{"version":"1.0.0","segments":[{"speaker":"Charles Goldfarb","startTime":3.63,"endTime":5.97,"body":"Welcome to the"},{"speaker":"Charles Goldfarb","startTime":3.63,"endTime":5.97,"body":"upper hand podcast where Chuck"},{"speaker":"Charles Goldfarb","startTime":6.0,"endTime":7.53,"body":"and Chris talk Hand Surgery."},{"speaker":"Chris Dy","startTime":7.89,"endTime":9.69,"body":"We are to hand"},{"speaker":"Chris Dy","startTime":7.89,"endTime":9.69,"body":"surgeons at Washington"},{"speaker":"Chris Dy","startTime":9.69,"endTime":12.33,"body":"University in St. Louis here to"},{"speaker":"Chris Dy","startTime":9.69,"endTime":12.33,"body":"talk about all things hand"},{"speaker":"Chris Dy","startTime":12.33,"endTime":14.64,"body":"surgery related from technical"},{"speaker":"Chris Dy","startTime":12.33,"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":18.93,"endTime":21.3,"body":"And thank you in"},{"speaker":"Chris Dy","startTime":18.93,"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 podcast."},{"speaker":"Charles Goldfarb","startTime":23.999,"endTime":24.869,"body":"Oh, hey,"},{"speaker":"Charles Goldfarb","startTime":23.999,"endTime":24.869,"body":"Chris."},{"speaker":"Chris Dy","startTime":25.17,"endTime":26.28,"body":"Hey, Chuck, how are"},{"speaker":"Chris Dy","startTime":25.17,"endTime":26.28,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":26.699,"endTime":30.209,"body":"I'm good. I'm"},{"speaker":"Charles Goldfarb","startTime":26.699,"endTime":30.209,"body":"doing doing back to back early"},{"speaker":"Charles Goldfarb","startTime":30.209,"endTime":31.709,"body":"morning podcast on the weekend."},{"speaker":"Chris Dy","startTime":32.1,"endTime":34.56,"body":"Yeah, you know, I"},{"speaker":"Chris Dy","startTime":32.1,"endTime":34.56,"body":"slept in today. I didn't do my"},{"speaker":"Chris Dy","startTime":34.56,"endTime":36.96,"body":"workout before the podcast"},{"speaker":"Chris Dy","startTime":34.56,"endTime":36.96,"body":"because I'm looking. I'm like,"},{"speaker":"Chris Dy","startTime":36.96,"endTime":40.29,"body":"Yeah, I know. I know. It's"},{"speaker":"Chris Dy","startTime":36.96,"endTime":40.29,"body":"crazy. It's crazy. I'm looking"},{"speaker":"Chris Dy","startTime":40.29,"endTime":44.25,"body":"at some, some REITs for later"},{"speaker":"Chris Dy","startTime":40.29,"endTime":44.25,"body":"on, but it's gonna be a fun day."},{"speaker":"Chris Dy","startTime":45.0,"endTime":47.34,"body":"Like we mentioned before, it's"},{"speaker":"Chris Dy","startTime":45.0,"endTime":47.34,"body":"one of the last weekend's I'm in"},{"speaker":"Chris Dy","startTime":47.34,"endTime":52.02,"body":"St. Louis Foley for a while. So"},{"speaker":"Chris Dy","startTime":47.34,"endTime":52.02,"body":"gonna cook again, cooked again"},{"speaker":"Chris Dy","startTime":52.05,"endTime":53.7,"body":"cooked yesterday. It was"},{"speaker":"Chris Dy","startTime":52.05,"endTime":53.7,"body":"fantastic."},{"speaker":"Charles Goldfarb","startTime":54.57,"endTime":57.99,"body":"We're so"},{"speaker":"Charles Goldfarb","startTime":54.57,"endTime":57.99,"body":"different. 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It's a"},{"speaker":"Charles Goldfarb","startTime":65.97,"endTime":68.31,"body":"way we connect with our"},{"speaker":"Charles Goldfarb","startTime":68.31,"endTime":72.45,"body":"residents and fellows, and each"},{"speaker":"Charles Goldfarb","startTime":68.31,"endTime":72.45,"body":"month have a session and should"},{"speaker":"Charles Goldfarb","startTime":72.45,"endTime":72.87,"body":"be great."},{"speaker":"Chris Dy","startTime":73.89,"endTime":76.71,"body":"Now you guys are doing"},{"speaker":"Chris Dy","startTime":73.89,"endTime":76.71,"body":"it over coffee, you mentioned in"},{"speaker":"Chris Dy","startTime":76.71,"endTime":79.83,"body":"your email, but the cafe used to"},{"speaker":"Chris Dy","startTime":76.71,"endTime":79.83,"body":"go to as an open early anymore."},{"speaker":"Charles Goldfarb","startTime":80.34,"endTime":81.78,"body":"Yeah, they"},{"speaker":"Charles Goldfarb","startTime":80.34,"endTime":81.78,"body":"changed their hours, they don't"},{"speaker":"Charles Goldfarb","startTime":81.78,"endTime":84.39,"body":"open till eight and I you know,"},{"speaker":"Charles Goldfarb","startTime":81.78,"endTime":84.39,"body":"eight o'clock is fine, except"},{"speaker":"Charles Goldfarb","startTime":84.39,"endTime":87.48,"body":"for starts to get into the day."},{"speaker":"Charles Goldfarb","startTime":84.39,"endTime":87.48,"body":"And I don't want this to be a"},{"speaker":"Charles Goldfarb","startTime":87.48,"endTime":91.26,"body":"burden. 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You get me into"},{"speaker":"Chris Dy","startTime":171.99,"endTime":174.21,"body":"this fellowship, you get exposed"},{"speaker":"Chris Dy","startTime":171.99,"endTime":174.21,"body":"to pretty much everything you"},{"speaker":"Chris Dy","startTime":174.21,"endTime":178.14,"body":"want to that's possible under"},{"speaker":"Chris Dy","startTime":174.21,"endTime":178.14,"body":"the sun in terms of hand and"},{"speaker":"Chris Dy","startTime":178.14,"endTime":182.19,"body":"upper extremity. You know, we're"},{"speaker":"Chris Dy","startTime":178.14,"endTime":182.19,"body":"light on elbow. And we're very"},{"speaker":"Chris Dy","startTime":182.19,"endTime":186.42,"body":"clear about that in our in our"},{"speaker":"Chris Dy","startTime":182.19,"endTime":186.42,"body":"interviews. But aside from that,"},{"speaker":"Chris Dy","startTime":186.45,"endTime":189.72,"body":"it's pretty awesome. 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I"},{"speaker":"Charles Goldfarb","startTime":198.509,"endTime":201.809,"body":"mean, advanced arthritic elbows"},{"speaker":"Charles Goldfarb","startTime":198.509,"endTime":201.809,"body":"really all I would say the soft"},{"speaker":"Charles Goldfarb","startTime":201.809,"endTime":204.899,"body":"tissue management around the"},{"speaker":"Charles Goldfarb","startTime":201.809,"endTime":204.899,"body":"elbow, the adolescent elbow, the"},{"speaker":"Charles Goldfarb","startTime":204.899,"endTime":209.669,"body":"young adult elbow, some ligament"},{"speaker":"Charles Goldfarb","startTime":204.899,"endTime":209.669,"body":"but you're right. We don't have"},{"speaker":"Charles Goldfarb","startTime":209.669,"endTime":212.729,"body":"that. We don't do total elbows,"},{"speaker":"Charles Goldfarb","startTime":209.669,"endTime":212.729,"body":"for example. But everything else"},{"speaker":"Charles Goldfarb","startTime":212.729,"endTime":214.829,"body":"you're right. I didn't used to"},{"speaker":"Charles Goldfarb","startTime":212.729,"endTime":214.829,"body":"be able to say that, right. I"},{"speaker":"Charles Goldfarb","startTime":214.829,"endTime":218.099,"body":"mean, we we used to have when I"},{"speaker":"Charles Goldfarb","startTime":214.829,"endTime":218.099,"body":"first started we didn't have"},{"speaker":"Charles Goldfarb","startTime":218.099,"endTime":221.099,"body":"great flexes. And we didn't have"},{"speaker":"Charles Goldfarb","startTime":218.099,"endTime":221.099,"body":"great soft tissue covers. So"},{"speaker":"Charles Goldfarb","startTime":221.099,"endTime":222.779,"body":"it's been it's been fun to"},{"speaker":"Charles Goldfarb","startTime":221.099,"endTime":222.779,"body":"watch."},{"speaker":"Chris Dy","startTime":223.649,"endTime":225.719,"body":"Yeah, absolutely. And"},{"speaker":"Chris Dy","startTime":223.649,"endTime":225.719,"body":"that's, you know, obviously the"},{"speaker":"Chris Dy","startTime":225.719,"endTime":228.239,"body":"elbow thing is the byproduct of"},{"speaker":"Chris Dy","startTime":225.719,"endTime":228.239,"body":"having probably one of the best"},{"speaker":"Chris Dy","startTime":228.239,"endTime":232.739,"body":"shoulder and elbow services in"},{"speaker":"Chris Dy","startTime":228.239,"endTime":232.739,"body":"the country next to us. So that"},{"speaker":"Chris Dy","startTime":232.799,"endTime":235.859,"body":"that certainly is impacts it but"},{"speaker":"Chris Dy","startTime":232.799,"endTime":235.859,"body":"yeah, it's our program has"},{"speaker":"Chris Dy","startTime":235.859,"endTime":239.219,"body":"changed even in the last you"},{"speaker":"Chris Dy","startTime":235.859,"endTime":239.219,"body":"know, seven years that I've been"},{"speaker":"Chris Dy","startTime":239.219,"endTime":239.759,"body":"practicing."},{"speaker":"Charles Goldfarb","startTime":240.27,"endTime":242.76,"body":"Yeah, well"},{"speaker":"Charles Goldfarb","startTime":240.27,"endTime":242.76,"body":"what's interesting is that our"},{"speaker":"Charles Goldfarb","startTime":242.76,"endTime":245.82,"body":"topic for today which we won't"},{"speaker":"Charles Goldfarb","startTime":242.76,"endTime":245.82,"body":"mention quite yet just to build"},{"speaker":"Charles Goldfarb","startTime":245.82,"endTime":248.73,"body":"the excitement, I feel like"},{"speaker":"Charles Goldfarb","startTime":245.82,"endTime":248.73,"body":"needs some sounds going on like"},{"speaker":"Charles Goldfarb","startTime":248.73,"endTime":253.8,"body":"all the good podcast or or at"},{"speaker":"Charles Goldfarb","startTime":248.73,"endTime":253.8,"body":"least we need lasers Yeah, like"},{"speaker":"Charles Goldfarb","startTime":253.8,"endTime":259.11,"body":"zooming in and out. But our"},{"speaker":"Charles Goldfarb","startTime":253.8,"endTime":259.11,"body":"topic for later is is definitely"},{"speaker":"Charles Goldfarb","startTime":259.35,"endTime":264.15,"body":"a general hand surgeon topic."},{"speaker":"Charles Goldfarb","startTime":259.35,"endTime":264.15,"body":"But the beauty is you and I love"},{"speaker":"Charles Goldfarb","startTime":264.15,"endTime":266.88,"body":"this stuff like it's not like"},{"speaker":"Charles Goldfarb","startTime":264.15,"endTime":266.88,"body":"you know even though we both"},{"speaker":"Charles Goldfarb","startTime":266.88,"endTime":270.27,"body":"have our specialties wise I"},{"speaker":"Charles Goldfarb","startTime":266.88,"endTime":270.27,"body":"still love bread and butter hand"},{"speaker":"Charles Goldfarb","startTime":270.27,"endTime":270.81,"body":"as I call it."},{"speaker":"Chris Dy","startTime":271.47,"endTime":273.93,"body":"Yeah, every now and"},{"speaker":"Chris Dy","startTime":271.47,"endTime":273.93,"body":"then I'll get asked if I want a"},{"speaker":"Chris Dy","startTime":273.93,"endTime":278.13,"body":"purely nerve practice. And I"},{"speaker":"Chris Dy","startTime":273.93,"endTime":278.13,"body":"don't think I do it's just you"},{"speaker":"Chris Dy","startTime":278.13,"endTime":281.1,"body":"know, first off it's"},{"speaker":"Chris Dy","startTime":278.13,"endTime":281.1,"body":"educationally it's not as great"},{"speaker":"Chris Dy","startTime":281.1,"endTime":283.77,"body":"for the trainees but I also love"},{"speaker":"Chris Dy","startTime":281.1,"endTime":283.77,"body":"this stuff. You know, I love"},{"speaker":"Chris Dy","startTime":283.77,"endTime":286.89,"body":"doing being the general hand"},{"speaker":"Chris Dy","startTime":283.77,"endTime":286.89,"body":"surgeon now it will could"},{"speaker":"Chris Dy","startTime":286.89,"endTime":288.93,"body":"probably get a little more"},{"speaker":"Chris Dy","startTime":286.89,"endTime":288.93,"body":"selective about this stuff I"},{"speaker":"Chris Dy","startTime":288.93,"endTime":293.52,"body":"will and will not see. But and"},{"speaker":"Chris Dy","startTime":288.93,"endTime":293.52,"body":"maybe you can share some insight"},{"speaker":"Chris Dy","startTime":293.52,"endTime":296.31,"body":"into how your practice your"},{"speaker":"Chris Dy","startTime":293.52,"endTime":296.31,"body":"selection criteria for your"},{"speaker":"Chris Dy","startTime":296.31,"endTime":299.34,"body":"scheduling has changed over"},{"speaker":"Chris Dy","startTime":296.31,"endTime":299.34,"body":"time. But overall, I love the"},{"speaker":"Chris Dy","startTime":299.34,"endTime":301.92,"body":"general hand stuff. I love the"},{"speaker":"Chris Dy","startTime":299.34,"endTime":301.92,"body":"trauma. It's all good."},{"speaker":"Charles Goldfarb","startTime":302.279,"endTime":305.129,"body":"Yeah, no, I"},{"speaker":"Charles Goldfarb","startTime":302.279,"endTime":305.129,"body":"think, ultimately time will do"},{"speaker":"Charles Goldfarb","startTime":305.129,"endTime":307.409,"body":"that to you, right? I mean, you"},{"speaker":"Charles Goldfarb","startTime":305.129,"endTime":307.409,"body":"just won't have time to do"},{"speaker":"Charles Goldfarb","startTime":307.409,"endTime":310.049,"body":"everything you want to do. And"},{"speaker":"Charles Goldfarb","startTime":307.409,"endTime":310.049,"body":"you're probably already there."