{"version":"1.0.0","segments":[{"speaker":"Charles Goldfarb","startTime":5.25,"endTime":7.44,"body":"Welcome to the"},{"speaker":"Charles Goldfarb","startTime":5.25,"endTime":7.44,"body":"upper hand podcast where Chuck"},{"speaker":"Charles Goldfarb","startTime":7.47,"endTime":8.85,"body":"and Chris talk hand surgery."},{"speaker":"Chris Dy","startTime":9.51,"endTime":11.43,"body":"We are two hand"},{"speaker":"Chris Dy","startTime":9.51,"endTime":11.43,"body":"surgeons at Washington"},{"speaker":"Chris Dy","startTime":11.43,"endTime":14.37,"body":"University in St. Louis here to"},{"speaker":"Chris Dy","startTime":11.43,"endTime":14.37,"body":"talk about all things hand"},{"speaker":"Chris Dy","startTime":14.37,"endTime":16.59,"body":"surgery related from technical"},{"speaker":"Chris Dy","startTime":14.37,"endTime":16.59,"body":"to personal."},{"speaker":"Charles Goldfarb","startTime":17.13,"endTime":19.02,"body":"Please"},{"speaker":"Charles Goldfarb","startTime":17.13,"endTime":19.02,"body":"subscribe, wherever you get your"},{"speaker":"Charles Goldfarb","startTime":19.02,"endTime":19.8,"body":"podcasts"},{"speaker":"Chris Dy","startTime":20.31,"endTime":22.8,"body":"in thank you in"},{"speaker":"Chris Dy","startTime":20.31,"endTime":22.8,"body":"advance for leaving a review and"},{"speaker":"Chris Dy","startTime":22.8,"endTime":25.98,"body":"rating that helps us get the"},{"speaker":"Chris Dy","startTime":22.8,"endTime":25.98,"body":"word out. You can email us at"},{"speaker":"Chris Dy","startTime":26.01,"endTime":30.39,"body":"Han podcast@gmail.com. So let's"},{"speaker":"Chris Dy","startTime":26.01,"endTime":30.39,"body":"get to the episode. Oh, hey,"},{"speaker":"Chris Dy","startTime":30.39,"endTime":32.25,"body":"Chris. Hey, Chuck, how are you?"},{"speaker":"Charles Goldfarb","startTime":32.58,"endTime":35.4,"body":"I'm really"},{"speaker":"Charles Goldfarb","startTime":32.58,"endTime":35.4,"body":"good. We're, we're here together"},{"speaker":"Charles Goldfarb","startTime":35.4,"endTime":37.95,"body":"early on Friday morning getting"},{"speaker":"Charles Goldfarb","startTime":35.4,"endTime":37.95,"body":"ready to go to the or"},{"speaker":"Chris Dy","startTime":38.1,"endTime":42.03,"body":"nothing. Nothing like"},{"speaker":"Chris Dy","startTime":38.1,"endTime":42.03,"body":"a little podcast before a big OR"},{"speaker":"Chris Dy","startTime":42.03,"endTime":42.33,"body":"day?"},{"speaker":"Charles Goldfarb","startTime":42.84,"endTime":44.82,"body":"Absolutely. Do"},{"speaker":"Charles Goldfarb","startTime":42.84,"endTime":44.82,"body":"you have a big one? Hey, you"},{"speaker":"Chris Dy","startTime":44.82,"endTime":47.37,"body":"know, I can't say but"},{"speaker":"Chris Dy","startTime":44.82,"endTime":47.37,"body":"it's, you know, it's not a small"},{"speaker":"Chris Dy","startTime":47.37,"endTime":48.66,"body":"case. Put it that way."},{"speaker":"Charles Goldfarb","startTime":49.26,"endTime":50.76,"body":"Excellent."},{"speaker":"Charles Goldfarb","startTime":49.26,"endTime":50.76,"body":"Well, hope you make our"},{"speaker":"Charles Goldfarb","startTime":50.76,"endTime":52.98,"body":"fellowship recruitment dinner"},{"speaker":"Charles Goldfarb","startTime":50.76,"endTime":52.98,"body":"tonight."},{"speaker":"Chris Dy","startTime":53.16,"endTime":56.04,"body":"Oh, no, I will. We"},{"speaker":"Chris Dy","startTime":53.16,"endTime":56.04,"body":"didn't put a we intentionally"},{"speaker":"Chris Dy","startTime":56.04,"endTime":59.46,"body":"did not put a free function in"},{"speaker":"Chris Dy","startTime":56.04,"endTime":59.46,"body":"gracilis today. For that reason?"},{"speaker":"Charles Goldfarb","startTime":60.84,"endTime":63.0,"body":"Excellent. I"},{"speaker":"Charles Goldfarb","startTime":60.84,"endTime":63.0,"body":"have little finger fractures to"},{"speaker":"Charles Goldfarb","startTime":63.0,"endTime":65.13,"body":"stamp out. So I think I'll be"},{"speaker":"Charles Goldfarb","startTime":63.0,"endTime":65.13,"body":"fine."},{"speaker":"Chris Dy","startTime":65.489,"endTime":67.799,"body":"Good, good. Well, you"},{"speaker":"Chris Dy","startTime":65.489,"endTime":67.799,"body":"can hold down the fort, but I'm"},{"speaker":"Chris Dy","startTime":67.799,"endTime":71.399,"body":"sure that we have tried our best"},{"speaker":"Chris Dy","startTime":67.799,"endTime":71.399,"body":"to make sure that we are set up"},{"speaker":"Chris Dy","startTime":71.399,"endTime":73.679,"body":"for success. Yes, it's"},{"speaker":"Chris Dy","startTime":71.399,"endTime":73.679,"body":"fellowship recruitment weekend,"},{"speaker":"Chris Dy","startTime":73.679,"endTime":74.999,"body":"so we're really excited about"},{"speaker":"Chris Dy","startTime":73.679,"endTime":74.999,"body":"it."},{"speaker":"Charles Goldfarb","startTime":75.6,"endTime":77.55,"body":"Absolutely. We"},{"speaker":"Charles Goldfarb","startTime":75.6,"endTime":77.55,"body":"have a great day of interviews"},{"speaker":"Charles Goldfarb","startTime":77.55,"endTime":80.25,"body":"scheduled a great dinner tonight"},{"speaker":"Charles Goldfarb","startTime":77.55,"endTime":80.25,"body":"as mentioned. Yeah. Should be"},{"speaker":"Charles Goldfarb","startTime":80.25,"endTime":81.0,"body":"fantastic."},{"speaker":"Chris Dy","startTime":81.15,"endTime":83.4,"body":"Yeah, by the time this"},{"speaker":"Chris Dy","startTime":81.15,"endTime":83.4,"body":"episode drops, everybody will"},{"speaker":"Chris Dy","startTime":83.4,"endTime":87.24,"body":"have already come and gone from"},{"speaker":"Chris Dy","startTime":83.4,"endTime":87.24,"body":"St. Louis. I'm hoping that in"},{"speaker":"Chris Dy","startTime":87.24,"endTime":89.7,"body":"the traditional washy fashion,"},{"speaker":"Chris Dy","startTime":87.24,"endTime":89.7,"body":"it goes off in the way that we"},{"speaker":"Chris Dy","startTime":89.7,"endTime":90.42,"body":"expect it to."},{"speaker":"Charles Goldfarb","startTime":91.05,"endTime":94.05,"body":"Absolutely the"},{"speaker":"Charles Goldfarb","startTime":91.05,"endTime":94.05,"body":"the weather is cooperating. It"},{"speaker":"Charles Goldfarb","startTime":94.05,"endTime":98.61,"body":"is unbelievably unseasonably"},{"speaker":"Charles Goldfarb","startTime":94.05,"endTime":98.61,"body":"warm, which will take every day."},{"speaker":"Chris Dy","startTime":98.88,"endTime":102.12,"body":"This is this is pretty"},{"speaker":"Chris Dy","startTime":98.88,"endTime":102.12,"body":"standard February in St. Louis,"},{"speaker":"Chris Dy","startTime":102.12,"endTime":105.69,"body":"for anybody, you know,"},{"speaker":"Chris Dy","startTime":102.12,"endTime":105.69,"body":"listening. I hope when you're"},{"speaker":"Chris Dy","startTime":105.69,"endTime":108.45,"body":"listening, this is a pre Super"},{"speaker":"Chris Dy","startTime":105.69,"endTime":108.45,"body":"Bowl or right after the Super"},{"speaker":"Chris Dy","startTime":108.45,"endTime":110.73,"body":"Bowl. I guess this is going to"},{"speaker":"Chris Dy","startTime":108.45,"endTime":110.73,"body":"drop on Sunday. So it's gonna be"},{"speaker":"Chris Dy","startTime":110.73,"endTime":113.16,"body":"a beautiful fun weekend."},{"speaker":"Chris Dy","startTime":110.73,"endTime":113.16,"body":"Absolutely."},{"speaker":"Charles Goldfarb","startTime":113.16,"endTime":116.67,"body":"So any, any"},{"speaker":"Charles Goldfarb","startTime":113.16,"endTime":116.67,"body":"reader or I should say listeners"},{"speaker":"Charles Goldfarb","startTime":116.67,"endTime":117.84,"body":"submitted questions."},{"speaker":"Chris Dy","startTime":118.05,"endTime":120.33,"body":"Yeah, we have a great"},{"speaker":"Chris Dy","startTime":118.05,"endTime":120.33,"body":"question to kick off, kick off"},{"speaker":"Chris Dy","startTime":120.33,"endTime":125.43,"body":"the episode. This is from Chris"},{"speaker":"Chris Dy","startTime":120.33,"endTime":125.43,"body":"Gayton. Dr. Gayton is from"},{"speaker":"Chris Dy","startTime":125.97,"endTime":129.15,"body":"Myrtle Beach, South Carolina. He"},{"speaker":"Chris Dy","startTime":125.97,"endTime":129.15,"body":"says that he's actually listened"},{"speaker":"Chris Dy","startTime":129.15,"endTime":132.96,"body":"to every episode. So thank you,"},{"speaker":"Chris Dy","startTime":129.15,"endTime":132.96,"body":"Chris. We're listening to every"},{"speaker":"Chris Dy","startTime":132.96,"endTime":136.17,"body":"episode. And hopefully you're"},{"speaker":"Chris Dy","startTime":132.96,"endTime":136.17,"body":"not tired of us yet. But"},{"speaker":"Chris Dy","startTime":136.92,"endTime":141.69,"body":"question is, how do you position"},{"speaker":"Chris Dy","startTime":136.92,"endTime":141.69,"body":"for Middleton oasis? This is"},{"speaker":"Chris Dy","startTime":142.74,"endTime":145.44,"body":"sometimes a not a favorite"},{"speaker":"Chris Dy","startTime":142.74,"endTime":145.44,"body":"surgery for some because you're"},{"speaker":"Chris Dy","startTime":145.44,"endTime":147.36,"body":"uncomfortable against a"},{"speaker":"Chris Dy","startTime":145.44,"endTime":147.36,"body":"stretcher and trying to see"},{"speaker":"Chris Dy","startTime":147.36,"endTime":151.11,"body":"under the elbow, especially when"},{"speaker":"Chris Dy","startTime":147.36,"endTime":151.11,"body":"the shoulder doesn't rotate. So"},{"speaker":"Chris Dy","startTime":151.11,"endTime":152.49,"body":"Chuck, what are your thoughts on"},{"speaker":"Chris Dy","startTime":151.11,"endTime":152.49,"body":"this?"},{"speaker":"Charles Goldfarb","startTime":153.03,"endTime":154.59,"body":"Yeah,"},{"speaker":"Charles Goldfarb","startTime":153.03,"endTime":154.59,"body":"unfortunately, as I mentioned,"},{"speaker":"Charles Goldfarb","startTime":154.59,"endTime":157.26,"body":"I've had a fair number of these"},{"speaker":"Charles Goldfarb","startTime":154.59,"endTime":157.26,"body":"procedures lately. And I think"},{"speaker":"Charles Goldfarb","startTime":157.26,"endTime":162.54,"body":"of you always, as I embark upon"},{"speaker":"Charles Goldfarb","startTime":157.26,"endTime":162.54,"body":"them, I you know, you there are"},{"speaker":"Charles Goldfarb","startTime":162.54,"endTime":165.6,"body":"certainly those patients who"},{"speaker":"Charles Goldfarb","startTime":162.54,"endTime":165.6,"body":"lack external rotation. And that"},{"speaker":"Charles Goldfarb","startTime":165.6,"endTime":169.11,"body":"makes it really tricky."},{"speaker":"Charles Goldfarb","startTime":165.6,"endTime":169.11,"body":"Thankfully, many of my patients"},{"speaker":"Charles Goldfarb","startTime":169.11,"endTime":172.83,"body":"are younger, and that is less"},{"speaker":"Charles Goldfarb","startTime":169.11,"endTime":172.83,"body":"commonly a problem. To be very"},{"speaker":"Charles Goldfarb","startTime":172.86,"endTime":175.8,"body":"kind of straightforward, my"},{"speaker":"Charles Goldfarb","startTime":172.86,"endTime":175.8,"body":"patients are supine, I make a"},{"speaker":"Charles Goldfarb","startTime":175.8,"endTime":180.99,"body":"massive towel bump that I put"},{"speaker":"Charles Goldfarb","startTime":175.8,"endTime":180.99,"body":"under the elbow in maximum"},{"speaker":"Charles Goldfarb","startTime":181.17,"endTime":184.26,"body":"external rotation of the"},{"speaker":"Charles Goldfarb","startTime":181.17,"endTime":184.26,"body":"shoulder. And that seems to work"},{"speaker":"Charles Goldfarb","startTime":184.26,"endTime":188.46,"body":"well for me, I will occasionally"},{"speaker":"Charles Goldfarb","startTime":184.26,"endTime":188.46,"body":"do transpositions and allow the"},{"speaker":"Charles Goldfarb","startTime":188.46,"endTime":191.82,"body":"Cubitus position over an arm"},{"speaker":"Charles Goldfarb","startTime":188.46,"endTime":191.82,"body":"holder when I'm performing"},{"speaker":"Charles Goldfarb","startTime":191.82,"endTime":195.51,"body":"arthroscopy in the same patient."},{"speaker":"Charles Goldfarb","startTime":191.82,"endTime":195.51,"body":"Or if I'm doing something with"},{"speaker":"Charles Goldfarb","startTime":195.51,"endTime":199.26,"body":"electron fracture, for example,"},{"speaker":"Charles Goldfarb","startTime":195.51,"endTime":199.26,"body":"but typically supine external"},{"speaker":"Charles Goldfarb","startTime":199.26,"endTime":201.12,"body":"rotation. Big Bob, what about"},{"speaker":"Charles Goldfarb","startTime":199.26,"endTime":201.12,"body":"you,"},{"speaker":"Chris Dy","startTime":201.12,"endTime":202.98,"body":"and that's the same"},{"speaker":"Chris Dy","startTime":201.12,"endTime":202.98,"body":"positioning for a straight"},{"speaker":"Chris Dy","startTime":202.98,"endTime":205.32,"body":"inside to decompression and for"},{"speaker":"Chris Dy","startTime":202.98,"endTime":205.32,"body":"transposition."},{"speaker":"Charles Goldfarb","startTime":205.92,"endTime":208.56,"body":"Yes, every"},{"speaker":"Charles Goldfarb","startTime":205.92,"endTime":208.56,"body":"time I do an insight to I am"},{"speaker":"Charles Goldfarb","startTime":208.56,"endTime":212.46,"body":"prepared to do a transposition"},{"speaker":"Charles Goldfarb","startTime":208.56,"endTime":212.46,"body":"and as we have discussed, I do"},{"speaker":"Charles Goldfarb","startTime":212.46,"endTime":215.82,"body":"fewer and fewer insight to"},{"speaker":"Charles Goldfarb","startTime":212.46,"endTime":215.82,"body":"decompression. And again, partly"},{"speaker":"Charles Goldfarb","startTime":215.82,"endTime":219.84,"body":"because of my age, the age of my"},{"speaker":"Charles Goldfarb","startTime":215.82,"endTime":219.84,"body":"patients, as I say your age."},{"speaker":"Chris Dy","startTime":223.23,"endTime":225.36,"body":"We need any special"},{"speaker":"Chris Dy","startTime":223.23,"endTime":225.36,"body":"counsel talking about your age."},{"speaker":"Chris Dy","startTime":225.75,"endTime":230.85,"body":"So for for me, I think it it"},{"speaker":"Chris Dy","startTime":225.75,"endTime":230.85,"body":"tends to be very similar."