{"version":"1.0.0","segments":[{"speaker":"Charles Goldfarb","startTime":3.6,"endTime":6.0,"body":"Welcome to the"},{"speaker":"Charles Goldfarb","startTime":3.6,"endTime":6.0,"body":"upper hand podcast where Chuck"},{"speaker":"Charles Goldfarb","startTime":6.0,"endTime":7.56,"body":"and Chris talk hand surgery."},{"speaker":"Chris Dy","startTime":7.89,"endTime":9.72,"body":"We are two hand"},{"speaker":"Chris Dy","startTime":7.89,"endTime":9.72,"body":"surgeons at Washington"},{"speaker":"Chris Dy","startTime":9.72,"endTime":12.36,"body":"University in St. Louis here to"},{"speaker":"Chris Dy","startTime":9.72,"endTime":12.36,"body":"talk about all things hand"},{"speaker":"Chris Dy","startTime":12.36,"endTime":14.64,"body":"surgery related from technical"},{"speaker":"Chris Dy","startTime":12.36,"endTime":14.64,"body":"to personal."},{"speaker":"Charles Goldfarb","startTime":15.33,"endTime":17.43,"body":"Please"},{"speaker":"Charles Goldfarb","startTime":15.33,"endTime":17.43,"body":"subscribe, wherever you get your"},{"speaker":"Charles Goldfarb","startTime":17.43,"endTime":18.18,"body":"podcasts."},{"speaker":"Chris Dy","startTime":18.96,"endTime":21.3,"body":"And thank you in"},{"speaker":"Chris Dy","startTime":18.96,"endTime":21.3,"body":"advance for leaving a review and"},{"speaker":"Chris Dy","startTime":21.3,"endTime":23.58,"body":"leaving a rating wherever you"},{"speaker":"Chris Dy","startTime":21.3,"endTime":23.58,"body":"get your podcasts."},{"speaker":"Charles Goldfarb","startTime":24.989,"endTime":26.069,"body":"Oh, hey,"},{"speaker":"Charles Goldfarb","startTime":24.989,"endTime":26.069,"body":"Chris."},{"speaker":"Chris Dy","startTime":26.55,"endTime":27.81,"body":"Hey, Chuck, how are"},{"speaker":"Chris Dy","startTime":26.55,"endTime":27.81,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":27.0,"endTime":30.72,"body":"I'm good. You"},{"speaker":"Charles Goldfarb","startTime":27.0,"endTime":30.72,"body":"would think I would learn."},{"speaker":"Chris Dy","startTime":32.79,"endTime":33.9,"body":"Learn from what."},{"speaker":"Charles Goldfarb","startTime":34.89,"endTime":37.8,"body":"I this is not"},{"speaker":"Charles Goldfarb","startTime":34.89,"endTime":37.8,"body":"our first podcast together. I"},{"speaker":"Charles Goldfarb","startTime":37.8,"endTime":41.25,"body":"don't know how many we've done"},{"speaker":"Charles Goldfarb","startTime":37.8,"endTime":41.25,"body":"together because it's a lot. And"},{"speaker":"Charles Goldfarb","startTime":41.25,"endTime":45.93,"body":"I just had a quick bite of an"},{"speaker":"Charles Goldfarb","startTime":41.25,"endTime":45.93,"body":"ice cream sandwich. And now I'm"},{"speaker":"Charles Goldfarb","startTime":45.93,"endTime":47.01,"body":"having trouble talking."},{"speaker":"Chris Dy","startTime":49.2,"endTime":51.06,"body":"Chuck, you have to"},{"speaker":"Chris Dy","startTime":49.2,"endTime":51.06,"body":"take care of yourself. I mean,"},{"speaker":"Chris Dy","startTime":51.06,"endTime":53.67,"body":"you're the talent here. You're"},{"speaker":"Chris Dy","startTime":51.06,"endTime":53.67,"body":"you're the one carrying this"},{"speaker":"Chris Dy","startTime":53.7,"endTime":57.42,"body":"dynamic duo. You know, to"},{"speaker":"Chris Dy","startTime":53.7,"endTime":57.42,"body":"stardom."},{"speaker":"Charles Goldfarb","startTime":57.66,"endTime":59.88,"body":"Oh, that's"},{"speaker":"Charles Goldfarb","startTime":57.66,"endTime":59.88,"body":"true. That's true. I do a lot of"},{"speaker":"Charles Goldfarb","startTime":59.88,"endTime":62.88,"body":"vocal cord workouts. I hope"},{"speaker":"Charles Goldfarb","startTime":59.88,"endTime":62.88,"body":"you're doing the same just to"},{"speaker":"Charles Goldfarb","startTime":62.88,"endTime":64.8,"body":"really maximize what we got"},{"speaker":"Charles Goldfarb","startTime":62.88,"endTime":64.8,"body":"going on."},{"speaker":"Chris Dy","startTime":65.4,"endTime":67.59,"body":"Yeah, I think that's"},{"speaker":"Chris Dy","startTime":65.4,"endTime":67.59,"body":"what people are tuning in for"},{"speaker":"Chris Dy","startTime":67.59,"endTime":70.59,"body":"the the timbre of your voice,"},{"speaker":"Chris Dy","startTime":67.59,"endTime":70.59,"body":"Chuck, they just want you to not"},{"speaker":"Chris Dy","startTime":70.59,"endTime":73.38,"body":"choke on yourself as you're"},{"speaker":"Chris Dy","startTime":70.59,"endTime":73.38,"body":"recording the podcast."},{"speaker":"Charles Goldfarb","startTime":73.53,"endTime":75.93,"body":"I my voice"},{"speaker":"Charles Goldfarb","startTime":73.53,"endTime":75.93,"body":"I've been told is good for one"},{"speaker":"Charles Goldfarb","startTime":75.93,"endTime":80.43,"body":"thing falling asleep, too. So I"},{"speaker":"Charles Goldfarb","startTime":75.93,"endTime":80.43,"body":"think that's that's a skill set."},{"speaker":"Charles Goldfarb","startTime":80.43,"endTime":81.84,"body":"I have putting people to sleep."},{"speaker":"Chris Dy","startTime":83.28,"endTime":86.7,"body":"Yeah, you know, the"},{"speaker":"Chris Dy","startTime":83.28,"endTime":86.7,"body":"skill set I had recently is when"},{"speaker":"Chris Dy","startTime":86.7,"endTime":89.82,"body":"I traveled up to Rochester to"},{"speaker":"Chris Dy","startTime":86.7,"endTime":89.82,"body":"visit our friends at Mayo, they"},{"speaker":"Chris Dy","startTime":89.82,"endTime":92.37,"body":"allowed me to pick the articles"},{"speaker":"Chris Dy","startTime":89.82,"endTime":92.37,"body":"for the peripheral nerves"},{"speaker":"Chris Dy","startTime":92.37,"endTime":95.91,"body":"journal club. So I picked"},{"speaker":"Chris Dy","startTime":92.37,"endTime":95.91,"body":"articles based on the locations"},{"speaker":"Chris Dy","startTime":95.91,"endTime":99.69,"body":"that I traveled, and I won't say"},{"speaker":"Chris Dy","startTime":95.91,"endTime":99.69,"body":"where the article was from. But"},{"speaker":"Chris Dy","startTime":99.69,"endTime":102.66,"body":"one of the articles had the"},{"speaker":"Chris Dy","startTime":99.69,"endTime":102.66,"body":"dubious distinction of putting"},{"speaker":"Chris Dy","startTime":103.86,"endTime":109.74,"body":"Dr. Spinner to sleep. That was"},{"speaker":"Chris Dy","startTime":103.86,"endTime":109.74,"body":"he questioned the veracity of"},{"speaker":"Chris Dy","startTime":109.74,"endTime":112.53,"body":"the article and said it was good"},{"speaker":"Chris Dy","startTime":109.74,"endTime":112.53,"body":"because it was lasting I read"},{"speaker":"Chris Dy","startTime":112.53,"endTime":113.28,"body":"before I went to bed."},{"speaker":"Charles Goldfarb","startTime":114.9,"endTime":117.36,"body":"Hey, it"},{"speaker":"Charles Goldfarb","startTime":114.9,"endTime":117.36,"body":"happens. You know what it"},{"speaker":"Charles Goldfarb","startTime":117.36,"endTime":118.05,"body":"happens."},{"speaker":"Chris Dy","startTime":119.01,"endTime":119.91,"body":"You can't win them"},{"speaker":"Chris Dy","startTime":119.01,"endTime":119.91,"body":"all."},{"speaker":"Charles Goldfarb","startTime":120.0,"endTime":124.23,"body":"No, for sure"},{"speaker":"Charles Goldfarb","startTime":120.0,"endTime":124.23,"body":"not. So catch me up. You've been"},{"speaker":"Charles Goldfarb","startTime":124.56,"endTime":128.4,"body":"traveling, you recently went to"},{"speaker":"Charles Goldfarb","startTime":124.56,"endTime":128.4,"body":"Rochester, you're clinically"},{"speaker":"Charles Goldfarb","startTime":128.4,"endTime":130.05,"body":"busy. Are you hanging in there?"},{"speaker":"Chris Dy","startTime":131.19,"endTime":134.16,"body":"Yeah, we talked last"},{"speaker":"Chris Dy","startTime":131.19,"endTime":134.16,"body":"week about like, you know, the"},{"speaker":"Chris Dy","startTime":134.19,"endTime":136.86,"body":"adding on the clinic. And you"},{"speaker":"Chris Dy","startTime":134.19,"endTime":136.86,"body":"know, the more I think about it,"},{"speaker":"Chris Dy","startTime":136.86,"endTime":138.84,"body":"the more I'm regretting doing"},{"speaker":"Chris Dy","startTime":136.86,"endTime":138.84,"body":"it. I did the same thing for"},{"speaker":"Chris Dy","startTime":138.84,"endTime":142.23,"body":"next week. So we're going out of"},{"speaker":"Chris Dy","startTime":138.84,"endTime":142.23,"body":"town on Friday, and I put a"},{"speaker":"Chris Dy","startTime":142.23,"endTime":144.21,"body":"little half day guy on"},{"speaker":"Chris Dy","startTime":142.23,"endTime":144.21,"body":"Wednesday, because I was like,"},{"speaker":"Chris Dy","startTime":144.21,"endTime":146.58,"body":"You know what might as well. And"},{"speaker":"Chris Dy","startTime":144.21,"endTime":146.58,"body":"now I'm like, I really couldn't"},{"speaker":"Chris Dy","startTime":146.58,"endTime":150.96,"body":"use that time. So even you know,"},{"speaker":"Chris Dy","startTime":146.58,"endTime":150.96,"body":"I think I mentioned last week,"},{"speaker":"Chris Dy","startTime":151.23,"endTime":153.57,"body":"the hand therapist, I work with"},{"speaker":"Chris Dy","startTime":151.23,"endTime":153.57,"body":"Jamie Findeiss she was like,"},{"speaker":"Chris Dy","startTime":153.57,"endTime":156.63,"body":"Yeah, remember when he just used"},{"speaker":"Chris Dy","startTime":153.57,"endTime":156.63,"body":"to like, take a day off and not"},{"speaker":"Chris Dy","startTime":156.63,"endTime":159.69,"body":"try to make up for it? It's"},{"speaker":"Chris Dy","startTime":156.63,"endTime":159.69,"body":"like, long time ago."},{"speaker":"Charles Goldfarb","startTime":160.14,"endTime":161.91,"body":"Well, if this"},{"speaker":"Charles Goldfarb","startTime":160.14,"endTime":161.91,"body":"makes you feel any better, I"},{"speaker":"Charles Goldfarb","startTime":161.91,"endTime":167.22,"body":"still haven't learned it. It's"},{"speaker":"Charles Goldfarb","startTime":161.91,"endTime":167.22,"body":"this constant. You know, I feel"},{"speaker":"Charles Goldfarb","startTime":167.22,"endTime":170.28,"body":"I don't know why. But I mean, I"},{"speaker":"Charles Goldfarb","startTime":167.22,"endTime":170.28,"body":"enjoy clinical care. But I'm"},{"speaker":"Charles Goldfarb","startTime":170.28,"endTime":174.51,"body":"always adding clinics, like like"},{"speaker":"Charles Goldfarb","startTime":170.28,"endTime":174.51,"body":"you just did. And I still regret"},{"speaker":"Charles Goldfarb","startTime":174.51,"endTime":178.23,"body":"it after it's done. And then the"},{"speaker":"Charles Goldfarb","startTime":174.51,"endTime":178.23,"body":"next time Guess what? I do it"},{"speaker":"Charles Goldfarb","startTime":178.23,"endTime":178.56,"body":"again."},{"speaker":"Chris Dy","startTime":180.21,"endTime":182.67,"body":"Yeah, you know, I"},{"speaker":"Chris Dy","startTime":180.21,"endTime":182.67,"body":"think the listeners are seeing"},{"speaker":"Chris Dy","startTime":182.67,"endTime":187.65,"body":"our pathology and I wonder where"},{"speaker":"Chris Dy","startTime":182.67,"endTime":187.65,"body":"I learned this pathology I"},{"speaker":"Chris Dy","startTime":187.65,"endTime":189.75,"body":"trained with that may model this"},{"speaker":"Chris Dy","startTime":187.65,"endTime":189.75,"body":"behavior."},{"speaker":"Charles Goldfarb","startTime":189.99,"endTime":191.88,"body":"I wonder if"},{"speaker":"Charles Goldfarb","startTime":189.99,"endTime":191.88,"body":"our listeners have the same"},{"speaker":"Charles Goldfarb","startTime":191.88,"endTime":195.63,"body":"pathology or if they are, you"},{"speaker":"Charles Goldfarb","startTime":191.88,"endTime":195.63,"body":"know, they just do a better job"},{"speaker":"Charles Goldfarb","startTime":195.63,"endTime":196.14,"body":"than we did."},{"speaker":"Chris Dy","startTime":196.62,"endTime":199.14,"body":"I think our overseas"},{"speaker":"Chris Dy","startTime":196.62,"endTime":199.14,"body":"listeners are saying Why can't"},{"speaker":"Chris Dy","startTime":199.14,"endTime":201.87,"body":"you Americans just take your"},{"speaker":"Chris Dy","startTime":199.14,"endTime":201.87,"body":"holiday and enjoy it? We"},{"speaker":"Chris Dy","startTime":201.9,"endTime":205.17,"body":"probably should I really need to"},{"speaker":"Chris Dy","startTime":201.9,"endTime":205.17,"body":"for sure. I've definitely craved"},{"speaker":"Chris Dy","startTime":205.17,"endTime":206.4,"body":"a self care day for sure."},{"speaker":"Charles Goldfarb","startTime":207.36,"endTime":209.49,"body":"Yeah, I could"},{"speaker":"Charles Goldfarb","startTime":207.36,"endTime":209.49,"body":"see you in the spa with your"},{"speaker":"Charles Goldfarb","startTime":209.49,"endTime":212.31,"body":"feet up getting a massage on"},{"speaker":"Charles Goldfarb","startTime":209.49,"endTime":212.31,"body":"your self care day."},{"speaker":"Chris Dy","startTime":212.91,"endTime":216.0,"body":"Not above it, man. But"},{"speaker":"Chris Dy","startTime":212.91,"endTime":216.0,"body":"I wish I had, I'm not above"},{"speaker":"Chris Dy","startTime":216.0,"endTime":219.84,"body":"admitting that I've as I've aged"},{"speaker":"Chris Dy","startTime":216.0,"endTime":219.84,"body":"Chuck, as you remind me I am"},{"speaker":"Chris Dy","startTime":219.87,"endTime":223.83,"body":"totally okay with owning myself"},{"speaker":"Chris Dy","startTime":219.87,"endTime":223.83,"body":"and who I am. So it's out there"},{"speaker":"Chris Dy","startTime":223.83,"endTime":226.23,"body":"on the pod. I wouldn't mind that"},{"speaker":"Chris Dy","startTime":223.83,"endTime":226.23,"body":"for sure."},{"speaker":"Charles Goldfarb","startTime":226.53,"endTime":229.26,"body":"Absolutely. So"},{"speaker":"Charles Goldfarb","startTime":226.53,"endTime":229.26,"body":"if anyone's looking to get Chris"},{"speaker":"Charles Goldfarb","startTime":229.26,"endTime":229.92,"body":"a gift."},{"speaker":"Chris Dy","startTime":233.59,"endTime":236.92,"body":"Oh, man. So we've"},{"speaker":"Chris Dy","startTime":233.59,"endTime":236.92,"body":"gotten some really cool emails."},{"speaker":"Chris Dy","startTime":236.92,"endTime":239.05,"body":"We're gonna go into a few of"},{"speaker":"Chris Dy","startTime":236.92,"endTime":239.05,"body":"them again today just like we"},{"speaker":"Chris Dy","startTime":239.05,"endTime":242.56,"body":"did last week, but I did want to"},{"speaker":"Chris Dy","startTime":239.05,"endTime":242.56,"body":"share a nice email. So this is"},{"speaker":"Chris Dy","startTime":242.56,"endTime":245.14,"body":"from Brad Hyatt. He's an"},{"speaker":"Chris Dy","startTime":242.56,"endTime":245.14,"body":"orthopedic hand surgeon"},{"speaker":"Chris Dy","startTime":245.14,"endTime":248.62,"body":"practicing about five years now"},{"speaker":"Chris Dy","startTime":245.14,"endTime":248.62,"body":"little pup compared to me and"},{"speaker":"Chris Dy","startTime":248.62,"endTime":251.71,"body":"Chuck I guess. And he said that"},{"speaker":"Chris Dy","startTime":248.62,"endTime":251.71,"body":"it was with special interests"},{"speaker":"Chris Dy","startTime":251.71,"endTime":255.34,"body":"that he listened to our latest"},{"speaker":"Chris Dy","startTime":251.71,"endTime":255.34,"body":"episode, the day before he had"},{"speaker":"Chris Dy","startTime":255.34,"endTime":257.56,"body":"actually undergone a carpal"},{"speaker":"Chris Dy","startTime":255.34,"endTime":257.56,"body":"tunnel release himself wide"},{"speaker":"Chris Dy","startTime":257.56,"endTime":259.81,"body":"awake by one of his trusted"},{"speaker":"Chris Dy","startTime":257.56,"endTime":259.81,"body":"colleagues and everything went"},{"speaker":"Chris Dy","startTime":259.81,"endTime":263.02,"body":"smoothly. But of course, he was"},{"speaker":"Chris Dy","startTime":259.81,"endTime":263.02,"body":"probably thinking of our episode"},{"speaker":"Chris Dy","startTime":263.02,"endTime":266.11,"body":"and he mentioned here, he wanted"},{"speaker":"Chris Dy","startTime":263.02,"endTime":266.11,"body":"us to share our thoughts on the"},{"speaker":"Chris Dy","startTime":266.11,"endTime":270.31,"body":"cause of nerve injury. So you he"},{"speaker":"Chris Dy","startTime":266.11,"endTime":270.31,"body":"said one of his the least"},{"speaker":"Chris Dy","startTime":270.31,"endTime":273.07,"body":"favorite parts of an open mini"},{"speaker":"Chris Dy","startTime":270.31,"endTime":273.07,"body":"open carpal tunnel is the"},{"speaker":"Chris Dy","startTime":273.07,"endTime":276.91,"body":"controlled glide to release the"},{"speaker":"Chris Dy","startTime":273.07,"endTime":276.91,"body":"proximal aspect of the TCL"},{"speaker":"Chris Dy","startTime":276.91,"endTime":280.06,"body":"distal volar antebrachial"},{"speaker":"Chris Dy","startTime":276.91,"endTime":280.06,"body":"fascia. And all the technique"},{"speaker":"Chris Dy","startTime":280.06,"endTime":283.78,"body":"articles describe this as being"},{"speaker":"Chris Dy","startTime":280.06,"endTime":283.78,"body":"under direct visualization. Now"},{"speaker":"Chris Dy","startTime":283.78,"endTime":286.63,"body":"there are times where this slide"},{"speaker":"Chris Dy","startTime":283.78,"endTime":286.63,"body":"is not directly visualized, and"},{"speaker":"Chris Dy","startTime":286.63,"endTime":289.18,"body":"I have occasionally extended the"},{"speaker":"Chris Dy","startTime":286.63,"endTime":289.18,"body":"incision proximately but less"},{"speaker":"Chris Dy","startTime":289.18,"endTime":291.67,"body":"disliked the prolonged healing"},{"speaker":"Chris Dy","startTime":289.18,"endTime":291.67,"body":"and wider scar when crossing the"},{"speaker":"Chris Dy","startTime":291.67,"endTime":295.48,"body":"wrist crease. So why I've been"},{"speaker":"Chris Dy","startTime":291.67,"endTime":295.48,"body":"tempted to perform a scissor"},{"speaker":"Chris Dy","startTime":295.48,"endTime":298.99,"body":"glide without 100%"},{"speaker":"Chris Dy","startTime":295.48,"endTime":298.99,"body":"visualization. This can seem so"},{"speaker":"Chris Dy","startTime":298.99,"endTime":301.96,"body":"routine and seems A few of the"},{"speaker":"Chris Dy","startTime":298.99,"endTime":301.96,"body":"consequences of an error can be"},{"speaker":"Chris Dy","startTime":301.96,"endTime":305.41,"body":"catastrophic. I can't help but"},{"speaker":"Chris Dy","startTime":301.96,"endTime":305.41,"body":"wonder if this is what happened"},{"speaker":"Chris Dy","startTime":305.41,"endTime":308.08,"body":"in the case he presented. I'm"},{"speaker":"Chris Dy","startTime":305.41,"endTime":308.08,"body":"interested to hear your thoughts"},{"speaker":"Chris Dy","startTime":308.08,"endTime":312.25,"body":"and any tips or tricks for the"},{"speaker":"Chris Dy","startTime":308.08,"endTime":312.25,"body":"proximal release. Chuck, what do"},{"speaker":"Chris Dy","startTime":312.25,"endTime":314.89,"body":"you think about the slide? I"},{"speaker":"Chris Dy","startTime":312.25,"endTime":314.89,"body":"remember what you told me when I"},{"speaker":"Chris Dy","startTime":314.89,"endTime":317.68,"body":"was your fellow, and I'm going"},{"speaker":"Chris Dy","startTime":314.89,"endTime":317.68,"body":"to allow you to answer first and"},{"speaker":"Chris Dy","startTime":317.68,"endTime":322.09,"body":"I'll recant the, recall, excuse"},{"speaker":"Chris Dy","startTime":317.68,"endTime":322.09,"body":"me, what you told me."