{"version":"1.0.0","segments":[{"speaker":"Charles Goldfarb","startTime":3.6,"endTime":5.97,"body":"Welcome to the"},{"speaker":"Charles Goldfarb","startTime":3.6,"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 two 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":18.0,"body":"podcasts."},{"speaker":"Chris Dy","startTime":18.96,"endTime":21.3,"body":"And thank you in"},{"speaker":"Chris Dy","startTime":18.96,"endTime":21.3,"body":"advance for leaving a review and"},{"speaker":"Chris Dy","startTime":21.3,"endTime":23.55,"body":"leaving a rating wherever you"},{"speaker":"Chris Dy","startTime":21.3,"endTime":23.55,"body":"get your podcasts."},{"speaker":"Charles Goldfarb","startTime":24.36,"endTime":25.17,"body":"Oh hey. Chris."},{"speaker":"Chris Dy","startTime":25.92,"endTime":26.85,"body":"Hey, Chuck, how are"},{"speaker":"Chris Dy","startTime":25.92,"endTime":26.85,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":27.75,"endTime":29.34,"body":"It's good."},{"speaker":"Charles Goldfarb","startTime":27.75,"endTime":29.34,"body":"We're recording in the evening."},{"speaker":"Charles Goldfarb","startTime":29.34,"endTime":32.19,"body":"It's kind of nice. I found some"},{"speaker":"Charles Goldfarb","startTime":29.34,"endTime":32.19,"body":"energy. I hope you did too."},{"speaker":"Chris Dy","startTime":32.73,"endTime":36.3,"body":"I did. It's it's it's"},{"speaker":"Chris Dy","startTime":32.73,"endTime":36.3,"body":"been a day. You know, in my"},{"speaker":"Chris Dy","startTime":36.33,"endTime":39.69,"body":"young ish attending yours, I"},{"speaker":"Chris Dy","startTime":36.33,"endTime":39.69,"body":"think I've kind of gotten the"},{"speaker":"Chris Dy","startTime":39.69,"endTime":44.07,"body":"two room thing down down better"},{"speaker":"Chris Dy","startTime":39.69,"endTime":44.07,"body":"than before. You know, block"},{"speaker":"Chris Dy","startTime":44.07,"endTime":49.68,"body":"utilization ended exactly at"},{"speaker":"Chris Dy","startTime":44.07,"endTime":49.68,"body":"4:58pm. So you'd be proud. 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Did you"},{"speaker":"Chris Dy","startTime":90.96,"endTime":96.93,"body":"order pizza now got it done. How"},{"speaker":"Chris Dy","startTime":96.93,"endTime":100.53,"body":"long we got we got done we just"},{"speaker":"Chris Dy","startTime":96.93,"endTime":100.53,"body":"push the timeline back a little"},{"speaker":"Chris Dy","startTime":100.53,"endTime":103.74,"body":"bit. My wife was kind enough to"},{"speaker":"Chris Dy","startTime":100.53,"endTime":103.74,"body":"come home before seeing the"},{"speaker":"Chris Dy","startTime":103.74,"endTime":106.59,"body":"console she's already on her way"},{"speaker":"Chris Dy","startTime":103.74,"endTime":106.59,"body":"to the hospital letting me in"},{"speaker":"Chris Dy","startTime":106.59,"endTime":111.12,"body":"the house gave me a look."},{"speaker":"Chris Dy","startTime":106.59,"endTime":111.12,"body":"Welcome lovingly left me the key"},{"speaker":"Chris Dy","startTime":111.48,"endTime":113.67,"body":"and then went and saw the"},{"speaker":"Chris Dy","startTime":111.48,"endTime":113.67,"body":"console. I got dinner ready and"},{"speaker":"Chris Dy","startTime":113.67,"endTime":116.73,"body":"it's all okay. Just push back or"},{"speaker":"Chris Dy","startTime":113.67,"endTime":116.73,"body":"recording time a little bit."},{"speaker":"Charles Goldfarb","startTime":117.09,"endTime":120.54,"body":"Yeah, I my my"},{"speaker":"Charles Goldfarb","startTime":117.09,"endTime":120.54,"body":"story is my family used to spend"},{"speaker":"Charles Goldfarb","startTime":120.54,"endTime":123.3,"body":"a fair amount of time up in New"},{"speaker":"Charles Goldfarb","startTime":120.54,"endTime":123.3,"body":"Hampshire with Talia's family at"},{"speaker":"Charles Goldfarb","startTime":123.3,"endTime":128.61,"body":"our lake house. And those used"},{"speaker":"Charles Goldfarb","startTime":123.3,"endTime":128.61,"body":"to be many, many weeks. And now"},{"speaker":"Charles Goldfarb","startTime":128.61,"endTime":132.45,"body":"it's not and they left"},{"speaker":"Charles Goldfarb","startTime":128.61,"endTime":132.45,"body":"yesterday. 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He hasn't given them"},{"speaker":"Chris Dy","startTime":147.33,"endTime":150.57,"body":"directly to me, but he's kind of"},{"speaker":"Chris Dy","startTime":147.33,"endTime":150.57,"body":"given when he was here at Wash U"},{"speaker":"Chris Dy","startTime":150.6,"endTime":153.45,"body":"giving like junior faculty"},{"speaker":"Chris Dy","startTime":150.6,"endTime":153.45,"body":"advice and one of them was there"},{"speaker":"Chris Dy","startTime":153.45,"endTime":156.72,"body":"is nothing more stressful than"},{"speaker":"Chris Dy","startTime":153.45,"endTime":156.72,"body":"operating before a flight. It's"},{"speaker":"Chris Dy","startTime":156.72,"endTime":160.8,"body":"true. But yeah, yeah. So here we"},{"speaker":"Chris Dy","startTime":156.72,"endTime":160.8,"body":"are, and excited. We've had some"},{"speaker":"Chris Dy","startTime":160.8,"endTime":164.34,"body":"great engagement from folks"},{"speaker":"Chris Dy","startTime":160.8,"endTime":164.34,"body":"recently. There's a really great"},{"speaker":"Chris Dy","startTime":164.34,"endTime":167.16,"body":"review that I was hoping you'd"},{"speaker":"Chris Dy","startTime":164.34,"endTime":167.16,"body":"let me read. I would love to"},{"speaker":"Chris Dy","startTime":167.16,"endTime":167.76,"body":"hear it. Thank"},{"speaker":"Charles Goldfarb","startTime":167.76,"endTime":168.93,"body":"you. Alright,"},{"speaker":"Charles Goldfarb","startTime":167.76,"endTime":168.93,"body":"so"},{"speaker":"Chris Dy","startTime":168.93,"endTime":173.13,"body":"This is recently from"},{"speaker":"Chris Dy","startTime":168.93,"endTime":173.13,"body":"Britt Mitch. OTRL. Five stars,"},{"speaker":"Chris Dy","startTime":173.13,"endTime":176.4,"body":"of course, always five stars."},{"speaker":"Chris Dy","startTime":173.13,"endTime":176.4,"body":"Oh, thank you for all that you"},{"speaker":"Chris Dy","startTime":176.4,"endTime":181.71,"body":"do. Chris and Chuck, not Chuck"},{"speaker":"Chris Dy","startTime":176.4,"endTime":181.71,"body":"and Chris. Thank you. Oh, and I"},{"speaker":"Chris Dy","startTime":181.71,"endTime":184.83,"body":"want to thank you so much for"},{"speaker":"Chris Dy","startTime":181.71,"endTime":184.83,"body":"creating this podcast, which has"},{"speaker":"Chris Dy","startTime":184.83,"endTime":187.71,"body":"provided me the opportunity to"},{"speaker":"Chris Dy","startTime":184.83,"endTime":187.71,"body":"listen and learn about the hand"},{"speaker":"Chris Dy","startTime":187.71,"endTime":191.13,"body":"and upper extremity over the"},{"speaker":"Chris Dy","startTime":187.71,"endTime":191.13,"body":"past year and year and a half."},{"speaker":"Chris Dy","startTime":191.37,"endTime":194.37,"body":"While I study for my ch T."},{"speaker":"Chris Dy","startTime":191.37,"endTime":194.37,"body":"That's it. For those outside of"},{"speaker":"Chris Dy","startTime":194.37,"endTime":197.13,"body":"the US that is a certified hand"},{"speaker":"Chris Dy","startTime":194.37,"endTime":197.13,"body":"therapy examination has many"},{"speaker":"Chris Dy","startTime":197.13,"endTime":200.67,"body":"many hours of patient care"},{"speaker":"Chris Dy","startTime":197.13,"endTime":200.67,"body":"contact related to hand and"},{"speaker":"Chris Dy","startTime":200.67,"endTime":204.45,"body":"upper extremity in a really"},{"speaker":"Chris Dy","startTime":200.67,"endTime":204.45,"body":"rough test. So birth continues,"},{"speaker":"Chris Dy","startTime":204.45,"endTime":207.06,"body":"I'm happy to announce that I"},{"speaker":"Chris Dy","startTime":204.45,"endTime":207.06,"body":"have successfully passed my CHT"},{"speaker":"Chris Dy","startTime":207.06,"endTime":210.36,"body":"exam on the first attempt."},{"speaker":"Chris Dy","startTime":207.06,"endTime":210.36,"body":"Listening to the upper hand"},{"speaker":"Chris Dy","startTime":210.36,"endTime":213.36,"body":"helped me to understand the"},{"speaker":"Chris Dy","startTime":210.36,"endTime":213.36,"body":"surgeons perspective. I really"},{"speaker":"Chris Dy","startTime":213.36,"endTime":215.52,"body":"enjoyed it. Appreciate the"},{"speaker":"Chris Dy","startTime":213.36,"endTime":215.52,"body":"collaboration episodes and"},{"speaker":"Chris Dy","startTime":215.52,"endTime":218.82,"body":"discuss options with AC. You"},{"speaker":"Chris Dy","startTime":215.52,"endTime":218.82,"body":"helped me make my studying"},{"speaker":"Chris Dy","startTime":218.88,"endTime":221.43,"body":"experience more interactive, and"},{"speaker":"Chris Dy","startTime":218.88,"endTime":221.43,"body":"I have learned a great deal from"},{"speaker":"Chris Dy","startTime":221.43,"endTime":223.59,"body":"you both. Thank you for"},{"speaker":"Chris Dy","startTime":221.43,"endTime":223.59,"body":"answering my questions I had"},{"speaker":"Chris Dy","startTime":223.59,"endTime":226.41,"body":"along the way while I study for"},{"speaker":"Chris Dy","startTime":223.59,"endTime":226.41,"body":"my exam, I plan to continue to"},{"speaker":"Chris Dy","startTime":226.41,"endTime":228.99,"body":"listen and learn to the upper"},{"speaker":"Chris Dy","startTime":226.41,"endTime":228.99,"body":"hand as I continue into my"},{"speaker":"Chris Dy","startTime":228.99,"endTime":232.83,"body":"professional career as a CHT."},{"speaker":"Chris Dy","startTime":228.99,"endTime":232.83,"body":"Well, Brett, thank you for that."},{"speaker":"Chris Dy","startTime":232.83,"endTime":235.2,"body":"And congrats on passing your"},{"speaker":"Chris Dy","startTime":232.83,"endTime":235.2,"body":"exam. It's wonderful."},{"speaker":"Charles Goldfarb","startTime":235.56,"endTime":237.81,"body":"Absolutely."},{"speaker":"Charles Goldfarb","startTime":235.56,"endTime":237.81,"body":"It's not an easy test. And I've"},{"speaker":"Charles Goldfarb","startTime":237.81,"endTime":241.68,"body":"known very impressive therapists"},{"speaker":"Charles Goldfarb","startTime":237.81,"endTime":241.68,"body":"to take it more than once. And"},{"speaker":"Charles Goldfarb","startTime":241.68,"endTime":243.78,"body":"so congrats, and I'm glad to"},{"speaker":"Charles Goldfarb","startTime":241.68,"endTime":243.78,"body":"hear you're gonna keep"},{"speaker":"Charles Goldfarb","startTime":243.78,"endTime":246.51,"body":"listening, because maybe you'll"},{"speaker":"Charles Goldfarb","startTime":243.78,"endTime":246.51,"body":"share some insights with us"},{"speaker":"Charles Goldfarb","startTime":246.51,"endTime":247.26,"body":"moving forward."},{"speaker":"Chris Dy","startTime":248.04,"endTime":250.11,"body":"Yes, yes. And we're"},{"speaker":"Chris Dy","startTime":248.04,"endTime":250.11,"body":"gonna get do a little bit of a"},{"speaker":"Chris Dy","startTime":250.11,"endTime":254.61,"body":"listener grab bag email episode"},{"speaker":"Chris Dy","startTime":250.11,"endTime":254.61,"body":"today. So remember to send"},{"speaker":"Chris Dy","startTime":254.61,"endTime":257.97,"body":"questions, comments, thoughts,"},{"speaker":"Chris Dy","startTime":254.61,"endTime":257.97,"body":"suggestions for episodes to hand"},{"speaker":"Chris Dy","startTime":257.97,"endTime":261.78,"body":"podcast@gmail.com. And maybe"},{"speaker":"Chris Dy","startTime":257.97,"endTime":261.78,"body":"we'll get on this new thing,"},{"speaker":"Chris Dy","startTime":261.78,"endTime":264.51,"body":"threads that everybody's doing."},{"speaker":"Chris Dy","startTime":261.78,"endTime":264.51,"body":"By the time this drops, it'll"},{"speaker":"Chris Dy","startTime":264.51,"endTime":269.07,"body":"probably reach you know, half of"},{"speaker":"Chris Dy","startTime":264.51,"endTime":269.07,"body":"the world. But But yes, for now,"},{"speaker":"Chris Dy","startTime":269.1,"endTime":271.05,"body":"send us an email because we're"},{"speaker":"Chris Dy","startTime":269.1,"endTime":271.05,"body":"old."},{"speaker":"Charles Goldfarb","startTime":271.59,"endTime":274.8,"body":"You know, I am"},{"speaker":"Charles Goldfarb","startTime":271.59,"endTime":274.8,"body":"on Threads. 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I'll say, I have"},{"speaker":"Chris Dy","startTime":302.94,"endTime":307.41,"body":"also been off Twitter for a"},{"speaker":"Chris Dy","startTime":307.41,"endTime":311.37,"body":"while out of kind of pseudo"},{"speaker":"Chris Dy","startTime":307.41,"endTime":311.37,"body":"protests as well. But, you know,"},{"speaker":"Chris Dy","startTime":311.37,"endTime":314.55,"body":"I guess there's there's a reason"},{"speaker":"Chris Dy","startTime":311.37,"endTime":314.55,"body":"to re engage. 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So thank you"},{"speaker":"Chris Dy","startTime":343.71,"endTime":347.19,"body":"for that. I know the residents"},{"speaker":"Chris Dy","startTime":347.19,"endTime":348.72,"body":"really, really, really enjoyed"},{"speaker":"Chris Dy","startTime":347.19,"endTime":348.72,"body":"it."},{"speaker":"Charles Goldfarb","startTime":349.08,"endTime":350.7,"body":"They loved it,"},{"speaker":"Charles Goldfarb","startTime":349.08,"endTime":350.7,"body":"they shared a great picture,"},{"speaker":"Charles Goldfarb","startTime":350.7,"endTime":354.39,"body":"which can appreciate it. And"},{"speaker":"Charles Goldfarb","startTime":350.7,"endTime":354.39,"body":"yeah, it was it was very, very"},{"speaker":"Charles Goldfarb","startTime":354.39,"endTime":357.63,"body":"generous. And, and, and, and we"},{"speaker":"Charles Goldfarb","startTime":354.39,"endTime":357.63,"body":"as a department had an event. 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So as you"},{"speaker":"Chris Dy","startTime":386.43,"endTime":388.8,"body":"mentioned, couldn't make it"},{"speaker":"Chris Dy","startTime":388.8,"endTime":392.58,"body":"myself. But I look forward to"},{"speaker":"Chris Dy","startTime":388.8,"endTime":392.58,"body":"doing it again. Going at some"},{"speaker":"Chris Dy","startTime":392.58,"endTime":395.22,"body":"point in the future. I heard the"},{"speaker":"Chris Dy","startTime":392.58,"endTime":395.22,"body":"other hand service to come some"},{"speaker":"Chris Dy","startTime":395.22,"endTime":395.76,"body":"hardware"},{"speaker":"Charles Goldfarb","startTime":396.18,"endTime":398.1,"body":"to hand"},{"speaker":"Charles Goldfarb","startTime":396.18,"endTime":398.1,"body":"service took on some hardware."},{"speaker":"Charles Goldfarb","startTime":398.46,"endTime":403.62,"body":"Yes, we are. Our division was"},{"speaker":"Charles Goldfarb","startTime":398.46,"endTime":403.62,"body":"the Press Ganey highest average"},{"speaker":"Charles Goldfarb","startTime":403.62,"endTime":408.45,"body":"score, which I think should come"},{"speaker":"Charles Goldfarb","startTime":403.62,"endTime":408.45,"body":"to no surprise to us, at least."},{"speaker":"Charles Goldfarb","startTime":409.44,"endTime":410.58,"body":"I think we do. Well."},{"speaker":"Chris Dy","startTime":411.06,"endTime":414.0,"body":"I'm glad I'm glad we"},{"speaker":"Chris Dy","startTime":411.06,"endTime":414.0,"body":"have people like you to bring up"},{"speaker":"Chris Dy","startTime":414.0,"endTime":418.05,"body":"the score because again, if an"},{"speaker":"Chris Dy","startTime":414.0,"endTime":418.05,"body":"average so when my clinic we"},{"speaker":"Chris Dy","startTime":418.05,"endTime":420.87,"body":"keep to your Kelly's. So that is"},{"speaker":"Chris Dy","startTime":418.05,"endTime":420.87,"body":"the number of patients that have"},{"speaker":"Chris Dy","startTime":420.87,"endTime":423.78,"body":"cried during office encounters"},{"speaker":"Chris Dy","startTime":420.87,"endTime":423.78,"body":"with me. So sometimes my scores"},{"speaker":"Chris Dy","startTime":423.78,"endTime":424.5,"body":"probably aren't that good."},{"speaker":"Charles Goldfarb","startTime":425.46,"endTime":427.65,"body":"Your scores"},{"speaker":"Charles Goldfarb","startTime":425.46,"endTime":427.65,"body":"are good part a population"},{"speaker":"Charles Goldfarb","startTime":427.65,"endTime":431.04,"body":"matters to these things. There"},{"speaker":"Charles Goldfarb","startTime":427.65,"endTime":431.04,"body":"are a no workup probably doesn't"},{"speaker":"Charles Goldfarb","startTime":431.04,"endTime":435.6,"body":"help my scores. Dr. Calfee, it"},{"speaker":"Charles Goldfarb","startTime":431.04,"endTime":435.6,"body":"leads the way for us. He was"},{"speaker":"Charles Goldfarb","startTime":435.6,"endTime":438.42,"body":"edged out for the highest in the"},{"speaker":"Charles Goldfarb","startTime":435.6,"endTime":438.42,"body":"department, but still pretty"},{"speaker":"Charles Goldfarb","startTime":438.42,"endTime":438.87,"body":"impressive."