},{"speaker":"Charles Goldfarb","startTime":310.229,"endTime":314.999,"body":"But I tried to change my"},{"speaker":"Charles Goldfarb","startTime":310.229,"endTime":314.999,"body":"practice a bit by saying I"},{"speaker":"Charles Goldfarb","startTime":314.999,"endTime":318.959,"body":"wouldn't see patients over the"},{"speaker":"Charles Goldfarb","startTime":314.999,"endTime":318.959,"body":"age of 45. And that does"},{"speaker":"Charles Goldfarb","startTime":318.959,"endTime":321.509,"body":"fundamentally change your"},{"speaker":"Charles Goldfarb","startTime":318.959,"endTime":321.509,"body":"practice, I do fewer triggers"},{"speaker":"Charles Goldfarb","startTime":321.509,"endTime":326.399,"body":"and fewer cartels, not zero,"},{"speaker":"Charles Goldfarb","startTime":321.509,"endTime":326.399,"body":"fewer CMCS. But the reality is,"},{"speaker":"Charles Goldfarb","startTime":326.399,"endTime":329.279,"body":"I also am a pushover and"},{"speaker":"Charles Goldfarb","startTime":326.399,"endTime":329.279,"body":"patients I've seen before they"},{"speaker":"Charles Goldfarb","startTime":329.279,"endTime":332.159,"body":"want to come back, obviously, I"},{"speaker":"Charles Goldfarb","startTime":329.279,"endTime":332.159,"body":"lead them and direct referrals"},{"speaker":"Charles Goldfarb","startTime":332.159,"endTime":335.789,"body":"and patient, you know, so it's"},{"speaker":"Charles Goldfarb","startTime":332.159,"endTime":335.789,"body":"just a random person who calls"},{"speaker":"Charles Goldfarb","startTime":335.789,"endTime":339.419,"body":"WashU and says, Hey, I need a"},{"speaker":"Charles Goldfarb","startTime":335.789,"endTime":339.419,"body":"doctor from our carpal tunnel."},{"speaker":"Charles Goldfarb","startTime":339.419,"endTime":344.189,"body":"I'm 73. The way our system works"},{"speaker":"Charles Goldfarb","startTime":339.419,"endTime":344.189,"body":"is our schedulers kind of find"},{"speaker":"Charles Goldfarb","startTime":344.189,"endTime":346.919,"body":"the first available and when"},{"speaker":"Charles Goldfarb","startTime":344.189,"endTime":346.919,"body":"they see I'm the first available"},{"speaker":"Charles Goldfarb","startTime":346.919,"endTime":349.619,"body":"if that happens, then they just"},{"speaker":"Charles Goldfarb","startTime":346.919,"endTime":349.619,"body":"get which which I think is"},{"speaker":"Charles Goldfarb","startTime":349.619,"endTime":351.359,"body":"great. It helps others build"},{"speaker":"Charles Goldfarb","startTime":349.619,"endTime":351.359,"body":"their practice to"},{"speaker":"Chris Dy","startTime":351.839,"endTime":353.909,"body":"Yes, I've been the"},{"speaker":"Chris Dy","startTime":351.839,"endTime":353.909,"body":"recipient of many patients to"},{"speaker":"Chris Dy","startTime":353.909,"endTime":357.539,"body":"see Dr. Goldfarb. This is only"},{"speaker":"Chris Dy","startTime":353.909,"endTime":357.539,"body":"seeing children now. Right,"},{"speaker":"Chris Dy","startTime":357.539,"endTime":361.709,"body":"right. Yes, that's that's what"},{"speaker":"Chris Dy","startTime":357.539,"endTime":361.709,"body":"we're going with. Yeah, I'm too"},{"speaker":"Chris Dy","startTime":361.709,"endTime":363.569,"body":"old to see Dr. Goldfarb. Okay,"},{"speaker":"Chris Dy","startTime":361.709,"endTime":363.569,"body":"cool."},{"speaker":"Charles Goldfarb","startTime":363.689,"endTime":368.339,"body":"I love it. We,"},{"speaker":"Charles Goldfarb","startTime":363.689,"endTime":368.339,"body":"you know, we we, as everyone"},{"speaker":"Charles Goldfarb","startTime":368.339,"endTime":371.789,"body":"knows, we appreciate our"},{"speaker":"Charles Goldfarb","startTime":368.339,"endTime":371.789,"body":"audience. And we really do, it"},{"speaker":"Charles Goldfarb","startTime":371.789,"endTime":376.139,"body":"remains the fuel that helps us."},{"speaker":"Charles Goldfarb","startTime":371.789,"endTime":376.139,"body":"We are trying to gather more"},{"speaker":"Charles Goldfarb","startTime":376.139,"endTime":378.389,"body":"information. So if you look in"},{"speaker":"Charles Goldfarb","startTime":376.139,"endTime":378.389,"body":"the shownotes, there's a request"},{"speaker":"Charles Goldfarb","startTime":378.389,"endTime":385.649,"body":"to complete a new survey. We are"},{"speaker":"Charles Goldfarb","startTime":378.389,"endTime":385.649,"body":"asking for new reviews. Because"},{"speaker":"Charles Goldfarb","startTime":385.649,"endTime":387.719,"body":"that, you know, helps us build"},{"speaker":"Charles Goldfarb","startTime":385.649,"endTime":387.719,"body":"our brand. And we're still"},{"speaker":"Charles Goldfarb","startTime":387.719,"endTime":390.179,"body":"hoping we're still planning I'm"},{"speaker":"Charles Goldfarb","startTime":387.719,"endTime":390.179,"body":"hoping planning on doing a"},{"speaker":"Charles Goldfarb","startTime":390.179,"endTime":394.979,"body":"giveaway of Chris has signed"},{"speaker":"Charles Goldfarb","startTime":390.179,"endTime":394.979,"body":"textbooks. So lots out there for"},{"speaker":"Charles Goldfarb","startTime":394.979,"endTime":395.129,"body":"you"},{"speaker":"Chris Dy","startTime":395.13,"endTime":399.57,"body":"guys are one of chucks"},{"speaker":"Chris Dy","startTime":395.13,"endTime":399.57,"body":"many assignment textbooks. Yeah,"},{"speaker":"Chris Dy","startTime":399.6,"endTime":403.68,"body":"thank you for doing the survey."},{"speaker":"Chris Dy","startTime":399.6,"endTime":403.68,"body":"I don't want to belabor it too"},{"speaker":"Chris Dy","startTime":403.68,"endTime":407.13,"body":"much. But it is really important"},{"speaker":"Chris Dy","startTime":403.68,"endTime":407.13,"body":"to us. And then also the reviews"},{"speaker":"Chris Dy","startTime":407.13,"endTime":410.19,"body":"are helpful. You know, I like"},{"speaker":"Chris Dy","startTime":407.13,"endTime":410.19,"body":"hearing nice things about Chuck."},{"speaker":"Chris Dy","startTime":410.28,"endTime":413.25,"body":"So please feel free to write"},{"speaker":"Chris Dy","startTime":410.28,"endTime":413.25,"body":"those and ask questions in the"},{"speaker":"Chris Dy","startTime":413.25,"endTime":416.82,"body":"reviews as well. And we'll make"},{"speaker":"Chris Dy","startTime":413.25,"endTime":416.82,"body":"sure to answer them. Have you"},{"speaker":"Chris Dy","startTime":416.82,"endTime":418.5,"body":"had any interesting cases"},{"speaker":"Chris Dy","startTime":416.82,"endTime":418.5,"body":"recently,"},{"speaker":"Charles Goldfarb","startTime":419.22,"endTime":424.47,"body":"I have I have"},{"speaker":"Charles Goldfarb","startTime":419.22,"endTime":424.47,"body":"how much detail to go into, but"},{"speaker":"Charles Goldfarb","startTime":424.47,"endTime":428.67,"body":"I'll say a patient who traveled"},{"speaker":"Charles Goldfarb","startTime":424.47,"endTime":428.67,"body":"from overseas great family, I"},{"speaker":"Charles Goldfarb","startTime":428.67,"endTime":433.38,"body":"saw them when they were quite"},{"speaker":"Charles Goldfarb","startTime":428.67,"endTime":433.38,"body":"young, and made the diagnosis of"},{"speaker":"Charles Goldfarb","startTime":433.38,"endTime":435.87,"body":"ulnar deficiency. And so I don't"},{"speaker":"Charles Goldfarb","startTime":433.38,"endTime":435.87,"body":"want to get into the weeds and"},{"speaker":"Charles Goldfarb","startTime":435.87,"endTime":440.79,"body":"congenital too much. But I tried"},{"speaker":"Charles Goldfarb","startTime":435.87,"endTime":440.79,"body":"something, which I've done"},{"speaker":"Charles Goldfarb","startTime":440.79,"endTime":445.26,"body":"before with some success, not"},{"speaker":"Charles Goldfarb","startTime":440.79,"endTime":445.26,"body":"perfect success. This patient"},{"speaker":"Charles Goldfarb","startTime":445.26,"endTime":448.8,"body":"had a when you have severe older"},{"speaker":"Charles Goldfarb","startTime":445.26,"endTime":448.8,"body":"deficiency, you can have a"},{"speaker":"Charles Goldfarb","startTime":448.8,"endTime":453.72,"body":"fusion between the radius and"},{"speaker":"Charles Goldfarb","startTime":448.8,"endTime":453.72,"body":"the humerus. And sometimes those"},{"speaker":"Charles Goldfarb","startTime":453.72,"endTime":457.08,"body":"patients still have a well"},{"speaker":"Charles Goldfarb","startTime":453.72,"endTime":457.08,"body":"formed all night at the elbow."},{"speaker":"Charles Goldfarb","startTime":457.08,"endTime":459.75,"body":"So theoretically, if you didn't"},{"speaker":"Charles Goldfarb","startTime":457.08,"endTime":459.75,"body":"have that bony fusion, you could"},{"speaker":"Charles Goldfarb","startTime":459.75,"endTime":462.66,"body":"regain elbow motion with the"},{"speaker":"Charles Goldfarb","startTime":459.75,"endTime":462.66,"body":"bony fusion, your elbows are"},{"speaker":"Charles Goldfarb","startTime":462.66,"endTime":466.53,"body":"where they are. And so with this"},{"speaker":"Charles Goldfarb","startTime":462.66,"endTime":466.53,"body":"patient, we took down the the"},{"speaker":"Charles Goldfarb","startTime":466.56,"endTime":471.45,"body":"synostosis, between the radius"},{"speaker":"Charles Goldfarb","startTime":466.56,"endTime":471.45,"body":"and the ulna interposed tissue,"},{"speaker":"Charles Goldfarb","startTime":471.75,"endTime":475.62,"body":"and initially had regained some"},{"speaker":"Charles Goldfarb","startTime":471.75,"endTime":475.62,"body":"really good motion. And over"},{"speaker":"Charles Goldfarb","startTime":475.62,"endTime":482.13,"body":"time, unfortunately, bone re"},{"speaker":"Charles Goldfarb","startTime":475.62,"endTime":482.13,"body":"formed. Which, you know, I can't"},{"speaker":"Charles Goldfarb","startTime":482.13,"endTime":484.77,"body":"say it's 100% unexpected, and"},{"speaker":"Charles Goldfarb","startTime":482.13,"endTime":484.77,"body":"it's certainly a risk we talked"},{"speaker":"Charles Goldfarb","startTime":484.77,"endTime":487.2,"body":"about, but disappointing. Well,"},{"speaker":"Charles Goldfarb","startTime":484.77,"endTime":487.2,"body":"the patient came back years"},{"speaker":"Charles Goldfarb","startTime":487.2,"endTime":491.55,"body":"later. And what's interesting"},{"speaker":"Charles Goldfarb","startTime":487.2,"endTime":491.55,"body":"is, the diagnosis was only"},{"speaker":"Charles Goldfarb","startTime":491.55,"endTime":495.0,"body":"partially correct. I think the"},{"speaker":"Charles Goldfarb","startTime":491.55,"endTime":495.0,"body":"patient actually has a multiple"},{"speaker":"Charles Goldfarb","startTime":495.0,"endTime":498.9,"body":"synostosis syndrome, which is"},{"speaker":"Charles Goldfarb","startTime":495.0,"endTime":498.9,"body":"not something I've encountered a"},{"speaker":"Charles Goldfarb","startTime":498.9,"endTime":501.75,"body":"great deal but there are lower"},{"speaker":"Charles Goldfarb","startTime":498.9,"endTime":501.75,"body":"extremity issues at the foot"},{"speaker":"Charles Goldfarb","startTime":501.75,"endTime":506.73,"body":"level. There are some Falange"},{"speaker":"Charles Goldfarb","startTime":501.75,"endTime":506.73,"body":"ism issues at the hand where the"},{"speaker":"Charles Goldfarb","startTime":506.73,"endTime":510.45,"body":"joints didn't form. And so the"},{"speaker":"Charles Goldfarb","startTime":506.73,"endTime":510.45,"body":"fingers don't been all all the"},{"speaker":"Charles Goldfarb","startTime":510.45,"endTime":513.81,"body":"joints don't bend in the finger."},{"speaker":"Charles Goldfarb","startTime":510.45,"endTime":513.81,"body":"And so I think that makes me"},{"speaker":"Charles Goldfarb","startTime":513.81,"endTime":519.18,"body":"feel a little bit better about"},{"speaker":"Charles Goldfarb","startTime":513.81,"endTime":519.18,"body":"why the bone reformed. So just"},{"speaker":"Charles Goldfarb","startTime":519.18,"endTime":521.25,"body":"super interesting. We did some"},{"speaker":"Charles Goldfarb","startTime":519.18,"endTime":521.25,"body":"genetic testing super"},{"speaker":"Charles Goldfarb","startTime":521.25,"endTime":526.14,"body":"interesting. I'll close by"},{"speaker":"Charles Goldfarb","startTime":521.25,"endTime":526.14,"body":"saying, you know, her elbows"},{"speaker":"Charles Goldfarb","startTime":526.14,"endTime":530.55,"body":"were essentially fused in a"},{"speaker":"Charles Goldfarb","startTime":526.14,"endTime":530.55,"body":"straight position. And that's"},{"speaker":"Charles Goldfarb","startTime":530.58,"endTime":534.0,"body":"difficult for a couple of"},{"speaker":"Charles Goldfarb","startTime":530.58,"endTime":534.0,"body":"reasons. One, you can't feed"},{"speaker":"Charles Goldfarb","startTime":534.0,"endTime":538.05,"body":"yourself easily or at all."},{"speaker":"Charles Goldfarb","startTime":534.0,"endTime":538.05,"body":"Personal hygiene is easy, you"},{"speaker":"Charles Goldfarb","startTime":538.05,"endTime":542.25,"body":"know, toilet eating is easy, but"},{"speaker":"Charles Goldfarb","startTime":538.05,"endTime":542.25,"body":"can't feed yourself. And as your"},{"speaker":"Charles Goldfarb","startTime":542.25,"endTime":546.33,"body":"arms grow longer, your hands get"},{"speaker":"Charles Goldfarb","startTime":542.25,"endTime":546.33,"body":"further and further from your"},{"speaker":"Charles Goldfarb","startTime":546.36,"endTime":549.24,"body":"face and from the ability to"},{"speaker":"Charles Goldfarb","startTime":546.36,"endTime":549.24,"body":"eat. And so we did a surgery"},{"speaker":"Charles Goldfarb","startTime":549.24,"endTime":553.8,"body":"where we bent one of the elbows"},{"speaker":"Charles Goldfarb","startTime":549.24,"endTime":553.8,"body":"and it was tough, a lot of"},{"speaker":"Charles Goldfarb","startTime":553.8,"endTime":559.89,"body":"scarring. And we you know had to"},{"speaker":"Charles Goldfarb","startTime":553.8,"endTime":559.89,"body":"shorten and also flex through"},{"speaker":"Charles Goldfarb","startTime":559.89,"endTime":563.94,"body":"the bone and surgery technically"},{"speaker":"Charles Goldfarb","startTime":559.89,"endTime":563.94,"body":"went well but it's a it's a very"},{"speaker":"Charles Goldfarb","startTime":563.94,"endTime":569.52,"body":"unusual and interesting and I"},{"speaker":"Charles Goldfarb","startTime":563.94,"endTime":569.52,"body":"think successful surgery. But"},{"speaker":"Charles Goldfarb","startTime":569.52,"endTime":571.77,"body":"it'll be something we have to"},{"speaker":"Charles Goldfarb","startTime":569.52,"endTime":571.77,"body":"watch over time because she's"},{"speaker":"Charles Goldfarb","startTime":571.77,"endTime":574.26,"body":"not done growing and her arms"},{"speaker":"Charles Goldfarb","startTime":571.77,"endTime":574.26,"body":"will grow away further. So"},{"speaker":"Charles Goldfarb","startTime":574.26,"endTime":575.52,"body":"really interesting stuff for me."