":807.07,"body":"in my practice, not that I've"},{"speaker":"Charles Goldfarb","startTime":807.07,"endTime":809.41,"body":"done more than half dozen to a"},{"speaker":"Charles Goldfarb","startTime":807.07,"endTime":809.41,"body":"dozen."},{"speaker":"Chris Dy","startTime":810.34,"endTime":813.16,"body":"Same indications as"},{"speaker":"Chris Dy","startTime":810.34,"endTime":813.16,"body":"the capitate, resurfacing this"},{"speaker":"Chris Dy","startTime":813.16,"endTime":813.91,"body":"kind of patient?"},{"speaker":"Charles Goldfarb","startTime":814.42,"endTime":817.9,"body":"I think so. I"},{"speaker":"Charles Goldfarb","startTime":814.42,"endTime":817.9,"body":"think so certainly far cheaper."},{"speaker":"Charles Goldfarb","startTime":817.9,"endTime":821.08,"body":"I don't know what the capitate"},{"speaker":"Charles Goldfarb","startTime":817.9,"endTime":821.08,"body":"resurfacing costs. It might be"},{"speaker":"Charles Goldfarb","startTime":821.08,"endTime":824.71,"body":"more fun in operating room. But"},{"speaker":"Charles Goldfarb","startTime":821.08,"endTime":824.71,"body":"I don't know about cost analysis"},{"speaker":"Charles Goldfarb","startTime":824.71,"endTime":825.07,"body":"for that."},{"speaker":"Chris Dy","startTime":825.13,"endTime":828.37,"body":"Surgeon enjoyment is"},{"speaker":"Chris Dy","startTime":825.13,"endTime":828.37,"body":"not included in our case logs"},{"speaker":"Chris Dy","startTime":828.4,"endTime":831.43,"body":"with cost. It's interesting you"},{"speaker":"Chris Dy","startTime":828.4,"endTime":831.43,"body":"mentioned, it's interesting you"},{"speaker":"Chris Dy","startTime":831.43,"endTime":833.92,"body":"mentioned the capsulodesis"},{"speaker":"Chris Dy","startTime":831.43,"endTime":833.92,"body":"because I actually raised a"},{"speaker":"Chris Dy","startTime":833.92,"endTime":840.13,"body":"Blatt Capsulodesis flap as part"},{"speaker":"Chris Dy","startTime":833.92,"endTime":840.13,"body":"of an SL reconstruction case"},{"speaker":"Chris Dy","startTime":840.13,"endTime":843.25,"body":"because I knew I wasn't going to"},{"speaker":"Chris Dy","startTime":840.13,"endTime":843.25,"body":"be able to reconstruct the SL"},{"speaker":"Chris Dy","startTime":843.25,"endTime":845.62,"body":"ligament actually wanted the"},{"speaker":"Chris Dy","startTime":843.25,"endTime":845.62,"body":"trainee to see, here's how he"},{"speaker":"Chris Dy","startTime":845.62,"endTime":849.34,"body":"would do this in case you don't"},{"speaker":"Chris Dy","startTime":845.62,"endTime":849.34,"body":"have access to various, you"},{"speaker":"Chris Dy","startTime":849.34,"endTime":852.1,"body":"know, implants like a suture"},{"speaker":"Chris Dy","startTime":849.34,"endTime":852.1,"body":"tape or something like that. But"},{"speaker":"Chris Dy","startTime":852.1,"endTime":854.65,"body":"the suture tape, I think, for me"},{"speaker":"Chris Dy","startTime":852.1,"endTime":854.65,"body":"has supplanted the use of the"},{"speaker":"Chris Dy","startTime":854.65,"endTime":857.98,"body":"Blatt. But it's important to"},{"speaker":"Chris Dy","startTime":854.65,"endTime":857.98,"body":"know how to do a Blatt in case"},{"speaker":"Chris Dy","startTime":857.98,"endTime":859.09,"body":"you need to bail yourself out."},{"speaker":"Charles Goldfarb","startTime":859.81,"endTime":862.57,"body":"Yeah, and you"},{"speaker":"Charles Goldfarb","startTime":859.81,"endTime":862.57,"body":"know, as you mentioned, I mean"},{"speaker":"Charles Goldfarb","startTime":862.57,"endTime":867.34,"body":"there's many ways to accomplish"},{"speaker":"Charles Goldfarb","startTime":862.57,"endTime":867.34,"body":"the same goal. What was probably"},{"speaker":"Charles Goldfarb","startTime":867.34,"endTime":870.7,"body":"not super healthy is sometimes"},{"speaker":"Charles Goldfarb","startTime":867.34,"endTime":870.7,"body":"we have a little bit of"},{"speaker":"Charles Goldfarb","startTime":870.7,"endTime":873.58,"body":"groupthink, I think for the"},{"speaker":"Charles Goldfarb","startTime":870.7,"endTime":873.58,"body":"right reasons. But like you say"},{"speaker":"Charles Goldfarb","startTime":873.58,"endTime":876.37,"body":"we're we've been pretty happy"},{"speaker":"Charles Goldfarb","startTime":873.58,"endTime":876.37,"body":"the internal brace for SL and"},{"speaker":"Charles Goldfarb","startTime":876.37,"endTime":883.81,"body":"we've been very, very happy for"},{"speaker":"Charles Goldfarb","startTime":876.37,"endTime":883.81,"body":"the internal brace for CMC. And"},{"speaker":"Charles Goldfarb","startTime":883.81,"endTime":886.75,"body":"I did an LRTI yesterday and"},{"speaker":"Charles Goldfarb","startTime":883.81,"endTime":886.75,"body":"Harrison, one of our fellows was"},{"speaker":"Charles Goldfarb","startTime":886.75,"endTime":890.41,"body":"super excited, because he had"},{"speaker":"Charles Goldfarb","startTime":886.75,"endTime":890.41,"body":"seen a lot of LRTI which is"},{"speaker":"Charles Goldfarb","startTime":890.41,"endTime":893.95,"body":"fascinating. And we you know, it"},{"speaker":"Charles Goldfarb","startTime":890.41,"endTime":893.95,"body":"was great and we did together."},{"speaker":"Charles Goldfarb","startTime":894.01,"endTime":897.13,"body":"There's nothing tricky about it,"},{"speaker":"Charles Goldfarb","startTime":894.01,"endTime":897.13,"body":"but it was fun for him to see."},{"speaker":"Chris Dy","startTime":897.58,"endTime":899.89,"body":"Right because if you"},{"speaker":"Chris Dy","startTime":897.58,"endTime":899.89,"body":"go into a practice where you're"},{"speaker":"Chris Dy","startTime":899.89,"endTime":902.53,"body":"at a Surgery Center and they say"},{"speaker":"Chris Dy","startTime":899.89,"endTime":902.53,"body":"Why are you spending this much"},{"speaker":"Chris Dy","startTime":902.53,"endTime":905.71,"body":"money on a surgery? That's going"},{"speaker":"Chris Dy","startTime":902.53,"endTime":905.71,"body":"to make a difference because you"},{"speaker":"Chris Dy","startTime":905.71,"endTime":909.43,"body":"could do an LRTI on the cheap"},{"speaker":"Chris Dy","startTime":905.71,"endTime":909.43,"body":"using an FCR and or various the"},{"speaker":"Chris Dy","startTime":909.43,"endTime":913.54,"body":"Wilde or the, you know, the"},{"speaker":"Chris Dy","startTime":909.43,"endTime":913.54,"body":"technique that Jeanne Delsignore"},{"speaker":"Chris Dy","startTime":913.54,"endTime":915.85,"body":"described there are a lot of"},{"speaker":"Chris Dy","startTime":913.54,"endTime":915.85,"body":"ways you can treat thumb CMC"},{"speaker":"Chris Dy","startTime":915.85,"endTime":917.74,"body":"arthritis in a very cost"},{"speaker":"Chris Dy","startTime":915.85,"endTime":917.74,"body":"effective manner."},{"speaker":"Charles Goldfarb","startTime":918.25,"endTime":920.05,"body":"Absolutely."},{"speaker":"Charles Goldfarb","startTime":918.25,"endTime":920.05,"body":"And I'm not here to promote"},{"speaker":"Charles Goldfarb","startTime":920.05,"endTime":923.08,"body":"anything. But we have two papers"},{"speaker":"Charles Goldfarb","startTime":920.05,"endTime":923.08,"body":"coming out on this, which I'm"},{"speaker":"Charles Goldfarb","startTime":923.08,"endTime":926.08,"body":"excited about one's a"},{"speaker":"Charles Goldfarb","startTime":923.08,"endTime":926.08,"body":"retrospective study on a large"},{"speaker":"Charles Goldfarb","startTime":926.08,"endTime":930.16,"body":"number of LRTI versus the"},{"speaker":"Charles Goldfarb","startTime":926.08,"endTime":930.16,"body":"internal brace and another is a"},{"speaker":"Charles Goldfarb","startTime":930.16,"endTime":933.61,"body":"prospective study. So those data"},{"speaker":"Charles Goldfarb","startTime":930.16,"endTime":933.61,"body":"will be interesting. I'll give"},{"speaker":"Charles Goldfarb","startTime":933.61,"endTime":934.87,"body":"teasers as we go along."},{"speaker":"Chris Dy","startTime":935.68,"endTime":938.8,"body":"Oh, people are on the"},{"speaker":"Chris Dy","startTime":935.68,"endTime":938.8,"body":"edge of their seats during their"},{"speaker":"Chris Dy","startTime":938.8,"endTime":941.68,"body":"commutes. So let's get to it."},{"speaker":"Chris Dy","startTime":938.8,"endTime":941.68,"body":"Let's get to the meat of this"},{"speaker":"Chris Dy","startTime":941.68,"endTime":945.16,"body":"episode. So I wanted to talk"},{"speaker":"Chris Dy","startTime":941.68,"endTime":945.16,"body":"detail surgical technique about"},{"speaker":"Chris Dy","startTime":945.16,"endTime":948.07,"body":"four corner fusions. Just"},{"speaker":"Chris Dy","startTime":945.16,"endTime":948.07,"body":"because I know there are a lot"},{"speaker":"Chris Dy","startTime":948.1,"endTime":951.97,"body":"of ways to do this. You know, in"},{"speaker":"Chris Dy","startTime":948.1,"endTime":951.97,"body":"essence, so say for example,"},{"speaker":"Chris Dy","startTime":951.97,"endTime":955.18,"body":"you've gotten your surgical"},{"speaker":"Chris Dy","startTime":951.97,"endTime":955.18,"body":"approach done. You're staring at"},{"speaker":"Chris Dy","startTime":955.21,"endTime":959.71,"body":"a bare spot on the capitate. The"},{"speaker":"Chris Dy","startTime":955.21,"endTime":959.71,"body":"lunate proximal surface where it"},{"speaker":"Chris Dy","startTime":959.71,"endTime":963.52,"body":"articulates with the radius is"},{"speaker":"Chris Dy","startTime":959.71,"endTime":963.52,"body":"okay. You've decided you're"},{"speaker":"Chris Dy","startTime":963.52,"endTime":967.87,"body":"going to do a four corner"},{"speaker":"Chris Dy","startTime":963.52,"endTime":967.87,"body":"fusion. How do you prepare your"},{"speaker":"Chris Dy","startTime":967.87,"endTime":969.46,"body":"joint surfaces just to get"},{"speaker":"Chris Dy","startTime":967.87,"endTime":969.46,"body":"started?"