},{"speaker":"Chris Dy","startTime":439.41,"endTime":441.75,"body":"Yes, I believe was"},{"speaker":"Chris Dy","startTime":439.41,"endTime":441.75,"body":"that Dr. keener on the shoulder"},{"speaker":"Chris Dy","startTime":441.75,"endTime":443.55,"body":"service on that trophy?"},{"speaker":"Charles Goldfarb","startTime":443.64,"endTime":445.98,"body":"absolutely"},{"speaker":"Charles Goldfarb","startTime":443.64,"endTime":445.98,"body":"impressive work by Dr. Keener?"},{"speaker":"Charles Goldfarb","startTime":446.67,"endTime":447.69,"body":"Yes. Well,"},{"speaker":"Chris Dy","startTime":448.23,"endTime":451.29,"body":"speaking of impressive"},{"speaker":"Chris Dy","startTime":448.23,"endTime":451.29,"body":"work, I wanted to get your"},{"speaker":"Chris Dy","startTime":451.29,"endTime":453.84,"body":"thoughts on a case that has been"},{"speaker":"Chris Dy","startTime":451.29,"endTime":453.84,"body":"emailed to us by a friend of the"},{"speaker":"Chris Dy","startTime":453.84,"endTime":458.31,"body":"podcast. We have tremendous"},{"speaker":"Chris Dy","startTime":453.84,"endTime":458.31,"body":"reach Chuck, this is our second"},{"speaker":"Chris Dy","startTime":458.43,"endTime":461.04,"body":"discussion we're going to have"},{"speaker":"Chris Dy","startTime":458.43,"endTime":461.04,"body":"based on a case from Yonas in"},{"speaker":"Chris Dy","startTime":461.04,"endTime":465.48,"body":"Athens, so Yonas Laconis , thank"},{"speaker":"Chris Dy","startTime":461.04,"endTime":465.48,"body":"you for emailing this question"},{"speaker":"Chris Dy","startTime":465.48,"endTime":469.35,"body":"and obviously for your questions"},{"speaker":"Chris Dy","startTime":465.48,"endTime":469.35,"body":"in the past. So here's the"},{"speaker":"Chris Dy","startTime":469.68,"endTime":473.94,"body":"here's the case. And he said"},{"speaker":"Chris Dy","startTime":469.68,"endTime":473.94,"body":"maybe suggests a subject for an"},{"speaker":"Chris Dy","startTime":473.94,"endTime":477.45,"body":"episode. So the case is a 45"},{"speaker":"Chris Dy","startTime":473.94,"endTime":477.45,"body":"year old right hand dominant man"},{"speaker":"Chris Dy","startTime":477.45,"endTime":480.93,"body":"who sustained a left small"},{"speaker":"Chris Dy","startTime":477.45,"endTime":480.93,"body":"finger tip dislocation six"},{"speaker":"Chris Dy","startTime":480.93,"endTime":484.89,"body":"months ago in a basketball game"},{"speaker":"Chris Dy","startTime":480.93,"endTime":484.89,"body":"was reduced to close reduction"},{"speaker":"Chris Dy","startTime":484.89,"endTime":486.96,"body":"and an outside institution"},{"speaker":"Chris Dy","startTime":484.89,"endTime":486.96,"body":"immobilized for a few weeks and"},{"speaker":"Chris Dy","startTime":486.96,"endTime":489.69,"body":"then sent to physiotherapy in"},{"speaker":"Chris Dy","startTime":486.96,"endTime":489.69,"body":"the comments, and unfortunately,"},{"speaker":"Chris Dy","startTime":489.69,"endTime":494.1,"body":"they didn't have any dedicated"},{"speaker":"Chris Dy","startTime":489.69,"endTime":494.1,"body":"hand therapists in Greece. At"},{"speaker":"Chris Dy","startTime":494.1,"endTime":498.75,"body":"least aren't that many. And he"},{"speaker":"Chris Dy","startTime":494.1,"endTime":498.75,"body":"came to Mr. Yonas' clinic with a"},{"speaker":"Chris Dy","startTime":498.75,"endTime":501.99,"body":"subluxated very stiff PJ pap"},{"speaker":"Chris Dy","startTime":498.75,"endTime":501.99,"body":"joint which is stuck in"},{"speaker":"Chris Dy","startTime":501.99,"endTime":505.95,"body":"extension with no active or"},{"speaker":"Chris Dy","startTime":501.99,"endTime":505.95,"body":"passive flexion. And there was"},{"speaker":"Chris Dy","startTime":505.95,"endTime":509.28,"body":"no difference in the position of"},{"speaker":"Chris Dy","startTime":505.95,"endTime":509.28,"body":"the MP when when the MP Jo was"},{"speaker":"Chris Dy","startTime":509.28,"endTime":513.21,"body":"flexor extended, and his di t"},{"speaker":"Chris Dy","startTime":509.28,"endTime":513.21,"body":"motion has zero to 20 degrees"},{"speaker":"Chris Dy","startTime":513.21,"endTime":517.35,"body":"actively and passively. No pain,"},{"speaker":"Chris Dy","startTime":513.21,"endTime":517.35,"body":"and he's managed to cope with"},{"speaker":"Chris Dy","startTime":517.35,"endTime":520.41,"body":"his activities of daily living"},{"speaker":"Chris Dy","startTime":517.35,"endTime":520.41,"body":"again, this is affecting his"},{"speaker":"Chris Dy","startTime":520.47,"endTime":524.43,"body":"small finger on the left side."},{"speaker":"Chris Dy","startTime":520.47,"endTime":524.43,"body":"But the lack of flexion bothers"},{"speaker":"Chris Dy","startTime":524.43,"endTime":527.61,"body":"him. For example, He cannot fit"},{"speaker":"Chris Dy","startTime":524.43,"endTime":527.61,"body":"his hand in a boxing glove seems"},{"speaker":"Chris Dy","startTime":527.61,"endTime":529.86,"body":"like quite the active guy. I"},{"speaker":"Chris Dy","startTime":527.61,"endTime":529.86,"body":"hope to be like that when I"},{"speaker":"Chris Dy","startTime":529.86,"endTime":533.31,"body":"myself and 45 Given a severe"},{"speaker":"Chris Dy","startTime":529.86,"endTime":533.31,"body":"stiffness. So what do you think"},{"speaker":"Chris Dy","startTime":533.31,"endTime":536.7,"body":"the most appropriate course of"},{"speaker":"Chris Dy","startTime":533.31,"endTime":536.7,"body":"action is? So Chuck, what do you"},{"speaker":"Chris Dy","startTime":536.7,"endTime":539.58,"body":"think maybe you can hit the"},{"speaker":"Chris Dy","startTime":536.7,"endTime":539.58,"body":"honest did send us some X rays."},{"speaker":"Chris Dy","startTime":540.36,"endTime":543.99,"body":"I don't want to be at risk for"},{"speaker":"Chris Dy","startTime":540.36,"endTime":543.99,"body":"vertical pimping. But do you"},{"speaker":"Chris Dy","startTime":543.99,"endTime":545.58,"body":"want to tell us what the X ray"},{"speaker":"Chris Dy","startTime":543.99,"endTime":545.58,"body":"show?"},{"speaker":"Charles Goldfarb","startTime":546.09,"endTime":549.09,"body":"Yeah, let's do"},{"speaker":"Charles Goldfarb","startTime":546.09,"endTime":549.09,"body":"this. Maybe if you're honest,"},{"speaker":"Charles Goldfarb","startTime":549.09,"endTime":552.96,"body":"gives us permission and we can"},{"speaker":"Charles Goldfarb","startTime":549.09,"endTime":552.96,"body":"blind it. Perhaps we could share"},{"speaker":"Charles Goldfarb","startTime":552.96,"endTime":556.29,"body":"it on social media at the time"},{"speaker":"Charles Goldfarb","startTime":552.96,"endTime":556.29,"body":"of the podcast drop if we get"},{"speaker":"Charles Goldfarb","startTime":556.29,"endTime":558.99,"body":"permission and is blind and"},{"speaker":"Charles Goldfarb","startTime":556.29,"endTime":558.99,"body":"maybe that'd be okay. Yeah,"},{"speaker":"Chris Dy","startTime":559.02,"endTime":561.0,"body":"yada, yada. So we'll"},{"speaker":"Chris Dy","startTime":559.02,"endTime":561.0,"body":"have received an email and"},{"speaker":"Chris Dy","startTime":561.0,"endTime":562.89,"body":"likely given permission by the"},{"speaker":"Chris Dy","startTime":561.0,"endTime":562.89,"body":"time"},{"speaker":"Charles Goldfarb","startTime":563.34,"endTime":565.83,"body":"Yeah, so let"},{"speaker":"Charles Goldfarb","startTime":563.34,"endTime":565.83,"body":"let before we talk about the X"},{"speaker":"Charles Goldfarb","startTime":565.83,"endTime":568.86,"body":"rays if it's okay, let's let's"},{"speaker":"Charles Goldfarb","startTime":565.83,"endTime":568.86,"body":"break down the physical exam the"},{"speaker":"Charles Goldfarb","startTime":568.86,"endTime":573.27,"body":"key points. So one point that"},{"speaker":"Charles Goldfarb","startTime":568.86,"endTime":573.27,"body":"caught my ear was the fact that"},{"speaker":"Charles Goldfarb","startTime":573.27,"endTime":578.37,"body":"the PRP joint was stiff and"},{"speaker":"Charles Goldfarb","startTime":573.27,"endTime":578.37,"body":"extension. The DI P joint really"},{"speaker":"Charles Goldfarb","startTime":578.37,"endTime":583.38,"body":"didn't have much flexion and"},{"speaker":"Charles Goldfarb","startTime":578.37,"endTime":583.38,"body":"when you move MP joint it did"},{"speaker":"Charles Goldfarb","startTime":583.38,"endTime":586.77,"body":"not affect the PRP joint motion."},{"speaker":"Charles Goldfarb","startTime":583.38,"endTime":586.77,"body":"So there's kind of three"},{"speaker":"Charles Goldfarb","startTime":586.77,"endTime":590.97,"body":"separate points. And so number"},{"speaker":"Charles Goldfarb","startTime":586.77,"endTime":590.97,"body":"one moving the NP join and"},{"speaker":"Charles Goldfarb","startTime":590.97,"endTime":593.85,"body":"reassessing the PAP joint is,"},{"speaker":"Charles Goldfarb","startTime":590.97,"endTime":593.85,"body":"you know, a test for intrinsic"},{"speaker":"Charles Goldfarb","startTime":593.85,"endTime":598.02,"body":"tightness as soon as what yawns"},{"speaker":"Charles Goldfarb","startTime":593.85,"endTime":598.02,"body":"was getting at and though the"},{"speaker":"Charles Goldfarb","startTime":598.02,"endTime":601.62,"body":"note no evidence of intrinsic"},{"speaker":"Charles Goldfarb","startTime":598.02,"endTime":601.62,"body":"tightness That's number one."},{"speaker":"Charles Goldfarb","startTime":602.4,"endTime":606.27,"body":"Number two, the PRP joints step."},{"speaker":"Charles Goldfarb","startTime":602.4,"endTime":606.27,"body":"Now classically, I would say"},{"speaker":"Charles Goldfarb","startTime":606.27,"endTime":609.57,"body":"that could be for maybe three"},{"speaker":"Charles Goldfarb","startTime":606.27,"endTime":609.57,"body":"reasons. Maybe you have others."},{"speaker":"Charles Goldfarb","startTime":609.57,"endTime":614.67,"body":"Number one, there can be a"},{"speaker":"Charles Goldfarb","startTime":609.57,"endTime":614.67,"body":"capsular, contracture, dorsally."},{"speaker":"Charles Goldfarb","startTime":615.63,"endTime":618.33,"body":"Number two, there could be"},{"speaker":"Charles Goldfarb","startTime":615.63,"endTime":618.33,"body":"significant scarring of the"},{"speaker":"Charles Goldfarb","startTime":618.33,"endTime":621.69,"body":"extensor mechanism. And number"},{"speaker":"Charles Goldfarb","startTime":618.33,"endTime":621.69,"body":"three, there could be something"},{"speaker":"Charles Goldfarb","startTime":621.69,"endTime":625.74,"body":"intrinsically going on inside"},{"speaker":"Charles Goldfarb","startTime":621.69,"endTime":625.74,"body":"the joint. Any other reasons you"},{"speaker":"Charles Goldfarb","startTime":625.74,"endTime":626.79,"body":"can think of? Yeah,"},{"speaker":"Chris Dy","startTime":627.3,"endTime":630.36,"body":"well, I think this is"},{"speaker":"Chris Dy","startTime":627.3,"endTime":630.36,"body":"good. So first off, for any of"},{"speaker":"Chris Dy","startTime":630.36,"endTime":632.73,"body":"you listening, who are in"},{"speaker":"Chris Dy","startTime":630.36,"endTime":632.73,"body":"training, this was a perfectly"},{"speaker":"Chris Dy","startTime":632.73,"endTime":635.97,"body":"presented case, in terms of all"},{"speaker":"Chris Dy","startTime":632.73,"endTime":635.97,"body":"the pertinent positives and"},{"speaker":"Chris Dy","startTime":635.97,"endTime":640.02,"body":"negatives. I mean, honestly, you"},{"speaker":"Chris Dy","startTime":635.97,"endTime":640.02,"body":"can tell this, this, this doc"},{"speaker":"Chris Dy","startTime":640.02,"endTime":643.23,"body":"knows what he's doing. So, you"},{"speaker":"Chris Dy","startTime":640.02,"endTime":643.23,"body":"know, I think the points about"},{"speaker":"Chris Dy","startTime":643.23,"endTime":646.47,"body":"the reasons for for the"},{"speaker":"Chris Dy","startTime":643.23,"endTime":646.47,"body":"stiffness are really important."},{"speaker":"Chris Dy","startTime":646.47,"endTime":649.41,"body":"So you mentioned that there"},{"speaker":"Chris Dy","startTime":646.47,"endTime":649.41,"body":"could be a dorsal capsular"},{"speaker":"Chris Dy","startTime":649.41,"endTime":652.23,"body":"contracture and a dorsal"},{"speaker":"Chris Dy","startTime":649.41,"endTime":652.23,"body":"contracture would limit you"},{"speaker":"Chris Dy","startTime":652.44,"endTime":655.86,"body":"from, you know, passive flexion,"},{"speaker":"Chris Dy","startTime":652.44,"endTime":655.86,"body":"presumably, right, exactly. And"},{"speaker":"Chris Dy","startTime":655.86,"endTime":658.83,"body":"then you mentioned that there"},{"speaker":"Chris Dy","startTime":655.86,"endTime":658.83,"body":"could be some adhesions on the"},{"speaker":"Chris Dy","startTime":658.83,"endTime":662.55,"body":"extensor mechanism, which would"},{"speaker":"Chris Dy","startTime":658.83,"endTime":662.55,"body":"limit you could potentially"},{"speaker":"Chris Dy","startTime":662.55,"endTime":665.73,"body":"limit you in both potential for"},{"speaker":"Chris Dy","startTime":662.55,"endTime":665.73,"body":"passive flexion as well as the"},{"speaker":"Chris Dy","startTime":665.73,"endTime":670.29,"body":"ability to, to actively extend"},{"speaker":"Chris Dy","startTime":665.73,"endTime":670.29,"body":"so that you know, and then I"},{"speaker":"Chris Dy","startTime":670.29,"endTime":674.1,"body":"think you have made, you know,"},{"speaker":"Chris Dy","startTime":670.29,"endTime":674.1,"body":"you had a great presentation and"},{"speaker":"Chris Dy","startTime":674.1,"endTime":677.22,"body":"paper with with Marty Boyer that"},{"speaker":"Chris Dy","startTime":674.1,"endTime":677.22,"body":"we often referenced here in our,"},{"speaker":"Chris Dy","startTime":677.22,"endTime":680.16,"body":"in our teachings, about the"},{"speaker":"Chris Dy","startTime":677.22,"endTime":680.16,"body":"stiff finger, there was a great"},{"speaker":"Chris Dy","startTime":680.16,"endTime":684.18,"body":"ICL paper. And you know, you"},{"speaker":"Chris Dy","startTime":680.16,"endTime":684.18,"body":"can't even assess active motion"},{"speaker":"Chris Dy","startTime":684.18,"endTime":687.12,"body":"until you have passive motion."},{"speaker":"Chris Dy","startTime":684.18,"endTime":687.12,"body":"And I think that's a super"},{"speaker":"Chris Dy","startTime":687.12,"endTime":689.67,"body":"important point. And then the"},{"speaker":"Chris Dy","startTime":687.12,"endTime":689.67,"body":"last thing you commented, you"},{"speaker":"Chris Dy","startTime":689.67,"endTime":691.59,"body":"actually had three things this"},{"speaker":"Chris Dy","startTime":689.67,"endTime":691.59,"body":"time not to, I'm impressed."},{"speaker":"Chris Dy","startTime":691.59,"endTime":694.71,"body":"You've, you've grown. Your third"},{"speaker":"Chris Dy","startTime":691.59,"endTime":694.71,"body":"thing was about potential"},{"speaker":"Chris Dy","startTime":694.71,"endTime":697.2,"body":"intrinsic issues in the joints."},{"speaker":"Chris Dy","startTime":694.71,"endTime":697.2,"body":"So what do you think that could"},{"speaker":"Chris Dy","startTime":697.2,"endTime":700.98,"body":"potentially be in a case like"},{"speaker":"Chris Dy","startTime":697.2,"endTime":700.98,"body":"this, where you have a PAP"},{"speaker":"Chris Dy","startTime":700.98,"endTime":703.11,"body":"fracture dislocation, and just"},{"speaker":"Chris Dy","startTime":700.98,"endTime":703.11,"body":"to give away a little bit of the"},{"speaker":"Chris Dy","startTime":703.11,"endTime":706.44,"body":"X ray, there is a very small"},{"speaker":"Chris Dy","startTime":703.11,"endTime":706.44,"body":"volar plate ish type fragment,"},{"speaker":"Chris Dy","startTime":706.44,"endTime":709.29,"body":"not a huge piece that we get"},{"speaker":"Chris Dy","startTime":706.44,"endTime":709.29,"body":"super excited about putting a"},{"speaker":"Chris Dy","startTime":709.29,"endTime":711.36,"body":"screw in or anything like that,"},{"speaker":"Chris Dy","startTime":709.29,"endTime":711.36,"body":"but one that would, you know,"},{"speaker":"Chris Dy","startTime":711.36,"endTime":712.02,"body":"give us pause?"},{"speaker":"Charles Goldfarb","startTime":712.68,"endTime":714.9,"body":"Yeah, not a"},{"speaker":"Charles Goldfarb","startTime":712.68,"endTime":714.9,"body":"piece that one would think needs"},{"speaker":"Charles Goldfarb","startTime":714.9,"endTime":718.98,"body":"to be fixed. But in addition to"},{"speaker":"Charles Goldfarb","startTime":714.9,"endTime":718.98,"body":"that the joint alignment was was"},{"speaker":"Charles Goldfarb","startTime":718.98,"endTime":723.21,"body":"not ideal. And we can talk about"},{"speaker":"Charles Goldfarb","startTime":718.98,"endTime":723.21,"body":"more, I would say that an intra"},{"speaker":"Charles Goldfarb","startTime":723.21,"endTime":728.61,"body":"articular MalUnion could limit"},{"speaker":"Charles Goldfarb","startTime":723.21,"endTime":728.61,"body":"flexion. And obviously, joint"},{"speaker":"Charles Goldfarb","startTime":728.61,"endTime":730.68,"body":"subluxation can limit flexion."