},{"speaker":"Charles Goldfarb","startTime":322.6,"endTime":323.95,"body":"Recall so I"},{"speaker":"Charles Goldfarb","startTime":322.6,"endTime":323.95,"body":"can recant?"},{"speaker":"Chris Dy","startTime":324.7,"endTime":325.6,"body":"Exactly."},{"speaker":"Charles Goldfarb","startTime":326.35,"endTime":328.51,"body":"Well, first of"},{"speaker":"Charles Goldfarb","startTime":326.35,"endTime":328.51,"body":"all, thank you, Brad. And it's"},{"speaker":"Charles Goldfarb","startTime":328.51,"endTime":330.58,"body":"not a good time to listen to"},{"speaker":"Charles Goldfarb","startTime":328.51,"endTime":330.58,"body":"that episode, I guess. Right"},{"speaker":"Charles Goldfarb","startTime":330.58,"endTime":332.86,"body":"before one has his own carpal"},{"speaker":"Charles Goldfarb","startTime":330.58,"endTime":332.86,"body":"tunnel released."},{"speaker":"Chris Dy","startTime":332.92,"endTime":334.06,"body":"Right after."},{"speaker":"Charles Goldfarb","startTime":334.24,"endTime":335.35,"body":"Oh, right"},{"speaker":"Charles Goldfarb","startTime":334.24,"endTime":335.35,"body":"after okay."},{"speaker":"Chris Dy","startTime":335.53,"endTime":335.98,"body":"Yeah."},{"speaker":"Charles Goldfarb","startTime":337.33,"endTime":342.58,"body":"Well, a couple"},{"speaker":"Charles Goldfarb","startTime":337.33,"endTime":342.58,"body":"of thoughts. distally, I don't"},{"speaker":"Charles Goldfarb","startTime":342.58,"endTime":346.15,"body":"think anyone tries to slide or"},{"speaker":"Charles Goldfarb","startTime":342.58,"endTime":346.15,"body":"glide with scissors didn't work."},{"speaker":"Charles Goldfarb","startTime":346.72,"endTime":349.75,"body":"It's about careful"},{"speaker":"Charles Goldfarb","startTime":346.72,"endTime":349.75,"body":"visualization. And I've always"},{"speaker":"Charles Goldfarb","startTime":349.75,"endTime":355.33,"body":"been told that the most common"},{"speaker":"Charles Goldfarb","startTime":349.75,"endTime":355.33,"body":"injury is to the sensory branch"},{"speaker":"Charles Goldfarb","startTime":355.36,"endTime":360.1,"body":"to the third webspace. I have"},{"speaker":"Charles Goldfarb","startTime":355.36,"endTime":360.1,"body":"not seen that in the meaning of"},{"speaker":"Charles Goldfarb","startTime":360.1,"endTime":362.68,"body":"complications, I have seen it."},{"speaker":"Charles Goldfarb","startTime":360.1,"endTime":362.68,"body":"But it's not the most common"},{"speaker":"Charles Goldfarb","startTime":362.68,"endTime":365.86,"body":"that I've encountered as a"},{"speaker":"Charles Goldfarb","startTime":362.68,"endTime":365.86,"body":"surgeon caring for the"},{"speaker":"Charles Goldfarb","startTime":365.86,"endTime":374.59,"body":"complications of others. My more"},{"speaker":"Charles Goldfarb","startTime":365.86,"endTime":374.59,"body":"common scenario is a direct"},{"speaker":"Charles Goldfarb","startTime":374.59,"endTime":379.33,"body":"injury to the nerve itself. And"},{"speaker":"Charles Goldfarb","startTime":374.59,"endTime":379.33,"body":"some certainly are related to"},{"speaker":"Charles Goldfarb","startTime":379.33,"endTime":384.88,"body":"sliding, I'll say this. I think"},{"speaker":"Charles Goldfarb","startTime":379.33,"endTime":384.88,"body":"we should always try to"},{"speaker":"Charles Goldfarb","startTime":384.88,"endTime":394.36,"body":"visualize what we're doing. But"},{"speaker":"Charles Goldfarb","startTime":384.88,"endTime":394.36,"body":"I have on occasion, slid my"},{"speaker":"Charles Goldfarb","startTime":394.36,"endTime":398.08,"body":"scissors approximately without"},{"speaker":"Charles Goldfarb","startTime":394.36,"endTime":398.08,"body":"full visualization. I'll say"},{"speaker":"Charles Goldfarb","startTime":398.08,"endTime":404.62,"body":"this, though, I do it very"},{"speaker":"Charles Goldfarb","startTime":398.08,"endTime":404.62,"body":"carefully, with aware of where"},{"speaker":"Charles Goldfarb","startTime":404.62,"endTime":408.49,"body":"the median nerve is. And the"},{"speaker":"Charles Goldfarb","startTime":404.62,"endTime":408.49,"body":"Palmar cutaneous branch is also"},{"speaker":"Charles Goldfarb","startTime":408.49,"endTime":413.11,"body":"aware of where the ulnar bundle"},{"speaker":"Charles Goldfarb","startTime":408.49,"endTime":413.11,"body":"is. And I carefully drop my hand"},{"speaker":"Charles Goldfarb","startTime":413.11,"endTime":416.74,"body":"as far as it goes to the tips of"},{"speaker":"Charles Goldfarb","startTime":413.11,"endTime":416.74,"body":"my scissors are really heading"},{"speaker":"Charles Goldfarb","startTime":416.77,"endTime":423.73,"body":"volarly, rather than any other"},{"speaker":"Charles Goldfarb","startTime":416.77,"endTime":423.73,"body":"direction. So A, am I wrong to"},{"speaker":"Charles Goldfarb","startTime":423.73,"endTime":428.11,"body":"do it that way on occasion,"},{"speaker":"Charles Goldfarb","startTime":423.73,"endTime":428.11,"body":"Chris, and B, do you?"},{"speaker":"Chris Dy","startTime":430.36,"endTime":434.23,"body":"So I remember what you"},{"speaker":"Chris Dy","startTime":430.36,"endTime":434.23,"body":"told me, because I had seen"},{"speaker":"Chris Dy","startTime":434.23,"endTime":438.67,"body":"others do the slide in training"},{"speaker":"Chris Dy","startTime":434.23,"endTime":438.67,"body":"at other places. And it always"},{"speaker":"Chris Dy","startTime":438.67,"endTime":443.38,"body":"made me nervous. I remember you"},{"speaker":"Chris Dy","startTime":438.67,"endTime":443.38,"body":"told me that it was okay,"},{"speaker":"Chris Dy","startTime":443.38,"endTime":447.1,"body":"depending on who was doing it."},{"speaker":"Chris Dy","startTime":443.38,"endTime":447.1,"body":"Which I always found very"},{"speaker":"Chris Dy","startTime":447.1,"endTime":451.66,"body":"interesting. And then the other"},{"speaker":"Chris Dy","startTime":447.1,"endTime":451.66,"body":"thing that I remember you"},{"speaker":"Chris Dy","startTime":451.69,"endTime":454.96,"body":"commenting on was the way in"},{"speaker":"Chris Dy","startTime":451.69,"endTime":454.96,"body":"which the orientation of your"},{"speaker":"Chris Dy","startTime":454.96,"endTime":458.29,"body":"curve tenotomies. So depending"},{"speaker":"Chris Dy","startTime":454.96,"endTime":458.29,"body":"on how you put them, you can"},{"speaker":"Chris Dy","startTime":458.29,"endTime":460.96,"body":"either have them curved towards"},{"speaker":"Chris Dy","startTime":458.29,"endTime":460.96,"body":"the ulnar vascular bundle or"},{"speaker":"Chris Dy","startTime":460.96,"endTime":463.78,"body":"towards the Palmar cutaneous"},{"speaker":"Chris Dy","startTime":460.96,"endTime":463.78,"body":"branch of the median nerve. Now,"},{"speaker":"Chris Dy","startTime":463.78,"endTime":466.69,"body":"neither of those I want to"},{"speaker":"Chris Dy","startTime":463.78,"endTime":466.69,"body":"endanger but if I had to pick"},{"speaker":"Chris Dy","startTime":466.69,"endTime":469.99,"body":"one, it's definitely going to be"},{"speaker":"Chris Dy","startTime":466.69,"endTime":469.99,"body":"the Palmar cutaneous branch. So"},{"speaker":"Chris Dy","startTime":470.02,"endTime":474.16,"body":"even when I don't slide"},{"speaker":"Chris Dy","startTime":470.02,"endTime":474.16,"body":"personally, but when I'm doing"},{"speaker":"Chris Dy","startTime":474.16,"endTime":477.28,"body":"that part of the procedure a"},{"speaker":"Chris Dy","startTime":474.16,"endTime":477.28,"body":"that's the part that I do, not"},{"speaker":"Chris Dy","startTime":477.28,"endTime":480.19,"body":"the trainee. You know, of"},{"speaker":"Chris Dy","startTime":477.28,"endTime":480.19,"body":"course, I'm there with them the"},{"speaker":"Chris Dy","startTime":480.19,"endTime":483.85,"body":"entire time. But in terms of how"},{"speaker":"Chris Dy","startTime":480.19,"endTime":483.85,"body":"we orient position on the table,"},{"speaker":"Chris Dy","startTime":484.39,"endTime":486.76,"body":"I'm sitting in the direction"},{"speaker":"Chris Dy","startTime":484.39,"endTime":486.76,"body":"where my right hand can use the"},{"speaker":"Chris Dy","startTime":486.79,"endTime":489.94,"body":"tenotomies going proximately."},{"speaker":"Chris Dy","startTime":486.79,"endTime":489.94,"body":"And they are typically on the"},{"speaker":"Chris Dy","startTime":489.94,"endTime":492.49,"body":"other side of the table because"},{"speaker":"Chris Dy","startTime":489.94,"endTime":492.49,"body":"usually they're right handed."},{"speaker":"Chris Dy","startTime":493.57,"endTime":496.54,"body":"And I turn my tips towards the"},{"speaker":"Chris Dy","startTime":493.57,"endTime":496.54,"body":"Palmar cutaneous because you"},{"speaker":"Chris Dy","startTime":496.54,"endTime":499.12,"body":"have to pick one. And I like"},{"speaker":"Chris Dy","startTime":496.54,"endTime":499.12,"body":"exactly what you said about"},{"speaker":"Chris Dy","startTime":499.12,"endTime":502.0,"body":"making sure that you're going"},{"speaker":"Chris Dy","startTime":499.12,"endTime":502.0,"body":"more volar anterior than"},{"speaker":"Chris Dy","startTime":502.0,"endTime":505.51,"body":"anything else. This is clearly"},{"speaker":"Chris Dy","startTime":502.0,"endTime":505.51,"body":"one in which our colleagues that"},{"speaker":"Chris Dy","startTime":505.51,"endTime":507.4,"body":"use endoscopy could say well,"},{"speaker":"Chris Dy","startTime":505.51,"endTime":507.4,"body":"you could just use the"},{"speaker":"Chris Dy","startTime":507.4,"endTime":509.56,"body":"endoscope, and yeah, I get it. I"},{"speaker":"Chris Dy","startTime":507.4,"endTime":509.56,"body":"mean, like, you know, that's"},{"speaker":"Chris Dy","startTime":509.56,"endTime":512.08,"body":"that's part of the perks. Right."},{"speaker":"Chris Dy","startTime":509.56,"endTime":512.08,"body":"But, you know, if you look at"},{"speaker":"Chris Dy","startTime":512.08,"endTime":515.32,"body":"the literature, one of the"},{"speaker":"Chris Dy","startTime":512.08,"endTime":515.32,"body":"biggest series on locations of"},{"speaker":"Chris Dy","startTime":515.32,"endTime":518.17,"body":"incomplete release, and it"},{"speaker":"Chris Dy","startTime":515.32,"endTime":518.17,"body":"actually typically is noted as"},{"speaker":"Chris Dy","startTime":518.17,"endTime":521.05,"body":"distal, although in practice,"},{"speaker":"Chris Dy","startTime":518.17,"endTime":521.05,"body":"I've noted it to be proximal, I"},{"speaker":"Chris Dy","startTime":521.05,"endTime":523.72,"body":"have not noticed it to be"},{"speaker":"Chris Dy","startTime":521.05,"endTime":523.72,"body":"distal. So at least that's"},{"speaker":"Chris Dy","startTime":523.72,"endTime":525.1,"body":"what's out there in terms of"},{"speaker":"Chris Dy","startTime":523.72,"endTime":525.1,"body":"literature."},{"speaker":"Charles Goldfarb","startTime":529.17,"endTime":530.82,"body":"Yeah,"},{"speaker":"Charles Goldfarb","startTime":529.17,"endTime":530.82,"body":"interesting. I agree with"},{"speaker":"Charles Goldfarb","startTime":530.82,"endTime":535.17,"body":"everything you said, I set the"},{"speaker":"Charles Goldfarb","startTime":530.82,"endTime":535.17,"body":"same direction, I think the risk"},{"speaker":"Charles Goldfarb","startTime":535.17,"endTime":537.72,"body":"is greater approximately. And"},{"speaker":"Charles Goldfarb","startTime":535.17,"endTime":537.72,"body":"that's why I want to do that"},{"speaker":"Charles Goldfarb","startTime":537.72,"endTime":541.56,"body":"proximal cut slash slide. I've"},{"speaker":"Charles Goldfarb","startTime":537.72,"endTime":541.56,"body":"said this before and I'll say it"},{"speaker":"Charles Goldfarb","startTime":541.56,"endTime":545.4,"body":"again, my technical Pearl here"},{"speaker":"Charles Goldfarb","startTime":541.56,"endTime":545.4,"body":"is from Tom Kiefhaber in"},{"speaker":"Charles Goldfarb","startTime":545.4,"endTime":551.34,"body":"Cincinnati, which is to use one"},{"speaker":"Charles Goldfarb","startTime":545.4,"endTime":551.34,"body":"Ragnell and two Senns to really"},{"speaker":"Charles Goldfarb","startTime":551.34,"endTime":556.02,"body":"create a box proximally. It"},{"speaker":"Charles Goldfarb","startTime":551.34,"endTime":556.02,"body":"gives you visualization so that"},{"speaker":"Charles Goldfarb","startTime":556.05,"endTime":559.74,"body":"the vast majority of times you"},{"speaker":"Charles Goldfarb","startTime":556.05,"endTime":559.74,"body":"can see now you can use a a"},{"speaker":"Charles Goldfarb","startTime":559.74,"endTime":563.64,"body":"larger retractor as well but"},{"speaker":"Charles Goldfarb","startTime":559.74,"endTime":563.64,"body":"that usually works and I do not"},{"speaker":"Charles Goldfarb","startTime":563.64,"endTime":566.7,"body":"cross the wrist crease. I mean"},{"speaker":"Charles Goldfarb","startTime":563.64,"endTime":566.7,"body":"today I did a distal radius"},{"speaker":"Charles Goldfarb","startTime":566.7,"endTime":570.15,"body":"fracture with a carpal tunnel"},{"speaker":"Charles Goldfarb","startTime":566.7,"endTime":570.15,"body":"release because the patient had"},{"speaker":"Charles Goldfarb","startTime":570.15,"endTime":573.57,"body":"tingling and I made a quote"},{"speaker":"Charles Goldfarb","startTime":570.15,"endTime":573.57,"body":"larger incision and it was two"},{"speaker":"Charles Goldfarb","startTime":573.57,"endTime":577.5,"body":"and a half centimeters. I just"},{"speaker":"Charles Goldfarb","startTime":573.57,"endTime":577.5,"body":"don't feel the need to make an"},{"speaker":"Charles Goldfarb","startTime":577.56,"endTime":581.31,"body":"even larger incision unless"},{"speaker":"Charles Goldfarb","startTime":577.56,"endTime":581.31,"body":"something's really really you"},{"speaker":"Charles Goldfarb","startTime":581.31,"endTime":585.06,"body":"know out of out of sorts so I"},{"speaker":"Charles Goldfarb","startTime":581.31,"endTime":585.06,"body":"think we see eye to eye on this"},{"speaker":"Charles Goldfarb","startTime":585.06,"endTime":585.27,"body":"one."},{"speaker":"Chris Dy","startTime":586.62,"endTime":590.16,"body":"Yeah, I agree with"},{"speaker":"Chris Dy","startTime":586.62,"endTime":590.16,"body":"that. And you know, I've having"},{"speaker":"Chris Dy","startTime":590.19,"endTime":594.57,"body":"you guys train me in terms of"},{"speaker":"Chris Dy","startTime":590.19,"endTime":594.57,"body":"the technique and the Kiefhaber"},{"speaker":"Chris Dy","startTime":594.57,"endTime":597.93,"body":"box I've actually modified how I"},{"speaker":"Chris Dy","startTime":594.57,"endTime":597.93,"body":"use the Kiefhaber box and I"},{"speaker":"Chris Dy","startTime":597.93,"endTime":602.64,"body":"actually have started to use"},{"speaker":"Chris Dy","startTime":597.93,"endTime":602.64,"body":"some baby army Navy's after I've"},{"speaker":"Chris Dy","startTime":602.64,"endTime":607.65,"body":"gotten my Senns in for some of"},{"speaker":"Chris Dy","startTime":602.64,"endTime":607.65,"body":"those patients, in which, when"},{"speaker":"Chris Dy","startTime":607.65,"endTime":610.44,"body":"you make the skin incision, some"},{"speaker":"Chris Dy","startTime":607.65,"endTime":610.44,"body":"of that ulnar neurovascular"},{"speaker":"Chris Dy","startTime":610.47,"endTime":613.65,"body":"protective fat starts to make"},{"speaker":"Chris Dy","startTime":610.47,"endTime":613.65,"body":"its way into your incision. And"},{"speaker":"Chris Dy","startTime":613.65,"endTime":616.02,"body":"I found it very nice to just use"},{"speaker":"Chris Dy","startTime":613.65,"endTime":616.02,"body":"a little baby Army Navy to get"},{"speaker":"Chris Dy","startTime":616.02,"endTime":618.81,"body":"that out of the way. So that's"},{"speaker":"Chris Dy","startTime":616.02,"endTime":618.81,"body":"the only modification I made"},{"speaker":"Chris Dy","startTime":618.81,"endTime":620.22,"body":"from what you taught me."