{"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":"And 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":26.01,"body":"rating that helps us get the"},{"speaker":"Chris Dy","startTime":22.8,"endTime":26.01,"body":"word out. You can email us at"},{"speaker":"Chris Dy","startTime":26.04,"endTime":29.46,"body":"Handpodcast@gmail.com. So let's"},{"speaker":"Chris Dy","startTime":26.04,"endTime":29.46,"body":"get to the episode."},{"speaker":"Charles Goldfarb","startTime":31.53,"endTime":32.43,"body":"Oh, hey,"},{"speaker":"Charles Goldfarb","startTime":31.53,"endTime":32.43,"body":"Chris."},{"speaker":"Chris Dy","startTime":32.52,"endTime":33.48,"body":"Hey, Chuck, how are"},{"speaker":"Chris Dy","startTime":32.52,"endTime":33.48,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":34.02,"endTime":35.43,"body":"I'm great. How"},{"speaker":"Charles Goldfarb","startTime":34.02,"endTime":35.43,"body":"are you?"},{"speaker":"Chris Dy","startTime":35.61,"endTime":38.28,"body":"I'm well, I'm good."},{"speaker":"Chris Dy","startTime":35.61,"endTime":38.28,"body":"I'm finally trying to recover"},{"speaker":"Chris Dy","startTime":38.28,"endTime":41.73,"body":"from some of this jetlag, you"},{"speaker":"Chris Dy","startTime":38.28,"endTime":41.73,"body":"know, from the the old Singapore"},{"speaker":"Chris Dy","startTime":41.73,"endTime":45.54,"body":"trip. That was rough. Usually"},{"speaker":"Chris Dy","startTime":41.73,"endTime":45.54,"body":"jetlag doesn't get me but I"},{"speaker":"Chris Dy","startTime":45.54,"endTime":48.9,"body":"guess in my old age now it's"},{"speaker":"Chris Dy","startTime":45.54,"endTime":48.9,"body":"starting to starting to hit me"},{"speaker":"Chris Dy","startTime":48.9,"endTime":49.35,"body":"harder."},{"speaker":"Charles Goldfarb","startTime":49.71,"endTime":51.87,"body":"Yeah, welcome"},{"speaker":"Charles Goldfarb","startTime":49.71,"endTime":51.87,"body":"to my world. You're not really"},{"speaker":"Charles Goldfarb","startTime":51.87,"endTime":55.86,"body":"in my world, you'll never be"},{"speaker":"Charles Goldfarb","startTime":51.87,"endTime":55.86,"body":"here. Yeah, jetlag while doesn't"},{"speaker":"Charles Goldfarb","startTime":55.86,"endTime":56.67,"body":"seem like you."},{"speaker":"Chris Dy","startTime":57.0,"endTime":61.17,"body":"It actually doesn't."},{"speaker":"Chris Dy","startTime":57.0,"endTime":61.17,"body":"Which is weird, because I like"},{"speaker":"Chris Dy","startTime":61.17,"endTime":64.74,"body":"to think that I'm chronically"},{"speaker":"Chris Dy","startTime":61.17,"endTime":64.74,"body":"sleep deprived. So it just kind"},{"speaker":"Chris Dy","startTime":64.74,"endTime":68.1,"body":"of it's like being on call. But"},{"speaker":"Chris Dy","startTime":64.74,"endTime":68.1,"body":"you know, like many people say,"},{"speaker":"Chris Dy","startTime":68.13,"endTime":70.56,"body":"you know, it's harder to bounce"},{"speaker":"Chris Dy","startTime":68.13,"endTime":70.56,"body":"back from the all night calls,"},{"speaker":"Chris Dy","startTime":70.83,"endTime":71.88,"body":"the older you get."},{"speaker":"Charles Goldfarb","startTime":72.66,"endTime":75.0,"body":"So I'd love to"},{"speaker":"Charles Goldfarb","startTime":72.66,"endTime":75.0,"body":"hear about the trip. How was How"},{"speaker":"Charles Goldfarb","startTime":75.0,"endTime":76.23,"body":"was the trip, tell me about"},{"speaker":"Chris Dy","startTime":75.0,"endTime":79.14,"body":"trip was great. Spent"},{"speaker":"Chris Dy","startTime":75.0,"endTime":79.14,"body":"a lot of good time with the"},{"speaker":"Chris Dy","startTime":79.2,"endTime":83.4,"body":"research teams that the"},{"speaker":"Chris Dy","startTime":79.2,"endTime":83.4,"body":"different Singapore hospitals,"},{"speaker":"Chris Dy","startTime":83.46,"endTime":86.16,"body":"they all kind of came together"},{"speaker":"Chris Dy","startTime":83.46,"endTime":86.16,"body":"for this research course, which"},{"speaker":"Chris Dy","startTime":86.16,"endTime":91.29,"body":"was great. You know, it was a"},{"speaker":"Chris Dy","startTime":86.16,"endTime":91.29,"body":"pretty whirlwind tour of how to"},{"speaker":"Chris Dy","startTime":91.29,"endTime":95.55,"body":"do research as a surgeon. So it"},{"speaker":"Chris Dy","startTime":91.29,"endTime":95.55,"body":"was very dense. And I learned a"},{"speaker":"Chris Dy","startTime":95.55,"endTime":98.61,"body":"lot honestly, sitting in the"},{"speaker":"Chris Dy","startTime":95.55,"endTime":98.61,"body":"audience. There were some great"},{"speaker":"Chris Dy","startTime":98.61,"endTime":103.02,"body":"lectures. And it was it was very"},{"speaker":"Chris Dy","startTime":98.61,"endTime":103.02,"body":"fun. And we spent a couple extra"},{"speaker":"Chris Dy","startTime":103.02,"endTime":106.8,"body":"days on the back end hanging out"},{"speaker":"Chris Dy","startTime":103.02,"endTime":106.8,"body":"with the family in Singapore,"},{"speaker":"Chris Dy","startTime":106.8,"endTime":107.64,"body":"which was very fun."},{"speaker":"Charles Goldfarb","startTime":108.12,"endTime":110.07,"body":"I can only"},{"speaker":"Charles Goldfarb","startTime":108.12,"endTime":110.07,"body":"imagine and you weren't the only"},{"speaker":"Charles Goldfarb","startTime":110.07,"endTime":111.57,"body":"American guest they brought"},{"speaker":"Charles Goldfarb","startTime":110.07,"endTime":111.57,"body":"over."},{"speaker":"Chris Dy","startTime":112.65,"endTime":116.7,"body":"I wasn't-  it was"},{"speaker":"Chris Dy","startTime":112.65,"endTime":116.7,"body":"nice. There was a another"},{"speaker":"Chris Dy","startTime":116.7,"endTime":118.83,"body":"invited guests from the"},{"speaker":"Chris Dy","startTime":116.7,"endTime":118.83,"body":"University of Michigan, Dr."