},{"speaker":"Chris Dy","startTime":730.89,"endTime":733.5,"body":"Are you focusing on"},{"speaker":"Chris Dy","startTime":730.89,"endTime":733.5,"body":"the limitations that deflection"},{"speaker":"Chris Dy","startTime":733.5,"endTime":736.02,"body":"because that is just the first"},{"speaker":"Chris Dy","startTime":733.5,"endTime":736.02,"body":"way to talk about it? And then"},{"speaker":"Chris Dy","startTime":736.02,"endTime":738.66,"body":"we'll talk about the limitations"},{"speaker":"Chris Dy","startTime":736.02,"endTime":738.66,"body":"and extension later or because"},{"speaker":"Chris Dy","startTime":738.66,"endTime":741.06,"body":"that's just what Jana said, is"},{"speaker":"Chris Dy","startTime":738.66,"endTime":741.06,"body":"bothering this patient?"},{"speaker":"Charles Goldfarb","startTime":741.81,"endTime":743.49,"body":"Well, both I"},{"speaker":"Charles Goldfarb","startTime":741.81,"endTime":743.49,"body":"think we're you know, we're"},{"speaker":"Charles Goldfarb","startTime":743.49,"endTime":746.97,"body":"starting by, you know, thinking"},{"speaker":"Charles Goldfarb","startTime":743.49,"endTime":746.97,"body":"about the reasoning behind the"},{"speaker":"Charles Goldfarb","startTime":746.97,"endTime":750.54,"body":"limited flexion. Is it only the"},{"speaker":"Charles Goldfarb","startTime":746.97,"endTime":750.54,"body":"joint are there secondary"},{"speaker":"Charles Goldfarb","startTime":750.54,"endTime":754.11,"body":"considerations as well, I think"},{"speaker":"Charles Goldfarb","startTime":750.54,"endTime":754.11,"body":"in this patient who again, the X"},{"speaker":"Charles Goldfarb","startTime":754.11,"endTime":757.68,"body":"rays do show some joint"},{"speaker":"Charles Goldfarb","startTime":754.11,"endTime":757.68,"body":"subluxation in the coronal"},{"speaker":"Charles Goldfarb","startTime":757.68,"endTime":762.45,"body":"plane, and also some slight"},{"speaker":"Charles Goldfarb","startTime":757.68,"endTime":762.45,"body":"dorsal subluxation in the"},{"speaker":"Charles Goldfarb","startTime":762.54,"endTime":766.53,"body":"sagittal plane, with some mild"},{"speaker":"Charles Goldfarb","startTime":762.54,"endTime":766.53,"body":"or throws is so all of those"},{"speaker":"Charles Goldfarb","startTime":766.53,"endTime":770.25,"body":"things can be hurting us, but"},{"speaker":"Charles Goldfarb","startTime":766.53,"endTime":770.25,"body":"doesn't mean they're, they're"},{"speaker":"Charles Goldfarb","startTime":770.28,"endTime":773.94,"body":"the only reasons for the joint"},{"speaker":"Charles Goldfarb","startTime":770.28,"endTime":773.94,"body":"being stuck and extension."},{"speaker":"Chris Dy","startTime":774.63,"endTime":776.58,"body":"Sure, I think that's a"},{"speaker":"Chris Dy","startTime":774.63,"endTime":776.58,"body":"great point. So I'll break down"},{"speaker":"Chris Dy","startTime":776.61,"endTime":780.75,"body":"the X ray. So we have just based"},{"speaker":"Chris Dy","startTime":776.61,"endTime":780.75,"body":"on the image, the file names on"},{"speaker":"Chris Dy","startTime":780.75,"endTime":784.23,"body":"the images, it looks like we"},{"speaker":"Chris Dy","startTime":780.75,"endTime":784.23,"body":"have one injury image, which is"},{"speaker":"Chris Dy","startTime":784.23,"endTime":788.4,"body":"a lateral of the small finger"},{"speaker":"Chris Dy","startTime":784.23,"endTime":788.4,"body":"with it in what appears to be a"},{"speaker":"Chris Dy","startTime":788.4,"endTime":791.61,"body":"very long Illuma foam splint"},{"speaker":"Chris Dy","startTime":788.4,"endTime":791.61,"body":"that wraps around all the way"},{"speaker":"Chris Dy","startTime":791.61,"endTime":794.97,"body":"from the tip of the finger to"},{"speaker":"Chris Dy","startTime":791.61,"endTime":794.97,"body":"presumably the MPs based on the"},{"speaker":"Chris Dy","startTime":794.97,"endTime":798.18,"body":"appearance on this kind of"},{"speaker":"Chris Dy","startTime":794.97,"endTime":798.18,"body":"snapshot of the X ray. And we've"},{"speaker":"Chris Dy","startTime":798.18,"endTime":804.3,"body":"got a we've got a PIP joint with"},{"speaker":"Chris Dy","startTime":798.18,"endTime":804.3,"body":"a small volar fragment, I'd say"},{"speaker":"Chris Dy","startTime":804.33,"endTime":807.36,"body":"probably less than 10% of the"},{"speaker":"Chris Dy","startTime":804.33,"endTime":807.36,"body":"surface kind of more in the"},{"speaker":"Chris Dy","startTime":807.36,"endTime":811.5,"body":"volar plate fragment category as"},{"speaker":"Chris Dy","startTime":807.36,"endTime":811.5,"body":"opposed to an actual volar lip"},{"speaker":"Chris Dy","startTime":811.5,"endTime":814.11,"body":"piece. That's probably fair to"},{"speaker":"Chris Dy","startTime":811.5,"endTime":814.11,"body":"say, and you've got some subtle"},{"speaker":"Chris Dy","startTime":814.11,"endTime":818.13,"body":"dorsal subluxation with I think,"},{"speaker":"Chris Dy","startTime":814.11,"endTime":818.13,"body":"what looks like a V sign on the"},{"speaker":"Chris Dy","startTime":818.13,"endTime":820.98,"body":"dorsal aspect of the joint,"},{"speaker":"Chris Dy","startTime":818.13,"endTime":820.98,"body":"they're suggesting that as you"},{"speaker":"Chris Dy","startTime":820.98,"endTime":824.52,"body":"said, this is not just a"},{"speaker":"Chris Dy","startTime":820.98,"endTime":824.52,"body":"boilerplate fragment without any"},{"speaker":"Chris Dy","startTime":824.52,"endTime":827.73,"body":"instability, there is an element"},{"speaker":"Chris Dy","startTime":824.52,"endTime":827.73,"body":"of dorsal subluxation and pap"},{"speaker":"Chris Dy","startTime":827.73,"endTime":828.36,"body":"instability."},{"speaker":"Charles Goldfarb","startTime":829.05,"endTime":831.6,"body":"Now the DIP"},{"speaker":"Charles Goldfarb","startTime":829.05,"endTime":831.6,"body":"joint is interesting, because"},{"speaker":"Charles Goldfarb","startTime":831.6,"endTime":837.03,"body":"classically, one loses flexion"},{"speaker":"Charles Goldfarb","startTime":831.6,"endTime":837.03,"body":"of the DIP joint when the PIP"},{"speaker":"Charles Goldfarb","startTime":837.09,"endTime":843.51,"body":"joint is stuck in flexion. So a"},{"speaker":"Charles Goldfarb","startTime":837.09,"endTime":843.51,"body":"boon airtight posture. And the"},{"speaker":"Charles Goldfarb","startTime":843.51,"endTime":847.08,"body":"reasoning behind that is, so if"},{"speaker":"Charles Goldfarb","startTime":843.51,"endTime":847.08,"body":"you have your Pap joint stuck in"},{"speaker":"Charles Goldfarb","startTime":847.08,"endTime":850.44,"body":"flexion, whether it's a Volar"},{"speaker":"Charles Goldfarb","startTime":847.08,"endTime":850.44,"body":"plate contracture, or whatever,"},{"speaker":"Charles Goldfarb","startTime":850.53,"endTime":853.83,"body":"what happens there is your"},{"speaker":"Charles Goldfarb","startTime":850.53,"endTime":853.83,"body":"dorsal what should be your"},{"speaker":"Charles Goldfarb","startTime":853.83,"endTime":858.09,"body":"dorsal lateral band slide mole"},{"speaker":"Charles Goldfarb","startTime":853.83,"endTime":858.09,"body":"early, and then you lose the"},{"speaker":"Charles Goldfarb","startTime":858.09,"endTime":861.72,"body":"ability to flex the tip joint."},{"speaker":"Charles Goldfarb","startTime":858.09,"endTime":861.72,"body":"But this is not that situation."},{"speaker":"Charles Goldfarb","startTime":861.72,"endTime":865.71,"body":"That's the common situation."},{"speaker":"Charles Goldfarb","startTime":861.72,"endTime":865.71,"body":"Here, it seems to me like"},{"speaker":"Charles Goldfarb","startTime":865.71,"endTime":868.5,"body":"there's probably just some"},{"speaker":"Charles Goldfarb","startTime":865.71,"endTime":868.5,"body":"scarring of the extensor"},{"speaker":"Charles Goldfarb","startTime":868.5,"endTime":871.32,"body":"mechanism. And if you believe in"},{"speaker":"Charles Goldfarb","startTime":868.5,"endTime":871.32,"body":"the oblique redneck about a"},{"speaker":"Charles Goldfarb","startTime":871.32,"endTime":873.99,"body":"ligament, and maybe it's"},{"speaker":"Charles Goldfarb","startTime":871.32,"endTime":873.99,"body":"limiting us as well."},{"speaker":"Chris Dy","startTime":874.92,"endTime":877.98,"body":"Right, right. Right."},{"speaker":"Chris Dy","startTime":874.92,"endTime":877.98,"body":"So I mean, I think that you've"},{"speaker":"Chris Dy","startTime":877.98,"endTime":880.29,"body":"covered a lot of ground there,"},{"speaker":"Chris Dy","startTime":877.98,"endTime":880.29,"body":"you kind of switched up and"},{"speaker":"Chris Dy","startTime":880.29,"endTime":883.08,"body":"talked about volere. I'm gonna"},{"speaker":"Chris Dy","startTime":880.29,"endTime":883.08,"body":"try to digest this for"},{"speaker":"Chris Dy","startTime":883.08,"endTime":886.02,"body":"everybody. He switched up and"},{"speaker":"Chris Dy","startTime":883.08,"endTime":886.02,"body":"talked about reasons for limited"},{"speaker":"Chris Dy","startTime":886.02,"endTime":888.24,"body":"extension after he said we"},{"speaker":"Chris Dy","startTime":886.02,"endTime":888.24,"body":"weren't going to talk about that"},{"speaker":"Chris Dy","startTime":890.25,"endTime":893.25,"body":"with your boilerplate"},{"speaker":"Chris Dy","startTime":890.25,"endTime":893.25,"body":"contracture, but you know, then"},{"speaker":"Chris Dy","startTime":893.25,"endTime":896.43,"body":"to go through the final X rays"},{"speaker":"Chris Dy","startTime":893.25,"endTime":896.43,"body":"that Yanis was kind enough to"},{"speaker":"Chris Dy","startTime":896.43,"endTime":899.76,"body":"send us you've got now got a"},{"speaker":"Chris Dy","startTime":896.43,"endTime":899.76,"body":"joint that looks like it's"},{"speaker":"Chris Dy","startTime":899.76,"endTime":902.7,"body":"chrome Nikoli subluxated that"},{"speaker":"Chris Dy","startTime":899.76,"endTime":902.7,"body":"starts that looks like it's got"},{"speaker":"Chris Dy","startTime":903.33,"endTime":906.75,"body":"some cartilage were on the base"},{"speaker":"Chris Dy","startTime":903.33,"endTime":906.75,"body":"of the middle phalanx and Marty"},{"speaker":"Chris Dy","startTime":906.75,"endTime":909.12,"body":"Boyer would kill me for saying"},{"speaker":"Chris Dy","startTime":906.75,"endTime":909.12,"body":"looks like a few times in the"},{"speaker":"Chris Dy","startTime":909.12,"endTime":911.82,"body":"last couple of minutes when I"},{"speaker":"Chris Dy","startTime":909.12,"endTime":911.82,"body":"described X rays, but there's"},{"speaker":"Chris Dy","startTime":911.82,"endTime":914.61,"body":"cartilage were at the base of"},{"speaker":"Chris Dy","startTime":911.82,"endTime":914.61,"body":"the middle phalanx. So a"},{"speaker":"Chris Dy","startTime":914.61,"endTime":918.81,"body":"chronically subluxated joint"},{"speaker":"Chris Dy","startTime":914.61,"endTime":918.81,"body":"with some early arthritis. And"},{"speaker":"Chris Dy","startTime":918.81,"endTime":922.38,"body":"then, as we described above,"},{"speaker":"Chris Dy","startTime":918.81,"endTime":922.38,"body":"kind of the limitations in"},{"speaker":"Chris Dy","startTime":922.41,"endTime":924.57,"body":"motion both for the PIP and the"},{"speaker":"Chris Dy","startTime":922.41,"endTime":924.57,"body":"DIP."},{"speaker":"Charles Goldfarb","startTime":925.59,"endTime":928.59,"body":"Right, so we"},{"speaker":"Charles Goldfarb","startTime":925.59,"endTime":928.59,"body":"did throw a lot at the listeners"},{"speaker":"Charles Goldfarb","startTime":928.62,"endTime":931.23,"body":"who don't have the hopefully"},{"speaker":"Charles Goldfarb","startTime":928.62,"endTime":931.23,"body":"will have the ability to see the"},{"speaker":"Charles Goldfarb","startTime":931.23,"endTime":933.45,"body":"X rays. But I think"},{"speaker":"Charles Goldfarb","startTime":931.23,"endTime":933.45,"body":"fundamentally, what we're"},{"speaker":"Charles Goldfarb","startTime":933.45,"endTime":940.56,"body":"talking about this case is a"},{"speaker":"Charles Goldfarb","startTime":933.45,"endTime":940.56,"body":"chronically subluxated join. And"},{"speaker":"Charles Goldfarb","startTime":940.56,"endTime":945.24,"body":"the real question becomes, can"},{"speaker":"Charles Goldfarb","startTime":940.56,"endTime":945.24,"body":"this joint be salvaged? And you"},{"speaker":"Charles Goldfarb","startTime":945.24,"endTime":948.6,"body":"know, I don't for me, and I'd"},{"speaker":"Charles Goldfarb","startTime":945.24,"endTime":948.6,"body":"love to hear your thoughts."},{"speaker":"Charles Goldfarb","startTime":948.9,"endTime":952.77,"body":"advanced imaging doesn't help"},{"speaker":"Charles Goldfarb","startTime":948.9,"endTime":952.77,"body":"me. So I don't think a CT scan"},{"speaker":"Charles Goldfarb","startTime":952.77,"endTime":955.5,"body":"or an MRI gives me useful"},{"speaker":"Charles Goldfarb","startTime":952.77,"endTime":955.5,"body":"information. For me, it's about"},{"speaker":"Charles Goldfarb","startTime":955.5,"endTime":959.34,"body":"the X rays, and likely about"},{"speaker":"Charles Goldfarb","startTime":955.5,"endTime":959.34,"body":"intraoperative decision making,"},{"speaker":"Charles Goldfarb","startTime":959.37,"endTime":962.52,"body":"although I always like to go"},{"speaker":"Charles Goldfarb","startTime":959.37,"endTime":962.52,"body":"into a case with a plan. How do"},{"speaker":"Charles Goldfarb","startTime":962.52,"endTime":963.18,"body":"you think about"},{"speaker":"Chris Dy","startTime":964.14,"endTime":965.91,"body":"I think about the same"},{"speaker":"Chris Dy","startTime":964.14,"endTime":965.91,"body":"way, I mean, I think that if"},{"speaker":"Chris Dy","startTime":965.91,"endTime":970.08,"body":"this patient had better passive"},{"speaker":"Chris Dy","startTime":965.91,"endTime":970.08,"body":"motion, but had limited active"},{"speaker":"Chris Dy","startTime":970.08,"endTime":972.78,"body":"flexion, or limited active"},{"speaker":"Chris Dy","startTime":970.08,"endTime":972.78,"body":"extension, I think an ultrasound"},{"speaker":"Chris Dy","startTime":972.78,"endTime":976.05,"body":"might be pretty useful to look"},{"speaker":"Chris Dy","startTime":972.78,"endTime":976.05,"body":"and see if you can spot some"},{"speaker":"Chris Dy","startTime":976.05,"endTime":977.97,"body":"adhesions, I think that's"},{"speaker":"Chris Dy","startTime":976.05,"endTime":977.97,"body":"challenging in some clinical"},{"speaker":"Chris Dy","startTime":977.97,"endTime":981.27,"body":"settings, just because you may"},{"speaker":"Chris Dy","startTime":977.97,"endTime":981.27,"body":"not have the small enough probe"},{"speaker":"Chris Dy","startTime":981.3,"endTime":983.58,"body":"to be able to get it on the"},{"speaker":"Chris Dy","startTime":981.3,"endTime":983.58,"body":"finger, that's actually a"},{"speaker":"Chris Dy","startTime":983.58,"endTime":986.55,"body":"limitation I have in the clinic"},{"speaker":"Chris Dy","startTime":983.58,"endTime":986.55,"body":"that I work in mainly. So we"},{"speaker":"Chris Dy","startTime":986.55,"endTime":989.61,"body":"just don't have the small"},{"speaker":"Chris Dy","startTime":986.55,"endTime":989.61,"body":"footprint probe to look at"},{"speaker":"Chris Dy","startTime":989.61,"endTime":993.42,"body":"flexor and extensor tendons, apt"},{"speaker":"Chris Dy","startTime":989.61,"endTime":993.42,"body":"to look for adhesions. But I"},{"speaker":"Chris Dy","startTime":993.42,"endTime":994.89,"body":"think if you've got that"},{"speaker":"Chris Dy","startTime":993.42,"endTime":994.89,"body":"available, that might be"},{"speaker":"Chris Dy","startTime":994.89,"endTime":998.22,"body":"interesting. But truly advanced"},{"speaker":"Chris Dy","startTime":994.89,"endTime":998.22,"body":"imaging, such as a CT or an MRI"},{"speaker":"Chris Dy","startTime":998.22,"endTime":999.39,"body":"does not add anything for me."