},{"speaker":"Chris Dy","startTime":577.049,"endTime":579.269,"body":"Interesting case,"},{"speaker":"Chris Dy","startTime":577.049,"endTime":579.269,"body":"never heard of something like"},{"speaker":"Chris Dy","startTime":579.269,"endTime":581.849,"body":"that even through all the"},{"speaker":"Chris Dy","startTime":579.269,"endTime":581.849,"body":"congenital journal cloths I went"},{"speaker":"Chris Dy","startTime":581.849,"endTime":585.269,"body":"do probably heard about and"},{"speaker":"Chris Dy","startTime":581.849,"endTime":585.269,"body":"forgot about it, but at least I"},{"speaker":"Chris Dy","startTime":585.269,"endTime":588.329,"body":"learned it at some point. How do"},{"speaker":"Chris Dy","startTime":585.269,"endTime":588.329,"body":"you make an elbow joint without"},{"speaker":"Chris Dy","startTime":588.329,"endTime":588.989,"body":"making a joint?"},{"speaker":"Charles Goldfarb","startTime":590.34,"endTime":592.23,"body":"So in the"},{"speaker":"Charles Goldfarb","startTime":590.34,"endTime":592.23,"body":"first, you know when we treated"},{"speaker":"Charles Goldfarb","startTime":592.23,"endTime":595.71,"body":"this child as young and one of"},{"speaker":"Charles Goldfarb","startTime":592.23,"endTime":595.71,"body":"my principles is I believe that"},{"speaker":"Charles Goldfarb","startTime":595.71,"endTime":597.72,"body":"if you're going to try to do"},{"speaker":"Charles Goldfarb","startTime":595.71,"endTime":597.72,"body":"something where you restore"},{"speaker":"Charles Goldfarb","startTime":597.72,"endTime":601.56,"body":"motion or improve motion, that"},{"speaker":"Charles Goldfarb","startTime":597.72,"endTime":601.56,"body":"really redo it, the better"},{"speaker":"Charles Goldfarb","startTime":601.59,"endTime":603.69,"body":"because there's so much"},{"speaker":"Charles Goldfarb","startTime":601.59,"endTime":603.69,"body":"remodeling potential the young"},{"speaker":"Charles Goldfarb","startTime":603.69,"endTime":607.68,"body":"child and so six months of age"},{"speaker":"Charles Goldfarb","startTime":603.69,"endTime":607.68,"body":"or, or sometimes even younger,"},{"speaker":"Charles Goldfarb","startTime":607.92,"endTime":610.32,"body":"to me makes a lot of sense. And"},{"speaker":"Charles Goldfarb","startTime":607.92,"endTime":610.32,"body":"we do that with the other"},{"speaker":"Charles Goldfarb","startTime":610.32,"endTime":612.78,"body":"condition we do that, and we're"},{"speaker":"Charles Goldfarb","startTime":610.32,"endTime":612.78,"body":"getting we're getting in the"},{"speaker":"Charles Goldfarb","startTime":612.78,"endTime":618.51,"body":"weeds, but is with owner daimyo"},{"speaker":"Charles Goldfarb","startTime":612.78,"endTime":618.51,"body":"otherwise known as mere hand"},{"speaker":"Charles Goldfarb","startTime":618.51,"endTime":622.53,"body":"where some kids are born to own"},{"speaker":"Charles Goldfarb","startTime":618.51,"endTime":622.53,"body":"the bones. So they don't have"},{"speaker":"Charles Goldfarb","startTime":622.53,"endTime":627.12,"body":"good elbow motion. Same idea"},{"speaker":"Charles Goldfarb","startTime":622.53,"endTime":627.12,"body":"early, early intervention for"},{"speaker":"Charles Goldfarb","startTime":627.12,"endTime":632.04,"body":"this case, there was an older"},{"speaker":"Charles Goldfarb","startTime":627.12,"endTime":632.04,"body":"humeral joint, it just couldn't"},{"speaker":"Charles Goldfarb","startTime":632.04,"endTime":637.62,"body":"develop in function because the"},{"speaker":"Charles Goldfarb","startTime":632.04,"endTime":637.62,"body":"radio humoral sounds doses. So"},{"speaker":"Charles Goldfarb","startTime":637.62,"endTime":637.89,"body":"to"},{"speaker":"Chris Dy","startTime":638.249,"endTime":640.769,"body":"take down, you take"},{"speaker":"Chris Dy","startTime":638.249,"endTime":640.769,"body":"the unready who will synostosis"},{"speaker":"Chris Dy","startTime":640.769,"endTime":644.429,"body":"and allow the only hero joint to"},{"speaker":"Chris Dy","startTime":640.769,"endTime":644.429,"body":"to move set correct to move,"},{"speaker":"Charles Goldfarb","startTime":644.759,"endTime":646.319,"body":"and the"},{"speaker":"Charles Goldfarb","startTime":644.759,"endTime":646.319,"body":"muscles aren't perfect. But you"},{"speaker":"Charles Goldfarb","startTime":646.319,"endTime":649.169,"body":"know, even if you just get"},{"speaker":"Charles Goldfarb","startTime":646.319,"endTime":649.169,"body":"passive motion or therapist"},{"speaker":"Charles Goldfarb","startTime":649.199,"endTime":652.139,"body":"listeners will appreciate this,"},{"speaker":"Charles Goldfarb","startTime":649.199,"endTime":652.139,"body":"even if you just get passive"},{"speaker":"Charles Goldfarb","startTime":652.139,"endTime":654.599,"body":"motion that's dramatically"},{"speaker":"Charles Goldfarb","startTime":652.139,"endTime":654.599,"body":"better than having"},{"speaker":"Chris Dy","startTime":655.589,"endTime":658.919,"body":"well, and especially,"},{"speaker":"Chris Dy","startTime":655.589,"endTime":658.919,"body":"you know, in the era of, you"},{"speaker":"Chris Dy","startTime":658.919,"endTime":661.289,"body":"know, active assist devices that"},{"speaker":"Chris Dy","startTime":658.919,"endTime":661.289,"body":"are going to be much more"},{"speaker":"Chris Dy","startTime":661.289,"endTime":665.189,"body":"helpful. You know, that"},{"speaker":"Chris Dy","startTime":661.289,"endTime":665.189,"body":"something that one this patient"},{"speaker":"Chris Dy","startTime":665.189,"endTime":668.729,"body":"comes, comes to be an adult,"},{"speaker":"Chris Dy","startTime":665.189,"endTime":668.729,"body":"it's probably a nascent"},{"speaker":"Chris Dy","startTime":668.729,"endTime":669.869,"body":"technology, it's gonna help her."},{"speaker":"Charles Goldfarb","startTime":670.139,"endTime":672.509,"body":"Absolutely,"},{"speaker":"Charles Goldfarb","startTime":670.139,"endTime":672.509,"body":"that's exactly right. And we"},{"speaker":"Charles Goldfarb","startTime":672.509,"endTime":675.749,"body":"watch children with"},{"speaker":"Charles Goldfarb","startTime":672.509,"endTime":675.749,"body":"arthrogryposis, where they"},{"speaker":"Charles Goldfarb","startTime":675.749,"endTime":679.109,"body":"usually don't have active"},{"speaker":"Charles Goldfarb","startTime":675.749,"endTime":679.109,"body":"motion. And if we can restore"},{"speaker":"Charles Goldfarb","startTime":679.109,"endTime":682.049,"body":"some passive motion, the"},{"speaker":"Charles Goldfarb","startTime":679.109,"endTime":682.049,"body":"function is incredible. Watching"},{"speaker":"Charles Goldfarb","startTime":682.049,"endTime":687.779,"body":"kids adapt, is really"},{"speaker":"Charles Goldfarb","startTime":682.049,"endTime":687.779,"body":"remarkable. So cool case,"},{"speaker":"Charles Goldfarb","startTime":687.809,"endTime":690.029,"body":"challenging, technically,"},{"speaker":"Charles Goldfarb","startTime":687.809,"endTime":690.029,"body":"interoperability, ultimately,"},{"speaker":"Charles Goldfarb","startTime":690.029,"endTime":693.779,"body":"great outcome. But we should"},{"speaker":"Charles Goldfarb","startTime":690.029,"endTime":693.779,"body":"switch to some bread and butter."},{"speaker":"Chris Dy","startTime":694.199,"endTime":695.789,"body":"Well, we should"},{"speaker":"Chris Dy","startTime":694.199,"endTime":695.789,"body":"actually want to ask you a"},{"speaker":"Chris Dy","startTime":695.819,"endTime":698.789,"body":"question about practice"},{"speaker":"Chris Dy","startTime":695.819,"endTime":698.789,"body":"management. So if you have"},{"speaker":"Chris Dy","startTime":698.789,"endTime":702.299,"body":"somebody coming internationally,"},{"speaker":"Chris Dy","startTime":698.789,"endTime":702.299,"body":"first off, you know, when How"},{"speaker":"Chris Dy","startTime":702.299,"endTime":704.999,"body":"long did it take you to develop"},{"speaker":"Chris Dy","startTime":702.299,"endTime":704.999,"body":"that aspect of your practice,"},{"speaker":"Chris Dy","startTime":704.999,"endTime":708.839,"body":"when people start seeking you"},{"speaker":"Chris Dy","startTime":704.999,"endTime":708.839,"body":"out like that? And then how do"},{"speaker":"Chris Dy","startTime":708.839,"endTime":711.299,"body":"you manage that? Do they contact"},{"speaker":"Chris Dy","startTime":708.839,"endTime":711.299,"body":"you directly? How do they"},{"speaker":"Chris Dy","startTime":711.299,"endTime":713.909,"body":"arrange travel? How often do"},{"speaker":"Chris Dy","startTime":711.299,"endTime":713.909,"body":"they come back? What's done"},{"speaker":"Chris Dy","startTime":713.909,"endTime":718.289,"body":"locally? What's done, overseas?"},{"speaker":"Chris Dy","startTime":713.909,"endTime":718.289,"body":"And, you know, I know that"},{"speaker":"Chris Dy","startTime":718.289,"endTime":721.859,"body":"you're a surgeon to the stars."},{"speaker":"Chris Dy","startTime":718.289,"endTime":721.859,"body":"But in all seriousness, we in"},{"speaker":"Chris Dy","startTime":721.859,"endTime":724.559,"body":"our practice, we have had"},{"speaker":"Chris Dy","startTime":721.859,"endTime":724.559,"body":"patients coming from, you know,"},{"speaker":"Chris Dy","startTime":724.559,"endTime":727.949,"body":"all over the world to have, you"},{"speaker":"Chris Dy","startTime":724.559,"endTime":727.949,"body":"know, spine surgery here. Hip"},{"speaker":"Chris Dy","startTime":727.949,"endTime":732.389,"body":"scopes here, for example. And"},{"speaker":"Chris Dy","startTime":727.949,"endTime":732.389,"body":"apparently, congenital Hansard"},{"speaker":"Chris Dy","startTime":732.389,"endTime":732.779,"body":"are here."},{"speaker":"Charles Goldfarb","startTime":733.62,"endTime":738.09,"body":"Yes. So it is"},{"speaker":"Charles Goldfarb","startTime":733.62,"endTime":738.09,"body":"a increasing, I guess, I would"},{"speaker":"Charles Goldfarb","startTime":738.09,"endTime":743.91,"body":"say opportunity, which I very"},{"speaker":"Charles Goldfarb","startTime":738.09,"endTime":743.91,"body":"much enjoy, I tend to deal with"},{"speaker":"Charles Goldfarb","startTime":743.91,"endTime":748.29,"body":"most of it myself, patients find"},{"speaker":"Charles Goldfarb","startTime":743.91,"endTime":748.29,"body":"me, at least been different"},{"speaker":"Charles Goldfarb","startTime":748.29,"endTime":751.83,"body":"things. My blog is one resource"},{"speaker":"Charles Goldfarb","startTime":748.29,"endTime":751.83,"body":"for patients, which i That's why"},{"speaker":"Charles Goldfarb","startTime":751.83,"endTime":755.01,"body":"I write it for congenital"},{"speaker":"Charles Goldfarb","startTime":751.83,"endTime":755.01,"body":"anomalies, you know, so patients"},{"speaker":"Charles Goldfarb","startTime":755.01,"endTime":758.25,"body":"and families have a knowledge"},{"speaker":"Charles Goldfarb","startTime":755.01,"endTime":758.25,"body":"source, but some of them that"},{"speaker":"Charles Goldfarb","startTime":758.25,"endTime":763.5,"body":"reach out for more. And I've"},{"speaker":"Charles Goldfarb","startTime":758.25,"endTime":763.5,"body":"done it, initially, I was just"},{"speaker":"Charles Goldfarb","startTime":763.5,"endTime":766.8,"body":"FaceTiming saying hi, and kind"},{"speaker":"Charles Goldfarb","startTime":763.5,"endTime":766.8,"body":"of learning a little bit. But"},{"speaker":"Charles Goldfarb","startTime":766.8,"endTime":770.04,"body":"recently, I've tried to make it"},{"speaker":"Charles Goldfarb","startTime":766.8,"endTime":770.04,"body":"a little more standardized and"},{"speaker":"Charles Goldfarb","startTime":770.25,"endTime":773.13,"body":"use some of the consulting"},{"speaker":"Charles Goldfarb","startTime":770.25,"endTime":773.13,"body":"services that are there online."},{"speaker":"Charles Goldfarb","startTime":773.37,"endTime":776.97,"body":"The one I've used and I have no"},{"speaker":"Charles Goldfarb","startTime":773.37,"endTime":776.97,"body":"vested interest, I think they do"},{"speaker":"Charles Goldfarb","startTime":776.97,"endTime":779.91,"body":"a good job. It's actually from"},{"speaker":"Charles Goldfarb","startTime":776.97,"endTime":779.91,"body":"your residency institutions"},{"speaker":"Charles Goldfarb","startTime":779.91,"endTime":783.54,"body":"called BICMD. And actually, I"},{"speaker":"Charles Goldfarb","startTime":779.91,"endTime":783.54,"body":"was writing an email to a"},{"speaker":"Charles Goldfarb","startTime":783.54,"endTime":788.28,"body":"patient before we got on. And"},{"speaker":"Charles Goldfarb","startTime":783.54,"endTime":788.28,"body":"BICMD is allows you to do"},{"speaker":"Charles Goldfarb","startTime":788.82,"endTime":792.15,"body":"teleconsultations, which are"},{"speaker":"Charles Goldfarb","startTime":788.82,"endTime":792.15,"body":"really just educational"},{"speaker":"Charles Goldfarb","startTime":792.21,"endTime":795.66,"body":"opportunities for the family."