},{"speaker":"Charles Goldfarb","startTime":970.42,"endTime":972.19,"body":"I would like"},{"speaker":"Charles Goldfarb","startTime":970.42,"endTime":972.19,"body":"with your permission to go back"},{"speaker":"Charles Goldfarb","startTime":972.19,"endTime":975.73,"body":"and emphasize two things. One,"},{"speaker":"Charles Goldfarb","startTime":972.19,"endTime":975.73,"body":"the approach for me is simply"},{"speaker":"Charles Goldfarb","startTime":975.73,"endTime":979.12,"body":"through the third compartment. I"},{"speaker":"Charles Goldfarb","startTime":975.73,"endTime":979.12,"body":"transpose and leave the EPL"},{"speaker":"Charles Goldfarb","startTime":979.12,"endTime":982.72,"body":"transpose I do not routinely"},{"speaker":"Charles Goldfarb","startTime":979.12,"endTime":982.72,"body":"take out the post interosseous"},{"speaker":"Charles Goldfarb","startTime":982.72,"endTime":987.55,"body":"nerve but don't have any issue"},{"speaker":"Charles Goldfarb","startTime":982.72,"endTime":987.55,"body":"if you know others might. I'm"},{"speaker":"Charles Goldfarb","startTime":987.55,"endTime":988.06,"body":"really about"},{"speaker":"Chris Dy","startTime":988.24,"endTime":989.62,"body":"Just don't bill for it"},{"speaker":"Chris Dy","startTime":988.24,"endTime":989.62,"body":"separately."},{"speaker":"Charles Goldfarb","startTime":990.76,"endTime":993.25,"body":"I agree with"},{"speaker":"Charles Goldfarb","startTime":990.76,"endTime":993.25,"body":"that. I'm all about the nerves."},{"speaker":"Charles Goldfarb","startTime":993.25,"endTime":996.43,"body":"I'm gonna save them. Yeah, I"},{"speaker":"Charles Goldfarb","startTime":993.25,"endTime":996.43,"body":"don't believe in billing for"},{"speaker":"Charles Goldfarb","startTime":996.43,"endTime":998.14,"body":"them. But some some out there"},{"speaker":"Charles Goldfarb","startTime":996.43,"endTime":998.14,"body":"will"},{"speaker":"Chris Dy","startTime":998.47,"endTime":1000.12,"body":"Some do, some do"},{"speaker":"Chris Dy","startTime":998.47,"endTime":1000.12,"body":"that's cool."},{"speaker":"Charles Goldfarb","startTime":1000.27,"endTime":1003.63,"body":"And to be very"},{"speaker":"Charles Goldfarb","startTime":1000.27,"endTime":1003.63,"body":"clear. You know, one of our"},{"speaker":"Charles Goldfarb","startTime":1003.63,"endTime":1007.29,"body":"favorite studies is Kirk"},{"speaker":"Charles Goldfarb","startTime":1003.63,"endTime":1007.29,"body":"Watson's study of defining SLAC"},{"speaker":"Charles Goldfarb","startTime":1007.29,"endTime":1010.98,"body":"wrist and apparently reviewing"},{"speaker":"Charles Goldfarb","startTime":1007.29,"endTime":1010.98,"body":"4000 radiographs of various"},{"speaker":"Charles Goldfarb","startTime":1010.98,"endTime":1016.08,"body":"wrist arthritis patterns, though"},{"speaker":"Charles Goldfarb","startTime":1010.98,"endTime":1016.08,"body":"proximal lunate is always okay."},{"speaker":"Chris Dy","startTime":1019.56,"endTime":1020.34,"body":"Until it's not."},{"speaker":"Charles Goldfarb","startTime":1021.89,"endTime":1024.11,"body":"But it's"},{"speaker":"Charles Goldfarb","startTime":1021.89,"endTime":1024.11,"body":"always okay. But you do have to"},{"speaker":"Charles Goldfarb","startTime":1024.11,"endTime":1028.91,"body":"confirm that so, so wide"},{"speaker":"Charles Goldfarb","startTime":1024.11,"endTime":1028.91,"body":"exposure. And then the first"},{"speaker":"Charles Goldfarb","startTime":1028.91,"endTime":1031.85,"body":"step is obviously removing the"},{"speaker":"Charles Goldfarb","startTime":1028.91,"endTime":1031.85,"body":"scaphoid in these situations"},{"speaker":"Charles Goldfarb","startTime":1031.85,"endTime":1035.9,"body":"with a little bit older patients"},{"speaker":"Charles Goldfarb","startTime":1031.85,"endTime":1035.9,"body":"and patients who've been in pain"},{"speaker":"Charles Goldfarb","startTime":1035.9,"endTime":1038.39,"body":"for a while, it's usually not"},{"speaker":"Charles Goldfarb","startTime":1035.9,"endTime":1038.39,"body":"the hardest part of the"},{"speaker":"Charles Goldfarb","startTime":1038.39,"endTime":1041.12,"body":"procedure. You know, there may"},{"speaker":"Charles Goldfarb","startTime":1038.39,"endTime":1041.12,"body":"be some scarring of the scaphoid"},{"speaker":"Charles Goldfarb","startTime":1041.12,"endTime":1045.26,"body":"tuberosity to the volar capsule."},{"speaker":"Charles Goldfarb","startTime":1041.12,"endTime":1045.26,"body":"But getting some Hohmanns around"},{"speaker":"Charles Goldfarb","startTime":1045.26,"endTime":1048.29,"body":"the scaphoid to me is the"},{"speaker":"Charles Goldfarb","startTime":1045.26,"endTime":1048.29,"body":"simplest way to get this"},{"speaker":"Charles Goldfarb","startTime":1048.29,"endTime":1050.63,"body":"scaphoid out. I don't use"},{"speaker":"Charles Goldfarb","startTime":1048.29,"endTime":1050.63,"body":"threaded K wires, I don't think"},{"speaker":"Charles Goldfarb","startTime":1050.63,"endTime":1055.91,"body":"they're necessary. I am super"},{"speaker":"Charles Goldfarb","startTime":1050.63,"endTime":1055.91,"body":"careful about the volar capsule,"},{"speaker":"Charles Goldfarb","startTime":1055.91,"endTime":1058.01,"body":"especially the"},{"speaker":"Charles Goldfarb","startTime":1055.91,"endTime":1058.01,"body":"radioscaphocapitate and long"},{"speaker":"Charles Goldfarb","startTime":1058.04,"endTime":1060.77,"body":"radiolunate ligaments because if"},{"speaker":"Charles Goldfarb","startTime":1058.04,"endTime":1060.77,"body":"those are cut, you will see"},{"speaker":"Charles Goldfarb","startTime":1060.77,"endTime":1063.44,"body":"translocation of the carpus. But"},{"speaker":"Charles Goldfarb","startTime":1060.77,"endTime":1063.44,"body":"getting the scaphoid out is the"},{"speaker":"Charles Goldfarb","startTime":1063.44,"endTime":1065.48,"body":"first step. Usually not so hard."},{"speaker":"Chris Dy","startTime":1066.08,"endTime":1068.12,"body":"I agree with that. And"},{"speaker":"Chris Dy","startTime":1066.08,"endTime":1068.12,"body":"I think the last point you made"},{"speaker":"Chris Dy","startTime":1068.12,"endTime":1071.15,"body":"about the RSC and making sure"},{"speaker":"Chris Dy","startTime":1068.12,"endTime":1071.15,"body":"that you don't get that ulnar"},{"speaker":"Chris Dy","startTime":1071.15,"endTime":1075.14,"body":"translation of your carpet is"},{"speaker":"Chris Dy","startTime":1071.15,"endTime":1075.14,"body":"huge. And for that reason, you"},{"speaker":"Chris Dy","startTime":1075.14,"endTime":1078.62,"body":"know it is largely a blunt"},{"speaker":"Chris Dy","startTime":1075.14,"endTime":1078.62,"body":"dissection to release the"},{"speaker":"Chris Dy","startTime":1078.62,"endTime":1081.41,"body":"scaphoid on the ulnar side. I"},{"speaker":"Chris Dy","startTime":1078.62,"endTime":1081.41,"body":"like to use them a mcglamry"},{"speaker":"Chris Dy","startTime":1081.41,"endTime":1085.04,"body":"elevator from the foot world and"},{"speaker":"Chris Dy","startTime":1081.41,"endTime":1085.04,"body":"I've seen that that seems to"},{"speaker":"Chris Dy","startTime":1085.04,"endTime":1088.28,"body":"work well for me. I just don't"},{"speaker":"Chris Dy","startTime":1085.04,"endTime":1088.28,"body":"like taking a knife and going"},{"speaker":"Chris Dy","startTime":1088.28,"endTime":1091.1,"body":"along the volar surface there"},{"speaker":"Chris Dy","startTime":1088.28,"endTime":1091.1,"body":"because I think you can get into"},{"speaker":"Chris Dy","startTime":1091.1,"endTime":1095.45,"body":"trouble there for for a number"},{"speaker":"Chris Dy","startTime":1091.1,"endTime":1095.45,"body":"of reasons. So yeah, I agree it"},{"speaker":"Chris Dy","startTime":1095.45,"endTime":1098.42,"body":"usually not the hardest part."},{"speaker":"Chris Dy","startTime":1095.45,"endTime":1098.42,"body":"Are you the kind of guy that"},{"speaker":"Chris Dy","startTime":1098.42,"endTime":1101.51,"body":"likes to take the scaphoid out"},{"speaker":"Chris Dy","startTime":1098.42,"endTime":1101.51,"body":"in one piece? Is that a pride"},{"speaker":"Chris Dy","startTime":1101.51,"endTime":1102.17,"body":"point for you?"},{"speaker":"Charles Goldfarb","startTime":1102.71,"endTime":1104.63,"body":"I'm the kind"},{"speaker":"Charles Goldfarb","startTime":1102.71,"endTime":1104.63,"body":"of guy who wants to get the"},{"speaker":"Charles Goldfarb","startTime":1104.63,"endTime":1110.42,"body":"scaphoid out fast and if it's in"},{"speaker":"Charles Goldfarb","startTime":1104.63,"endTime":1110.42,"body":"one piece awesome but no, there"},{"speaker":"Charles Goldfarb","startTime":1110.42,"endTime":1112.01,"body":"is no requirement there."},{"speaker":"Chris Dy","startTime":1112.07,"endTime":1113.51,"body":"Do you ever split it"},{"speaker":"Chris Dy","startTime":1112.07,"endTime":1113.51,"body":"from the beginning?"},{"speaker":"Charles Goldfarb","startTime":1114.44,"endTime":1116.9,"body":"No, I actually"},{"speaker":"Charles Goldfarb","startTime":1114.44,"endTime":1116.9,"body":"don't split it. I think the"},{"speaker":"Charles Goldfarb","startTime":1116.9,"endTime":1121.37,"body":"question is I like the you know"},{"speaker":"Charles Goldfarb","startTime":1116.9,"endTime":1121.37,"body":"dissection near"},{"speaker":"Charles Goldfarb","startTime":1121.37,"endTime":1124.85,"body":"circumferentially grab it with"},{"speaker":"Charles Goldfarb","startTime":1121.37,"endTime":1124.85,"body":"the biggest rongeur I have and"},{"speaker":"Charles Goldfarb","startTime":1124.85,"endTime":1128.12,"body":"then the slow alligator roll and"},{"speaker":"Charles Goldfarb","startTime":1124.85,"endTime":1128.12,"body":"either comes out or you hear"},{"speaker":"Charles Goldfarb","startTime":1128.12,"endTime":1131.21,"body":"that snap and then you got two"},{"speaker":"Charles Goldfarb","startTime":1128.12,"endTime":1131.21,"body":"pieces. What do you do?"},{"speaker":"Chris Dy","startTime":1131.21,"endTime":1132.71,"body":"With the biggest"},{"speaker":"Chris Dy","startTime":1131.21,"endTime":1132.71,"body":"Rongeur it might be more than"},{"speaker":"Chris Dy","startTime":1132.71,"endTime":1137.36,"body":"two pieces. I actually just"},{"speaker":"Chris Dy","startTime":1132.71,"endTime":1137.36,"body":"heckle the trainees until it's"},{"speaker":"Chris Dy","startTime":1137.36,"endTime":1139.52,"body":"no longer possible for them to"},{"speaker":"Chris Dy","startTime":1137.36,"endTime":1139.52,"body":"take it out in one piece and"},{"speaker":"Chris Dy","startTime":1139.52,"endTime":1141.53,"body":"then I make it into multiple"},{"speaker":"Chris Dy","startTime":1139.52,"endTime":1141.53,"body":"pieces so they don't feel bad."},{"speaker":"Chris Dy","startTime":1141.74,"endTime":1142.73,"body":"It's kind of how it goes"},{"speaker":"Chris Dy","startTime":1141.74,"endTime":1142.73,"body":"usually."