},{"speaker":"Charles Goldfarb","startTime":1000.169,"endTime":1002.749,"body":"So in this"},{"speaker":"Charles Goldfarb","startTime":1000.169,"endTime":1002.749,"body":"case, where there looks like"},{"speaker":"Charles Goldfarb","startTime":1003.589,"endTime":1007.549,"body":"that, thank you, where there"},{"speaker":"Charles Goldfarb","startTime":1003.589,"endTime":1007.549,"body":"appears to be, there appears to"},{"speaker":"Charles Goldfarb","startTime":1007.549,"endTime":1011.209,"body":"be some arthritis, and a joint"},{"speaker":"Charles Goldfarb","startTime":1007.549,"endTime":1011.209,"body":"is not particularly well"},{"speaker":"Charles Goldfarb","startTime":1011.209,"endTime":1016.279,"body":"aligned. In a young ish, I don't"},{"speaker":"Charles Goldfarb","startTime":1011.209,"endTime":1016.279,"body":"mean to offend you, because this"},{"speaker":"Charles Goldfarb","startTime":1016.279,"endTime":1021.079,"body":"patient's not super young. But"},{"speaker":"Charles Goldfarb","startTime":1016.279,"endTime":1021.079,"body":"it's not old, either. 45, do you"},{"speaker":"Charles Goldfarb","startTime":1021.079,"endTime":1025.969,"body":"think it, you know, is"},{"speaker":"Charles Goldfarb","startTime":1021.079,"endTime":1025.969,"body":"reasonable to consider an option"},{"speaker":"Charles Goldfarb","startTime":1026.029,"endTime":1031.339,"body":"to explore and potentially"},{"speaker":"Charles Goldfarb","startTime":1026.029,"endTime":1031.339,"body":"reduce the joints? Or is it your"},{"speaker":"Charles Goldfarb","startTime":1031.339,"endTime":1034.669,"body":"sense that in this case, the"},{"speaker":"Charles Goldfarb","startTime":1031.339,"endTime":1034.669,"body":"horse has left the barn?"},{"speaker":"Chris Dy","startTime":1035.929,"endTime":1037.789,"body":"You know, I'm not, I"},{"speaker":"Chris Dy","startTime":1035.929,"endTime":1037.789,"body":"don't think the horse has left"},{"speaker":"Chris Dy","startTime":1037.789,"endTime":1041.689,"body":"the barn, I think this is this"},{"speaker":"Chris Dy","startTime":1037.789,"endTime":1041.689,"body":"doesn't get down to, you know,"},{"speaker":"Chris Dy","startTime":1042.259,"endTime":1044.569,"body":"and I hate to use this term,"},{"speaker":"Chris Dy","startTime":1042.259,"endTime":1044.569,"body":"because it's kind of a catch all"},{"speaker":"Chris Dy","startTime":1044.569,"endTime":1048.649,"body":"term of patient preferences and"},{"speaker":"Chris Dy","startTime":1044.569,"endTime":1048.649,"body":"expectations. And if you get the"},{"speaker":"Chris Dy","startTime":1048.649,"endTime":1050.959,"body":"sense that this patient, you"},{"speaker":"Chris Dy","startTime":1048.649,"endTime":1050.959,"body":"know, even if you don't have"},{"speaker":"Chris Dy","startTime":1050.959,"endTime":1054.499,"body":"specialized therapy is going to"},{"speaker":"Chris Dy","startTime":1050.959,"endTime":1054.499,"body":"be able to do whatever you ask"},{"speaker":"Chris Dy","startTime":1054.559,"endTime":1060.079,"body":"him to do. And understands that"},{"speaker":"Chris Dy","startTime":1054.559,"endTime":1060.079,"body":"at the end of the day, they may"},{"speaker":"Chris Dy","startTime":1060.079,"endTime":1063.649,"body":"still have either the same"},{"speaker":"Chris Dy","startTime":1060.079,"endTime":1063.649,"body":"finger or a worst finger that's"},{"speaker":"Chris Dy","startTime":1063.649,"endTime":1068.809,"body":"been operated upon one two or"},{"speaker":"Chris Dy","startTime":1063.649,"endTime":1068.809,"body":"three times and is okay with"},{"speaker":"Chris Dy","startTime":1068.809,"endTime":1072.379,"body":"that, and is willing to invest"},{"speaker":"Chris Dy","startTime":1068.809,"endTime":1072.379,"body":"the time, energy effort"},{"speaker":"Chris Dy","startTime":1072.379,"endTime":1077.809,"body":"resources to do it, then I think"},{"speaker":"Chris Dy","startTime":1072.379,"endTime":1077.809,"body":"it's reasonable, I would not"},{"speaker":"Chris Dy","startTime":1077.809,"endTime":1080.869,"body":"throw this, I would not throw"},{"speaker":"Chris Dy","startTime":1077.809,"endTime":1080.869,"body":"the towel in on this one meeting"},{"speaker":"Chris Dy","startTime":1080.899,"endTime":1081.859,"body":"give up on this one."},{"speaker":"Charles Goldfarb","startTime":1082.67,"endTime":1086.54,"body":"So I think"},{"speaker":"Charles Goldfarb","startTime":1082.67,"endTime":1086.54,"body":"that's very fair. In a little"},{"speaker":"Charles Goldfarb","startTime":1086.54,"endTime":1092.48,"body":"finger, we do have some younger"},{"speaker":"Charles Goldfarb","startTime":1086.54,"endTime":1092.48,"body":"listeners, the little finger is"},{"speaker":"Charles Goldfarb","startTime":1092.48,"endTime":1097.76,"body":"designed for flexion. And it is"},{"speaker":"Charles Goldfarb","startTime":1092.48,"endTime":1097.76,"body":"necessary for power grip. And we"},{"speaker":"Charles Goldfarb","startTime":1097.76,"endTime":1099.53,"body":"get we get our grip strength"},{"speaker":"Charles Goldfarb","startTime":1097.76,"endTime":1099.53,"body":"from the ring and little"},{"speaker":"Charles Goldfarb","startTime":1099.53,"endTime":1102.62,"body":"fingers. And if that little"},{"speaker":"Charles Goldfarb","startTime":1099.53,"endTime":1102.62,"body":"finger doesn't flex, then"},{"speaker":"Charles Goldfarb","startTime":1102.62,"endTime":1107.93,"body":"functionally it's a problem. And"},{"speaker":"Charles Goldfarb","startTime":1102.62,"endTime":1107.93,"body":"so if we would hope to restore"},{"speaker":"Charles Goldfarb","startTime":1107.93,"endTime":1111.74,"body":"motion to maximize this"},{"speaker":"Charles Goldfarb","startTime":1107.93,"endTime":1111.74,"body":"gentleman's function, and so in"},{"speaker":"Charles Goldfarb","startTime":1111.74,"endTime":1117.32,"body":"this age group, I probably would"},{"speaker":"Charles Goldfarb","startTime":1111.74,"endTime":1117.32,"body":"explore as well, trying to get a"},{"speaker":"Charles Goldfarb","startTime":1117.32,"endTime":1120.83,"body":"sense of whether the joint"},{"speaker":"Charles Goldfarb","startTime":1117.32,"endTime":1120.83,"body":"arthritis is diffuse. Or perhaps"},{"speaker":"Charles Goldfarb","startTime":1120.83,"endTime":1123.32,"body":"if we're lucky, it's just the"},{"speaker":"Charles Goldfarb","startTime":1120.83,"endTime":1123.32,"body":"volar aspect of the middle"},{"speaker":"Charles Goldfarb","startTime":1123.32,"endTime":1127.13,"body":"phalanx. And if we can reduce"},{"speaker":"Charles Goldfarb","startTime":1123.32,"endTime":1127.13,"body":"the joint and if we have to"},{"speaker":"Charles Goldfarb","startTime":1127.4,"endTime":1129.53,"body":"consider something like a Hemi"},{"speaker":"Charles Goldfarb","startTime":1127.4,"endTime":1129.53,"body":"Hemi, we could do that."},{"speaker":"Chris Dy","startTime":1130.59,"endTime":1133.47,"body":"Does the does"},{"speaker":"Chris Dy","startTime":1130.59,"endTime":1133.47,"body":"quantifying the amount of post"},{"speaker":"Chris Dy","startTime":1133.47,"endTime":1139.47,"body":"traumatic arthrosis on the"},{"speaker":"Chris Dy","startTime":1133.47,"endTime":1139.47,"body":"middle phalanx affect your your"},{"speaker":"Chris Dy","startTime":1139.47,"endTime":1141.81,"body":"willingness to engage in some"},{"speaker":"Chris Dy","startTime":1139.47,"endTime":1141.81,"body":"kind of joint preserving"},{"speaker":"Chris Dy","startTime":1141.81,"endTime":1145.11,"body":"procedure, either quantifying"},{"speaker":"Chris Dy","startTime":1141.81,"endTime":1145.11,"body":"that during intraoperative"},{"speaker":"Chris Dy","startTime":1145.11,"endTime":1148.08,"body":"inspection or during"},{"speaker":"Chris Dy","startTime":1145.11,"endTime":1148.08,"body":"preoperative imaging, even"},{"speaker":"Chris Dy","startTime":1148.08,"endTime":1151.02,"body":"though both of us said that we"},{"speaker":"Chris Dy","startTime":1148.08,"endTime":1151.02,"body":"probably wouldn't, you know,"},{"speaker":"Chris Dy","startTime":1151.02,"endTime":1154.62,"body":"does that influence? Is it 30%"},{"speaker":"Chris Dy","startTime":1151.02,"endTime":1154.62,"body":"of the join? Is it 50% of the"},{"speaker":"Chris Dy","startTime":1154.62,"endTime":1157.26,"body":"joint? Does that tell you like"},{"speaker":"Chris Dy","startTime":1154.62,"endTime":1157.26,"body":"is this worth saving or not?"},{"speaker":"Charles Goldfarb","startTime":1158.16,"endTime":1160.11,"body":"I think it"},{"speaker":"Charles Goldfarb","startTime":1158.16,"endTime":1160.11,"body":"does. And let's just use the"},{"speaker":"Charles Goldfarb","startTime":1160.11,"endTime":1163.41,"body":"Hemi hemiarthroplasty as an"},{"speaker":"Charles Goldfarb","startTime":1160.11,"endTime":1163.41,"body":"example, and I have done a fair"},{"speaker":"Charles Goldfarb","startTime":1163.41,"endTime":1167.22,"body":"number of those procedures. And"},{"speaker":"Charles Goldfarb","startTime":1163.41,"endTime":1167.22,"body":"they're not all universally"},{"speaker":"Charles Goldfarb","startTime":1167.22,"endTime":1170.34,"body":"successful. And I think the ones"},{"speaker":"Charles Goldfarb","startTime":1167.22,"endTime":1170.34,"body":"that are successful are the ones"},{"speaker":"Charles Goldfarb","startTime":1170.34,"endTime":1174.42,"body":"that have a limited amount of"},{"speaker":"Charles Goldfarb","startTime":1170.34,"endTime":1174.42,"body":"arthritis on the volar aspect of"},{"speaker":"Charles Goldfarb","startTime":1174.42,"endTime":1178.35,"body":"the middle phalanx and the head"},{"speaker":"Charles Goldfarb","startTime":1174.42,"endTime":1178.35,"body":"of the proximal phalanx is good."},{"speaker":"Charles Goldfarb","startTime":1178.74,"endTime":1181.95,"body":"And so in those patients, you"},{"speaker":"Charles Goldfarb","startTime":1178.74,"endTime":1181.95,"body":"can really recreate that volar"},{"speaker":"Charles Goldfarb","startTime":1181.95,"endTime":1185.76,"body":"buttress of the middle phalanx."},{"speaker":"Charles Goldfarb","startTime":1181.95,"endTime":1185.76,"body":"But if the head of the proximal"},{"speaker":"Charles Goldfarb","startTime":1185.76,"endTime":1189.39,"body":"phalanx is arthritic, then my"},{"speaker":"Charles Goldfarb","startTime":1185.76,"endTime":1189.39,"body":"expectations for a good outcome"},{"speaker":"Charles Goldfarb","startTime":1189.42,"endTime":1192.54,"body":"or decreased and so either"},{"speaker":"Charles Goldfarb","startTime":1189.42,"endTime":1192.54,"body":"preoperatively or"},{"speaker":"Charles Goldfarb","startTime":1192.54,"endTime":1195.06,"body":"interoperability I really do"},{"speaker":"Charles Goldfarb","startTime":1192.54,"endTime":1195.06,"body":"think you have to be honest with"},{"speaker":"Charles Goldfarb","startTime":1195.06,"endTime":1199.14,"body":"yourself. And I think you should"},{"speaker":"Charles Goldfarb","startTime":1195.06,"endTime":1199.14,"body":"have variable options available."},{"speaker":"Charles Goldfarb","startTime":1199.14,"endTime":1201.93,"body":"So you should potentially be"},{"speaker":"Charles Goldfarb","startTime":1199.14,"endTime":1201.93,"body":"prepared to do a heavy homemade"},{"speaker":"Charles Goldfarb","startTime":1201.93,"endTime":1205.53,"body":"arthroplasty depending on the"},{"speaker":"Charles Goldfarb","startTime":1201.93,"endTime":1205.53,"body":"patient preference, this"},{"speaker":"Charles Goldfarb","startTime":1205.56,"endTime":1208.35,"body":"gentleman's young, but you"},{"speaker":"Charles Goldfarb","startTime":1205.56,"endTime":1208.35,"body":"should be prepared to consider"},{"speaker":"Charles Goldfarb","startTime":1208.35,"endTime":1213.75,"body":"an arthroplasty that is either a"},{"speaker":"Charles Goldfarb","startTime":1208.35,"endTime":1213.75,"body":"silicone or some type of"},{"speaker":"Charles Goldfarb","startTime":1213.75,"endTime":1217.53,"body":"arthroplasty. And then finally,"},{"speaker":"Charles Goldfarb","startTime":1213.75,"endTime":1217.53,"body":"in a 45 year old, especially if"},{"speaker":"Charles Goldfarb","startTime":1217.53,"endTime":1221.28,"body":"they you know, power grip and"},{"speaker":"Charles Goldfarb","startTime":1217.53,"endTime":1221.28,"body":"durability is your option, you"},{"speaker":"Charles Goldfarb","startTime":1221.28,"endTime":1225.27,"body":"have to be prepared to perform a"},{"speaker":"Charles Goldfarb","startTime":1221.28,"endTime":1225.27,"body":"fusion, because that's probably"},{"speaker":"Charles Goldfarb","startTime":1225.27,"endTime":1226.05,"body":"his best option."},{"speaker":"Chris Dy","startTime":1227.4,"endTime":1229.41,"body":"There's a lot to"},{"speaker":"Chris Dy","startTime":1227.4,"endTime":1229.41,"body":"unpack there. I think that's uh,"},{"speaker":"Chris Dy","startTime":1229.95,"endTime":1232.71,"body":"you said a lot of really"},{"speaker":"Chris Dy","startTime":1229.95,"endTime":1232.71,"body":"important things you mentioned,"},{"speaker":"Chris Dy","startTime":1232.74,"endTime":1235.5,"body":"you know, a limited, say"},{"speaker":"Chris Dy","startTime":1232.74,"endTime":1235.5,"body":"proximal phalanx head is clean."},{"speaker":"Chris Dy","startTime":1235.92,"endTime":1240.06,"body":"And you've got some post"},{"speaker":"Chris Dy","startTime":1235.92,"endTime":1240.06,"body":"traumatic arthritic changes at"},{"speaker":"Chris Dy","startTime":1240.06,"endTime":1242.79,"body":"the base of the middle phalanx,"},{"speaker":"Chris Dy","startTime":1240.06,"endTime":1242.79,"body":"you said a limited amount. And"},{"speaker":"Chris Dy","startTime":1242.82,"endTime":1246.33,"body":"what is that kind of threshold"},{"speaker":"Chris Dy","startTime":1242.82,"endTime":1246.33,"body":"in which you're like, oh, yeah,"},{"speaker":"Chris Dy","startTime":1246.33,"endTime":1251.34,"body":"this is going to do well, versus"},{"speaker":"Chris Dy","startTime":1246.33,"endTime":1251.34,"body":"you get a little more censored?"},{"speaker":"Charles Goldfarb","startTime":1252.45,"endTime":1255.21,"body":"I think it"},{"speaker":"Charles Goldfarb","startTime":1252.45,"endTime":1255.21,"body":"meaning. So if we're talking how"},{"speaker":"Charles Goldfarb","startTime":1255.21,"endTime":1258.39,"body":"much arthritis we're not, the"},{"speaker":"Charles Goldfarb","startTime":1255.21,"endTime":1258.39,"body":"depth of their arthritis doesn't"},{"speaker":"Charles Goldfarb","startTime":1258.39,"endTime":1262.26,"body":"matter. It's simply how much"},{"speaker":"Charles Goldfarb","startTime":1258.39,"endTime":1262.26,"body":"from volar to dorsal, that base"},{"speaker":"Charles Goldfarb","startTime":1262.26,"endTime":1265.05,"body":"of the middle phalanx. And what"},{"speaker":"Charles Goldfarb","startTime":1262.26,"endTime":1265.05,"body":"you're trying to do with that"},{"speaker":"Charles Goldfarb","startTime":1265.05,"endTime":1268.95,"body":"piece of bone is, you know,"},{"speaker":"Charles Goldfarb","startTime":1265.05,"endTime":1268.95,"body":"recreate a volar buttress. And"},{"speaker":"Charles Goldfarb","startTime":1268.95,"endTime":1274.11,"body":"so, you know, you can replace"},{"speaker":"Charles Goldfarb","startTime":1268.95,"endTime":1274.11,"body":"70, or 80%, of the base of the"},{"speaker":"Charles Goldfarb","startTime":1274.23,"endTime":1276.99,"body":"middle phalanx. But that"},{"speaker":"Charles Goldfarb","startTime":1274.23,"endTime":1276.99,"body":"probably is not ideal. I think"},{"speaker":"Charles Goldfarb","startTime":1276.99,"endTime":1280.44,"body":"if it's 60% or less, I think"},{"speaker":"Charles Goldfarb","startTime":1276.99,"endTime":1280.44,"body":"you're set up to have an"},{"speaker":"Charles Goldfarb","startTime":1280.44,"endTime":1281.34,"body":"outstanding outcome."},{"speaker":"Chris Dy","startTime":1282.27,"endTime":1283.86,"body":"And my threshold for"},{"speaker":"Chris Dy","startTime":1282.27,"endTime":1283.86,"body":"that, even though I don't have"},{"speaker":"Chris Dy","startTime":1283.86,"endTime":1285.93,"body":"the same depth of experience you"},{"speaker":"Chris Dy","startTime":1283.86,"endTime":1285.93,"body":"do would probably have been"},{"speaker":"Chris Dy","startTime":1285.93,"endTime":1289.26,"body":"around 30, or 40%. I just don't"},{"speaker":"Chris Dy","startTime":1285.93,"endTime":1289.26,"body":"I mean, that's a lot of"},{"speaker":"Chris Dy","startTime":1289.26,"endTime":1293.16,"body":"carpentry that you gotta get"},{"speaker":"Chris Dy","startTime":1289.26,"endTime":1293.16,"body":"perfect if you're going for 60"},{"speaker":"Chris Dy","startTime":1293.16,"endTime":1296.52,"body":"or 70%. But I agree with what"},{"speaker":"Chris Dy","startTime":1293.16,"endTime":1296.52,"body":"you said about wanting all the"},{"speaker":"Chris Dy","startTime":1296.52,"endTime":1298.53,"body":"options and just to backpedal a"},{"speaker":"Chris Dy","startTime":1296.52,"endTime":1298.53,"body":"little bit. For those of"},{"speaker":"Chris Dy","startTime":1298.53,"endTime":1301.62,"body":"listeners that may be a little"},{"speaker":"Chris Dy","startTime":1298.53,"endTime":1301.62,"body":"bit earlier on and experience."