},{"speaker":"Chris Dy","startTime":118.83,"endTime":121.89,"body":"Kevin Chung, who needs no"},{"speaker":"Chris Dy","startTime":118.83,"endTime":121.89,"body":"introduction, probably for the"},{"speaker":"Chris Dy","startTime":121.89,"endTime":125.88,"body":"majority of listeners, but"},{"speaker":"Chris Dy","startTime":121.89,"endTime":125.88,"body":"fantastic clinician scientists."},{"speaker":"Chris Dy","startTime":126.45,"endTime":130.38,"body":"And we had a nice time"},{"speaker":"Chris Dy","startTime":126.45,"endTime":130.38,"body":"discussing all things research"},{"speaker":"Chris Dy","startTime":130.38,"endTime":132.45,"body":"related from tactical to"},{"speaker":"Chris Dy","startTime":130.38,"endTime":132.45,"body":"personal."},{"speaker":"Charles Goldfarb","startTime":134.43,"endTime":138.21,"body":"Oh I love it."},{"speaker":"Charles Goldfarb","startTime":134.43,"endTime":138.21,"body":"Well, that's good. What? Are you"},{"speaker":"Charles Goldfarb","startTime":138.21,"endTime":140.31,"body":"home for a while or when's your"},{"speaker":"Charles Goldfarb","startTime":138.21,"endTime":140.31,"body":"next trip"},{"speaker":"Chris Dy","startTime":141.15,"endTime":143.34,"body":"home for a while. You"},{"speaker":"Chris Dy","startTime":141.15,"endTime":143.34,"body":"actually did the old out and"},{"speaker":"Chris Dy","startTime":143.34,"endTime":146.73,"body":"back to Chicago for a hidden"},{"speaker":"Chris Dy","startTime":143.34,"endTime":146.73,"body":"society research grants review"},{"speaker":"Chris Dy","startTime":146.73,"endTime":150.81,"body":"committee. Was it I guess"},{"speaker":"Chris Dy","startTime":146.73,"endTime":150.81,"body":"Friday? Yeah, two days ago. So I"},{"speaker":"Chris Dy","startTime":150.81,"endTime":153.09,"body":"don't know how often you do the"},{"speaker":"Chris Dy","startTime":150.81,"endTime":153.09,"body":"Outback, but it was an early"},{"speaker":"Chris Dy","startTime":153.09,"endTime":155.55,"body":"morning flight and a late"},{"speaker":"Chris Dy","startTime":153.09,"endTime":155.55,"body":"afternoon flight back and I'm"},{"speaker":"Chris Dy","startTime":155.58,"endTime":158.67,"body":"actually happy I didn't spend a"},{"speaker":"Chris Dy","startTime":155.58,"endTime":158.67,"body":"night there. It was it was good"},{"speaker":"Chris Dy","startTime":158.67,"endTime":161.46,"body":"to have the nighttime at home on"},{"speaker":"Chris Dy","startTime":158.67,"endTime":161.46,"body":"Thursday and Friday."},{"speaker":"Charles Goldfarb","startTime":161.91,"endTime":166.92,"body":"For sure. I I"},{"speaker":"Charles Goldfarb","startTime":161.91,"endTime":166.92,"body":"did. I was in Minneapolis for"},{"speaker":"Charles Goldfarb","startTime":166.92,"endTime":171.06,"body":"Saturday for an Saudi council"},{"speaker":"Charles Goldfarb","startTime":166.92,"endTime":171.06,"body":"meeting. And those trips are"},{"speaker":"Charles Goldfarb","startTime":171.06,"endTime":174.09,"body":"tiring, though. Like you know,"},{"speaker":"Charles Goldfarb","startTime":171.06,"endTime":174.09,"body":"you can do it all in a day. But"},{"speaker":"Charles Goldfarb","startTime":174.12,"endTime":175.77,"body":"I think those are tiring."},{"speaker":"Chris Dy","startTime":176.4,"endTime":179.22,"body":"Yeah, they are. They"},{"speaker":"Chris Dy","startTime":176.4,"endTime":179.22,"body":"are I actually have had a debate"},{"speaker":"Chris Dy","startTime":179.22,"endTime":181.92,"body":"with one of our with two of our"},{"speaker":"Chris Dy","startTime":179.22,"endTime":181.92,"body":"partners Dave Brogan and Ryan"},{"speaker":"Chris Dy","startTime":181.92,"endTime":185.31,"body":"Calfee about whether it's more"},{"speaker":"Chris Dy","startTime":181.92,"endTime":185.31,"body":"tiring or less tiring to, to go"},{"speaker":"Chris Dy","startTime":185.31,"endTime":187.38,"body":"out and back because they spent"},{"speaker":"Chris Dy","startTime":185.31,"endTime":187.38,"body":"the night in Chicago on"},{"speaker":"Chris Dy","startTime":187.38,"endTime":189.45,"body":"Thursday, but I couldn't because"},{"speaker":"Chris Dy","startTime":187.38,"endTime":189.45,"body":"it was our 15 year wedding"},{"speaker":"Chris Dy","startTime":189.45,"endTime":192.57,"body":"anniversary. So I was I figured"},{"speaker":"Chris Dy","startTime":189.45,"endTime":192.57,"body":"that was a higher priority."},{"speaker":"Chris Dy","startTime":192.87,"endTime":193.17,"body":"Yeah,"},{"speaker":"Charles Goldfarb","startTime":193.17,"endTime":196.86,"body":"thank you"},{"speaker":"Charles Goldfarb","startTime":193.17,"endTime":196.86,"body":"chose. You chose well. Wow, you"},{"speaker":"Charles Goldfarb","startTime":196.86,"endTime":200.22,"body":"just got 15 I'm about to have"},{"speaker":"Charles Goldfarb","startTime":196.86,"endTime":200.22,"body":"30- 30 years"},{"speaker":"Chris Dy","startTime":200.25,"endTime":202.62,"body":"Wow. Congratulations"},{"speaker":"Chris Dy","startTime":200.25,"endTime":202.62,"body":"to you guys. That's amazing."},{"speaker":"Chris Dy","startTime":202.62,"endTime":203.85,"body":"Yeah, pretty, pretty"},{"speaker":"Charles Goldfarb","startTime":203.85,"endTime":208.77,"body":"crazy. Pretty"},{"speaker":"Charles Goldfarb","startTime":203.85,"endTime":208.77,"body":"crazy. Good what what else is"},{"speaker":"Charles Goldfarb","startTime":208.77,"endTime":210.63,"body":"going on in your world? Kids are"},{"speaker":"Charles Goldfarb","startTime":208.77,"endTime":210.63,"body":"go."},{"speaker":"Chris Dy","startTime":211.17,"endTime":213.84,"body":"Kids are good."