},{"speaker":"Charles Goldfarb","startTime":620.97,"endTime":623.01,"body":"I think that"},{"speaker":"Charles Goldfarb","startTime":620.97,"endTime":623.01,"body":"modification is okay. I wouldn't"},{"speaker":"Charles Goldfarb","startTime":623.01,"endTime":625.56,"body":"go too crazy and do any more"},{"speaker":"Charles Goldfarb","startTime":623.01,"endTime":625.56,"body":"modifications, that would be"},{"speaker":"Charles Goldfarb","startTime":625.56,"endTime":630.39,"body":"sacrilege. All right."},{"speaker":"Chris Dy","startTime":631.26,"endTime":635.31,"body":"So it's just a couple"},{"speaker":"Chris Dy","startTime":631.26,"endTime":635.31,"body":"more things. And then we can"},{"speaker":"Chris Dy","startTime":635.34,"endTime":641.01,"body":"dive into an interesting case."},{"speaker":"Chris Dy","startTime":635.34,"endTime":641.01,"body":"So here is a an email from"},{"speaker":"Chris Dy","startTime":641.04,"endTime":646.11,"body":"Alexander Croog. And Alexander"},{"speaker":"Chris Dy","startTime":641.04,"endTime":646.11,"body":"Croog is in practice at"},{"speaker":"Chris Dy","startTime":646.11,"endTime":648.87,"body":"OrthoVirginia, and he wrote some"},{"speaker":"Chris Dy","startTime":646.11,"endTime":648.87,"body":"really, really nice things about"},{"speaker":"Chris Dy","startTime":648.99,"endTime":652.26,"body":"the podcast. He said he's been"},{"speaker":"Chris Dy","startTime":648.99,"endTime":652.26,"body":"binge listening since only"},{"speaker":"Chris Dy","startTime":652.26,"endTime":654.72,"body":"hearing about it a few weeks"},{"speaker":"Chris Dy","startTime":652.26,"endTime":654.72,"body":"ago, and this was, you know, in"},{"speaker":"Chris Dy","startTime":654.72,"endTime":658.68,"body":"May. And he just he saved his"},{"speaker":"Chris Dy","startTime":654.72,"endTime":658.68,"body":"sanity by putting it on while"},{"speaker":"Chris Dy","startTime":658.68,"endTime":662.25,"body":"folding laundry as a Mother's"},{"speaker":"Chris Dy","startTime":658.68,"endTime":662.25,"body":"Day gesture. Alexander, I hope"},{"speaker":"Chris Dy","startTime":662.25,"endTime":666.45,"body":"you didn't injure yourself. And"},{"speaker":"Chris Dy","startTime":662.25,"endTime":666.45,"body":"he also felt very guilty about"},{"speaker":"Chris Dy","startTime":666.45,"endTime":670.68,"body":"not going to the Mary Stern"},{"speaker":"Chris Dy","startTime":666.45,"endTime":670.68,"body":"fellowship, Jackson Hole meeting"},{"speaker":"Chris Dy","startTime":670.68,"endTime":673.62,"body":"because he had just listened to"},{"speaker":"Chris Dy","startTime":670.68,"endTime":673.62,"body":"the podcasts where Chuck"},{"speaker":"Chris Dy","startTime":673.65,"endTime":679.41,"body":"mentioned it many times. So he"},{"speaker":"Chris Dy","startTime":673.65,"endTime":679.41,"body":"says from grandpa, Chuck his"},{"speaker":"Chris Dy","startTime":679.41,"endTime":683.1,"body":"words, I've learned tons of"},{"speaker":"Chris Dy","startTime":679.41,"endTime":683.1,"body":"great technical and management"},{"speaker":"Chris Dy","startTime":683.1,"endTime":685.95,"body":"pearls and obviously relates due"},{"speaker":"Chris Dy","startTime":683.1,"endTime":685.95,"body":"to similar fellowship training,"},{"speaker":"Chris Dy","startTime":686.22,"endTime":690.18,"body":"and from young, inquisitive,"},{"speaker":"Chris Dy","startTime":686.22,"endTime":690.18,"body":"Chris, I relate to the feelings"},{"speaker":"Chris Dy","startTime":690.18,"endTime":691.74,"body":"not too distant, you're five"},{"speaker":"Chris Dy","startTime":690.18,"endTime":691.74,"body":"years out, and the patient"},{"speaker":"Chris Dy","startTime":691.74,"endTime":694.14,"body":"surgical victory seems so much"},{"speaker":"Chris Dy","startTime":691.74,"endTime":694.14,"body":"sweeter, and the complications"},{"speaker":"Chris Dy","startTime":694.14,"endTime":696.9,"body":"much more personally"},{"speaker":"Chris Dy","startTime":694.14,"endTime":696.9,"body":"devastating. Amen to that. Thank"},{"speaker":"Chris Dy","startTime":696.9,"endTime":699.09,"body":"you. And you're both great"},{"speaker":"Chris Dy","startTime":696.9,"endTime":699.09,"body":"examples, ambassadors for our"},{"speaker":"Chris Dy","startTime":699.09,"endTime":702.09,"body":"profession on this platform."},{"speaker":"Chris Dy","startTime":699.09,"endTime":702.09,"body":"Thank you. That is what keeps us"},{"speaker":"Chris Dy","startTime":702.09,"endTime":704.85,"body":"going. So he mentioned that"},{"speaker":"Chris Dy","startTime":702.09,"endTime":704.85,"body":"episode, he just finished about"},{"speaker":"Chris Dy","startTime":704.85,"endTime":710.25,"body":"the tip fracture dislocations."},{"speaker":"Chris Dy","startTime":704.85,"endTime":710.25,"body":"And he passed on with his"},{"speaker":"Chris Dy","startTime":710.25,"endTime":713.73,"body":"lessons from the dynamic X fix"},{"speaker":"Chris Dy","startTime":710.25,"endTime":713.73,"body":"that changed his things from his"},{"speaker":"Chris Dy","startTime":713.73,"endTime":717.36,"body":"practice dramatically. He used"},{"speaker":"Chris Dy","startTime":713.73,"endTime":717.36,"body":"to never give local when he took"},{"speaker":"Chris Dy","startTime":717.36,"endTime":720.0,"body":"off the X fix in the office,"},{"speaker":"Chris Dy","startTime":717.36,"endTime":720.0,"body":"then one patient pleaded and I"},{"speaker":"Chris Dy","startTime":720.0,"endTime":723.27,"body":"did after I took it off, left"},{"speaker":"Chris Dy","startTime":720.0,"endTime":723.27,"body":"the room and came back. And"},{"speaker":"Chris Dy","startTime":723.27,"endTime":726.6,"body":"because she was known, she was"},{"speaker":"Chris Dy","startTime":723.27,"endTime":726.6,"body":"also able to demonstrate full"},{"speaker":"Chris Dy","startTime":726.6,"endTime":730.11,"body":"active motion right in front of"},{"speaker":"Chris Dy","startTime":726.6,"endTime":730.11,"body":"me. So now I do a digital block"},{"speaker":"Chris Dy","startTime":730.11,"endTime":733.53,"body":"and four weeks from removing the"},{"speaker":"Chris Dy","startTime":730.11,"endTime":733.53,"body":"pins every time just for seeing"},{"speaker":"Chris Dy","startTime":733.53,"endTime":736.89,"body":"the motion immediately where I"},{"speaker":"Chris Dy","startTime":733.53,"endTime":736.89,"body":"went off, but also found it will"},{"speaker":"Chris Dy","startTime":736.89,"endTime":739.53,"body":"break up the occasional flexor"},{"speaker":"Chris Dy","startTime":736.89,"endTime":739.53,"body":"tendon adhesion that you can"},{"speaker":"Chris Dy","startTime":739.53,"endTime":743.7,"body":"hear here, Flash field, and that"},{"speaker":"Chris Dy","startTime":739.53,"endTime":743.7,"body":"infrequent patient that can't"},{"speaker":"Chris Dy","startTime":743.7,"endTime":747.18,"body":"fully bend after removing the"},{"speaker":"Chris Dy","startTime":743.7,"endTime":747.18,"body":"poor prognostic side, wishing"},{"speaker":"Chris Dy","startTime":747.18,"endTime":749.82,"body":"continued success to you both -"},{"speaker":"Chris Dy","startTime":747.18,"endTime":749.82,"body":"Alex Croog."},{"speaker":"Charles Goldfarb","startTime":750.99,"endTime":754.59,"body":"So Alex,"},{"speaker":"Charles Goldfarb","startTime":750.99,"endTime":754.59,"body":"thanks, and we missed you. In"},{"speaker":"Charles Goldfarb","startTime":754.59,"endTime":757.11,"body":"Jackson. And hopefully there'll"},{"speaker":"Charles Goldfarb","startTime":754.59,"endTime":757.11,"body":"be another reunion even though"},{"speaker":"Charles Goldfarb","startTime":757.35,"endTime":760.23,"body":"the good Dr. Stern will be"},{"speaker":"Charles Goldfarb","startTime":757.35,"endTime":760.23,"body":"retired, I'm guessing he will"},{"speaker":"Charles Goldfarb","startTime":760.23,"endTime":763.14,"body":"still host in the future. Chris"},{"speaker":"Charles Goldfarb","startTime":760.23,"endTime":763.14,"body":"could be invited as a special"},{"speaker":"Charles Goldfarb","startTime":763.14,"endTime":766.5,"body":"guest, given his long standing"},{"speaker":"Charles Goldfarb","startTime":763.14,"endTime":766.5,"body":"podcast for the hand society."},{"speaker":"Charles Goldfarb","startTime":766.5,"endTime":767.22,"body":"Who knows?"},{"speaker":"Chris Dy","startTime":767.36,"endTime":769.67,"body":"I'm just I'm just"},{"speaker":"Chris Dy","startTime":767.36,"endTime":769.67,"body":"hoping that it's kind of like a"},{"speaker":"Chris Dy","startTime":769.7,"endTime":773.81,"body":"Michael Jordan kind of"},{"speaker":"Chris Dy","startTime":769.7,"endTime":773.81,"body":"situation, you know, 23, 45 but"},{"speaker":"Chris Dy","startTime":773.81,"endTime":775.55,"body":"maybe no wizards phase of that,"},{"speaker":"Chris Dy","startTime":773.81,"endTime":775.55,"body":"you know?"},{"speaker":"Charles Goldfarb","startTime":776.06,"endTime":778.61,"body":"Maybe maybe"},{"speaker":"Charles Goldfarb","startTime":776.06,"endTime":778.61,"body":"maybe. So I it's kind of"},{"speaker":"Charles Goldfarb","startTime":778.61,"endTime":781.94,"body":"humorous. So we had a"},{"speaker":"Charles Goldfarb","startTime":778.61,"endTime":781.94,"body":"discussion, I think it was it"},{"speaker":"Charles Goldfarb","startTime":781.94,"endTime":785.57,"body":"may have been at or Lindley and"},{"speaker":"Charles Goldfarb","startTime":781.94,"endTime":785.57,"body":"I's indications or maybe it was"},{"speaker":"Charles Goldfarb","startTime":785.57,"endTime":788.45,"body":"at the main Monday morning"},{"speaker":"Charles Goldfarb","startTime":785.57,"endTime":788.45,"body":"conference."},{"speaker":"Chris Dy","startTime":788.48,"endTime":791.39,"body":"So you're so popular"},{"speaker":"Chris Dy","startTime":788.48,"endTime":791.39,"body":"that you can't even keep track"},{"speaker":"Chris Dy","startTime":791.42,"endTime":792.29,"body":"of where you say things."},{"speaker":"Charles Goldfarb","startTime":792.38,"endTime":794.12,"body":"So many"},{"speaker":"Charles Goldfarb","startTime":792.38,"endTime":794.12,"body":"conferences. Now, I don't know,"},{"speaker":"Charles Goldfarb","startTime":794.12,"endTime":797.93,"body":"I can't say that I said it, it"},{"speaker":"Charles Goldfarb","startTime":794.12,"endTime":797.93,"body":"was said, it was said by some of"},{"speaker":"Charles Goldfarb","startTime":797.93,"endTime":802.25,"body":"our partners who enjoy putting"},{"speaker":"Charles Goldfarb","startTime":797.93,"endTime":802.25,"body":"on the finger X fix for PIP"},{"speaker":"Charles Goldfarb","startTime":802.28,"endTime":806.39,"body":"fracture dislocations that"},{"speaker":"Charles Goldfarb","startTime":802.28,"endTime":806.39,"body":"sometimes they feel you might as"},{"speaker":"Charles Goldfarb","startTime":806.39,"endTime":808.85,"body":"well just hand the joint because"},{"speaker":"Charles Goldfarb","startTime":806.39,"endTime":808.85,"body":"they never have motion when the"},{"speaker":"Charles Goldfarb","startTime":808.85,"endTime":812.75,"body":"fixture comes off. And that is a"},{"speaker":"Charles Goldfarb","startTime":808.85,"endTime":812.75,"body":"little different than what Alex"},{"speaker":"Charles Goldfarb","startTime":812.75,"endTime":817.28,"body":"has related. And the truth may"},{"speaker":"Charles Goldfarb","startTime":812.75,"endTime":817.28,"body":"lie somewhere in between. I have"},{"speaker":"Charles Goldfarb","startTime":817.28,"endTime":821.72,"body":"never, ever numbed the finger to"},{"speaker":"Charles Goldfarb","startTime":817.28,"endTime":821.72,"body":"take off the fixture. But that"},{"speaker":"Charles Goldfarb","startTime":821.72,"endTime":823.73,"body":"is a really solid pearl."},{"speaker":"Chris Dy","startTime":824.21,"endTime":826.07,"body":"Yeah, and I'm totally"},{"speaker":"Chris Dy","startTime":824.21,"endTime":826.07,"body":"going to do that next time I"},{"speaker":"Chris Dy","startTime":826.07,"endTime":827.84,"body":"have to do that."},{"speaker":"Charles Goldfarb","startTime":827.88,"endTime":830.19,"body":"Yeah, I mean,"},{"speaker":"Charles Goldfarb","startTime":827.88,"endTime":830.19,"body":"some active motion, some passive"},{"speaker":"Charles Goldfarb","startTime":830.19,"endTime":832.5,"body":"motion, try to get some pull"},{"speaker":"Charles Goldfarb","startTime":830.19,"endTime":832.5,"body":"through to break up the"},{"speaker":"Charles Goldfarb","startTime":832.74,"endTime":835.17,"body":"adhesions or else just be able"},{"speaker":"Charles Goldfarb","startTime":832.74,"endTime":835.17,"body":"to manipulate a bit."},{"speaker":"Chris Dy","startTime":836.46,"endTime":838.86,"body":"Well, I mean, I think"},{"speaker":"Chris Dy","startTime":836.46,"endTime":838.86,"body":"that I remember Marty telling a"},{"speaker":"Chris Dy","startTime":838.86,"endTime":841.5,"body":"story about how, you know, he"},{"speaker":"Chris Dy","startTime":838.86,"endTime":841.5,"body":"would have to deal with some"},{"speaker":"Chris Dy","startTime":841.5,"endTime":845.49,"body":"patients who had finger"},{"speaker":"Chris Dy","startTime":841.5,"endTime":845.49,"body":"stiffness in his fellowship, and"},{"speaker":"Chris Dy","startTime":845.49,"endTime":848.79,"body":"he would have to go do digital"},{"speaker":"Chris Dy","startTime":845.49,"endTime":848.79,"body":"blocks every time the patient"},{"speaker":"Chris Dy","startTime":848.79,"endTime":852.6,"body":"came in. To help out with that."},{"speaker":"Chris Dy","startTime":848.79,"endTime":852.6,"body":"So I mean, there's something"},{"speaker":"Chris Dy","startTime":852.6,"endTime":853.38,"body":"there for sure."},{"speaker":"Charles Goldfarb","startTime":854.07,"endTime":858.06,"body":"Yeah. Love it."},{"speaker":"Charles Goldfarb","startTime":854.07,"endTime":858.06,"body":"We welcome all pearls, email us,"},{"speaker":"Charles Goldfarb","startTime":858.36,"endTime":862.2,"body":"tweet at us. Instagram at us. I"},{"speaker":"Charles Goldfarb","startTime":858.36,"endTime":862.2,"body":"don't know if that's the word."},{"speaker":"Chris Dy","startTime":862.0,"endTime":867.61,"body":"But let us know. Yeah,"},{"speaker":"Chris Dy","startTime":862.0,"endTime":867.61,"body":"these pearls are great. And I"},{"speaker":"Chris Dy","startTime":867.61,"endTime":870.91,"body":"think that it's a great way to"},{"speaker":"Chris Dy","startTime":867.61,"endTime":870.91,"body":"share your knowledge with the"},{"speaker":"Chris Dy","startTime":870.97,"endTime":872.95,"body":"with the listeners. I mean,"},{"speaker":"Chris Dy","startTime":870.97,"endTime":872.95,"body":"listen, our stats have been"},{"speaker":"Chris Dy","startTime":872.95,"endTime":876.07,"body":"great. We've gotten you know,"},{"speaker":"Chris Dy","startTime":872.95,"endTime":876.07,"body":"about 2000 downloads a week. And"},{"speaker":"Chris Dy","startTime":875.08,"endTime":972.73,"body":"When many years, one sees many"},{"speaker":"Chris Dy","startTime":875.08,"endTime":972.73,"body":"things and so yes, I have seen"},{"speaker":"Chris Dy","startTime":876.07,"endTime":879.22,"body":"we're very, very excited about"},{"speaker":"Chris Dy","startTime":876.07,"endTime":879.22,"body":"that. And that actually leads us"},{"speaker":"Chris Dy","startTime":879.22,"endTime":882.52,"body":"to the crux of our episode today"},{"speaker":"Chris Dy","startTime":879.22,"endTime":882.52,"body":"a great case that was sent in"},{"speaker":"Chris Dy","startTime":882.79,"endTime":888.58,"body":"all the way from Greece. And,"},{"speaker":"Chris Dy","startTime":882.79,"endTime":888.58,"body":"you know, Ioannis Lachanas sorry"},{"speaker":"Chris Dy","startTime":888.58,"endTime":892.72,"body":"for mispronouncing that, but he"},{"speaker":"Chris Dy","startTime":888.58,"endTime":892.72,"body":"did mention that, thanking us"},{"speaker":"Chris Dy","startTime":892.75,"endTime":895.72,"body":"for the time and effort to"},{"speaker":"Chris Dy","startTime":892.75,"endTime":895.72,"body":"deliver what is probably the"},{"speaker":"Chris Dy","startTime":895.72,"endTime":898.81,"body":"best medical podcast on the"},{"speaker":"Chris Dy","startTime":895.72,"endTime":898.81,"body":"internet. Now, if you had not"},{"speaker":"Chris Dy","startTime":898.81,"endTime":902.08,"body":"put that qualifier and probably"},{"speaker":"Chris Dy","startTime":898.81,"endTime":902.08,"body":"would have been really really"},{"speaker":"Chris Dy","startTime":902.08,"endTime":906.43,"body":"happy but I love it anyway. Well"},{"speaker":"Chris Dy","startTime":902.08,"endTime":906.43,"body":"now become exactly we will"},{"speaker":"Chris Dy","startTime":906.43,"endTime":910.18,"body":"absolutely take it. It has now"},{"speaker":"Chris Dy","startTime":906.43,"endTime":910.18,"body":"become almost compulsory for my"},{"speaker":"Chris Dy","startTime":910.18,"endTime":915.64,"body":"residents to listen to you guys"},{"speaker":"Chris Dy","startTime":910.18,"endTime":915.64,"body":"on their Monday commute. So I'm"},{"speaker":"Chris Dy","startTime":915.64,"endTime":918.79,"body":"going to change some leave out"},{"speaker":"Chris Dy","startTime":915.64,"endTime":918.79,"body":"some details here just you know"},{"speaker":"Chris Dy","startTime":918.79,"endTime":922.21,"body":"in terms of privacy and whatnot,"},{"speaker":"Chris Dy","startTime":918.79,"endTime":922.21,"body":"but um, you know, so we have a"},{"speaker":"Chris Dy","startTime":922.21,"endTime":927.67,"body":"patient who is not exactly"},{"speaker":"Chris Dy","startTime":922.21,"endTime":927.67,"body":"young, not exactly old and is a"},{"speaker":"Chris Dy","startTime":927.67,"endTime":931.6,"body":"nonsmoker and was in an"},{"speaker":"Chris Dy","startTime":927.67,"endTime":931.6,"body":"accident, a car accident, you"},{"speaker":"Chris Dy","startTime":931.6,"endTime":934.42,"body":"know, little under a year ago,"},{"speaker":"Chris Dy","startTime":931.6,"endTime":934.42,"body":"and she had radial side wrist"},{"speaker":"Chris Dy","startTime":934.42,"endTime":938.17,"body":"pain and X rays were negative,"},{"speaker":"Chris Dy","startTime":934.42,"endTime":938.17,"body":"she was going to the splint, lot"},{"speaker":"Chris Dy","startTime":938.17,"endTime":942.16,"body":"of back and forth, and then"},{"speaker":"Chris Dy","startTime":938.17,"endTime":942.16,"body":"negative X rays and a CT scan"},{"speaker":"Chris Dy","startTime":942.16,"endTime":945.82,"body":"six months after injury, didn't"},{"speaker":"Chris Dy","startTime":942.16,"endTime":945.82,"body":"show any bony issues and then"},{"speaker":"Chris Dy","startTime":945.82,"endTime":949.69,"body":"eventually had an MRI that"},{"speaker":"Chris Dy","startTime":945.82,"endTime":949.69,"body":"showed a proximal, proximal pole"},{"speaker":"Chris Dy","startTime":949.69,"endTime":953.95,"body":"nonunion with a very small"},{"speaker":"Chris Dy","startTime":949.69,"endTime":953.95,"body":"fragments and an avascular"},{"speaker":"Chris Dy","startTime":954.01,"endTime":958.33,"body":"proximal pole, and has lots of"},{"speaker":"Chris Dy","startTime":954.01,"endTime":958.33,"body":"pain. So what do you think about"},{"speaker":"Chris Dy","startTime":958.33,"endTime":961.21,"body":"this case? Chuck, hear that"},{"speaker":"Chris Dy","startTime":958.33,"endTime":961.21,"body":"you're the carpus maven. So how"},{"speaker":"Chris Dy","startTime":961.21,"endTime":964.99,"body":"do you start to think about this"},{"speaker":"Chris Dy","startTime":961.21,"endTime":964.99,"body":"case is something that has come"},{"speaker":"Chris Dy","startTime":964.99,"endTime":967.72,"body":"your way along your many, many,"},{"speaker":"Chris Dy","startTime":964.99,"endTime":967.72,"body":"many years?"