},{"speaker":"Charles Goldfarb","startTime":792.21,"endTime":795.66,"body":"And that's why it's legal. And"},{"speaker":"Charles Goldfarb","startTime":795.66,"endTime":799.2,"body":"they handle all the details. And"},{"speaker":"Charles Goldfarb","startTime":795.66,"endTime":799.2,"body":"so I've used that, I always"},{"speaker":"Charles Goldfarb","startTime":799.2,"endTime":802.86,"body":"offer patients the opportunity"},{"speaker":"Charles Goldfarb","startTime":799.2,"endTime":802.86,"body":"to come to St. Louis, in many"},{"speaker":"Charles Goldfarb","startTime":802.86,"endTime":806.58,"body":"do. The finances is where it"},{"speaker":"Charles Goldfarb","startTime":802.86,"endTime":806.58,"body":"gets tricky, right? Certainly"},{"speaker":"Charles Goldfarb","startTime":806.58,"endTime":808.5,"body":"you'll have some well off, and"},{"speaker":"Charles Goldfarb","startTime":806.58,"endTime":808.5,"body":"then you'll have some not so"},{"speaker":"Charles Goldfarb","startTime":808.5,"endTime":814.68,"body":"well off families. And I will"},{"speaker":"Charles Goldfarb","startTime":808.5,"endTime":814.68,"body":"say it's simply our institution"},{"speaker":"Charles Goldfarb","startTime":814.68,"endTime":818.49,"body":"doesn't make it super easy."},{"speaker":"Charles Goldfarb","startTime":814.68,"endTime":818.49,"body":"Either to do the"},{"speaker":"Charles Goldfarb","startTime":818.49,"endTime":823.17,"body":"teleconsultations or to deal"},{"speaker":"Charles Goldfarb","startTime":818.49,"endTime":823.17,"body":"with the payment issues. And so"},{"speaker":"Charles Goldfarb","startTime":823.38,"endTime":827.55,"body":"it's tricky. I do use the"},{"speaker":"Charles Goldfarb","startTime":823.38,"endTime":827.55,"body":"Shriners Hospital for this with"},{"speaker":"Charles Goldfarb","startTime":827.58,"endTime":830.73,"body":"kids because it just, it takes"},{"speaker":"Charles Goldfarb","startTime":827.58,"endTime":830.73,"body":"that issue off the table."},{"speaker":"Chris Dy","startTime":831.11,"endTime":834.41,"body":"Right. Right. And you"},{"speaker":"Chris Dy","startTime":831.11,"endTime":834.41,"body":"know, we've had Ben Nwachukwu on"},{"speaker":"Chris Dy","startTime":834.41,"endTime":837.62,"body":"the podcast in the past. He was"},{"speaker":"Chris Dy","startTime":834.41,"endTime":837.62,"body":"talking about his NBA bubble"},{"speaker":"Chris Dy","startTime":837.62,"endTime":840.8,"body":"experience, but then has been"},{"speaker":"Chris Dy","startTime":837.62,"endTime":840.8,"body":"the driving force with with"},{"speaker":"Chris Dy","startTime":840.8,"endTime":846.92,"body":"Riley Williams up at HSS for"},{"speaker":"Chris Dy","startTime":840.8,"endTime":846.92,"body":"this BICMD. I don't know what"},{"speaker":"Chris Dy","startTime":846.92,"endTime":847.4,"body":"you call it."},{"speaker":"Charles A. Goldfarb","startTime":847.94,"endTime":848.54,"body":"service."},{"speaker":"Chris Dy","startTime":848.72,"endTime":852.08,"body":"Service. Yeah. So but"},{"speaker":"Chris Dy","startTime":848.72,"endTime":852.08,"body":"yeah, so people should check"},{"speaker":"Chris Dy","startTime":852.08,"endTime":854.21,"body":"that out. If they're interested"},{"speaker":"Chris Dy","startTime":852.08,"endTime":854.21,"body":"in developing that part of it. I"},{"speaker":"Chris Dy","startTime":854.21,"endTime":858.98,"body":"thought that was interesting."},{"speaker":"Chris Dy","startTime":854.21,"endTime":858.98,"body":"So, bread and butter. I've had"},{"speaker":"Chris Dy","startTime":858.98,"endTime":862.94,"body":"some interesting cases recently"},{"speaker":"Chris Dy","startTime":858.98,"endTime":862.94,"body":"that I wanted to bend your ear"},{"speaker":"Chris Dy","startTime":862.94,"endTime":868.82,"body":"about. So how do you handle how"},{"speaker":"Chris Dy","startTime":862.94,"endTime":868.82,"body":"do you think about the MP joint"},{"speaker":"Chris Dy","startTime":868.88,"endTime":872.3,"body":"in the patient with thumb"},{"speaker":"Chris Dy","startTime":868.88,"endTime":872.3,"body":"advanced thumb CMC arthritis?"},{"speaker":"Charles Goldfarb","startTime":873.09,"endTime":875.82,"body":"Should we we"},{"speaker":"Charles Goldfarb","startTime":873.09,"endTime":875.82,"body":"should have gotten Macy on but"},{"speaker":"Charles Goldfarb","startTime":875.82,"endTime":879.33,"body":"should we talk about? Let's talk"},{"speaker":"Charles Goldfarb","startTime":875.82,"endTime":879.33,"body":"a little bit about what you look"},{"speaker":"Charles Goldfarb","startTime":879.33,"endTime":883.86,"body":"for in the clinic first, if"},{"speaker":"Charles Goldfarb","startTime":879.33,"endTime":883.86,"body":"that's okay, in a patient and"},{"speaker":"Charles Goldfarb","startTime":883.86,"endTime":887.31,"body":"I'll tell how I think about it,"},{"speaker":"Charles Goldfarb","startTime":883.86,"endTime":887.31,"body":"whether it's you know, exactly"},{"speaker":"Charles Goldfarb","startTime":887.31,"endTime":891.36,"body":"correct biomechanical and I"},{"speaker":"Charles Goldfarb","startTime":887.31,"endTime":891.36,"body":"don't know, but when I'm when a"},{"speaker":"Charles Goldfarb","startTime":891.36,"endTime":896.13,"body":"patient comes in, and let's do"},{"speaker":"Charles Goldfarb","startTime":891.36,"endTime":896.13,"body":"this stereotypical advanced CMC"},{"speaker":"Charles Goldfarb","startTime":896.13,"endTime":898.44,"body":"arthritis patient so we'll go"},{"speaker":"Charles Goldfarb","startTime":896.13,"endTime":898.44,"body":"back to that 73 year old I"},{"speaker":"Charles Goldfarb","startTime":898.44,"endTime":903.93,"body":"mentioned earlier, 73 year old A"},{"speaker":"Charles Goldfarb","startTime":898.44,"endTime":903.93,"body":"female who has severe CMC"},{"speaker":"Charles Goldfarb","startTime":903.93,"endTime":907.29,"body":"arthritis, what do you how do"},{"speaker":"Charles Goldfarb","startTime":903.93,"endTime":907.29,"body":"you think about that patient?"},{"speaker":"Charles Goldfarb","startTime":907.29,"endTime":909.75,"body":"What do you what is your"},{"speaker":"Charles Goldfarb","startTime":907.29,"endTime":909.75,"body":"examination look like? How are"},{"speaker":"Charles Goldfarb","startTime":909.75,"endTime":913.71,"body":"you better understanding what"},{"speaker":"Charles Goldfarb","startTime":909.75,"endTime":913.71,"body":"the thumb is able to do in this"},{"speaker":"Charles Goldfarb","startTime":913.74,"endTime":915.27,"body":"previously untreated patient?"},{"speaker":"Chris Dy","startTime":915.96,"endTime":918.24,"body":"first thought is"},{"speaker":"Chris Dy","startTime":915.96,"endTime":918.24,"body":"usually, gosh, I guess I know"},{"speaker":"Chris Dy","startTime":918.24,"endTime":923.61,"body":"why this patient didn't go to"},{"speaker":"Chris Dy","startTime":918.24,"endTime":923.61,"body":"Goldfarb is can we find a way to"},{"speaker":"Chris Dy","startTime":923.61,"endTime":926.82,"body":"not be surgery? Usually, you"},{"speaker":"Chris Dy","startTime":923.61,"endTime":926.82,"body":"know, honestly, it's my default"},{"speaker":"Chris Dy","startTime":926.82,"endTime":930.87,"body":"for thumb, CMC. You know, and"},{"speaker":"Chris Dy","startTime":926.82,"endTime":930.87,"body":"I've, you know, as I've become"},{"speaker":"Chris Dy","startTime":930.9,"endTime":935.4,"body":"more experienced with, you know,"},{"speaker":"Chris Dy","startTime":930.9,"endTime":935.4,"body":"just surgery in general, you"},{"speaker":"Chris Dy","startTime":935.4,"endTime":940.92,"body":"know, I think that I tried to"},{"speaker":"Chris Dy","startTime":935.4,"endTime":940.92,"body":"minimize surgery, if we can on"},{"speaker":"Chris Dy","startTime":940.92,"endTime":943.71,"body":"certain patients, and some"},{"speaker":"Chris Dy","startTime":940.92,"endTime":943.71,"body":"patients just really want to get"},{"speaker":"Chris Dy","startTime":943.71,"endTime":947.85,"body":"at it and do it, other people"},{"speaker":"Chris Dy","startTime":943.71,"endTime":947.85,"body":"are going to be a little slow to"},{"speaker":"Chris Dy","startTime":947.85,"endTime":951.0,"body":"recover, so to say. So I'm very"},{"speaker":"Chris Dy","startTime":947.85,"endTime":951.0,"body":"honest about the conversation"},{"speaker":"Chris Dy","startTime":951.0,"endTime":953.13,"body":"with them about how long it"},{"speaker":"Chris Dy","startTime":951.0,"endTime":953.13,"body":"takes to get over the surgery."},{"speaker":"Chris Dy","startTime":953.13,"endTime":956.25,"body":"And we talked about that paper"},{"speaker":"Chris Dy","startTime":953.13,"endTime":956.25,"body":"we've written in the past, about"},{"speaker":"Chris Dy","startTime":956.25,"endTime":960.24,"body":"how long it takes, and it takes"},{"speaker":"Chris Dy","startTime":956.25,"endTime":960.24,"body":"longer than everybody wants. And"},{"speaker":"Chris Dy","startTime":960.24,"endTime":963.15,"body":"that sometimes scares people"},{"speaker":"Chris Dy","startTime":960.24,"endTime":963.15,"body":"away. To be very honest with"},{"speaker":"Chris Dy","startTime":963.15,"endTime":964.98,"body":"you, you don't want to scare"},{"speaker":"Chris Dy","startTime":963.15,"endTime":964.98,"body":"them, but you do have to be"},{"speaker":"Chris Dy","startTime":964.98,"endTime":968.67,"body":"honest. And then in terms of"},{"speaker":"Chris Dy","startTime":964.98,"endTime":968.67,"body":"looking at the thumb itself,"},{"speaker":"Chris Dy","startTime":968.67,"endTime":970.8,"body":"sometimes you can tell when"},{"speaker":"Chris Dy","startTime":968.67,"endTime":970.8,"body":"they've got that really flexed"},{"speaker":"Chris Dy","startTime":970.8,"endTime":973.17,"body":"metacarpal head, and that tipped"},{"speaker":"Chris Dy","startTime":970.8,"endTime":973.17,"body":"over deformity, and then you"},{"speaker":"Chris Dy","startTime":973.17,"endTime":977.76,"body":"start to see the Z deformity"},{"speaker":"Chris Dy","startTime":973.17,"endTime":977.76,"body":"happen at the MP joint. And, you"},{"speaker":"Chris Dy","startTime":977.76,"endTime":982.35,"body":"know, one of the things I always"},{"speaker":"Chris Dy","startTime":977.76,"endTime":982.35,"body":"try to dictate and also talk to"},{"speaker":"Chris Dy","startTime":982.35,"endTime":984.99,"body":"our residents and fellows about"},{"speaker":"Chris Dy","startTime":982.35,"endTime":984.99,"body":"is what's going on with the MP"},{"speaker":"Chris Dy","startTime":984.99,"endTime":987.63,"body":"joint. Did you look at the MP"},{"speaker":"Chris Dy","startTime":984.99,"endTime":987.63,"body":"joint, you know, before we"},{"speaker":"Chris Dy","startTime":987.63,"endTime":991.14,"body":"indicate this patient for"},{"speaker":"Chris Dy","startTime":987.63,"endTime":991.14,"body":"surgery, because once you start"},{"speaker":"Chris Dy","startTime":991.14,"endTime":995.34,"body":"to see some extension?"},{"speaker":"Chris Dy","startTime":991.14,"endTime":995.34,"body":"posturing, I guess I'll call it"},{"speaker":"Chris Dy","startTime":995.94,"endTime":998.88,"body":"at the MP joint, then I start to"},{"speaker":"Chris Dy","startTime":995.94,"endTime":998.88,"body":"get worried about you know, if"},{"speaker":"Chris Dy","startTime":998.88,"endTime":1002.18,"body":"we address only the CMC joint,"},{"speaker":"Chris Dy","startTime":998.88,"endTime":1002.18,"body":"what's going to happen to the MP"},{"speaker":"Chris Dy","startTime":1002.18,"endTime":1005.18,"body":"joint are we going to, are we"},{"speaker":"Chris Dy","startTime":1002.18,"endTime":1005.18,"body":"going to potentially worsen the"},{"speaker":"Chris Dy","startTime":1005.18,"endTime":1005.75,"body":"deformity?"},{"speaker":"Charles Goldfarb","startTime":1006.23,"endTime":1009.5,"body":"Yeah. And so I"},{"speaker":"Charles Goldfarb","startTime":1006.23,"endTime":1009.5,"body":"agree with everything you said,"},{"speaker":"Charles Goldfarb","startTime":1009.53,"endTime":1012.8,"body":"I guess I'll add a little more"},{"speaker":"Charles Goldfarb","startTime":1009.53,"endTime":1012.8,"body":"flavor, or I guess my"},{"speaker":"Charles Goldfarb","startTime":1012.8,"endTime":1018.14,"body":"perspective. So when I think"},{"speaker":"Charles Goldfarb","startTime":1012.8,"endTime":1018.14,"body":"about severe CMC arthritis, the"},{"speaker":"Charles Goldfarb","startTime":1018.53,"endTime":1022.85,"body":"base of the metacarpal"},{"speaker":"Charles Goldfarb","startTime":1018.53,"endTime":1022.85,"body":"subluxation dorsally, almost"},{"speaker":"Charles Goldfarb","startTime":1022.85,"endTime":1027.05,"body":"always, that's the pattern of"},{"speaker":"Charles Goldfarb","startTime":1022.85,"endTime":1027.05,"body":"the arthritis that develops that"},{"speaker":"Chris Dy","startTime":1027.049,"endTime":1029.629,"body":"because of the so"},{"speaker":"Chris Dy","startTime":1027.049,"endTime":1029.629,"body":"called Peak ligament is intact"},{"speaker":"Chris Dy","startTime":1029.629,"endTime":1033.499,"body":"and it's pulling the they're"},{"speaker":"Chris Dy","startTime":1029.629,"endTime":1033.499,"body":"allowing it to escape what I"},{"speaker":"Chris Dy","startTime":1033.529,"endTime":1036.349,"body":"deeply believe that or do we"},{"speaker":"Chris Dy","startTime":1033.529,"endTime":1036.349,"body":"believe AB lads newer work"},{"speaker":"Chris Dy","startTime":1036.349,"endTime":1038.869,"body":"showing that you know, it's not"},{"speaker":"Chris Dy","startTime":1036.349,"endTime":1038.869,"body":"the big ligament that matters as"},{"speaker":"Chris Dy","startTime":1038.869,"endTime":1039.169,"body":"much?"