},{"speaker":"Chris Dy","startTime":231.36,"endTime":234.3,"body":"Totally understand, I do have a"},{"speaker":"Chris Dy","startTime":231.36,"endTime":234.3,"body":"broader age range. And in my"},{"speaker":"Chris Dy","startTime":234.3,"endTime":237.99,"body":"practice, then chuck, you know,"},{"speaker":"Chris Dy","startTime":234.3,"endTime":237.99,"body":"the shoulder external rotation"},{"speaker":"Chris Dy","startTime":237.99,"endTime":240.78,"body":"thing is an issue and you know,"},{"speaker":"Chris Dy","startTime":237.99,"endTime":240.78,"body":"you could still go so far as to"},{"speaker":"Chris Dy","startTime":240.81,"endTime":243.81,"body":"you know, even check it before"},{"speaker":"Chris Dy","startTime":240.81,"endTime":243.81,"body":"surgery. I think I have, you"},{"speaker":"Chris Dy","startTime":243.81,"endTime":247.02,"body":"know, seen some folks who are"},{"speaker":"Chris Dy","startTime":243.81,"endTime":247.02,"body":"doing, you know, these in the"},{"speaker":"Chris Dy","startTime":247.02,"endTime":250.11,"body":"office, do them with patients"},{"speaker":"Chris Dy","startTime":247.02,"endTime":250.11,"body":"prone, you know, doing wide"},{"speaker":"Chris Dy","startTime":250.11,"endTime":255.0,"body":"awake inside to decompressions"},{"speaker":"Chris Dy","startTime":250.11,"endTime":255.0,"body":"not my favorite thing to do. You"},{"speaker":"Chris Dy","startTime":255.0,"endTime":257.64,"body":"know, occasionally we'll have to"},{"speaker":"Chris Dy","startTime":255.0,"endTime":257.64,"body":"do like you said a insight to"},{"speaker":"Chris Dy","startTime":257.64,"endTime":260.43,"body":"decompression or ulnar nerve"},{"speaker":"Chris Dy","startTime":257.64,"endTime":260.43,"body":"transposition session when some"},{"speaker":"Chris Dy","startTime":260.43,"endTime":262.56,"body":"physician for another procedure"},{"speaker":"Chris Dy","startTime":260.43,"endTime":262.56,"body":"like an elbow arthroplasty where"},{"speaker":"Chris Dy","startTime":262.56,"endTime":266.7,"body":"they're lateral or even prone,"},{"speaker":"Chris Dy","startTime":262.56,"endTime":266.7,"body":"and it can be a challenge. Just"},{"speaker":"Chris Dy","startTime":266.7,"endTime":269.49,"body":"because you're doing what I"},{"speaker":"Chris Dy","startTime":266.7,"endTime":269.49,"body":"think is a relatively routine"},{"speaker":"Chris Dy","startTime":269.49,"endTime":274.11,"body":"and honestly one of my favorite"},{"speaker":"Chris Dy","startTime":269.49,"endTime":274.11,"body":"surgeries upside down. And it"},{"speaker":"Chris Dy","startTime":274.11,"endTime":276.6,"body":"just, it can become a little"},{"speaker":"Chris Dy","startTime":274.11,"endTime":276.6,"body":"more challenging, but I think if"},{"speaker":"Chris Dy","startTime":276.63,"endTime":279.33,"body":"if one were to routinely run"},{"speaker":"Chris Dy","startTime":276.63,"endTime":279.33,"body":"into this, I think positioning"},{"speaker":"Chris Dy","startTime":279.33,"endTime":281.85,"body":"prone and just having the arm"},{"speaker":"Chris Dy","startTime":279.33,"endTime":281.85,"body":"kind of hanging off would be a"},{"speaker":"Chris Dy","startTime":281.85,"endTime":285.54,"body":"very reasonable thing to do. You"},{"speaker":"Chris Dy","startTime":281.85,"endTime":285.54,"body":"know, I think in terms of if"},{"speaker":"Chris Dy","startTime":285.54,"endTime":288.45,"body":"you're going to stay supine, I"},{"speaker":"Chris Dy","startTime":285.54,"endTime":288.45,"body":"don't mind being against a"},{"speaker":"Chris Dy","startTime":288.45,"endTime":291.45,"body":"stretcher. I think just shifting"},{"speaker":"Chris Dy","startTime":288.45,"endTime":291.45,"body":"them all the way over to the"},{"speaker":"Chris Dy","startTime":291.45,"endTime":293.82,"body":"side of the bed ahead of time,"},{"speaker":"Chris Dy","startTime":291.45,"endTime":293.82,"body":"which is probably not anything"},{"speaker":"Chris Dy","startTime":293.85,"endTime":297.81,"body":"novel or new. And then I prep"},{"speaker":"Chris Dy","startTime":293.85,"endTime":297.81,"body":"the same way for a transposition"},{"speaker":"Chris Dy","startTime":297.81,"endTime":302.61,"body":"that I do for a inside tube just"},{"speaker":"Chris Dy","startTime":297.81,"endTime":302.61,"body":"because you never know. You"},{"speaker":"Chris Dy","startTime":302.61,"endTime":305.76,"body":"know, I like to do a sterile"},{"speaker":"Chris Dy","startTime":302.61,"endTime":305.76,"body":"tourniquet just to not lose any,"},{"speaker":"Chris Dy","startTime":306.51,"endTime":309.3,"body":"any potential room around the"},{"speaker":"Chris Dy","startTime":306.51,"endTime":309.3,"body":"elbow, which does give you a"},{"speaker":"Chris Dy","startTime":309.3,"endTime":312.66,"body":"little more maneuverability to"},{"speaker":"Chris Dy","startTime":309.3,"endTime":312.66,"body":"put your bump in. I remember one"},{"speaker":"Chris Dy","startTime":312.66,"endTime":315.21,"body":"time in residency working with"},{"speaker":"Chris Dy","startTime":312.66,"endTime":315.21,"body":"Bob Hotchkiss and he was big on"},{"speaker":"Chris Dy","startTime":315.21,"endTime":317.49,"body":"the sterile tourniquet because"},{"speaker":"Chris Dy","startTime":315.21,"endTime":317.49,"body":"you never want to get boxed out"},{"speaker":"Chris Dy","startTime":317.52,"endTime":321.42,"body":"on your draping for an elbow,"},{"speaker":"Chris Dy","startTime":317.52,"endTime":321.42,"body":"any elbow surgery. So even for"},{"speaker":"Chris Dy","startTime":321.42,"endTime":324.03,"body":"an insight to and just for ease"},{"speaker":"Chris Dy","startTime":321.42,"endTime":324.03,"body":"of our setup and the team that"},{"speaker":"Chris Dy","startTime":324.03,"endTime":328.35,"body":"I'm working with, same way every"},{"speaker":"Chris Dy","startTime":324.03,"endTime":328.35,"body":"time sterile tourniquet and get"},{"speaker":"Chris Dy","startTime":328.38,"endTime":330.78,"body":"get the sterile drapes as high"},{"speaker":"Chris Dy","startTime":328.38,"endTime":330.78,"body":"as you can before putting on"},{"speaker":"Chris Dy","startTime":330.78,"endTime":333.42,"body":"that sterile tourniquet. And"},{"speaker":"Chris Dy","startTime":330.78,"endTime":333.42,"body":"then it is very similar a stack"},{"speaker":"Chris Dy","startTime":333.48,"endTime":336.72,"body":"an entire stack of blue towels"},{"speaker":"Chris Dy","startTime":333.48,"endTime":336.72,"body":"COVID wrapped around it that"},{"speaker":"Chris Dy","startTime":336.72,"endTime":342.66,"body":"sits under the brake Ium. And"},{"speaker":"Chris Dy","startTime":336.72,"endTime":342.66,"body":"it's, you have to position it so"},{"speaker":"Chris Dy","startTime":342.66,"endTime":347.37,"body":"much so that you can have it at"},{"speaker":"Chris Dy","startTime":342.66,"endTime":347.37,"body":"the very edge of the medial Appa"},{"speaker":"Chris Dy","startTime":347.37,"endTime":349.77,"body":"condyle. So that you can work"},{"speaker":"Chris Dy","startTime":347.37,"endTime":349.77,"body":"underneath it. If you're"},{"speaker":"Chris Dy","startTime":349.77,"endTime":352.53,"body":"watching on YouTube, I'm trying"},{"speaker":"Chris Dy","startTime":349.77,"endTime":352.53,"body":"to illustrate that but be able"},{"speaker":"Chris Dy","startTime":352.53,"endTime":354.45,"body":"to work underneath because if"},{"speaker":"Chris Dy","startTime":352.53,"endTime":354.45,"body":"the bumps shifts out here, and"},{"speaker":"Chris Dy","startTime":354.45,"endTime":357.12,"body":"then you lose the ability to"},{"speaker":"Chris Dy","startTime":354.45,"endTime":357.12,"body":"work down in that plane. So even"},{"speaker":"Chris Dy","startTime":357.12,"endTime":360.18,"body":"if they're not fully externally"},{"speaker":"Chris Dy","startTime":357.12,"endTime":360.18,"body":"rotated, you still have that"},{"speaker":"Chris Dy","startTime":360.18,"endTime":363.24,"body":"ledge. So if anything building"},{"speaker":"Chris Dy","startTime":360.18,"endTime":363.24,"body":"up that but more and then we're"},{"speaker":"Chris Dy","startTime":363.24,"endTime":366.6,"body":"if we're doing a transposition,"},{"speaker":"Chris Dy","startTime":363.24,"endTime":366.6,"body":"I typically have them have a"},{"speaker":"Chris Dy","startTime":366.6,"endTime":369.3,"body":"separate bump that can hold the"},{"speaker":"Chris Dy","startTime":366.6,"endTime":369.3,"body":"elbow in a semi flex position"},{"speaker":"Chris Dy","startTime":369.3,"endTime":372.03,"body":"just to free up somebody's"},{"speaker":"Chris Dy","startTime":369.3,"endTime":372.03,"body":"hands. And for us, that used to"},{"speaker":"Chris Dy","startTime":372.03,"endTime":374.61,"body":"be what we would call the"},{"speaker":"Chris Dy","startTime":372.03,"endTime":374.61,"body":"Johnson bump bag from Jeff"},{"speaker":"Chris Dy","startTime":374.61,"endTime":380.13,"body":"Johnson and pod four, which was"},{"speaker":"Chris Dy","startTime":374.61,"endTime":380.13,"body":"a rolled sheet that they would"},{"speaker":"Chris Dy","startTime":380.13,"endTime":382.98,"body":"then cover and sterilize, which"},{"speaker":"Chris Dy","startTime":380.13,"endTime":382.98,"body":"apparently is now illegal. So"},{"speaker":"Chris Dy","startTime":382.98,"endTime":386.37,"body":"now it ends up being either some"},{"speaker":"Chris Dy","startTime":382.98,"endTime":386.37,"body":"kind of big, bulky Jones cotton"},{"speaker":"Chris Dy","startTime":386.37,"endTime":388.98,"body":"fluff that they would use as a"},{"speaker":"Chris Dy","startTime":386.37,"endTime":388.98,"body":"dressing for somebody else. But"},{"speaker":"Chris Dy","startTime":389.01,"endTime":390.96,"body":"that's probably way too much"},{"speaker":"Chris Dy","startTime":389.01,"endTime":390.96,"body":"detail. But I guess if you're"},{"speaker":"Chris Dy","startTime":390.96,"endTime":392.76,"body":"asking this question, you want"},{"speaker":"Chris Dy","startTime":390.96,"endTime":392.76,"body":"details?"},{"speaker":"Charles Goldfarb","startTime":393.24,"endTime":396.45,"body":"Yeah, just for"},{"speaker":"Charles Goldfarb","startTime":393.24,"endTime":396.45,"body":"a difference of opinion. I"},{"speaker":"Charles Goldfarb","startTime":396.45,"endTime":401.25,"body":"absolutely. Never use a sterile"},{"speaker":"Charles Goldfarb","startTime":396.45,"endTime":401.25,"body":"tourniquet ever. I don't find"},{"speaker":"Charles Goldfarb","startTime":401.25,"endTime":404.07,"body":"the need. I've never been"},{"speaker":"Charles Goldfarb","startTime":401.25,"endTime":404.07,"body":"burned. I do a lot of elbow"},{"speaker":"Charles Goldfarb","startTime":404.07,"endTime":408.57,"body":"surgery. So different ways to"},{"speaker":"Charles Goldfarb","startTime":404.07,"endTime":408.57,"body":"approach this for certain. But I"},{"speaker":"Charles Goldfarb","startTime":408.57,"endTime":411.9,"body":"think the general principles are"},{"speaker":"Charles Goldfarb","startTime":408.57,"endTime":411.9,"body":"the same extra rotation, big"},{"speaker":"Charles Goldfarb","startTime":411.9,"endTime":414.66,"body":"bump, good exposure. And there"},{"speaker":"Charles Goldfarb","startTime":411.9,"endTime":414.66,"body":"you go."},{"speaker":"Chris Dy","startTime":415.08,"endTime":419.1,"body":"So coding question"},{"speaker":"Chris Dy","startTime":415.08,"endTime":419.1,"body":"also from from Chris, is there a"},{"speaker":"Chris Dy","startTime":419.1,"endTime":422.94,"body":"CPT that you add to the cubital"},{"speaker":"Chris Dy","startTime":419.1,"endTime":422.94,"body":"tunnel code for when you're"},{"speaker":"Chris Dy","startTime":422.94,"endTime":426.72,"body":"doing your subcutaneous adipose"},{"speaker":"Chris Dy","startTime":422.94,"endTime":426.72,"body":"fascial fat flap. And then for a"},{"speaker":"Chris Dy","startTime":426.72,"endTime":429.87,"body":"submuscular transposition, I"},{"speaker":"Chris Dy","startTime":426.72,"endTime":429.87,"body":"will preface this answer by"},{"speaker":"Chris Dy","startTime":429.87,"endTime":432.9,"body":"saying we are not here to give"},{"speaker":"Chris Dy","startTime":429.87,"endTime":432.9,"body":"coding advice. We can only tell"},{"speaker":"Chris Dy","startTime":432.9,"endTime":436.23,"body":"you what we potentially would do"},{"speaker":"Chris Dy","startTime":432.9,"endTime":436.23,"body":"here. Coding is up to the"},{"speaker":"Chris Dy","startTime":436.23,"endTime":439.35,"body":"physician and their team. And"},{"speaker":"Chris Dy","startTime":436.23,"endTime":439.35,"body":"all of the live code that comes"},{"speaker":"Chris Dy","startTime":439.35,"endTime":441.0,"body":"with it is up to you."},{"speaker":"Charles Goldfarb","startTime":441.78,"endTime":444.63,"body":"That does"},{"speaker":"Charles Goldfarb","startTime":441.78,"endTime":444.63,"body":"sound like a legally advised"},{"speaker":"Charles Goldfarb","startTime":444.63,"endTime":445.38,"body":"response, which"},{"speaker":"Chris Dy","startTime":445.38,"endTime":448.74,"body":"seems smart. I don't"},{"speaker":"Chris Dy","startTime":445.38,"endTime":448.74,"body":"give coding advice. But we're"},{"speaker":"Chris Dy","startTime":448.74,"endTime":449.91,"body":"gonna say what we do maybe."},{"speaker":"Charles Goldfarb","startTime":450.42,"endTime":453.42,"body":"Yeah, well, I"},{"speaker":"Charles Goldfarb","startTime":450.42,"endTime":453.42,"body":"would say that, you know, we use"},{"speaker":"Charles Goldfarb","startTime":453.42,"endTime":457.95,"body":"the standard 64718 For"},{"speaker":"Charles Goldfarb","startTime":453.42,"endTime":457.95,"body":"transposition or decompression"},{"speaker":"Charles Goldfarb","startTime":457.95,"endTime":461.01,"body":"and and I cynically believe"},{"speaker":"Charles Goldfarb","startTime":457.95,"endTime":461.01,"body":"that's why the compressions took"},{"speaker":"Charles Goldfarb","startTime":461.01,"endTime":465.18,"body":"off, because you're talking"},{"speaker":"Charles Goldfarb","startTime":461.01,"endTime":465.18,"body":"about a 10 minute surgery versus"},{"speaker":"Charles Goldfarb","startTime":465.18,"endTime":470.34,"body":"at least a 45 minute surgery for"},{"speaker":"Charles Goldfarb","startTime":465.18,"endTime":470.34,"body":"most. I do not add a code for"},{"speaker":"Charles Goldfarb","startTime":470.34,"endTime":476.64,"body":"the fascia cutaneous flap, I do"},{"speaker":"Charles Goldfarb","startTime":470.34,"endTime":476.64,"body":"add lengthening to 4305 for the"},{"speaker":"Charles Goldfarb","startTime":476.64,"endTime":480.45,"body":"flexor pronator mass when I do a"},{"speaker":"Charles Goldfarb","startTime":476.64,"endTime":480.45,"body":"sub muscular. So for me, it's"},{"speaker":"Charles Goldfarb","startTime":480.45,"endTime":483.36,"body":"either a singular code or for"},{"speaker":"Charles Goldfarb","startTime":480.45,"endTime":483.36,"body":"sub muscular two codes. What"},{"speaker":"Charles Goldfarb","startTime":483.36,"endTime":483.75,"body":"about you?"},{"speaker":"Chris Dy","startTime":484.86,"endTime":488.04,"body":"Same thing for a sub"},{"speaker":"Chris Dy","startTime":484.86,"endTime":488.04,"body":"muscular. For the because it is"},{"speaker":"Chris Dy","startTime":488.04,"endTime":491.22,"body":"truly a flexor progenitors, the"},{"speaker":"Chris Dy","startTime":488.04,"endTime":491.22,"body":"lengthening for subcutaneous"},{"speaker":"Chris Dy","startTime":491.22,"endTime":494.52,"body":"with the adequate fascial flap I"},{"speaker":"Chris Dy","startTime":491.22,"endTime":494.52,"body":"have been listing it. And then"},{"speaker":"Chris Dy","startTime":494.52,"endTime":497.49,"body":"actually, before Chris said this"},{"speaker":"Chris Dy","startTime":494.52,"endTime":497.49,"body":"question, I actually had asked"},{"speaker":"Chris Dy","startTime":497.49,"endTime":500.85,"body":"our billing seem to look because"},{"speaker":"Chris Dy","startTime":497.49,"endTime":500.85,"body":"I do add requests that they add"},{"speaker":"Chris Dy","startTime":500.85,"endTime":504.69,"body":"a code and I had 1574 Because"},{"speaker":"Chris Dy","startTime":500.85,"endTime":504.69,"body":"it's technically a pedicle flap"},{"speaker":"Chris Dy","startTime":505.38,"endTime":509.61,"body":"from a known vessel that Dr."