},{"speaker":"Chris Dy","startTime":972.73,"endTime":977.68,"body":"my fair share of proximal pole"},{"speaker":"Chris Dy","startTime":972.73,"endTime":977.68,"body":"nonunions. So with or without"},{"speaker":"Chris Dy","startTime":977.68,"endTime":983.5,"body":"vascularity. It's a really"},{"speaker":"Chris Dy","startTime":977.68,"endTime":983.5,"body":"interesting topic, because I"},{"speaker":"Chris Dy","startTime":983.5,"endTime":987.1,"body":"think there are some"},{"speaker":"Chris Dy","startTime":983.5,"endTime":987.1,"body":"institutions and some physicians"},{"speaker":"Chris Dy","startTime":987.37,"endTime":992.08,"body":"who absolutely feel it can only"},{"speaker":"Chris Dy","startTime":987.37,"endTime":992.08,"body":"be treated one way. And there"},{"speaker":"Chris Dy","startTime":992.08,"endTime":995.56,"body":"are other institutions that have"},{"speaker":"Chris Dy","startTime":992.08,"endTime":995.56,"body":"a, you know, I was gonna say"},{"speaker":"Chris Dy","startTime":995.56,"endTime":999.28,"body":"diabolically, but I guess I"},{"speaker":"Chris Dy","startTime":995.56,"endTime":999.28,"body":"should say diametrically opposed"},{"speaker":"Chris Dy","startTime":999.7,"endTime":1001.59,"body":"point of view. So to be very"},{"speaker":"Chris Dy","startTime":999.7,"endTime":1001.59,"body":"clear-"},{"speaker":"Chris Dy","startTime":1001.62,"endTime":1003.9,"body":"Or diabolically I mean, you"},{"speaker":"Chris Dy","startTime":1001.62,"endTime":1003.9,"body":"know, you never know."},{"speaker":"Charles Goldfarb","startTime":1004.53,"endTime":1007.41,"body":"Some feel you"},{"speaker":"Charles Goldfarb","startTime":1004.53,"endTime":1007.41,"body":"have to use a vascularized bone"},{"speaker":"Charles Goldfarb","startTime":1007.41,"endTime":1012.45,"body":"graft, some feel you absolutely"},{"speaker":"Charles Goldfarb","startTime":1007.41,"endTime":1012.45,"body":"do not. For those that do."},{"speaker":"Charles Goldfarb","startTime":1012.75,"endTime":1020.55,"body":"There's choices to be made. The"},{"speaker":"Charles Goldfarb","startTime":1012.75,"endTime":1020.55,"body":"one to super retinacular vessel"},{"speaker":"Charles Goldfarb","startTime":1020.58,"endTime":1026.97,"body":"versus the more popular recent"},{"speaker":"Charles Goldfarb","startTime":1020.58,"endTime":1026.97,"body":"medial femoral condyle. Free,"},{"speaker":"Charles Goldfarb","startTime":1028.11,"endTime":1032.4,"body":"not flap, right, free flap,"},{"speaker":"Charles Goldfarb","startTime":1028.11,"endTime":1032.4,"body":"right? I forget the terminology."},{"speaker":"Charles Goldfarb","startTime":1033.18,"endTime":1033.99,"body":"Vascularized bone graft."},{"speaker":"Chris Dy","startTime":1033.99,"endTime":1035.91,"body":"It's a flap, it's a"},{"speaker":"Chris Dy","startTime":1033.99,"endTime":1035.91,"body":"flap because we don't do it."},{"speaker":"Charles Goldfarb","startTime":1037.05,"endTime":1041.88,"body":"Exactly right."},{"speaker":"Charles Goldfarb","startTime":1037.05,"endTime":1041.88,"body":"So So Chris, I I'll say this"},{"speaker":"Charles Goldfarb","startTime":1041.88,"endTime":1048.24,"body":"strongly, I much prefer going"},{"speaker":"Charles Goldfarb","startTime":1041.88,"endTime":1048.24,"body":"dorsally for scaphoids, I think"},{"speaker":"Charles Goldfarb","startTime":1048.24,"endTime":1051.27,"body":"it's less disruptive to normal"},{"speaker":"Charles Goldfarb","startTime":1048.24,"endTime":1051.27,"body":"anatomy, I think is a simpler"},{"speaker":"Charles Goldfarb","startTime":1051.27,"endTime":1056.61,"body":"approach. I think I can put a"},{"speaker":"Charles Goldfarb","startTime":1051.27,"endTime":1056.61,"body":"much better screw in. For every"},{"speaker":"Charles Goldfarb","startTime":1056.61,"endTime":1059.43,"body":"reason I like this approach"},{"speaker":"Charles Goldfarb","startTime":1056.61,"endTime":1059.43,"body":"better. So further than the"},{"speaker":"Charles Goldfarb","startTime":1059.43,"endTime":1062.1,"body":"approach standpoint, I'd prefer"},{"speaker":"Charles Goldfarb","startTime":1059.43,"endTime":1062.1,"body":"a proximal pole."},{"speaker":"Chris Dy","startTime":1064.23,"endTime":1068.16,"body":"Yeah, I mean, I guess"},{"speaker":"Chris Dy","startTime":1064.23,"endTime":1068.16,"body":"I also like going dorsal, I try"},{"speaker":"Chris Dy","startTime":1068.16,"endTime":1072.33,"body":"to go dorsal every time that I"},{"speaker":"Chris Dy","startTime":1068.16,"endTime":1072.33,"body":"can. And I, I actually have to"},{"speaker":"Chris Dy","startTime":1072.33,"endTime":1076.23,"body":"convince myself to consider"},{"speaker":"Chris Dy","startTime":1072.33,"endTime":1076.23,"body":"going volar just to make a have"},{"speaker":"Chris Dy","startTime":1076.23,"endTime":1078.24,"body":"a balanced opinion on things,"},{"speaker":"Chris Dy","startTime":1076.23,"endTime":1078.24,"body":"because there are some cases"},{"speaker":"Chris Dy","startTime":1078.24,"endTime":1080.58,"body":"where I was like, that's a"},{"speaker":"Chris Dy","startTime":1078.24,"endTime":1080.58,"body":"little too much deformity. So I"},{"speaker":"Chris Dy","startTime":1080.58,"endTime":1083.07,"body":"mean, we're not talking"},{"speaker":"Chris Dy","startTime":1080.58,"endTime":1083.07,"body":"specifically about proximal"},{"speaker":"Chris Dy","startTime":1083.07,"endTime":1085.8,"body":"poles anymore. But you know, a"},{"speaker":"Chris Dy","startTime":1083.07,"endTime":1085.8,"body":"waist fracture, what's your"},{"speaker":"Chris Dy","startTime":1085.8,"endTime":1089.49,"body":"threshold on scaphoid flexion."},{"speaker":"Chris Dy","startTime":1085.8,"endTime":1089.49,"body":"Before your, you'll say I find"},{"speaker":"Chris Dy","startTime":1089.49,"endTime":1090.24,"body":"I'll go volar."},{"speaker":"Charles Goldfarb","startTime":1090.87,"endTime":1093.96,"body":"Should we"},{"speaker":"Charles Goldfarb","startTime":1090.87,"endTime":1093.96,"body":"let's. Should we back up a step?"},{"speaker":"Chris Dy","startTime":1093.96,"endTime":1094.02,"body":"Yeah."},{"speaker":"Charles Goldfarb","startTime":1094.14,"endTime":1097.14,"body":"We have all"},{"speaker":"Charles Goldfarb","startTime":1094.14,"endTime":1097.14,"body":"different ilks all different"},{"speaker":"Charles Goldfarb","startTime":1097.14,"endTime":1100.11,"body":"training pathways and all"},{"speaker":"Charles Goldfarb","startTime":1097.14,"endTime":1100.11,"body":"different you know, we have"},{"speaker":"Charles Goldfarb","startTime":1100.11,"endTime":1103.95,"body":"therapists and students. So to"},{"speaker":"Charles Goldfarb","startTime":1100.11,"endTime":1103.95,"body":"be very clear, the basic"},{"speaker":"Charles Goldfarb","startTime":1103.95,"endTime":1109.8,"body":"principle, which we're alluding"},{"speaker":"Charles Goldfarb","startTime":1103.95,"endTime":1109.8,"body":"to, is your screw ideally,"},{"speaker":"Charles Goldfarb","startTime":1110.25,"endTime":1115.86,"body":"should be placed so that it is"},{"speaker":"Charles Goldfarb","startTime":1110.25,"endTime":1115.86,"body":"entering from the smaller"},{"speaker":"Charles Goldfarb","startTime":1115.89,"endTime":1120.78,"body":"fragment, and we'll have a good"},{"speaker":"Charles Goldfarb","startTime":1115.89,"endTime":1120.78,"body":"purchase in the larger fragment."},{"speaker":"Charles Goldfarb","startTime":1121.26,"endTime":1124.8,"body":"Now, sometimes the fragments are"},{"speaker":"Charles Goldfarb","startTime":1121.26,"endTime":1124.8,"body":"relatively equal size. But the"},{"speaker":"Charles Goldfarb","startTime":1124.8,"endTime":1129.15,"body":"reason one goes dorsal with a"},{"speaker":"Charles Goldfarb","startTime":1124.8,"endTime":1129.15,"body":"proximal pole, is to assure that"},{"speaker":"Charles Goldfarb","startTime":1129.15,"endTime":1131.97,"body":"you have control of that"},{"speaker":"Charles Goldfarb","startTime":1129.15,"endTime":1131.97,"body":"proximal pole, and the screw is"},{"speaker":"Charles Goldfarb","startTime":1131.97,"endTime":1135.36,"body":"going where you need it to go."},{"speaker":"Charles Goldfarb","startTime":1131.97,"endTime":1135.36,"body":"Likewise, a very distal"},{"speaker":"Charles Goldfarb","startTime":1135.36,"endTime":1138.18,"body":"fracture, you would flip that"},{"speaker":"Charles Goldfarb","startTime":1135.36,"endTime":1138.18,"body":"around and go from volar. So"},{"speaker":"Charles Goldfarb","startTime":1138.18,"endTime":1141.36,"body":"Chris's point is a good one. So"},{"speaker":"Charles Goldfarb","startTime":1138.18,"endTime":1141.36,"body":"you know, most of us for"},{"speaker":"Charles Goldfarb","startTime":1141.36,"endTime":1144.42,"body":"nonunions that choose to that we"},{"speaker":"Charles Goldfarb","startTime":1141.36,"endTime":1144.42,"body":"were feel were required to go"},{"speaker":"Charles Goldfarb","startTime":1144.42,"endTime":1150.54,"body":"volar is to correct a deformity"},{"speaker":"Charles Goldfarb","startTime":1144.42,"endTime":1150.54,"body":"the humpback deformity. And you"},{"speaker":"Charles Goldfarb","startTime":1150.54,"endTime":1155.25,"body":"can do some correcting from"},{"speaker":"Charles Goldfarb","startTime":1150.54,"endTime":1155.25,"body":"dorsal, but to really correct"},{"speaker":"Charles Goldfarb","startTime":1155.28,"endTime":1159.39,"body":"and hold that improved scaphoid"},{"speaker":"Charles Goldfarb","startTime":1155.28,"endTime":1159.39,"body":"alignment most people feel you"},{"speaker":"Charles Goldfarb","startTime":1159.39,"endTime":1163.8,"body":"have to do something from volar"},{"speaker":"Charles Goldfarb","startTime":1159.39,"endTime":1163.8,"body":"I don't know what the I don't"},{"speaker":"Charles Goldfarb","startTime":1163.8,"endTime":1166.5,"body":"know what the right answer is"},{"speaker":"Charles Goldfarb","startTime":1163.8,"endTime":1166.5,"body":"Chris, for the for the waist"},{"speaker":"Charles Goldfarb","startTime":1166.5,"endTime":1169.5,"body":"fractures and how much humpback"},{"speaker":"Charles Goldfarb","startTime":1166.5,"endTime":1169.5,"body":"is okay before you feel like you"},{"speaker":"Charles Goldfarb","startTime":1169.5,"endTime":1173.82,"body":"have to go volar but I'm with"},{"speaker":"Charles Goldfarb","startTime":1169.5,"endTime":1173.82,"body":"you. I will. I will maybe skirt"},{"speaker":"Charles Goldfarb","startTime":1173.82,"endTime":1177.39,"body":"the issue as long as my Lunate"},{"speaker":"Charles Goldfarb","startTime":1173.82,"endTime":1177.39,"body":"isn't tilted too far. dorsally I"},{"speaker":"Charles Goldfarb","startTime":1177.39,"endTime":1182.13,"body":"might try to treat to treat a a"},{"speaker":"Charles Goldfarb","startTime":1177.39,"endTime":1182.13,"body":"waist fracture with mild"},{"speaker":"Charles Goldfarb","startTime":1182.13,"endTime":1183.96,"body":"deformity I might try to treat"},{"speaker":"Charles Goldfarb","startTime":1182.13,"endTime":1183.96,"body":"from dorsal."},{"speaker":"Chris Dy","startTime":1185.49,"endTime":1187.11,"body":"Yeah, and I mean, a"},{"speaker":"Chris Dy","startTime":1185.49,"endTime":1187.11,"body":"fracture is not the same as a"},{"speaker":"Chris Dy","startTime":1187.11,"endTime":1189.63,"body":"non union. Right. So a fracture"},{"speaker":"Chris Dy","startTime":1187.11,"endTime":1189.63,"body":"that's acute, you still got a"},{"speaker":"Chris Dy","startTime":1189.63,"endTime":1192.24,"body":"chance to you know, so I think"},{"speaker":"Chris Dy","startTime":1189.63,"endTime":1192.24,"body":"the concern is that if you go"},{"speaker":"Chris Dy","startTime":1192.24,"endTime":1195.33,"body":"dorsal and you're working, you"},{"speaker":"Chris Dy","startTime":1192.24,"endTime":1195.33,"body":"know, if you're dissecting over"},{"speaker":"Chris Dy","startTime":1195.33,"endTime":1199.02,"body":"the waist, you're going to"},{"speaker":"Chris Dy","startTime":1195.33,"endTime":1199.02,"body":"disrupt that very delicate blood"},{"speaker":"Chris Dy","startTime":1199.02,"endTime":1202.44,"body":"supply Um, you know, I think"},{"speaker":"Chris Dy","startTime":1199.02,"endTime":1202.44,"body":"there are ways in which you can"},{"speaker":"Chris Dy","startTime":1202.47,"endTime":1205.8,"body":"work beyond distal to the blood"},{"speaker":"Chris Dy","startTime":1202.47,"endTime":1205.8,"body":"supply and leave the blood"},{"speaker":"Chris Dy","startTime":1205.8,"endTime":1209.16,"body":"supply intact and manipulate"},{"speaker":"Chris Dy","startTime":1205.8,"endTime":1209.16,"body":"your distal fragment to try to"},{"speaker":"Chris Dy","startTime":1209.16,"endTime":1211.92,"body":"get to pull it up. So you can"},{"speaker":"Chris Dy","startTime":1209.16,"endTime":1211.92,"body":"get that distal pole out of"},{"speaker":"Chris Dy","startTime":1211.92,"endTime":1215.16,"body":"flexion. And I've done that with"},{"speaker":"Chris Dy","startTime":1211.92,"endTime":1215.16,"body":"success. And I've been very"},{"speaker":"Chris Dy","startTime":1215.16,"endTime":1219.0,"body":"happy with x and it spares the"},{"speaker":"Chris Dy","startTime":1215.16,"endTime":1219.0,"body":"volar approach, it's much easier"},{"speaker":"Chris Dy","startTime":1219.0,"endTime":1222.33,"body":"shoot the screw down. In terms"},{"speaker":"Chris Dy","startTime":1219.0,"endTime":1222.33,"body":"of principles, before we get"},{"speaker":"Chris Dy","startTime":1222.33,"endTime":1225.72,"body":"back to the case that we brought"},{"speaker":"Chris Dy","startTime":1222.33,"endTime":1225.72,"body":"up. Are you a big, you know,"},{"speaker":"Chris Dy","startTime":1226.26,"endTime":1229.08,"body":"screw biggest screw down the"},{"speaker":"Chris Dy","startTime":1226.26,"endTime":1229.08,"body":"central axis? Or how much are"},{"speaker":"Chris Dy","startTime":1229.08,"endTime":1231.42,"body":"you like, we got to get it"},{"speaker":"Chris Dy","startTime":1229.08,"endTime":1231.42,"body":"perpendicular to the fracture?"},{"speaker":"Charles Goldfarb","startTime":1234.09,"endTime":1236.7,"body":"Central axis"},{"speaker":"Charles Goldfarb","startTime":1234.09,"endTime":1236.7,"body":"almost always, unless you really"},{"speaker":"Charles Goldfarb","startTime":1236.7,"endTime":1241.05,"body":"have an oblique fracture line"},{"speaker":"Charles Goldfarb","startTime":1236.7,"endTime":1241.05,"body":"that challenges that approach, I"},{"speaker":"Charles Goldfarb","startTime":1241.05,"endTime":1244.5,"body":"think central central meaning"},{"speaker":"Charles Goldfarb","startTime":1241.05,"endTime":1244.5,"body":"screw meaning the K wire and"},{"speaker":"Charles Goldfarb","startTime":1244.5,"endTime":1248.82,"body":"then the screw is center on a PA"},{"speaker":"Charles Goldfarb","startTime":1244.5,"endTime":1248.82,"body":"and center on a lateral. And I"},{"speaker":"Charles Goldfarb","startTime":1248.82,"endTime":1253.29,"body":"like how you corrected me, an"},{"speaker":"Charles Goldfarb","startTime":1248.82,"endTime":1253.29,"body":"acute fracture may be more"},{"speaker":"Charles Goldfarb","startTime":1253.29,"endTime":1258.24,"body":"amenable for going dorsally with"},{"speaker":"Charles Goldfarb","startTime":1253.29,"endTime":1258.24,"body":"some correction of any type of"},{"speaker":"Charles Goldfarb","startTime":1258.24,"endTime":1263.49,"body":"impending angulation. Whereas a"},{"speaker":"Charles Goldfarb","startTime":1258.24,"endTime":1263.49,"body":"non union, you're less likely to"},{"speaker":"Charles Goldfarb","startTime":1263.49,"endTime":1266.46,"body":"be able to correct that from"},{"speaker":"Charles Goldfarb","startTime":1263.49,"endTime":1266.46,"body":"dorsal and more likely to be"},{"speaker":"Charles Goldfarb","startTime":1266.46,"endTime":1269.13,"body":"required to go bowl or I think"},{"speaker":"Charles Goldfarb","startTime":1266.46,"endTime":1269.13,"body":"that's well said. I hope I said"},{"speaker":"Charles Goldfarb","startTime":1269.13,"endTime":1270.57,"body":"it right. Just like you said it."