},{"speaker":"Chris Dy","startTime":1301.92,"endTime":1304.26,"body":"You know, the reason that this"},{"speaker":"Chris Dy","startTime":1301.92,"endTime":1304.26,"body":"base of the middle phalanx is so"},{"speaker":"Chris Dy","startTime":1304.26,"endTime":1307.32,"body":"important is that, as Chuck"},{"speaker":"Chris Dy","startTime":1304.26,"endTime":1307.32,"body":"mentioned, it's a buttress that"},{"speaker":"Chris Dy","startTime":1307.32,"endTime":1312.48,"body":"stops the keeps the joint"},{"speaker":"Chris Dy","startTime":1307.32,"endTime":1312.48,"body":"reduced. And if you lose that"},{"speaker":"Chris Dy","startTime":1312.48,"endTime":1315.66,"body":"buttress, say you have, you"},{"speaker":"Chris Dy","startTime":1312.48,"endTime":1315.66,"body":"know, big fuller lip fragment,"},{"speaker":"Chris Dy","startTime":1316.71,"endTime":1319.32,"body":"that joint is just going to ride"},{"speaker":"Chris Dy","startTime":1316.71,"endTime":1319.32,"body":"out dorsally. And that's what's"},{"speaker":"Chris Dy","startTime":1319.32,"endTime":1323.22,"body":"happened in this case. So you"},{"speaker":"Chris Dy","startTime":1319.32,"endTime":1323.22,"body":"mentioned potentially being"},{"speaker":"Chris Dy","startTime":1323.25,"endTime":1325.53,"body":"ready to do all the things, is"},{"speaker":"Chris Dy","startTime":1323.25,"endTime":1325.53,"body":"this a single stage"},{"speaker":"Chris Dy","startTime":1325.53,"endTime":1328.65,"body":"reconstruction for you if you're"},{"speaker":"Chris Dy","startTime":1325.53,"endTime":1328.65,"body":"exploring I mean, I think some"},{"speaker":"Chris Dy","startTime":1328.65,"endTime":1332.43,"body":"would argue maybe do do your"},{"speaker":"Chris Dy","startTime":1328.65,"endTime":1332.43,"body":"inspection, do your releases,"},{"speaker":"Chris Dy","startTime":1332.43,"endTime":1334.65,"body":"get all your passive motion,"},{"speaker":"Chris Dy","startTime":1332.43,"endTime":1334.65,"body":"ensure that you can keep your"},{"speaker":"Chris Dy","startTime":1334.65,"endTime":1337.14,"body":"passive motion and then come"},{"speaker":"Chris Dy","startTime":1334.65,"endTime":1337.14,"body":"back. But I can also see"},{"speaker":"Chris Dy","startTime":1337.14,"endTime":1340.29,"body":"somebody saying, Why would you"},{"speaker":"Chris Dy","startTime":1337.14,"endTime":1340.29,"body":"go back to a joint twice?"},{"speaker":"Charles Goldfarb","startTime":1341.79,"endTime":1344.97,"body":"I look, I"},{"speaker":"Charles Goldfarb","startTime":1341.79,"endTime":1344.97,"body":"mean, a single stage operation"},{"speaker":"Charles Goldfarb","startTime":1344.97,"endTime":1348.09,"body":"is always preferable, but if the"},{"speaker":"Charles Goldfarb","startTime":1344.97,"endTime":1348.09,"body":"patient is insistent and you"},{"speaker":"Charles Goldfarb","startTime":1348.09,"endTime":1351.39,"body":"believe that there is a"},{"speaker":"Charles Goldfarb","startTime":1348.09,"endTime":1351.39,"body":"reasonable chance of success,"},{"speaker":"Charles Goldfarb","startTime":1351.78,"endTime":1354.84,"body":"then absolutely you can always"},{"speaker":"Charles Goldfarb","startTime":1351.78,"endTime":1354.84,"body":"come back and do a fusion or do"},{"speaker":"Charles Goldfarb","startTime":1354.84,"endTime":1358.29,"body":"a different type of"},{"speaker":"Charles Goldfarb","startTime":1354.84,"endTime":1358.29,"body":"arthroplasty. And in a young"},{"speaker":"Charles Goldfarb","startTime":1358.29,"endTime":1360.84,"body":"patient, this you know, this"},{"speaker":"Charles Goldfarb","startTime":1358.29,"endTime":1360.84,"body":"joint has some coronal"},{"speaker":"Charles Goldfarb","startTime":1360.84,"endTime":1363.48,"body":"instability, which is not the"},{"speaker":"Charles Goldfarb","startTime":1360.84,"endTime":1363.48,"body":"kiss of death, but you would"},{"speaker":"Charles Goldfarb","startTime":1363.48,"endTime":1366.96,"body":"prefer only sagittal"},{"speaker":"Charles Goldfarb","startTime":1363.48,"endTime":1366.96,"body":"instability. That is the middle"},{"speaker":"Charles Goldfarb","startTime":1366.96,"endTime":1370.47,"body":"failings rotting dorsally that"},{"speaker":"Charles Goldfarb","startTime":1366.96,"endTime":1370.47,"body":"would be the preference for a"},{"speaker":"Charles Goldfarb","startTime":1370.47,"endTime":1372.9,"body":"Hemi heading arthroplasty when"},{"speaker":"Charles Goldfarb","startTime":1370.47,"endTime":1372.9,"body":"there's criminal instability can"},{"speaker":"Charles Goldfarb","startTime":1372.9,"endTime":1376.56,"body":"still work. It's just a little"},{"speaker":"Charles Goldfarb","startTime":1372.9,"endTime":1376.56,"body":"trickier. But I think in this"},{"speaker":"Charles Goldfarb","startTime":1376.56,"endTime":1381.72,"body":"patient, I would approach it"},{"speaker":"Charles Goldfarb","startTime":1376.56,"endTime":1381.72,"body":"virtually with the idea that I'm"},{"speaker":"Charles Goldfarb","startTime":1381.72,"endTime":1383.79,"body":"going to work to save the joint."},{"speaker":"Chris Dy","startTime":1384.81,"endTime":1388.17,"body":"So just to summarize"},{"speaker":"Chris Dy","startTime":1384.81,"endTime":1388.17,"body":"your plan here, so if this is"},{"speaker":"Chris Dy","startTime":1388.17,"endTime":1390.78,"body":"somebody who you know, we"},{"speaker":"Chris Dy","startTime":1388.17,"endTime":1390.78,"body":"believe could do well with a"},{"speaker":"Chris Dy","startTime":1390.78,"endTime":1393.93,"body":"single stage procedure volar"},{"speaker":"Chris Dy","startTime":1390.78,"endTime":1393.93,"body":"approach shotgun, open the"},{"speaker":"Chris Dy","startTime":1393.93,"endTime":1397.53,"body":"joint, take a look at the base"},{"speaker":"Chris Dy","startTime":1393.93,"endTime":1397.53,"body":"of the middle phalanx and then"},{"speaker":"Chris Dy","startTime":1397.53,"endTime":1399.69,"body":"plan for a heavy handed"},{"speaker":"Chris Dy","startTime":1397.53,"endTime":1399.69,"body":"arthroplasty"},{"speaker":"Charles Goldfarb","startTime":1400.02,"endTime":1402.48,"body":"if we're going"},{"speaker":"Charles Goldfarb","startTime":1400.02,"endTime":1402.48,"body":"for and I think there's some"},{"speaker":"Charles Goldfarb","startTime":1402.51,"endTime":1407.97,"body":"element of examining in the"},{"speaker":"Charles Goldfarb","startTime":1402.51,"endTime":1407.97,"body":"clinic. Also, live cm"},{"speaker":"Charles Goldfarb","startTime":1407.97,"endTime":1411.96,"body":"fluoroscopy can be helpful. This"},{"speaker":"Charles Goldfarb","startTime":1407.97,"endTime":1411.96,"body":"is not a slam dunk by any"},{"speaker":"Charles Goldfarb","startTime":1411.96,"endTime":1415.02,"body":"stretch. If this patient said,"},{"speaker":"Charles Goldfarb","startTime":1411.96,"endTime":1415.02,"body":"Look, I need to have one"},{"speaker":"Charles Goldfarb","startTime":1415.02,"endTime":1418.53,"body":"surgery, I need to know what's"},{"speaker":"Charles Goldfarb","startTime":1415.02,"endTime":1418.53,"body":"going to work. And I don't want"},{"speaker":"Charles Goldfarb","startTime":1418.53,"endTime":1421.59,"body":"to take any chances than the"},{"speaker":"Charles Goldfarb","startTime":1418.53,"endTime":1421.59,"body":"absolute right answer would be a"},{"speaker":"Charles Goldfarb","startTime":1421.59,"endTime":1425.55,"body":"fusion 100%. And if I fuse this"},{"speaker":"Charles Goldfarb","startTime":1421.59,"endTime":1425.55,"body":"joint, and fuse it in about 15"},{"speaker":"Charles Goldfarb","startTime":1425.55,"endTime":1429.15,"body":"degrees of flexion. And I think"},{"speaker":"Charles Goldfarb","startTime":1425.55,"endTime":1429.15,"body":"the patient would do really"},{"speaker":"Charles Goldfarb","startTime":1429.15,"endTime":1433.2,"body":"well. But if I could restore"},{"speaker":"Charles Goldfarb","startTime":1429.15,"endTime":1433.2,"body":"motion in a painless fashion,"},{"speaker":"Charles Goldfarb","startTime":1433.47,"endTime":1434.61,"body":"then we'd all be happier."},{"speaker":"Chris Dy","startTime":1435.66,"endTime":1438.96,"body":"So to summarize, for"},{"speaker":"Chris Dy","startTime":1435.66,"endTime":1438.96,"body":"fusion is that tension band is"},{"speaker":"Chris Dy","startTime":1438.96,"endTime":1440.28,"body":"that little plate."},{"speaker":"Charles Goldfarb","startTime":1440.64,"endTime":1443.67,"body":"I'm a tension"},{"speaker":"Charles Goldfarb","startTime":1440.64,"endTime":1443.67,"body":"band fan. I do that from"},{"speaker":"Charles Goldfarb","startTime":1443.67,"endTime":1446.01,"body":"dorsally which is a little"},{"speaker":"Charles Goldfarb","startTime":1443.67,"endTime":1446.01,"body":"complicated here and we're gonna"},{"speaker":"Charles Goldfarb","startTime":1446.01,"endTime":1448.98,"body":"go boldly first, but what about"},{"speaker":"Charles Goldfarb","startTime":1446.01,"endTime":1448.98,"body":"you what's your first choice?"},{"speaker":"Chris Dy","startTime":1450.03,"endTime":1452.67,"body":"If we're going to do a"},{"speaker":"Chris Dy","startTime":1450.03,"endTime":1452.67,"body":"fusion I tend to like plates."},{"speaker":"Chris Dy","startTime":1453.93,"endTime":1456.06,"body":"Compression plating, I think"},{"speaker":"Chris Dy","startTime":1453.93,"endTime":1456.06,"body":"that we talked about this on a"},{"speaker":"Chris Dy","startTime":1456.06,"endTime":1458.94,"body":"prior episode. She mentioned it"},{"speaker":"Chris Dy","startTime":1456.06,"endTime":1458.94,"body":"recently with one of the fellows"},{"speaker":"Chris Dy","startTime":1458.97,"endTime":1463.38,"body":"we were doing an MP fusion for a"},{"speaker":"Chris Dy","startTime":1458.97,"endTime":1463.38,"body":"thumb and you know, their"},{"speaker":"Chris Dy","startTime":1463.38,"endTime":1466.29,"body":"experience recently with one of"},{"speaker":"Chris Dy","startTime":1463.38,"endTime":1466.29,"body":"our partners Marty Boyer was you"},{"speaker":"Chris Dy","startTime":1466.29,"endTime":1468.72,"body":"know, they did a bunch of"},{"speaker":"Chris Dy","startTime":1466.29,"endTime":1468.72,"body":"tension bands on somebody's PMP"},{"speaker":"Chris Dy","startTime":1468.72,"endTime":1472.62,"body":"joints and I just like the"},{"speaker":"Chris Dy","startTime":1468.72,"endTime":1472.62,"body":"dorsal plating I think it is"},{"speaker":"Chris Dy","startTime":1472.65,"endTime":1475.32,"body":"somewhat lower profile and if"},{"speaker":"Chris Dy","startTime":1472.65,"endTime":1475.32,"body":"you actually put the screws in"},{"speaker":"Chris Dy","startTime":1475.35,"endTime":1477.72,"body":"and so that they're not sitting"},{"speaker":"Chris Dy","startTime":1475.35,"endTime":1477.72,"body":"out I think it probably is a"},{"speaker":"Chris Dy","startTime":1477.72,"endTime":1480.27,"body":"little less prominent than some"},{"speaker":"Chris Dy","startTime":1477.72,"endTime":1480.27,"body":"tension bands when they're not"},{"speaker":"Chris Dy","startTime":1480.27,"endTime":1482.7,"body":"done perfectly well by somebody"},{"speaker":"Chris Dy","startTime":1480.27,"endTime":1482.7,"body":"like with the experience like"},{"speaker":"Chris Dy","startTime":1482.7,"endTime":1485.94,"body":"you cost more obviously, you"},{"speaker":"Chris Dy","startTime":1482.7,"endTime":1485.94,"body":"don't always have to use the"},{"speaker":"Chris Dy","startTime":1485.94,"endTime":1488.19,"body":"locking screws and the fancy"},{"speaker":"Chris Dy","startTime":1485.94,"endTime":1488.19,"body":"technology but I think some of"},{"speaker":"Chris Dy","startTime":1488.19,"endTime":1491.88,"body":"those some of these plates that"},{"speaker":"Chris Dy","startTime":1488.19,"endTime":1491.88,"body":"that are in the existing hand"},{"speaker":"Chris Dy","startTime":1491.88,"endTime":1493.2,"body":"modular sets are pretty nice."},{"speaker":"Charles Goldfarb","startTime":1493.53,"endTime":1494.79,"body":"Yeah,"},{"speaker":"Charles Goldfarb","startTime":1493.53,"endTime":1494.79,"body":"especially the new plates that"},{"speaker":"Charles Goldfarb","startTime":1494.79,"endTime":1496.86,"body":"are designed for there's no"},{"speaker":"Charles Goldfarb","startTime":1494.79,"endTime":1496.86,"body":"doubt they are they make it a"},{"speaker":"Charles Goldfarb","startTime":1496.86,"endTime":1500.61,"body":"little bit easier, and they"},{"speaker":"Charles Goldfarb","startTime":1496.86,"endTime":1500.61,"body":"decrease the fiddling but Yeah,"},{"speaker":"Charles Goldfarb","startTime":1500.61,"endTime":1503.37,"body":"I think this is an interesting"},{"speaker":"Charles Goldfarb","startTime":1500.61,"endTime":1503.37,"body":"case, it's the the PRP joint, as"},{"speaker":"Charles Goldfarb","startTime":1503.37,"endTime":1508.02,"body":"we all know, is super tricky. It"},{"speaker":"Charles Goldfarb","startTime":1503.37,"endTime":1508.02,"body":"has to be anatomically reduced."},{"speaker":"Charles Goldfarb","startTime":1508.29,"endTime":1512.19,"body":"And so the missed opportunity"},{"speaker":"Charles Goldfarb","startTime":1508.29,"endTime":1512.19,"body":"not necessarily by the, the"},{"speaker":"Charles Goldfarb","startTime":1512.19,"endTime":1514.59,"body":"surgeon who wrote in, but the"},{"speaker":"Charles Goldfarb","startTime":1512.19,"endTime":1514.59,"body":"missed opportunity was"},{"speaker":"Charles Goldfarb","startTime":1514.59,"endTime":1518.79,"body":"identifying a non anatomical"},{"speaker":"Charles Goldfarb","startTime":1514.59,"endTime":1518.79,"body":"reduction early and correcting"},{"speaker":"Charles Goldfarb","startTime":1518.79,"endTime":1521.88,"body":"that. Because if you don't get"},{"speaker":"Charles Goldfarb","startTime":1518.79,"endTime":1521.88,"body":"the joint perfect, even if it"},{"speaker":"Charles Goldfarb","startTime":1521.88,"endTime":1524.64,"body":"requires a k, where you don't"},{"speaker":"Charles Goldfarb","startTime":1521.88,"endTime":1524.64,"body":"get the joint perfect, it's"},{"speaker":"Charles Goldfarb","startTime":1524.64,"endTime":1526.89,"body":"going to go in the wrong"},{"speaker":"Charles Goldfarb","startTime":1524.64,"endTime":1526.89,"body":"direction. So you have to have"},{"speaker":"Charles Goldfarb","startTime":1526.89,"endTime":1530.1,"body":"an anatomical reduction, you can"},{"speaker":"Charles Goldfarb","startTime":1526.89,"endTime":1530.1,"body":"always deal with stiffness, but"},{"speaker":"Charles Goldfarb","startTime":1530.1,"endTime":1531.99,"body":"you have to have the anatomical"},{"speaker":"Charles Goldfarb","startTime":1530.1,"endTime":1531.99,"body":"reduction first."},{"speaker":"Chris Dy","startTime":1532.74,"endTime":1534.39,"body":"Right? Yeah, there are"},{"speaker":"Chris Dy","startTime":1532.74,"endTime":1534.39,"body":"a lot of ways to get to that"},{"speaker":"Chris Dy","startTime":1534.39,"endTime":1538.8,"body":"anatomical reduction, you know,"},{"speaker":"Chris Dy","startTime":1534.39,"endTime":1538.8,"body":"from the earlier identification"},{"speaker":"Chris Dy","startTime":1538.8,"endTime":1542.43,"body":"of the subluxated joints, you"},{"speaker":"Chris Dy","startTime":1538.8,"endTime":1542.43,"body":"know, even something as simple"},{"speaker":"Chris Dy","startTime":1542.43,"endTime":1546.24,"body":"as a dorsal blocking splint, you"},{"speaker":"Chris Dy","startTime":1542.43,"endTime":1546.24,"body":"know, checked under fluoroscopy."},{"speaker":"Chris Dy","startTime":1546.24,"endTime":1548.16,"body":"And, you know, kind of looking"},{"speaker":"Chris Dy","startTime":1546.24,"endTime":1548.16,"body":"at seeing the position of"},{"speaker":"Chris Dy","startTime":1548.16,"endTime":1551.25,"body":"stability of the joint and"},{"speaker":"Chris Dy","startTime":1548.16,"endTime":1551.25,"body":"acknowledging that you're going"},{"speaker":"Chris Dy","startTime":1551.25,"endTime":1555.0,"body":"to have to flex the PIJ to get"},{"speaker":"Chris Dy","startTime":1551.25,"endTime":1555.0,"body":"it to be concentrically stable,"},{"speaker":"Chris Dy","startTime":1555.0,"endTime":1557.67,"body":"and that you're gonna have to"},{"speaker":"Chris Dy","startTime":1555.0,"endTime":1557.67,"body":"fight through some of that lack"},{"speaker":"Chris Dy","startTime":1557.67,"endTime":1560.94,"body":"of extension later on, but you"},{"speaker":"Chris Dy","startTime":1557.67,"endTime":1560.94,"body":"are going to get the flexion"},{"speaker":"Chris Dy","startTime":1560.94,"endTime":1563.52,"body":"that you are wanting. And if you"},{"speaker":"Chris Dy","startTime":1560.94,"endTime":1563.52,"body":"don't do a dorsal blocking,"},{"speaker":"Chris Dy","startTime":1563.52,"endTime":1566.43,"body":"split, there's a dorsal blocking"},{"speaker":"Chris Dy","startTime":1563.52,"endTime":1566.43,"body":"pin, then you kind of progress"},{"speaker":"Chris Dy","startTime":1566.43,"endTime":1570.21,"body":"up the ladder to something like"},{"speaker":"Chris Dy","startTime":1566.43,"endTime":1570.21,"body":"a dynamic x axis azuki"},{"speaker":"Chris Dy","startTime":1570.21,"endTime":1573.12,"body":"timeframe. And then you kind of"},{"speaker":"Chris Dy","startTime":1570.21,"endTime":1573.12,"body":"get into these really big"},{"speaker":"Chris Dy","startTime":1573.12,"endTime":1575.58,"body":"reconstructive options. So if"},{"speaker":"Chris Dy","startTime":1573.12,"endTime":1575.58,"body":"you have something that remains"},{"speaker":"Chris Dy","startTime":1575.58,"endTime":1580.2,"body":"unstable, do you ever just pin"},{"speaker":"Chris Dy","startTime":1575.58,"endTime":1580.2,"body":"the joints and flexion? Not a"},{"speaker":"Chris Dy","startTime":1580.2,"endTime":1581.82,"body":"dorsal block knee pin, but just"},{"speaker":"Chris Dy","startTime":1580.2,"endTime":1581.82,"body":"a pin?"