},{"speaker":"Chris Dy","startTime":211.17,"endTime":213.84,"body":"Everything is good. You know,"},{"speaker":"Chris Dy","startTime":213.87,"endTime":217.2,"body":"you had a lot of great feedback"},{"speaker":"Chris Dy","startTime":213.87,"endTime":217.2,"body":"about the podcast eager to get"},{"speaker":"Chris Dy","startTime":217.2,"endTime":221.73,"body":"back into this. So what's new in"},{"speaker":"Chris Dy","startTime":217.2,"endTime":221.73,"body":"hand surgery part two. But"},{"speaker":"Chris Dy","startTime":221.73,"endTime":224.88,"body":"anything anything going on in"},{"speaker":"Chris Dy","startTime":221.73,"endTime":224.88,"body":"the world of Chuck Goldfarb that"},{"speaker":"Charles Goldfarb","startTime":224.88,"endTime":226.83,"body":"Just keep my"},{"speaker":"Charles Goldfarb","startTime":224.88,"endTime":226.83,"body":"head above water. I'm actually"},{"speaker":"Charles Goldfarb","startTime":226.83,"endTime":230.28,"body":"looking forward to we have"},{"speaker":"Charles Goldfarb","startTime":226.83,"endTime":230.28,"body":"resident graduation this coming"},{"speaker":"Charles Goldfarb","startTime":230.28,"endTime":233.37,"body":"up by the time the podcast"},{"speaker":"Charles Goldfarb","startTime":230.28,"endTime":233.37,"body":"dropped. Jim Weinstein is in"},{"speaker":"Charles Goldfarb","startTime":233.37,"endTime":239.01,"body":"town who I think will be a"},{"speaker":"Charles Goldfarb","startTime":233.37,"endTime":239.01,"body":"really exceptional resident"},{"speaker":"Charles Goldfarb","startTime":239.01,"endTime":241.71,"body":"graduation speaker. So looking"},{"speaker":"Charles Goldfarb","startTime":239.01,"endTime":241.71,"body":"forward to that. Yeah,"},{"speaker":"Chris Dy","startTime":241.71,"endTime":243.84,"body":"it's interesting. He's"},{"speaker":"Chris Dy","startTime":241.71,"endTime":243.84,"body":"very famous in the spine and"},{"speaker":"Chris Dy","startTime":243.84,"endTime":246.63,"body":"orthopedics world. I had no idea"},{"speaker":"Chris Dy","startTime":243.84,"endTime":246.63,"body":"what he was doing. Aside from"},{"speaker":"Chris Dy","startTime":246.63,"endTime":248.52,"body":"that, which is really"},{"speaker":"Chris Dy","startTime":246.63,"endTime":248.52,"body":"impressive. I mean, kind of an"},{"speaker":"Chris Dy","startTime":248.52,"endTime":252.57,"body":"AI guru. He's working at"},{"speaker":"Chris Dy","startTime":248.52,"endTime":252.57,"body":"Microsoft now. And, you know,"},{"speaker":"Chris Dy","startTime":252.57,"endTime":256.47,"body":"was, I didn't realize it served"},{"speaker":"Chris Dy","startTime":252.57,"endTime":256.47,"body":"for two different presidential"},{"speaker":"Chris Dy","startTime":256.47,"endTime":258.96,"body":"administrations really"},{"speaker":"Chris Dy","startTime":256.47,"endTime":258.96,"body":"fascinating stuff for an"},{"speaker":"Chris Dy","startTime":258.96,"endTime":260.22,"body":"orthopedic surgeon to be doing."},{"speaker":"Charles Goldfarb","startTime":260.46,"endTime":262.44,"body":"Absolutely,"},{"speaker":"Charles Goldfarb","startTime":260.46,"endTime":262.44,"body":"absolutely. So yeah, I look"},{"speaker":"Charles Goldfarb","startTime":262.44,"endTime":266.46,"body":"forward to look forward to"},{"speaker":"Charles Goldfarb","startTime":262.44,"endTime":266.46,"body":"learning about that. Well, maybe"},{"speaker":"Charles Goldfarb","startTime":266.46,"endTime":269.31,"body":"before we jump in, we can thank"},{"speaker":"Charles Goldfarb","startTime":266.46,"endTime":269.31,"body":"our sponsors."},{"speaker":"Chris Dy","startTime":270.24,"endTime":272.13,"body":"Yeah, so I think the"},{"speaker":"Chris Dy","startTime":270.24,"endTime":272.13,"body":"the first one is"},{"speaker":"Chris Dy","startTime":272.16,"endTime":275.22,"body":"Practicelink.com. And I'm gonna"},{"speaker":"Chris Dy","startTime":272.16,"endTime":275.22,"body":"let you kind of lead on that one"},{"speaker":"Chris Dy","startTime":275.22,"endTime":276.96,"body":"because it's not in the chat for"},{"speaker":"Chris Dy","startTime":275.22,"endTime":276.96,"body":"me anymore."},{"speaker":"Charles Goldfarb","startTime":279.39,"endTime":281.94,"body":"the upper hand"},{"speaker":"Charles Goldfarb","startTime":279.39,"endTime":281.94,"body":"is sponsored by practicelink.com"},{"speaker":"Charles Goldfarb","startTime":281.97,"endTime":284.79,"body":"The most widely used physician"},{"speaker":"Charles Goldfarb","startTime":281.97,"endTime":284.79,"body":"job search and career"},{"speaker":"Charles Goldfarb","startTime":284.79,"endTime":288.06,"body":"advancement resource, but coming"},{"speaker":"Charles Goldfarb","startTime":284.79,"endTime":288.06,"body":"up position is hard. Finding the"},{"speaker":"Charles Goldfarb","startTime":288.06,"endTime":291.33,"body":"right job doesn't have to be"},{"speaker":"Charles Goldfarb","startTime":288.06,"endTime":291.33,"body":"joint practice link for free"},{"speaker":"Charles Goldfarb","startTime":291.45,"endTime":296.76,"body":"today at"},{"speaker":"Charles Goldfarb","startTime":291.45,"endTime":296.76,"body":"www.practicelink.com/theupperhand."},{"speaker":"Chris Dy","startTime":297.3,"endTime":299.19,"body":"I actually thought you"},{"speaker":"Chris Dy","startTime":297.3,"endTime":299.19,"body":"were gonna let me try to go off"},{"speaker":"Chris Dy","startTime":299.19,"endTime":301.92,"body":"of memory there because I would"},{"speaker":"Chris Dy","startTime":299.19,"endTime":301.92,"body":"have tried to be that's the one"},{"speaker":"Chris Dy","startTime":301.92,"endTime":303.87,"body":"I could have gotten off"},{"speaker":"Chris Dy","startTime":301.92,"endTime":303.87,"body":"memories. I"},{"speaker":"Charles Goldfarb","startTime":303.87,"endTime":305.43,"body":"would hope we"},{"speaker":"Charles Goldfarb","startTime":303.87,"endTime":305.43,"body":"both could, but I didn't have"},{"speaker":"Charles Goldfarb","startTime":305.43,"endTime":306.57,"body":"faith in me already."