},{"speaker":"Chris Dy","startTime":1271.53,"endTime":1273.75,"body":"Yeah, no, I think that"},{"speaker":"Chris Dy","startTime":1271.53,"endTime":1273.75,"body":"it'd be very hard to try to get"},{"speaker":"Chris Dy","startTime":1273.75,"endTime":1276.45,"body":"any correction with something"},{"speaker":"Chris Dy","startTime":1273.75,"endTime":1276.45,"body":"that's been, you know, a non"},{"speaker":"Chris Dy","startTime":1276.45,"endTime":1280.35,"body":"union that flexed down or a"},{"speaker":"Chris Dy","startTime":1276.45,"endTime":1280.35,"body":"malnion or whatever. But these"},{"speaker":"Chris Dy","startTime":1280.35,"endTime":1285.12,"body":"are hard. And so I guess they're"},{"speaker":"Chris Dy","startTime":1280.35,"endTime":1285.12,"body":"the way I think about the case"},{"speaker":"Chris Dy","startTime":1285.12,"endTime":1290.07,"body":"that that Ioannis sent in, you"},{"speaker":"Chris Dy","startTime":1285.12,"endTime":1290.07,"body":"know, there's the proximal pole"},{"speaker":"Chris Dy","startTime":1290.07,"endTime":1293.07,"body":"fragment, then there's this kind"},{"speaker":"Chris Dy","startTime":1290.07,"endTime":1293.07,"body":"of weird occult case that he's"},{"speaker":"Chris Dy","startTime":1293.07,"endTime":1297.15,"body":"describing. So do you have you"},{"speaker":"Chris Dy","startTime":1293.07,"endTime":1297.15,"body":"seen a case that's been CT"},{"speaker":"Chris Dy","startTime":1297.15,"endTime":1300.21,"body":"negative MRI positive? And do"},{"speaker":"Chris Dy","startTime":1297.15,"endTime":1300.21,"body":"you think that's more of a"},{"speaker":"Chris Dy","startTime":1300.21,"endTime":1302.22,"body":"ligament issue than a proximal"},{"speaker":"Chris Dy","startTime":1300.21,"endTime":1302.22,"body":"pole issue?"},{"speaker":"Charles Goldfarb","startTime":1302.91,"endTime":1304.5,"body":"Well, I'll"},{"speaker":"Charles Goldfarb","startTime":1302.91,"endTime":1304.5,"body":"tell you, the first thing that"},{"speaker":"Charles Goldfarb","startTime":1304.5,"endTime":1310.98,"body":"comes to mind is the, I guess,"},{"speaker":"Charles Goldfarb","startTime":1304.5,"endTime":1310.98,"body":"mixed approaches in the"},{"speaker":"Charles Goldfarb","startTime":1310.98,"endTime":1314.28,"body":"literature for the"},{"speaker":"Charles Goldfarb","startTime":1310.98,"endTime":1314.28,"body":"identification of an acute"},{"speaker":"Charles Goldfarb","startTime":1314.28,"endTime":1318.63,"body":"fracture, and so not to get"},{"speaker":"Charles Goldfarb","startTime":1314.28,"endTime":1318.63,"body":"totally on a tangent. But if a"},{"speaker":"Charles Goldfarb","startTime":1318.63,"endTime":1320.76,"body":"patient comes down with regular"},{"speaker":"Charles Goldfarb","startTime":1318.63,"endTime":1320.76,"body":"side of wrist pain with negative"},{"speaker":"Charles Goldfarb","startTime":1320.76,"endTime":1324.75,"body":"X rays upon presentation and"},{"speaker":"Charles Goldfarb","startTime":1320.76,"endTime":1324.75,"body":"negative X rays at two weeks,"},{"speaker":"Charles Goldfarb","startTime":1324.96,"endTime":1327.96,"body":"then most of us would agree that"},{"speaker":"Charles Goldfarb","startTime":1324.96,"endTime":1327.96,"body":"advanced imaging would make"},{"speaker":"Charles Goldfarb","startTime":1327.96,"endTime":1331.47,"body":"sense unless the patient just"},{"speaker":"Charles Goldfarb","startTime":1327.96,"endTime":1331.47,"body":"wants to consent for a cast. And"},{"speaker":"Charles Goldfarb","startTime":1331.47,"endTime":1335.46,"body":"so do we obtain a CT scan? Or do"},{"speaker":"Charles Goldfarb","startTime":1331.47,"endTime":1335.46,"body":"we obtain an MRI? And the bottom"},{"speaker":"Charles Goldfarb","startTime":1335.46,"endTime":1338.76,"body":"line is there's not a right or"},{"speaker":"Charles Goldfarb","startTime":1335.46,"endTime":1338.76,"body":"wrong answer both can be"},{"speaker":"Charles Goldfarb","startTime":1338.76,"endTime":1343.11,"body":"sensitive, meaning pick up the"},{"speaker":"Charles Goldfarb","startTime":1338.76,"endTime":1343.11,"body":"fracture. Both can be specific"},{"speaker":"Charles Goldfarb","startTime":1343.11,"endTime":1345.21,"body":"meaning if they call it a"},{"speaker":"Charles Goldfarb","startTime":1343.11,"endTime":1345.21,"body":"fracture is really a fracture,"},{"speaker":"Charles Goldfarb","startTime":1345.27,"endTime":1350.43,"body":"but both can miss. And so, you"},{"speaker":"Charles Goldfarb","startTime":1345.27,"endTime":1350.43,"body":"know, I honestly, I get CT scans"},{"speaker":"Charles Goldfarb","startTime":1350.43,"endTime":1353.91,"body":"because they're cheaper and"},{"speaker":"Charles Goldfarb","startTime":1350.43,"endTime":1353.91,"body":"faster and easier to obtain. I"},{"speaker":"Charles Goldfarb","startTime":1353.91,"endTime":1357.27,"body":"think that's probably the same"},{"speaker":"Charles Goldfarb","startTime":1353.91,"endTime":1357.27,"body":"thing here. I'm surprised that a"},{"speaker":"Charles Goldfarb","startTime":1357.27,"endTime":1362.22,"body":"non union would be missed on CT"},{"speaker":"Charles Goldfarb","startTime":1357.27,"endTime":1362.22,"body":"scan for me. If if it's missed,"},{"speaker":"Charles Goldfarb","startTime":1362.25,"endTime":1365.37,"body":"if it's not seen in a CT scan,"},{"speaker":"Charles Goldfarb","startTime":1362.25,"endTime":1365.37,"body":"it doesn't exist, but I applaud"},{"speaker":"Charles Goldfarb","startTime":1366.93,"endTime":1369.15,"body":"the fact that they went ahead"},{"speaker":"Charles Goldfarb","startTime":1366.93,"endTime":1369.15,"body":"because of continued pain and"},{"speaker":"Charles Goldfarb","startTime":1369.15,"endTime":1373.02,"body":"got the MRI, I believe it's"},{"speaker":"Charles Goldfarb","startTime":1369.15,"endTime":1373.02,"body":"real, I believe it's a it's a"},{"speaker":"Charles Goldfarb","startTime":1373.02,"endTime":1377.58,"body":"proximal pole non union,"},{"speaker":"Charles Goldfarb","startTime":1373.02,"endTime":1377.58,"body":"especially if the ligament looks"},{"speaker":"Charles Goldfarb","startTime":1377.58,"endTime":1382.11,"body":"good on MRI, but I agree with"},{"speaker":"Charles Goldfarb","startTime":1377.58,"endTime":1382.11,"body":"you, if I opened this dorsally"},{"speaker":"Charles Goldfarb","startTime":1382.2,"endTime":1384.33,"body":"to look at it, I would"},{"speaker":"Charles Goldfarb","startTime":1382.2,"endTime":1384.33,"body":"absolutely make sure the"},{"speaker":"Charles Goldfarb","startTime":1384.33,"endTime":1385.14,"body":"ligament looks okay."},{"speaker":"Chris Dy","startTime":1386.22,"endTime":1388.56,"body":"Yes, so it's"},{"speaker":"Chris Dy","startTime":1386.22,"endTime":1388.56,"body":"interesting. I we disagree."},{"speaker":"Chris Dy","startTime":1388.59,"endTime":1391.95,"body":"Remember early on we were told"},{"speaker":"Chris Dy","startTime":1388.59,"endTime":1391.95,"body":"that we don't we don't disagree"},{"speaker":"Chris Dy","startTime":1391.95,"endTime":1395.46,"body":"enough. Yes. So I disagree with"},{"speaker":"Chris Dy","startTime":1391.95,"endTime":1395.46,"body":"you actually get the MRI at"},{"speaker":"Chris Dy","startTime":1395.46,"endTime":1398.85,"body":"that, you know, when it's not,"},{"speaker":"Chris Dy","startTime":1395.46,"endTime":1398.85,"body":"you know, X rays or negative"},{"speaker":"Chris Dy","startTime":1398.85,"endTime":1401.88,"body":"continued pain and they don't"},{"speaker":"Chris Dy","startTime":1398.85,"endTime":1401.88,"body":"just want to do a cast, mainly"},{"speaker":"Chris Dy","startTime":1401.88,"endTime":1405.12,"body":"because I like to be able to get"},{"speaker":"Chris Dy","startTime":1401.88,"endTime":1405.12,"body":"that bony edema pattern that so"},{"speaker":"Chris Dy","startTime":1405.12,"endTime":1408.0,"body":"called bone bruise and and be"},{"speaker":"Chris Dy","startTime":1405.12,"endTime":1408.0,"body":"able to tell patients Hey,"},{"speaker":"Chris Dy","startTime":1408.03,"endTime":1410.52,"body":"there's a bone bruise here. It's"},{"speaker":"Chris Dy","startTime":1408.03,"endTime":1410.52,"body":"not a fracture. I like having"},{"speaker":"Chris Dy","startTime":1410.52,"endTime":1413.46,"body":"that for counseling. Admittedly,"},{"speaker":"Chris Dy","startTime":1410.52,"endTime":1413.46,"body":"you could say you can manage"},{"speaker":"Chris Dy","startTime":1413.46,"endTime":1416.94,"body":"both the same way but I think"},{"speaker":"Chris Dy","startTime":1413.46,"endTime":1416.94,"body":"for a patient who is X ray"},{"speaker":"Chris Dy","startTime":1416.94,"endTime":1421.32,"body":"negative, still having pain but"},{"speaker":"Chris Dy","startTime":1416.94,"endTime":1421.32,"body":"as MRI negative, that comes back"},{"speaker":"Chris Dy","startTime":1421.35,"endTime":1424.02,"body":"that's good enough for me to say"},{"speaker":"Chris Dy","startTime":1421.35,"endTime":1424.02,"body":"look, we can go about this two"},{"speaker":"Chris Dy","startTime":1424.02,"endTime":1427.14,"body":"ways. We can either immobilize,"},{"speaker":"Chris Dy","startTime":1424.02,"endTime":1427.14,"body":"continue to immobilize you or we"},{"speaker":"Chris Dy","startTime":1427.14,"endTime":1430.53,"body":"can let you kind of work through"},{"speaker":"Chris Dy","startTime":1427.14,"endTime":1430.53,"body":"this pain with the brace and"},{"speaker":"Chris Dy","startTime":1430.53,"endTime":1433.74,"body":"take it off whenever you want."},{"speaker":"Chris Dy","startTime":1430.53,"endTime":1433.74,"body":"And know that it's likely going"},{"speaker":"Chris Dy","startTime":1433.74,"endTime":1437.85,"body":"to be okay. And I know what"},{"speaker":"Chris Dy","startTime":1433.74,"endTime":1437.85,"body":"you're saying. You know, the"},{"speaker":"Chris Dy","startTime":1437.85,"endTime":1441.3,"body":"sensitivity is not being perfect"},{"speaker":"Chris Dy","startTime":1437.85,"endTime":1441.3,"body":"for either study. And I guess"},{"speaker":"Chris Dy","startTime":1441.3,"endTime":1443.85,"body":"I'm wasting healthcare dollars"},{"speaker":"Chris Dy","startTime":1441.3,"endTime":1443.85,"body":"in the US by getting all these"},{"speaker":"Chris Dy","startTime":1443.85,"endTime":1448.92,"body":"MRIs doesn't come up that often."},{"speaker":"Chris Dy","startTime":1443.85,"endTime":1448.92,"body":"But I also remember the utility"},{"speaker":"Chris Dy","startTime":1448.92,"endTime":1451.95,"body":"of the offering or tasks, there"},{"speaker":"Chris Dy","startTime":1448.92,"endTime":1451.95,"body":"are some patients that just want"},{"speaker":"Chris Dy","startTime":1452.1,"endTime":1454.65,"body":"to not deal with it. And you"},{"speaker":"Chris Dy","startTime":1452.1,"endTime":1454.65,"body":"taught me that one."},{"speaker":"Charles Goldfarb","startTime":1455.61,"endTime":1457.83,"body":"Yeah, clearly"},{"speaker":"Charles Goldfarb","startTime":1455.61,"endTime":1457.83,"body":"I didn't teach you everything I"},{"speaker":"Charles Goldfarb","startTime":1457.83,"endTime":1460.65,"body":"should have the CT scan is"},{"speaker":"Charles Goldfarb","startTime":1457.83,"endTime":1460.65,"body":"clearly the better choice. I'm"},{"speaker":"Charles Goldfarb","startTime":1460.65,"endTime":1464.88,"body":"sorry, you're picking MRI here."},{"speaker":"Charles Goldfarb","startTime":1460.65,"endTime":1464.88,"body":"I'm sorry, you don't care about"},{"speaker":"Charles Goldfarb","startTime":1464.88,"endTime":1469.32,"body":"our Medicare debt and the fact"},{"speaker":"Charles Goldfarb","startTime":1464.88,"endTime":1469.32,"body":"that the banks gonna be empty in"},{"speaker":"Charles Goldfarb","startTime":1469.32,"endTime":1474.15,"body":"2028 Here in the US. Now I have"},{"speaker":"Charles Goldfarb","startTime":1469.32,"endTime":1474.15,"body":"absolutely zero problem with"},{"speaker":"Charles Goldfarb","startTime":1474.15,"endTime":1477.3,"body":"getting the MRI and I think"},{"speaker":"Charles Goldfarb","startTime":1474.15,"endTime":1477.3,"body":"you're right. The beauty of that"},{"speaker":"Charles Goldfarb","startTime":1477.3,"endTime":1482.16,"body":"MRI in the acute setting is the"},{"speaker":"Charles Goldfarb","startTime":1477.3,"endTime":1482.16,"body":"edema pattern and that is really"},{"speaker":"Charles Goldfarb","startTime":1482.16,"endTime":1485.91,"body":"valuable, especially in your"},{"speaker":"Charles Goldfarb","startTime":1482.16,"endTime":1485.91,"body":"right ear if you want to be if"},{"speaker":"Charles Goldfarb","startTime":1485.91,"endTime":1488.58,"body":"you want me to be totally"},{"speaker":"Charles Goldfarb","startTime":1485.91,"endTime":1488.58,"body":"honest, in certain patients that"},{"speaker":"Charles Goldfarb","startTime":1488.58,"endTime":1490.5,"body":"will get the MRI and"},{"speaker":"Charles Goldfarb","startTime":1488.58,"endTime":1490.5,"body":"professional athletes would be"},{"speaker":"Charles Goldfarb","startTime":1490.5,"endTime":1490.95,"body":"one of them."},{"speaker":"Chris Dy","startTime":1492.93,"endTime":1494.79,"body":"Well, you can always"},{"speaker":"Chris Dy","startTime":1492.93,"endTime":1494.79,"body":"print more money for our health"},{"speaker":"Chris Dy","startTime":1494.79,"endTime":1495.57,"body":"care system, right?"},{"speaker":"Charles Goldfarb","startTime":1496.02,"endTime":1496.77,"body":"Yeah, sure."},{"speaker":"Chris Dy","startTime":1498.84,"endTime":1500.61,"body":"Why don't want it like"},{"speaker":"Chris Dy","startTime":1498.84,"endTime":1500.61,"body":"putting more money into an"},{"speaker":"Chris Dy","startTime":1500.61,"endTime":1503.97,"body":"economy always works. So anyway,"},{"speaker":"Chris Dy","startTime":1500.61,"endTime":1503.97,"body":"I digress."},{"speaker":"Charles Goldfarb","startTime":1503.99,"endTime":1508.58,"body":"Yes, yeah, you"},{"speaker":"Charles Goldfarb","startTime":1503.99,"endTime":1508.58,"body":"do. So I want to I want to share"},{"speaker":"Charles Goldfarb","startTime":1508.58,"endTime":1512.6,"body":"an article about this, which I"},{"speaker":"Charles Goldfarb","startTime":1508.58,"endTime":1512.6,"body":"found very interesting. It's"},{"speaker":"Charles Goldfarb","startTime":1512.63,"endTime":1519.17,"body":"journal of Hand surgery European"},{"speaker":"Charles Goldfarb","startTime":1512.63,"endTime":1519.17,"body":"2018. So this is not new, or I"},{"speaker":"Charles Goldfarb","startTime":1519.17,"endTime":1522.11,"body":"admit that it wasn't at the tip"},{"speaker":"Charles Goldfarb","startTime":1519.17,"endTime":1522.11,"body":"of my tongue, but it was"},{"speaker":"Charles Goldfarb","startTime":1522.23,"endTime":1527.63,"body":"published. first author is"},{"speaker":"Charles Goldfarb","startTime":1522.23,"endTime":1527.63,"body":"Rancy, senior listed author is"},{"speaker":"Charles Goldfarb","startTime":1527.63,"endTime":1532.22,"body":"Scott Wolfe from HSS. And it's"},{"speaker":"Charles Goldfarb","startTime":1527.63,"endTime":1532.22,"body":"by the scaphoid, nonunion"},{"speaker":"Charles Goldfarb","startTime":1532.22,"endTime":1539.75,"body":"Consortium. Sounds a little"},{"speaker":"Charles Goldfarb","startTime":1532.22,"endTime":1539.75,"body":"ominous. And basically, they use"},{"speaker":"Charles Goldfarb","startTime":1539.75,"endTime":1544.25,"body":"a prospective longitudinal"},{"speaker":"Charles Goldfarb","startTime":1539.75,"endTime":1544.25,"body":"registry with 35, scaphoid"},{"speaker":"Charles Goldfarb","startTime":1544.25,"endTime":1548.66,"body":"nonunions. These were not"},{"speaker":"Charles Goldfarb","startTime":1544.25,"endTime":1548.66,"body":"necessarily proximal pole, all"},{"speaker":"Charles Goldfarb","startTime":1548.66,"endTime":1551.45,"body":"were treated with curettage,"},{"speaker":"Charles Goldfarb","startTime":1548.66,"endTime":1551.45,"body":"non-vascularized autogenous"},{"speaker":"Charles Goldfarb","startTime":1551.45,"endTime":1556.55,"body":"grafting and headless screw"},{"speaker":"Charles Goldfarb","startTime":1551.45,"endTime":1556.55,"body":"fixation. Some did have"},{"speaker":"Charles Goldfarb","startTime":1556.58,"endTime":1563.09,"body":"ischemia. 28 of 33 were found to"},{"speaker":"Charles Goldfarb","startTime":1556.58,"endTime":1563.09,"body":"have impaired vascularity as"},{"speaker":"Charles Goldfarb","startTime":1563.09,"endTime":1565.34,"body":"assessed by intraoperative"},{"speaker":"Charles Goldfarb","startTime":1563.09,"endTime":1565.34,"body":"bleeding, which I, by the way,"},{"speaker":"Charles Goldfarb","startTime":1565.34,"endTime":1571.55,"body":"don't believe in. And despite"},{"speaker":"Charles Goldfarb","startTime":1565.34,"endTime":1571.55,"body":"all that, 33 of 35 healed by 12"},{"speaker":"Charles Goldfarb","startTime":1571.55,"endTime":1575.06,"body":"weeks. And that's impressive,"},{"speaker":"Charles Goldfarb","startTime":1571.55,"endTime":1575.06,"body":"because 12 weeks is not that"},{"speaker":"Charles Goldfarb","startTime":1575.06,"endTime":1578.39,"body":"long. So a I didn't know there"},{"speaker":"Charles Goldfarb","startTime":1575.06,"endTime":1578.39,"body":"was a scaphoid, nonunion"},{"speaker":"Charles Goldfarb","startTime":1578.39,"endTime":1582.41,"body":"consortium. And B, this"},{"speaker":"Charles Goldfarb","startTime":1578.39,"endTime":1582.41,"body":"consortium showed what I believe"},{"speaker":"Charles Goldfarb","startTime":1582.41,"endTime":1585.74,"body":"is that I don't really care"},{"speaker":"Charles Goldfarb","startTime":1582.41,"endTime":1585.74,"body":"about the perceptions of"},{"speaker":"Charles Goldfarb","startTime":1585.74,"endTime":1590.66,"body":"ischemia and bleeding, and a"},{"speaker":"Charles Goldfarb","startTime":1585.74,"endTime":1590.66,"body":"vascularity. I think in these"},{"speaker":"Charles Goldfarb","startTime":1590.66,"endTime":1592.94,"body":"cases, a screw often works just"},{"speaker":"Charles Goldfarb","startTime":1590.66,"endTime":1592.94,"body":"fine."