},{"speaker":"Chris Dy","startTime":505.38,"endTime":509.61,"body":"Yamaguchi described for us. So"},{"speaker":"Chris Dy","startTime":510.12,"endTime":514.89,"body":"and the looking at the for us in"},{"speaker":"Chris Dy","startTime":510.12,"endTime":514.89,"body":"our experience, again, only us"},{"speaker":"Chris Dy","startTime":515.4,"endTime":519.9,"body":"it is a code that is reimbursed"},{"speaker":"Chris Dy","startTime":515.4,"endTime":519.9,"body":"at the similar rate, both in"},{"speaker":"Chris Dy","startTime":519.9,"endTime":523.17,"body":"terms of how often is actually"},{"speaker":"Chris Dy","startTime":519.9,"endTime":523.17,"body":"paid just binary yes or no. And"},{"speaker":"Chris Dy","startTime":523.17,"endTime":526.44,"body":"then the actual collection rate"},{"speaker":"Chris Dy","startTime":523.17,"endTime":526.44,"body":"is similar to when I asked the"},{"speaker":"Chris Dy","startTime":526.44,"endTime":529.77,"body":"same billing team to look up the"},{"speaker":"Chris Dy","startTime":526.44,"endTime":529.77,"body":"easy lengthening code that's put"},{"speaker":"Chris Dy","startTime":529.77,"endTime":531.24,"body":"in addition to 6471. A"},{"speaker":"Charles Goldfarb","startTime":532.26,"endTime":535.2,"body":"nice to hear"},{"speaker":"Charles Goldfarb","startTime":532.26,"endTime":535.2,"body":"great question and maybe I just"},{"speaker":"Charles Goldfarb","startTime":535.2,"endTime":536.22,"body":"learned something today."},{"speaker":"Chris Dy","startTime":536.7,"endTime":540.06,"body":"I don't think you did."},{"speaker":"Chris Dy","startTime":536.7,"endTime":540.06,"body":"But I'm very proud of myself for"},{"speaker":"Chris Dy","startTime":540.06,"endTime":543.45,"body":"doing some coding work. I never"},{"speaker":"Chris Dy","startTime":540.06,"endTime":543.45,"body":"do this stuff. But I did start"},{"speaker":"Chris Dy","startTime":543.45,"endTime":546.0,"body":"to think about it in a question"},{"speaker":"Chris Dy","startTime":543.45,"endTime":546.0,"body":"from a former fellow Andrew"},{"speaker":"Chris Dy","startTime":546.0,"endTime":549.93,"body":"Sobel, you know, proceeded when"},{"speaker":"Chris Dy","startTime":546.0,"endTime":549.93,"body":"I did that. And then this"},{"speaker":"Chris Dy","startTime":549.96,"endTime":551.97,"body":"perfect time, and Chris had the"},{"speaker":"Chris Dy","startTime":549.96,"endTime":551.97,"body":"same question. So thank you,"},{"speaker":"Chris Dy","startTime":551.97,"endTime":554.88,"body":"Chris, for the question. Really"},{"speaker":"Chris Dy","startTime":551.97,"endTime":554.88,"body":"appreciate it. Hopefully it was"},{"speaker":"Chris Dy","startTime":554.88,"endTime":557.97,"body":"helpful. You know, certainly"},{"speaker":"Chris Dy","startTime":554.88,"endTime":557.97,"body":"email us back if you have any"},{"speaker":"Chris Dy","startTime":557.97,"endTime":561.3,"body":"other follow up questions, or"},{"speaker":"Chris Dy","startTime":557.97,"endTime":561.3,"body":"anybody listening, we love"},{"speaker":"Chris Dy","startTime":561.33,"endTime":565.29,"body":"listener mailbag stuff, so Han"},{"speaker":"Chris Dy","startTime":561.33,"endTime":565.29,"body":"podcast@gmail.com. So with that,"},{"speaker":"Chris Dy","startTime":565.29,"endTime":567.63,"body":"we should thank our first"},{"speaker":"Chris Dy","startTime":565.29,"endTime":567.63,"body":"sponsor, absolutely."},{"speaker":"Charles Goldfarb","startTime":567.63,"endTime":569.22,"body":"The upper hand"},{"speaker":"Charles Goldfarb","startTime":567.63,"endTime":569.22,"body":"is sponsored by practice"},{"speaker":"Charles Goldfarb","startTime":569.22,"endTime":572.97,"body":"link.com The most widely used"},{"speaker":"Charles Goldfarb","startTime":569.22,"endTime":572.97,"body":"position job search and career"},{"speaker":"Charles Goldfarb","startTime":572.97,"endTime":574.29,"body":"advancement resource."},{"speaker":"Chris Dy","startTime":574.62,"endTime":577.29,"body":"Becoming a physician"},{"speaker":"Chris Dy","startTime":574.62,"endTime":577.29,"body":"is hard finding the right job"},{"speaker":"Chris Dy","startTime":577.29,"endTime":580.41,"body":"doesn't have to be joined"},{"speaker":"Chris Dy","startTime":577.29,"endTime":580.41,"body":"practice link for free today at"},{"speaker":"Chris Dy","startTime":580.41,"endTime":585.57,"body":"www dot practise length.com/the"},{"speaker":"Chris Dy","startTime":580.41,"endTime":585.57,"body":"upper hand. So"},{"speaker":"Charles Goldfarb","startTime":585.72,"endTime":587.37,"body":"I've done a"},{"speaker":"Charles Goldfarb","startTime":585.72,"endTime":587.37,"body":"lot of cubital tunnel surgery"},{"speaker":"Charles Goldfarb","startTime":587.37,"endTime":591.84,"body":"lately, and I've done a lot of"},{"speaker":"Charles Goldfarb","startTime":587.37,"endTime":591.84,"body":"revision skateboards lately."},{"speaker":"Charles Goldfarb","startTime":591.87,"endTime":593.22,"body":"What have you been busy doing?"},{"speaker":"Chris Dy","startTime":593.0,"endTime":596.3,"body":"A lot of distla radius"},{"speaker":"Chris Dy","startTime":593.0,"endTime":596.3,"body":"fractures as we talked about"},{"speaker":"Chris Dy","startTime":596.54,"endTime":601.97,"body":"last episode. My --- I've had a"},{"speaker":"Chris Dy","startTime":596.54,"endTime":601.97,"body":"pretty you know pretty good mix"},{"speaker":"Chris Dy","startTime":601.97,"endTime":605.66,"body":"I've actually the last few weeks"},{"speaker":"Chris Dy","startTime":601.97,"endTime":605.66,"body":"have been very happy I fit the"},{"speaker":"Chris Dy","startTime":605.72,"endTime":609.2,"body":"the hand surgery triathlon. I"},{"speaker":"Chris Dy","startTime":605.72,"endTime":609.2,"body":"don't know if you're familiar"},{"speaker":"Chris Dy","startTime":609.2,"endTime":612.89,"body":"with this concept of our fellow"},{"speaker":"Chris Dy","startTime":609.2,"endTime":612.89,"body":"Emily's all those had not heard"},{"speaker":"Chris Dy","startTime":612.89,"endTime":616.46,"body":"that term, but using the"},{"speaker":"Chris Dy","startTime":612.89,"endTime":616.46,"body":"fluoroscope the microscope and"},{"speaker":"Chris Dy","startTime":616.46,"endTime":617.78,"body":"the arthroscope in the same day"},{"speaker":"Charles Goldfarb","startTime":619.1,"endTime":621.11,"body":"that is a new"},{"speaker":"Charles Goldfarb","startTime":619.1,"endTime":621.11,"body":"one for me. And it does not"},{"speaker":"Charles Goldfarb","startTime":621.11,"endTime":623.24,"body":"sound like a good day. What do"},{"speaker":"Charles Goldfarb","startTime":621.11,"endTime":623.24,"body":"you throw in the microscope?"},{"speaker":"Charles Goldfarb","startTime":623.42,"endTime":623.72,"body":"I'll"},{"speaker":"Chris Dy","startTime":623.72,"endTime":625.94,"body":"Oh man, I love those"},{"speaker":"Chris Dy","startTime":623.72,"endTime":625.94,"body":"days. For me, that's the best"},{"speaker":"Chris Dy","startTime":626.12,"endTime":628.16,"body":"you know. And again, the"},{"speaker":"Chris Dy","startTime":626.12,"endTime":628.16,"body":"arthroscopy does not come up"},{"speaker":"Chris Dy","startTime":628.16,"endTime":632.54,"body":"that often for me, I'm, you"},{"speaker":"Chris Dy","startTime":628.16,"endTime":632.54,"body":"know, kind of general hand"},{"speaker":"Chris Dy","startTime":632.54,"endTime":634.82,"body":"surgery level arthroscopy"},{"speaker":"Chris Dy","startTime":632.54,"endTime":634.82,"body":"certainly not a master like"},{"speaker":"Chris Dy","startTime":634.82,"endTime":638.6,"body":"Chuck. But it's a nice thing to"},{"speaker":"Chris Dy","startTime":634.82,"endTime":638.6,"body":"do and nice thing to offer and I"},{"speaker":"Chris Dy","startTime":638.6,"endTime":640.7,"body":"love having that. I know that"},{"speaker":"Chris Dy","startTime":638.6,"endTime":640.7,"body":"you don't technically have a"},{"speaker":"Chris Dy","startTime":640.7,"endTime":643.73,"body":"microscope at the main facility"},{"speaker":"Chris Dy","startTime":640.7,"endTime":643.73,"body":"that you work at. So perhaps"},{"speaker":"Chris Dy","startTime":643.73,"endTime":645.74,"body":"that is limiting your"},{"speaker":"Chris Dy","startTime":643.73,"endTime":645.74,"body":"participation in the Hand"},{"speaker":"Chris Dy","startTime":645.74,"endTime":646.61,"body":"surgery triathlon."},{"speaker":"Charles Goldfarb","startTime":647.19,"endTime":649.8,"body":"It makes me"},{"speaker":"Charles Goldfarb","startTime":647.19,"endTime":649.8,"body":"laugh at myself because my"},{"speaker":"Charles Goldfarb","startTime":649.95,"endTime":653.7,"body":"children often give me grief and"},{"speaker":"Charles Goldfarb","startTime":649.95,"endTime":653.7,"body":"the old man's triathlon"},{"speaker":"Charles Goldfarb","startTime":653.7,"endTime":658.23,"body":"sometimes I participate in at"},{"speaker":"Charles Goldfarb","startTime":653.7,"endTime":658.23,"body":"home, which is rowing, biking"},{"speaker":"Charles Goldfarb","startTime":658.26,"endTime":661.44,"body":"and lifting. And so they laugh"},{"speaker":"Charles Goldfarb","startTime":658.26,"endTime":661.44,"body":"at me when I do the Old Man"},{"speaker":"Charles Goldfarb","startTime":661.44,"endTime":662.19,"body":"Triathlon."},{"speaker":"Chris Dy","startTime":662.55,"endTime":664.44,"body":"That's a pretty good"},{"speaker":"Chris Dy","startTime":662.55,"endTime":664.44,"body":"triathlon. I mean, come on, you"},{"speaker":"Chris Dy","startTime":664.44,"endTime":666.42,"body":"know, you're about to have a"},{"speaker":"Chris Dy","startTime":664.44,"endTime":666.42,"body":"partial knee replacement. You"},{"speaker":"Chris Dy","startTime":666.42,"endTime":668.16,"body":"know, I, what else can you ask"},{"speaker":"Chris Dy","startTime":666.42,"endTime":668.16,"body":"for?"},{"speaker":"Charles Goldfarb","startTime":669.39,"endTime":671.28,"body":"And you got to"},{"speaker":"Charles Goldfarb","startTime":669.39,"endTime":671.28,"body":"be able to laugh at yourself. I"},{"speaker":"Charles Goldfarb","startTime":671.28,"endTime":675.15,"body":"liked I liked the concept of the"},{"speaker":"Charles Goldfarb","startTime":671.28,"endTime":675.15,"body":"de triathlon. I like"},{"speaker":"Chris Dy","startTime":675.15,"endTime":677.52,"body":"Yeah, so it's been"},{"speaker":"Chris Dy","startTime":675.15,"endTime":677.52,"body":"it's been relatively busy,"},{"speaker":"Chris Dy","startTime":677.52,"endTime":681.09,"body":"steady. It's been good. It's a"},{"speaker":"Chris Dy","startTime":677.52,"endTime":681.09,"body":"success. I think we talked a"},{"speaker":"Chris Dy","startTime":681.09,"endTime":682.92,"body":"couple of weeks ago was getting"},{"speaker":"Chris Dy","startTime":681.09,"endTime":682.92,"body":"a little bit too much. But now"},{"speaker":"Chris Dy","startTime":682.92,"endTime":686.79,"body":"things have quieted down. Have a"},{"speaker":"Chris Dy","startTime":682.92,"endTime":686.79,"body":"nice, you know, our day to day,"},{"speaker":"Chris Dy","startTime":687.12,"endTime":690.24,"body":"nerve surgery, more relaxed,"},{"speaker":"Chris Dy","startTime":687.12,"endTime":690.24,"body":"less running around, and a"},{"speaker":"Chris Dy","startTime":690.24,"endTime":692.25,"body":"distal radius fracture to fix in"},{"speaker":"Chris Dy","startTime":690.24,"endTime":692.25,"body":"the afternoon, but"},{"speaker":"Charles Goldfarb","startTime":692.85,"endTime":695.49,"body":"yeah, I wish I"},{"speaker":"Charles Goldfarb","startTime":692.85,"endTime":695.49,"body":"could agree with the call down"},{"speaker":"Charles Goldfarb","startTime":695.49,"endTime":698.04,"body":"it has not at all, but maybe"},{"speaker":"Charles Goldfarb","startTime":695.49,"endTime":698.04,"body":"it's because I'm about to go out"},{"speaker":"Charles Goldfarb","startTime":698.04,"endTime":701.94,"body":"for a little bit of time next"},{"speaker":"Charles Goldfarb","startTime":698.04,"endTime":701.94,"body":"week with a small surgery. My"},{"speaker":"Chris Dy","startTime":702.03,"endTime":704.43,"body":"my iPhone, here you"},{"speaker":"Chris Dy","startTime":702.03,"endTime":704.43,"body":"go. Good luck to you on your"},{"speaker":"Chris Dy","startTime":704.43,"endTime":707.34,"body":"surgery, can't wait to hear you"},{"speaker":"Chris Dy","startTime":704.43,"endTime":707.34,"body":"hopped up during your recovery."},{"speaker":"Chris Dy","startTime":708.24,"endTime":710.55,"body":"My wife has advised me that and"},{"speaker":"Chris Dy","startTime":708.24,"endTime":710.55,"body":"you know, we talked about this"},{"speaker":"Chris Dy","startTime":710.58,"endTime":713.52,"body":"on prior clinic or prior"},{"speaker":"Chris Dy","startTime":710.58,"endTime":713.52,"body":"episodes, but I need to stop"},{"speaker":"Chris Dy","startTime":713.52,"endTime":716.76,"body":"scheduling the makeup clinics."},{"speaker":"Chris Dy","startTime":713.52,"endTime":716.76,"body":"Because I think that is what so"},{"speaker":"Chris Dy","startTime":716.79,"endTime":719.64,"body":"that's what's been hurting me"},{"speaker":"Chris Dy","startTime":716.79,"endTime":719.64,"body":"and I it's a very hard thing to"},{"speaker":"Chris Dy","startTime":719.67,"endTime":723.12,"body":"just let go of that. But I think"},{"speaker":"Chris Dy","startTime":719.67,"endTime":723.12,"body":"I'll follow that advice"},{"speaker":"Charles Goldfarb","startTime":723.78,"endTime":726.0,"body":"is good"},{"speaker":"Charles Goldfarb","startTime":723.78,"endTime":726.0,"body":"advice. But it's just hard. I"},{"speaker":"Charles Goldfarb","startTime":726.0,"endTime":728.76,"body":"mean, do you hate to make"},{"speaker":"Charles Goldfarb","startTime":726.0,"endTime":728.76,"body":"patients waiting or are not"},{"speaker":"Charles Goldfarb","startTime":728.76,"endTime":732.81,"body":"seeing them in a timely fashion"},{"speaker":"Charles Goldfarb","startTime":728.76,"endTime":732.81,"body":"and I had I had a very was going"},{"speaker":"Charles Goldfarb","startTime":732.81,"endTime":737.19,"body":"to be a very short afternoon"},{"speaker":"Charles Goldfarb","startTime":732.81,"endTime":737.19,"body":"clinic yesterday and it was a"},{"speaker":"Charles Goldfarb","startTime":737.19,"endTime":739.68,"body":"large number of patients and"},{"speaker":"Charles Goldfarb","startTime":737.19,"endTime":739.68,"body":"they were quite complicated and"},{"speaker":"Charles Goldfarb","startTime":739.68,"endTime":742.26,"body":"it was very frustrating. I"},{"speaker":"Charles Goldfarb","startTime":739.68,"endTime":742.26,"body":"haven't been frustrated like"},{"speaker":"Charles Goldfarb","startTime":742.26,"endTime":745.68,"body":"that in clinic in a while. But I"},{"speaker":"Charles Goldfarb","startTime":742.26,"endTime":745.68,"body":"think the key is knowing what"},{"speaker":"Charles Goldfarb","startTime":745.68,"endTime":747.96,"body":"you're gonna see and planning"},{"speaker":"Charles Goldfarb","startTime":745.68,"endTime":747.96,"body":"ahead, but it's not always easy"},{"speaker":"Charles Goldfarb","startTime":747.96,"endTime":749.76,"body":"to do. Absolutely."},{"speaker":"Chris Dy","startTime":750.27,"endTime":754.26,"body":"So before we get into"},{"speaker":"Chris Dy","startTime":750.27,"endTime":754.26,"body":"this volar scaphoid technique at"},{"speaker":"Chris Dy","startTime":754.26,"endTime":758.43,"body":"a deep dive. Why don't we thank"},{"speaker":"Chris Dy","startTime":754.26,"endTime":758.43,"body":"our other sponsor, checkpoint"},{"speaker":"Chris Dy","startTime":758.43,"endTime":760.47,"body":"surgical? Absolutely."