},{"speaker":"Charles Goldfarb","startTime":1039.199,"endTime":1041.119,"body":"I'm not sure"},{"speaker":"Charles Goldfarb","startTime":1039.199,"endTime":1041.119,"body":"it's the big ligament that just"},{"speaker":"Charles Goldfarb","startTime":1041.119,"endTime":1043.969,"body":"doesn't make enough sense. I do"},{"speaker":"Charles Goldfarb","startTime":1041.119,"endTime":1043.969,"body":"think there's, you know, there"},{"speaker":"Charles Goldfarb","startTime":1044.029,"endTime":1047.869,"body":"are obviously reasons that women"},{"speaker":"Charles Goldfarb","startTime":1044.029,"endTime":1047.869,"body":"develop arthritis more than men"},{"speaker":"Charles Goldfarb","startTime":1047.869,"endTime":1051.529,"body":"at this joint, although it's"},{"speaker":"Charles Goldfarb","startTime":1047.869,"endTime":1051.529,"body":"obviously not exclusive. I don't"},{"speaker":"Charles Goldfarb","startTime":1051.529,"endTime":1053.869,"body":"know that I understand it. And"},{"speaker":"Charles Goldfarb","startTime":1051.529,"endTime":1053.869,"body":"I'm happy there are people like"},{"speaker":"Charles Goldfarb","startTime":1053.869,"endTime":1060.979,"body":"me, lad that like to delve into"},{"speaker":"Charles Goldfarb","startTime":1053.869,"endTime":1060.979,"body":"the the why the what is as that"},{"speaker":"Charles Goldfarb","startTime":1060.979,"endTime":1065.929,"body":"metacarpal subluxation dorsally,"},{"speaker":"Charles Goldfarb","startTime":1060.979,"endTime":1065.929,"body":"what tends to happen is the"},{"speaker":"Charles Goldfarb","startTime":1065.929,"endTime":1070.189,"body":"thumb also at ducks, and is"},{"speaker":"Charles Goldfarb","startTime":1065.929,"endTime":1070.189,"body":"drawn towards the index"},{"speaker":"Charles Goldfarb","startTime":1070.189,"endTime":1075.469,"body":"metacarpal. So that creates its"},{"speaker":"Charles Goldfarb","startTime":1070.189,"endTime":1075.469,"body":"own set of problems in the way I"},{"speaker":"Charles Goldfarb","startTime":1075.589,"endTime":1078.109,"body":"try to keep things simple. And"},{"speaker":"Charles Goldfarb","startTime":1075.589,"endTime":1078.109,"body":"tell me you're gonna laugh at me"},{"speaker":"Charles Goldfarb","startTime":1078.109,"endTime":1080.689,"body":"probably. But the way I think"},{"speaker":"Charles Goldfarb","startTime":1078.109,"endTime":1080.689,"body":"about it is all of a sudden you"},{"speaker":"Charles Goldfarb","startTime":1080.689,"endTime":1085.069,"body":"have a thumb that is 80 ducted."},{"speaker":"Charles Goldfarb","startTime":1080.689,"endTime":1085.069,"body":"And if you were showing this for"},{"speaker":"Charles Goldfarb","startTime":1085.069,"endTime":1089.719,"body":"YouTube, if you try to then grab"},{"speaker":"Charles Goldfarb","startTime":1085.069,"endTime":1089.719,"body":"that soda can with 80 ducted,"},{"speaker":"Charles Goldfarb","startTime":1089.719,"endTime":1092.959,"body":"thumb, you can't get the soda"},{"speaker":"Charles Goldfarb","startTime":1089.719,"endTime":1092.959,"body":"can in there. And so patients"},{"speaker":"Charles Goldfarb","startTime":1092.959,"endTime":1096.889,"body":"that have at least some degree"},{"speaker":"Charles Goldfarb","startTime":1092.959,"endTime":1096.889,"body":"of laxity will break at the MP"},{"speaker":"Charles Goldfarb","startTime":1096.889,"endTime":1099.799,"body":"joint, they'll hyperextend the"},{"speaker":"Charles Goldfarb","startTime":1096.889,"endTime":1099.799,"body":"MP join. So the metacarpal"},{"speaker":"Charles Goldfarb","startTime":1099.799,"endTime":1102.769,"body":"instead of being straight is now"},{"speaker":"Charles Goldfarb","startTime":1099.799,"endTime":1102.769,"body":"tilted. So the base the"},{"speaker":"Charles Goldfarb","startTime":1102.769,"endTime":1106.009,"body":"metacarpal is up, the head is"},{"speaker":"Charles Goldfarb","startTime":1102.769,"endTime":1106.009,"body":"down and you can get the Z"},{"speaker":"Charles Goldfarb","startTime":1106.009,"endTime":1110.599,"body":"deformity where the proximal"},{"speaker":"Charles Goldfarb","startTime":1106.009,"endTime":1110.599,"body":"phalanx then hyperextend at the"},{"speaker":"Charles Goldfarb","startTime":1110.599,"endTime":1115.249,"body":"MP joint and so you get this MP"},{"speaker":"Charles Goldfarb","startTime":1110.599,"endTime":1115.249,"body":"instability because of your CMC"},{"speaker":"Charles Goldfarb","startTime":1115.249,"endTime":1118.579,"body":"instability, which allows"},{"speaker":"Charles Goldfarb","startTime":1115.249,"endTime":1118.579,"body":"patients to sort of function"},{"speaker":"Charles Goldfarb","startTime":1118.579,"endTime":1120.829,"body":"while their arthritis is"},{"speaker":"Charles Goldfarb","startTime":1118.579,"endTime":1120.829,"body":"progressing."},{"speaker":"Chris Dy","startTime":1122.0,"endTime":1125.69,"body":"Yeah, I think about it"},{"speaker":"Chris Dy","startTime":1122.0,"endTime":1125.69,"body":"similarly. But I think that the"},{"speaker":"Chris Dy","startTime":1125.69,"endTime":1129.14,"body":"way you described it is perfect."},{"speaker":"Chris Dy","startTime":1125.69,"endTime":1129.14,"body":"You know, what happens if you"},{"speaker":"Chris Dy","startTime":1129.14,"endTime":1132.53,"body":"don't address the MP joint? And"},{"speaker":"Chris Dy","startTime":1129.14,"endTime":1132.53,"body":"you just do say you do your"},{"speaker":"Chris Dy","startTime":1132.53,"endTime":1136.13,"body":"standard CMC surgery, whether"},{"speaker":"Chris Dy","startTime":1132.53,"endTime":1136.13,"body":"that's a suture suspension like"},{"speaker":"Chris Dy","startTime":1136.16,"endTime":1141.32,"body":"Jeanne Delson yori or it's a"},{"speaker":"Chris Dy","startTime":1136.16,"endTime":1141.32,"body":"lrti, Burton Pellegrini or your"},{"speaker":"Chris Dy","startTime":1141.32,"endTime":1143.48,"body":"expensive suture tape"},{"speaker":"Chris Dy","startTime":1141.32,"endTime":1143.48,"body":"suspension."},{"speaker":"Charles Goldfarb","startTime":1144.74,"endTime":1148.97,"body":"The one thing"},{"speaker":"Charles Goldfarb","startTime":1144.74,"endTime":1148.97,"body":"is clear, if you don't address"},{"speaker":"Charles Goldfarb","startTime":1148.97,"endTime":1151.79,"body":"it, even if you help the pain,"},{"speaker":"Charles Goldfarb","startTime":1148.97,"endTime":1151.79,"body":"and you will help the paint that"},{"speaker":"Charles Goldfarb","startTime":1151.79,"endTime":1155.54,"body":"seems to join, most patients"},{"speaker":"Charles Goldfarb","startTime":1151.79,"endTime":1155.54,"body":"will not be happy. That is a"},{"speaker":"Charles Goldfarb","startTime":1155.54,"endTime":1160.67,"body":"significant can be a significant"},{"speaker":"Charles Goldfarb","startTime":1155.54,"endTime":1160.67,"body":"deformity. So I think one way or"},{"speaker":"Charles Goldfarb","startTime":1160.67,"endTime":1164.15,"body":"another, you have to address it,"},{"speaker":"Charles Goldfarb","startTime":1160.67,"endTime":1164.15,"body":"and you should start with"},{"speaker":"Charles Goldfarb","startTime":1164.15,"endTime":1167.09,"body":"therapy. You know, I think if"},{"speaker":"Charles Goldfarb","startTime":1164.15,"endTime":1167.09,"body":"some patients if it's not too"},{"speaker":"Charles Goldfarb","startTime":1167.09,"endTime":1170.0,"body":"advanced arthritis, but let's"},{"speaker":"Charles Goldfarb","startTime":1167.09,"endTime":1170.0,"body":"say as a ligament as the wax"},{"speaker":"Charles Goldfarb","startTime":1170.0,"endTime":1173.51,"body":"patient, their arthritis is in"},{"speaker":"Charles Goldfarb","startTime":1170.0,"endTime":1173.51,"body":"terrible, then I think you start"},{"speaker":"Charles Goldfarb","startTime":1173.51,"endTime":1176.9,"body":"as Macy has informed us on this"},{"speaker":"Charles Goldfarb","startTime":1173.51,"endTime":1176.9,"body":"before you should start with"},{"speaker":"Charles Goldfarb","startTime":1176.9,"endTime":1182.0,"body":"therapy and try to help with the"},{"speaker":"Charles Goldfarb","startTime":1176.9,"endTime":1182.0,"body":"position of the CMC joint"},{"speaker":"Charles Goldfarb","startTime":1182.0,"endTime":1185.51,"body":"therefore the position of the NP"},{"speaker":"Charles Goldfarb","startTime":1182.0,"endTime":1185.51,"body":"joint and maybe just maybe you"},{"speaker":"Charles Goldfarb","startTime":1185.51,"endTime":1189.5,"body":"can minimize this problem. But"},{"speaker":"Charles Goldfarb","startTime":1185.51,"endTime":1189.5,"body":"if you go to surgery,"},{"speaker":"Chris Dy","startTime":1189.98,"endTime":1192.59,"body":"well hold on a second."},{"speaker":"Chris Dy","startTime":1189.98,"endTime":1192.59,"body":"I do like a I agree with you"},{"speaker":"Chris Dy","startTime":1192.59,"endTime":1195.11,"body":"entirely and our therapy"},{"speaker":"Chris Dy","startTime":1192.59,"endTime":1195.11,"body":"colleagues are invaluable for"},{"speaker":"Chris Dy","startTime":1195.11,"endTime":1199.58,"body":"that for that particular issue."},{"speaker":"Chris Dy","startTime":1195.11,"endTime":1199.58,"body":"And I like an MP joint customer"},{"speaker":"Chris Dy","startTime":1199.58,"endTime":1203.15,"body":"orthosis Sometimes to really get"},{"speaker":"Chris Dy","startTime":1199.58,"endTime":1203.15,"body":"the MP join into least neutral"},{"speaker":"Chris Dy","startTime":1203.15,"endTime":1207.71,"body":"or some flexion. To see if you"},{"speaker":"Chris Dy","startTime":1203.15,"endTime":1207.71,"body":"can control that. You know, are"},{"speaker":"Chris Dy","startTime":1207.71,"endTime":1215.45,"body":"there are there? What's your"},{"speaker":"Chris Dy","startTime":1207.71,"endTime":1215.45,"body":"threshold to address the MP"},{"speaker":"Chris Dy","startTime":1215.45,"endTime":1219.08,"body":"joint in surgery? Versus just"},{"speaker":"Chris Dy","startTime":1215.45,"endTime":1219.08,"body":"doing a thumb, CMC? So say"},{"speaker":"Chris Dy","startTime":1219.08,"endTime":1221.99,"body":"you've gotten some reasonable"},{"speaker":"Chris Dy","startTime":1219.08,"endTime":1221.99,"body":"improvement with therapy of the"},{"speaker":"Chris Dy","startTime":1221.99,"endTime":1224.66,"body":"position of the MP joint? Are"},{"speaker":"Chris Dy","startTime":1221.99,"endTime":1224.66,"body":"you done just doing your"},{"speaker":"Chris Dy","startTime":1224.66,"endTime":1227.84,"body":"standard CMC surgery? Or do you"},{"speaker":"Chris Dy","startTime":1224.66,"endTime":1227.84,"body":"do anything differently in that"},{"speaker":"Chris Dy","startTime":1227.84,"endTime":1228.47,"body":"surgery to?"},{"speaker":"Charles Goldfarb","startTime":1230.54,"endTime":1233.33,"body":"I guess, first"},{"speaker":"Charles Goldfarb","startTime":1230.54,"endTime":1233.33,"body":"question is threshold, the"},{"speaker":"Charles Goldfarb","startTime":1233.33,"endTime":1237.11,"body":"literature would tell us 30"},{"speaker":"Charles Goldfarb","startTime":1233.33,"endTime":1237.11,"body":"degrees of hyperextension. I"},{"speaker":"Charles Goldfarb","startTime":1237.11,"endTime":1239.75,"body":"think that's a an arbitrary"},{"speaker":"Charles Goldfarb","startTime":1237.11,"endTime":1239.75,"body":"number is just as good a number"},{"speaker":"Charles Goldfarb","startTime":1239.75,"endTime":1242.45,"body":"as anything else. But I like"},{"speaker":"Charles Goldfarb","startTime":1239.75,"endTime":1242.45,"body":"like most of our criteria in"},{"speaker":"Charles Goldfarb","startTime":1242.45,"endTime":1248.03,"body":"orthopedic surgery, I don't"},{"speaker":"Charles Goldfarb","startTime":1242.45,"endTime":1248.03,"body":"think that that's as you know, a"},{"speaker":"Charles Goldfarb","startTime":1248.03,"endTime":1251.72,"body":"line that cannot be considered."},{"speaker":"Charles Goldfarb","startTime":1248.03,"endTime":1251.72,"body":"But it's a good play is a good"},{"speaker":"Charles Goldfarb","startTime":1251.72,"endTime":1254.75,"body":"number to have in your head, to"},{"speaker":"Charles Goldfarb","startTime":1251.72,"endTime":1254.75,"body":"understand whether you should"},{"speaker":"Charles Goldfarb","startTime":1254.75,"endTime":1257.54,"body":"think about it. But here's how I"},{"speaker":"Charles Goldfarb","startTime":1254.75,"endTime":1257.54,"body":"think about it. And I think I"},{"speaker":"Charles Goldfarb","startTime":1257.54,"endTime":1262.37,"body":"learned this doing CMC fusions,"},{"speaker":"Charles Goldfarb","startTime":1257.54,"endTime":1262.37,"body":"because when you fuse the CMC"},{"speaker":"Charles Goldfarb","startTime":1262.37,"endTime":1266.24,"body":"joint, you realign the joint."