},{"speaker":"Chris Dy","startTime":1595.01,"endTime":1597.53,"body":"Yes, so I remember"},{"speaker":"Chris Dy","startTime":1595.01,"endTime":1597.53,"body":"that paper, I think I was"},{"speaker":"Chris Dy","startTime":1597.53,"endTime":1600.5,"body":"actually up there when some of"},{"speaker":"Chris Dy","startTime":1597.53,"endTime":1600.5,"body":"that was going on. And while I"},{"speaker":"Chris Dy","startTime":1600.83,"endTime":1605.66,"body":"have tremendous respect for my"},{"speaker":"Chris Dy","startTime":1600.83,"endTime":1605.66,"body":"mentor, Dr. Wolfe, Scott has"},{"speaker":"Chris Dy","startTime":1605.66,"endTime":1609.65,"body":"been fantastic to me. I"},{"speaker":"Chris Dy","startTime":1605.66,"endTime":1609.65,"body":"personally remember the papers"},{"speaker":"Chris Dy","startTime":1609.65,"endTime":1612.44,"body":"not being received very well, at"},{"speaker":"Chris Dy","startTime":1609.65,"endTime":1612.44,"body":"least when it was presented on"},{"speaker":"Chris Dy","startTime":1612.44,"endTime":1615.56,"body":"the podium, but some of the"},{"speaker":"Chris Dy","startTime":1612.44,"endTime":1615.56,"body":"meetings, I think, and I cannot"},{"speaker":"Chris Dy","startTime":1615.56,"endTime":1620.54,"body":"remember the exact paper details"},{"speaker":"Chris Dy","startTime":1615.56,"endTime":1620.54,"body":"off the top of my head. So maybe"},{"speaker":"Chris Dy","startTime":1620.54,"endTime":1623.18,"body":"a little homework assignment for"},{"speaker":"Chris Dy","startTime":1620.54,"endTime":1623.18,"body":"me, but the definition of"},{"speaker":"Chris Dy","startTime":1623.18,"endTime":1626.36,"body":"healing was not uniformly"},{"speaker":"Chris Dy","startTime":1623.18,"endTime":1626.36,"body":"accepted. I will leave it at"},{"speaker":"Chris Dy","startTime":1626.36,"endTime":1626.69,"body":"that."},{"speaker":"Charles Goldfarb","startTime":1627.89,"endTime":1630.74,"body":"Yeah, and I"},{"speaker":"Charles Goldfarb","startTime":1627.89,"endTime":1630.74,"body":"get that you know what people"},{"speaker":"Charles Goldfarb","startTime":1630.77,"endTime":1635.54,"body":"get upset when they feel"},{"speaker":"Charles Goldfarb","startTime":1630.77,"endTime":1635.54,"body":"dogmatic about something and"},{"speaker":"Charles Goldfarb","startTime":1635.54,"endTime":1638.9,"body":"there's a presentation to the"},{"speaker":"Charles Goldfarb","startTime":1635.54,"endTime":1638.9,"body":"contrary. And that same journal"},{"speaker":"Charles Goldfarb","startTime":1638.9,"endTime":1642.17,"body":"of hand surgery European 2018"},{"speaker":"Charles Goldfarb","startTime":1638.9,"endTime":1642.17,"body":"edition, there's a good paper"},{"speaker":"Charles Goldfarb","startTime":1642.17,"endTime":1646.82,"body":"out of Chicago. And Robert"},{"speaker":"Charles Goldfarb","startTime":1642.17,"endTime":1646.82,"body":"Wysocki is the senior author"},{"speaker":"Charles Goldfarb","startTime":1646.82,"endTime":1650.12,"body":"there with Mark Cohen and John"},{"speaker":"Charles Goldfarb","startTime":1646.82,"endTime":1650.12,"body":"Fernandez, and others. And they"},{"speaker":"Charles Goldfarb","startTime":1650.12,"endTime":1653.6,"body":"show the same thing, that really"},{"speaker":"Charles Goldfarb","startTime":1650.12,"endTime":1653.6,"body":"high rates of healing with"},{"speaker":"Charles Goldfarb","startTime":1653.66,"endTime":1658.25,"body":"nonvascularized cancellous graft"},{"speaker":"Charles Goldfarb","startTime":1653.66,"endTime":1658.25,"body":"for proximal pole nonunions. The"},{"speaker":"Charles Goldfarb","startTime":1658.25,"endTime":1661.97,"body":"point is, it's part of a"},{"speaker":"Charles Goldfarb","startTime":1658.25,"endTime":1661.97,"body":"conversation with a patient,"},{"speaker":"Charles Goldfarb","startTime":1662.93,"endTime":1666.26,"body":"even though ultimately, we as"},{"speaker":"Charles Goldfarb","startTime":1662.93,"endTime":1666.26,"body":"the physician have to make this"},{"speaker":"Charles Goldfarb","startTime":1666.26,"endTime":1669.59,"body":"decision. At least in my"},{"speaker":"Charles Goldfarb","startTime":1666.26,"endTime":1669.59,"body":"opinion, I think, you know, if"},{"speaker":"Charles Goldfarb","startTime":1669.59,"endTime":1672.62,"body":"you have a super educated"},{"speaker":"Charles Goldfarb","startTime":1669.59,"endTime":1672.62,"body":"patient in your office, then"},{"speaker":"Charles Goldfarb","startTime":1672.62,"endTime":1676.64,"body":"maybe you get into more details,"},{"speaker":"Charles Goldfarb","startTime":1672.62,"endTime":1676.64,"body":"I typically present options and"},{"speaker":"Charles Goldfarb","startTime":1676.64,"endTime":1679.07,"body":"then guide the patient as you"},{"speaker":"Charles Goldfarb","startTime":1676.64,"endTime":1679.07,"body":"and I've talked about where I"},{"speaker":"Charles Goldfarb","startTime":1679.07,"endTime":1682.34,"body":"think this should go. But I"},{"speaker":"Charles Goldfarb","startTime":1679.07,"endTime":1682.34,"body":"don't know what how do you"},{"speaker":"Charles Goldfarb","startTime":1682.34,"endTime":1684.77,"body":"handle these situations? What"},{"speaker":"Charles Goldfarb","startTime":1682.34,"endTime":1684.77,"body":"would you tell this patient? And"},{"speaker":"Charles Goldfarb","startTime":1684.77,"endTime":1689.0,"body":"how would you manage her one"},{"speaker":"Charles Goldfarb","startTime":1684.77,"endTime":1689.0,"body":"year old fracture recently"},{"speaker":"Charles Goldfarb","startTime":1689.0,"endTime":1690.8,"body":"identified proximal pole"},{"speaker":"Charles Goldfarb","startTime":1689.0,"endTime":1690.8,"body":"nonunion?"},{"speaker":"Chris Dy","startTime":1691.68,"endTime":1694.32,"body":"Yeah, I mean, I think"},{"speaker":"Chris Dy","startTime":1691.68,"endTime":1694.32,"body":"that there's enough evidence, I"},{"speaker":"Chris Dy","startTime":1694.32,"endTime":1697.23,"body":"mean, so this has not had a"},{"speaker":"Chris Dy","startTime":1694.32,"endTime":1697.23,"body":"chance to heal because it hasn't"},{"speaker":"Chris Dy","startTime":1697.23,"endTime":1701.43,"body":"had stability. So it's not, you"},{"speaker":"Chris Dy","startTime":1697.23,"endTime":1701.43,"body":"know, like you're biologically,"},{"speaker":"Chris Dy","startTime":1701.43,"endTime":1703.77,"body":"you've already tried some"},{"speaker":"Chris Dy","startTime":1701.43,"endTime":1703.77,"body":"stability, and that's not"},{"speaker":"Chris Dy","startTime":1703.77,"endTime":1706.44,"body":"working. And you're clearly"},{"speaker":"Chris Dy","startTime":1703.77,"endTime":1706.44,"body":"dealing with a blood flow issue."},{"speaker":"Chris Dy","startTime":1706.44,"endTime":1708.78,"body":"Now, this is obviously the worst"},{"speaker":"Chris Dy","startTime":1706.44,"endTime":1708.78,"body":"part of the scaphoid to deal"},{"speaker":"Chris Dy","startTime":1708.78,"endTime":1711.9,"body":"with, just given that it's the"},{"speaker":"Chris Dy","startTime":1708.78,"endTime":1711.9,"body":"furthest away from the blood"},{"speaker":"Chris Dy","startTime":1711.9,"endTime":1715.23,"body":"supply. But I think giving it a"},{"speaker":"Chris Dy","startTime":1711.9,"endTime":1715.23,"body":"chance at fixation is a very"},{"speaker":"Chris Dy","startTime":1715.23,"endTime":1718.92,"body":"reasonable thing, I probably"},{"speaker":"Chris Dy","startTime":1715.23,"endTime":1718.92,"body":"would go to nonvascularized, the"},{"speaker":"Chris Dy","startTime":1718.92,"endTime":1724.11,"body":"only thing gives me pause is"},{"speaker":"Chris Dy","startTime":1718.92,"endTime":1724.11,"body":"that if this doesn't work, then"},{"speaker":"Chris Dy","startTime":1724.11,"endTime":1727.53,"body":"what am I going to do? Have I"},{"speaker":"Chris Dy","startTime":1724.11,"endTime":1727.53,"body":"left enough options for my"},{"speaker":"Chris Dy","startTime":1727.53,"endTime":1733.23,"body":"partners who are, you know, the"},{"speaker":"Chris Dy","startTime":1727.53,"endTime":1733.23,"body":"microvascular surgeons. So, you"},{"speaker":"Chris Dy","startTime":1733.23,"endTime":1735.51,"body":"know, honestly, I probably would"},{"speaker":"Chris Dy","startTime":1733.23,"endTime":1735.51,"body":"tell the patient, I'm going to"},{"speaker":"Chris Dy","startTime":1735.51,"endTime":1738.21,"body":"talk about it with a partner."},{"speaker":"Chris Dy","startTime":1735.51,"endTime":1738.21,"body":"And you know, here's what I"},{"speaker":"Chris Dy","startTime":1738.21,"endTime":1741.15,"body":"would do, but I want to talk to"},{"speaker":"Chris Dy","startTime":1738.21,"endTime":1741.15,"body":"somebody who has, who would be"},{"speaker":"Chris Dy","startTime":1741.15,"endTime":1745.68,"body":"the person to take care of you"},{"speaker":"Chris Dy","startTime":1741.15,"endTime":1745.68,"body":"after, if this didn't work. And"},{"speaker":"Chris Dy","startTime":1745.71,"endTime":1748.47,"body":"I would find my friend David"},{"speaker":"Chris Dy","startTime":1745.71,"endTime":1748.47,"body":"Brogan, who is a fantastic micro"},{"speaker":"Chris Dy","startTime":1748.47,"endTime":1751.11,"body":"surgeon and ask him his"},{"speaker":"Chris Dy","startTime":1748.47,"endTime":1751.11,"body":"thoughts. And he always"},{"speaker":"Chris Dy","startTime":1751.11,"endTime":1753.93,"body":"volunteers to see them because"},{"speaker":"Chris Dy","startTime":1751.11,"endTime":1753.93,"body":"he's great like that. But you"},{"speaker":"Chris Dy","startTime":1753.93,"endTime":1755.46,"body":"know, at the very least, I want"},{"speaker":"Chris Dy","startTime":1753.93,"endTime":1755.46,"body":"his thoughts."},{"speaker":"Charles Goldfarb","startTime":1756.66,"endTime":1759.15,"body":"I appreciate"},{"speaker":"Charles Goldfarb","startTime":1756.66,"endTime":1759.15,"body":"that. I mean, he certainly has,"},{"speaker":"Charles Goldfarb","startTime":1759.18,"endTime":1762.24,"body":"as we all do his set of biases,"},{"speaker":"Charles Goldfarb","startTime":1759.18,"endTime":1762.24,"body":"and he's a big fan of the medial"},{"speaker":"Charles Goldfarb","startTime":1762.24,"endTime":1767.46,"body":"femoral condyle, I get that. I"},{"speaker":"Charles Goldfarb","startTime":1762.24,"endTime":1767.46,"body":"will do the one, two, because"},{"speaker":"Charles Goldfarb","startTime":1767.46,"endTime":1770.25,"body":"it's local, because it's"},{"speaker":"Charles Goldfarb","startTime":1767.46,"endTime":1770.25,"body":"straightforward. And because"},{"speaker":"Charles Goldfarb","startTime":1770.28,"endTime":1774.0,"body":"there are good results in the"},{"speaker":"Charles Goldfarb","startTime":1770.28,"endTime":1774.0,"body":"literature. But I will not go to"},{"speaker":"Charles Goldfarb","startTime":1774.0,"endTime":1780.33,"body":"the mat for that operation. I"},{"speaker":"Charles Goldfarb","startTime":1774.0,"endTime":1780.33,"body":"just sometimes question how much"},{"speaker":"Charles Goldfarb","startTime":1780.33,"endTime":1784.08,"body":"vascularity I'm truly bringing,"},{"speaker":"Charles Goldfarb","startTime":1780.33,"endTime":1784.08,"body":"I questioned whether I'm just"},{"speaker":"Charles Goldfarb","startTime":1784.08,"endTime":1788.4,"body":"creating scar tissue. But I"},{"speaker":"Charles Goldfarb","startTime":1784.08,"endTime":1788.4,"body":"don't think it's an unreasonable"},{"speaker":"Charles Goldfarb","startTime":1788.4,"endTime":1790.23,"body":"option in the right patient."},{"speaker":"Chris Dy","startTime":1791.98,"endTime":1795.1,"body":"Is fragment excision"},{"speaker":"Chris Dy","startTime":1791.98,"endTime":1795.1,"body":"an option here? That was brought"},{"speaker":"Chris Dy","startTime":1795.1,"endTime":1796.93,"body":"up in the email from Ioannis."},{"speaker":"Charles Goldfarb","startTime":1798.25,"endTime":1800.56,"body":"Not for me,"},{"speaker":"Charles Goldfarb","startTime":1798.25,"endTime":1800.56,"body":"because I don't Think you can"},{"speaker":"Charles Goldfarb","startTime":1800.56,"endTime":1805.45,"body":"take out a fragment This isn't."},{"speaker":"Charles Goldfarb","startTime":1800.56,"endTime":1805.45,"body":"So there are the super proximal"},{"speaker":"Charles Goldfarb","startTime":1805.45,"endTime":1809.35,"body":"proximal poles, and there are"},{"speaker":"Charles Goldfarb","startTime":1805.45,"endTime":1809.35,"body":"the small proximal bolt, and"},{"speaker":"Charles Goldfarb","startTime":1809.35,"endTime":1813.79,"body":"there's just a proximal pole."},{"speaker":"Charles Goldfarb","startTime":1809.35,"endTime":1813.79,"body":"And that super clearly everyone"},{"speaker":"Charles Goldfarb","startTime":1813.79,"endTime":1817.66,"body":"knows what I'm talking about."},{"speaker":"Charles Goldfarb","startTime":1813.79,"endTime":1817.66,"body":"The Super proximal proximal pole"},{"speaker":"Charles Goldfarb","startTime":1817.66,"endTime":1820.81,"body":"is when it's really just a"},{"speaker":"Charles Goldfarb","startTime":1817.66,"endTime":1820.81,"body":"sliver, mainly the cartilage at"},{"speaker":"Charles Goldfarb","startTime":1820.81,"endTime":1825.34,"body":"the insertion of the"},{"speaker":"Charles Goldfarb","startTime":1820.81,"endTime":1825.34,"body":"Scapholunate ligament, those are"},{"speaker":"Charles Goldfarb","startTime":1825.34,"endTime":1827.98,"body":"just really hard because there's"},{"speaker":"Charles Goldfarb","startTime":1825.34,"endTime":1827.98,"body":"no expectation of healing,"},{"speaker":"Charles Goldfarb","startTime":1828.01,"endTime":1831.28,"body":"there's no real bone on the"},{"speaker":"Charles Goldfarb","startTime":1828.01,"endTime":1831.28,"body":"fragment. This is a fragment"},{"speaker":"Charles Goldfarb","startTime":1831.28,"endTime":1835.51,"body":"that has bone, I think you have"},{"speaker":"Charles Goldfarb","startTime":1831.28,"endTime":1835.51,"body":"to fix it. And I think you can"},{"speaker":"Charles Goldfarb","startTime":1835.51,"endTime":1840.28,"body":"expect it will heal. I think if"},{"speaker":"Charles Goldfarb","startTime":1835.51,"endTime":1840.28,"body":"you try to take this out, you"},{"speaker":"Charles Goldfarb","startTime":1840.28,"endTime":1844.66,"body":"will create a problem because"},{"speaker":"Charles Goldfarb","startTime":1840.28,"endTime":1844.66,"body":"there's simply the ligament"},{"speaker":"Charles Goldfarb","startTime":1844.66,"endTime":1846.79,"body":"won't have enough surface area"},{"speaker":"Charles Goldfarb","startTime":1844.66,"endTime":1846.79,"body":"to attach to."},{"speaker":"Chris Dy","startTime":1847.96,"endTime":1852.1,"body":"So say you're bringing"},{"speaker":"Chris Dy","startTime":1847.96,"endTime":1852.1,"body":"in your one, two, or you're not"},{"speaker":"Chris Dy","startTime":1852.1,"endTime":1854.77,"body":"going to the mat for it and"},{"speaker":"Chris Dy","startTime":1852.1,"endTime":1854.77,"body":"you're doing some kind of"},{"speaker":"Chris Dy","startTime":1855.4,"endTime":1859.24,"body":"cancellous grafting. How do you"},{"speaker":"Chris Dy","startTime":1855.4,"endTime":1859.24,"body":"fix it? How do you do the"},{"speaker":"Chris Dy","startTime":1859.24,"endTime":1862.99,"body":"carpentry on this one? For some"},{"speaker":"Chris Dy","startTime":1859.24,"endTime":1862.99,"body":"of the more sizable proximal"},{"speaker":"Chris Dy","startTime":1862.99,"endTime":1865.3,"body":"pole fragments? And oh, there's"},{"speaker":"Chris Dy","startTime":1862.99,"endTime":1865.3,"body":"some literature out of New York,"},{"speaker":"Chris Dy","startTime":1865.33,"endTime":1868.87,"body":"I think it was combined maybe"},{"speaker":"Chris Dy","startTime":1865.33,"endTime":1868.87,"body":"with Seattle, looking at their"},{"speaker":"Chris Dy","startTime":1868.87,"endTime":1873.1,"body":"experience. So using very small,"},{"speaker":"Chris Dy","startTime":1868.87,"endTime":1873.1,"body":"headless compression screws in"},{"speaker":"Chris Dy","startTime":1873.1,"endTime":1876.76,"body":"tandem usually one or two. What"},{"speaker":"Chris Dy","startTime":1873.1,"endTime":1876.76,"body":"are your thoughts on that"},{"speaker":"Chris Dy","startTime":1876.76,"endTime":1879.1,"body":"technique? Or what would you do"},{"speaker":"Chris Dy","startTime":1876.76,"endTime":1879.1,"body":"in terms of fixation."