},{"speaker":"Charles Goldfarb","startTime":1143.29,"endTime":1147.13,"body":"Do you care if"},{"speaker":"Charles Goldfarb","startTime":1143.29,"endTime":1147.13,"body":"there's a little shell of"},{"speaker":"Charles Goldfarb","startTime":1147.13,"endTime":1151.0,"body":"scaphoid volarly that's scarred"},{"speaker":"Charles Goldfarb","startTime":1147.13,"endTime":1151.0,"body":"to the capsule or do you"},{"speaker":"Charles Goldfarb","startTime":1151.03,"endTime":1153.13,"body":"meticulously work to get that"},{"speaker":"Charles Goldfarb","startTime":1151.03,"endTime":1153.13,"body":"those fragments-"},{"speaker":"Chris Dy","startTime":1153.22,"endTime":1156.76,"body":"No, I mean It hurts my"},{"speaker":"Chris Dy","startTime":1153.22,"endTime":1156.76,"body":"ego a little bit. I think in at"},{"speaker":"Chris Dy","startTime":1156.76,"endTime":1159.01,"body":"least in orthopedics, we're all"},{"speaker":"Chris Dy","startTime":1156.76,"endTime":1159.01,"body":"guilty of trying to make X rays"},{"speaker":"Chris Dy","startTime":1159.01,"endTime":1161.56,"body":"look a little bit better"},{"speaker":"Chris Dy","startTime":1159.01,"endTime":1161.56,"body":"sometimes unnecessarily but no,"},{"speaker":"Chris Dy","startTime":1161.56,"endTime":1163.84,"body":"I mean, at that point, you know,"},{"speaker":"Chris Dy","startTime":1161.56,"endTime":1163.84,"body":"it's more about moving on to the"},{"speaker":"Chris Dy","startTime":1163.84,"endTime":1165.97,"body":"next part of the case because I"},{"speaker":"Chris Dy","startTime":1163.84,"endTime":1165.97,"body":"don't like to think that little"},{"speaker":"Chris Dy","startTime":1165.97,"endTime":1168.61,"body":"volar shell's gonna make a big"},{"speaker":"Chris Dy","startTime":1165.97,"endTime":1168.61,"body":"difference. I will try to get it"},{"speaker":"Chris Dy","startTime":1168.61,"endTime":1170.32,"body":"if it's in the field, but I"},{"speaker":"Chris Dy","startTime":1168.61,"endTime":1170.32,"body":"don't endeavor."},{"speaker":"Charles Goldfarb","startTime":1171.04,"endTime":1177.91,"body":"Totally agree."},{"speaker":"Charles Goldfarb","startTime":1171.04,"endTime":1177.91,"body":"Totally agree. So are you a keep"},{"speaker":"Charles Goldfarb","startTime":1177.91,"endTime":1181.54,"body":"the triquetrum and truly do a"},{"speaker":"Charles Goldfarb","startTime":1177.91,"endTime":1181.54,"body":"for bone fusion? Have you"},{"speaker":"Charles Goldfarb","startTime":1181.54,"endTime":1185.71,"body":"transitioned to take out the"},{"speaker":"Charles Goldfarb","startTime":1181.54,"endTime":1185.71,"body":"triquetrum, do you fuse the"},{"speaker":"Charles Goldfarb","startTime":1185.71,"endTime":1187.96,"body":"triquetrum? What's your"},{"speaker":"Charles Goldfarb","startTime":1185.71,"endTime":1187.96,"body":"strategy?"},{"speaker":"Chris Dy","startTime":1188.62,"endTime":1192.19,"body":"I will keep the"},{"speaker":"Chris Dy","startTime":1188.62,"endTime":1192.19,"body":"triquetrum I will try to do a"},{"speaker":"Chris Dy","startTime":1192.49,"endTime":1195.85,"body":"fusion of the capitolunate for"},{"speaker":"Chris Dy","startTime":1192.49,"endTime":1195.85,"body":"sure. And then if I can get the"},{"speaker":"Chris Dy","startTime":1195.85,"endTime":1199.09,"body":"triquetrum and the hamate"},{"speaker":"Chris Dy","startTime":1195.85,"endTime":1199.09,"body":"together if it presents itself"},{"speaker":"Chris Dy","startTime":1199.09,"endTime":1203.77,"body":"very easily to me. I will denude"},{"speaker":"Chris Dy","startTime":1199.09,"endTime":1203.77,"body":"those surfaces, the triquetrum"},{"speaker":"Chris Dy","startTime":1203.77,"endTime":1206.56,"body":"and the hamate, but if it is not"},{"speaker":"Chris Dy","startTime":1203.77,"endTime":1206.56,"body":"presenting itself very easily,"},{"speaker":"Chris Dy","startTime":1206.56,"endTime":1210.85,"body":"they will just be held by a"},{"speaker":"Chris Dy","startTime":1206.56,"endTime":1210.85,"body":"compression screw. I think"},{"speaker":"Chris Dy","startTime":1210.85,"endTime":1214.3,"body":"technically, yes, you should"},{"speaker":"Chris Dy","startTime":1210.85,"endTime":1214.3,"body":"really try to get those surfaces"},{"speaker":"Chris Dy","startTime":1214.3,"endTime":1217.51,"body":"but I don't think it's worth"},{"speaker":"Chris Dy","startTime":1214.3,"endTime":1217.51,"body":"extra a ton of extra effort"},{"speaker":"Chris Dy","startTime":1217.51,"endTime":1220.15,"body":"during the case. How do you what"},{"speaker":"Chris Dy","startTime":1217.51,"endTime":1220.15,"body":"are you? How do you think about"},{"speaker":"Chris Dy","startTime":1220.15,"endTime":1220.24,"body":"it?"},{"speaker":"Charles Goldfarb","startTime":1220.45,"endTime":1223.36,"body":"Yeah, I agree."},{"speaker":"Charles Goldfarb","startTime":1220.45,"endTime":1223.36,"body":"A while back, the St. Louis"},{"speaker":"Charles Goldfarb","startTime":1223.36,"endTime":1227.32,"body":"group and the Memphis group led"},{"speaker":"Charles Goldfarb","startTime":1223.36,"endTime":1227.32,"body":"by Jim Calandruccio and Dr."},{"speaker":"Charles Goldfarb","startTime":1227.35,"endTime":1232.72,"body":"Gelberman looked at this this"},{"speaker":"Charles Goldfarb","startTime":1227.35,"endTime":1232.72,"body":"capitolunate only fusion with"},{"speaker":"Charles Goldfarb","startTime":1232.72,"endTime":1236.08,"body":"removal of the scaphoid and"},{"speaker":"Charles Goldfarb","startTime":1232.72,"endTime":1236.08,"body":"removal of the triquetrum. At"},{"speaker":"Charles Goldfarb","startTime":1236.08,"endTime":1238.81,"body":"the time, the results were not"},{"speaker":"Charles Goldfarb","startTime":1236.08,"endTime":1238.81,"body":"better, and probably were a"},{"speaker":"Charles Goldfarb","startTime":1238.81,"endTime":1241.66,"body":"little worse than just a four"},{"speaker":"Charles Goldfarb","startTime":1238.81,"endTime":1241.66,"body":"bone fusion. So we didn't really"},{"speaker":"Charles Goldfarb","startTime":1241.66,"endTime":1245.53,"body":"go in that direction as a group."},{"speaker":"Charles Goldfarb","startTime":1241.66,"endTime":1245.53,"body":"My general philosophy is, you"},{"speaker":"Charles Goldfarb","startTime":1245.53,"endTime":1248.26,"body":"know, it's all about the"},{"speaker":"Charles Goldfarb","startTime":1245.53,"endTime":1248.26,"body":"capitolunate. And a patient with"},{"speaker":"Charles Goldfarb","startTime":1248.26,"endTime":1251.32,"body":"gout though I do worry about the"},{"speaker":"Charles Goldfarb","startTime":1248.26,"endTime":1251.32,"body":"ligaments, you know, the LT and"},{"speaker":"Charles Goldfarb","startTime":1251.32,"endTime":1256.45,"body":"others. And so, I will my"},{"speaker":"Charles Goldfarb","startTime":1251.32,"endTime":1256.45,"body":"general procedure is fused the"},{"speaker":"Charles Goldfarb","startTime":1256.45,"endTime":1259.6,"body":"capitolunate. And then I tried"},{"speaker":"Charles Goldfarb","startTime":1256.45,"endTime":1259.6,"body":"to place a screw triquetrum,"},{"speaker":"Charles Goldfarb","startTime":1259.6,"endTime":1263.32,"body":"hamate, capitate, that's through"},{"speaker":"Charles Goldfarb","startTime":1259.6,"endTime":1263.32,"body":"a separate separate ulnar sided"},{"speaker":"Charles Goldfarb","startTime":1263.32,"endTime":1265.6,"body":"incision where I protect the"},{"speaker":"Charles Goldfarb","startTime":1263.32,"endTime":1265.6,"body":"sensory branch of the ulnar"},{"speaker":"Charles Goldfarb","startTime":1265.6,"endTime":1268.6,"body":"nerve. And I've been really"},{"speaker":"Charles Goldfarb","startTime":1265.6,"endTime":1268.6,"body":"happy with this. And you know,"},{"speaker":"Charles Goldfarb","startTime":1268.63,"endTime":1271.48,"body":"there are occasional rare"},{"speaker":"Charles Goldfarb","startTime":1268.63,"endTime":1271.48,"body":"nonunions but I've been really"},{"speaker":"Charles Goldfarb","startTime":1271.48,"endTime":1272.08,"body":"happy with it."},{"speaker":"Chris Dy","startTime":1273.01,"endTime":1276.07,"body":"Do you think that a"},{"speaker":"Chris Dy","startTime":1273.01,"endTime":1276.07,"body":"non union of that joint really"},{"speaker":"Chris Dy","startTime":1276.07,"endTime":1276.61,"body":"matters?"},{"speaker":"Charles Goldfarb","startTime":1277.63,"endTime":1278.26,"body":"Of the-"},{"speaker":"Chris Dy","startTime":1278.56,"endTime":1280.03,"body":"Triquetro-hamate"},{"speaker":"Charles Goldfarb","startTime":1280.87,"endTime":1282.37,"body":"No. And I"},{"speaker":"Charles Goldfarb","startTime":1280.87,"endTime":1282.37,"body":"certainly have never seen a"},{"speaker":"Charles Goldfarb","startTime":1282.37,"endTime":1285.46,"body":"broken screw or never seen pain"},{"speaker":"Charles Goldfarb","startTime":1282.37,"endTime":1285.46,"body":"when I want to have pain"},{"speaker":"Charles Goldfarb","startTime":1285.46,"endTime":1290.02,"body":"afterwards. It is more at the"},{"speaker":"Charles Goldfarb","startTime":1285.46,"endTime":1290.02,"body":"foveal area kind of ulnar wrist"},{"speaker":"Charles Goldfarb","startTime":1290.02,"endTime":1294.97,"body":"not related to triquetro-hamate."},{"speaker":"Charles Goldfarb","startTime":1290.02,"endTime":1294.97,"body":"So here's here's a, here's a I"},{"speaker":"Charles Goldfarb","startTime":1294.97,"endTime":1297.73,"body":"guess I read my mind question."},{"speaker":"Charles Goldfarb","startTime":1294.97,"endTime":1297.73,"body":"What's the hardest part of the"},{"speaker":"Charles Goldfarb","startTime":1297.73,"endTime":1300.43,"body":"procedure for you? And maybe"},{"speaker":"Charles Goldfarb","startTime":1297.73,"endTime":1300.43,"body":"I'll go first, the hardest part"},{"speaker":"Charles Goldfarb","startTime":1300.43,"endTime":1303.55,"body":"of the the easiest part of the"},{"speaker":"Charles Goldfarb","startTime":1300.43,"endTime":1303.55,"body":"procedure for me is denuding the"},{"speaker":"Charles Goldfarb","startTime":1303.55,"endTime":1307.03,"body":"proximal capitate. The hardest"},{"speaker":"Charles Goldfarb","startTime":1303.55,"endTime":1307.03,"body":"part of the procedure is"},{"speaker":"Charles Goldfarb","startTime":1307.03,"endTime":1309.61,"body":"denuding the distal lunate."