},{"speaker":"Chris Dy","startTime":307.89,"endTime":311.22,"body":"Alright, so you're"},{"speaker":"Chris Dy","startTime":307.89,"endTime":311.22,"body":"back to one of our most favorite"},{"speaker":"Chris Dy","startTime":311.22,"endTime":313.86,"body":"things to do reviewing what's"},{"speaker":"Chris Dy","startTime":311.22,"endTime":313.86,"body":"new in hand surgery. This is"},{"speaker":"Chris Dy","startTime":313.86,"endTime":319.41,"body":"part two. By the way, Agnes"},{"speaker":"Chris Dy","startTime":313.86,"endTime":319.41,"body":"Dardes, former WashU medical"},{"speaker":"Chris Dy","startTime":319.41,"endTime":323.97,"body":"student and friend to both of us"},{"speaker":"Chris Dy","startTime":319.41,"endTime":323.97,"body":"a texted me saying that she also"},{"speaker":"Chris Dy","startTime":323.97,"endTime":327.57,"body":"would only listen at 1x speed"},{"speaker":"Chris Dy","startTime":323.97,"endTime":327.57,"body":"and didn't know there was a 1.5x"},{"speaker":"Chris Dy","startTime":327.57,"endTime":329.25,"body":"speed until our last episode,"},{"speaker":"Charles Goldfarb","startTime":329.49,"endTime":331.2,"body":"we have"},{"speaker":"Charles Goldfarb","startTime":329.49,"endTime":331.2,"body":"changed her world."},{"speaker":"Chris Dy","startTime":331.77,"endTime":334.23,"body":"So shout out to Agnes,"},{"speaker":"Chris Dy","startTime":331.77,"endTime":334.23,"body":"thank you for listening. We love"},{"speaker":"Chris Dy","startTime":334.23,"endTime":339.93,"body":"you. So this the next section"},{"speaker":"Chris Dy","startTime":334.23,"endTime":339.93,"body":"was about arthritis. So the"},{"speaker":"Chris Dy","startTime":339.96,"endTime":344.1,"body":"first paper that Deb talks about"},{"speaker":"Chris Dy","startTime":339.96,"endTime":344.1,"body":"here is about PRC proximal"},{"speaker":"Chris Dy","startTime":344.1,"endTime":348.3,"body":"corpectomy. And a conversion"},{"speaker":"Chris Dy","startTime":344.1,"endTime":348.3,"body":"rate to total risks are three"},{"speaker":"Chris Dy","startTime":348.3,"endTime":353.22,"body":"pieces of 5%. So one and 20 at a"},{"speaker":"Chris Dy","startTime":348.3,"endTime":353.22,"body":"mean of 6.5 years. Does that"},{"speaker":"Chris Dy","startTime":353.22,"endTime":355.38,"body":"feel right to you in terms of"},{"speaker":"Chris Dy","startTime":353.22,"endTime":355.38,"body":"conversion rate?"},{"speaker":"Charles Goldfarb","startTime":356.01,"endTime":361.14,"body":"I guess so."},{"speaker":"Charles Goldfarb","startTime":356.01,"endTime":361.14,"body":"Probably seems a little high."},{"speaker":"Charles Goldfarb","startTime":361.17,"endTime":363.45,"body":"Honestly, what what's your"},{"speaker":"Charles Goldfarb","startTime":361.17,"endTime":363.45,"body":"what's your take?"},{"speaker":"Chris Dy","startTime":364.02,"endTime":367.62,"body":"I haven't I don't"},{"speaker":"Chris Dy","startTime":364.02,"endTime":367.62,"body":"think I've done 100 of these to"},{"speaker":"Chris Dy","startTime":367.62,"endTime":372.12,"body":"know, you know how many end up"},{"speaker":"Chris Dy","startTime":367.62,"endTime":372.12,"body":"going on to total wrist. I think"},{"speaker":"Chris Dy","startTime":372.12,"endTime":375.81,"body":"it's a nice number to quote it"},{"speaker":"Chris Dy","startTime":372.12,"endTime":375.81,"body":"feels like a reasonable way to"},{"speaker":"Chris Dy","startTime":375.81,"endTime":382.8,"body":"quote it. But that has not been"},{"speaker":"Chris Dy","startTime":375.81,"endTime":382.8,"body":"my experience. So one in 5%. So,"},{"speaker":"Chris Dy","startTime":383.04,"endTime":385.83,"body":"one in 20 Seems a little bit"},{"speaker":"Chris Dy","startTime":383.04,"endTime":385.83,"body":"high. That seems okay."},{"speaker":"Charles Goldfarb","startTime":386.58,"endTime":387.81,"body":"You know, I"},{"speaker":"Charles Goldfarb","startTime":386.58,"endTime":387.81,"body":"really like proximal row"},{"speaker":"Charles Goldfarb","startTime":387.81,"endTime":391.65,"body":"carpectomy is I think it's a"},{"speaker":"Charles Goldfarb","startTime":387.81,"endTime":391.65,"body":"great surgery. I think that we"},{"speaker":"Charles Goldfarb","startTime":391.65,"endTime":396.36,"body":"know that you're going to see"},{"speaker":"Charles Goldfarb","startTime":391.65,"endTime":396.36,"body":"arthritis. Every single patient"},{"speaker":"Charles Goldfarb","startTime":396.36,"endTime":399.63,"body":"with a PRC develops radiographic"},{"speaker":"Charles Goldfarb","startTime":396.36,"endTime":399.63,"body":"arthritis. The question is how"},{"speaker":"Charles Goldfarb","startTime":399.63,"endTime":403.77,"body":"many develops symptomatic"},{"speaker":"Charles Goldfarb","startTime":399.63,"endTime":403.77,"body":"arthritis, and 5% is certainly"},{"speaker":"Charles Goldfarb","startTime":403.8,"endTime":406.56,"body":"higher than my experience. But I"},{"speaker":"Charles Goldfarb","startTime":403.8,"endTime":406.56,"body":"absolutely have used a number of"},{"speaker":"Charles Goldfarb","startTime":406.56,"endTime":409.89,"body":"these. And so it doesn't feel"},{"speaker":"Charles Goldfarb","startTime":406.56,"endTime":409.89,"body":"way off to me, is"},{"speaker":"Chris Dy","startTime":409.89,"endTime":412.8,"body":"a fusion any harder"},{"speaker":"Chris