},{"speaker":"Charles Goldfarb","startTime":760.53,"endTime":762.21,"body":"The upper hand"},{"speaker":"Charles Goldfarb","startTime":760.53,"endTime":762.21,"body":"is sponsored by checkpoint"},{"speaker":"Charles Goldfarb","startTime":762.21,"endTime":765.03,"body":"surgical eye provider of"},{"speaker":"Charles Goldfarb","startTime":762.21,"endTime":765.03,"body":"innovative solutions for"},{"speaker":"Charles Goldfarb","startTime":765.03,"endTime":766.47,"body":"peripheral nerve surgery."},{"speaker":"Chris Dy","startTime":767.5,"endTime":769.6,"body":"Checkpoints next"},{"speaker":"Chris Dy","startTime":767.5,"endTime":769.6,"body":"professional education program."},{"speaker":"Chris Dy","startTime":769.63,"endTime":772.0,"body":"Upper extremity acute nerve"},{"speaker":"Chris Dy","startTime":769.63,"endTime":772.0,"body":"injury management will include"},{"speaker":"Chris Dy","startTime":772.0,"endTime":774.61,"body":"an overview of intraoperative"},{"speaker":"Chris Dy","startTime":772.0,"endTime":774.61,"body":"ultrasound imaging to augment"},{"speaker":"Chris Dy","startTime":774.64,"endTime":776.62,"body":"nerves zone of injury"},{"speaker":"Chris Dy","startTime":774.64,"endTime":776.62,"body":"assessment. Now that sounds"},{"speaker":"Chris Dy","startTime":776.62,"endTime":780.1,"body":"really cool. The person will be"},{"speaker":"Chris Dy","startTime":776.62,"endTime":780.1,"body":"led by luminary faculty,"},{"speaker":"Chris Dy","startTime":780.28,"endTime":784.03,"body":"luminary nice, including doctors"},{"speaker":"Chris Dy","startTime":780.28,"endTime":784.03,"body":"Deanna Mercer Amber Leis and"},{"speaker":"Chris Dy","startTime":784.03,"endTime":787.63,"body":"Brooke Baker and takes place on"},{"speaker":"Chris Dy","startTime":784.03,"endTime":787.63,"body":"March 15 and 16th in Scottsdale,"},{"speaker":"Chris Dy","startTime":787.63,"endTime":791.5,"body":"Arizona. That sounds really"},{"speaker":"Chris Dy","startTime":787.63,"endTime":791.5,"body":"cool. To learn more about this"},{"speaker":"Chris Dy","startTime":791.5,"endTime":793.39,"body":"and other educational programs"},{"speaker":"Chris Dy","startTime":791.5,"endTime":793.39,"body":"sponsored by checkpoint"},{"speaker":"Chris Dy","startTime":793.39,"endTime":796.99,"body":"surgical, please visit nerve"},{"speaker":"Chris Dy","startTime":793.39,"endTime":796.99,"body":"mastery.com Checkpoint surgical"},{"speaker":"Chris Dy","startTime":796.99,"endTime":798.97,"body":"driving innovation in nerve"},{"speaker":"Chris Dy","startTime":796.99,"endTime":798.97,"body":"surgery,"},{"speaker":"Charles Goldfarb","startTime":799.17,"endTime":801.39,"body":"they really"},{"speaker":"Charles Goldfarb","startTime":799.17,"endTime":801.39,"body":"are hosting some, some really"},{"speaker":"Charles Goldfarb","startTime":801.39,"endTime":804.69,"body":"good courses, I have to applaud"},{"speaker":"Charles Goldfarb","startTime":801.39,"endTime":804.69,"body":"the efforts. Yeah,"},{"speaker":"Chris Dy","startTime":804.69,"endTime":806.52,"body":"and I think"},{"speaker":"Chris Dy","startTime":804.69,"endTime":806.52,"body":"interoperative assessment with"},{"speaker":"Chris Dy","startTime":806.52,"endTime":808.71,"body":"ultrasound is really cool. I"},{"speaker":"Chris Dy","startTime":806.52,"endTime":808.71,"body":"mean, I've tried, I've done that"},{"speaker":"Chris Dy","startTime":808.89,"endTime":812.1,"body":"a handful of times. And it's"},{"speaker":"Chris Dy","startTime":808.89,"endTime":812.1,"body":"been helpful, and certainly not"},{"speaker":"Chris Dy","startTime":812.1,"endTime":815.73,"body":"to a skilled photographer just"},{"speaker":"Chris Dy","startTime":812.1,"endTime":815.73,"body":"yet. But even in novice hands,"},{"speaker":"Chris Dy","startTime":815.73,"endTime":818.4,"body":"it can provide useful"},{"speaker":"Chris Dy","startTime":815.73,"endTime":818.4,"body":"information. And you know, it's"},{"speaker":"Chris Dy","startTime":818.4,"endTime":821.97,"body":"not as limited by you know,"},{"speaker":"Chris Dy","startTime":818.4,"endTime":821.97,"body":"things like the tourniquet,"},{"speaker":"Chris Dy","startTime":822.81,"endTime":826.05,"body":"which can be an issue as you get"},{"speaker":"Chris Dy","startTime":822.81,"endTime":826.05,"body":"later on into a case. And"},{"speaker":"Chris Dy","startTime":826.05,"endTime":829.14,"body":"checkpoints, also helping"},{"speaker":"Chris Dy","startTime":826.05,"endTime":829.14,"body":"sponsor our WashU peripheral"},{"speaker":"Chris Dy","startTime":829.14,"endTime":832.71,"body":"nerve course for those of you"},{"speaker":"Chris Dy","startTime":829.14,"endTime":832.71,"body":"watching on YouTube. Here's the"},{"speaker":"Chris Dy","startTime":832.71,"endTime":838.11,"body":"flyer, April 5 to sixth. Here in"},{"speaker":"Chris Dy","startTime":832.71,"endTime":838.11,"body":"St. Louis, keynote speaker,"},{"speaker":"Chris Dy","startTime":838.11,"endTime":840.81,"body":"Susan MacKinnon. We really want"},{"speaker":"Chris Dy","startTime":838.11,"endTime":840.81,"body":"everybody to come and check it"},{"speaker":"Chris Dy","startTime":840.81,"endTime":844.23,"body":"out ortho plastics, neurosurgery"},{"speaker":"Chris Dy","startTime":840.81,"endTime":844.23,"body":"coming together, I think for the"},{"speaker":"Chris Dy","startTime":844.23,"endTime":847.86,"body":"first time in WashU history to"},{"speaker":"Chris Dy","startTime":844.23,"endTime":847.86,"body":"host this meeting, and hopefully"},{"speaker":"Chris Dy","startTime":847.86,"endTime":850.44,"body":"the first of many, but some"},{"speaker":"Chris Dy","startTime":847.86,"endTime":850.44,"body":"great sponsors including"},{"speaker":"Chris Dy","startTime":850.44,"endTime":852.39,"body":"checkpoint, I'm trying to"},{"speaker":"Chris Dy","startTime":850.44,"endTime":852.39,"body":"wrangle practicing into"},{"speaker":"Chris Dy","startTime":852.39,"endTime":856.17,"body":"exhibiting. So anyway, please"},{"speaker":"Chris Dy","startTime":852.39,"endTime":856.17,"body":"come check us out. I think it'd"},{"speaker":"Chris Dy","startTime":856.17,"endTime":859.77,"body":"be really fun meeting."},{"speaker":"Chris Dy","startTime":856.17,"endTime":859.77,"body":"Registrations open. I think"},{"speaker":"Chris Dy","startTime":859.77,"endTime":863.13,"body":"there are still some spots left."},{"speaker":"Chris Dy","startTime":859.77,"endTime":863.13,"body":"But you know, if we tell you the"},{"speaker":"Chris Dy","startTime":863.16,"endTime":865.44,"body":"spots are limited, maybe you'll"},{"speaker":"Chris Dy","startTime":863.16,"endTime":865.44,"body":"be more interested. So check it"},{"speaker":"Chris Dy","startTime":865.44,"endTime":866.58,"body":"out. Move"},{"speaker":"Charles Goldfarb","startTime":866.58,"endTime":870.66,"body":"quickly. I"},{"speaker":"Charles Goldfarb","startTime":866.58,"endTime":870.66,"body":"will not one that'd be very new"},{"speaker":"Charles Goldfarb","startTime":870.66,"endTime":873.21,"body":"for a spot in this course, even"},{"speaker":"Charles Goldfarb","startTime":870.66,"endTime":873.21,"body":"though I think it'll be a"},{"speaker":"Charles Goldfarb","startTime":873.21,"endTime":876.9,"body":"fantastic course. That's too"},{"speaker":"Charles Goldfarb","startTime":873.21,"endTime":876.9,"body":"much nerve for me too much."},{"speaker":"Chris Dy","startTime":877.53,"endTime":879.69,"body":"That's okay. All"},{"speaker":"Chris Dy","startTime":877.53,"endTime":879.69,"body":"right. So tell me a bit a bit"},{"speaker":"Chris Dy","startTime":879.69,"endTime":881.91,"body":"about some of these revisions."},{"speaker":"Chris Dy","startTime":879.69,"endTime":881.91,"body":"scaphoid cases that you've been"},{"speaker":"Chris Dy","startTime":881.91,"endTime":885.87,"body":"doing that sounds honestly quite"},{"speaker":"Chris Dy","startTime":881.91,"endTime":885.87,"body":"awful from my perspective, but"},{"speaker":"Chris Dy","startTime":885.87,"endTime":889.38,"body":"it is it is a such a technically"},{"speaker":"Chris Dy","startTime":885.87,"endTime":889.38,"body":"demanding surgery, both in"},{"speaker":"Chris Dy","startTime":889.38,"endTime":892.92,"body":"indications selecting your"},{"speaker":"Chris Dy","startTime":889.38,"endTime":892.92,"body":"surgery, and then the carpentry"},{"speaker":"Chris Dy","startTime":892.92,"endTime":895.53,"body":"and the plumbing, for lack of a"},{"speaker":"Chris Dy","startTime":892.92,"endTime":895.53,"body":"better term can be really quite"},{"speaker":"Chris Dy","startTime":895.53,"endTime":895.86,"body":"tough."},{"speaker":"Charles Goldfarb","startTime":896.29,"endTime":897.94,"body":"Yeah, it's"},{"speaker":"Charles Goldfarb","startTime":896.29,"endTime":897.94,"body":"interesting, you know, I always"},{"speaker":"Charles Goldfarb","startTime":897.94,"endTime":902.41,"body":"try to understand and so I two"},{"speaker":"Charles Goldfarb","startTime":897.94,"endTime":902.41,"body":"cases. And I'll just briefly"},{"speaker":"Charles Goldfarb","startTime":902.41,"endTime":904.63,"body":"give the highlights and then we"},{"speaker":"Charles Goldfarb","startTime":902.41,"endTime":904.63,"body":"can talk about the technical and"},{"speaker":"Charles Goldfarb","startTime":904.63,"endTime":909.61,"body":"the revision setting. You know,"},{"speaker":"Charles Goldfarb","startTime":904.63,"endTime":909.61,"body":"one of the cases was does a 16."},{"speaker":"Charles Goldfarb","startTime":909.64,"endTime":913.0,"body":"Now, I'm sorry, an 18 year old,"},{"speaker":"Charles Goldfarb","startTime":909.64,"endTime":913.0,"body":"who was treated out of state,"},{"speaker":"Charles Goldfarb","startTime":913.21,"endTime":918.04,"body":"and had initially apparently"},{"speaker":"Charles Goldfarb","startTime":913.21,"endTime":918.04,"body":"been treated for a scaphoid non"},{"speaker":"Charles Goldfarb","startTime":918.04,"endTime":922.45,"body":"union from a bowler approach"},{"speaker":"Charles Goldfarb","startTime":918.04,"endTime":922.45,"body":"with two micro acutracks."},{"speaker":"Chris Dy","startTime":923.53,"endTime":927.76,"body":"So do you feel like"},{"speaker":"Chris Dy","startTime":923.53,"endTime":927.76,"body":"what's the right size screw? You"},{"speaker":"Chris Dy","startTime":927.76,"endTime":930.91,"body":"know, whether it's an accurate"},{"speaker":"Chris Dy","startTime":927.76,"endTime":930.91,"body":"track screw or not, I mean,"},{"speaker":"Chris Dy","startTime":931.0,"endTime":935.29,"body":"those micro type screws to is"},{"speaker":"Chris Dy","startTime":931.0,"endTime":935.29,"body":"okay, if you've got two of them,"},{"speaker":"Chris Dy","startTime":935.29,"endTime":937.9,"body":"right? It's usually one is"},{"speaker":"Chris Dy","startTime":935.29,"endTime":937.9,"body":"unless they're quite a small"},{"speaker":"Chris Dy","startTime":937.9,"endTime":940.84,"body":"patient, one probably is not"},{"speaker":"Chris Dy","startTime":937.9,"endTime":940.84,"body":"enough unless it's backed up"},{"speaker":"Chris Dy","startTime":940.84,"endTime":942.16,"body":"with kwire or something, or,"},{"speaker":"Charles Goldfarb","startTime":942.52,"endTime":945.1,"body":"yeah, I don't,"},{"speaker":"Charles Goldfarb","startTime":942.52,"endTime":945.1,"body":"I haven't seen any anatomical"},{"speaker":"Charles Goldfarb","startTime":945.1,"endTime":952.12,"body":"studies but one micro acutrack"},{"speaker":"Charles Goldfarb","startTime":945.1,"endTime":952.12,"body":"for a waste non union and a"},{"speaker":"Charles Goldfarb","startTime":952.12,"endTime":957.76,"body":"standard human being is in my"},{"speaker":"Charles Goldfarb","startTime":952.12,"endTime":957.76,"body":"mind is probably not enough. For"},{"speaker":"Charles Goldfarb","startTime":957.76,"endTime":962.8,"body":"me, it's almost always a mini"},{"speaker":"Charles Goldfarb","startTime":957.76,"endTime":962.8,"body":"sized. And occasionally, in a"},{"speaker":"Charles Goldfarb","startTime":962.8,"endTime":967.45,"body":"revision, I'll do a standard but"},{"speaker":"Charles Goldfarb","startTime":962.8,"endTime":967.45,"body":"a micro is tiny. It looked tiny,"},{"speaker":"Charles Goldfarb","startTime":967.45,"endTime":969.4,"body":"it was tiny, and the bone didn't"},{"speaker":"Charles Goldfarb","startTime":967.45,"endTime":969.4,"body":"heal."},{"speaker":"Chris Dy","startTime":970.3,"endTime":973.51,"body":"So, you know, I guess"},{"speaker":"Chris Dy","startTime":970.3,"endTime":973.51,"body":"the basic hand surgery and"},{"speaker":"Chris Dy","startTime":973.51,"endTime":975.67,"body":"orthopedic principles when"},{"speaker":"Chris Dy","startTime":973.51,"endTime":975.67,"body":"you're thinking about a bona"},{"speaker":"Chris Dy","startTime":975.67,"endTime":978.91,"body":"healing, you know, is it a blood"},{"speaker":"Chris Dy","startTime":975.67,"endTime":978.91,"body":"supply issue for this bone? Is"},{"speaker":"Chris Dy","startTime":978.91,"endTime":981.82,"body":"it lack of inadequate"},{"speaker":"Chris Dy","startTime":978.91,"endTime":981.82,"body":"immobilization of the bone"},{"speaker":"Chris Dy","startTime":981.82,"endTime":986.08,"body":"either in some settings casting"},{"speaker":"Chris Dy","startTime":981.82,"endTime":986.08,"body":"versus fixation? Is it"},{"speaker":"Chris Dy","startTime":986.08,"endTime":989.29,"body":"infection? Like what What's your"},{"speaker":"Chris Dy","startTime":986.08,"endTime":989.29,"body":"thinking just for the very basic"},{"speaker":"Chris Dy","startTime":989.32,"endTime":992.44,"body":"people maybe that earlier on how"},{"speaker":"Chris Dy","startTime":989.32,"endTime":992.44,"body":"do you approach this in terms of"},{"speaker":"Chris Dy","startTime":992.44,"endTime":995.56,"body":"how to figure out what's going"},{"speaker":"Chris Dy","startTime":992.44,"endTime":995.56,"body":"on and what you can do to make"},{"speaker":"Chris Dy","startTime":995.56,"endTime":995.92,"body":"it better?"},{"speaker":"Charles Goldfarb","startTime":996.94,"endTime":998.71,"body":"Yeah, let me"},{"speaker":"Charles Goldfarb","startTime":996.94,"endTime":998.71,"body":"let me briefly have the second"},{"speaker":"Charles Goldfarb","startTime":998.71,"endTime":1001.59,"body":"case, because it gets to one of"},{"speaker":"Charles Goldfarb","startTime":998.71,"endTime":1001.59,"body":"your points. The second case was"},{"speaker":"Charles Goldfarb","startTime":1001.59,"endTime":1006.99,"body":"also a waste non union. And this"},{"speaker":"Charles Goldfarb","startTime":1001.59,"endTime":1006.99,"body":"patient had not previously been"},{"speaker":"Charles Goldfarb","startTime":1006.99,"endTime":1012.03,"body":"treated, and was treated with a"},{"speaker":"Charles Goldfarb","startTime":1006.99,"endTime":1012.03,"body":"vascularized bone flap, which in"},{"speaker":"Charles Goldfarb","startTime":1012.03,"endTime":1016.32,"body":"retrospect, and for me, it just"},{"speaker":"Charles Goldfarb","startTime":1012.03,"endTime":1016.32,"body":"wasn't necessary. And I think it"},{"speaker":"Charles Goldfarb","startTime":1016.32,"endTime":1021.21,"body":"compromise the carpentry so to"},{"speaker":"Charles Goldfarb","startTime":1016.32,"endTime":1021.21,"body":"speak, and the fixation, which"},{"speaker":"Charles Goldfarb","startTime":1021.27,"endTime":1025.2,"body":"which led to another non union,"},{"speaker":"Charles Goldfarb","startTime":1021.27,"endTime":1025.2,"body":"non union of the non union. So I"},{"speaker":"Charles Goldfarb","startTime":1025.2,"endTime":1028.59,"body":"think from a basic principles"},{"speaker":"Charles Goldfarb","startTime":1025.2,"endTime":1028.59,"body":"standpoint, waist scaphoid"},{"speaker":"Charles Goldfarb","startTime":1028.59,"endTime":1033.96,"body":"fractures should typically heal."