},{"speaker":"Charles Goldfarb","startTime":1582.27,"endTime":1585.12,"body":"I have I mean,"},{"speaker":"Charles Goldfarb","startTime":1582.27,"endTime":1585.12,"body":"I that's not my first choice."},{"speaker":"Charles Goldfarb","startTime":1585.12,"endTime":1589.02,"body":"But again, you got to figure out"},{"speaker":"Charles Goldfarb","startTime":1585.12,"endTime":1589.02,"body":"a way to get the joints stable,"},{"speaker":"Charles Goldfarb","startTime":1589.02,"endTime":1591.99,"body":"let the soft tissues heal. Take"},{"speaker":"Charles Goldfarb","startTime":1589.02,"endTime":1591.99,"body":"out your pen and worry about"},{"speaker":"Charles Goldfarb","startTime":1591.99,"endTime":1595.98,"body":"motion later. Yeah, so in the"},{"speaker":"Charles Goldfarb","startTime":1591.99,"endTime":1595.98,"body":"right situation, which would be"},{"speaker":"Charles Goldfarb","startTime":1595.98,"endTime":1598.92,"body":"a really complex situation. I"},{"speaker":"Charles Goldfarb","startTime":1595.98,"endTime":1598.92,"body":"don't think there's wrong"},{"speaker":"Charles Goldfarb","startTime":1598.92,"endTime":1600.39,"body":"dependent joint. I really don't."},{"speaker":"Chris Dy","startTime":1601.38,"endTime":1603.72,"body":"Right. And then I do"},{"speaker":"Chris Dy","startTime":1601.38,"endTime":1603.72,"body":"want to touch on one thing that"},{"speaker":"Chris Dy","startTime":1603.72,"endTime":1606.51,"body":"you mentioned, you mentioned,"},{"speaker":"Chris Dy","startTime":1603.72,"endTime":1606.51,"body":"this would be a volere approach."},{"speaker":"Chris Dy","startTime":1606.54,"endTime":1610.53,"body":"And you know, shock getting the"},{"speaker":"Chris Dy","startTime":1606.54,"endTime":1610.53,"body":"joint. How do you deal with the"},{"speaker":"Chris Dy","startTime":1610.53,"endTime":1613.62,"body":"dorsal tissues, the dorsal"},{"speaker":"Chris Dy","startTime":1610.53,"endTime":1613.62,"body":"capsule potentially being tight,"},{"speaker":"Chris Dy","startTime":1613.62,"endTime":1616.83,"body":"which could limit your flexion?"},{"speaker":"Chris Dy","startTime":1613.62,"endTime":1616.83,"body":"You know, both the capsule and"},{"speaker":"Chris Dy","startTime":1616.83,"endTime":1618.57,"body":"potentially the extensor"},{"speaker":"Chris Dy","startTime":1616.83,"endTime":1618.57,"body":"tendons?"},{"speaker":"Charles Goldfarb","startTime":1618.99,"endTime":1621.99,"body":"Yeah. So we"},{"speaker":"Charles Goldfarb","startTime":1618.99,"endTime":1621.99,"body":"and that is Marty and I and I"},{"speaker":"Charles Goldfarb","startTime":1621.99,"endTime":1624.9,"body":"think I think all of us now have"},{"speaker":"Charles Goldfarb","startTime":1621.99,"endTime":1624.9,"body":"this sort of the same belief"},{"speaker":"Charles Goldfarb","startTime":1624.93,"endTime":1627.36,"body":"that we don't like operating on"},{"speaker":"Charles Goldfarb","startTime":1624.93,"endTime":1627.36,"body":"both sides have a finger at the"},{"speaker":"Charles Goldfarb","startTime":1627.36,"endTime":1630.6,"body":"same time. And the theory there"},{"speaker":"Charles Goldfarb","startTime":1627.36,"endTime":1630.6,"body":"is that if you operate dorsally"},{"speaker":"Charles Goldfarb","startTime":1630.6,"endTime":1634.44,"body":"and vole early, then it's"},{"speaker":"Charles Goldfarb","startTime":1630.6,"endTime":1634.44,"body":"probably too much, especially"},{"speaker":"Charles Goldfarb","startTime":1634.44,"endTime":1637.74,"body":"for a little finger and you'll"},{"speaker":"Charles Goldfarb","startTime":1634.44,"endTime":1637.74,"body":"get resultant swelling. And the"},{"speaker":"Charles Goldfarb","startTime":1637.74,"endTime":1642.12,"body":"swelling will limit your therapy"},{"speaker":"Charles Goldfarb","startTime":1637.74,"endTime":1642.12,"body":"success after surgery. And so we"},{"speaker":"Charles Goldfarb","startTime":1642.12,"endTime":1644.76,"body":"typically operate on one side"},{"speaker":"Charles Goldfarb","startTime":1642.12,"endTime":1644.76,"body":"only. In this situation, if"},{"speaker":"Charles Goldfarb","startTime":1644.76,"endTime":1647.76,"body":"you're going volar, I think"},{"speaker":"Charles Goldfarb","startTime":1644.76,"endTime":1647.76,"body":"there's a you can deal with the"},{"speaker":"Charles Goldfarb","startTime":1647.76,"endTime":1651.81,"body":"dorsal capsule without too much"},{"speaker":"Charles Goldfarb","startTime":1647.76,"endTime":1651.81,"body":"trouble with a fear elevator, or"},{"speaker":"Charles Goldfarb","startTime":1651.81,"endTime":1655.26,"body":"something like that, I think"},{"speaker":"Charles Goldfarb","startTime":1651.81,"endTime":1655.26,"body":"it's a little trickier to scooch"},{"speaker":"Charles Goldfarb","startTime":1655.26,"endTime":1658.17,"body":"around, so to speak the side of"},{"speaker":"Charles Goldfarb","startTime":1655.26,"endTime":1658.17,"body":"the joint to get the extensor"},{"speaker":"Charles Goldfarb","startTime":1658.17,"endTime":1663.63,"body":"mechanism. So I think that's a"},{"speaker":"Charles Goldfarb","startTime":1658.17,"endTime":1663.63,"body":"fair concern. But that may be"},{"speaker":"Charles Goldfarb","startTime":1663.66,"endTime":1665.61,"body":"that may mean you're looking at"},{"speaker":"Charles Goldfarb","startTime":1663.66,"endTime":1665.61,"body":"two servers."},{"speaker":"Chris Dy","startTime":1666.24,"endTime":1669.12,"body":"Right now, I think the"},{"speaker":"Chris Dy","startTime":1666.24,"endTime":1669.12,"body":"sensor to license if you do have"},{"speaker":"Chris Dy","startTime":1669.12,"endTime":1673.98,"body":"to do it is a nice one done a"},{"speaker":"Chris Dy","startTime":1669.12,"endTime":1673.98,"body":"week. So kind of lower, less"},{"speaker":"Chris Dy","startTime":1673.98,"endTime":1676.44,"body":"morbidity for the patient. And"},{"speaker":"Chris Dy","startTime":1673.98,"endTime":1676.44,"body":"honestly, you get some useful"},{"speaker":"Chris Dy","startTime":1676.44,"endTime":1678.66,"body":"information. And you're lucky if"},{"speaker":"Chris Dy","startTime":1676.44,"endTime":1678.66,"body":"you get to that point where"},{"speaker":"Chris Dy","startTime":1678.66,"endTime":1683.28,"body":"you're working on on the"},{"speaker":"Chris Dy","startTime":1678.66,"endTime":1683.28,"body":"extensor mechanism after such a"},{"speaker":"Chris Dy","startTime":1683.28,"endTime":1686.43,"body":"big surgery. So just to"},{"speaker":"Chris Dy","startTime":1683.28,"endTime":1686.43,"body":"summarize for Mr. Yonis, who was"},{"speaker":"Chris Dy","startTime":1686.43,"endTime":1690.78,"body":"kind enough to send us this"},{"speaker":"Chris Dy","startTime":1686.43,"endTime":1690.78,"body":"case, the consensus among"},{"speaker":"Chris Dy","startTime":1691.14,"endTime":1694.86,"body":"between Chuck and I would be for"},{"speaker":"Chris Dy","startTime":1691.14,"endTime":1694.86,"body":"probably a single stage surgery"},{"speaker":"Chris Dy","startTime":1694.89,"endTime":1698.22,"body":"really going for your for your"},{"speaker":"Chris Dy","startTime":1694.89,"endTime":1698.22,"body":"release, and moving towards a"},{"speaker":"Chris Dy","startTime":1698.22,"endTime":1702.33,"body":"heavy handmade, if at all"},{"speaker":"Chris Dy","startTime":1698.22,"endTime":1702.33,"body":"possible. So single stage, go"},{"speaker":"Chris Dy","startTime":1702.33,"endTime":1703.05,"body":"big or go home."},{"speaker":"Charles Goldfarb","startTime":1703.74,"endTime":1705.84,"body":"Yeah, looking"},{"speaker":"Charles Goldfarb","startTime":1703.74,"endTime":1705.84,"body":"for the home run with a baseball"},{"speaker":"Charles Goldfarb","startTime":1705.84,"endTime":1708.63,"body":"analogy, given the the all star"},{"speaker":"Charles Goldfarb","startTime":1705.84,"endTime":1708.63,"body":"games tonight looking for the"},{"speaker":"Charles Goldfarb","startTime":1708.63,"endTime":1711.39,"body":"home run. But it may not be"},{"speaker":"Charles Goldfarb","startTime":1708.63,"endTime":1711.39,"body":"possible. And if it's not"},{"speaker":"Charles Goldfarb","startTime":1711.39,"endTime":1714.03,"body":"possible, then we should do the"},{"speaker":"Charles Goldfarb","startTime":1711.39,"endTime":1714.03,"body":"best thing for the patient,"},{"speaker":"Charles Goldfarb","startTime":1714.03,"endTime":1716.4,"body":"which is probably providing"},{"speaker":"Charles Goldfarb","startTime":1714.03,"endTime":1716.4,"body":"stability with the VIP joint"},{"speaker":"Charles Goldfarb","startTime":1716.4,"endTime":1716.79,"body":"fusion."},{"speaker":"Chris Dy","startTime":1717.9,"endTime":1720.6,"body":"All right. So I wanted"},{"speaker":"Chris Dy","startTime":1717.9,"endTime":1720.6,"body":"to zoom through a couple of"},{"speaker":"Chris Dy","startTime":1720.6,"endTime":1723.57,"body":"other quick emails that we have"},{"speaker":"Chris Dy","startTime":1720.6,"endTime":1723.57,"body":"an email from a longtime"},{"speaker":"Chris Dy","startTime":1723.57,"endTime":1727.74,"body":"listener, who, who recently"},{"speaker":"Chris Dy","startTime":1723.57,"endTime":1727.74,"body":"enjoyed our episode about FPL"},{"speaker":"Chris Dy","startTime":1727.74,"endTime":1731.01,"body":"rupture. And I'm not sure if I"},{"speaker":"Chris Dy","startTime":1727.74,"endTime":1731.01,"body":"have permission to share his"},{"speaker":"Chris Dy","startTime":1731.01,"endTime":1733.32,"body":"name. So I won't maybe we'll"},{"speaker":"Chris Dy","startTime":1731.01,"endTime":1733.32,"body":"reveal it in a future episode"},{"speaker":"Chris Dy","startTime":1733.32,"endTime":1738.75,"body":"but hand surgeon in the US who"},{"speaker":"Chris Dy","startTime":1733.32,"endTime":1738.75,"body":"asked us about potentially"},{"speaker":"Chris Dy","startTime":1738.78,"endTime":1742.23,"body":"what's the role of AIP joint"},{"speaker":"Chris Dy","startTime":1738.78,"endTime":1742.23,"body":"fusion for somebody with a"},{"speaker":"Chris Dy","startTime":1742.23,"endTime":1748.47,"body":"really chronically delayed FPL"},{"speaker":"Chris Dy","startTime":1742.23,"endTime":1748.47,"body":"rupture after the case that this"},{"speaker":"Chris Dy","startTime":1748.71,"endTime":1751.71,"body":"listener is mentioning is 13"},{"speaker":"Chris Dy","startTime":1748.71,"endTime":1751.71,"body":"years after volar planing had an"},{"speaker":"Chris Dy","startTime":1751.71,"endTime":1755.55,"body":"FPL rupture. So what do you"},{"speaker":"Chris Dy","startTime":1751.71,"endTime":1755.55,"body":"think about IP, some IP joint"},{"speaker":"Chris Dy","startTime":1755.55,"endTime":1758.7,"body":"fusion as a treatment option the"},{"speaker":"Chris Dy","startTime":1755.55,"endTime":1758.7,"body":"patient needs describing is"},{"speaker":"Chris Dy","startTime":1758.7,"endTime":1762.48,"body":"actually I think both of us are"},{"speaker":"Chris Dy","startTime":1758.7,"endTime":1762.48,"body":"agrees elderly, five years old."},{"speaker":"Charles Goldfarb","startTime":1764.04,"endTime":1767.4,"body":"Yes, a little"},{"speaker":"Charles Goldfarb","startTime":1764.04,"endTime":1767.4,"body":"older than I, either. There's"},{"speaker":"Charles Goldfarb","startTime":1767.43,"endTime":1770.67,"body":"absolutely nothing wrong with an"},{"speaker":"Charles Goldfarb","startTime":1767.43,"endTime":1770.67,"body":"IP joint fusion. And I think"},{"speaker":"Charles Goldfarb","startTime":1770.67,"endTime":1774.18,"body":"it's a conversation with the"},{"speaker":"Charles Goldfarb","startTime":1770.67,"endTime":1774.18,"body":"patient and hopefully the family"},{"speaker":"Charles Goldfarb","startTime":1774.48,"endTime":1778.2,"body":"because you're you're not giving"},{"speaker":"Charles Goldfarb","startTime":1774.48,"endTime":1778.2,"body":"them back what they had before."},{"speaker":"Charles Goldfarb","startTime":1778.23,"endTime":1781.17,"body":"And that's problematic for some"},{"speaker":"Charles Goldfarb","startTime":1778.23,"endTime":1781.17,"body":"patients, I think you would"},{"speaker":"Charles Goldfarb","startTime":1781.17,"endTime":1784.38,"body":"provide a really good thumb for"},{"speaker":"Charles Goldfarb","startTime":1781.17,"endTime":1784.38,"body":"that patient. And they can use"},{"speaker":"Charles Goldfarb","startTime":1784.38,"endTime":1788.79,"body":"the thinner musculature for"},{"speaker":"Charles Goldfarb","startTime":1784.38,"endTime":1788.79,"body":"flexion of the MP joint. And I"},{"speaker":"Charles Goldfarb","startTime":1788.79,"endTime":1791.7,"body":"think the patient would do"},{"speaker":"Charles Goldfarb","startTime":1788.79,"endTime":1791.7,"body":"really well, but they would not"},{"speaker":"Charles Goldfarb","startTime":1791.7,"endTime":1793.77,"body":"be happy unless they truly"},{"speaker":"Charles Goldfarb","startTime":1791.7,"endTime":1793.77,"body":"understand what you're"},{"speaker":"Charles Goldfarb","startTime":1793.77,"endTime":1797.34,"body":"accomplishing with that IP joint"},{"speaker":"Charles Goldfarb","startTime":1793.77,"endTime":1797.34,"body":"fusion. For that reason, I tend"},{"speaker":"Charles Goldfarb","startTime":1797.34,"endTime":1801.87,"body":"to prefer to reconstruct The"},{"speaker":"Charles Goldfarb","startTime":1797.34,"endTime":1801.87,"body":"FPL, but it's not wrong to fuse"},{"speaker":"Charles Goldfarb","startTime":1801.87,"endTime":1802.56,"body":"the IP joints."},{"speaker":"Chris Dy","startTime":1803.28,"endTime":1805.26,"body":"Yeah, and I think"},{"speaker":"Chris Dy","startTime":1803.28,"endTime":1805.26,"body":"this, this listener had a really"},{"speaker":"Chris Dy","startTime":1805.26,"endTime":1809.07,"body":"good point that he tried non"},{"speaker":"Chris Dy","startTime":1805.26,"endTime":1809.07,"body":"operative treatment to see if"},{"speaker":"Chris Dy","startTime":1809.07,"endTime":1811.71,"body":"just trialing it to see if the"},{"speaker":"Chris Dy","startTime":1809.07,"endTime":1811.71,"body":"patient could live with it. But"},{"speaker":"Chris Dy","startTime":1811.71,"endTime":1814.32,"body":"the patient didn't like the"},{"speaker":"Chris Dy","startTime":1811.71,"endTime":1814.32,"body":"instability. And when somebody"},{"speaker":"Chris Dy","startTime":1814.32,"endTime":1817.68,"body":"like doesn't like instability, I"},{"speaker":"Chris Dy","startTime":1814.32,"endTime":1817.68,"body":"love the option of giving the"},{"speaker":"Chris Dy","startTime":1817.68,"endTime":1819.51,"body":"maximum stability with the"},{"speaker":"Chris Dy","startTime":1817.68,"endTime":1819.51,"body":"fusion."},{"speaker":"Charles Goldfarb","startTime":1819.84,"endTime":1821.49,"body":"Yeah, that's a"},{"speaker":"Charles Goldfarb","startTime":1819.84,"endTime":1821.49,"body":"great point. It's really a great"},{"speaker":"Charles Goldfarb","startTime":1821.49,"endTime":1821.7,"body":"point,"},{"speaker":"Chris Dy","startTime":1822.12,"endTime":1824.94,"body":"would you go ahead and"},{"speaker":"Chris Dy","startTime":1822.12,"endTime":1824.94,"body":"remove the volar plate? If the"},{"speaker":"Chris Dy","startTime":1824.94,"endTime":1827.4,"body":"FPL is already gone? Do you just"},{"speaker":"Chris Dy","startTime":1824.94,"endTime":1827.4,"body":"remove the plate at the same"},{"speaker":"Chris Dy","startTime":1827.4,"endTime":1830.64,"body":"time? Because how often do you"},{"speaker":"Chris Dy","startTime":1827.4,"endTime":1830.64,"body":"see FDP issues for the index"},{"speaker":"Chris Dy","startTime":1830.64,"endTime":1831.21,"body":"through small."