Dy","startTime":409.89,"endTime":412.8,"body":"and more challenging than doing"},{"speaker":"Chris Dy","startTime":412.8,"endTime":414.18,"body":"a fusion off the bat? You know,"},{"speaker":"Charles Goldfarb","startTime":414.18,"endTime":416.25,"body":"essentially my"},{"speaker":"Charles Goldfarb","startTime":414.18,"endTime":416.25,"body":"partner and I Lindley Wall"},{"speaker":"Charles Goldfarb","startTime":417.21,"endTime":421.74,"body":"discuss this a lot because one"},{"speaker":"Charles Goldfarb","startTime":417.21,"endTime":421.74,"body":"could argue that doing a PRC,"},{"speaker":"Charles Goldfarb","startTime":421.83,"endTime":421.92,"body":"she's"},{"speaker":"Chris Dy","startTime":422.31,"endTime":423.87,"body":"my partner, she's my"},{"speaker":"Chris Dy","startTime":422.31,"endTime":423.87,"body":"partner to Joe,"},{"speaker":"Charles Goldfarb","startTime":423.9,"endTime":428.82,"body":"she's more of"},{"speaker":"Charles Goldfarb","startTime":423.9,"endTime":428.82,"body":"my partner. One could argue that"},{"speaker":"Charles Goldfarb","startTime":428.82,"endTime":433.74,"body":"doing a PRC in every risk fusion"},{"speaker":"Charles Goldfarb","startTime":428.82,"endTime":433.74,"body":"makes some sense. And I think"},{"speaker":"Charles Goldfarb","startTime":433.74,"endTime":436.56,"body":"Lindley really likes that, you"},{"speaker":"Charles Goldfarb","startTime":433.74,"endTime":436.56,"body":"know, she does a lot of we do a"},{"speaker":"Charles Goldfarb","startTime":436.56,"endTime":440.37,"body":"lot with spasticity. And so"},{"speaker":"Charles Goldfarb","startTime":436.56,"endTime":440.37,"body":"you're trying to shorten the"},{"speaker":"Charles Goldfarb","startTime":440.37,"endTime":443.82,"body":"skeleton to balance the flexors"},{"speaker":"Charles Goldfarb","startTime":440.37,"endTime":443.82,"body":"and extensors so we do a lot of"},{"speaker":"Charles Goldfarb","startTime":443.82,"endTime":448.2,"body":"risk fusions with a PRC, it's an"},{"speaker":"Charles Goldfarb","startTime":443.82,"endTime":448.2,"body":"easier operation. And so there's"},{"speaker":"Charles Goldfarb","startTime":448.2,"endTime":452.07,"body":"one less fusion surface. So I"},{"speaker":"Charles Goldfarb","startTime":448.2,"endTime":452.07,"body":"like doing risk fusions without"},{"speaker":"Charles Goldfarb","startTime":452.07,"endTime":453.96,"body":"the proximal row. Yeah,"},{"speaker":"Chris Dy","startTime":453.96,"endTime":457.23,"body":"she did one the other"},{"speaker":"Chris Dy","startTime":453.96,"endTime":457.23,"body":"day for for Plexus patients and"},{"speaker":"Chris Dy","startTime":457.26,"endTime":460.47,"body":"you know, it's it's I agree,"},{"speaker":"Chris Dy","startTime":457.26,"endTime":460.47,"body":"it's, it's just easier, does"},{"speaker":"Chris Dy","startTime":460.47,"endTime":462.96,"body":"give you a nice source a local"},{"speaker":"Chris Dy","startTime":460.47,"endTime":462.96,"body":"bone, depending on the situation"},{"speaker":"Chris Dy","startTime":462.96,"endTime":468.72,"body":"if the if the bone graft is"},{"speaker":"Chris Dy","startTime":462.96,"endTime":468.72,"body":"reasonable. But, ya know, and"},{"speaker":"Chris Dy","startTime":468.72,"endTime":471.39,"body":"then when you do just, I guess"},{"speaker":"Chris Dy","startTime":468.72,"endTime":471.39,"body":"vary a little bit away from the"},{"speaker":"Chris Dy","startTime":471.39,"endTime":475.11,"body":"What's New, but when you do a"},{"speaker":"Chris Dy","startTime":471.39,"endTime":475.11,"body":"total restore through desus, so"},{"speaker":"Chris Dy","startTime":475.11,"endTime":479.52,"body":"not a PRC. Are you fusing? Are"},{"speaker":"Chris Dy","startTime":475.11,"endTime":479.52,"body":"you trying to prepare the CMC"},{"speaker":"Chris Dy","startTime":479.52,"endTime":480.36,"body":"surface as well?"},{"speaker":"Charles Goldfarb","startTime":480.87,"endTime":483.15,"body":"Yeah, I've"},{"speaker":"Charles Goldfarb","startTime":480.87,"endTime":483.15,"body":"there have certainly been"},{"speaker":"Charles Goldfarb","startTime":483.15,"endTime":486.66,"body":"occasions when I do not I"},{"speaker":"Charles Goldfarb","startTime":483.15,"endTime":486.66,"body":"typically do. But I would say"},{"speaker":"Charles Goldfarb","startTime":486.66,"endTime":490.53,"body":"it's, it's an expenditure of"},{"speaker":"Charles Goldfarb","startTime":486.66,"endTime":490.53,"body":"three minutes of time. You know,"},{"speaker":"Charles Goldfarb","startTime":490.53,"endTime":495.24,"body":"I take a Roger, I, Roger, the"},{"speaker":"Charles Goldfarb","startTime":490.53,"endTime":495.24,"body":"surface, the base of the third"},{"speaker":"Charles Goldfarb","startTime":495.24,"endTime":498.6,"body":"metacarpal, the distal aspect of"},{"speaker":"Charles Goldfarb","startTime":495.24,"endTime":498.6,"body":"the capitate. And I pack a"},{"speaker":"Charles Goldfarb","startTime":498.6,"endTime":501.57,"body":"little bone graft. And so it's"},{"speaker":"Charles Goldfarb","startTime":498.6,"endTime":501.57,"body":"nothing fancy, which is why"},{"speaker":"Charles Goldfarb","startTime":501.75,"endTime":505.17,"body":"probably should do it. What"},{"speaker":"Charles Goldfarb","startTime":501.75,"endTime":505.17,"body":"about you? Do you routinely"},{"speaker":"Charles Goldfarb","startTime":505.17,"endTime":507.0,"body":"prepare that surface? Yeah, I"},{"speaker":"Chris Dy","startTime":506.88,"endTime":509.869,"body":"don't know if I do"},{"speaker":"Chris Dy","startTime":506.88,"endTime":509.869,"body":"enough restore arthrodeses to"},{"speaker":"Chris Dy","startTime":509.931,"endTime":513.669,"body":"say I have routine I do enough."