},{"speaker":"Charles Goldfarb","startTime":1262.37,"endTime":1266.24,"body":"And when you realign the joint,"},{"speaker":"Charles Goldfarb","startTime":1266.48,"endTime":1269.45,"body":"it is not uncommon that you also"},{"speaker":"Charles Goldfarb","startTime":1266.48,"endTime":1269.45,"body":"take care of the MP joint as"},{"speaker":"Charles Goldfarb","startTime":1269.45,"endTime":1274.04,"body":"well. And so when I do soft"},{"speaker":"Charles Goldfarb","startTime":1269.45,"endTime":1274.04,"body":"tissue reconstructions, whether"},{"speaker":"Charles Goldfarb","startTime":1274.04,"endTime":1277.97,"body":"that's an lrti, or whether"},{"speaker":"Charles Goldfarb","startTime":1274.04,"endTime":1277.97,"body":"that's an internal brace, there"},{"speaker":"Charles Goldfarb","startTime":1277.97,"endTime":1282.5,"body":"are different ways to assure"},{"speaker":"Charles Goldfarb","startTime":1277.97,"endTime":1282.5,"body":"that you bring the base of the"},{"speaker":"Charles Goldfarb","startTime":1282.5,"endTime":1285.14,"body":"metacarpal, back down, and when"},{"speaker":"Charles Goldfarb","startTime":1282.5,"endTime":1285.14,"body":"you bring the base of the"},{"speaker":"Charles Goldfarb","startTime":1285.14,"endTime":1288.71,"body":"metacarpal, back down, if your"},{"speaker":"Charles Goldfarb","startTime":1285.14,"endTime":1288.71,"body":"soft tissue contractures aren't"},{"speaker":"Charles Goldfarb","startTime":1288.71,"endTime":1293.27,"body":"too severe, your MP joint will"},{"speaker":"Charles Goldfarb","startTime":1288.71,"endTime":1293.27,"body":"then assume a normal posture and"},{"speaker":"Charles Goldfarb","startTime":1293.27,"endTime":1297.26,"body":"you can skip intervening there."},{"speaker":"Charles Goldfarb","startTime":1293.27,"endTime":1297.26,"body":"That's how I think about got it."},{"speaker":"Chris Dy","startTime":1297.59,"endTime":1301.64,"body":"So then how do you"},{"speaker":"Chris Dy","startTime":1297.59,"endTime":1301.64,"body":"bring the MP joint or the CMC, a"},{"speaker":"Chris Dy","startTime":1301.64,"endTime":1305.06,"body":"base of the thumb metacarpal? I"},{"speaker":"Chris Dy","startTime":1301.64,"endTime":1305.06,"body":"should say, back down? How are"},{"speaker":"Chris Dy","startTime":1305.06,"endTime":1308.33,"body":"you adjusting your technique? Is"},{"speaker":"Chris Dy","startTime":1305.06,"endTime":1308.33,"body":"it a tensioning? thing? Is it"},{"speaker":"Chris Dy","startTime":1308.33,"endTime":1311.0,"body":"where you're putting? If you're"},{"speaker":"Chris Dy","startTime":1308.33,"endTime":1311.0,"body":"doing an LRT? Is that where you"},{"speaker":"Chris Dy","startTime":1311.0,"endTime":1314.51,"body":"put a tunnel? If you're doing a"},{"speaker":"Chris Dy","startTime":1311.0,"endTime":1314.51,"body":"suture tape suspension? Is it"},{"speaker":"Chris Dy","startTime":1314.54,"endTime":1317.72,"body":"you know, how you Where are you"},{"speaker":"Chris Dy","startTime":1314.54,"endTime":1317.72,"body":"put those anchors? How do you do"},{"speaker":"Chris Dy","startTime":1317.72,"endTime":1317.84,"body":"it?"},{"speaker":"Charles Goldfarb","startTime":1318.229,"endTime":1320.149,"body":"The two"},{"speaker":"Charles Goldfarb","startTime":1318.229,"endTime":1320.149,"body":"operations that I do are easy"},{"speaker":"Charles Goldfarb","startTime":1320.149,"endTime":1324.409,"body":"for me to talk about I don't do"},{"speaker":"Charles Goldfarb","startTime":1320.149,"endTime":1324.409,"body":"you know, other operations. But"},{"speaker":"Charles Goldfarb","startTime":1324.409,"endTime":1327.859,"body":"for the two I do, I think that"},{"speaker":"Charles Goldfarb","startTime":1324.409,"endTime":1327.859,"body":"for the suture type suspension"},{"speaker":"Charles Goldfarb","startTime":1327.859,"endTime":1330.529,"body":"plasti, which I continue to"},{"speaker":"Charles Goldfarb","startTime":1327.859,"endTime":1330.529,"body":"enjoy, I think it's a good"},{"speaker":"Charles Goldfarb","startTime":1330.529,"endTime":1335.809,"body":"operation, you were classically"},{"speaker":"Charles Goldfarb","startTime":1330.529,"endTime":1335.809,"body":"taught to create a, essentially"},{"speaker":"Charles Goldfarb","startTime":1336.409,"endTime":1341.059,"body":"a suspension bridge for the base"},{"speaker":"Charles Goldfarb","startTime":1336.409,"endTime":1341.059,"body":"of the thumb metacarpal. And you"},{"speaker":"Charles Goldfarb","startTime":1341.059,"endTime":1344.869,"body":"do that by putting an anchor"},{"speaker":"Charles Goldfarb","startTime":1341.059,"endTime":1344.869,"body":"into the radial bass to the"},{"speaker":"Charles Goldfarb","startTime":1344.869,"endTime":1348.259,"body":"metacarpal, and an anchor into"},{"speaker":"Charles Goldfarb","startTime":1344.869,"endTime":1348.259,"body":"the radial base of the index"},{"speaker":"Charles Goldfarb","startTime":1348.259,"endTime":1352.219,"body":"metacarpal, and you have a"},{"speaker":"Charles Goldfarb","startTime":1348.259,"endTime":1352.219,"body":"sling. The problem is the base"},{"speaker":"Charles Goldfarb","startTime":1352.219,"endTime":1355.159,"body":"and metacarpal can go sort of"},{"speaker":"Charles Goldfarb","startTime":1352.219,"endTime":1355.159,"body":"where it once supported by that"},{"speaker":"Charles Goldfarb","startTime":1355.159,"endTime":1358.789,"body":"sling. So I had a third leg to"},{"speaker":"Charles Goldfarb","startTime":1355.159,"endTime":1358.789,"body":"that, when I'm worried about"},{"speaker":"Charles Goldfarb","startTime":1358.789,"endTime":1363.679,"body":"this, and essentially, put a put"},{"speaker":"Charles Goldfarb","startTime":1358.789,"endTime":1363.679,"body":"a heavy needle through the"},{"speaker":"Charles Goldfarb","startTime":1363.679,"endTime":1368.269,"body":"dorsal base of the metacarpal"},{"speaker":"Charles Goldfarb","startTime":1363.679,"endTime":1368.269,"body":"and then pull it down. And so by"},{"speaker":"Charles Goldfarb","startTime":1368.269,"endTime":1373.879,"body":"doing that third kind of knot"},{"speaker":"Charles Goldfarb","startTime":1368.269,"endTime":1373.879,"body":"anchor, just putting the suture"},{"speaker":"Charles Goldfarb","startTime":1373.879,"endTime":1376.309,"body":"tape through the dorsal base,"},{"speaker":"Charles Goldfarb","startTime":1373.879,"endTime":1376.309,"body":"the metacarpal, and then tight"},{"speaker":"Charles Goldfarb","startTime":1376.309,"endTime":1380.629,"body":"and onto itself, you essentially"},{"speaker":"Charles Goldfarb","startTime":1376.309,"endTime":1380.629,"body":"bring the base and metacarpal"},{"speaker":"Charles Goldfarb","startTime":1380.629,"endTime":1384.139,"body":"down, bring the head of the"},{"speaker":"Charles Goldfarb","startTime":1380.629,"endTime":1384.139,"body":"metacarpal up and addresses the"},{"speaker":"Charles Goldfarb","startTime":1384.139,"endTime":1384.739,"body":"MP joint."},{"speaker":"Chris Dy","startTime":1385.13,"endTime":1389.18,"body":"And so before you go"},{"speaker":"Chris Dy","startTime":1385.13,"endTime":1389.18,"body":"further, let me just rehash"},{"speaker":"Chris Dy","startTime":1389.18,"endTime":1392.06,"body":"summarize that yeah, clarify"},{"speaker":"Chris Dy","startTime":1389.18,"endTime":1392.06,"body":"make sure that Yeah. So you've"},{"speaker":"Chris Dy","startTime":1392.06,"endTime":1394.79,"body":"got your you've set your"},{"speaker":"Chris Dy","startTime":1392.06,"endTime":1394.79,"body":"proximal distal kind of"},{"speaker":"Chris Dy","startTime":1394.79,"endTime":1398.45,"body":"distraction, right with the"},{"speaker":"Chris Dy","startTime":1394.79,"endTime":1398.45,"body":"suture tape. And you've already"},{"speaker":"Chris Dy","startTime":1398.45,"endTime":1403.16,"body":"set that. So now you're then"},{"speaker":"Chris Dy","startTime":1398.45,"endTime":1403.16,"body":"taking. So after you've got your"},{"speaker":"Chris Dy","startTime":1403.16,"endTime":1406.64,"body":"anchors in your suture tape is"},{"speaker":"Chris Dy","startTime":1403.16,"endTime":1406.64,"body":"in, you've got the free portion"},{"speaker":"Chris Dy","startTime":1406.64,"endTime":1407.36,"body":"of the suture tape."},{"speaker":"Charles Goldfarb","startTime":1407.84,"endTime":1410.93,"body":"And for me,"},{"speaker":"Charles Goldfarb","startTime":1407.84,"endTime":1410.93,"body":"that's, that's the residual from"},{"speaker":"Charles Goldfarb","startTime":1410.96,"endTime":1412.94,"body":"the base, right at the"},{"speaker":"Charles Goldfarb","startTime":1410.96,"endTime":1412.94,"body":"metacarpal."},{"speaker":"Chris Dy","startTime":1413.24,"endTime":1415.01,"body":"From the base of the"},{"speaker":"Chris Dy","startTime":1413.24,"endTime":1415.01,"body":"second metacarpal. So you go"},{"speaker":"Chris Dy","startTime":1415.01,"endTime":1418.85,"body":"thumb metacarpal first, then you"},{"speaker":"Chris Dy","startTime":1415.01,"endTime":1418.85,"body":"put it into the index, and"},{"speaker":"Chris Dy","startTime":1418.85,"endTime":1421.76,"body":"you've got this long extra"},{"speaker":"Chris Dy","startTime":1418.85,"endTime":1421.76,"body":"suture tape, and you're taking"},{"speaker":"Chris Dy","startTime":1421.88,"endTime":1424.97,"body":"the free needle that is already"},{"speaker":"Chris Dy","startTime":1421.88,"endTime":1424.97,"body":"in the package. And you're"},{"speaker":"Chris Dy","startTime":1424.97,"endTime":1428.84,"body":"taking it going from the dorsal"},{"speaker":"Chris Dy","startTime":1424.97,"endTime":1428.84,"body":"base of the thumb metacarpal."},{"speaker":"Charles Goldfarb","startTime":1430.1,"endTime":1431.6,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":1430.1,"endTime":1431.6,"body":"you can go either way. I don't"},{"speaker":"Charles Goldfarb","startTime":1431.6,"endTime":1435.02,"body":"think it matters. But you're"},{"speaker":"Charles Goldfarb","startTime":1431.6,"endTime":1435.02,"body":"basically pushing the needle"},{"speaker":"Charles Goldfarb","startTime":1435.02,"endTime":1440.0,"body":"through the bone. I go from the"},{"speaker":"Charles Goldfarb","startTime":1435.02,"endTime":1440.0,"body":"article from what used to be the"},{"speaker":"Charles Goldfarb","startTime":1440.0,"endTime":1443.99,"body":"articular surface of the"},{"speaker":"Charles Goldfarb","startTime":1440.0,"endTime":1443.99,"body":"metacarpal through the dorsal"},{"speaker":"Charles Goldfarb","startTime":1443.99,"endTime":1448.04,"body":"bone of the metacarpal and then"},{"speaker":"Charles Goldfarb","startTime":1443.99,"endTime":1448.04,"body":"pull it back down onto itself."},{"speaker":"Chris Dy","startTime":1448.43,"endTime":1452.42,"body":"And then how do you"},{"speaker":"Chris Dy","startTime":1448.43,"endTime":1452.42,"body":"tie that back to itself? You tie"},{"speaker":"Chris Dy","startTime":1452.42,"endTime":1453.77,"body":"it to the whatever the bridge"},{"speaker":"Chris Dy","startTime":1452.42,"endTime":1453.77,"body":"is?"},{"speaker":"Charles Goldfarb","startTime":1453.83,"endTime":1456.74,"body":"Yeah, tied to"},{"speaker":"Charles Goldfarb","startTime":1453.83,"endTime":1456.74,"body":"the bridge. It's easy. Okay."},{"speaker":"Chris Dy","startTime":1457.28,"endTime":1459.56,"body":"I haven't thought"},{"speaker":"Chris Dy","startTime":1457.28,"endTime":1459.56,"body":"about it that way. Is that"},{"speaker":"Chris Dy","startTime":1459.56,"endTime":1460.97,"body":"something you do for everybody?"},{"speaker":"Charles Goldfarb","startTime":1462.32,"endTime":1464.3,"body":"I always say I"},{"speaker":"Charles Goldfarb","startTime":1462.32,"endTime":1464.3,"body":"do it for half the patients. If"},{"speaker":"Charles Goldfarb","startTime":1464.3,"endTime":1466.7,"body":"there's any inclination that"},{"speaker":"Charles Goldfarb","startTime":1464.3,"endTime":1466.7,"body":"that metacarpal is not going to"},{"speaker":"Charles Goldfarb","startTime":1466.7,"endTime":1469.55,"body":"be stable. I go ahead and do it"},{"speaker":"Charles Goldfarb","startTime":1466.7,"endTime":1469.55,"body":"because there's no downside. The"},{"speaker":"Charles Goldfarb","startTime":1469.55,"endTime":1473.42,"body":"only potential downside is you"},{"speaker":"Charles Goldfarb","startTime":1469.55,"endTime":1473.42,"body":"creating a bulky knot. But if"},{"speaker":"Charles Goldfarb","startTime":1473.42,"endTime":1475.85,"body":"you try to keep your knot down,"},{"speaker":"Charles Goldfarb","startTime":1473.42,"endTime":1475.85,"body":"it doesn't cause a problem."},{"speaker":"Chris Dy","startTime":1476.39,"endTime":1479.12,"body":"How would you how"},{"speaker":"Chris Dy","startTime":1476.39,"endTime":1479.12,"body":"would you handle that? If you"},{"speaker":"Chris Dy","startTime":1479.15,"endTime":1481.85,"body":"say for example, were in the"},{"speaker":"Chris Dy","startTime":1479.15,"endTime":1481.85,"body":"real world and couldn't spend"},{"speaker":"Chris Dy","startTime":1481.88,"endTime":1485.03,"body":"$1,000 on a thumb CMC surgery."