},{"speaker":"Chris Dy","startTime":1310.21,"endTime":1312.25,"body":"Yeah, yeah, it's"},{"speaker":"Chris Dy","startTime":1310.21,"endTime":1312.25,"body":"interesting because when I came"},{"speaker":"Chris Dy","startTime":1312.25,"endTime":1315.16,"body":"up the other day, I told the"},{"speaker":"Chris Dy","startTime":1312.25,"endTime":1315.16,"body":"trainee that you're going to do"},{"speaker":"Chris Dy","startTime":1315.16,"endTime":1317.59,"body":"the capitate. I'll do the lunate"},{"speaker":"Chris Dy","startTime":1315.16,"endTime":1317.59,"body":"because I'm never satisfied with"},{"speaker":"Chris Dy","startTime":1317.59,"endTime":1321.1,"body":"anybody else doing the lunate."},{"speaker":"Chris Dy","startTime":1317.59,"endTime":1321.1,"body":"And I'd rather and I said I told"},{"speaker":"Chris Dy","startTime":1321.1,"endTime":1324.1,"body":"the trainee I said the Lunate"},{"speaker":"Chris Dy","startTime":1321.1,"endTime":1324.1,"body":"disappears relatively quickly."},{"speaker":"Chris Dy","startTime":1324.64,"endTime":1327.28,"body":"If you're too aggressive and I'd"},{"speaker":"Chris Dy","startTime":1324.64,"endTime":1327.28,"body":"rather than be me than you."},{"speaker":"Charles Goldfarb","startTime":1328.2,"endTime":1331.77,"body":"It's hard to"},{"speaker":"Charles Goldfarb","startTime":1328.2,"endTime":1331.77,"body":"get good cancellous bone on that"},{"speaker":"Charles Goldfarb","startTime":1331.77,"endTime":1335.43,"body":"distal lunate and you can do a"},{"speaker":"Charles Goldfarb","startTime":1331.77,"endTime":1335.43,"body":"crappy cartilage resection and"},{"speaker":"Charles Goldfarb","startTime":1335.43,"endTime":1339.12,"body":"have that sub cortical bone. But"},{"speaker":"Charles Goldfarb","startTime":1335.43,"endTime":1339.12,"body":"if it doesn't heal, that's why"},{"speaker":"Charles Goldfarb","startTime":1339.15,"endTime":1342.42,"body":"and so you really that is does"},{"speaker":"Charles Goldfarb","startTime":1339.15,"endTime":1342.42,"body":"need to be done precisely. It's"},{"speaker":"Charles Goldfarb","startTime":1342.42,"endTime":1346.11,"body":"also why our partner Lindley"},{"speaker":"Charles Goldfarb","startTime":1342.42,"endTime":1346.11,"body":"Wall believes strongly that for"},{"speaker":"Charles Goldfarb","startTime":1346.11,"endTime":1349.89,"body":"even for total wrist"},{"speaker":"Charles Goldfarb","startTime":1346.11,"endTime":1349.89,"body":"arthrodeses, we should take out"},{"speaker":"Charles Goldfarb","startTime":1349.89,"endTime":1351.87,"body":"the proximal row. I don't think"},{"speaker":"Charles Goldfarb","startTime":1349.89,"endTime":1351.87,"body":"she's wrong."},{"speaker":"Chris Dy","startTime":1352.92,"endTime":1355.14,"body":"Yeah, it's a it's a"},{"speaker":"Chris Dy","startTime":1352.92,"endTime":1355.14,"body":"hard surface to get to fuse and"},{"speaker":"Chris Dy","startTime":1355.17,"endTime":1357.63,"body":"clearly the capitate is easier"},{"speaker":"Chris Dy","startTime":1355.17,"endTime":1357.63,"body":"surface to work with. And and"},{"speaker":"Chris Dy","startTime":1357.63,"endTime":1360.75,"body":"that's setting the obviously the"},{"speaker":"Chris Dy","startTime":1357.63,"endTime":1360.75,"body":"radius is relatively easy to"},{"speaker":"Chris Dy","startTime":1360.75,"endTime":1366.36,"body":"work with. You know, I think"},{"speaker":"Chris Dy","startTime":1360.75,"endTime":1366.36,"body":"that it is frustrating how long"},{"speaker":"Chris Dy","startTime":1366.36,"endTime":1370.02,"body":"it takes to do the lunate I try"},{"speaker":"Chris Dy","startTime":1366.36,"endTime":1370.02,"body":"not to get out the power tools."},{"speaker":"Chris Dy","startTime":1370.5,"endTime":1373.38,"body":"But I think inevitably for the"},{"speaker":"Chris Dy","startTime":1370.5,"endTime":1373.38,"body":"lunate I have to get out the"},{"speaker":"Chris Dy","startTime":1373.38,"endTime":1373.68,"body":"burr."},{"speaker":"Charles Goldfarb","startTime":1374.25,"endTime":1376.35,"body":"Yeah, I don't"},{"speaker":"Charles Goldfarb","startTime":1374.25,"endTime":1376.35,"body":"like it. I don't do it very"},{"speaker":"Charles Goldfarb","startTime":1376.35,"endTime":1379.11,"body":"often, probably less frequently"},{"speaker":"Charles Goldfarb","startTime":1376.35,"endTime":1379.11,"body":"than you because I like it less"},{"speaker":"Charles Goldfarb","startTime":1379.11,"endTime":1382.14,"body":"than you. But occasionally I'll"},{"speaker":"Charles Goldfarb","startTime":1379.11,"endTime":1382.14,"body":"get it out. Otherwise, it's just"},{"speaker":"Charles Goldfarb","startTime":1382.14,"endTime":1385.5,"body":"rongeur curette, rongeur"},{"speaker":"Charles Goldfarb","startTime":1382.14,"endTime":1385.5,"body":"curette, a few F bombs, rongeur"},{"speaker":"Charles Goldfarb","startTime":1385.5,"endTime":1385.92,"body":"curette."},{"speaker":"Chris Dy","startTime":1386.37,"endTime":1390.99,"body":"I was gonna say just a"},{"speaker":"Chris Dy","startTime":1386.37,"endTime":1390.99,"body":"few, huh. So I think the hardest"},{"speaker":"Chris Dy","startTime":1390.99,"endTime":1393.96,"body":"part of the case actually for me"},{"speaker":"Chris Dy","startTime":1390.99,"endTime":1393.96,"body":"is once you've taken down that"},{"speaker":"Chris Dy","startTime":1393.96,"endTime":1396.63,"body":"mid carpal joint, I think we"},{"speaker":"Chris Dy","startTime":1393.96,"endTime":1396.63,"body":"talked about this on a prior"},{"speaker":"Chris Dy","startTime":1396.63,"endTime":1399.36,"body":"episode. Once you take down to"},{"speaker":"Chris Dy","startTime":1396.63,"endTime":1399.36,"body":"mid carpal joint, and then"},{"speaker":"Chris Dy","startTime":1399.36,"endTime":1403.56,"body":"you're trying to fuse the lunate"},{"speaker":"Chris Dy","startTime":1399.36,"endTime":1403.56,"body":"to the capitate. And I like to"},{"speaker":"Chris Dy","startTime":1403.56,"endTime":1406.23,"body":"use a headless compression"},{"speaker":"Chris Dy","startTime":1403.56,"endTime":1406.23,"body":"screw. So you're trying to get"},{"speaker":"Chris Dy","startTime":1406.23,"endTime":1410.34,"body":"the headless compression screw"},{"speaker":"Chris Dy","startTime":1406.23,"endTime":1410.34,"body":"kind of right mid axial on the"},{"speaker":"Chris Dy","startTime":1410.34,"endTime":1416.16,"body":"lunate kind of right at the most"},{"speaker":"Chris Dy","startTime":1410.34,"endTime":1416.16,"body":"approximal part of that concave"},{"speaker":"Chris Dy","startTime":1416.16,"endTime":1420.66,"body":"surface, or excuse me convex"},{"speaker":"Chris Dy","startTime":1416.16,"endTime":1420.66,"body":"surface so that then when you"},{"speaker":"Chris Dy","startTime":1420.66,"endTime":1423.54,"body":"try to flex the wrist in order"},{"speaker":"Chris Dy","startTime":1420.66,"endTime":1423.54,"body":"to do that, you want to flexing"},{"speaker":"Chris Dy","startTime":1423.54,"endTime":1427.14,"body":"through the capitolunate joint"},{"speaker":"Chris Dy","startTime":1423.54,"endTime":1427.14,"body":"that you just prepared. So how"},{"speaker":"Chris Dy","startTime":1427.14,"endTime":1428.61,"body":"do you guard against that?"},{"speaker":"Charles Goldfarb","startTime":1429.59,"endTime":1431.69,"body":"I think you're"},{"speaker":"Charles Goldfarb","startTime":1429.59,"endTime":1431.69,"body":"right, that is technically the"},{"speaker":"Charles Goldfarb","startTime":1431.69,"endTime":1436.46,"body":"hardest part and the more severe"},{"speaker":"Charles Goldfarb","startTime":1431.69,"endTime":1436.46,"body":"the arthritis ie the more dorsal"},{"speaker":"Charles Goldfarb","startTime":1436.52,"endTime":1441.05,"body":"intercalated you know lunate"},{"speaker":"Charles Goldfarb","startTime":1436.52,"endTime":1441.05,"body":"dorsiflexion so sorry, I said"},{"speaker":"Charles Goldfarb","startTime":1441.05,"endTime":1443.81,"body":"that very awkwardly, the more"},{"speaker":"Charles Goldfarb","startTime":1441.05,"endTime":1443.81,"body":"the lunate is tilted dorsally"},{"speaker":"Charles Goldfarb","startTime":1443.81,"endTime":1448.94,"body":"the harder that is, and so my my"},{"speaker":"Charles Goldfarb","startTime":1443.81,"endTime":1448.94,"body":"sequence of steps, which is"},{"speaker":"Charles Goldfarb","startTime":1448.94,"endTime":1451.07,"body":"certainly not foolproof, but"},{"speaker":"Charles Goldfarb","startTime":1448.94,"endTime":1451.07,"body":"I've been pretty happy with it"},{"speaker":"Charles Goldfarb","startTime":1451.07,"endTime":1457.94,"body":"is get the cartilage denuded"},{"speaker":"Charles Goldfarb","startTime":1451.07,"endTime":1457.94,"body":"from the proximal capitate the"},{"speaker":"Charles Goldfarb","startTime":1457.94,"endTime":1464.6,"body":"distal lunate. I then flex the"},{"speaker":"Charles Goldfarb","startTime":1457.94,"endTime":1464.6,"body":"wrist to try to get the lunate"},{"speaker":"Charles Goldfarb","startTime":1464.6,"endTime":1468.98,"body":"back in a neutral posture and"},{"speaker":"Charles Goldfarb","startTime":1464.6,"endTime":1468.98,"body":"then get the capitolunate joint"},{"speaker":"Charles Goldfarb","startTime":1469.01,"endTime":1473.33,"body":"aligned in flexion. And then I"},{"speaker":"Charles Goldfarb","startTime":1469.01,"endTime":1473.33,"body":"place a derotation or a static K"},{"speaker":"Charles Goldfarb","startTime":1473.33,"endTime":1477.83,"body":"wire away from where a planned"},{"speaker":"Charles Goldfarb","startTime":1473.33,"endTime":1477.83,"body":"screw is and then you know"},{"speaker":"Charles Goldfarb","startTime":1477.83,"endTime":1480.65,"body":"usually you can extend the wrist"},{"speaker":"Charles Goldfarb","startTime":1477.83,"endTime":1480.65,"body":"or so you're manipulating the"},{"speaker":"Charles Goldfarb","startTime":1480.68,"endTime":1484.88,"body":"capitolunate joint to place a"},{"speaker":"Charles Goldfarb","startTime":1480.68,"endTime":1484.88,"body":"temporary K wire and then you"},{"speaker":"Charles Goldfarb","startTime":1484.88,"endTime":1488.54,"body":"can flex the capitolunate, and"},{"speaker":"Charles Goldfarb","startTime":1484.88,"endTime":1488.54,"body":"then you can flex the wrist with"},{"speaker":"Charles Goldfarb","startTime":1488.54,"endTime":1490.94,"body":"the capitate secured to the"},{"speaker":"Charles Goldfarb","startTime":1488.54,"endTime":1490.94,"body":"lunate and place your"},{"speaker":"Charles Goldfarb","startTime":1490.94,"endTime":1493.97,"body":"longitudinal K wire. To me it;s"},{"speaker":"Charles Goldfarb","startTime":1490.94,"endTime":1493.97,"body":"that derotation wire which is"},{"speaker":"Charles Goldfarb","startTime":1493.97,"endTime":1494.45,"body":"everything."