},{"speaker":"Chris Dy","startTime":509.931,"endTime":513.669,"body":"But yeah, I don't. Because I"},{"speaker":"Chris Dy","startTime":513.731,"endTime":517.592,"body":"don't think that's where the the"},{"speaker":"Chris Dy","startTime":513.731,"endTime":517.592,"body":"issue is going to be if if it"},{"speaker":"Chris Dy","startTime":517.655,"endTime":521.641,"body":"were to go on to any issues with"},{"speaker":"Chris Dy","startTime":517.655,"endTime":521.641,"body":"Union, but I found that to be a"},{"speaker":"Chris Dy","startTime":521.703,"endTime":525.69,"body":"relatively reliable surgery,"},{"speaker":"Chris Dy","startTime":521.703,"endTime":525.69,"body":"even without doing the CMC surface."},{"speaker":"Charles Goldfarb","startTime":525.99,"endTime":529.08,"body":"Yeah, well,"},{"speaker":"Charles Goldfarb","startTime":525.99,"endTime":529.08,"body":"it's hard to argue there. There"},{"speaker":"Charles Goldfarb","startTime":529.08,"endTime":531.27,"body":"are some long term follow ups"},{"speaker":"Charles Goldfarb","startTime":529.08,"endTime":531.27,"body":"where occasionally it's an"},{"speaker":"Charles Goldfarb","startTime":531.27,"endTime":534.9,"body":"issue, but it's just that it's"},{"speaker":"Charles Goldfarb","startTime":531.27,"endTime":534.9,"body":"pretty uncommon. So"},{"speaker":"Chris Dy","startTime":534.54,"endTime":537.388,"body":"moving to a slightly"},{"speaker":"Chris Dy","startTime":534.54,"endTime":537.388,"body":"different form of carpentry. So"},{"speaker":"Chris Dy","startTime":537.443,"endTime":540.73,"body":"say you're not doing a PRC, but"},{"speaker":"Chris Dy","startTime":537.443,"endTime":540.73,"body":"you're doing a Invercargill."},{"speaker":"Chris Dy","startTime":540.785,"endTime":543.907,"body":"arthrodesis, I guess is what"},{"speaker":"Chris Dy","startTime":540.785,"endTime":543.907,"body":"we'll call it. Now. The next"},{"speaker":"Chris Dy","startTime":543.962,"endTime":546.811,"body":"paper that Deb talks about and"},{"speaker":"Chris Dy","startTime":543.962,"endTime":546.811,"body":"kind of summarize all"},{"speaker":"Chris Dy","startTime":546.866,"endTime":550.317,"body":"literature's I think something"},{"speaker":"Chris Dy","startTime":546.866,"endTime":550.317,"body":"that we kind of have thought for"},{"speaker":"Chris Dy","startTime":550.372,"endTime":553.604,"body":"a while that it's mainly Neo,"},{"speaker":"Chris Dy","startTime":550.372,"endTime":553.604,"body":"the Capitol illuminate Arthur"},{"speaker":"Chris Dy","startTime":553.659,"endTime":557.11,"body":"desus surface, that's the most"},{"speaker":"Chris Dy","startTime":553.659,"endTime":557.11,"body":"important as opposed to the kind"},{"speaker":"Chris Dy","startTime":557.165,"endTime":560.233,"body":"of standard four corner. And I"},{"speaker":"Chris Dy","startTime":557.165,"endTime":560.233,"body":"think that's based on the"},{"speaker":"Chris Dy","startTime":560.287,"endTime":563.52,"body":"experience that Dr. Gelberman"},{"speaker":"Chris Dy","startTime":560.287,"endTime":563.52,"body":"had with Calandruccio I think"},{"speaker":"Chris Dy","startTime":563.574,"endTime":566.642,"body":"was the first author. So have"},{"speaker":"Chris Dy","startTime":563.574,"endTime":566.642,"body":"you noticed any difference"},{"speaker":"Chris Dy","startTime":566.697,"endTime":570.093,"body":"between when you go for a four"},{"speaker":"Chris Dy","startTime":566.697,"endTime":570.093,"body":"quarter versus mainly going for"},{"speaker":"Chris Dy","startTime":570.148,"endTime":571.08,"body":"the capitolunate."},{"speaker":"Charles Goldfarb","startTime":571.08,"endTime":573.259,"body":"You know, that"},{"speaker":"Charles Goldfarb","startTime":571.08,"endTime":573.259,"body":"study I was part of that study"},{"speaker":"Charles Goldfarb","startTime":573.307,"endTime":575.1,"body":"Jim Calandruccio  at Campbell Clinic?"},{"speaker":"Chris Dy","startTime":575.85,"endTime":578.7,"body":"Of course, you're"},{"speaker":"Chris Dy","startTime":575.85,"endTime":578.7,"body":"working in hammering nails on"},{"speaker":"Chris Dy","startTime":578.7,"endTime":579.09,"body":"how could you"},{"speaker":"Charles Goldfarb","startTime":579.09,"endTime":582.3,"body":"forget that? I"},{"speaker":"Charles Goldfarb","startTime":579.09,"endTime":582.3,"body":"was the I was the fifth of 17"},{"speaker":"Charles Goldfarb","startTime":582.3,"endTime":588.51,"body":"authors. Just kidding. You know,"},{"speaker":"Charles Goldfarb","startTime":582.3,"endTime":588.51,"body":"our paper actually was not"},{"speaker":"Charles Goldfarb","startTime":588.51,"endTime":592.53,"body":"totally supportive of that"},{"speaker":"Charles Goldfarb","startTime":588.51,"endTime":592.53,"body":"concept, but it's, uh, I totally"},{"speaker":"Charles Goldfarb","startTime":592.53,"endTime":595.2,"body":"agree with the idea that it's"},{"speaker":"Charles Goldfarb","startTime":592.53,"endTime":595.2,"body":"all about the capital donate and"},{"speaker":"Charles Goldfarb","startTime":595.2,"endTime":599.31,"body":"so I don't really focus on that"},{"speaker":"Charles Goldfarb","startTime":595.2,"endTime":599.31,"body":"I do add that your creature will"},{"speaker":"Charles Goldfarb","startTime":599.31,"endTime":605.55,"body":"handmade Orkestra quatro,"},{"speaker":"Charles Goldfarb","startTime":599.31,"endTime":605.55,"body":"capital handmade screw. Because"},{"speaker":"Charles Goldfarb","startTime":605.55,"endTime":609.69,"body":"it feels better. I think my"},{"speaker":"Charles Goldfarb","startTime":605.55,"endTime":609.69,"body":"fusion rates higher. But it is"},{"speaker":"Charles