},{"speaker":"Charles Goldfarb","startTime":1028.59,"endTime":1033.96,"body":"They are rarely compromised by"},{"speaker":"Charles Goldfarb","startTime":1033.96,"endTime":1037.86,"body":"blood supply issues. And so we"},{"speaker":"Charles Goldfarb","startTime":1033.96,"endTime":1037.86,"body":"as surgeons, when we approach"},{"speaker":"Charles Goldfarb","startTime":1037.86,"endTime":1042.96,"body":"these need to restore the"},{"speaker":"Charles Goldfarb","startTime":1037.86,"endTime":1042.96,"body":"anatomy, ideally, apply a"},{"speaker":"Charles Goldfarb","startTime":1042.96,"endTime":1046.95,"body":"compressive screw and add bone"},{"speaker":"Charles Goldfarb","startTime":1042.96,"endTime":1046.95,"body":"graft, if necessary, which in a"},{"speaker":"Charles Goldfarb","startTime":1046.95,"endTime":1049.62,"body":"non union, it would be"},{"speaker":"Charles Goldfarb","startTime":1046.95,"endTime":1049.62,"body":"necessary, but those are the"},{"speaker":"Charles Goldfarb","startTime":1049.83,"endTime":1053.43,"body":"simplistic, basic concepts."},{"speaker":"Charles Goldfarb","startTime":1049.83,"endTime":1053.43,"body":"Right."},{"speaker":"Chris Dy","startTime":1053.43,"endTime":1055.83,"body":"And you know, you say"},{"speaker":"Chris Dy","startTime":1053.43,"endTime":1055.83,"body":"here that just to clarify, you"},{"speaker":"Chris Dy","startTime":1055.83,"endTime":1058.56,"body":"say that the blood supply is"},{"speaker":"Chris Dy","startTime":1055.83,"endTime":1058.56,"body":"rarely an issue, but that is the"},{"speaker":"Chris Dy","startTime":1058.56,"endTime":1062.73,"body":"textbook concern for at least"},{"speaker":"Chris Dy","startTime":1058.56,"endTime":1062.73,"body":"any skateboard factory more"},{"speaker":"Chris Dy","startTime":1062.73,"endTime":1065.04,"body":"relevant for proximal pole"},{"speaker":"Chris Dy","startTime":1062.73,"endTime":1065.04,"body":"fractures, as opposed to"},{"speaker":"Chris Dy","startTime":1065.04,"endTime":1066.9,"body":"skateboard waste fracturing,"},{"speaker":"Chris Dy","startTime":1065.04,"endTime":1066.9,"body":"just want to make sure that that"},{"speaker":"Chris Dy","startTime":1066.9,"endTime":1069.42,"body":"distinction is made for those"},{"speaker":"Chris Dy","startTime":1066.9,"endTime":1069.42,"body":"that are listening. Is that Is"},{"speaker":"Chris Dy","startTime":1069.42,"endTime":1071.1,"body":"that an accurate summation of"},{"speaker":"Chris Dy","startTime":1069.42,"endTime":1071.1,"body":"what you're saying?"},{"speaker":"Charles Goldfarb","startTime":1071.52,"endTime":1074.07,"body":"Yeah, so you"},{"speaker":"Charles Goldfarb","startTime":1071.52,"endTime":1074.07,"body":"know, this skateboard blood"},{"speaker":"Charles Goldfarb","startTime":1074.07,"endTime":1077.73,"body":"supply comes in distally and"},{"speaker":"Charles Goldfarb","startTime":1074.07,"endTime":1077.73,"body":"travels proximately. Therefore,"},{"speaker":"Charles Goldfarb","startTime":1077.73,"endTime":1082.02,"body":"the further proximal the"},{"speaker":"Charles Goldfarb","startTime":1077.73,"endTime":1082.02,"body":"fracture line is, theoretically,"},{"speaker":"Charles Goldfarb","startTime":1082.02,"endTime":1086.73,"body":"the greater risk of a blood"},{"speaker":"Charles Goldfarb","startTime":1082.02,"endTime":1086.73,"body":"supply compromised, and an"},{"speaker":"Charles Goldfarb","startTime":1086.76,"endTime":1090.69,"body":"avascular necrosis type"},{"speaker":"Charles Goldfarb","startTime":1086.76,"endTime":1090.69,"body":"situation, or simply a non"},{"speaker":"Charles Goldfarb","startTime":1090.69,"endTime":1096.24,"body":"union. I'm just my point earlier"},{"speaker":"Charles Goldfarb","startTime":1090.69,"endTime":1096.24,"body":"was simply that I don't recall,"},{"speaker":"Charles Goldfarb","startTime":1097.41,"endTime":1102.57,"body":"real blood supply issues for any"},{"speaker":"Charles Goldfarb","startTime":1097.41,"endTime":1102.57,"body":"waist fracture, it can happen,"},{"speaker":"Charles Goldfarb","startTime":1102.72,"endTime":1105.3,"body":"but really, we think about blood"},{"speaker":"Charles Goldfarb","startTime":1102.72,"endTime":1105.3,"body":"supply issues with proximal"},{"speaker":"Charles Goldfarb","startTime":1105.3,"endTime":1105.63,"body":"pole."},{"speaker":"Chris Dy","startTime":1106.05,"endTime":1108.66,"body":"Right, right. And then"},{"speaker":"Chris Dy","startTime":1106.05,"endTime":1108.66,"body":"I guess your other point that I"},{"speaker":"Chris Dy","startTime":1108.66,"endTime":1114.24,"body":"wanted to expand on a bit was"},{"speaker":"Chris Dy","startTime":1108.66,"endTime":1114.24,"body":"saying that these nonunions in"},{"speaker":"Chris Dy","startTime":1114.24,"endTime":1118.62,"body":"the setting of no prior surgery,"},{"speaker":"Chris Dy","startTime":1114.24,"endTime":1118.62,"body":"typically, they don't typically"},{"speaker":"Chris Dy","startTime":1118.62,"endTime":1123.18,"body":"require anything more than good"},{"speaker":"Chris Dy","startTime":1118.62,"endTime":1123.18,"body":"fixation, and some cancellous"},{"speaker":"Chris Dy","startTime":1123.18,"endTime":1126.18,"body":"bone graft. And I think with all"},{"speaker":"Chris Dy","startTime":1123.18,"endTime":1126.18,"body":"the excitement that there has"},{"speaker":"Chris Dy","startTime":1126.18,"endTime":1130.62,"body":"been with various pedicle bone"},{"speaker":"Chris Dy","startTime":1126.18,"endTime":1130.62,"body":"flaps, and then subsequently"},{"speaker":"Chris Dy","startTime":1130.62,"endTime":1133.92,"body":"free, you know, cartilage type"},{"speaker":"Chris Dy","startTime":1130.62,"endTime":1133.92,"body":"transfers, you know,"},{"speaker":"Chris Dy","startTime":1133.95,"endTime":1138.66,"body":"vascularized, free flaps,"},{"speaker":"Chris Dy","startTime":1133.95,"endTime":1138.66,"body":"essentially, of bone. There has"},{"speaker":"Chris Dy","startTime":1138.66,"endTime":1142.41,"body":"been a bit of a pullback, and I"},{"speaker":"Chris Dy","startTime":1138.66,"endTime":1142.41,"body":"think there's been another"},{"speaker":"Chris Dy","startTime":1142.41,"endTime":1144.78,"body":"suggestion that you really don't"},{"speaker":"Chris Dy","startTime":1142.41,"endTime":1144.78,"body":"need much more than what you"},{"speaker":"Chris Dy","startTime":1144.78,"endTime":1148.11,"body":"described in terms of getting"},{"speaker":"Chris Dy","startTime":1144.78,"endTime":1148.11,"body":"good compression for the first"},{"speaker":"Chris Dy","startTime":1148.14,"endTime":1150.63,"body":"you know, surgery for a non"},{"speaker":"Chris Dy","startTime":1148.14,"endTime":1150.63,"body":"union adding some cancellous"},{"speaker":"Chris Dy","startTime":1150.63,"endTime":1152.61,"body":"graft is that do Would you agree"},{"speaker":"Chris Dy","startTime":1150.63,"endTime":1152.61,"body":"with that?"},{"speaker":"Charles Goldfarb","startTime":1152.93,"endTime":1155.36,"body":"Yeah, and the"},{"speaker":"Charles Goldfarb","startTime":1152.93,"endTime":1155.36,"body":"technical part and this is this"},{"speaker":"Charles Goldfarb","startTime":1155.36,"endTime":1158.33,"body":"has been demonstrated by"},{"speaker":"Charles Goldfarb","startTime":1155.36,"endTime":1158.33,"body":"mechanically out of Seattle is"},{"speaker":"Charles Goldfarb","startTime":1158.33,"endTime":1161.3,"body":"you want your screws center"},{"speaker":"Charles Goldfarb","startTime":1158.33,"endTime":1161.3,"body":"center in the axis of the"},{"speaker":"Charles Goldfarb","startTime":1161.3,"endTime":1164.33,"body":"scaphoid. So it's centered on"},{"speaker":"Charles Goldfarb","startTime":1161.3,"endTime":1164.33,"body":"the PA center on the lateral."},{"speaker":"Charles Goldfarb","startTime":1164.51,"endTime":1169.85,"body":"And in both of these cases,"},{"speaker":"Charles Goldfarb","startTime":1164.51,"endTime":1169.85,"body":"these revision cases just did"},{"speaker":"Charles Goldfarb","startTime":1169.88,"endTime":1173.12,"body":"the screw was far from the"},{"speaker":"Charles Goldfarb","startTime":1169.88,"endTime":1173.12,"body":"center center axis. And"},{"speaker":"Charles Goldfarb","startTime":1173.12,"endTime":1175.28,"body":"sometimes it's difficult to"},{"speaker":"Charles Goldfarb","startTime":1173.12,"endTime":1175.28,"body":"place that screw exactly where"},{"speaker":"Charles Goldfarb","startTime":1175.28,"endTime":1179.81,"body":"you want it but it needs to be"},{"speaker":"Charles Goldfarb","startTime":1175.28,"endTime":1179.81,"body":"pretty close or exactly center"},{"speaker":"Charles Goldfarb","startTime":1179.81,"endTime":1184.61,"body":"center to maximize the patient's"},{"speaker":"Charles Goldfarb","startTime":1179.81,"endTime":1184.61,"body":"chances of healing and so not"},{"speaker":"Charles Goldfarb","startTime":1184.64,"endTime":1188.06,"body":"overdoing concepts like"},{"speaker":"Charles Goldfarb","startTime":1184.64,"endTime":1188.06,"body":"vascularized bone graft and"},{"speaker":"Charles Goldfarb","startTime":1188.06,"endTime":1191.21,"body":"focusing on the basics that is"},{"speaker":"Charles Goldfarb","startTime":1188.06,"endTime":1191.21,"body":"you know, make sure if it's a"},{"speaker":"Charles Goldfarb","startTime":1191.21,"endTime":1195.2,"body":"non union you to breed the non"},{"speaker":"Charles Goldfarb","startTime":1191.21,"endTime":1195.2,"body":"union site you add can sell his"},{"speaker":"Charles Goldfarb","startTime":1195.2,"endTime":1198.02,"body":"bone graft and you put a good"},{"speaker":"Charles Goldfarb","startTime":1195.2,"endTime":1198.02,"body":"screw in. So"},{"speaker":"Chris Dy","startTime":1198.05,"endTime":1202.49,"body":"for for you, um, When"},{"speaker":"Chris Dy","startTime":1198.05,"endTime":1202.49,"body":"you talk about the approach to"},{"speaker":"Chris Dy","startTime":1202.49,"endTime":1206.72,"body":"something like this, when do you"},{"speaker":"Chris Dy","startTime":1202.49,"endTime":1206.72,"body":"need something more is one"},{"speaker":"Chris Dy","startTime":1206.72,"endTime":1209.03,"body":"question. And then the second"},{"speaker":"Chris Dy","startTime":1206.72,"endTime":1209.03,"body":"question is you talk about being"},{"speaker":"Chris Dy","startTime":1209.03,"endTime":1211.76,"body":"center center, but there are"},{"speaker":"Chris Dy","startTime":1209.03,"endTime":1211.76,"body":"some, you know, fractures that"},{"speaker":"Chris Dy","startTime":1211.76,"endTime":1214.34,"body":"are in nonunions, that might be"},{"speaker":"Chris Dy","startTime":1211.76,"endTime":1214.34,"body":"the exception to that rule where"},{"speaker":"Chris Dy","startTime":1214.34,"endTime":1216.44,"body":"you want to be more"},{"speaker":"Chris Dy","startTime":1214.34,"endTime":1216.44,"body":"perpendicular to the fracture"},{"speaker":"Chris Dy","startTime":1216.44,"endTime":1219.92,"body":"itself, as opposed to being"},{"speaker":"Chris Dy","startTime":1216.44,"endTime":1219.92,"body":"center center to maximize fit."},{"speaker":"Chris Dy","startTime":1219.92,"endTime":1222.92,"body":"So can you talk me through when"},{"speaker":"Chris Dy","startTime":1219.92,"endTime":1222.92,"body":"you need something more than"},{"speaker":"Chris Dy","startTime":1222.92,"endTime":1224.9,"body":"maybe answer the second question"},{"speaker":"Chris Dy","startTime":1222.92,"endTime":1224.9,"body":"first, because that might be"},{"speaker":"Chris Dy","startTime":1224.9,"endTime":1225.5,"body":"more direct."},{"speaker":"Charles Goldfarb","startTime":1225.77,"endTime":1228.56,"body":"So there is a"},{"speaker":"Charles Goldfarb","startTime":1225.77,"endTime":1228.56,"body":"higher rate of non union for"},{"speaker":"Charles Goldfarb","startTime":1228.56,"endTime":1233.69,"body":"oblique fractures. And that's"},{"speaker":"Charles Goldfarb","startTime":1228.56,"endTime":1233.69,"body":"pretty well established. And,"},{"speaker":"Charles Goldfarb","startTime":1234.23,"endTime":1236.42,"body":"you know, it is a little tricky"},{"speaker":"Charles Goldfarb","startTime":1234.23,"endTime":1236.42,"body":"to decide when do you want"},{"speaker":"Charles Goldfarb","startTime":1236.42,"endTime":1240.05,"body":"center center? Or when do you"},{"speaker":"Charles Goldfarb","startTime":1236.42,"endTime":1240.05,"body":"want your screw perpendicular, I"},{"speaker":"Charles Goldfarb","startTime":1240.05,"endTime":1244.58,"body":"think if you can have a good"},{"speaker":"Charles Goldfarb","startTime":1240.05,"endTime":1244.58,"body":"entry point, that is an"},{"speaker":"Charles Goldfarb","startTime":1244.58,"endTime":1247.43,"body":"appropriately starting an"},{"speaker":"Charles Goldfarb","startTime":1244.58,"endTime":1247.43,"body":"appropriately placed starting"},{"speaker":"Charles Goldfarb","startTime":1247.43,"endTime":1253.19,"body":"point. And you can create a"},{"speaker":"Charles Goldfarb","startTime":1247.43,"endTime":1253.19,"body":"screw trajectory, which is"},{"speaker":"Charles Goldfarb","startTime":1253.19,"endTime":1256.22,"body":"perpendicular to fracture line,"},{"speaker":"Charles Goldfarb","startTime":1253.19,"endTime":1256.22,"body":"which allows compression, I'm"},{"speaker":"Charles Goldfarb","startTime":1256.22,"endTime":1259.13,"body":"not against that buddy stretch."},{"speaker":"Charles Goldfarb","startTime":1256.22,"endTime":1259.13,"body":"And that would be for the"},{"speaker":"Charles Goldfarb","startTime":1259.13,"endTime":1262.61,"body":"oblique fracture pattern for"},{"speaker":"Charles Goldfarb","startTime":1259.13,"endTime":1262.61,"body":"most other fracture patterns"},{"speaker":"Charles Goldfarb","startTime":1262.64,"endTime":1264.65,"body":"center center. That's my"},{"speaker":"Charles Goldfarb","startTime":1262.64,"endTime":1264.65,"body":"approach."},{"speaker":"Chris Dy","startTime":1265.07,"endTime":1266.57,"body":"Yeah. And I think"},{"speaker":"Chris Dy","startTime":1265.07,"endTime":1266.57,"body":"that's where those micro screws,"},{"speaker":"Chris Dy","startTime":1266.57,"endTime":1269.06,"body":"or at least a smaller diameter"},{"speaker":"Chris Dy","startTime":1266.57,"endTime":1269.06,"body":"screws can be really kind of"},{"speaker":"Chris Dy","startTime":1269.06,"endTime":1273.8,"body":"useful to, to accomplish that."