},{"speaker":"Chris Dy","startTime":1495.62,"endTime":1497.99,"body":"I think to get to that"},{"speaker":"Chris Dy","startTime":1495.62,"endTime":1497.99,"body":"step though can also sometimes"},{"speaker":"Chris Dy","startTime":1497.99,"endTime":1500.69,"body":"be challenging. I agree 100%"},{"speaker":"Chris Dy","startTime":1497.99,"endTime":1500.69,"body":"that putting that extra wire it"},{"speaker":"Chris Dy","startTime":1500.69,"endTime":1504.59,"body":"is critical. Do you ever use a"},{"speaker":"Chris Dy","startTime":1500.69,"endTime":1504.59,"body":"pointed reduction clamp or"},{"speaker":"Chris Dy","startTime":1504.59,"endTime":1507.83,"body":"anything like that to hold the"},{"speaker":"Chris Dy","startTime":1504.59,"endTime":1507.83,"body":"capitolunate joint compressed,"},{"speaker":"Chris Dy","startTime":1508.25,"endTime":1510.5,"body":"while you put it in that"},{"speaker":"Chris Dy","startTime":1508.25,"endTime":1510.5,"body":"derotational wire and while you"},{"speaker":"Chris Dy","startTime":1510.5,"endTime":1512.6,"body":"put in your headless compression"},{"speaker":"Chris Dy","startTime":1510.5,"endTime":1512.6,"body":"screw?"},{"speaker":"Charles Goldfarb","startTime":1512.99,"endTime":1514.94,"body":"No, the only"},{"speaker":"Charles Goldfarb","startTime":1512.99,"endTime":1514.94,"body":"time and I'd love to hear your"},{"speaker":"Charles Goldfarb","startTime":1514.94,"endTime":1517.34,"body":"technique. If you do the only"},{"speaker":"Charles Goldfarb","startTime":1514.94,"endTime":1517.34,"body":"time I've used a pointed"},{"speaker":"Charles Goldfarb","startTime":1517.34,"endTime":1523.91,"body":"reduction clamp is when the"},{"speaker":"Charles Goldfarb","startTime":1517.34,"endTime":1523.91,"body":"capitate is shifted in radial"},{"speaker":"Charles Goldfarb","startTime":1523.91,"endTime":1528.89,"body":"direction. And you need to"},{"speaker":"Charles Goldfarb","startTime":1523.91,"endTime":1528.89,"body":"reduce the capital in a joint in"},{"speaker":"Charles Goldfarb","startTime":1528.89,"endTime":1533.12,"body":"that plane as well. So the"},{"speaker":"Charles Goldfarb","startTime":1528.89,"endTime":1533.12,"body":"capitate needs to shift ulnarly"},{"speaker":"Charles Goldfarb","startTime":1533.42,"endTime":1536.51,"body":"and the lunate needs to flex a"},{"speaker":"Charles Goldfarb","startTime":1533.42,"endTime":1536.51,"body":"little bit. And so for when I"},{"speaker":"Charles Goldfarb","startTime":1536.51,"endTime":1539.06,"body":"have both of those situations, I"},{"speaker":"Charles Goldfarb","startTime":1536.51,"endTime":1539.06,"body":"have used the pointed reduction"},{"speaker":"Charles Goldfarb","startTime":1539.06,"endTime":1540.62,"body":"clamp, tell me how you use it?"},{"speaker":"Chris Dy","startTime":1541.1,"endTime":1543.29,"body":"Pretty similarly. I"},{"speaker":"Chris Dy","startTime":1541.1,"endTime":1543.29,"body":"mean, I think that it's"},{"speaker":"Chris Dy","startTime":1543.29,"endTime":1545.6,"body":"something that is useful at"},{"speaker":"Chris Dy","startTime":1543.29,"endTime":1545.6,"body":"times, but again, you know, you"},{"speaker":"Chris Dy","startTime":1545.6,"endTime":1548.24,"body":"don't want your you don't wanna"},{"speaker":"Chris Dy","startTime":1545.6,"endTime":1548.24,"body":"bugger up that lunate surface"},{"speaker":"Chris Dy","startTime":1548.63,"endTime":1551.21,"body":"too much I like it, once you've"},{"speaker":"Chris Dy","startTime":1548.63,"endTime":1551.21,"body":"put in your derotational wire to"},{"speaker":"Chris Dy","startTime":1551.21,"endTime":1554.27,"body":"use the proximal tie in and not"},{"speaker":"Chris Dy","startTime":1551.21,"endTime":1554.27,"body":"so much park it on the cartilage"},{"speaker":"Chris Dy","startTime":1554.27,"endTime":1556.88,"body":"surface of the lunate. But then"},{"speaker":"Chris Dy","startTime":1554.27,"endTime":1556.88,"body":"the pull it up against that K"},{"speaker":"Chris Dy","startTime":1556.88,"endTime":1563.72,"body":"wire, and then clamp it distally"},{"speaker":"Chris Dy","startTime":1556.88,"endTime":1563.72,"body":"at the CMC joint, and use that"},{"speaker":"Chris Dy","startTime":1563.72,"endTime":1566.21,"body":"to just hold a little extra"},{"speaker":"Chris Dy","startTime":1563.72,"endTime":1566.21,"body":"compression, I think for the"},{"speaker":"Chris Dy","startTime":1566.21,"endTime":1568.76,"body":"maneuver that we were talking"},{"speaker":"Chris Dy","startTime":1566.21,"endTime":1568.76,"body":"about to try and get the"},{"speaker":"Chris Dy","startTime":1568.79,"endTime":1572.36,"body":"capitolunate joint reduced. What"},{"speaker":"Chris Dy","startTime":1568.79,"endTime":1572.36,"body":"I found is if you have an extra"},{"speaker":"Chris Dy","startTime":1572.36,"endTime":1574.97,"body":"set of hands, if somebody"},{"speaker":"Chris Dy","startTime":1572.36,"endTime":1574.97,"body":"else's, is assisting you,"},{"speaker":"Chris Dy","startTime":1575.24,"endTime":1577.91,"body":"instead of having them pull"},{"speaker":"Chris Dy","startTime":1575.24,"endTime":1577.91,"body":"traction and flex through the"},{"speaker":"Chris Dy","startTime":1577.94,"endTime":1580.52,"body":"you know, essentially by"},{"speaker":"Chris Dy","startTime":1577.94,"endTime":1580.52,"body":"grabbing the hand, I have them"},{"speaker":"Chris Dy","startTime":1580.52,"endTime":1583.97,"body":"just pull some gentle traction"},{"speaker":"Chris Dy","startTime":1580.52,"endTime":1583.97,"body":"and then I when I'm looking down"},{"speaker":"Chris Dy","startTime":1583.97,"endTime":1586.49,"body":"the radiolunate joint, I will"},{"speaker":"Chris Dy","startTime":1583.97,"endTime":1586.49,"body":"take a hohmann or something and"},{"speaker":"Chris Dy","startTime":1586.49,"endTime":1590.3,"body":"just kind of put the lunate"},{"speaker":"Chris Dy","startTime":1586.49,"endTime":1590.3,"body":"where I want it. And then I'll"},{"speaker":"Chris Dy","startTime":1590.3,"endTime":1594.71,"body":"put my derotational wire, and"},{"speaker":"Chris Dy","startTime":1590.3,"endTime":1594.71,"body":"then things seem just to kind of"},{"speaker":"Chris Dy","startTime":1594.71,"endTime":1597.89,"body":"fall into place. But I find that"},{"speaker":"Chris Dy","startTime":1594.71,"endTime":1597.89,"body":"doing correcting the lunate"},{"speaker":"Chris Dy","startTime":1597.89,"endTime":1601.04,"body":"rather than trying to,"},{"speaker":"Chris Dy","startTime":1597.89,"endTime":1601.04,"body":"correcting the lunate by"},{"speaker":"Chris Dy","startTime":1601.04,"endTime":1603.62,"body":"manipulating it proximally"},{"speaker":"Chris Dy","startTime":1601.04,"endTime":1603.62,"body":"rather than trying to work from"},{"speaker":"Chris Dy","startTime":1603.62,"endTime":1606.86,"body":"distal to proximal is the way"},{"speaker":"Chris Dy","startTime":1603.62,"endTime":1606.86,"body":"that I've gotten around that."},{"speaker":"Charles Goldfarb","startTime":1606.0,"endTime":1606.87,"body":"Yeah, the only"},{"speaker":"Charles Goldfarb","startTime":1606.0,"endTime":1606.87,"body":"other pearl I have I like that."},{"speaker":"Charles Goldfarb","startTime":1608.73,"endTime":1614.94,"body":"The only other pro I would say"},{"speaker":"Charles Goldfarb","startTime":1608.73,"endTime":1614.94,"body":"is it sometimes taking off the"},{"speaker":"Charles Goldfarb","startTime":1614.94,"endTime":1621.09,"body":"dorsal lip of the lunate, or the"},{"speaker":"Charles Goldfarb","startTime":1614.94,"endTime":1621.09,"body":"volar lip of the lunate, and"},{"speaker":"Charles Goldfarb","startTime":1621.09,"endTime":1625.2,"body":"releasing volar scar between the"},{"speaker":"Charles Goldfarb","startTime":1621.09,"endTime":1625.2,"body":"lunate and the volar capsule can"},{"speaker":"Charles Goldfarb","startTime":1625.2,"endTime":1629.31,"body":"help mobilize the lunate and"},{"speaker":"Charles Goldfarb","startTime":1625.2,"endTime":1629.31,"body":"help with this process. But the"},{"speaker":"Charles Goldfarb","startTime":1629.31,"endTime":1633.06,"body":"key is that you do need to get"},{"speaker":"Charles Goldfarb","startTime":1629.31,"endTime":1633.06,"body":"the capitolunate alignment. And"},{"speaker":"Charles Goldfarb","startTime":1633.06,"endTime":1635.58,"body":"that's tricky at times,"},{"speaker":"Charles Goldfarb","startTime":1633.06,"endTime":1635.58,"body":"especially when the bones"},{"speaker":"Charles Goldfarb","startTime":1635.58,"endTime":1638.61,"body":"osteopenic because then you have"},{"speaker":"Charles Goldfarb","startTime":1635.58,"endTime":1638.61,"body":"to be careful not to place that"},{"speaker":"Charles Goldfarb","startTime":1638.61,"endTime":1641.88,"body":"temporary k-wire too dorsal or"},{"speaker":"Charles Goldfarb","startTime":1638.61,"endTime":1641.88,"body":"your screw too dorsal because"},{"speaker":"Charles Goldfarb","startTime":1641.88,"endTime":1643.74,"body":"then you'll you'll break the"},{"speaker":"Charles Goldfarb","startTime":1641.88,"endTime":1643.74,"body":"lunate and then you got real"},{"speaker":"Charles Goldfarb","startTime":1643.74,"endTime":1644.13,"body":"trouble."},{"speaker":"Chris Dy","startTime":1644.94,"endTime":1647.04,"body":"Oh yeah, that's the"},{"speaker":"Chris Dy","startTime":1644.94,"endTime":1647.04,"body":"that's the thing that we're"},{"speaker":"Chris Dy","startTime":1647.1,"endTime":1649.98,"body":"obviously we're worried about in"},{"speaker":"Chris Dy","startTime":1647.1,"endTime":1649.98,"body":"this patient with not great"},{"speaker":"Chris Dy","startTime":1649.98,"endTime":1653.04,"body":"bone. You know, and I think"},{"speaker":"Chris Dy","startTime":1649.98,"endTime":1653.04,"body":"that, you know, the point of"},{"speaker":"Chris Dy","startTime":1653.04,"endTime":1655.74,"body":"making sure that the lunate is"},{"speaker":"Chris Dy","startTime":1653.04,"endTime":1655.74,"body":"out of extension out of its"},{"speaker":"Chris Dy","startTime":1655.74,"endTime":1658.65,"body":"dorsiflex position and getting"},{"speaker":"Chris Dy","startTime":1655.74,"endTime":1658.65,"body":"that to correct and and making"},{"speaker":"Chris Dy","startTime":1658.65,"endTime":1661.29,"body":"sure the capitolunate joint is"},{"speaker":"Chris Dy","startTime":1658.65,"endTime":1661.29,"body":"appropriately reduced and not"},{"speaker":"Chris Dy","startTime":1661.29,"endTime":1664.41,"body":"flex to the capito- You know,"},{"speaker":"Chris Dy","startTime":1661.29,"endTime":1664.41,"body":"the capitate isn't flexing down."