Goldfarb","startTime":609.69,"endTime":612.09,"body":"all about the capital. And and I"},{"speaker":"Charles Goldfarb","startTime":609.69,"endTime":612.09,"body":"will say it's interesting that"},{"speaker":"Charles Goldfarb","startTime":612.12,"endTime":614.61,"body":"there must not have been any"},{"speaker":"Charles Goldfarb","startTime":612.12,"endTime":614.61,"body":"articles this year, the years"},{"speaker":"Charles Goldfarb","startTime":614.61,"endTime":618.03,"body":"running together when you get"},{"speaker":"Charles Goldfarb","startTime":614.61,"endTime":618.03,"body":"old like me. And it's pretty"},{"speaker":"Charles Goldfarb","startTime":618.03,"endTime":621.12,"body":"clear that we should avoid for"},{"speaker":"Charles Goldfarb","startTime":618.03,"endTime":621.12,"body":"corner fusions. And I say that,"},{"speaker":"Charles Goldfarb","startTime":621.21,"endTime":623.85,"body":"as someone who really has done a"},{"speaker":"Charles Goldfarb","startTime":621.21,"endTime":623.85,"body":"lot of work on infusions, the"},{"speaker":"Charles Goldfarb","startTime":623.85,"endTime":626.91,"body":"literature is clear that PRCs"},{"speaker":"Charles Goldfarb","startTime":623.85,"endTime":626.91,"body":"have a far lower revision rate"},{"speaker":"Charles Goldfarb","startTime":626.91,"endTime":632.55,"body":"and requirements for secondary"},{"speaker":"Charles Goldfarb","startTime":626.91,"endTime":632.55,"body":"surgery. And I, to me, it's a"},{"speaker":"Charles Goldfarb","startTime":632.55,"endTime":636.54,"body":"very narrow indication these"},{"speaker":"Charles Goldfarb","startTime":632.55,"endTime":636.54,"body":"days young worker is really when"},{"speaker":"Charles Goldfarb","startTime":636.54,"endTime":638.79,"body":"I think about a full corner is"},{"speaker":"Charles Goldfarb","startTime":636.54,"endTime":638.79,"body":"that which"},{"speaker":"Chris Dy","startTime":638.79,"endTime":642.15,"body":"does not mean how much"},{"speaker":"Chris Dy","startTime":638.79,"endTime":642.15,"body":"does the surface, the base of"},{"speaker":"Chris Dy","startTime":642.15,"endTime":645.6,"body":"the capitate matter? Because,"},{"speaker":"Chris Dy","startTime":642.15,"endTime":645.6,"body":"you know, I think that most"},{"speaker":"Chris Dy","startTime":645.6,"endTime":647.97,"body":"people, I think, still would"},{"speaker":"Chris Dy","startTime":645.6,"endTime":647.97,"body":"say, Well, if there's arthritic"},{"speaker":"Chris Dy","startTime":647.97,"endTime":651.75,"body":"way or Kandra, were at the base"},{"speaker":"Chris Dy","startTime":647.97,"endTime":651.75,"body":"of the capitate, that maybe"},{"speaker":"Chris Dy","startTime":651.78,"endTime":656.7,"body":"using that as your articulating"},{"speaker":"Chris Dy","startTime":651.78,"endTime":656.7,"body":"surface and a PRC is maybe not"},{"speaker":"Chris Dy","startTime":656.7,"endTime":658.35,"body":"best, or have you found it's"},{"speaker":"Chris Dy","startTime":656.7,"endTime":658.35,"body":"okay."},{"speaker":"Charles Goldfarb","startTime":658.65,"endTime":660.6,"body":"Yeah, I just"},{"speaker":"Charles Goldfarb","startTime":658.65,"endTime":660.6,"body":"had a delightful who I think you"},{"speaker":"Charles Goldfarb","startTime":660.6,"endTime":664.38,"body":"met once or twice, delightful"},{"speaker":"Charles Goldfarb","startTime":660.6,"endTime":664.38,"body":"visitor from the UK, actually,"},{"speaker":"Charles Goldfarb","startTime":664.47,"endTime":668.22,"body":"by way of Auckland, Holly"},{"speaker":"Charles Goldfarb","startTime":664.47,"endTime":668.22,"body":"Morris, who will be in Darby"},{"speaker":"Charles Goldfarb","startTime":668.49,"endTime":670.95,"body":"next year at the polar tap"},{"speaker":"Charles Goldfarb","startTime":668.49,"endTime":670.95,"body":"center. So it's great to meet"},{"speaker":"Charles Goldfarb","startTime":670.95,"endTime":674.55,"body":"Holly, and we had a long"},{"speaker":"Charles Goldfarb","startTime":670.95,"endTime":674.55,"body":"conversation about this. I don't"},{"speaker":"Charles Goldfarb","startTime":674.55,"endTime":677.07,"body":"think the head of the cavitate"},{"speaker":"Charles Goldfarb","startTime":674.55,"endTime":677.07,"body":"matters. I think you have"},{"speaker":"Charles Goldfarb","startTime":677.1,"endTime":680.34,"body":"options. I shouldn't say it"},{"speaker":"Charles Goldfarb","startTime":677.1,"endTime":680.34,"body":"that. Absolutely. I mean, if"},{"speaker":"Charles Goldfarb","startTime":680.34,"endTime":683.22,"body":"there's really bad arthritis,"},{"speaker":"Charles Goldfarb","startTime":680.34,"endTime":683.22,"body":"that's different. But But I"},{"speaker":"Charles Goldfarb","startTime":683.22,"endTime":686.25,"body":"think you can do a capsular"},{"speaker":"Charles Goldfarb","startTime":683.22,"endTime":686.25,"body":"interposition, which at this"},{"speaker":"Charles Goldfarb","startTime":686.25,"endTime":690.36,"body":"institution has become a staple."