},{"speaker":"Chris Dy","startTime":1269.06,"endTime":1273.8,"body":"You know, so then, let's get"},{"speaker":"Chris Dy","startTime":1273.8,"endTime":1277.97,"body":"into the second question. I just"},{"speaker":"Chris Dy","startTime":1273.8,"endTime":1277.97,"body":"want to say, you know, there's"},{"speaker":"Chris Dy","startTime":1277.97,"endTime":1280.52,"body":"the scaphoid nonunion that"},{"speaker":"Chris Dy","startTime":1277.97,"endTime":1280.52,"body":"presents after inadequate"},{"speaker":"Chris Dy","startTime":1280.52,"endTime":1283.64,"body":"immobilization, either, you"},{"speaker":"Chris Dy","startTime":1280.52,"endTime":1283.64,"body":"know, they it's a missed"},{"speaker":"Chris Dy","startTime":1283.64,"endTime":1286.58,"body":"fracture, or they've had"},{"speaker":"Chris Dy","startTime":1283.64,"endTime":1286.58,"body":"casting, and it's just not"},{"speaker":"Chris Dy","startTime":1286.58,"endTime":1290.03,"body":"enough, and then you're looking"},{"speaker":"Chris Dy","startTime":1286.58,"endTime":1290.03,"body":"at screw fixation with some"},{"speaker":"Chris Dy","startTime":1290.03,"endTime":1293.69,"body":"graph perhaps can't sell his"},{"speaker":"Chris Dy","startTime":1290.03,"endTime":1293.69,"body":"craft. That's a separate entity"},{"speaker":"Chris Dy","startTime":1293.69,"endTime":1296.75,"body":"than what we're about to dive"},{"speaker":"Chris Dy","startTime":1293.69,"endTime":1296.75,"body":"into now, which is the patient"},{"speaker":"Chris Dy","startTime":1296.75,"endTime":1301.43,"body":"who has had surgery, and now has"},{"speaker":"Chris Dy","startTime":1296.75,"endTime":1301.43,"body":"a non union after an attempt at"},{"speaker":"Chris Dy","startTime":1301.43,"endTime":1304.58,"body":"surgical treatment. So is that a"},{"speaker":"Chris Dy","startTime":1301.43,"endTime":1304.58,"body":"fair way to set the stage for"},{"speaker":"Chris Dy","startTime":1304.58,"endTime":1306.77,"body":"the rest of the conversation?"},{"speaker":"Chris Dy","startTime":1304.58,"endTime":1306.77,"body":"Yeah,"},{"speaker":"Charles Goldfarb","startTime":1306.77,"endTime":1308.63,"body":"it's a fair"},{"speaker":"Charles Goldfarb","startTime":1306.77,"endTime":1308.63,"body":"way to set the stage. And I"},{"speaker":"Charles Goldfarb","startTime":1308.63,"endTime":1311.27,"body":"would say your previous also"},{"speaker":"Charles Goldfarb","startTime":1308.63,"endTime":1311.27,"body":"question, you know, when do you"},{"speaker":"Charles Goldfarb","startTime":1311.27,"endTime":1316.85,"body":"need more than a screw. And, you"},{"speaker":"Charles Goldfarb","startTime":1311.27,"endTime":1316.85,"body":"know, the screws we have to"},{"speaker":"Charles Goldfarb","startTime":1316.85,"endTime":1320.12,"body":"choose from no matter what the"},{"speaker":"Charles Goldfarb","startTime":1316.85,"endTime":1320.12,"body":"manufacturer is, are really good"},{"speaker":"Charles Goldfarb","startTime":1320.12,"endTime":1324.17,"body":"and really strong screws. I"},{"speaker":"Charles Goldfarb","startTime":1320.12,"endTime":1324.17,"body":"think the beauty of cancellous"},{"speaker":"Charles Goldfarb","startTime":1324.17,"endTime":1330.02,"body":"bone graft is it simply brings,"},{"speaker":"Charles Goldfarb","startTime":1324.17,"endTime":1330.02,"body":"you know, healing factors into"},{"speaker":"Charles Goldfarb","startTime":1330.02,"endTime":1333.86,"body":"the area of the non union"},{"speaker":"Charles Goldfarb","startTime":1330.02,"endTime":1333.86,"body":"without providing structural"},{"speaker":"Charles Goldfarb","startTime":1333.86,"endTime":1337.1,"body":"support. I'm not against"},{"speaker":"Charles Goldfarb","startTime":1333.86,"endTime":1337.1,"body":"structural support. And"},{"speaker":"Charles Goldfarb","startTime":1337.1,"endTime":1339.86,"body":"actually, in both of these"},{"speaker":"Charles Goldfarb","startTime":1337.1,"endTime":1339.86,"body":"cases, I went to the crest, I"},{"speaker":"Charles Goldfarb","startTime":1339.86,"endTime":1343.7,"body":"can sometimes use a roussy"},{"speaker":"Charles Goldfarb","startTime":1339.86,"endTime":1343.7,"body":"technique in some of the bowler"},{"speaker":"Charles Goldfarb","startTime":1343.7,"endTime":1346.97,"body":"cortical bone from the distal"},{"speaker":"Charles Goldfarb","startTime":1343.7,"endTime":1346.97,"body":"radius along with bowler and"},{"speaker":"Charles Goldfarb","startTime":1346.97,"endTime":1351.05,"body":"cellos bone from the distal"},{"speaker":"Charles Goldfarb","startTime":1346.97,"endTime":1351.05,"body":"radius. But when I really am"},{"speaker":"Charles Goldfarb","startTime":1351.05,"endTime":1354.5,"body":"worried, I do go to the iliac"},{"speaker":"Charles Goldfarb","startTime":1351.05,"endTime":1354.5,"body":"crest and one of our partners,"},{"speaker":"Charles Goldfarb","startTime":1354.5,"endTime":1357.56,"body":"Marty Boyer always goes to the"},{"speaker":"Charles Goldfarb","startTime":1354.5,"endTime":1357.56,"body":"crest. And I don't know about"},{"speaker":"Charles Goldfarb","startTime":1357.56,"endTime":1361.19,"body":"you, I do think the crest is"},{"speaker":"Charles Goldfarb","startTime":1357.56,"endTime":1361.19,"body":"slightly better. I think the"},{"speaker":"Charles Goldfarb","startTime":1361.19,"endTime":1364.79,"body":"bone graft is slightly better."},{"speaker":"Charles Goldfarb","startTime":1361.19,"endTime":1364.79,"body":"But it's also a bigger deal. So"},{"speaker":"Charles Goldfarb","startTime":1364.79,"endTime":1367.67,"body":"I don't do it often. I just"},{"speaker":"Charles Goldfarb","startTime":1364.79,"endTime":1367.67,"body":"happen to do it twice in these"},{"speaker":"Charles Goldfarb","startTime":1367.67,"endTime":1369.35,"body":"most two recent cases."},{"speaker":"Chris Dy","startTime":1369.74,"endTime":1371.63,"body":"Yeah, and I think the"},{"speaker":"Chris Dy","startTime":1369.74,"endTime":1371.63,"body":"iliac crest is probably the gold"},{"speaker":"Chris Dy","startTime":1371.63,"endTime":1374.78,"body":"standard in terms of structural,"},{"speaker":"Chris Dy","startTime":1371.63,"endTime":1374.78,"body":"yeah, either by cortical try"},{"speaker":"Chris Dy","startTime":1374.78,"endTime":1377.72,"body":"cortical support, depending on"},{"speaker":"Chris Dy","startTime":1374.78,"endTime":1377.72,"body":"when and where you're using it."},{"speaker":"Chris Dy","startTime":1378.41,"endTime":1382.58,"body":"It hurts so much, in terms of,"},{"speaker":"Chris Dy","startTime":1378.41,"endTime":1382.58,"body":"you know, the thing that"},{"speaker":"Chris Dy","startTime":1382.58,"endTime":1384.77,"body":"patients will describe"},{"speaker":"Chris Dy","startTime":1382.58,"endTime":1384.77,"body":"afterwards and there's"},{"speaker":"Chris Dy","startTime":1384.77,"endTime":1387.5,"body":"definitely some technical skill"},{"speaker":"Chris Dy","startTime":1384.77,"endTime":1387.5,"body":"in terms of how to do it"},{"speaker":"Chris Dy","startTime":1387.5,"endTime":1389.54,"body":"appropriately. And you can"},{"speaker":"Chris Dy","startTime":1387.5,"endTime":1389.54,"body":"obviously get a lot of counsel"},{"speaker":"Chris Dy","startTime":1389.54,"endTime":1391.58,"body":"as to while you're working in"},{"speaker":"Chris Dy","startTime":1389.54,"endTime":1391.58,"body":"that in those between those"},{"speaker":"Chris Dy","startTime":1391.58,"endTime":1396.35,"body":"tables. You know, I I guess one"},{"speaker":"Chris Dy","startTime":1391.58,"endTime":1396.35,"body":"thing is that actually one of"},{"speaker":"Chris Dy","startTime":1396.35,"endTime":1399.2,"body":"these cases was discussed in"},{"speaker":"Chris Dy","startTime":1396.35,"endTime":1399.2,"body":"conference on Monday and I was"},{"speaker":"Chris Dy","startTime":1399.2,"endTime":1401.93,"body":"the only one that brought up the"},{"speaker":"Chris Dy","startTime":1399.2,"endTime":1401.93,"body":"the modified per se as an"},{"speaker":"Chris Dy","startTime":1401.93,"endTime":1406.34,"body":"option. So you know, I think"},{"speaker":"Chris Dy","startTime":1401.93,"endTime":1406.34,"body":"that because mainly because you"},{"speaker":"Chris Dy","startTime":1406.34,"endTime":1409.4,"body":"weren't there to bring that"},{"speaker":"Chris Dy","startTime":1406.34,"endTime":1409.4,"body":"option up, you know, but I think"},{"speaker":"Chris Dy","startTime":1409.4,"endTime":1412.01,"body":"the conversation was good about"},{"speaker":"Chris Dy","startTime":1409.4,"endTime":1412.01,"body":"you know, when you potentially"},{"speaker":"Chris Dy","startTime":1412.01,"endTime":1415.79,"body":"go to the crest is when you"},{"speaker":"Chris Dy","startTime":1412.01,"endTime":1415.79,"body":"think about when you need more"},{"speaker":"Chris Dy","startTime":1415.79,"endTime":1419.48,"body":"than just a screw and can sell"},{"speaker":"Chris Dy","startTime":1415.79,"endTime":1419.48,"body":"us is it largely based on pre op"},{"speaker":"Chris Dy","startTime":1419.48,"endTime":1423.65,"body":"deformity and or the prior"},{"speaker":"Chris Dy","startTime":1419.48,"endTime":1423.65,"body":"surgical approach? And how do"},{"speaker":"Chris Dy","startTime":1423.65,"endTime":1426.5,"body":"you assess the deformity? What's"},{"speaker":"Chris Dy","startTime":1423.65,"endTime":1426.5,"body":"your best way to do that?"},{"speaker":"Charles Goldfarb","startTime":1426.5,"endTime":1428.974,"body":"The simple"},{"speaker":"Charles Goldfarb","startTime":1426.5,"endTime":1428.974,"body":"answer to your question is yes,"},{"speaker":"Charles Goldfarb","startTime":1429.033,"endTime":1432.685,"body":"preoperative deformity sets the"},{"speaker":"Charles Goldfarb","startTime":1429.033,"endTime":1432.685,"body":"stage for what do I need? Do I"},{"speaker":"Charles Goldfarb","startTime":1432.744,"endTime":1436.514,"body":"need more bone graft? Do I need"},{"speaker":"Charles Goldfarb","startTime":1432.744,"endTime":1436.514,"body":"iliac crest and So absolutely, I"},{"speaker":"Charles Goldfarb","startTime":1436.573,"endTime":1440.167,"body":"am not someone who always wants"},{"speaker":"Charles Goldfarb","startTime":1436.573,"endTime":1440.167,"body":"a CT scan. Although the intra"},{"speaker":"Charles Goldfarb","startTime":1440.226,"endTime":1443.878,"body":"scaphoid angle on a CT scan is"},{"speaker":"Charles Goldfarb","startTime":1440.226,"endTime":1443.878,"body":"most helpful. Plain radiographs"},{"speaker":"Charles Goldfarb","startTime":1443.937,"endTime":1447.118,"body":"will give you plenty of"},{"speaker":"Charles Goldfarb","startTime":1443.937,"endTime":1447.118,"body":"information, especially if you"},{"speaker":"Charles Goldfarb","startTime":1447.177,"endTime":1450.771,"body":"use the secondary indicator of"},{"speaker":"Charles Goldfarb","startTime":1447.177,"endTime":1450.771,"body":"the loonie position. So if the"},{"speaker":"Charles Goldfarb","startTime":1450.829,"endTime":1454.246,"body":"illuminate is tilted dorsally"},{"speaker":"Charles Goldfarb","startTime":1450.829,"endTime":1454.246,"body":"which which happens when the"},{"speaker":"Charles Goldfarb","startTime":1454.305,"endTime":1457.545,"body":"scaphoid flexes through the"},{"speaker":"Charles Goldfarb","startTime":1454.305,"endTime":1457.545,"body":"through the non union, then"},{"speaker":"Charles Goldfarb","startTime":1457.604,"endTime":1460.962,"body":"that's an indication you're"},{"speaker":"Charles Goldfarb","startTime":1457.604,"endTime":1460.962,"body":"meant to open the scaphoid to"},{"speaker":"Charles Goldfarb","startTime":1461.021,"endTime":1464.791,"body":"correct the humpback to for me,"},{"speaker":"Charles Goldfarb","startTime":1461.021,"endTime":1464.791,"body":"but it's the humpback deformity."},{"speaker":"Charles Goldfarb","startTime":1464.85,"endTime":1468.561,"body":"And if there is a humpback, and"},{"speaker":"Charles Goldfarb","startTime":1464.85,"endTime":1468.561,"body":"for me, I've not found a way to"},{"speaker":"Charles Goldfarb","startTime":1468.62,"endTime":1472.391,"body":"deal with that successfully from"},{"speaker":"Charles Goldfarb","startTime":1468.62,"endTime":1472.391,"body":"the dorsal approach. So humback"},{"speaker":"Charles Goldfarb","startTime":1472.45,"endTime":1476.102,"body":"deformities for me are always"},{"speaker":"Charles Goldfarb","startTime":1472.45,"endTime":1476.102,"body":"volar. I think most people would"},{"speaker":"Charles Goldfarb","startTime":1476.161,"endTime":1479.872,"body":"agree with that. I think there's"},{"speaker":"Charles Goldfarb","startTime":1476.161,"endTime":1479.872,"body":"some that might try to do this"},{"speaker":"Charles Goldfarb","startTime":1479.931,"endTime":1481.64,"body":"dorsal I think that's tricky."},{"speaker":"Chris Dy","startTime":1482.39,"endTime":1483.86,"body":"I think that is"},{"speaker":"Chris Dy","startTime":1482.39,"endTime":1483.86,"body":"tricky. I think you can get a"},{"speaker":"Chris Dy","startTime":1483.86,"endTime":1486.56,"body":"little bit of correction, maybe"},{"speaker":"Chris Dy","startTime":1483.86,"endTime":1486.56,"body":"from dorsal, but obviously as"},{"speaker":"Chris Dy","startTime":1486.56,"endTime":1489.2,"body":"you're working dorsally and"},{"speaker":"Chris Dy","startTime":1486.56,"endTime":1489.2,"body":"you're getting more towards the"},{"speaker":"Chris Dy","startTime":1489.2,"endTime":1491.0,"body":"waist and you're doing more"},{"speaker":"Chris Dy","startTime":1489.2,"endTime":1491.0,"body":"manipulating, you're getting to"},{"speaker":"Chris Dy","startTime":1491.0,"endTime":1494.12,"body":"that blood supply that Dr."},{"speaker":"Chris Dy","startTime":1491.0,"endTime":1494.12,"body":"gelderman very beautifully"},{"speaker":"Chris Dy","startTime":1494.24,"endTime":1498.86,"body":"illustrated, you know, 40 years"},{"speaker":"Chris Dy","startTime":1494.24,"endTime":1498.86,"body":"ago, you know, with you know the"},{"speaker":"Chris Dy","startTime":1498.86,"endTime":1500.99,"body":"concern about doing too much"},{"speaker":"Chris Dy","startTime":1498.86,"endTime":1500.99,"body":"storage slowly, so you need a"},{"speaker":"Chris Dy","startTime":1500.99,"endTime":1503.42,"body":"little bit. But if you need any"},{"speaker":"Chris Dy","startTime":1500.99,"endTime":1503.42,"body":"real correction, you really got"},{"speaker":"Chris Dy","startTime":1503.42,"endTime":1506.39,"body":"to go. volar. And, you know, I"},{"speaker":"Chris Dy","startTime":1503.42,"endTime":1506.39,"body":"think that the interest rate"},{"speaker":"Chris Dy","startTime":1506.39,"endTime":1509.33,"body":"wedding was a good point for"},{"speaker":"Chris Dy","startTime":1506.39,"endTime":1509.33,"body":"the, for the residents and"},{"speaker":"Chris Dy","startTime":1509.33,"endTime":1512.06,"body":"fellows, you know, that was"},{"speaker":"Chris Dy","startTime":1509.33,"endTime":1512.06,"body":"described by Amadeo and you"},{"speaker":"Chris Dy","startTime":1512.06,"endTime":1514.85,"body":"know, originally on the lateral"},{"speaker":"Chris Dy","startTime":1512.06,"endTime":1514.85,"body":"film, but a CT scan gets you a"},{"speaker":"Chris Dy","startTime":1514.85,"endTime":1518.18,"body":"much better perspective on that"},{"speaker":"Chris Dy","startTime":1514.85,"endTime":1518.18,"body":"just making sure you reformat"},{"speaker":"Chris Dy","startTime":1518.6,"endTime":1520.67,"body":"your CT scan appropriately"},{"speaker":"Chris Dy","startTime":1518.6,"endTime":1520.67,"body":"request that from your"},{"speaker":"Chris Dy","startTime":1520.67,"endTime":1523.55,"body":"radiologist so you can get a"},{"speaker":"Chris Dy","startTime":1520.67,"endTime":1523.55,"body":"really good scaphoid assessment."