},{"speaker":"Chris Dy","startTime":1664.98,"endTime":1668.91,"body":"Also super important. Do you"},{"speaker":"Chris Dy","startTime":1664.98,"endTime":1668.91,"body":"typically put any cancellous"},{"speaker":"Chris Dy","startTime":1668.91,"endTime":1672.24,"body":"autograft in there? And when do"},{"speaker":"Chris Dy","startTime":1668.91,"endTime":1672.24,"body":"you put that in? I found that I"},{"speaker":"Chris Dy","startTime":1672.24,"endTime":1674.76,"body":"need to remind myself to put"},{"speaker":"Chris Dy","startTime":1672.24,"endTime":1674.76,"body":"that in before I do my"},{"speaker":"Chris Dy","startTime":1674.79,"endTime":1676.92,"body":"derotational pin because I don't"},{"speaker":"Chris Dy","startTime":1674.79,"endTime":1676.92,"body":"want to open that thing up"},{"speaker":"Chris Dy","startTime":1676.92,"endTime":1677.16,"body":"again."},{"speaker":"Charles Goldfarb","startTime":1678.09,"endTime":1681.15,"body":"I usually do I"},{"speaker":"Charles Goldfarb","startTime":1678.09,"endTime":1681.15,"body":"simply just take some cancellous"},{"speaker":"Charles Goldfarb","startTime":1681.15,"endTime":1684.39,"body":"bone from the distal radius. I"},{"speaker":"Charles Goldfarb","startTime":1681.15,"endTime":1684.39,"body":"think the morbidity is near"},{"speaker":"Charles Goldfarb","startTime":1684.39,"endTime":1688.44,"body":"zero. And I believe it makes me"},{"speaker":"Charles Goldfarb","startTime":1684.39,"endTime":1688.44,"body":"feel better whether it's"},{"speaker":"Charles Goldfarb","startTime":1688.44,"endTime":1691.26,"body":"statistically increases the"},{"speaker":"Charles Goldfarb","startTime":1688.44,"endTime":1691.26,"body":"chance of healing or not. I"},{"speaker":"Charles Goldfarb","startTime":1691.26,"endTime":1693.03,"body":"don't know. But I almost always"},{"speaker":"Charles Goldfarb","startTime":1691.26,"endTime":1693.03,"body":"do."},{"speaker":"Chris Dy","startTime":1693.99,"endTime":1697.65,"body":"Yeah, I almost always"},{"speaker":"Chris Dy","startTime":1693.99,"endTime":1697.65,"body":"do. And especially in patients"},{"speaker":"Chris Dy","startTime":1697.65,"endTime":1699.63,"body":"probably gonna have a harder"},{"speaker":"Chris Dy","startTime":1697.65,"endTime":1699.63,"body":"time with bone healing. I was"},{"speaker":"Chris Dy","startTime":1699.63,"endTime":1701.82,"body":"telling the trainee that I"},{"speaker":"Chris Dy","startTime":1699.63,"endTime":1701.82,"body":"honestly I'm gonna feel better"},{"speaker":"Chris Dy","startTime":1701.82,"endTime":1704.88,"body":"about it because if it doesn't"},{"speaker":"Chris Dy","startTime":1701.82,"endTime":1704.88,"body":"fuse and I didn't put in the"},{"speaker":"Chris Dy","startTime":1704.88,"endTime":1708.96,"body":"autograft I'll wish that I had"},{"speaker":"Chris Dy","startTime":1704.88,"endTime":1708.96,"body":"and like you said minimal"},{"speaker":"Chris Dy","startTime":1708.96,"endTime":1712.11,"body":"morbidity, I make an incision"},{"speaker":"Chris Dy","startTime":1708.96,"endTime":1712.11,"body":"kind of like you just proximal"},{"speaker":"Chris Dy","startTime":1712.11,"endTime":1715.14,"body":"and radial to listers to keep"},{"speaker":"Chris Dy","startTime":1712.11,"endTime":1715.14,"body":"myself away from the EPL"},{"speaker":"Chris Dy","startTime":1715.23,"endTime":1716.97,"body":"essentially ends up being"},{"speaker":"Chris Dy","startTime":1715.23,"endTime":1716.97,"body":"underneath the second"},{"speaker":"Chris Dy","startTime":1716.97,"endTime":1721.29,"body":"compartment. And making a small"},{"speaker":"Chris Dy","startTime":1716.97,"endTime":1721.29,"body":"window and shelling out as much"},{"speaker":"Chris Dy","startTime":1721.32,"endTime":1722.49,"body":"cancellous as we need."},{"speaker":"Charles Goldfarb","startTime":1723.6,"endTime":1725.82,"body":"Love it. So"},{"speaker":"Charles Goldfarb","startTime":1723.6,"endTime":1725.82,"body":"you and I both put two screws"},{"speaker":"Charles Goldfarb","startTime":1725.82,"endTime":1731.25,"body":"and mainly, you know lunate to"},{"speaker":"Charles Goldfarb","startTime":1725.82,"endTime":1731.25,"body":"capitate. And triquetrum to"},{"speaker":"Charles Goldfarb","startTime":1731.25,"endTime":1733.53,"body":"hamate or triquetrum to hamate"},{"speaker":"Charles Goldfarb","startTime":1731.25,"endTime":1733.53,"body":"to capitate."},{"speaker":"Chris Dy","startTime":1734.49,"endTime":1737.7,"body":"Yeah, no, I like if I"},{"speaker":"Chris Dy","startTime":1734.49,"endTime":1737.7,"body":"can, if I can make it work. I"},{"speaker":"Chris Dy","startTime":1737.7,"endTime":1742.14,"body":"like that kind of where they"},{"speaker":"Chris Dy","startTime":1737.7,"endTime":1742.14,"body":"converge at the tip at distally"},{"speaker":"Chris Dy","startTime":1742.14,"endTime":1744.84,"body":"at the capitate. But if it's not"},{"speaker":"Chris Dy","startTime":1742.14,"endTime":1744.84,"body":"going to work out, it's not"},{"speaker":"Chris Dy","startTime":1744.84,"endTime":1748.47,"body":"going to work out. I prepped the"},{"speaker":"Chris Dy","startTime":1744.84,"endTime":1748.47,"body":"triquetro-hamate surface if it's"},{"speaker":"Chris Dy","startTime":1748.47,"endTime":1751.95,"body":"within my field if it's not, I"},{"speaker":"Chris Dy","startTime":1748.47,"endTime":1751.95,"body":"don't go nuts. Um, I used to"},{"speaker":"Chris Dy","startTime":1751.95,"endTime":1755.46,"body":"routinely make a separate"},{"speaker":"Chris Dy","startTime":1751.95,"endTime":1755.46,"body":"incision like you described, I"},{"speaker":"Chris Dy","startTime":1755.46,"endTime":1758.61,"body":"think if you can get it from"},{"speaker":"Chris Dy","startTime":1755.46,"endTime":1758.61,"body":"within your dorsal approach,"},{"speaker":"Chris Dy","startTime":1758.64,"endTime":1761.46,"body":"great. Sometimes you need to"},{"speaker":"Chris Dy","startTime":1758.64,"endTime":1761.46,"body":"make a separate capsular"},{"speaker":"Chris Dy","startTime":1761.46,"endTime":1764.97,"body":"incision kind of over by the"},{"speaker":"Chris Dy","startTime":1761.46,"endTime":1764.97,"body":"fifth compartment just to sneak"},{"speaker":"Chris Dy","startTime":1764.97,"endTime":1766.98,"body":"in and sometimes that's nice"},{"speaker":"Chris Dy","startTime":1764.97,"endTime":1766.98,"body":"because then you're working"},{"speaker":"Chris Dy","startTime":1767.01,"endTime":1769.62,"body":"underneath the dorsal cutaneous"},{"speaker":"Chris Dy","startTime":1767.01,"endTime":1769.62,"body":"branch of the ulnar nerve as"},{"speaker":"Chris Dy","startTime":1769.62,"endTime":1772.77,"body":"opposed to making a new skin"},{"speaker":"Chris Dy","startTime":1769.62,"endTime":1772.77,"body":"incision and going on top of it."},{"speaker":"Charles Goldfarb","startTime":1773.4,"endTime":1775.92,"body":"Nice I haven't"},{"speaker":"Charles Goldfarb","startTime":1773.4,"endTime":1775.92,"body":"done that. But that is a nice"},{"speaker":"Charles Goldfarb","startTime":1775.95,"endTime":1777.12,"body":"tip. That's a nice tip."},{"speaker":"Chris Dy","startTime":1777.93,"endTime":1781.38,"body":"Well, I remember when"},{"speaker":"Chris Dy","startTime":1777.93,"endTime":1781.38,"body":"I was a trainee, Ryan Calfee"},{"speaker":"Chris Dy","startTime":1781.38,"endTime":1785.04,"body":"does it exactly the way that you"},{"speaker":"Chris Dy","startTime":1781.38,"endTime":1785.04,"body":"described. And then I was doing"},{"speaker":"Chris Dy","startTime":1785.07,"endTime":1787.92,"body":"one and I made my small counter"},{"speaker":"Chris Dy","startTime":1785.07,"endTime":1787.92,"body":"incision and I was with the"},{"speaker":"Chris Dy","startTime":1787.92,"endTime":1790.17,"body":"fellow and so yeah, this is how"},{"speaker":"Chris Dy","startTime":1787.92,"endTime":1790.17,"body":"Dr. Calfee does it and then"},{"speaker":"Chris Dy","startTime":1790.17,"endTime":1792.36,"body":"we're like no, Dr. Calfee"},{"speaker":"Chris Dy","startTime":1790.17,"endTime":1792.36,"body":"doesn't do it that way. I was"},{"speaker":"Chris Dy","startTime":1792.36,"endTime":1794.46,"body":"like, What are you talking"},{"speaker":"Chris Dy","startTime":1792.36,"endTime":1794.46,"body":"about? Like Dr. Calfee just does"},{"speaker":"Chris Dy","startTime":1794.46,"endTime":1796.8,"body":"it all through the dorsal"},{"speaker":"Chris Dy","startTime":1794.46,"endTime":1796.8,"body":"incision. So then I said Ryan is"},{"speaker":"Chris Dy","startTime":1796.8,"endTime":1798.9,"body":"like hey, what would changed"},{"speaker":"Chris Dy","startTime":1796.8,"endTime":1798.9,"body":"because that's how he taught me"},{"speaker":"Chris Dy","startTime":1798.9,"endTime":1801.33,"body":"he's like, oh, yeah, you know"},{"speaker":"Chris Dy","startTime":1798.9,"endTime":1801.33,"body":"Just one day just like thought"},{"speaker":"Chris Dy","startTime":1801.33,"endTime":1803.13,"body":"that, you know, you could just I"},{"speaker":"Chris Dy","startTime":1801.33,"endTime":1803.13,"body":"heard it at a meeting you just"},{"speaker":"Chris Dy","startTime":1803.13,"endTime":1805.68,"body":"go through that dorsal incision."},{"speaker":"Chris Dy","startTime":1803.13,"endTime":1805.68,"body":"I was like, oh, okay, so now"},{"speaker":"Chris Dy","startTime":1805.68,"endTime":1806.52,"body":"we're changing. Cool."},{"speaker":"Charles Goldfarb","startTime":1807.14,"endTime":1808.46,"body":"All right,"},{"speaker":"Charles Goldfarb","startTime":1807.14,"endTime":1808.46,"body":"maybe I'll learn something here"},{"speaker":"Charles Goldfarb","startTime":1808.46,"endTime":1809.27,"body":"today, thank you."