},{"speaker":"Charles Goldfarb","startTime":1831.63,"endTime":1833.13,"body":"it really"},{"speaker":"Charles Goldfarb","startTime":1831.63,"endTime":1833.13,"body":"depends on how prominent the"},{"speaker":"Charles Goldfarb","startTime":1833.13,"endTime":1836.04,"body":"plate is, you know, sometimes"},{"speaker":"Charles Goldfarb","startTime":1833.13,"endTime":1836.04,"body":"you're surprised with an FPL"},{"speaker":"Charles Goldfarb","startTime":1836.04,"endTime":1838.47,"body":"issue. And sometimes you're not"},{"speaker":"Charles Goldfarb","startTime":1836.04,"endTime":1838.47,"body":"surprised and that the whole"},{"speaker":"Charles Goldfarb","startTime":1838.47,"endTime":1842.46,"body":"issue develops. If the plate is"},{"speaker":"Charles Goldfarb","startTime":1838.47,"endTime":1842.46,"body":"not prominent at all, I probably"},{"speaker":"Charles Goldfarb","startTime":1842.46,"endTime":1844.65,"body":"would, I wouldn't feel the need"},{"speaker":"Charles Goldfarb","startTime":1842.46,"endTime":1844.65,"body":"to remove it. If there's any"},{"speaker":"Charles Goldfarb","startTime":1844.65,"endTime":1846.72,"body":"question though, and you're"},{"speaker":"Charles Goldfarb","startTime":1844.65,"endTime":1846.72,"body":"going to the operating room?"},{"speaker":"Charles Goldfarb","startTime":1846.9,"endTime":1849.48,"body":"Take the plate out. That's my"},{"speaker":"Charles Goldfarb","startTime":1846.9,"endTime":1849.48,"body":"opinion, do you see any"},{"speaker":"Charles Goldfarb","startTime":1849.48,"endTime":1849.9,"body":"differently?"},{"speaker":"Chris Dy","startTime":1850.95,"endTime":1853.65,"body":"I don't, you know, I"},{"speaker":"Chris Dy","startTime":1850.95,"endTime":1853.65,"body":"think I have a lower threshold"},{"speaker":"Chris Dy","startTime":1853.65,"endTime":1856.56,"body":"to remove the plate. But this"},{"speaker":"Chris Dy","startTime":1853.65,"endTime":1856.56,"body":"listener actually did something"},{"speaker":"Chris Dy","startTime":1856.56,"endTime":1861.72,"body":"pretty slick and did the the IP"},{"speaker":"Chris Dy","startTime":1856.56,"endTime":1861.72,"body":"fusion awake. So if your point"},{"speaker":"Chris Dy","startTime":1861.72,"endTime":1863.34,"body":"is if you're going to the bar,"},{"speaker":"Chris Dy","startTime":1861.72,"endTime":1863.34,"body":"but if you don't have the"},{"speaker":"Chris Dy","startTime":1863.34,"endTime":1867.36,"body":"Monterey CGI, you could clearly"},{"speaker":"Chris Dy","startTime":1863.34,"endTime":1867.36,"body":"do a volar plate removal awake,"},{"speaker":"Chris Dy","startTime":1867.36,"endTime":1870.51,"body":"it's obviously a little more"},{"speaker":"Chris Dy","startTime":1867.36,"endTime":1870.51,"body":"tedious and trying and you know,"},{"speaker":"Chris Dy","startTime":1870.69,"endTime":1874.38,"body":"a little more effort on"},{"speaker":"Chris Dy","startTime":1870.69,"endTime":1874.38,"body":"surgeons, surgeons part. But,"},{"speaker":"Chris Dy","startTime":1874.56,"endTime":1877.98,"body":"you know, if the patient is"},{"speaker":"Chris Dy","startTime":1874.56,"endTime":1877.98,"body":"undergoing any sort of"},{"speaker":"Chris Dy","startTime":1878.01,"endTime":1881.28,"body":"anesthesia with a block, at"},{"speaker":"Chris Dy","startTime":1878.01,"endTime":1881.28,"body":"least, you know, regional block"},{"speaker":"Chris Dy","startTime":1881.46,"endTime":1884.58,"body":"and some sedation, I think it's"},{"speaker":"Chris Dy","startTime":1881.46,"endTime":1884.58,"body":"fair to just take the plate on"},{"speaker":"Chris Dy","startTime":1884.64,"endTime":1886.56,"body":"both. You don't have to worry"},{"speaker":"Chris Dy","startTime":1884.64,"endTime":1886.56,"body":"about it anymore."},{"speaker":"Charles Goldfarb","startTime":1887.19,"endTime":1888.33,"body":"Yeah, you"},{"speaker":"Charles Goldfarb","startTime":1887.19,"endTime":1888.33,"body":"know, we had a really"},{"speaker":"Charles Goldfarb","startTime":1888.33,"endTime":1891.27,"body":"interesting discussion on Monday"},{"speaker":"Charles Goldfarb","startTime":1888.33,"endTime":1891.27,"body":"morning conference about a"},{"speaker":"Charles Goldfarb","startTime":1891.27,"endTime":1894.72,"body":"classic rheumatoid patient,"},{"speaker":"Charles Goldfarb","startTime":1891.27,"endTime":1894.72,"body":"which got me thinking and"},{"speaker":"Charles Goldfarb","startTime":1894.72,"endTime":1898.95,"body":"morning, I have been talking"},{"speaker":"Charles Goldfarb","startTime":1894.72,"endTime":1898.95,"body":"since there are things that we"},{"speaker":"Charles Goldfarb","startTime":1898.95,"endTime":1902.73,"body":"are losing, that trainees just"},{"speaker":"Charles Goldfarb","startTime":1898.95,"endTime":1902.73,"body":"don't get to experience in the"},{"speaker":"Charles Goldfarb","startTime":1902.73,"endTime":1904.98,"body":"care they're warming to a hand"},{"speaker":"Charles Goldfarb","startTime":1902.73,"endTime":1904.98,"body":"is one of those and you're not,"},{"speaker":"Charles Goldfarb","startTime":1905.01,"endTime":1907.2,"body":"you know, I've had a couple of"},{"speaker":"Charles Goldfarb","startTime":1905.01,"endTime":1907.2,"body":"this year and we saw that one"},{"speaker":"Charles Goldfarb","startTime":1907.2,"endTime":1909.9,"body":"and but they just don't happen"},{"speaker":"Charles Goldfarb","startTime":1907.2,"endTime":1909.9,"body":"much. Thanks for the disease"},{"speaker":"Charles Goldfarb","startTime":1909.9,"endTime":1913.62,"body":"modifying anti rheumatic drugs"},{"speaker":"Charles Goldfarb","startTime":1909.9,"endTime":1913.62,"body":"tend to transfers are not"},{"speaker":"Charles Goldfarb","startTime":1913.62,"endTime":1917.91,"body":"exactly. Well, they're just not"},{"speaker":"Charles Goldfarb","startTime":1913.62,"endTime":1917.91,"body":"as common as they used to be for"},{"speaker":"Charles Goldfarb","startTime":1917.91,"endTime":1921.45,"body":"a lot of reasons, including what"},{"speaker":"Charles Goldfarb","startTime":1917.91,"endTime":1921.45,"body":"you have, personally single"},{"speaker":"Charles Goldfarb","startTime":1921.45,"endTime":1924.21,"body":"handedly destroyed in our"},{"speaker":"Charles Goldfarb","startTime":1921.45,"endTime":1924.21,"body":"patient population by using"},{"speaker":"Charles Goldfarb","startTime":1924.21,"endTime":1927.39,"body":"nerve transfers. Without you,"},{"speaker":"Charles Goldfarb","startTime":1924.21,"endTime":1927.39,"body":"we'd be doing way more intended"},{"speaker":"Charles Goldfarb","startTime":1927.39,"endTime":1928.23,"body":"transfers."},{"speaker":"Chris Dy","startTime":1928.68,"endTime":1930.6,"body":"Oh, hardly hardly, we"},{"speaker":"Chris Dy","startTime":1928.68,"endTime":1930.6,"body":"did write an interesting paper"},{"speaker":"Chris Dy","startTime":1930.6,"endTime":1933.33,"body":"and one of our current partners"},{"speaker":"Chris Dy","startTime":1930.6,"endTime":1933.33,"body":"Marie Morris, when she was a"},{"speaker":"Chris Dy","startTime":1933.33,"endTime":1936.81,"body":"resident, we got a nice grant"},{"speaker":"Chris Dy","startTime":1933.33,"endTime":1936.81,"body":"from the and society to pull"},{"speaker":"Chris Dy","startTime":1936.81,"endTime":1940.08,"body":"data from the aapos, looking at"},{"speaker":"Chris Dy","startTime":1936.81,"endTime":1940.08,"body":"how frequently nerve transfers"},{"speaker":"Chris Dy","startTime":1940.08,"endTime":1941.88,"body":"were being used, and new"},{"speaker":"Chris Dy","startTime":1940.08,"endTime":1941.88,"body":"graduates who are doing their"},{"speaker":"Chris Dy","startTime":1941.88,"endTime":1945.03,"body":"case logging, and went up six"},{"speaker":"Chris Dy","startTime":1941.88,"endTime":1945.03,"body":"times, just over the course of a"},{"speaker":"Chris Dy","startTime":1945.03,"endTime":1948.24,"body":"decade. Now probably a lot of"},{"speaker":"Chris Dy","startTime":1945.03,"endTime":1948.24,"body":"that is to be honest with you"},{"speaker":"Chris Dy","startTime":1948.24,"endTime":1951.33,"body":"kind of AIN- ulnar nerve"},{"speaker":"Chris Dy","startTime":1948.24,"endTime":1951.33,"body":"supercharging kind of thing. I"},{"speaker":"Chris Dy","startTime":1951.33,"endTime":1955.29,"body":"don't think there are tons of"},{"speaker":"Chris Dy","startTime":1951.33,"endTime":1955.29,"body":"new board eligible orthopedic"},{"speaker":"Chris Dy","startTime":1955.29,"endTime":1959.01,"body":"surgeons that are you know,"},{"speaker":"Chris Dy","startTime":1955.29,"endTime":1959.01,"body":"doing over Linz and all sorts of"},{"speaker":"Chris Dy","startTime":1959.01,"endTime":1963.24,"body":"transfers. But you know, the,"},{"speaker":"Chris Dy","startTime":1959.01,"endTime":1963.24,"body":"the very accessible transfer of"},{"speaker":"Chris Dy","startTime":1963.39,"endTime":1966.15,"body":"like an AIN pronator quadratus"},{"speaker":"Chris Dy","startTime":1963.39,"endTime":1966.15,"body":"supercharge is probably being"},{"speaker":"Chris Dy","startTime":1966.15,"endTime":1971.49,"body":"done a lot. I I'd say two things"},{"speaker":"Chris Dy","startTime":1966.15,"endTime":1971.49,"body":"in your in your fashion, one of"},{"speaker":"Chris Dy","startTime":1971.49,"endTime":1974.76,"body":"us brought up in conference, how"},{"speaker":"Chris Dy","startTime":1971.49,"endTime":1974.76,"body":"it's a shame that our trainees"},{"speaker":"Chris Dy","startTime":1974.76,"endTime":1977.43,"body":"are not learning more about"},{"speaker":"Chris Dy","startTime":1974.76,"endTime":1977.43,"body":"these tenant tracers, and then"},{"speaker":"Chris Dy","startTime":1977.43,"endTime":1980.37,"body":"another one on this podcast,"},{"speaker":"Chris Dy","startTime":1977.43,"endTime":1980.37,"body":"then shut them down immediately"},{"speaker":"Chris Dy","startTime":1980.37,"endTime":1982.77,"body":"with some clip of that"},{"speaker":"Chris Dy","startTime":1980.37,"endTime":1982.77,"body":"intergenerational differences"},{"speaker":"Chris Dy","startTime":1982.77,"endTime":1987.54,"body":"yet, you then went and talked"},{"speaker":"Chris Dy","startTime":1982.77,"endTime":1987.54,"body":"about this with Marty Marty"},{"speaker":"Chris Dy","startTime":1987.54,"endTime":1991.74,"body":"about what to do about it. So"},{"speaker":"Chris Dy","startTime":1987.54,"endTime":1991.74,"body":"you're welcome for the idea. I"},{"speaker":"Chris Dy","startTime":1991.74,"endTime":1994.44,"body":"look forward to seeing whatever"},{"speaker":"Chris Dy","startTime":1991.74,"endTime":1994.44,"body":"content you and you and Marty to"},{"speaker":"Chris Dy","startTime":1994.44,"endTime":1997.59,"body":"create. I agree, it's, it's a"},{"speaker":"Chris Dy","startTime":1994.44,"endTime":1997.59,"body":"shame that our trainees don't"},{"speaker":"Chris Dy","startTime":1997.59,"endTime":2001.16,"body":"get the access to care, the"},{"speaker":"Chris Dy","startTime":1997.59,"endTime":2001.16,"body":"rheumatoid hand and wrist. And"},{"speaker":"Chris Dy","startTime":2001.16,"endTime":2004.04,"body":"then with regards to tenant"},{"speaker":"Chris Dy","startTime":2001.16,"endTime":2004.04,"body":"transfers, I completely agree I"},{"speaker":"Chris Dy","startTime":2004.04,"endTime":2007.58,"body":"actually tried to get the"},{"speaker":"Chris Dy","startTime":2004.04,"endTime":2007.58,"body":"residents and fellows to to the"},{"speaker":"Chris Dy","startTime":2007.58,"endTime":2011.15,"body":"tenant transfer cases that we do"},{"speaker":"Chris Dy","startTime":2007.58,"endTime":2011.15,"body":"for nerve patients as much as we"},{"speaker":"Chris Dy","startTime":2011.15,"endTime":2013.91,"body":"can, because you need to know"},{"speaker":"Chris Dy","startTime":2011.15,"endTime":2013.91,"body":"how to do some of these basic"},{"speaker":"Chris Dy","startTime":2013.91,"endTime":2016.04,"body":"things. If you're gonna call"},{"speaker":"Chris Dy","startTime":2013.91,"endTime":2016.04,"body":"yourself a comprehensive nerve"},{"speaker":"Chris Dy","startTime":2016.04,"endTime":2018.47,"body":"surgeon, you need to know how to"},{"speaker":"Chris Dy","startTime":2016.04,"endTime":2018.47,"body":"deal with issues when they come"},{"speaker":"Chris Dy","startTime":2018.47,"endTime":2020.84,"body":"to you late or when your own"},{"speaker":"Chris Dy","startTime":2018.47,"endTime":2020.84,"body":"reconstructions for somebody"},{"speaker":"Chris Dy","startTime":2020.84,"endTime":2021.89,"body":"else's don't work."},{"speaker":"Charles Goldfarb","startTime":2022.49,"endTime":2024.62,"body":"Yeah, all well"},{"speaker":"Charles Goldfarb","startTime":2022.49,"endTime":2024.62,"body":"said Marty, and I are not"},{"speaker":"Charles Goldfarb","startTime":2024.65,"endTime":2029.21,"body":"producing any content, but I"},{"speaker":"Charles Goldfarb","startTime":2024.65,"endTime":2029.21,"body":"think you are got enough content"},{"speaker":"Charles Goldfarb","startTime":2029.21,"endTime":2033.02,"body":"to produce what what we talked"},{"speaker":"Charles Goldfarb","startTime":2029.21,"endTime":2033.02,"body":"about is in a practice like"},{"speaker":"Charles Goldfarb","startTime":2033.02,"endTime":2037.34,"body":"ours, there clearly is already"},{"speaker":"Charles Goldfarb","startTime":2033.02,"endTime":2037.34,"body":"some specialization. And, you"},{"speaker":"Charles Goldfarb","startTime":2037.34,"endTime":2040.37,"body":"know, do we all need to know how"},{"speaker":"Charles Goldfarb","startTime":2037.34,"endTime":2040.37,"body":"to reconstruct the rheumatoid"},{"speaker":"Charles Goldfarb","startTime":2040.37,"endTime":2045.59,"body":"hand? And the answer that"},{"speaker":"Charles Goldfarb","startTime":2040.37,"endTime":2045.59,"body":"clearly is we do not. But the"},{"speaker":"Charles Goldfarb","startTime":2045.59,"endTime":2049.37,"body":"concepts and the kind of"},{"speaker":"Charles Goldfarb","startTime":2045.59,"endTime":2049.37,"body":"approach is absolutely something"},{"speaker":"Charles Goldfarb","startTime":2049.37,"endTime":2053.66,"body":"we have to still teach. But it's"},{"speaker":"Charles Goldfarb","startTime":2049.37,"endTime":2053.66,"body":"interesting, because, you know,"},{"speaker":"Charles Goldfarb","startTime":2053.69,"endTime":2057.38,"body":"I've thought about this a lot."},{"speaker":"Charles Goldfarb","startTime":2053.69,"endTime":2057.38,"body":"As we get into practice, you do"},{"speaker":"Charles Goldfarb","startTime":2057.38,"endTime":2059.93,"body":"not want to narrow your practice"},{"speaker":"Charles Goldfarb","startTime":2057.38,"endTime":2059.93,"body":"too early. And you and I talked"},{"speaker":"Charles Goldfarb","startTime":2059.93,"endTime":2061.94,"body":"about that. You want to keep"},{"speaker":"Charles Goldfarb","startTime":2059.93,"endTime":2061.94,"body":"your practice as broad as"},{"speaker":"Charles Goldfarb","startTime":2061.94,"endTime":2064.58,"body":"possible for as long as"},{"speaker":"Charles Goldfarb","startTime":2061.94,"endTime":2064.58,"body":"possible. And then you want to"},{"speaker":"Charles Goldfarb","startTime":2064.58,"endTime":2066.8,"body":"narrow to stuff that you are"},{"speaker":"Charles Goldfarb","startTime":2064.58,"endTime":2066.8,"body":"passionate about, because once"},{"speaker":"Charles Goldfarb","startTime":2066.8,"endTime":2070.73,"body":"you narrow your practice, you"},{"speaker":"Charles Goldfarb","startTime":2066.8,"endTime":2070.73,"body":"can't go back out. But things"},{"speaker":"Charles Goldfarb","startTime":2070.73,"endTime":2073.55,"body":"like this super specialized"},{"speaker":"Charles Goldfarb","startTime":2070.73,"endTime":2073.55,"body":"things like the rheumatoid hand"},{"speaker":"Charles Goldfarb","startTime":2073.55,"endTime":2076.1,"body":"or, you know, Marty, I trade"},{"speaker":"Charles Goldfarb","startTime":2073.55,"endTime":2076.1,"body":"back and forth. I do wrist"},{"speaker":"Charles Goldfarb","startTime":2076.1,"endTime":2079.64,"body":"arthroscopy. He does joint"},{"speaker":"Charles Goldfarb","startTime":2076.1,"endTime":2079.64,"body":"arthroplasties. But we're older."},{"speaker":"Charles Goldfarb","startTime":2079.97,"endTime":2082.37,"body":"So I understand where our"},{"speaker":"Charles Goldfarb","startTime":2079.97,"endTime":2082.37,"body":"younger partners don't want to"},{"speaker":"Charles Goldfarb","startTime":2082.37,"endTime":2084.41,"body":"give up something like the"},{"speaker":"Charles Goldfarb","startTime":2082.37,"endTime":2084.41,"body":"rheumatoid and they want to be a"},{"speaker":"Charles Goldfarb","startTime":2084.41,"endTime":2086.39,"body":"part of the reconstruction. So I"},{"speaker":"Charles Goldfarb","startTime":2084.41,"endTime":2086.39,"body":"think we have the best of both"},{"speaker":"Charles Goldfarb","startTime":2086.39,"endTime":2089.33,"body":"worlds. He's not sending the"},{"speaker":"Charles Goldfarb","startTime":2086.39,"endTime":2089.33,"body":"patient to Marty. He's doing the"},{"speaker":"Charles Goldfarb","startTime":2089.33,"endTime":2089.99,"body":"case of morning."