},{"speaker":"Chris Dy","startTime":1523.88,"endTime":1526.1,"body":"So we're gonna have to wrap up"},{"speaker":"Chris Dy","startTime":1523.88,"endTime":1526.1,"body":"pretty soon. But can you talk me"},{"speaker":"Chris Dy","startTime":1526.1,"endTime":1530.15,"body":"through kind of your, your"},{"speaker":"Chris Dy","startTime":1526.1,"endTime":1530.15,"body":"volere approach? I think we I"},{"speaker":"Chris Dy","startTime":1530.15,"endTime":1532.43,"body":"don't think we've gone through"},{"speaker":"Chris Dy","startTime":1530.15,"endTime":1532.43,"body":"that volar approach in detail on"},{"speaker":"Chris Dy","startTime":1532.43,"endTime":1532.82,"body":"the pod."},{"speaker":"Charles Goldfarb","startTime":1532.82,"endTime":1535.865,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":1532.82,"endTime":1535.865,"body":"it would be it would be good and"},{"speaker":"Charles Goldfarb","startTime":1535.932,"endTime":1539.375,"body":"hopefully lead to some some"},{"speaker":"Charles Goldfarb","startTime":1535.932,"endTime":1539.375,"body":"listener questions. So I"},{"speaker":"Charles Goldfarb","startTime":1539.441,"endTime":1543.745,"body":"essentially, you know, if you're"},{"speaker":"Charles Goldfarb","startTime":1539.441,"endTime":1543.745,"body":"on YouTube, especially if you're"},{"speaker":"Charles Goldfarb","startTime":1543.811,"endTime":1547.916,"body":"a younger listener, my finger is"},{"speaker":"Charles Goldfarb","startTime":1543.811,"endTime":1547.916,"body":"on the skateboard tuberosity,"},{"speaker":"Charles Goldfarb","startTime":1547.983,"endTime":1551.889,"body":"which is just distal to your"},{"speaker":"Charles Goldfarb","startTime":1547.983,"endTime":1551.889,"body":"wrist crease. And so what I do"},{"speaker":"Charles Goldfarb","startTime":1551.955,"endTime":1555.73,"body":"is I have a longitudinal"},{"speaker":"Charles Goldfarb","startTime":1551.955,"endTime":1555.73,"body":"incision of the fcr, and then an"},{"speaker":"Charles Goldfarb","startTime":1555.796,"endTime":1559.504,"body":"oblique extension over the"},{"speaker":"Charles Goldfarb","startTime":1555.796,"endTime":1559.504,"body":"thinner musculature. And that"},{"speaker":"Charles Goldfarb","startTime":1559.57,"endTime":1563.543,"body":"gives you great exposure of the"},{"speaker":"Charles Goldfarb","startTime":1559.57,"endTime":1563.543,"body":"tuberosity of escape void of"},{"speaker":"Charles Goldfarb","startTime":1563.609,"endTime":1567.052,"body":"escape void, and trapezoidal"},{"speaker":"Charles Goldfarb","startTime":1563.609,"endTime":1567.052,"body":"joints, as well as more"},{"speaker":"Charles Goldfarb","startTime":1567.118,"endTime":1570.959,"body":"approximately, so make your"},{"speaker":"Charles Goldfarb","startTime":1567.118,"endTime":1570.959,"body":"decision. I released the volar"},{"speaker":"Charles Goldfarb","startTime":1571.025,"endTime":1575.13,"body":"ligaments, that is the radius"},{"speaker":"Charles Goldfarb","startTime":1571.025,"endTime":1575.13,"body":"scaphocapitate, long radiolunate"},{"speaker":"Charles Goldfarb","startTime":1575.196,"endTime":1579.103,"body":"for later repair, to repair"},{"speaker":"Charles Goldfarb","startTime":1575.196,"endTime":1579.103,"body":"those on your way out. And it's"},{"speaker":"Charles Goldfarb","startTime":1579.169,"endTime":1582.944,"body":"a sharp approach for me,"},{"speaker":"Charles Goldfarb","startTime":1579.169,"endTime":1582.944,"body":"essentially, all the way down to"},{"speaker":"Charles Goldfarb","startTime":1583.01,"endTime":1586.916,"body":"the joint. And then you expose"},{"speaker":"Charles Goldfarb","startTime":1583.01,"endTime":1586.916,"body":"the skateboard. Do you think"},{"speaker":"Charles Goldfarb","startTime":1586.983,"endTime":1590.36,"body":"about the same way? Do you do"},{"speaker":"Charles Goldfarb","startTime":1586.983,"endTime":1590.36,"body":"anything differently?"},{"speaker":"Chris Dy","startTime":1590.36,"endTime":1592.994,"body":"No, I do I think about"},{"speaker":"Chris Dy","startTime":1590.36,"endTime":1592.994,"body":"it the same way. And I was just"},{"speaker":"Chris Dy","startTime":1593.043,"endTime":1596.116,"body":"thinking this is approach. This"},{"speaker":"Chris Dy","startTime":1593.043,"endTime":1596.116,"body":"is an approach where, you know,"},{"speaker":"Chris Dy","startTime":1596.165,"endTime":1599.288,"body":"we just, you don't get to see it"},{"speaker":"Chris Dy","startTime":1596.165,"endTime":1599.288,"body":"enough. I think, you know, what"},{"speaker":"Chris Dy","startTime":1599.336,"endTime":1602.459,"body":"I make sure to tell our fellows,"},{"speaker":"Chris Dy","startTime":1599.336,"endTime":1602.459,"body":"you know, if somebody's doing a"},{"speaker":"Chris Dy","startTime":1602.508,"endTime":1605.045,"body":"bowler approach escape, we"},{"speaker":"Chris Dy","startTime":1602.508,"endTime":1605.045,"body":"definitely see that case,"},{"speaker":"Chris Dy","startTime":1605.093,"endTime":1607.777,"body":"because scaffold nonunions are"},{"speaker":"Chris Dy","startTime":1605.093,"endTime":1607.777,"body":"something that a general"},{"speaker":"Chris Dy","startTime":1607.825,"endTime":1610.704,"body":"practicing hand surgeon should"},{"speaker":"Chris Dy","startTime":1607.825,"endTime":1610.704,"body":"be able to tackle, you know,"},{"speaker":"Chris Dy","startTime":1610.753,"endTime":1613.485,"body":"especially considering the"},{"speaker":"Chris Dy","startTime":1610.753,"endTime":1613.485,"body":"growing evidence that some of"},{"speaker":"Chris Dy","startTime":1613.534,"endTime":1616.412,"body":"the MFC, MFT, things are less or"},{"speaker":"Chris Dy","startTime":1613.534,"endTime":1616.412,"body":"more narrowly indicated, I"},{"speaker":"Chris Dy","startTime":1616.461,"endTime":1619.339,"body":"should say. So this is something"},{"speaker":"Chris Dy","startTime":1616.461,"endTime":1619.339,"body":"that you should be able to"},{"speaker":"Chris Dy","startTime":1619.388,"endTime":1622.266,"body":"tackle and approach and you"},{"speaker":"Chris Dy","startTime":1619.388,"endTime":1622.266,"body":"know, I agree entirely with the"},{"speaker":"Chris Dy","startTime":1622.315,"endTime":1624.56,"body":"with the incision, and and what"},{"speaker":"Chris Dy","startTime":1622.315,"endTime":1624.56,"body":"you described."},{"speaker":"Charles Goldfarb","startTime":1624.56,"endTime":1627.321,"body":"Yeah, and the"},{"speaker":"Charles Goldfarb","startTime":1624.56,"endTime":1627.321,"body":"fiddle factor can be high once"},{"speaker":"Charles Goldfarb","startTime":1627.383,"endTime":1631.274,"body":"you're addressing the scaphoid"},{"speaker":"Charles Goldfarb","startTime":1627.383,"endTime":1631.274,"body":"itself. And so a rapid approach"},{"speaker":"Charles Goldfarb","startTime":1631.337,"endTime":1635.165,"body":"is super helpful, because you"},{"speaker":"Charles Goldfarb","startTime":1631.337,"endTime":1635.165,"body":"don't want to waste time with a"},{"speaker":"Charles Goldfarb","startTime":1635.227,"endTime":1639.306,"body":"prolonged approach. It shouldn't"},{"speaker":"Charles Goldfarb","startTime":1635.227,"endTime":1639.306,"body":"take long. But to your point, if"},{"speaker":"Charles Goldfarb","startTime":1639.369,"endTime":1643.26,"body":"you're not doing this approach"},{"speaker":"Charles Goldfarb","startTime":1639.369,"endTime":1643.26,"body":"all the time, then you you move"},{"speaker":"Charles Goldfarb","startTime":1643.323,"endTime":1647.213,"body":"a little more slowly. So once"},{"speaker":"Charles Goldfarb","startTime":1643.323,"endTime":1647.213,"body":"things are exposed, old hardware"},{"speaker":"Charles Goldfarb","startTime":1647.276,"endTime":1651.229,"body":"has been removed, whether from"},{"speaker":"Charles Goldfarb","startTime":1647.276,"endTime":1651.229,"body":"dorsal or Bohler. And I will say"},{"speaker":"Charles Goldfarb","startTime":1651.292,"endTime":1655.12,"body":"that I don't mind going both"},{"speaker":"Charles Goldfarb","startTime":1651.292,"endTime":1655.12,"body":"sides of the skateboard. I don't"},{"speaker":"Charles Goldfarb","startTime":1655.183,"endTime":1658.509,"body":"think that's a big deal."},{"speaker":"Charles Goldfarb","startTime":1655.183,"endTime":1658.509,"body":"Ideally, you'd just pick one"},{"speaker":"Charles Goldfarb","startTime":1658.571,"endTime":1662.399,"body":"side and you go volar in this"},{"speaker":"Charles Goldfarb","startTime":1658.571,"endTime":1662.399,"body":"case, and then it's preparation"},{"speaker":"Charles Goldfarb","startTime":1662.462,"endTime":1666.102,"body":"of the nonunion. So that has to"},{"speaker":"Charles Goldfarb","startTime":1662.462,"endTime":1666.102,"body":"be done really well. And I"},{"speaker":"Charles Goldfarb","startTime":1666.164,"endTime":1670.118,"body":"typically put joysticks in the"},{"speaker":"Charles Goldfarb","startTime":1666.164,"endTime":1670.118,"body":"proximal and distal skateboards,"},{"speaker":"Charles Goldfarb","startTime":1670.181,"endTime":1673.946,"body":"so 0.062k wire, all right, was"},{"speaker":"Charles Goldfarb","startTime":1670.181,"endTime":1673.946,"body":"that a 1.1 millimeter or one?"},{"speaker":"Charles Goldfarb","startTime":1674.009,"endTime":1677.711,"body":"Maybe it's I don't know, but"},{"speaker":"Charles Goldfarb","startTime":1674.009,"endTime":1677.711,"body":"Well, I think it's a 1.2 - 1.2"},{"speaker":"Charles Goldfarb","startTime":1677.774,"endTime":1678.59,"body":"mm . Anyways,"},{"speaker":"Chris Dy","startTime":1678.74,"endTime":1681.62,"body":"we have a chart we"},{"speaker":"Chris Dy","startTime":1678.74,"endTime":1681.62,"body":"have a chart in my or convert"},{"speaker":"Chris Dy","startTime":1681.62,"endTime":1685.58,"body":"these things. Because even the"},{"speaker":"Chris Dy","startTime":1681.62,"endTime":1685.58,"body":"reps don't talk American. Talk"},{"speaker":"Chris Dy","startTime":1685.58,"endTime":1688.82,"body":"to me and millimeters oh my god,"},{"speaker":"Chris Dy","startTime":1685.58,"endTime":1688.82,"body":"K wires are actually in standard"},{"speaker":"Chris Dy","startTime":1688.82,"endTime":1690.83,"body":"units. So anyway,"},{"speaker":"Charles Goldfarb","startTime":1691.22,"endTime":1694.01,"body":"so joysticks"},{"speaker":"Charles Goldfarb","startTime":1691.22,"endTime":1694.01,"body":"open up the scaphoid curette"},{"speaker":"Charles Goldfarb","startTime":1694.01,"endTime":1697.76,"body":"runs your get to good Kitselas"},{"speaker":"Charles Goldfarb","startTime":1694.01,"endTime":1697.76,"body":"bone if you don't do that, it"},{"speaker":"Charles Goldfarb","startTime":1697.76,"endTime":1699.02,"body":"doesn't matter what to do after."},{"speaker":"Chris Dy","startTime":1699.86,"endTime":1701.87,"body":"Right. So you're"},{"speaker":"Chris Dy","startTime":1699.86,"endTime":1701.87,"body":"talking briefly about getting"},{"speaker":"Chris Dy","startTime":1701.87,"endTime":1704.63,"body":"out the hardware, sometimes you"},{"speaker":"Chris Dy","startTime":1701.87,"endTime":1704.63,"body":"if they that hardware was"},{"speaker":"Chris Dy","startTime":1704.63,"endTime":1707.6,"body":"inserted in, you know,"},{"speaker":"Chris Dy","startTime":1704.63,"endTime":1707.6,"body":"retrograde manner, you know, are"},{"speaker":"Chris Dy","startTime":1707.6,"endTime":1711.05,"body":"you having to, you know, trim"},{"speaker":"Chris Dy","startTime":1707.6,"endTime":1711.05,"body":"back some trapezium, or just in"},{"speaker":"Chris Dy","startTime":1711.05,"endTime":1714.14,"body":"general, if you're putting in in"},{"speaker":"Chris Dy","startTime":1711.05,"endTime":1714.14,"body":"retrograde screw, you do have to"},{"speaker":"Chris Dy","startTime":1714.14,"endTime":1716.3,"body":"take a little trapezium at the"},{"speaker":"Chris Dy","startTime":1714.14,"endTime":1716.3,"body":"st joint, right?"},{"speaker":"Charles Goldfarb","startTime":1716.3,"endTime":1718.811,"body":"Yeah, it makes"},{"speaker":"Charles Goldfarb","startTime":1716.3,"endTime":1718.811,"body":"these two cases made me think"},{"speaker":"Charles Goldfarb","startTime":1718.869,"endTime":1722.408,"body":"about how to put in hardware in"},{"speaker":"Charles Goldfarb","startTime":1718.869,"endTime":1722.408,"body":"a way that if you have to take"},{"speaker":"Charles Goldfarb","startTime":1722.465,"endTime":1726.005,"body":"it out, it's not a disaster. And"},{"speaker":"Charles Goldfarb","startTime":1722.465,"endTime":1726.005,"body":"so, it, these were both quite"},{"speaker":"Charles Goldfarb","startTime":1726.062,"endTime":1729.544,"body":"challenging, because number one,"},{"speaker":"Charles Goldfarb","startTime":1726.062,"endTime":1729.544,"body":"the screws were countersunk,"},{"speaker":"Charles Goldfarb","startTime":1729.602,"endTime":1733.027,"body":"quite a bit. And number two,"},{"speaker":"Charles Goldfarb","startTime":1729.602,"endTime":1733.027,"body":"they weren't inserted in what I"},{"speaker":"Charles Goldfarb","startTime":1733.084,"endTime":1736.509,"body":"would say the typical location"},{"speaker":"Charles Goldfarb","startTime":1733.084,"endTime":1736.509,"body":"is, so you have to work a lot"},{"speaker":"Charles Goldfarb","startTime":1736.567,"endTime":1740.049,"body":"harder to identify the entry"},{"speaker":"Charles Goldfarb","startTime":1736.567,"endTime":1740.049,"body":"point, you don't want to destroy"},{"speaker":"Charles Goldfarb","startTime":1740.106,"endTime":1743.417,"body":"the cartilage of whether it's"},{"speaker":"Charles Goldfarb","startTime":1740.106,"endTime":1743.417,"body":"the proximal scaphoid or the"},{"speaker":"Charles Goldfarb","startTime":1743.474,"endTime":1746.557,"body":"distal scaphoid. And it becomes"},{"speaker":"Charles Goldfarb","startTime":1743.474,"endTime":1746.557,"body":"very, very tricky. But"},{"speaker":"Charles Goldfarb","startTime":1746.614,"endTime":1750.44,"body":"ultimately, you have to take out"},{"speaker":"Charles Goldfarb","startTime":1746.614,"endTime":1750.44,"body":"the hardware one way or the other."},{"speaker":"Chris Dy","startTime":1750.95,"endTime":1753.71,"body":"Right, so hardware is"},{"speaker":"Chris Dy","startTime":1750.95,"endTime":1753.71,"body":"out, you've opened up you've got"},{"speaker":"Chris Dy","startTime":1753.71,"endTime":1757.91,"body":"your, your joysticks, and you've"},{"speaker":"Chris Dy","startTime":1753.71,"endTime":1757.91,"body":"depleted the non union site. So"},{"speaker":"Chris Dy","startTime":1757.91,"endTime":1760.61,"body":"then we don't have to get into"},{"speaker":"Chris Dy","startTime":1757.91,"endTime":1760.61,"body":"the technical aspects of you"},{"speaker":"Chris Dy","startTime":1760.61,"endTime":1763.37,"body":"know, we should maybe in a"},{"speaker":"Chris Dy","startTime":1760.61,"endTime":1763.37,"body":"follow up episode talk about you"},{"speaker":"Chris Dy","startTime":1763.37,"endTime":1767.24,"body":"know, your approach to"},{"speaker":"Chris Dy","startTime":1763.37,"endTime":1767.24,"body":"harvesting a modified per se, or"},{"speaker":"Chris Dy","startTime":1767.24,"endTime":1771.02,"body":"try cortical or by cortical"},{"speaker":"Chris Dy","startTime":1767.24,"endTime":1771.02,"body":"iliac crest. How do you approach"},{"speaker":"Chris Dy","startTime":1771.02,"endTime":1772.28,"body":"the fixation part of it?"