},{"speaker":"Chris Dy","startTime":1811.16,"endTime":1814.52,"body":"But if you are going"},{"speaker":"Chris Dy","startTime":1811.16,"endTime":1814.52,"body":"to go through that through a"},{"speaker":"Chris Dy","startTime":1814.52,"endTime":1818.33,"body":"separate incision, one thing"},{"speaker":"Chris Dy","startTime":1814.52,"endTime":1818.33,"body":"that is nice if you can find the"},{"speaker":"Chris Dy","startTime":1818.33,"endTime":1822.47,"body":"right sized angiocath that can"},{"speaker":"Chris Dy","startTime":1818.33,"endTime":1822.47,"body":"be a nice little protector for"},{"speaker":"Chris Dy","startTime":1822.47,"endTime":1826.64,"body":"your guide wire, just so you"},{"speaker":"Chris Dy","startTime":1822.47,"endTime":1826.64,"body":"feel like unless you make a"},{"speaker":"Chris Dy","startTime":1826.64,"endTime":1829.7,"body":"bigger incision and really"},{"speaker":"Chris Dy","startTime":1826.64,"endTime":1829.7,"body":"dissect out that nerve, using a"},{"speaker":"Chris Dy","startTime":1829.7,"endTime":1832.97,"body":"small angiocath can be a nice"},{"speaker":"Chris Dy","startTime":1829.7,"endTime":1832.97,"body":"protector as you're drilling."},{"speaker":"Charles Goldfarb","startTime":1833.51,"endTime":1835.88,"body":"For sure the"},{"speaker":"Charles Goldfarb","startTime":1833.51,"endTime":1835.88,"body":"benefit of going from the ulnar,"},{"speaker":"Charles Goldfarb","startTime":1835.91,"endTime":1839.0,"body":"a separate small ulnar incision"},{"speaker":"Charles Goldfarb","startTime":1835.91,"endTime":1839.0,"body":"is that that gives you the best"},{"speaker":"Charles Goldfarb","startTime":1839.0,"endTime":1842.99,"body":"chance to really get all three"},{"speaker":"Charles Goldfarb","startTime":1839.0,"endTime":1842.99,"body":"bones with that screw. If you"},{"speaker":"Charles Goldfarb","startTime":1842.99,"endTime":1845.57,"body":"think that's important, I don't"},{"speaker":"Charles Goldfarb","startTime":1842.99,"endTime":1845.57,"body":"think anyone would would say"},{"speaker":"Charles Goldfarb","startTime":1845.57,"endTime":1847.58,"body":"that is the most important"},{"speaker":"Charles Goldfarb","startTime":1845.57,"endTime":1847.58,"body":"feature of your screws."},{"speaker":"Chris Dy","startTime":1847.97,"endTime":1850.31,"body":"Right. And also,"},{"speaker":"Chris Dy","startTime":1847.97,"endTime":1850.31,"body":"because of the the angle at"},{"speaker":"Chris Dy","startTime":1850.31,"endTime":1854.06,"body":"which you're inserting the"},{"speaker":"Chris Dy","startTime":1850.31,"endTime":1854.06,"body":"screw, you're going to get more"},{"speaker":"Chris Dy","startTime":1854.09,"endTime":1856.94,"body":"central in terms of the sagittal"},{"speaker":"Chris Dy","startTime":1854.09,"endTime":1856.94,"body":"plane in terms of not being too"},{"speaker":"Chris Dy","startTime":1856.94,"endTime":1860.21,"body":"volar or not being too dorsal,"},{"speaker":"Chris Dy","startTime":1856.94,"endTime":1860.21,"body":"it will put the screw exactly"},{"speaker":"Chris Dy","startTime":1860.24,"endTime":1862.46,"body":"you have the opportunity put the"},{"speaker":"Chris Dy","startTime":1860.24,"endTime":1862.46,"body":"screw exactly where you want to"},{"speaker":"Chris Dy","startTime":1862.46,"endTime":1863.24,"body":"biomechanically."},{"speaker":"Charles Goldfarb","startTime":1864.05,"endTime":1868.52,"body":"Yeah exactly,"},{"speaker":"Charles Goldfarb","startTime":1864.05,"endTime":1868.52,"body":"I do close dorsal capsule. And I"},{"speaker":"Charles Goldfarb","startTime":1868.52,"endTime":1871.43,"body":"tend to immobilize for six"},{"speaker":"Charles Goldfarb","startTime":1868.52,"endTime":1871.43,"body":"weeks, what about you?"},{"speaker":"Chris Dy","startTime":1872.33,"endTime":1874.76,"body":"I close the dorsal"},{"speaker":"Chris Dy","startTime":1872.33,"endTime":1874.76,"body":"capsule, I immobilize it, treat"},{"speaker":"Chris Dy","startTime":1874.76,"endTime":1877.4,"body":"it like a fusion. You know, I"},{"speaker":"Chris Dy","startTime":1874.76,"endTime":1877.4,"body":"think maybe I immobilized too"},{"speaker":"Chris Dy","startTime":1877.4,"endTime":1880.82,"body":"long, I think based on talking"},{"speaker":"Chris Dy","startTime":1877.4,"endTime":1880.82,"body":"to others, but I have seen these"},{"speaker":"Chris Dy","startTime":1880.82,"endTime":1885.53,"body":"fail, you know, fortunately, not"},{"speaker":"Chris Dy","startTime":1880.82,"endTime":1885.53,"body":"mine, but I have seen them fail."},{"speaker":"Chris Dy","startTime":1885.53,"endTime":1888.92,"body":"So that is one thing that I'm"},{"speaker":"Chris Dy","startTime":1885.53,"endTime":1888.92,"body":"concerned about. And I think"},{"speaker":"Chris Dy","startTime":1888.92,"endTime":1890.99,"body":"that's one important"},{"speaker":"Chris Dy","startTime":1888.92,"endTime":1890.99,"body":"preoperative consideration in"},{"speaker":"Chris Dy","startTime":1890.99,"endTime":1894.56,"body":"terms of talking to patients"},{"speaker":"Chris Dy","startTime":1890.99,"endTime":1894.56,"body":"about the surgery, the surgical"},{"speaker":"Chris Dy","startTime":1894.56,"endTime":1896.48,"body":"options, the fact they're gonna"},{"speaker":"Chris Dy","startTime":1894.56,"endTime":1896.48,"body":"have to heal a fusion you"},{"speaker":"Chris Dy","startTime":1896.48,"endTime":1898.73,"body":"mentioned earlier, you know,"},{"speaker":"Chris Dy","startTime":1896.48,"endTime":1898.73,"body":"talking about difficulties with"},{"speaker":"Chris Dy","startTime":1898.73,"endTime":1903.32,"body":"bone healing. I want to ask you,"},{"speaker":"Chris Dy","startTime":1898.73,"endTime":1903.32,"body":"do you have any experience using"},{"speaker":"Chris Dy","startTime":1903.38,"endTime":1906.05,"body":"plates for this because I know"},{"speaker":"Chris Dy","startTime":1903.38,"endTime":1906.05,"body":"that's a newer technique that"},{"speaker":"Chris Dy","startTime":1906.05,"endTime":1907.28,"body":"has gotten some airplay."},{"speaker":"Charles Goldfarb","startTime":1908.45,"endTime":1910.49,"body":"It's a newer"},{"speaker":"Charles Goldfarb","startTime":1908.45,"endTime":1910.49,"body":"technique, that's an older"},{"speaker":"Charles Goldfarb","startTime":1910.49,"endTime":1914.12,"body":"technique. And so these circular"},{"speaker":"Charles Goldfarb","startTime":1910.49,"endTime":1914.12,"body":"plates were"},{"speaker":"Chris Dy","startTime":1914.12,"endTime":1915.44,"body":"Old technique with new"},{"speaker":"Chris Dy","startTime":1914.12,"endTime":1915.44,"body":"plates?"},{"speaker":"Charles Goldfarb","startTime":1915.59,"endTime":1920.24,"body":"Yep, you know,"},{"speaker":"Charles Goldfarb","startTime":1915.59,"endTime":1920.24,"body":"industry and surgeons are always"},{"speaker":"Charles Goldfarb","startTime":1920.24,"endTime":1922.43,"body":"looking for ways to make things"},{"speaker":"Charles Goldfarb","startTime":1920.24,"endTime":1922.43,"body":"easier, which I'd be grateful"},{"speaker":"Charles Goldfarb","startTime":1922.43,"endTime":1926.18,"body":"for. And certainly, the approach"},{"speaker":"Charles Goldfarb","startTime":1922.43,"endTime":1926.18,"body":"is very simple. And we used to"},{"speaker":"Charles Goldfarb","startTime":1926.18,"endTime":1928.88,"body":"use circular plate and those"},{"speaker":"Charles Goldfarb","startTime":1926.18,"endTime":1928.88,"body":"kind of fell out of favor, I"},{"speaker":"Charles Goldfarb","startTime":1928.88,"endTime":1933.29,"body":"have not used the newer plates,"},{"speaker":"Charles Goldfarb","startTime":1928.88,"endTime":1933.29,"body":"pretty happy with the headless"},{"speaker":"Charles Goldfarb","startTime":1933.29,"endTime":1937.34,"body":"compression screw. Of course,"},{"speaker":"Charles Goldfarb","startTime":1933.29,"endTime":1937.34,"body":"the issue with the original"},{"speaker":"Charles Goldfarb","startTime":1937.34,"endTime":1940.58,"body":"plates, the circular plates was"},{"speaker":"Charles Goldfarb","startTime":1937.34,"endTime":1940.58,"body":"they would impinge with"},{"speaker":"Charles Goldfarb","startTime":1940.58,"endTime":1943.31,"body":"dorsiflexion and further limit"},{"speaker":"Charles Goldfarb","startTime":1940.58,"endTime":1943.31,"body":"your ability to extend the"},{"speaker":"Charles Goldfarb","startTime":1943.31,"endTime":1947.12,"body":"wrist, which is a big issue. So"},{"speaker":"Charles Goldfarb","startTime":1943.31,"endTime":1947.12,"body":"you have to recess them"},{"speaker":"Charles Goldfarb","startTime":1947.12,"endTime":1949.16,"body":"appropriately. If that's your"},{"speaker":"Charles Goldfarb","startTime":1947.12,"endTime":1949.16,"body":"technique of choice."},{"speaker":"Chris Dy","startTime":1950.15,"endTime":1951.8,"body":"When was the last time"},{"speaker":"Chris Dy","startTime":1950.15,"endTime":1951.8,"body":"you use one of those?"},{"speaker":"Charles Goldfarb","startTime":1953.81,"endTime":1955.76,"body":"I've taken out"},{"speaker":"Charles Goldfarb","startTime":1953.81,"endTime":1955.76,"body":"a couple in the last few years,"},{"speaker":"Charles Goldfarb","startTime":1955.76,"endTime":1957.83,"body":"I probably hadn't put one in and"},{"speaker":"Charles Goldfarb","startTime":1955.76,"endTime":1957.83,"body":"15 years."},{"speaker":"Chris Dy","startTime":1958.16,"endTime":1959.99,"body":"Yeah, I think that"},{"speaker":"Chris Dy","startTime":1958.16,"endTime":1959.99,"body":"impingement risk is real."},{"speaker":"Chris Dy","startTime":1960.02,"endTime":1963.14,"body":"Obviously, the goal is to"},{"speaker":"Chris Dy","startTime":1960.02,"endTime":1963.14,"body":"preserve whatever motion you can"},{"speaker":"Chris Dy","startTime":1963.14,"endTime":1966.86,"body":"you're already taking one joint"},{"speaker":"Chris Dy","startTime":1963.14,"endTime":1966.86,"body":"surface away or a couple you"},{"speaker":"Chris Dy","startTime":1966.86,"endTime":1969.47,"body":"know, the basically the carpus"},{"speaker":"Chris Dy","startTime":1966.86,"endTime":1969.47,"body":"away. So preserving what you can"},{"speaker":"Chris Dy","startTime":1969.47,"endTime":1970.31,"body":"is super important."