},{"speaker":"Chris Dy","startTime":2091.07,"endTime":2093.35,"body":"Yeah, agree entirely."},{"speaker":"Chris Dy","startTime":2091.07,"endTime":2093.35,"body":"And you know, honestly, I've"},{"speaker":"Chris Dy","startTime":2093.35,"endTime":2096.11,"body":"been, I've been on both sides of"},{"speaker":"Chris Dy","startTime":2093.35,"endTime":2096.11,"body":"that in terms of sending the"},{"speaker":"Chris Dy","startTime":2096.11,"endTime":2099.02,"body":"case versus doing it because"},{"speaker":"Chris Dy","startTime":2096.11,"endTime":2099.02,"body":"sometimes it is really hard to"},{"speaker":"Chris Dy","startTime":2099.02,"endTime":2101.51,"body":"just coordinate schedule. And,"},{"speaker":"Chris Dy","startTime":2099.02,"endTime":2101.51,"body":"you know, not delayed the"},{"speaker":"Chris Dy","startTime":2101.51,"endTime":2104.66,"body":"patient's care for many months"},{"speaker":"Chris Dy","startTime":2101.51,"endTime":2104.66,"body":"just to, so you can have that"},{"speaker":"Chris Dy","startTime":2104.66,"endTime":2107.75,"body":"experience. So I'm torn on that."},{"speaker":"Chris Dy","startTime":2104.66,"endTime":2107.75,"body":"And, you know, I feel like"},{"speaker":"Chris Dy","startTime":2107.75,"endTime":2110.12,"body":"that's something where I wish I"},{"speaker":"Chris Dy","startTime":2107.75,"endTime":2110.12,"body":"had more experience with"},{"speaker":"Chris Dy","startTime":2110.12,"endTime":2113.06,"body":"rheumatoid hand and wrist with"},{"speaker":"Chris Dy","startTime":2110.12,"endTime":2113.06,"body":"with arthroplasties. I'm"},{"speaker":"Chris Dy","startTime":2113.42,"endTime":2116.09,"body":"fortunate enough to have"},{"speaker":"Chris Dy","startTime":2113.42,"endTime":2116.09,"body":"partners, a partner who is"},{"speaker":"Chris Dy","startTime":2116.12,"endTime":2120.38,"body":"excels at it. So yeah, I think"},{"speaker":"Chris Dy","startTime":2116.12,"endTime":2120.38,"body":"that's it, it's certainly a"},{"speaker":"Chris Dy","startTime":2120.38,"endTime":2122.9,"body":"different ballgame. Once you"},{"speaker":"Chris Dy","startTime":2120.38,"endTime":2122.9,"body":"step outside of the academic"},{"speaker":"Chris Dy","startTime":2122.9,"endTime":2126.26,"body":"arena, and you're at a smaller"},{"speaker":"Chris Dy","startTime":2122.9,"endTime":2126.26,"body":"group, and or potentially solo"},{"speaker":"Chris Dy","startTime":2126.26,"endTime":2130.04,"body":"practice, I wanted to squeeze in"},{"speaker":"Chris Dy","startTime":2126.26,"endTime":2130.04,"body":"one more listener email as it"},{"speaker":"Chris Dy","startTime":2130.04,"endTime":2134.6,"body":"relates to FPL. So Bob"},{"speaker":"Chris Dy","startTime":2130.04,"endTime":2134.6,"body":"vandermark, who has listened for"},{"speaker":"Chris Dy","startTime":2134.6,"endTime":2137.57,"body":"many for a long time, and as"},{"speaker":"Chris Dy","startTime":2134.6,"endTime":2137.57,"body":"always given us permission to"},{"speaker":"Chris Dy","startTime":2137.57,"endTime":2141.83,"body":"share his thoughts. You know,"},{"speaker":"Chris Dy","startTime":2137.57,"endTime":2141.83,"body":"he's he shared that about the"},{"speaker":"Chris Dy","startTime":2141.83,"endTime":2144.8,"body":"FTL rupture, his junior partner"},{"speaker":"Chris Dy","startTime":2141.83,"endTime":2144.8,"body":"couldn't find any literature"},{"speaker":"Chris Dy","startTime":2144.8,"endTime":2148.43,"body":"about FTL reconstruction"},{"speaker":"Chris Dy","startTime":2144.8,"endTime":2148.43,"body":"techniques. So, you know, when"},{"speaker":"Chris Dy","startTime":2148.43,"endTime":2151.43,"body":"we get our article out there,"},{"speaker":"Chris Dy","startTime":2148.43,"endTime":2151.43,"body":"you know, he mentioned, Bob"},{"speaker":"Chris Dy","startTime":2151.43,"endTime":2153.89,"body":"mentioned that we might want to"},{"speaker":"Chris Dy","startTime":2151.43,"endTime":2153.89,"body":"mention wide awake as an option."},{"speaker":"Chris Dy","startTime":2154.22,"endTime":2159.05,"body":"He's done one FTS, one"},{"speaker":"Chris Dy","startTime":2154.22,"endTime":2159.05,"body":"reconstruction using FDS. And he"},{"speaker":"Chris Dy","startTime":2159.05,"endTime":2161.99,"body":"said, The Rupture was old in the"},{"speaker":"Chris Dy","startTime":2159.05,"endTime":2161.99,"body":"FPL muscle was not good. And"},{"speaker":"Chris Dy","startTime":2161.99,"endTime":2164.27,"body":"he's kind enough to send us an"},{"speaker":"Chris Dy","startTime":2161.99,"endTime":2164.27,"body":"article about just general"},{"speaker":"Chris Dy","startTime":2164.27,"endTime":2168.08,"body":"principles about using wide"},{"speaker":"Chris Dy","startTime":2164.27,"endTime":2168.08,"body":"awake to help judge your tendon"},{"speaker":"Chris Dy","startTime":2168.08,"endTime":2173.27,"body":"transfers. So it's a great way"},{"speaker":"Chris Dy","startTime":2168.08,"endTime":2173.27,"body":"to to set your 10 intention. And"},{"speaker":"Chris Dy","startTime":2173.27,"endTime":2175.43,"body":"then the other advantage that"},{"speaker":"Chris Dy","startTime":2173.27,"endTime":2175.43,"body":"Bob states about wide awake is"},{"speaker":"Chris Dy","startTime":2175.43,"endTime":2177.65,"body":"that the patient can see what"},{"speaker":"Chris Dy","startTime":2175.43,"endTime":2177.65,"body":"the reconstruction looks like"},{"speaker":"Chris Dy","startTime":2177.68,"endTime":2180.2,"body":"said my patient was a farmer and"},{"speaker":"Chris Dy","startTime":2177.68,"endTime":2180.2,"body":"remarked that the repair looked"},{"speaker":"Chris Dy","startTime":2180.23,"endTime":2183.29,"body":"pretty weak. And he would have"},{"speaker":"Chris Dy","startTime":2180.23,"endTime":2183.29,"body":"to be careful not to screw it up"},{"speaker":"Chris Dy","startTime":2183.38,"endTime":2186.44,"body":"a great example of patient"},{"speaker":"Chris Dy","startTime":2183.38,"endTime":2186.44,"body":"education. So what do you think"},{"speaker":"Chris Dy","startTime":2186.44,"endTime":2186.98,"body":"about that?"},{"speaker":"Charles Goldfarb","startTime":2187.33,"endTime":2190.75,"body":"Well, I think"},{"speaker":"Charles Goldfarb","startTime":2187.33,"endTime":2190.75,"body":"it actually feeds into what we"},{"speaker":"Charles Goldfarb","startTime":2190.75,"endTime":2195.34,"body":"just said. So if you can do this"},{"speaker":"Charles Goldfarb","startTime":2190.75,"endTime":2195.34,"body":"procedure wide awake, it does"},{"speaker":"Charles Goldfarb","startTime":2195.34,"endTime":2199.09,"body":"negate to some degree and"},{"speaker":"Charles Goldfarb","startTime":2195.34,"endTime":2199.09,"body":"experience issue, because you"},{"speaker":"Charles Goldfarb","startTime":2199.09,"endTime":2202.75,"body":"can judge your tension with the"},{"speaker":"Charles Goldfarb","startTime":2199.09,"endTime":2202.75,"body":"patient helping you with active"},{"speaker":"Charles Goldfarb","startTime":2202.75,"endTime":2206.8,"body":"motion. Without that you have to"},{"speaker":"Charles Goldfarb","startTime":2202.75,"endTime":2206.8,"body":"depend on experience and reading"},{"speaker":"Charles Goldfarb","startTime":2206.8,"endTime":2209.47,"body":"to know exactly how to tension"},{"speaker":"Charles Goldfarb","startTime":2206.8,"endTime":2209.47,"body":"each of these tendon transfers."},{"speaker":"Charles Goldfarb","startTime":2209.65,"endTime":2212.89,"body":"And so the wide awake surgery"},{"speaker":"Charles Goldfarb","startTime":2209.65,"endTime":2212.89,"body":"may be part of the answer to the"},{"speaker":"Charles Goldfarb","startTime":2212.89,"endTime":2217.21,"body":"lack of experience with these"},{"speaker":"Charles Goldfarb","startTime":2212.89,"endTime":2217.21,"body":"cases. I don't know that I'm up"},{"speaker":"Charles Goldfarb","startTime":2217.21,"endTime":2220.81,"body":"for a lot of wide awake, big"},{"speaker":"Charles Goldfarb","startTime":2217.21,"endTime":2220.81,"body":"tendon transfers, but I applaud"},{"speaker":"Charles Goldfarb","startTime":2220.81,"endTime":2221.65,"body":"those who are,"},{"speaker":"Chris Dy","startTime":2222.46,"endTime":2225.16,"body":"I've done, I've done"},{"speaker":"Chris Dy","startTime":2222.46,"endTime":2225.16,"body":"some and, you know, I think that"},{"speaker":"Chris Dy","startTime":2225.19,"endTime":2229.15,"body":"it is way more work on your end"},{"speaker":"Chris Dy","startTime":2225.19,"endTime":2229.15,"body":"that way more is more work. Just"},{"speaker":"Chris Dy","startTime":2229.15,"endTime":2232.54,"body":"because you've got to, for lack"},{"speaker":"Chris Dy","startTime":2229.15,"endTime":2232.54,"body":"of a better term, entertain the"},{"speaker":"Chris Dy","startTime":2232.54,"endTime":2236.23,"body":"patient, and engage them and"},{"speaker":"Chris Dy","startTime":2232.54,"endTime":2236.23,"body":"calm them when, you know,"},{"speaker":"Chris Dy","startTime":2236.23,"endTime":2239.41,"body":"sometimes the local needs to be"},{"speaker":"Chris Dy","startTime":2236.23,"endTime":2239.41,"body":"kind of added back and that kind"},{"speaker":"Chris Dy","startTime":2239.41,"endTime":2242.83,"body":"of thing. So it's more effort"},{"speaker":"Chris Dy","startTime":2239.41,"endTime":2242.83,"body":"and what is can already be a"},{"speaker":"Chris Dy","startTime":2242.83,"endTime":2245.2,"body":"challenging case, especially if"},{"speaker":"Chris Dy","startTime":2242.83,"endTime":2245.2,"body":"you've got trainees with you who"},{"speaker":"Chris Dy","startTime":2245.2,"endTime":2249.04,"body":"you want to engage in have"},{"speaker":"Chris Dy","startTime":2245.2,"endTime":2249.04,"body":"participated in the case. So but"},{"speaker":"Chris Dy","startTime":2249.04,"endTime":2251.98,"body":"I do think, you know, the, the"},{"speaker":"Chris Dy","startTime":2249.04,"endTime":2251.98,"body":"tensioning that I've established"},{"speaker":"Chris Dy","startTime":2251.98,"endTime":2254.92,"body":"with doing some right away"},{"speaker":"Chris Dy","startTime":2251.98,"endTime":2254.92,"body":"tenant tracers I've been really"},{"speaker":"Chris Dy","startTime":2254.92,"endTime":2257.83,"body":"happy with. So yeah, I kind of"},{"speaker":"Chris Dy","startTime":2254.92,"endTime":2257.83,"body":"go back and forth. And he always"},{"speaker":"Chris Dy","startTime":2257.83,"endTime":2259.99,"body":"kind of wait for the right"},{"speaker":"Chris Dy","startTime":2257.83,"endTime":2259.99,"body":"patient because you know, the"},{"speaker":"Chris Dy","startTime":2260.02,"endTime":2261.76,"body":"the patient's condition and"},{"speaker":"Chris Dy","startTime":2260.02,"endTime":2261.76,"body":"you're playing surgical"},{"speaker":"Chris Dy","startTime":2261.76,"endTime":2264.19,"body":"treatment may be right, but the"},{"speaker":"Chris Dy","startTime":2261.76,"endTime":2264.19,"body":"patient themselves may not be"},{"speaker":"Chris Dy","startTime":2264.19,"endTime":2264.76,"body":"right for Well, I"},{"speaker":"Charles Goldfarb","startTime":2264.76,"endTime":2268.36,"body":"don't exactly"},{"speaker":"Charles Goldfarb","startTime":2264.76,"endTime":2268.36,"body":"well said, Well, we kind of went"},{"speaker":"Charles Goldfarb","startTime":2268.36,"endTime":2271.42,"body":"all over the place, even though"},{"speaker":"Charles Goldfarb","startTime":2268.36,"endTime":2271.42,"body":"we only had two cases. I think"},{"speaker":"Charles Goldfarb","startTime":2271.42,"endTime":2273.79,"body":"we approached it from a lot of"},{"speaker":"Charles Goldfarb","startTime":2271.42,"endTime":2273.79,"body":"different angles. I hope it was"},{"speaker":"Charles Goldfarb","startTime":2273.79,"endTime":2275.95,"body":"comprehensible. And hopefully we"},{"speaker":"Charles Goldfarb","startTime":2273.79,"endTime":2275.95,"body":"can share those x rays."},{"speaker":"Chris Dy","startTime":2276.29,"endTime":2278.33,"body":"Yeah, absolutely. So"},{"speaker":"Chris Dy","startTime":2276.29,"endTime":2278.33,"body":"thank everybody for listening."},{"speaker":"Chris Dy","startTime":2278.33,"endTime":2280.64,"body":"If you'd like to grab bag stuff,"},{"speaker":"Chris Dy","startTime":2278.33,"endTime":2280.64,"body":"or you have a suggestion for a"},{"speaker":"Chris Dy","startTime":2280.64,"endTime":2284.66,"body":"topic, feel free to email us at"},{"speaker":"Chris Dy","startTime":2280.64,"endTime":2284.66,"body":"handpodcast@gmail.com. And we"},{"speaker":"Chris Dy","startTime":2284.66,"endTime":2286.37,"body":"look forward to talking with you"},{"speaker":"Chris Dy","startTime":2284.66,"endTime":2286.37,"body":"again soon."},{"speaker":"Charles Goldfarb","startTime":2286.61,"endTime":2288.83,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":2286.61,"endTime":2288.83,"body":"we do have a couple of we've"},{"speaker":"Charles Goldfarb","startTime":2288.83,"endTime":2291.32,"body":"talked about some topics which I"},{"speaker":"Charles Goldfarb","startTime":2288.83,"endTime":2291.32,"body":"am really excited about one we"},{"speaker":"Charles Goldfarb","startTime":2291.32,"endTime":2294.08,"body":"may have a guest on to talk"},{"speaker":"Charles Goldfarb","startTime":2291.32,"endTime":2294.08,"body":"about distal radius Malunions"},{"speaker":"Charles Goldfarb","startTime":2294.29,"endTime":2297.95,"body":"and approaches in 2023. And two,"},{"speaker":"Charles Goldfarb","startTime":2294.29,"endTime":2297.95,"body":"we want to we need to hit that"},{"speaker":"Charles Goldfarb","startTime":2297.95,"endTime":2301.7,"body":"therapy episode. We have some"},{"speaker":"Charles Goldfarb","startTime":2297.95,"endTime":2301.7,"body":"real real opportunity there"},{"speaker":"Charles Goldfarb","startTime":2301.7,"endTime":2302.84,"body":"because we It's been too long."},{"speaker":"Chris Dy","startTime":2303.29,"endTime":2306.53,"body":"Macy's back from there"},{"speaker":"Chris Dy","startTime":2303.29,"endTime":2306.53,"body":"from from her parental leave"},{"speaker":"Chris Dy","startTime":2306.53,"endTime":2309.92,"body":"this week. Oh, good timing."},{"speaker":"Chris Dy","startTime":2306.53,"endTime":2309.92,"body":"Good. Time to be chomping at the"},{"speaker":"Chris Dy","startTime":2309.92,"endTime":2312.92,"body":"bit for sure. Have a good one."},{"speaker":"Chris Dy","startTime":2309.92,"endTime":2312.92,"body":"All right. See ya."},{"speaker":"Charles Goldfarb","startTime":2313.88,"endTime":2315.86,"body":"Hey, Chris."},{"speaker":"Charles Goldfarb","startTime":2313.88,"endTime":2315.86,"body":"That was fun. Let's do it again"},{"speaker":"Charles Goldfarb","startTime":2315.86,"endTime":2316.37,"body":"real soon."},{"speaker":"Chris Dy","startTime":2316.64,"endTime":2319.16,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":2316.64,"endTime":2319.16,"body":"sure to check us out on Twitter"},{"speaker":"Chris Dy","startTime":2319.31,"endTime":2321.59,"body":"@handpodcast. Hey, Chuck, what's"},{"speaker":"Chris Dy","startTime":2319.31,"endTime":2321.59,"body":"your Twitter handle?"},{"speaker":"Charles Goldfarb","startTime":2321.92,"endTime":2324.89,"body":"Mine is"},{"speaker":"Charles Goldfarb","startTime":2321.92,"endTime":2324.89,"body":"@congenitalhand. What about you?"},{"speaker":"Chris Dy","startTime":2324.0,"endTime":2324.72,"body":"Mine is @ChrisDYMD"},{"speaker":"Chris Dy","startTime":2324.0,"endTime":2324.72,"body":"spelled d-y. And if you'd like"},{"speaker":"Chris Dy","startTime":2324.72,"endTime":2327.66,"body":"to email us, you can reach us at"},{"speaker":"Chris Dy","startTime":2324.72,"endTime":2327.66,"body":"handpodcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":2327.75,"endTime":2334.86,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":2327.75,"endTime":2334.86,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2334.86,"endTime":2335.94,"body":"get your podcast"},{"speaker":"Chris Dy","startTime":2336.0,"endTime":2338.22,"body":"and be sure to leave a"},{"speaker":"Chris Dy","startTime":2336.0,"endTime":2338.22,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2338.22,"endTime":2338.61,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":2339.0,"endTime":2341.28,"body":"Special thanks"},{"speaker":"Charles Goldfarb","startTime":2339.0,"endTime":2341.28,"body":"to Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":2341.28,"endTime":2345.27,"body":"music. And remember, keep the"},{"speaker":"Charles Goldfarb","startTime":2341.28,"endTime":2345.27,"body":"upper hand. Come back next time"}]}