},{"speaker":"Charles Goldfarb","startTime":1486.74,"endTime":1488.9,"body":"I think in"},{"speaker":"Charles Goldfarb","startTime":1486.74,"endTime":1488.9,"body":"that case, it's not $1,000 But"},{"speaker":"Charles Goldfarb","startTime":1489.44,"endTime":1494.18,"body":"it's definitely not in that case"},{"speaker":"Charles Goldfarb","startTime":1489.44,"endTime":1494.18,"body":"is about your tunnels. And if"},{"speaker":"Charles Goldfarb","startTime":1494.18,"endTime":1499.04,"body":"you're doing an lrti really is"},{"speaker":"Charles Goldfarb","startTime":1494.18,"endTime":1499.04,"body":"the lrti should allow you to"},{"speaker":"Charles Goldfarb","startTime":1499.04,"endTime":1502.28,"body":"control that that Bass to the"},{"speaker":"Charles Goldfarb","startTime":1499.04,"endTime":1502.28,"body":"metacarpal. And so if you're"},{"speaker":"Charles Goldfarb","startTime":1502.28,"endTime":1505.37,"body":"trying to have your drilled"},{"speaker":"Charles Goldfarb","startTime":1502.28,"endTime":1505.37,"body":"tunnel really goes from dorsal"},{"speaker":"Charles Goldfarb","startTime":1505.37,"endTime":1509.42,"body":"to volere, and you pass your fcr"},{"speaker":"Charles Goldfarb","startTime":1505.37,"endTime":1509.42,"body":"tendon really from near its"},{"speaker":"Charles Goldfarb","startTime":1509.42,"endTime":1512.0,"body":"insertion to the base of the"},{"speaker":"Charles Goldfarb","startTime":1509.42,"endTime":1512.0,"body":"second metacarpal through the"},{"speaker":"Charles Goldfarb","startTime":1512.0,"endTime":1514.97,"body":"metacarpal. And bring it back on"},{"speaker":"Charles Goldfarb","startTime":1512.0,"endTime":1514.97,"body":"itself, it should accomplish the"},{"speaker":"Charles Goldfarb","startTime":1514.97,"endTime":1519.62,"body":"same goal, which is really magic"},{"speaker":"Charles Goldfarb","startTime":1514.97,"endTime":1519.62,"body":"when it happens. It's very cool."},{"speaker":"Chris Dy","startTime":1520.01,"endTime":1522.86,"body":"Yeah, no, absolutely."},{"speaker":"Chris Dy","startTime":1520.01,"endTime":1522.86,"body":"And that's how I would. I"},{"speaker":"Chris Dy","startTime":1522.86,"endTime":1528.02,"body":"haven't done a true lrti In a"},{"speaker":"Chris Dy","startTime":1522.86,"endTime":1528.02,"body":"while. But that is the technique"},{"speaker":"Chris Dy","startTime":1528.02,"endTime":1530.96,"body":"that I learned from mainly Dr."},{"speaker":"Chris Dy","startTime":1528.02,"endTime":1530.96,"body":"Government are doing a lot of"},{"speaker":"Chris Dy","startTime":1530.96,"endTime":1533.99,"body":"LRTs with Dr. gelderman. And"},{"speaker":"Chris Dy","startTime":1530.96,"endTime":1533.99,"body":"having a lot of anxiety because"},{"speaker":"Chris Dy","startTime":1533.99,"endTime":1535.7,"body":"every step had to be perfect."},{"speaker":"Charles Goldfarb","startTime":1536.48,"endTime":1538.85,"body":"Yeah, yeah,"},{"speaker":"Charles Goldfarb","startTime":1536.48,"endTime":1538.85,"body":"absolutely. And the reason I,"},{"speaker":"Charles Goldfarb","startTime":1538.85,"endTime":1541.31,"body":"you know, there's, you know,"},{"speaker":"Charles Goldfarb","startTime":1538.85,"endTime":1541.31,"body":"this makes sense. If you can"},{"speaker":"Charles Goldfarb","startTime":1541.31,"endTime":1544.07,"body":"avoid that second surgery at the"},{"speaker":"Charles Goldfarb","startTime":1541.31,"endTime":1544.07,"body":"empty joint, obviously, it's"},{"speaker":"Charles Goldfarb","startTime":1544.07,"endTime":1547.88,"body":"great. When I think about the"},{"speaker":"Charles Goldfarb","startTime":1544.07,"endTime":1547.88,"body":"empty joint, there's a few"},{"speaker":"Charles Goldfarb","startTime":1547.88,"endTime":1550.49,"body":"operations, I think about one"},{"speaker":"Charles Goldfarb","startTime":1547.88,"endTime":1550.49,"body":"just pinning it, which I don't"},{"speaker":"Charles Goldfarb","startTime":1550.49,"endTime":1552.62,"body":"think makes much sense, even"},{"speaker":"Charles Goldfarb","startTime":1550.49,"endTime":1552.62,"body":"though I've been guilty of doing"},{"speaker":"Charles Goldfarb","startTime":1552.62,"endTime":1555.5,"body":"that, because I don't want to do"},{"speaker":"Charles Goldfarb","startTime":1552.62,"endTime":1555.5,"body":"more. You can do the boilerplate"},{"speaker":"Charles Goldfarb","startTime":1555.5,"endTime":1558.86,"body":"advancement, which I've never"},{"speaker":"Charles Goldfarb","startTime":1555.5,"endTime":1558.86,"body":"been thrilled with, I think a"},{"speaker":"Charles Goldfarb","startTime":1558.86,"endTime":1562.13,"body":"soft tissue procedure there if"},{"speaker":"Charles Goldfarb","startTime":1558.86,"endTime":1562.13,"body":"you haven't balanced the forces,"},{"speaker":"Charles Goldfarb","startTime":1562.4,"endTime":1566.15,"body":"doing a soft tissue procedure"},{"speaker":"Charles Goldfarb","startTime":1562.4,"endTime":1566.15,"body":"like that is doable, but doesn't"},{"speaker":"Charles Goldfarb","startTime":1566.15,"endTime":1568.73,"body":"always give you the results you"},{"speaker":"Charles Goldfarb","startTime":1566.15,"endTime":1568.73,"body":"want. And then the fusion."},{"speaker":"Chris Dy","startTime":1569.24,"endTime":1572.03,"body":"What about what before"},{"speaker":"Chris Dy","startTime":1569.24,"endTime":1572.03,"body":"fusion? What about I've seen"},{"speaker":"Chris Dy","startTime":1572.03,"endTime":1575.18,"body":"people talk about EPP anonomys,"},{"speaker":"Chris Dy","startTime":1572.03,"endTime":1575.18,"body":"or tenant transfers, any"},{"speaker":"Chris Dy","startTime":1575.18,"endTime":1575.99,"body":"experience with that?"},{"speaker":"Charles Goldfarb","startTime":1576.68,"endTime":1579.89,"body":"You know, I"},{"speaker":"Charles Goldfarb","startTime":1576.68,"endTime":1579.89,"body":"don't understand the EPB. I"},{"speaker":"Charles Goldfarb","startTime":1579.89,"endTime":1583.85,"body":"don't understand this insertion."},{"speaker":"Charles Goldfarb","startTime":1579.89,"endTime":1583.85,"body":"I think it's it. You know, we It"},{"speaker":"Charles Goldfarb","startTime":1583.85,"endTime":1586.7,"body":"sounds straightforward, the BB"},{"speaker":"Charles Goldfarb","startTime":1583.85,"endTime":1586.7,"body":"and serves on the dorsal base of"},{"speaker":"Charles Goldfarb","startTime":1586.7,"endTime":1592.58,"body":"the of the proximal failings, it"},{"speaker":"Charles Goldfarb","startTime":1586.7,"endTime":1592.58,"body":"doesn't always and you can get"},{"speaker":"Charles Goldfarb","startTime":1592.58,"endTime":1596.78,"body":"an extension lag. But I don't"},{"speaker":"Charles Goldfarb","startTime":1592.58,"endTime":1596.78,"body":"have a lot of faith in the EPB."},{"speaker":"Charles Goldfarb","startTime":1597.41,"endTime":1600.02,"body":"I do think it probably is a"},{"speaker":"Charles Goldfarb","startTime":1597.41,"endTime":1600.02,"body":"deforming force. It's"},{"speaker":"Charles Goldfarb","startTime":1600.02,"endTime":1604.79,"body":"hyperextending the joint. I've"},{"speaker":"Charles Goldfarb","startTime":1600.02,"endTime":1604.79,"body":"never done an EPB to anatomy or"},{"speaker":"Charles Goldfarb","startTime":1604.79,"endTime":1605.93,"body":"transfer. Have you"},{"speaker":"Chris Dy","startTime":1605.87,"endTime":1609.65,"body":"- in training? I saw"},{"speaker":"Chris Dy","startTime":1605.87,"endTime":1609.65,"body":"it. In residency, there is a"},{"speaker":"Chris Dy","startTime":1609.65,"endTime":1613.34,"body":"surgeon residency that would do"},{"speaker":"Chris Dy","startTime":1609.65,"endTime":1613.34,"body":"this routinely for basically"},{"speaker":"Chris Dy","startTime":1613.34,"endTime":1619.79,"body":"there, they would transfer the"},{"speaker":"Chris Dy","startTime":1613.34,"endTime":1619.79,"body":"EPB. And over to the APL for"},{"speaker":"Chris Dy","startTime":1619.79,"endTime":1623.06,"body":"pretty much every thumb CMC"},{"speaker":"Chris Dy","startTime":1619.79,"endTime":1623.06,"body":"surgery. Now I'm not I'm not"},{"speaker":"Chris Dy","startTime":1623.06,"endTime":1625.46,"body":"sure that's what works for me."},{"speaker":"Chris Dy","startTime":1623.06,"endTime":1625.46,"body":"And I don't know how much of"},{"speaker":"Chris Dy","startTime":1625.46,"endTime":1629.06,"body":"that was a billing thing too,"},{"speaker":"Chris Dy","startTime":1625.46,"endTime":1629.06,"body":"because you can build. Okay,"},{"speaker":"Chris Dy","startTime":1629.06,"endTime":1632.72,"body":"believe I said that. But, you"},{"speaker":"Chris Dy","startTime":1629.06,"endTime":1632.72,"body":"know, one of the fellows at that"},{"speaker":"Chris Dy","startTime":1632.72,"endTime":1634.94,"body":"point, because I asked a fellow"},{"speaker":"Chris Dy","startTime":1632.72,"endTime":1634.94,"body":"that I was working with, like,"},{"speaker":"Chris Dy","startTime":1635.03,"endTime":1636.95,"body":"well, what's the deal? They're"},{"speaker":"Chris Dy","startTime":1635.03,"endTime":1636.95,"body":"like, that's a building thing."},{"speaker":"Charles Goldfarb","startTime":1637.7,"endTime":1639.8,"body":"Oh, man. But"},{"speaker":"Charles Goldfarb","startTime":1637.7,"endTime":1639.8,"body":"what it does raise the question"},{"speaker":"Charles Goldfarb","startTime":1639.8,"endTime":1644.42,"body":"of, Do you release the APL from"},{"speaker":"Charles Goldfarb","startTime":1639.8,"endTime":1644.42,"body":"the base of the metacarpal? When"},{"speaker":"Charles Goldfarb","startTime":1644.42,"endTime":1646.07,"body":"you do when you treat the CMC"},{"speaker":"Charles Goldfarb","startTime":1644.42,"endTime":1646.07,"body":"joint?"},{"speaker":"Chris Dy","startTime":1647.63,"endTime":1650.42,"body":"I mean, I guess"},{"speaker":"Chris Dy","startTime":1647.63,"endTime":1650.42,"body":"conceptually, it yes, that would"},{"speaker":"Chris Dy","startTime":1650.42,"endTime":1654.68,"body":"make sense. But, you know, not"},{"speaker":"Chris Dy","startTime":1650.42,"endTime":1654.68,"body":"anything that I've done. So as"},{"speaker":"Chris Dy","startTime":1654.68,"endTime":1659.39,"body":"we so when do you ever fuse the"},{"speaker":"Chris Dy","startTime":1654.68,"endTime":1659.39,"body":"MP joint? Because this has come"},{"speaker":"Chris Dy","startTime":1659.39,"endTime":1661.46,"body":"up for me recently, and some"},{"speaker":"Chris Dy","startTime":1659.39,"endTime":1661.46,"body":"crazy deformities?"},{"speaker":"Charles Goldfarb","startTime":1661.91,"endTime":1664.01,"body":"Well, it's"},{"speaker":"Charles Goldfarb","startTime":1661.91,"endTime":1664.01,"body":"obviously much easier if you"},{"speaker":"Charles Goldfarb","startTime":1664.01,"endTime":1667.37,"body":"have arthritis at the NP joint."},{"speaker":"Charles Goldfarb","startTime":1664.01,"endTime":1667.37,"body":"And certainly that happens. And"},{"speaker":"Charles Goldfarb","startTime":1667.37,"endTime":1670.31,"body":"then you should just go ahead"},{"speaker":"Charles Goldfarb","startTime":1667.37,"endTime":1670.31,"body":"and use it. And in to reiterate"},{"speaker":"Charles Goldfarb","startTime":1670.31,"endTime":1672.5,"body":"this, we've said this on the"},{"speaker":"Charles Goldfarb","startTime":1670.31,"endTime":1672.5,"body":"podcast before, but for the"},{"speaker":"Charles Goldfarb","startTime":1672.5,"endTime":1676.76,"body":"younger listeners, when there"},{"speaker":"Charles Goldfarb","startTime":1672.5,"endTime":1676.76,"body":"have been studies looking at the"},{"speaker":"Charles Goldfarb","startTime":1676.76,"endTime":1680.27,"body":"utility of different procedures"},{"speaker":"Charles Goldfarb","startTime":1676.76,"endTime":1680.27,"body":"in the citation about two"},{"speaker":"Charles Goldfarb","startTime":1680.27,"endTime":1683.0,"body":"providers regarding rheumatoid"},{"speaker":"Charles Goldfarb","startTime":1680.27,"endTime":1683.0,"body":"arthritis, but it doesn't"},{"speaker":"Charles Goldfarb","startTime":1683.0,"endTime":1686.81,"body":"matter. One of the best"},{"speaker":"Charles Goldfarb","startTime":1683.0,"endTime":1686.81,"body":"operations you can provide to a"},{"speaker":"Charles Goldfarb","startTime":1686.81,"endTime":1690.35,"body":"patient enhancer is np joint"},{"speaker":"Charles Goldfarb","startTime":1686.81,"endTime":1690.35,"body":"fusion of the thumb. It's a"},{"speaker":"Charles Goldfarb","startTime":1690.38,"endTime":1693.62,"body":"great operation, it takes care"},{"speaker":"Charles Goldfarb","startTime":1690.38,"endTime":1693.62,"body":"of alignment, it takes care of"},{"speaker":"Charles Goldfarb","startTime":1693.62,"endTime":1696.89,"body":"pain, and there's very little"},{"speaker":"Charles Goldfarb","startTime":1693.62,"endTime":1696.89,"body":"morbidity to doing it. So"},{"speaker":"Charles Goldfarb","startTime":1696.95,"endTime":1699.83,"body":"there's you shouldn't hesitate"},{"speaker":"Charles Goldfarb","startTime":1696.95,"endTime":1699.83,"body":"if there's an indication, and"},{"speaker":"Charles Goldfarb","startTime":1699.83,"endTime":1703.16,"body":"arthritis is a great indication,"},{"speaker":"Charles Goldfarb","startTime":1699.83,"endTime":1703.16,"body":"instability is a reasonable"},{"speaker":"Charles Goldfarb","startTime":1703.16,"endTime":1706.67,"body":"indication. But I offered if I"},{"speaker":"Charles Goldfarb","startTime":1703.16,"endTime":1706.67,"body":"don't think I can control the"},{"speaker":"Charles Goldfarb","startTime":1706.67,"endTime":1711.26,"body":"metacarpal posture through the"},{"speaker":"Charles Goldfarb","startTime":1706.67,"endTime":1711.26,"body":"CMC joint. And that absolutely"},{"speaker":"Charles Goldfarb","startTime":1711.26,"endTime":1714.17,"body":"happens is a vague answer,"},{"speaker":"Charles Goldfarb","startTime":1711.26,"endTime":1714.17,"body":"because I think it has to be a"},{"speaker":"Charles Goldfarb","startTime":1714.17,"endTime":1714.74,"body":"vague answer."