},{"speaker":"Charles Goldfarb","startTime":1971.15,"endTime":1974.15,"body":"And what do"},{"speaker":"Charles Goldfarb","startTime":1971.15,"endTime":1974.15,"body":"you quote patients as far as"},{"speaker":"Charles Goldfarb","startTime":1974.15,"endTime":1979.04,"body":"motion? So if they come in and"},{"speaker":"Charles Goldfarb","startTime":1974.15,"endTime":1979.04,"body":"she's got a wrist that sore, and"},{"speaker":"Charles Goldfarb","startTime":1979.4,"endTime":1983.0,"body":"I don't know, maybe her motion"},{"speaker":"Charles Goldfarb","startTime":1979.4,"endTime":1983.0,"body":"is 50-50. You know 50 extension"},{"speaker":"Charles Goldfarb","startTime":1983.0,"endTime":1986.93,"body":"and 50 flexion pre op. What do"},{"speaker":"Charles Goldfarb","startTime":1983.0,"endTime":1986.93,"body":"you tell her she's gonna have"},{"speaker":"Charles Goldfarb","startTime":1986.96,"endTime":1988.04,"body":"postoperatively?"},{"speaker":"Chris Dy","startTime":1988.64,"endTime":1992.69,"body":"Half. Half of what"},{"speaker":"Chris Dy","startTime":1988.64,"endTime":1992.69,"body":"she's got pre op post op, and I"},{"speaker":"Chris Dy","startTime":1992.69,"endTime":1995.48,"body":"think that doesn't set the bar"},{"speaker":"Chris Dy","startTime":1992.69,"endTime":1995.48,"body":"too high doesn't set the bar too"},{"speaker":"Chris Dy","startTime":1995.48,"endTime":1999.26,"body":"low. That'd be people been"},{"speaker":"Chris Dy","startTime":1995.48,"endTime":1999.26,"body":"pleasantly surprised how well"},{"speaker":"Chris Dy","startTime":1999.26,"endTime":2003.04,"body":"people will do. I mean, there's"},{"speaker":"Chris Dy","startTime":1999.26,"endTime":2003.04,"body":"a numbers is a classic decision"},{"speaker":"Chris Dy","startTime":2003.04,"endTime":2005.98,"body":"making between PRC and four"},{"speaker":"Chris Dy","startTime":2003.04,"endTime":2005.98,"body":"corner fusion, which I think has"},{"speaker":"Chris Dy","startTime":2005.98,"endTime":2009.61,"body":"been debunked recently was that"},{"speaker":"Chris Dy","startTime":2005.98,"endTime":2009.61,"body":"four corner fusion is going to"},{"speaker":"Chris Dy","startTime":2009.61,"endTime":2012.13,"body":"be better for strength and not"},{"speaker":"Chris Dy","startTime":2009.61,"endTime":2012.13,"body":"as great promotion and vice"},{"speaker":"Chris Dy","startTime":2012.13,"endTime":2014.86,"body":"versa, meaning a PRC is going to"},{"speaker":"Chris Dy","startTime":2012.13,"endTime":2014.86,"body":"be better for motion not as good"},{"speaker":"Chris Dy","startTime":2014.86,"endTime":2018.25,"body":"for strength. That being said,"},{"speaker":"Chris Dy","startTime":2014.86,"endTime":2018.25,"body":"there are a number of very"},{"speaker":"Chris Dy","startTime":2018.25,"endTime":2020.56,"body":"reasonable studies that have"},{"speaker":"Chris Dy","startTime":2018.25,"endTime":2020.56,"body":"demonstrated that grip strength"},{"speaker":"Chris Dy","startTime":2020.56,"endTime":2022.81,"body":"is still pretty good after a"},{"speaker":"Chris Dy","startTime":2020.56,"endTime":2022.81,"body":"PRC. And that motion is still"},{"speaker":"Chris Dy","startTime":2022.81,"endTime":2028.21,"body":"fairly good after four corner"},{"speaker":"Chris Dy","startTime":2022.81,"endTime":2028.21,"body":"fusion. I think if one thing is"},{"speaker":"Chris Dy","startTime":2028.21,"endTime":2031.39,"body":"that, you know, really if"},{"speaker":"Chris Dy","startTime":2028.21,"endTime":2031.39,"body":"patients rely on certain range"},{"speaker":"Chris Dy","startTime":2031.39,"endTime":2033.55,"body":"of motion for different"},{"speaker":"Chris Dy","startTime":2031.39,"endTime":2033.55,"body":"exercises or different"},{"speaker":"Chris Dy","startTime":2034.06,"endTime":2036.64,"body":"vocational things that they need"},{"speaker":"Chris Dy","startTime":2034.06,"endTime":2036.64,"body":"to do, that may make a"},{"speaker":"Chris Dy","startTime":2036.64,"endTime":2039.1,"body":"difference in terms of how you"},{"speaker":"Chris Dy","startTime":2036.64,"endTime":2039.1,"body":"decide which surgery to offer"},{"speaker":"Chris Dy","startTime":2039.1,"endTime":2039.31,"body":"them."},{"speaker":"Charles Goldfarb","startTime":2040.69,"endTime":2044.29,"body":"Yeah, totally"},{"speaker":"Charles Goldfarb","startTime":2040.69,"endTime":2044.29,"body":"agree. All right. I love it."},{"speaker":"Charles Goldfarb","startTime":2044.83,"endTime":2046.84,"body":"I'll send also four corners to"},{"speaker":"Charles Goldfarb","startTime":2044.83,"endTime":2046.84,"body":"you."},{"speaker":"Chris Dy","startTime":2048.46,"endTime":2050.89,"body":"Maybe I'll find a new"},{"speaker":"Chris Dy","startTime":2048.46,"endTime":2050.89,"body":"plate to use No, I like I like"},{"speaker":"Chris Dy","startTime":2050.89,"endTime":2055.18,"body":"the technique that we described."},{"speaker":"Chris Dy","startTime":2050.89,"endTime":2055.18,"body":"If anybody else has any, you"},{"speaker":"Chris Dy","startTime":2055.18,"endTime":2059.08,"body":"know, additional pearls, please"},{"speaker":"Chris Dy","startTime":2055.18,"endTime":2059.08,"body":"feel free to share them. Email"},{"speaker":"Chris Dy","startTime":2059.11,"endTime":2063.31,"body":"handpodcast@gmail.com And Chuck,"},{"speaker":"Chris Dy","startTime":2059.11,"endTime":2063.31,"body":"we have to end on a win. Can you"},{"speaker":"Chris Dy","startTime":2063.31,"endTime":2064.06,"body":"give us a win?"},{"speaker":"Charles Goldfarb","startTime":2065.47,"endTime":2067.18,"body":"You want to"},{"speaker":"Charles Goldfarb","startTime":2065.47,"endTime":2067.18,"body":"know my win, Chris? I'll tell"},{"speaker":"Chris Dy","startTime":2067.0,"endTime":2067.72,"body":"What's your win?"},{"speaker":"Chris Dy","startTime":2067.18,"endTime":2067.24,"body":"you."},{"speaker":"Charles Goldfarb","startTime":2068.23,"endTime":2070.3,"body":"I played"},{"speaker":"Charles Goldfarb","startTime":2068.23,"endTime":2070.3,"body":"meteorologist for our department"},{"speaker":"Charles Goldfarb","startTime":2070.3,"endTime":2073.45,"body":"this week and was trying to"},{"speaker":"Charles Goldfarb","startTime":2070.3,"endTime":2073.45,"body":"figure out when we were going to"},{"speaker":"Charles Goldfarb","startTime":2073.45,"endTime":2076.78,"body":"be open and when we were going"},{"speaker":"Charles Goldfarb","startTime":2073.45,"endTime":2076.78,"body":"to be closed and we didn't get"},{"speaker":"Charles Goldfarb","startTime":2076.78,"endTime":2080.8,"body":"it exactly right but I was"},{"speaker":"Charles Goldfarb","startTime":2076.78,"endTime":2080.8,"body":"pretty happy we had a good"},{"speaker":"Charles Goldfarb","startTime":2080.8,"endTime":2083.74,"body":"conversation and got it kind of"},{"speaker":"Charles Goldfarb","startTime":2080.8,"endTime":2083.74,"body":"right."},{"speaker":"Chris Dy","startTime":2086.65,"endTime":2088.33,"body":"Well, thanks for"},{"speaker":"Chris Dy","startTime":2086.65,"endTime":2088.33,"body":"getting it kind of right."},{"speaker":"Chris Dy","startTime":2089.23,"endTime":2092.32,"body":"Whatever you my wind was"},{"speaker":"Chris Dy","startTime":2089.23,"endTime":2092.32,"body":"honestly just getting to work"},{"speaker":"Chris Dy","startTime":2092.32,"endTime":2098.95,"body":"today. No, not gonna do anything"},{"speaker":"Chris Dy","startTime":2092.32,"endTime":2098.95,"body":"else. It was a source of stress"},{"speaker":"Chris Dy","startTime":2098.95,"endTime":2102.64,"body":"this morning. I was like I think"},{"speaker":"Chris Dy","startTime":2098.95,"endTime":2102.64,"body":"I could do this. I did. Did you"},{"speaker":"Chris Dy","startTime":2102.64,"endTime":2106.51,"body":"know when I saw I logged in to"},{"speaker":"Chris Dy","startTime":2102.64,"endTime":2106.51,"body":"epic this morning on my phone"},{"speaker":"Chris Dy","startTime":2106.69,"endTime":2109.6,"body":"because I was on call last night"},{"speaker":"Chris Dy","startTime":2106.69,"endTime":2109.6,"body":"and I saw that my patient and"},{"speaker":"Chris Dy","startTime":2109.6,"endTime":2112.27,"body":"made it in. I was like, Alright,"},{"speaker":"Chris Dy","startTime":2109.6,"endTime":2112.27,"body":"good. As long as the patient's"},{"speaker":"Chris Dy","startTime":2112.27,"endTime":2115.48,"body":"there I'm going in. So. Alright,"},{"speaker":"Chris Dy","startTime":2112.27,"endTime":2115.48,"body":"so we'll catch up next time."},{"speaker":"Charles Goldfarb","startTime":2115.99,"endTime":2120.07,"body":"Awesome. Thank"},{"speaker":"Charles Goldfarb","startTime":2115.99,"endTime":2120.07,"body":"you. Hey, Chris. That was fun."},{"speaker":"Charles Goldfarb","startTime":2120.1,"endTime":2121.27,"body":"Let's do it again real soon."},{"speaker":"Chris Dy","startTime":2121.51,"endTime":2124.03,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":2121.51,"endTime":2124.03,"body":"sure to check us out on Twitter"},{"speaker":"Chris Dy","startTime":2124.24,"endTime":2126.46,"body":"@handpodcast. Hey, Chuck, what's"},{"speaker":"Chris Dy","startTime":2124.24,"endTime":2126.46,"body":"your Twitter handle?"},{"speaker":"Charles Goldfarb","startTime":2126.79,"endTime":2129.64,"body":"Mine is"},{"speaker":"Charles Goldfarb","startTime":2126.79,"endTime":2129.64,"body":"@congenitalhand. What about you?"},{"speaker":"Chris Dy","startTime":2129.79,"endTime":2133.27,"body":"Mine is @ChrisDyMD"},{"speaker":"Chris Dy","startTime":2129.79,"endTime":2133.27,"body":"spelled dy. If you'd like to"},{"speaker":"Chris Dy","startTime":2133.27,"endTime":2137.02,"body":"email us, you can reach us at"},{"speaker":"Chris Dy","startTime":2133.27,"endTime":2137.02,"body":"handpodcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":2137.59,"endTime":2139.75,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":2137.59,"endTime":2139.75,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2139.75,"endTime":2140.83,"body":"get your podcast"},{"speaker":"Chris Dy","startTime":2140.89,"endTime":2143.08,"body":"And be sure to leave a"},{"speaker":"Chris Dy","startTime":2140.89,"endTime":2143.08,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2143.08,"endTime":2143.53,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":2143.859,"endTime":2146.169,"body":"Special thanks"},{"speaker":"Charles Goldfarb","startTime":2143.859,"endTime":2146.169,"body":"to Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":2146.169,"endTime":2150.069,"body":"music. And remember, keep the"},{"speaker":"Charles Goldfarb","startTime":2146.169,"endTime":2150.069,"body":"upper hand come back next"}]}