},{"speaker":"Charles Goldfarb","startTime":1772.28,"endTime":1775.408,"body":"What I think"},{"speaker":"Charles Goldfarb","startTime":1772.28,"endTime":1775.408,"body":"is critical is is once you have"},{"speaker":"Charles Goldfarb","startTime":1775.479,"endTime":1779.888,"body":"opened up the escape void and"},{"speaker":"Charles Goldfarb","startTime":1775.479,"endTime":1779.888,"body":"placed your bone grab, I like to"},{"speaker":"Charles Goldfarb","startTime":1779.959,"endTime":1784.084,"body":"create the skateboard as a"},{"speaker":"Charles Goldfarb","startTime":1779.959,"endTime":1784.084,"body":"single mobile unit. And so I do"},{"speaker":"Charles Goldfarb","startTime":1784.155,"endTime":1788.492,"body":"place a derotation K wire off"},{"speaker":"Charles Goldfarb","startTime":1784.155,"endTime":1788.492,"body":"axis. Typically its a 0.045 and"},{"speaker":"Charles Goldfarb","startTime":1788.564,"endTime":1792.688,"body":"that allows me then to move the"},{"speaker":"Charles Goldfarb","startTime":1788.564,"endTime":1792.688,"body":"scaphoid is a unit and the"},{"speaker":"Charles Goldfarb","startTime":1792.759,"endTime":1797.168,"body":"reason that's so helpful is you"},{"speaker":"Charles Goldfarb","startTime":1792.759,"endTime":1797.168,"body":"can put a retractor underneath"},{"speaker":"Charles Goldfarb","startTime":1797.239,"endTime":1801.861,"body":"the distal skate void giving you"},{"speaker":"Charles Goldfarb","startTime":1797.239,"endTime":1801.861,"body":"better exposure to the articular"},{"speaker":"Charles Goldfarb","startTime":1801.932,"endTime":1806.056,"body":"surface at the trapezium, which"},{"speaker":"Charles Goldfarb","startTime":1801.932,"endTime":1806.056,"body":"allows you to put a better"},{"speaker":"Charles Goldfarb","startTime":1806.128,"endTime":1810.039,"body":"homerun screw in a retrograde"},{"speaker":"Charles Goldfarb","startTime":1806.128,"endTime":1810.039,"body":"fashion. So for me that's"},{"speaker":"Charles Goldfarb","startTime":1810.11,"endTime":1814.305,"body":"critically important and allows"},{"speaker":"Charles Goldfarb","startTime":1810.11,"endTime":1814.305,"body":"just a much more satisfying"},{"speaker":"Charles Goldfarb","startTime":1814.376,"endTime":1817.79,"body":"progression of steps. Do you do"},{"speaker":"Charles Goldfarb","startTime":1814.376,"endTime":1817.79,"body":"that same thing?"},{"speaker":"Chris Dy","startTime":1818.66,"endTime":1820.85,"body":"Um, yeah, I think I"},{"speaker":"Chris Dy","startTime":1818.66,"endTime":1820.85,"body":"think that's super helpful. I"},{"speaker":"Chris Dy","startTime":1820.85,"endTime":1822.74,"body":"think the rotational wire is"},{"speaker":"Chris Dy","startTime":1820.85,"endTime":1822.74,"body":"helpful, and I agree it does"},{"speaker":"Chris Dy","startTime":1822.74,"endTime":1825.2,"body":"help with the exposure. I'm what"},{"speaker":"Chris Dy","startTime":1822.74,"endTime":1825.2,"body":"I'm pondering right now is"},{"speaker":"Chris Dy","startTime":1825.2,"endTime":1827.15,"body":"whether I would actually then"},{"speaker":"Chris Dy","startTime":1825.2,"endTime":1827.15,"body":"after I've gotten that"},{"speaker":"Chris Dy","startTime":1827.15,"endTime":1830.27,"body":"skateboard in better position,"},{"speaker":"Chris Dy","startTime":1827.15,"endTime":1830.27,"body":"then choose to do a percutaneous"},{"speaker":"Chris Dy","startTime":1830.27,"endTime":1833.06,"body":"dorsal or mini open approach if"},{"speaker":"Chris Dy","startTime":1830.27,"endTime":1833.06,"body":"I haven't already done that to"},{"speaker":"Chris Dy","startTime":1833.06,"endTime":1836.33,"body":"put the screw from in an"},{"speaker":"Chris Dy","startTime":1833.06,"endTime":1836.33,"body":"integrated manner. But I guess"},{"speaker":"Chris Dy","startTime":1836.33,"endTime":1838.28,"body":"at that point, if I already"},{"speaker":"Chris Dy","startTime":1836.33,"endTime":1838.28,"body":"removed hardware and kind of"},{"speaker":"Chris Dy","startTime":1838.28,"endTime":1840.59,"body":"gone to the trapezium, it might"},{"speaker":"Chris Dy","startTime":1838.28,"endTime":1840.59,"body":"make more sense to get your home"},{"speaker":"Chris Dy","startTime":1840.59,"endTime":1844.64,"body":"run screw, as you call it from,"},{"speaker":"Chris Dy","startTime":1840.59,"endTime":1844.64,"body":"you know, from distal to"},{"speaker":"Chris Dy","startTime":1844.64,"endTime":1845.78,"body":"proximal or retrograde."},{"speaker":"Charles Goldfarb","startTime":1846.38,"endTime":1848.54,"body":"Yeah,"},{"speaker":"Charles Goldfarb","startTime":1846.38,"endTime":1848.54,"body":"especially if your distal"},{"speaker":"Charles Goldfarb","startTime":1848.54,"endTime":1851.12,"body":"fragment is the smaller"},{"speaker":"Charles Goldfarb","startTime":1848.54,"endTime":1851.12,"body":"fragment. In that case,"},{"speaker":"Charles Goldfarb","startTime":1851.21,"endTime":1853.97,"body":"obviously, you would put your"},{"speaker":"Charles Goldfarb","startTime":1851.21,"endTime":1853.97,"body":"screw in from volere and from"},{"speaker":"Charles Goldfarb","startTime":1853.97,"endTime":1857.3,"body":"distal, to give you the best"},{"speaker":"Charles Goldfarb","startTime":1853.97,"endTime":1857.3,"body":"possible stability. But to your"},{"speaker":"Charles Goldfarb","startTime":1857.3,"endTime":1860.9,"body":"point, it's never wrong to go"},{"speaker":"Charles Goldfarb","startTime":1857.3,"endTime":1860.9,"body":"back dorsal it's easier to put"},{"speaker":"Charles Goldfarb","startTime":1860.9,"endTime":1865.1,"body":"the homerun screw in from dorsal"},{"speaker":"Charles Goldfarb","startTime":1860.9,"endTime":1865.1,"body":"for sure. I typically have been"},{"speaker":"Charles Goldfarb","startTime":1865.1,"endTime":1868.58,"body":"on one screw person, and you"},{"speaker":"Charles Goldfarb","startTime":1865.1,"endTime":1868.58,"body":"sort of have to balance"},{"speaker":"Charles Goldfarb","startTime":1868.58,"endTime":1871.55,"body":"placement of the screw without"},{"speaker":"Charles Goldfarb","startTime":1868.58,"endTime":1871.55,"body":"dislodging your bone graft,"},{"speaker":"Charles Goldfarb","startTime":1871.55,"endTime":1874.31,"body":"especially when it's a by"},{"speaker":"Charles Goldfarb","startTime":1871.55,"endTime":1874.31,"body":"cortical or tri cortical graph."},{"speaker":"Charles Goldfarb","startTime":1875.36,"endTime":1878.75,"body":"But that graft is a source of"},{"speaker":"Charles Goldfarb","startTime":1875.36,"endTime":1878.75,"body":"stability as well. And so if"},{"speaker":"Charles Goldfarb","startTime":1878.75,"endTime":1881.6,"body":"you've, if you tailored your"},{"speaker":"Charles Goldfarb","startTime":1878.75,"endTime":1881.6,"body":"graph, well, if you've done good"},{"speaker":"Charles Goldfarb","startTime":1881.6,"endTime":1885.17,"body":"carpentry on your graph, and you"},{"speaker":"Charles Goldfarb","startTime":1881.6,"endTime":1885.17,"body":"put it on the volar aspect of"},{"speaker":"Charles Goldfarb","startTime":1885.17,"endTime":1887.81,"body":"the skateboard, hopefully your"},{"speaker":"Charles Goldfarb","startTime":1885.17,"endTime":1887.81,"body":"screw starts and proceed"},{"speaker":"Charles Goldfarb","startTime":1887.81,"endTime":1890.72,"body":"slightly dorsally. But still,"},{"speaker":"Charles Goldfarb","startTime":1887.81,"endTime":1890.72,"body":"hopefully this inner center"},{"speaker":"Charles Goldfarb","startTime":1890.72,"endTime":1891.95,"body":"location, right"},{"speaker":"Chris Dy","startTime":1891.95,"endTime":1893.69,"body":"as we draw to a close,"},{"speaker":"Chris Dy","startTime":1891.95,"endTime":1893.69,"body":"I mean, you're really hoping for"},{"speaker":"Chris Dy","startTime":1893.69,"endTime":1899.12,"body":"an interference fit of that of"},{"speaker":"Chris Dy","startTime":1893.69,"endTime":1899.12,"body":"that cortical graft on a bowler"},{"speaker":"Chris Dy","startTime":1899.12,"endTime":1903.14,"body":"aspect. Question for you. Would"},{"speaker":"Chris Dy","startTime":1899.12,"endTime":1903.14,"body":"you ever consider a plate in"},{"speaker":"Chris Dy","startTime":1903.14,"endTime":1903.86,"body":"this situation?"},{"speaker":"Charles Goldfarb","startTime":1905.87,"endTime":1908.12,"body":"I would"},{"speaker":"Charles Goldfarb","startTime":1905.87,"endTime":1908.12,"body":"consider a plate I have not"},{"speaker":"Charles Goldfarb","startTime":1908.15,"endTime":1913.73,"body":"placed a plate I have done K"},{"speaker":"Charles Goldfarb","startTime":1908.15,"endTime":1913.73,"body":"wire only fixation. I don't love"},{"speaker":"Charles Goldfarb","startTime":1913.73,"endTime":1916.67,"body":"K wire only fixation. But again,"},{"speaker":"Charles Goldfarb","startTime":1913.73,"endTime":1916.67,"body":"if you've done your carpenter"},{"speaker":"Charles Goldfarb","startTime":1916.67,"endTime":1921.68,"body":"correct, and you have good press"},{"speaker":"Charles Goldfarb","startTime":1916.67,"endTime":1921.68,"body":"fit. In our case, it was by"},{"speaker":"Charles Goldfarb","startTime":1921.68,"endTime":1925.31,"body":"cortical iliac crest. I don't"},{"speaker":"Charles Goldfarb","startTime":1921.68,"endTime":1925.31,"body":"think it's crazy to stick to K"},{"speaker":"Charles Goldfarb","startTime":1925.31,"endTime":1929.06,"body":"wires if you can't get a good"},{"speaker":"Charles Goldfarb","startTime":1925.31,"endTime":1929.06,"body":"starting point because of a"},{"speaker":"Charles Goldfarb","startTime":1929.06,"endTime":1932.66,"body":"previously placed placed screw,"},{"speaker":"Charles Goldfarb","startTime":1929.06,"endTime":1932.66,"body":"which makes everything more"},{"speaker":"Charles Goldfarb","startTime":1932.66,"endTime":1936.65,"body":"challenging. So it's it can be"},{"speaker":"Charles Goldfarb","startTime":1932.66,"endTime":1936.65,"body":"really tricky in these revisions"},{"speaker":"Charles Goldfarb","startTime":1936.65,"endTime":1940.94,"body":"with hardware removal I played"},{"speaker":"Charles Goldfarb","startTime":1936.65,"endTime":1940.94,"body":"is not a bad idea. And I would I"},{"speaker":"Charles Goldfarb","startTime":1940.94,"endTime":1943.64,"body":"would probably stick to you know"},{"speaker":"Charles Goldfarb","startTime":1940.94,"endTime":1943.64,"body":"a two Oh plate or something like"},{"speaker":"Charles Goldfarb","startTime":1943.64,"endTime":1945.62,"body":"that. But I don't have any"},{"speaker":"Charles Goldfarb","startTime":1943.64,"endTime":1945.62,"body":"personal experience with plates."},{"speaker":"Charles Goldfarb","startTime":1945.62,"endTime":1946.52,"body":"Have you done plates?"},{"speaker":"Chris Dy","startTime":1947.21,"endTime":1949.46,"body":"Haven't I know that"},{"speaker":"Chris Dy","startTime":1947.21,"endTime":1949.46,"body":"there is one manufacturer that"},{"speaker":"Chris Dy","startTime":1949.46,"endTime":1952.25,"body":"does have a scaphoid specific"},{"speaker":"Chris Dy","startTime":1949.46,"endTime":1952.25,"body":"plate that's been talked about"},{"speaker":"Chris Dy","startTime":1952.25,"endTime":1956.06,"body":"quite a bit and published about"},{"speaker":"Chris Dy","startTime":1952.25,"endTime":1956.06,"body":"quite a bit. I have not yet. But"},{"speaker":"Chris Dy","startTime":1956.3,"endTime":1959.15,"body":"if I were to, you know, that"},{"speaker":"Chris Dy","startTime":1956.3,"endTime":1959.15,"body":"might be the one situation in"},{"speaker":"Chris Dy","startTime":1959.15,"endTime":1962.6,"body":"which I would consider this. You"},{"speaker":"Chris Dy","startTime":1959.15,"endTime":1962.6,"body":"know if it does help obviously"},{"speaker":"Chris Dy","startTime":1962.66,"endTime":1968.54,"body":"secure the location of your of"},{"speaker":"Chris Dy","startTime":1962.66,"endTime":1968.54,"body":"your carpentry. So that was fun."},{"speaker":"Chris Dy","startTime":1968.96,"endTime":1971.93,"body":"If you IF listeners if you want"},{"speaker":"Chris Dy","startTime":1968.96,"endTime":1971.93,"body":"to hear more about Chuck's"},{"speaker":"Chris Dy","startTime":1971.93,"endTime":1974.15,"body":"adventures with revision"},{"speaker":"Chris Dy","startTime":1971.93,"endTime":1974.15,"body":"skateboard and get into some of"},{"speaker":"Chris Dy","startTime":1974.15,"endTime":1978.68,"body":"the weeds and details about you"},{"speaker":"Chris Dy","startTime":1974.15,"endTime":1978.68,"body":"know the trade off, let us know"},{"speaker":"Chris Dy","startTime":1978.68,"endTime":1980.69,"body":"or if there are any other"},{"speaker":"Chris Dy","startTime":1978.68,"endTime":1980.69,"body":"questions, feel free to send in"},{"speaker":"Chris Dy","startTime":1980.69,"endTime":1983.39,"body":"suggestions for topics and look"},{"speaker":"Chris Dy","startTime":1980.69,"endTime":1983.39,"body":"forward to catching up soon."},{"speaker":"Charles Goldfarb","startTime":1984.08,"endTime":1985.52,"body":"Fantastic."},{"speaker":"Charles Goldfarb","startTime":1984.08,"endTime":1985.52,"body":"Great to see you. Have a good"},{"speaker":"Charles Goldfarb","startTime":1985.52,"endTime":1986.96,"body":"day. Enjoy those nerve cases."},{"speaker":"Chris Dy","startTime":1987.41,"endTime":1989.33,"body":"get to enjoy your"},{"speaker":"Chris Dy","startTime":1987.41,"endTime":1989.33,"body":"case. All right, take"},{"speaker":"Charles Goldfarb","startTime":1989.33,"endTime":1992.42,"body":"care. Hey,"},{"speaker":"Charles Goldfarb","startTime":1989.33,"endTime":1992.42,"body":"Chris, that was fun. Let's do it"},{"speaker":"Charles Goldfarb","startTime":1992.42,"endTime":1993.35,"body":"again real soon."},{"speaker":"Chris Dy","startTime":1993.35,"endTime":1996.152,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":1993.35,"endTime":1996.152,"body":"sure to email us with topic"},{"speaker":"Chris Dy","startTime":1996.21,"endTime":2000.1,"body":"suggestions and feedback, you"},{"speaker":"Chris Dy","startTime":1996.21,"endTime":2000.1,"body":"can reach us at handpodcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":2000.76,"endTime":2002.89,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":2000.76,"endTime":2002.89,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2002.89,"endTime":2003.85,"body":"get your podcast."},{"speaker":"Chris Dy","startTime":2003.85,"endTime":2007.537,"body":"And be sure to leave a"},{"speaker":"Chris Dy","startTime":2003.85,"endTime":2007.537,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2007.609,"endTime":2008.26,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":2008.26,"endTime":2011.213,"body":"Special thanks"},{"speaker":"Charles Goldfarb","startTime":2008.26,"endTime":2011.213,"body":"to Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":2011.277,"endTime":2011.92,"body":"music. And"},{"speaker":"Chris Dy","startTime":2012.16,"endTime":2014.26,"body":"remember, keep the"},{"speaker":"Chris Dy","startTime":2012.16,"endTime":2014.26,"body":"upper hand come back next time"}]}