},{"speaker":"Chris Dy","startTime":1715.43,"endTime":1718.22,"body":"Is that an interrupt"},{"speaker":"Chris Dy","startTime":1715.43,"endTime":1718.22,"body":"call? Because that kind of"},{"speaker":"Chris Dy","startTime":1718.22,"endTime":1719.81,"body":"messes with your surgery"},{"speaker":"Chris Dy","startTime":1718.22,"endTime":1719.81,"body":"scheduling, right?"},{"speaker":"Charles Goldfarb","startTime":1720.02,"endTime":1721.46,"body":"It does, but"},{"speaker":"Charles Goldfarb","startTime":1720.02,"endTime":1721.46,"body":"thankfully, it's a quick"},{"speaker":"Charles Goldfarb","startTime":1721.46,"endTime":1726.86,"body":"surgery. So quick addition, I"},{"speaker":"Charles Goldfarb","startTime":1721.46,"endTime":1726.86,"body":"think you have to consider that"},{"speaker":"Charles Goldfarb","startTime":1726.86,"endTime":1732.11,"body":"option when you meet the patient"},{"speaker":"Charles Goldfarb","startTime":1726.86,"endTime":1732.11,"body":"in the office. And, you know,"},{"speaker":"Charles Goldfarb","startTime":1732.11,"endTime":1736.46,"body":"I'd rather have them expecting"},{"speaker":"Charles Goldfarb","startTime":1732.11,"endTime":1736.46,"body":"that and my doing it, rather"},{"speaker":"Charles Goldfarb","startTime":1736.46,"endTime":1739.43,"body":"than not expecting it and my"},{"speaker":"Charles Goldfarb","startTime":1736.46,"endTime":1739.43,"body":"feeling like we needed to do it."},{"speaker":"Charles Goldfarb","startTime":1739.43,"endTime":1741.56,"body":"So if you don't think about"},{"speaker":"Charles Goldfarb","startTime":1739.43,"endTime":1741.56,"body":"early, you're not going to think"},{"speaker":"Charles Goldfarb","startTime":1741.56,"endTime":1743.78,"body":"about later. So you should"},{"speaker":"Charles Goldfarb","startTime":1741.56,"endTime":1743.78,"body":"always think about it in the"},{"speaker":"Charles Goldfarb","startTime":1743.78,"endTime":1747.29,"body":"office. And then I do think it's"},{"speaker":"Charles Goldfarb","startTime":1743.78,"endTime":1747.29,"body":"an interpretive call, although"},{"speaker":"Charles Goldfarb","startTime":1747.32,"endTime":1750.68,"body":"generally my mind's made up"},{"speaker":"Charles Goldfarb","startTime":1747.32,"endTime":1750.68,"body":"beforehand, because I know what"},{"speaker":"Charles Goldfarb","startTime":1750.68,"endTime":1752.75,"body":"we can accomplish at the CMC"},{"speaker":"Charles Goldfarb","startTime":1750.68,"endTime":1752.75,"body":"joint."},{"speaker":"Chris Dy","startTime":1753.26,"endTime":1755.72,"body":"So when you fuse it"},{"speaker":"Chris Dy","startTime":1753.26,"endTime":1755.72,"body":"flexes, do you do a little bit"},{"speaker":"Chris Dy","startTime":1755.72,"endTime":1758.24,"body":"of flexion? What do you like to"},{"speaker":"Chris Dy","startTime":1755.72,"endTime":1758.24,"body":"how do you like to do that?"},{"speaker":"Chris Dy","startTime":1758.24,"endTime":1758.81,"body":"Technically?"},{"speaker":"Charles Goldfarb","startTime":1759.08,"endTime":1761.87,"body":"Yeah, I like a"},{"speaker":"Charles Goldfarb","startTime":1759.08,"endTime":1761.87,"body":"tension man technique because"},{"speaker":"Charles Goldfarb","startTime":1761.93,"endTime":1765.98,"body":"like everything, Chris is"},{"speaker":"Charles Goldfarb","startTime":1761.93,"endTime":1765.98,"body":"inexpensive to $90,000 and I"},{"speaker":"Charles Goldfarb","startTime":1765.98,"endTime":1769.04,"body":"tend to put a little flexion"},{"speaker":"Charles Goldfarb","startTime":1765.98,"endTime":1769.04,"body":"intended 20 degrees, what do you"},{"speaker":"Charles Goldfarb","startTime":1769.04,"endTime":1769.28,"body":"do?"},{"speaker":"Chris Dy","startTime":1770.63,"endTime":1773.87,"body":"A little bit of"},{"speaker":"Chris Dy","startTime":1770.63,"endTime":1773.87,"body":"flexion. I, you're gonna laugh"},{"speaker":"Chris Dy","startTime":1773.87,"endTime":1777.59,"body":"at this headless compression"},{"speaker":"Chris Dy","startTime":1773.87,"endTime":1777.59,"body":"screws. I like it, you know,"},{"speaker":"Chris Dy","startTime":1777.59,"endTime":1781.55,"body":"spend some money. But to me"},{"speaker":"Chris Dy","startTime":1777.59,"endTime":1781.55,"body":"that, you know, I think that the"},{"speaker":"Chris Dy","startTime":1781.61,"endTime":1784.82,"body":"K wires can be a little bit"},{"speaker":"Chris Dy","startTime":1781.61,"endTime":1784.82,"body":"fussy at times tension Manding,"},{"speaker":"Chris Dy","startTime":1784.85,"endTime":1788.24,"body":"I think does work well. But you"},{"speaker":"Chris Dy","startTime":1784.85,"endTime":1788.24,"body":"know, essentially, I'm using the"},{"speaker":"Chris Dy","startTime":1788.24,"endTime":1791.72,"body":"headless compression screws as"},{"speaker":"Chris Dy","startTime":1788.24,"endTime":1791.72,"body":"internal struts. Not necessarily"},{"speaker":"Chris Dy","startTime":1791.72,"endTime":1794.06,"body":"in this patient population. You"},{"speaker":"Chris Dy","startTime":1791.72,"endTime":1794.06,"body":"have the best bone and so you're"},{"speaker":"Chris Dy","startTime":1794.06,"endTime":1796.58,"body":"not looking for tons of strong"},{"speaker":"Chris Dy","startTime":1794.06,"endTime":1796.58,"body":"compression, but it's a nice way"},{"speaker":"Chris Dy","startTime":1796.58,"endTime":1798.92,"body":"to have an implant in there"},{"speaker":"Chris Dy","startTime":1796.58,"endTime":1798.92,"body":"that's not going to be"},{"speaker":"Chris Dy","startTime":1798.92,"endTime":1800.93,"body":"prominent, but Hold it in place."},{"speaker":"Charles Goldfarb","startTime":1801.53,"endTime":1803.84,"body":"You know,"},{"speaker":"Charles Goldfarb","startTime":1801.53,"endTime":1803.84,"body":"that's very fair. And I haven't"},{"speaker":"Charles Goldfarb","startTime":1803.84,"endTime":1807.83,"body":"done that. We were in peds"},{"speaker":"Charles Goldfarb","startTime":1803.84,"endTime":1807.83,"body":"conference on Friday morning and"},{"speaker":"Charles Goldfarb","startTime":1807.83,"endTime":1811.13,"body":"one of my partners was talking"},{"speaker":"Charles Goldfarb","startTime":1807.83,"endTime":1811.13,"body":"about doing putting a dorsal"},{"speaker":"Charles Goldfarb","startTime":1811.13,"endTime":1813.62,"body":"plate on a distal 1/3 of the"},{"speaker":"Charles Goldfarb","startTime":1811.13,"endTime":1813.62,"body":"radius fracture because he"},{"speaker":"Charles Goldfarb","startTime":1813.62,"endTime":1815.69,"body":"didn't show residents how to do"},{"speaker":"Charles Goldfarb","startTime":1813.62,"endTime":1815.69,"body":"it. No one's ever going to show"},{"speaker":"Charles Goldfarb","startTime":1815.69,"endTime":1819.68,"body":"him. And I think tension bands"},{"speaker":"Charles Goldfarb","startTime":1815.69,"endTime":1819.68,"body":"are really a wonderful"},{"speaker":"Charles Goldfarb","startTime":1819.68,"endTime":1823.88,"body":"orthopedic technique that is"},{"speaker":"Charles Goldfarb","startTime":1819.68,"endTime":1823.88,"body":"slowly disappearing from right,"},{"speaker":"Charles Goldfarb","startTime":1824.09,"endTime":1828.02,"body":"you know, from training. And so"},{"speaker":"Charles Goldfarb","startTime":1824.09,"endTime":1828.02,"body":"this is a great, reliable way to"},{"speaker":"Charles Goldfarb","startTime":1828.02,"endTime":1830.45,"body":"use it. I use it for PRP joints"},{"speaker":"Charles Goldfarb","startTime":1828.02,"endTime":1830.45,"body":"as well. What do you do for PRP"},{"speaker":"Charles Goldfarb","startTime":1830.45,"endTime":1830.87,"body":"Jones?"},{"speaker":"Chris Dy","startTime":1831.679,"endTime":1834.169,"body":"I you know, I'm honest"},{"speaker":"Chris Dy","startTime":1831.679,"endTime":1834.169,"body":"with you, I haven't I would use"},{"speaker":"Chris Dy","startTime":1834.169,"endTime":1838.879,"body":"the tension band, but I haven't"},{"speaker":"Chris Dy","startTime":1834.169,"endTime":1838.879,"body":"used it in a long time. So I"},{"speaker":"Chris Dy","startTime":1838.879,"endTime":1841.249,"body":"think I did one early in"},{"speaker":"Chris Dy","startTime":1838.879,"endTime":1841.249,"body":"practice, but I can't remember"},{"speaker":"Chris Dy","startTime":1841.249,"endTime":1842.929,"body":"the last one I did to be very"},{"speaker":"Chris Dy","startTime":1841.249,"endTime":1842.929,"body":"honest with you."},{"speaker":"Charles Goldfarb","startTime":1843.229,"endTime":1844.279,"body":"You're"},{"speaker":"Charles Goldfarb","startTime":1843.229,"endTime":1844.279,"body":"probably not missing them"},{"speaker":"Charles Goldfarb","startTime":1844.279,"endTime":1844.639,"body":"either."},{"speaker":"Chris Dy","startTime":1845.12,"endTime":1847.22,"body":"Yeah, well, if it"},{"speaker":"Chris Dy","startTime":1845.12,"endTime":1847.22,"body":"makes you feel better, maybe"},{"speaker":"Chris Dy","startTime":1847.22,"endTime":1851.06,"body":"I'll slide some some stainless"},{"speaker":"Chris Dy","startTime":1847.22,"endTime":1851.06,"body":"steel wire through the"},{"speaker":"Chris Dy","startTime":1851.09,"endTime":1853.28,"body":"cannulated portion of the head"},{"speaker":"Chris Dy","startTime":1851.09,"endTime":1853.28,"body":"this compressions group"},{"speaker":"Chris Dy","startTime":1853.76,"endTime":1858.41,"body":"intention, pathway, complete"},{"speaker":"Chris Dy","startTime":1853.76,"endTime":1858.41,"body":"orthopedic window dressing, it's"},{"speaker":"Chris Dy","startTime":1858.41,"endTime":1858.92,"body":"important to"},{"speaker":"Charles Goldfarb","startTime":1860.3,"endTime":1862.43,"body":"the 2022"},{"speaker":"Charles Goldfarb","startTime":1860.3,"endTime":1862.43,"body":"tension man technique. Yeah,"},{"speaker":"Chris Dy","startTime":1862.46,"endTime":1864.65,"body":"no, I think I think I"},{"speaker":"Chris Dy","startTime":1862.46,"endTime":1864.65,"body":"agree with you. Tension banding"},{"speaker":"Chris Dy","startTime":1864.65,"endTime":1866.51,"body":"is important. And it's a"},{"speaker":"Chris Dy","startTime":1864.65,"endTime":1866.51,"body":"technique that we don't use"},{"speaker":"Chris Dy","startTime":1866.51,"endTime":1869.54,"body":"enough anymore, just because we"},{"speaker":"Chris Dy","startTime":1866.51,"endTime":1869.54,"body":"I think that the younger"},{"speaker":"Chris Dy","startTime":1869.54,"endTime":1873.41,"body":"generation of surgeons thinks of"},{"speaker":"Chris Dy","startTime":1869.54,"endTime":1873.41,"body":"other options first. So I think"},{"speaker":"Chris Dy","startTime":1873.74,"endTime":1875.66,"body":"you know if you have the"},{"speaker":"Chris Dy","startTime":1873.74,"endTime":1875.66,"body":"opportunity to teach it"},{"speaker":"Charles Goldfarb","startTime":1875.69,"endTime":1878.57,"body":"fantastic."},{"speaker":"Charles Goldfarb","startTime":1875.69,"endTime":1878.57,"body":"Hey, Chris, that was fun. Let's"},{"speaker":"Charles Goldfarb","startTime":1878.57,"endTime":1880.55,"body":"do it again real soon. Sounds"},{"speaker":"Charles Goldfarb","startTime":1878.57,"endTime":1880.55,"body":"good."},{"speaker":"Chris Dy","startTime":1880.61,"endTime":1882.77,"body":"Well, be sure to check"},{"speaker":"Chris Dy","startTime":1880.61,"endTime":1882.77,"body":"us out on Twitter at hand"},{"speaker":"Chris Dy","startTime":1882.77,"endTime":1884.69,"body":"podcast. Hey, Chuck, what's your"},{"speaker":"Chris Dy","startTime":1882.77,"endTime":1884.69,"body":"Twitter handle?"},{"speaker":"Charles Goldfarb","startTime":1885.05,"endTime":1887.9,"body":"Mine is at"},{"speaker":"Charles Goldfarb","startTime":1885.05,"endTime":1887.9,"body":"congenital hand. What about you?"},{"speaker":"Chris Dy","startTime":1888.05,"endTime":1891.53,"body":"Mine is at Chris de MD"},{"speaker":"Chris Dy","startTime":1888.05,"endTime":1891.53,"body":"spelled dy. And if you'd like to"},{"speaker":"Chris Dy","startTime":1891.53,"endTime":1895.31,"body":"email us, you can reach us at"},{"speaker":"Chris Dy","startTime":1891.53,"endTime":1895.31,"body":"hand podcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":1895.88,"endTime":1898.01,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":1895.88,"endTime":1898.01,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":1898.01,"endTime":1899.09,"body":"get your podcast"},{"speaker":"Chris Dy","startTime":1899.12,"endTime":1901.34,"body":"and be sure to leave a"},{"speaker":"Chris Dy","startTime":1899.12,"endTime":1901.34,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":1901.34,"endTime":1901.73,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":1902.12,"endTime":1904.43,"body":"Special thanks"},{"speaker":"Charles Goldfarb","startTime":1902.12,"endTime":1904.43,"body":"to Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":1904.43,"endTime":1908.33,"body":"music. And remember, keep the"},{"speaker":"Charles Goldfarb","startTime":1904.43,"endTime":1908.33,"body":"upper hand come back next"}]}