},{"speaker":"Charles Goldfarb","startTime":1880.05,"endTime":1882.06,"body":"So it really"},{"speaker":"Charles Goldfarb","startTime":1880.05,"endTime":1882.06,"body":"does get down to the size of the"},{"speaker":"Charles Goldfarb","startTime":1882.06,"endTime":1884.37,"body":"fragment, but I should say"},{"speaker":"Charles Goldfarb","startTime":1882.06,"endTime":1884.37,"body":"strongly that I'm a Joe Slade"},{"speaker":"Charles Goldfarb","startTime":1884.37,"endTime":1888.81,"body":"disciple. And Joe Slade taught"},{"speaker":"Charles Goldfarb","startTime":1884.37,"endTime":1888.81,"body":"us that one could approach these"},{"speaker":"Charles Goldfarb","startTime":1888.81,"endTime":1891.33,"body":"fractures from dorsal and"},{"speaker":"Charles Goldfarb","startTime":1888.81,"endTime":1891.33,"body":"initially it was advocated that"},{"speaker":"Charles Goldfarb","startTime":1891.33,"endTime":1893.61,"body":"to be percutaneous, I don't"},{"speaker":"Charles Goldfarb","startTime":1891.33,"endTime":1893.61,"body":"believe in percutaneous because"},{"speaker":"Charles Goldfarb","startTime":1893.85,"endTime":1896.04,"body":"I don't like to wrap up all the"},{"speaker":"Charles Goldfarb","startTime":1893.85,"endTime":1896.04,"body":"soft tissues and tendons in the"},{"speaker":"Charles Goldfarb","startTime":1896.04,"endTime":1901.05,"body":"area, but very small incision,"},{"speaker":"Charles Goldfarb","startTime":1896.04,"endTime":1901.05,"body":"and I placed my K wire and it"},{"speaker":"Charles Goldfarb","startTime":1901.05,"endTime":1905.94,"body":"typically if I think is large"},{"speaker":"Charles Goldfarb","startTime":1901.05,"endTime":1905.94,"body":"enough from a biologist say that"},{"speaker":"Charles Goldfarb","startTime":1905.94,"endTime":1909.21,"body":"mini acutrak, then that's what"},{"speaker":"Charles Goldfarb","startTime":1905.94,"endTime":1909.21,"body":"I'll drill for. And I think"},{"speaker":"Charles Goldfarb","startTime":1909.21,"endTime":1913.77,"body":"that's a two five drill bit for"},{"speaker":"Charles Goldfarb","startTime":1909.21,"endTime":1913.77,"body":"a 3-0 screw, I think I get those"},{"speaker":"Charles Goldfarb","startTime":1913.77,"endTime":1914.43,"body":"confused."},{"speaker":"Chris Dy","startTime":1914.52,"endTime":1916.71,"body":"I think it's two five,"},{"speaker":"Chris Dy","startTime":1914.52,"endTime":1916.71,"body":"two eight in terms of the"},{"speaker":"Chris Dy","startTime":1916.71,"endTime":1918.93,"body":"threads on the tail versus the"},{"speaker":"Chris Dy","startTime":1916.71,"endTime":1918.93,"body":"leading."},{"speaker":"Charles Goldfarb","startTime":1919.17,"endTime":1923.91,"body":"Okay, so So K"},{"speaker":"Charles Goldfarb","startTime":1919.17,"endTime":1923.91,"body":"wire, and then I drill and then"},{"speaker":"Charles Goldfarb","startTime":1923.91,"endTime":1928.11,"body":"I use cancellous bone graft"},{"speaker":"Charles Goldfarb","startTime":1923.91,"endTime":1928.11,"body":"harvested from the same incision"},{"speaker":"Charles Goldfarb","startTime":1929.01,"endTime":1932.73,"body":"lister's tubercle or wherever I"},{"speaker":"Charles Goldfarb","startTime":1929.01,"endTime":1932.73,"body":"pack it down the drill hole, I"},{"speaker":"Charles Goldfarb","startTime":1932.73,"endTime":1935.25,"body":"don't disrupt the cartilage and"},{"speaker":"Charles Goldfarb","startTime":1932.73,"endTime":1935.25,"body":"the cartilage in these cases"},{"speaker":"Charles Goldfarb","startTime":1935.28,"endTime":1938.43,"body":"always looks normal. So if"},{"speaker":"Charles Goldfarb","startTime":1935.28,"endTime":1938.43,"body":"you're going to truly open the"},{"speaker":"Charles Goldfarb","startTime":1938.43,"endTime":1942.12,"body":"fracture, you're going to create"},{"speaker":"Charles Goldfarb","startTime":1938.43,"endTime":1942.12,"body":"a lot more instability, so to"},{"speaker":"Charles Goldfarb","startTime":1942.12,"endTime":1945.3,"body":"speak. So I leave that alone,"},{"speaker":"Charles Goldfarb","startTime":1942.12,"endTime":1945.3,"body":"just drill bone grafting the"},{"speaker":"Charles Goldfarb","startTime":1945.3,"endTime":1949.35,"body":"drill hole placement screw. If"},{"speaker":"Charles Goldfarb","startTime":1945.3,"endTime":1949.35,"body":"it's not big enough for the mini"},{"speaker":"Charles Goldfarb","startTime":1949.35,"endTime":1954.93,"body":"and you're thinking about a"},{"speaker":"Charles Goldfarb","startTime":1949.35,"endTime":1954.93,"body":"micro or to micros, you either"},{"speaker":"Charles Goldfarb","startTime":1954.93,"endTime":1957.72,"body":"do the same thing and just try"},{"speaker":"Charles Goldfarb","startTime":1954.93,"endTime":1957.72,"body":"to place bone graft down the"},{"speaker":"Charles Goldfarb","startTime":1957.72,"endTime":1960.87,"body":"smaller screw holes, or you can"},{"speaker":"Charles Goldfarb","startTime":1957.72,"endTime":1960.87,"body":"create a little window I'm not a"},{"speaker":"Charles Goldfarb","startTime":1960.87,"endTime":1963.18,"body":"huge fan of creating a window"},{"speaker":"Charles Goldfarb","startTime":1960.87,"endTime":1963.18,"body":"through the cartilage to bone"},{"speaker":"Charles Goldfarb","startTime":1963.18,"endTime":1966.9,"body":"graft. But I do sometimes use"},{"speaker":"Charles Goldfarb","startTime":1963.18,"endTime":1966.9,"body":"those micro screws. And I think"},{"speaker":"Charles Goldfarb","startTime":1966.9,"endTime":1969.81,"body":"there's a great role there's"},{"speaker":"Charles Goldfarb","startTime":1966.9,"endTime":1969.81,"body":"still nice compression achieved."},{"speaker":"Charles Goldfarb","startTime":1970.2,"endTime":1973.68,"body":"I do like the concept of placing"},{"speaker":"Charles Goldfarb","startTime":1970.2,"endTime":1973.68,"body":"too but sometimes once all you"},{"speaker":"Charles Goldfarb","startTime":1973.68,"endTime":1977.67,"body":"get Now, if you only get one"},{"speaker":"Charles Goldfarb","startTime":1973.68,"endTime":1977.67,"body":"again, going back to what Joe"},{"speaker":"Charles Goldfarb","startTime":1977.67,"endTime":1983.73,"body":"Slade taught us, you can also"},{"speaker":"Charles Goldfarb","startTime":1977.67,"endTime":1983.73,"body":"decrease the forces across the"},{"speaker":"Charles Goldfarb","startTime":1983.73,"endTime":1988.14,"body":"scaphoid by placing something"},{"speaker":"Charles Goldfarb","startTime":1983.73,"endTime":1988.14,"body":"distally. And I will often use a"},{"speaker":"Charles Goldfarb","startTime":1988.14,"endTime":1991.23,"body":"six-two K wire from the distal"},{"speaker":"Charles Goldfarb","startTime":1988.14,"endTime":1991.23,"body":"scaphoid into the capitate to"},{"speaker":"Charles Goldfarb","startTime":1991.23,"endTime":1994.89,"body":"decrease that lever arm forces."},{"speaker":"Charles Goldfarb","startTime":1991.23,"endTime":1994.89,"body":"Some have advocated Putting a"},{"speaker":"Charles Goldfarb","startTime":1994.89,"endTime":1998.43,"body":"screw, you know putting an"},{"speaker":"Charles Goldfarb","startTime":1994.89,"endTime":1998.43,"body":"acutrak from scaphoid to the"},{"speaker":"Charles Goldfarb","startTime":1998.43,"endTime":2001.82,"body":"capitate and take it out six or"},{"speaker":"Charles Goldfarb","startTime":1998.43,"endTime":2001.82,"body":"eight weeks later. I like a K"},{"speaker":"Charles Goldfarb","startTime":2001.82,"endTime":2004.85,"body":"wire and I'll leave it proud and"},{"speaker":"Charles Goldfarb","startTime":2001.82,"endTime":2004.85,"body":"take it out for six or eight"},{"speaker":"Charles Goldfarb","startTime":2004.85,"endTime":2007.01,"body":"weeks. And I've been happy with"},{"speaker":"Charles Goldfarb","startTime":2004.85,"endTime":2007.01,"body":"that approach. I think it makes"},{"speaker":"Charles Goldfarb","startTime":2007.01,"endTime":2007.67,"body":"some sense."},{"speaker":"Chris Dy","startTime":2008.09,"endTime":2010.91,"body":"So is that like a"},{"speaker":"Chris Dy","startTime":2008.09,"endTime":2010.91,"body":"scaphocapitate Razzle almost?"},{"speaker":"Charles Goldfarb","startTime":2011.39,"endTime":2014.63,"body":"It would be,"},{"speaker":"Charles Goldfarb","startTime":2011.39,"endTime":2014.63,"body":"it would be, with planned"},{"speaker":"Charles Goldfarb","startTime":2014.63,"endTime":2015.23,"body":"removal."},{"speaker":"Chris Dy","startTime":2015.75,"endTime":2018.39,"body":"That's of course you"},{"speaker":"Chris Dy","startTime":2015.75,"endTime":2018.39,"body":"gotta put the planned removal in"},{"speaker":"Chris Dy","startTime":2018.39,"endTime":2021.87,"body":"there. But that's intense. But"},{"speaker":"Chris Dy","startTime":2018.39,"endTime":2021.87,"body":"you know for those that are"},{"speaker":"Chris Dy","startTime":2022.53,"endTime":2025.92,"body":"wondering why put the pin across"},{"speaker":"Chris Dy","startTime":2022.53,"endTime":2025.92,"body":"the SC you know, your scaphoid"},{"speaker":"Chris Dy","startTime":2025.92,"endTime":2028.02,"body":"is going to want to flex if you"},{"speaker":"Chris Dy","startTime":2025.92,"endTime":2028.02,"body":"don't have a lot of stability"},{"speaker":"Chris Dy","startTime":2028.02,"endTime":2032.13,"body":"proximately so you want to stop"},{"speaker":"Chris Dy","startTime":2028.02,"endTime":2032.13,"body":"the scaphoid from flexing. So"},{"speaker":"Chris Dy","startTime":2032.13,"endTime":2034.53,"body":"you've got the pin across the"},{"speaker":"Chris Dy","startTime":2032.13,"endTime":2034.53,"body":"scaphocapitate joint the hold"},{"speaker":"Chris Dy","startTime":2034.53,"endTime":2039.33,"body":"that in place. I find that"},{"speaker":"Chris Dy","startTime":2034.53,"endTime":2039.33,"body":"really interesting. You know, I"},{"speaker":"Chris Dy","startTime":2039.33,"endTime":2042.99,"body":"think that these can be really"},{"speaker":"Chris Dy","startTime":2039.33,"endTime":2042.99,"body":"super, super challenging. The"},{"speaker":"Chris Dy","startTime":2042.99,"endTime":2047.31,"body":"carpentry is really, really"},{"speaker":"Chris Dy","startTime":2042.99,"endTime":2047.31,"body":"important. Is this somebody that"},{"speaker":"Chris Dy","startTime":2047.31,"endTime":2051.63,"body":"you're going to immobilize until"},{"speaker":"Chris Dy","startTime":2047.31,"endTime":2051.63,"body":"off the bat for 10 to 12 weeks"},{"speaker":"Chris Dy","startTime":2051.72,"endTime":2053.46,"body":"and how are you monitoring"},{"speaker":"Chris Dy","startTime":2051.72,"endTime":2053.46,"body":"healing?"},{"speaker":"Charles Goldfarb","startTime":2054.71,"endTime":2056.72,"body":"So that's"},{"speaker":"Charles Goldfarb","startTime":2054.71,"endTime":2056.72,"body":"great point. And you know, it's"},{"speaker":"Charles Goldfarb","startTime":2056.72,"endTime":2059.87,"body":"interesting what I remember from"},{"speaker":"Charles Goldfarb","startTime":2056.72,"endTime":2059.87,"body":"my mentors, you know, some"},{"speaker":"Charles Goldfarb","startTime":2059.87,"endTime":2062.75,"body":"things that you know, granted I"},{"speaker":"Charles Goldfarb","startTime":2059.87,"endTime":2062.75,"body":"don't think I've ever said that"},{"speaker":"Charles Goldfarb","startTime":2062.75,"endTime":2064.67,"body":"someone's gonna remember 10"},{"speaker":"Charles Goldfarb","startTime":2062.75,"endTime":2064.67,"body":"years later, but there are some"},{"speaker":"Charles Goldfarb","startTime":2064.67,"endTime":2068.39,"body":"things that Dr. Mansky would say"},{"speaker":"Charles Goldfarb","startTime":2064.67,"endTime":2068.39,"body":"about congenital or Dr."},{"speaker":"Charles Goldfarb","startTime":2068.42,"endTime":2071.09,"body":"Gelberman would say about"},{"speaker":"Charles Goldfarb","startTime":2068.42,"endTime":2071.09,"body":"different topics and I will"},{"speaker":"Charles Goldfarb","startTime":2071.09,"endTime":2074.51,"body":"never forget Dr. Gelberman it"},{"speaker":"Charles Goldfarb","startTime":2071.09,"endTime":2074.51,"body":"was never just a statement it"},{"speaker":"Charles Goldfarb","startTime":2074.51,"endTime":2079.25,"body":"was always a pimp question. That"},{"speaker":"Charles Goldfarb","startTime":2074.51,"endTime":2079.25,"body":"was full expectation that the"},{"speaker":"Charles Goldfarb","startTime":2079.25,"endTime":2083.15,"body":"answer would be correct. But"},{"speaker":"Charles Goldfarb","startTime":2079.25,"endTime":2083.15,"body":"proximal poles take forever to"},{"speaker":"Charles Goldfarb","startTime":2083.15,"endTime":2086.54,"body":"heal. An average healing time"},{"speaker":"Charles Goldfarb","startTime":2083.15,"endTime":2086.54,"body":"for approximately all non union"},{"speaker":"Charles Goldfarb","startTime":2086.54,"endTime":2092.84,"body":"is 12 to 14 weeks. That is a"},{"speaker":"Charles Goldfarb","startTime":2086.54,"endTime":2092.84,"body":"long time. And so my general"},{"speaker":"Charles Goldfarb","startTime":2092.84,"endTime":2096.14,"body":"strategy and I'd love to hear"},{"speaker":"Charles Goldfarb","startTime":2092.84,"endTime":2096.14,"body":"yours. My general strategy"},{"speaker":"Charles Goldfarb","startTime":2096.14,"endTime":2099.89,"body":"doesn't change for these"},{"speaker":"Charles Goldfarb","startTime":2096.14,"endTime":2099.89,"body":"fractures. It is six weeks post"},{"speaker":"Charles Goldfarb","startTime":2099.89,"endTime":2103.19,"body":"op operative immobilization and"},{"speaker":"Charles Goldfarb","startTime":2099.89,"endTime":2103.19,"body":"a thumb Spica IP free and it's"},{"speaker":"Charles Goldfarb","startTime":2103.19,"endTime":2106.52,"body":"six weeks I get them out"},{"speaker":"Charles Goldfarb","startTime":2103.19,"endTime":2106.52,"body":"assuming I have some trust in"},{"speaker":"Charles Goldfarb","startTime":2106.52,"endTime":2110.33,"body":"the patient. And that doesn't"},{"speaker":"Charles Goldfarb","startTime":2106.52,"endTime":2110.33,"body":"always exist that trust. But if"},{"speaker":"Charles Goldfarb","startTime":2110.33,"endTime":2113.99,"body":"I do trust them, they go into"},{"speaker":"Charles Goldfarb","startTime":2110.33,"endTime":2113.99,"body":"removable brace, they can"},{"speaker":"Charles Goldfarb","startTime":2113.99,"endTime":2117.56,"body":"shower, they can do some gentle"},{"speaker":"Charles Goldfarb","startTime":2113.99,"endTime":2117.56,"body":"wrist motion, if there's no"},{"speaker":"Charles Goldfarb","startTime":2117.56,"endTime":2122.15,"body":"escape, oh capitate pen, but"},{"speaker":"Charles Goldfarb","startTime":2117.56,"endTime":2122.15,"body":"nothing passive, nothing"},{"speaker":"Charles Goldfarb","startTime":2122.15,"endTime":2127.07,"body":"aggressive, and splint to be"},{"speaker":"Charles Goldfarb","startTime":2122.15,"endTime":2127.07,"body":"worn essentially 24/7. And then"},{"speaker":"Charles Goldfarb","startTime":2127.07,"endTime":2132.14,"body":"I consider a CT scan of eight to"},{"speaker":"Charles Goldfarb","startTime":2127.07,"endTime":2132.14,"body":"10 weeks to give me give me an"},{"speaker":"Charles Goldfarb","startTime":2132.14,"endTime":2134.6,"body":"update, especially when the X"},{"speaker":"Charles Goldfarb","startTime":2132.14,"endTime":2134.6,"body":"rays are inconclusive, which"},{"speaker":"Charles Goldfarb","startTime":2134.6,"endTime":2137.18,"body":"they always are. How does your"},{"speaker":"Charles Goldfarb","startTime":2134.6,"endTime":2137.18,"body":"strategy differ?"},{"speaker":"Chris Dy","startTime":2138.29,"endTime":2140.09,"body":"Not terribly"},{"speaker":"Chris Dy","startTime":2138.29,"endTime":2140.09,"body":"different. I remember being on"},{"speaker":"Chris Dy","startTime":2140.09,"endTime":2146.63,"body":"the receiving end of that pimp"},{"speaker":"Chris Dy","startTime":2140.09,"endTime":2146.63,"body":"question. That's always fun. I"},{"speaker":"Chris Dy","startTime":2146.63,"endTime":2149.0,"body":"was actually telling some Dr."},{"speaker":"Chris Dy","startTime":2146.63,"endTime":2149.0,"body":"Gelberman stories in the OR"},{"speaker":"Chris Dy","startTime":2149.0,"endTime":2152.39,"body":"yesterday, because his his"},{"speaker":"Chris Dy","startTime":2149.0,"endTime":2152.39,"body":"longtime scrub Nancy had come in"},{"speaker":"Chris Dy","startTime":2152.39,"endTime":2155.96,"body":"to relieve my scrub tech when I"},{"speaker":"Chris Dy","startTime":2152.39,"endTime":2155.96,"body":"was doing a case down there. So"},{"speaker":"Chris Dy","startTime":2155.96,"endTime":2159.53,"body":"we're having a good time. And"},{"speaker":"Chris Dy","startTime":2155.96,"endTime":2159.53,"body":"yeah, my protocol doesn't differ"},{"speaker":"Chris Dy","startTime":2159.53,"endTime":2164.48,"body":"very much. I like to CT scan. I"},{"speaker":"Chris Dy","startTime":2159.53,"endTime":2164.48,"body":"don't always agree with how the"},{"speaker":"Chris Dy","startTime":2164.48,"endTime":2167.33,"body":"radiologists interpret it in"},{"speaker":"Chris Dy","startTime":2164.48,"endTime":2167.33,"body":"terms of quantification of"},{"speaker":"Chris Dy","startTime":2167.33,"endTime":2170.6,"body":"healing. But I think it's an"},{"speaker":"Chris Dy","startTime":2167.33,"endTime":2170.6,"body":"important thing to have, it is"},{"speaker":"Chris Dy","startTime":2170.6,"endTime":2172.64,"body":"important to pay attention to"},{"speaker":"Chris Dy","startTime":2170.6,"endTime":2172.64,"body":"the radiologist read because"},{"speaker":"Chris Dy","startTime":2172.64,"endTime":2175.28,"body":"that's what patients get. And"},{"speaker":"Chris Dy","startTime":2172.64,"endTime":2175.28,"body":"that's what they see they get it"},{"speaker":"Chris Dy","startTime":2175.28,"endTime":2178.16,"body":"in the mail or they used to now"},{"speaker":"Chris Dy","startTime":2175.28,"endTime":2178.16,"body":"they get it in the portal. So if"},{"speaker":"Chris Dy","startTime":2178.16,"endTime":2181.55,"body":"you have a disagreement with the"},{"speaker":"Chris Dy","startTime":2178.16,"endTime":2181.55,"body":"radiology read, it's important"},{"speaker":"Chris Dy","startTime":2181.55,"endTime":2184.61,"body":"to let the patient know about"},{"speaker":"Chris Dy","startTime":2181.55,"endTime":2184.61,"body":"that. Usually I use point"},{"speaker":"Chris Dy","startTime":2184.61,"endTime":2187.19,"body":"tenderness. This is obviously an"},{"speaker":"Chris Dy","startTime":2184.61,"endTime":2187.19,"body":"area that's difficult to assess"},{"speaker":"Chris Dy","startTime":2187.22,"endTime":2190.13,"body":"true point tenderness on so"},{"speaker":"Chris Dy","startTime":2187.22,"endTime":2190.13,"body":"that's you know, one less thing"},{"speaker":"Chris Dy","startTime":2190.13,"endTime":2195.44,"body":"that you can use. Try for it."},{"speaker":"Chris Dy","startTime":2190.13,"endTime":2195.44,"body":"Otherwise, protocol doesn't"},{"speaker":"Chris Dy","startTime":2195.44,"endTime":2196.67,"body":"really differ from what you"},{"speaker":"Chris Dy","startTime":2195.44,"endTime":2196.67,"body":"said."},{"speaker":"Charles Goldfarb","startTime":2197.77,"endTime":2202.57,"body":"Yeah. Great"},{"speaker":"Charles Goldfarb","startTime":2197.77,"endTime":2202.57,"body":"case. I think we can do well"},{"speaker":"Charles Goldfarb","startTime":2202.57,"endTime":2205.06,"body":"with these. I really do. I"},{"speaker":"Charles Goldfarb","startTime":2202.57,"endTime":2205.06,"body":"expect them to heal as long as"},{"speaker":"Charles Goldfarb","startTime":2205.06,"endTime":2208.48,"body":"we are patient enough and and"},{"speaker":"Charles Goldfarb","startTime":2205.06,"endTime":2208.48,"body":"the patient can be patient"},{"speaker":"Charles Goldfarb","startTime":2208.48,"endTime":2213.76,"body":"enough. So I love the case. And"},{"speaker":"Charles Goldfarb","startTime":2208.48,"endTime":2213.76,"body":"I hope we learned the outcome"},{"speaker":"Charles Goldfarb","startTime":2213.79,"endTime":2215.83,"body":"from all the way from our"},{"speaker":"Charles Goldfarb","startTime":2213.79,"endTime":2215.83,"body":"friends in Greece."},{"speaker":"Chris Dy","startTime":2216.25,"endTime":2220.3,"body":"Yes, please share,"},{"speaker":"Chris Dy","startTime":2216.25,"endTime":2220.3,"body":"please share. And just to follow"},{"speaker":"Chris Dy","startTime":2220.3,"endTime":2224.17,"body":"up on what you just said, I"},{"speaker":"Chris Dy","startTime":2220.3,"endTime":2224.17,"body":"agree setting the stage in terms"},{"speaker":"Chris Dy","startTime":2224.17,"endTime":2226.93,"body":"of expectations of how long it's"},{"speaker":"Chris Dy","startTime":2224.17,"endTime":2226.93,"body":"going to take to heal and what"},{"speaker":"Chris Dy","startTime":2226.93,"endTime":2230.11,"body":"the postoperative course is"},{"speaker":"Chris Dy","startTime":2226.93,"endTime":2230.11,"body":"going to look like and how how"},{"speaker":"Chris Dy","startTime":2230.11,"endTime":2233.26,"body":"much consternation you may feel"},{"speaker":"Chris Dy","startTime":2230.11,"endTime":2233.26,"body":"about this particular diagnosis"},{"speaker":"Chris Dy","startTime":2233.26,"endTime":2235.54,"body":"is important. You don't want to"},{"speaker":"Chris Dy","startTime":2233.26,"endTime":2235.54,"body":"scare them, but you want to set"},{"speaker":"Chris Dy","startTime":2235.54,"endTime":2238.57,"body":"realistic expectations, and then"},{"speaker":"Chris Dy","startTime":2235.54,"endTime":2238.57,"body":"look like a hero at the end."},{"speaker":"Charles Goldfarb","startTime":2239.35,"endTime":2241.36,"body":"Absolutely,"},{"speaker":"Charles Goldfarb","startTime":2239.35,"endTime":2241.36,"body":"you're playing hero ball again."},{"speaker":"Charles Goldfarb","startTime":2243.46,"endTime":2247.93,"body":"I would like to close by saying"},{"speaker":"Charles Goldfarb","startTime":2243.46,"endTime":2247.93,"body":"I moved my office, I am back in"},{"speaker":"Charles Goldfarb","startTime":2247.93,"endTime":2253.24,"body":"the adult world at our main"},{"speaker":"Charles Goldfarb","startTime":2247.93,"endTime":2253.24,"body":"office. And I have to say, so I"},{"speaker":"Charles Goldfarb","startTime":2253.24,"endTime":2255.91,"body":"moved my office seven years ago"},{"speaker":"Charles Goldfarb","startTime":2253.24,"endTime":2255.91,"body":"to go over to Children's"},{"speaker":"Charles Goldfarb","startTime":2255.91,"endTime":2260.74,"body":"Hospital. And then I'm moved"},{"speaker":"Charles Goldfarb","startTime":2255.91,"endTime":2260.74,"body":"back to the adult office space."},{"speaker":"Charles Goldfarb","startTime":2261.04,"endTime":2266.38,"body":"It is amazing how much crap one"},{"speaker":"Charles Goldfarb","startTime":2261.04,"endTime":2266.38,"body":"accumulates in seven years. And"},{"speaker":"Charles Goldfarb","startTime":2266.62,"endTime":2270.94,"body":"it was absolutely fantastic to"},{"speaker":"Charles Goldfarb","startTime":2266.62,"endTime":2270.94,"body":"liberate myself from some of the"},{"speaker":"Charles Goldfarb","startTime":2270.94,"endTime":2275.11,"body":"crap that I accumulated. But I"},{"speaker":"Charles Goldfarb","startTime":2270.94,"endTime":2275.11,"body":"also my one of my favorite"},{"speaker":"Charles Goldfarb","startTime":2275.11,"endTime":2279.34,"body":"things, I came across my file of"},{"speaker":"Charles Goldfarb","startTime":2275.11,"endTime":2279.34,"body":"grateful patient notes. And"},{"speaker":"Charles Goldfarb","startTime":2279.34,"endTime":2282.61,"body":"these handwritten notes still"},{"speaker":"Charles Goldfarb","startTime":2279.34,"endTime":2282.61,"body":"happen. And I still save them."},{"speaker":"Charles Goldfarb","startTime":2282.91,"endTime":2285.88,"body":"And I even print them out if I"},{"speaker":"Charles Goldfarb","startTime":2282.91,"endTime":2285.88,"body":"haven't a good email, but most"},{"speaker":"Charles Goldfarb","startTime":2285.88,"endTime":2289.24,"body":"times they're handwritten. And"},{"speaker":"Charles Goldfarb","startTime":2285.88,"endTime":2289.24,"body":"it's kind of like the nice"},{"speaker":"Charles Goldfarb","startTime":2289.24,"endTime":2292.18,"body":"things people say about the"},{"speaker":"Charles Goldfarb","startTime":2289.24,"endTime":2292.18,"body":"podcast, which gives us fuel,"},{"speaker":"Charles Goldfarb","startTime":2292.51,"endTime":2297.7,"body":"though that file of cards is"},{"speaker":"Charles Goldfarb","startTime":2292.51,"endTime":2297.7,"body":"it's gold. And I am so grateful."},{"speaker":"Chris Dy","startTime":2298.23,"endTime":2302.25,"body":"Yeah, we stopped doing"},{"speaker":"Chris Dy","startTime":2298.23,"endTime":2302.25,"body":"our win of the week segment and"},{"speaker":"Chris Dy","startTime":2302.25,"endTime":2306.45,"body":"thank you for reminding me of"},{"speaker":"Chris Dy","startTime":2302.25,"endTime":2306.45,"body":"that. And on a related note, so"},{"speaker":"Chris Dy","startTime":2306.45,"endTime":2310.02,"body":"first off, it's great to have"},{"speaker":"Chris Dy","startTime":2306.45,"endTime":2310.02,"body":"you back in the IOH, the reason"},{"speaker":"Chris Dy","startTime":2310.02,"endTime":2315.48,"body":"is not because you were fired as"},{"speaker":"Chris Dy","startTime":2310.02,"endTime":2315.48,"body":"chief of peds but because the"},{"speaker":"Chris Dy","startTime":2315.48,"endTime":2318.27,"body":"role was taken over by one of"},{"speaker":"Chris Dy","startTime":2315.48,"endTime":2318.27,"body":"our hand surgery partners, Dr."},{"speaker":"Chris Dy","startTime":2318.27,"endTime":2321.39,"body":"Lindley Wall is following your"},{"speaker":"Chris Dy","startTime":2318.27,"endTime":2321.39,"body":"footsteps and being chief of"},{"speaker":"Chris Dy","startTime":2321.39,"endTime":2324.03,"body":"pediatric orthopedics for for"},{"speaker":"Chris Dy","startTime":2321.39,"endTime":2324.03,"body":"our department. So"},{"speaker":"Chris Dy","startTime":2324.03,"endTime":2325.29,"body":"congratulations to her."},{"speaker":"Charles Goldfarb","startTime":2325.59,"endTime":2328.71,"body":"And she's"},{"speaker":"Charles Goldfarb","startTime":2325.59,"endTime":2328.71,"body":"she's going to be fantastic. We"},{"speaker":"Charles Goldfarb","startTime":2328.71,"endTime":2334.29,"body":"had a nationwide search. And,"},{"speaker":"Charles Goldfarb","startTime":2328.71,"endTime":2334.29,"body":"you know, it was it was, you"},{"speaker":"Charles Goldfarb","startTime":2334.29,"endTime":2337.08,"body":"know, I think we're all happy"},{"speaker":"Charles Goldfarb","startTime":2334.29,"endTime":2337.08,"body":"that Lindley accepted this"},{"speaker":"Charles Goldfarb","startTime":2337.08,"endTime":2339.75,"body":"position, and she will do great"},{"speaker":"Charles Goldfarb","startTime":2337.08,"endTime":2339.75,"body":"things at Children's. She's not"},{"speaker":"Charles Goldfarb","startTime":2339.75,"endTime":2342.36,"body":"she's still be a hand surgeon,"},{"speaker":"Charles Goldfarb","startTime":2339.75,"endTime":2342.36,"body":"but she's gonna be she's"},{"speaker":"Charles Goldfarb","startTime":2342.36,"endTime":2347.01,"body":"transitioning to just being a"},{"speaker":"Charles Goldfarb","startTime":2342.36,"endTime":2347.01,"body":"hand surgeon for kids, maybe a"},{"speaker":"Charles Goldfarb","startTime":2347.01,"endTime":2349.89,"body":"little liberal definition of"},{"speaker":"Charles Goldfarb","startTime":2347.01,"endTime":2349.89,"body":"kids and needs to transition"},{"speaker":"Charles Goldfarb","startTime":2349.89,"endTime":2352.71,"body":"because she didn't want to just"},{"speaker":"Charles Goldfarb","startTime":2349.89,"endTime":2352.71,"body":"abandon her patients, but it's"},{"speaker":"Charles Goldfarb","startTime":2352.71,"endTime":2353.85,"body":"great. I'm so excited for her."},{"speaker":"Chris Dy","startTime":2355.45,"endTime":2358.81,"body":"So that brings me to"},{"speaker":"Chris Dy","startTime":2355.45,"endTime":2358.81,"body":"the reason why I thought about"},{"speaker":"Chris Dy","startTime":2358.81,"endTime":2361.27,"body":"the gratitude thing that you"},{"speaker":"Chris Dy","startTime":2358.81,"endTime":2361.27,"body":"mentioned is I actually have a"},{"speaker":"Chris Dy","startTime":2361.27,"endTime":2367.33,"body":"gratitude folder in my Outlook"},{"speaker":"Chris Dy","startTime":2361.27,"endTime":2367.33,"body":"inbox. So my, my fantastic"},{"speaker":"Chris Dy","startTime":2367.33,"endTime":2371.02,"body":"research coordinator, Carrie"},{"speaker":"Chris Dy","startTime":2367.33,"endTime":2371.02,"body":"Burke, was saying some very nice"},{"speaker":"Chris Dy","startTime":2371.02,"endTime":2374.53,"body":"things about some patient"},{"speaker":"Chris Dy","startTime":2371.02,"endTime":2374.53,"body":"interactions recently. And I"},{"speaker":"Chris Dy","startTime":2374.53,"endTime":2377.62,"body":"just kept dropping those emails"},{"speaker":"Chris Dy","startTime":2374.53,"endTime":2377.62,"body":"into the gratitude folder and"},{"speaker":"Chris Dy","startTime":2377.65,"endTime":2380.62,"body":"that is, you know, my virtual"},{"speaker":"Chris Dy","startTime":2377.65,"endTime":2380.62,"body":"way of keeping track of some"},{"speaker":"Chris Dy","startTime":2380.62,"endTime":2384.16,"body":"things that make me very happy."},{"speaker":"Chris Dy","startTime":2380.62,"endTime":2384.16,"body":"And then I still have like you"},{"speaker":"Chris Dy","startTime":2384.16,"endTime":2389.17,"body":"do the folder in the Office of"},{"speaker":"Chris Dy","startTime":2384.16,"endTime":2389.17,"body":"Patient notes and that is the"},{"speaker":"Chris Dy","startTime":2389.17,"endTime":2392.68,"body":"best I mean, it's why we do it."},{"speaker":"Chris Dy","startTime":2389.17,"endTime":2392.68,"body":"You know, so to anybody"},{"speaker":"Chris Dy","startTime":2392.68,"endTime":2395.2,"body":"listening, I know many of you"},{"speaker":"Chris Dy","startTime":2392.68,"endTime":2395.2,"body":"probably already do this."},{"speaker":"Chris Dy","startTime":2395.44,"endTime":2399.46,"body":"Therapists surgeons trainees, it"},{"speaker":"Chris Dy","startTime":2395.44,"endTime":2399.46,"body":"is the best to do something like"},{"speaker":"Chris Dy","startTime":2399.46,"endTime":2399.76,"body":"that."},{"speaker":"Charles Goldfarb","startTime":2400.0,"endTime":2403.33,"body":"I have to say"},{"speaker":"Charles Goldfarb","startTime":2400.0,"endTime":2403.33,"body":"full disclosure, I struggle a"},{"speaker":"Charles Goldfarb","startTime":2403.33,"endTime":2409.6,"body":"little bit more with the either"},{"speaker":"Charles Goldfarb","startTime":2403.33,"endTime":2409.6,"body":"single like poster size framed"},{"speaker":"Charles Goldfarb","startTime":2409.63,"endTime":2413.86,"body":"patient photos, and sometimes I"},{"speaker":"Charles Goldfarb","startTime":2409.63,"endTime":2413.86,"body":"get collages which are really"},{"speaker":"Charles Goldfarb","startTime":2413.86,"endTime":2417.49,"body":"cool. But then I just don't know"},{"speaker":"Charles Goldfarb","startTime":2413.86,"endTime":2417.49,"body":"what to do with them after you"},{"speaker":"Charles Goldfarb","startTime":2417.49,"endTime":2420.22,"body":"know a while. Those are super"},{"speaker":"Charles Goldfarb","startTime":2417.49,"endTime":2420.22,"body":"thoughtful as well but they"},{"speaker":"Charles Goldfarb","startTime":2420.22,"endTime":2422.68,"body":"don't store quite as easily as a"},{"speaker":"Charles Goldfarb","startTime":2420.22,"endTime":2422.68,"body":"nice card."},{"speaker":"Chris Dy","startTime":2423.55,"endTime":2426.76,"body":"I'm waiting for the"},{"speaker":"Chris Dy","startTime":2423.55,"endTime":2426.76,"body":"Goldfarb microfiche collection"},{"speaker":"Chris Dy","startTime":2427.75,"endTime":2428.56,"body":"of gratitude."},{"speaker":"Charles Goldfarb","startTime":2428.0,"endTime":2432.29,"body":"All right,"},{"speaker":"Charles Goldfarb","startTime":2428.0,"endTime":2432.29,"body":"man, it's great spending late on"},{"speaker":"Charles Goldfarb","startTime":2432.29,"endTime":2435.44,"body":"a Thursday night with you. I"},{"speaker":"Charles Goldfarb","startTime":2432.29,"endTime":2435.44,"body":"it's good to see you."},{"speaker":"Chris Dy","startTime":2435.95,"endTime":2438.65,"body":"Pleasure's mine. Look"},{"speaker":"Chris Dy","startTime":2435.95,"endTime":2438.65,"body":"forward to our next recording."},{"speaker":"Chris Dy","startTime":2438.65,"endTime":2441.08,"body":"Everybody have a wonderful week."},{"speaker":"Charles Goldfarb","startTime":2441.56,"endTime":2444.62,"body":"Absolutely."},{"speaker":"Charles Goldfarb","startTime":2441.56,"endTime":2444.62,"body":"Thank you. Happy Bastille Day,"},{"speaker":"Charles Goldfarb","startTime":2444.65,"endTime":2445.28,"body":"by the way."},{"speaker":"Chris Dy","startTime":2446.42,"endTime":2448.64,"body":"That's a that's not an"},{"speaker":"Chris Dy","startTime":2446.42,"endTime":2448.64,"body":"American holiday. Right. That's"},{"speaker":"Chris Dy","startTime":2448.64,"endTime":2449.63,"body":"that's a French holiday."},{"speaker":"Charles Goldfarb","startTime":2449.66,"endTime":2450.77,"body":"It's a reason"},{"speaker":"Charles Goldfarb","startTime":2449.66,"endTime":2450.77,"body":"to celebrate."},{"speaker":"Chris Dy","startTime":2452.6,"endTime":2454.76,"body":"I do love French"},{"speaker":"Chris Dy","startTime":2452.6,"endTime":2454.76,"body":"pastries. So I will go eat some."},{"speaker":"Charles Goldfarb","startTime":2457.34,"endTime":2459.32,"body":"Hey, Chris,"},{"speaker":"Charles Goldfarb","startTime":2457.34,"endTime":2459.32,"body":"that was fun. Let's do it again"},{"speaker":"Charles Goldfarb","startTime":2459.32,"endTime":2459.83,"body":"real soon."},{"speaker":"Chris Dy","startTime":2460.1,"endTime":2462.62,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":2460.1,"endTime":2462.62,"body":"sure to check us out on Twitter"},{"speaker":"Chris Dy","startTime":2462.77,"endTime":2465.05,"body":"@handpodcast. Hey, Chuck, what's"},{"speaker":"Chris Dy","startTime":2462.77,"endTime":2465.05,"body":"your Twitter handle?"},{"speaker":"Charles Goldfarb","startTime":2465.35,"endTime":2467.48,"body":"Mine is"},{"speaker":"Charles Goldfarb","startTime":2465.35,"endTime":2467.48,"body":"@congenitalhand."},{"speaker":"Chris Dy","startTime":2467.63,"endTime":2471.44,"body":"What about you? Mine"},{"speaker":"Chris Dy","startTime":2467.63,"endTime":2471.44,"body":"is @ChrisDyMD spelled dy. And if"},{"speaker":"Chris Dy","startTime":2471.44,"endTime":2473.51,"body":"you'd like to email us, you can"},{"speaker":"Chris Dy","startTime":2471.44,"endTime":2473.51,"body":"reach us at"},{"speaker":"Chris Dy","startTime":2473.69,"endTime":2475.25,"body":"handpodcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":2476.18,"endTime":2478.34,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":2476.18,"endTime":2478.34,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2478.34,"endTime":2479.39,"body":"get your podcasts."},{"speaker":"Chris Dy","startTime":2479.45,"endTime":2481.67,"body":"And be sure to leave a"},{"speaker":"Chris Dy","startTime":2479.45,"endTime":2481.67,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2481.67,"endTime":2482.09,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":2482.45,"endTime":2484.76,"body":"Special thanks"},{"speaker":"Charles Goldfarb","startTime":2482.45,"endTime":2484.76,"body":"to Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":2484.76,"endTime":2488.72,"body":"music. And remember, keep the"},{"speaker":"Charles Goldfarb","startTime":2484.76,"endTime":2488.72,"body":"upper hand. Come back next time."}]}