},{"speaker":"Charles Goldfarb","startTime":686.25,"endTime":690.36,"body":"And some people will will really"},{"speaker":"Charles Goldfarb","startTime":690.36,"endTime":693.87,"body":"singing the praises of the"},{"speaker":"Charles Goldfarb","startTime":690.36,"endTime":693.87,"body":"capitate resurfacing, which is a"},{"speaker":"Charles Goldfarb","startTime":693.87,"endTime":697.29,"body":"very slick operation, which I've"},{"speaker":"Charles Goldfarb","startTime":693.87,"endTime":697.29,"body":"never done. Yeah,"},{"speaker":"Chris Dy","startTime":697.29,"endTime":700.47,"body":"no, I've, it's one of"},{"speaker":"Chris Dy","startTime":697.29,"endTime":700.47,"body":"those things where I feel like I"},{"speaker":"Chris Dy","startTime":700.47,"endTime":704.01,"body":"am there's a lot of confirmation"},{"speaker":"Chris Dy","startTime":700.47,"endTime":704.01,"body":"bias for lack of a better term"},{"speaker":"Chris Dy","startTime":704.01,"endTime":707.31,"body":"when I want the capitate to look"},{"speaker":"Chris Dy","startTime":704.01,"endTime":707.31,"body":"Okay, it looks okay. And then I"},{"speaker":"Chris Dy","startTime":707.31,"endTime":710.76,"body":"feel better if I put a little"},{"speaker":"Chris Dy","startTime":707.31,"endTime":710.76,"body":"capsule in there. No doubt, it's"},{"speaker":"Chris Dy","startTime":710.76,"endTime":713.25,"body":"an easier surgery for patients"},{"speaker":"Chris Dy","startTime":710.76,"endTime":713.25,"body":"to get over. And I think there's"},{"speaker":"Chris Dy","startTime":713.25,"endTime":716.79,"body":"enough as you stated enough"},{"speaker":"Chris Dy","startTime":713.25,"endTime":716.79,"body":"literature out there suggesting"},{"speaker":"Chris Dy","startTime":716.79,"endTime":721.08,"body":"that the results are not"},{"speaker":"Chris Dy","startTime":716.79,"endTime":721.08,"body":"inferior and perhaps better with"},{"speaker":"Chris Dy","startTime":721.08,"endTime":723.72,"body":"a PRC as opposed to a four"},{"speaker":"Chris Dy","startTime":721.08,"endTime":723.72,"body":"corner. Yeah,"},{"speaker":"Charles Goldfarb","startTime":723.81,"endTime":724.98,"body":"and it just"},{"speaker":"Charles Goldfarb","startTime":723.81,"endTime":724.98,"body":"for those who haven't"},{"speaker":"Charles Goldfarb","startTime":724.98,"endTime":728.28,"body":"technically done that, if you're"},{"speaker":"Charles Goldfarb","startTime":724.98,"endTime":728.28,"body":"worried about the head of the"},{"speaker":"Charles Goldfarb","startTime":728.28,"endTime":731.37,"body":"capitate, think about it as you"},{"speaker":"Charles Goldfarb","startTime":728.28,"endTime":731.37,"body":"consider your approach to the"},{"speaker":"Charles Goldfarb","startTime":731.37,"endTime":737.07,"body":"carpus. And I essentially make"},{"speaker":"Charles Goldfarb","startTime":731.37,"endTime":737.07,"body":"my longitudinal capsulotomy, a"},{"speaker":"Charles Goldfarb","startTime":737.07,"endTime":743.19,"body":"little more radio. And then I"},{"speaker":"Charles Goldfarb","startTime":737.07,"endTime":743.19,"body":"elevate the soft tissues off of"},{"speaker":"Charles Goldfarb","startTime":743.19,"endTime":746.79,"body":"the distal radius, and then make"},{"speaker":"Charles Goldfarb","startTime":743.19,"endTime":746.79,"body":"potentially a second"},{"speaker":"Charles Goldfarb","startTime":746.88,"endTime":750.3,"body":"longitudinal capsulotomy more"},{"speaker":"Charles Goldfarb","startTime":746.88,"endTime":750.3,"body":"own early so you have a nice"},{"speaker":"Charles Goldfarb","startTime":750.3,"endTime":753.48,"body":"flap of tissue that you can"},{"speaker":"Charles Goldfarb","startTime":750.3,"endTime":753.48,"body":"bring down resurfacing the"},{"speaker":"Charles Goldfarb","startTime":753.48,"endTime":756.51,"body":"capitate and suturing carefully"},{"speaker":"Charles Goldfarb","startTime":753.48,"endTime":756.51,"body":"into the bowler capsule."},{"speaker":"Chris Dy","startTime":757.05,"endTime":759.81,"body":"So this is a"},{"speaker":"Chris Dy","startTime":757.05,"endTime":759.81,"body":"proximately base. So based off"},{"speaker":"Chris Dy","startTime":759.81,"endTime":761.07,"body":"of the radius,"},{"speaker":"Charles Goldfarb","startTime":762.51,"endTime":764.64,"body":"no, I'm sorry,"},{"speaker":"Charles Goldfarb","startTime":762.51,"endTime":764.64,"body":"if that came across wrong, it's"},{"speaker":"Charles Goldfarb","startTime":764.64,"endTime":768.78,"body":"a distally based the releases"},{"speaker":"Charles Goldfarb","startTime":764.64,"endTime":768.78,"body":"off the distal radius. Got it, I"},{"speaker":"Charles Goldfarb","startTime":768.78,"endTime":771.81,"body":"think you can do it any old way"},{"speaker":"Charles Goldfarb","startTime":768.78,"endTime":771.81,"body":"you want. Even if you're not"},{"speaker":"Charles Goldfarb","startTime":771.81,"endTime":774.27,"body":"proactive in your incision,"},{"speaker":"Charles Goldfarb","startTime":771.81,"endTime":774.27,"body":"planning, you can still figure"},{"speaker":"Charles Goldfarb","startTime":774.27,"endTime":777.15,"body":"out a way to interpose"},{"speaker":"Charles Goldfarb","startTime":774.27,"endTime":777.15,"body":"something. But if you are"},{"speaker":"Charles Goldfarb","startTime":777.15,"endTime":780.42,"body":"proactive, you can make a"},{"speaker":"Charles Goldfarb","startTime":777.15,"endTime":780.42,"body":"beautiful flat. Yeah,"},{"speaker":"Chris Dy","startTime":780.42,"endTime":783.48,"body":"it's like when we're"},{"speaker":"Chris Dy","startTime":780.42,"endTime":783.48,"body":"back, if you remember this,"},{"speaker":"Chris Dy","startTime":783.48,"endTime":787.26,"body":"because he used to do too, but"},{"speaker":"Chris Dy","startTime":783.48,"endTime":787.26,"body":"the black capsula thesis for SL,"},{"speaker":"Chris Dy","startTime":787.26,"endTime":789.87,"body":"which I think is still a nice"},{"speaker":"Chris Dy","startTime":787.26,"endTime":789.87,"body":"trick to have in your you know,"},{"speaker":"Chris Dy","startTime":789.87,"endTime":793.62,"body":"plan, you know, ABCDE when"},{"speaker":"Chris Dy","startTime":789.87,"endTime":793.62,"body":"you're doing an SL"},{"speaker":"Chris Dy","startTime":793.62,"endTime":797.79,"body":"reconstruction, I still whenever"},{"speaker":"Chris Dy","startTime":793.62,"endTime":797.79,"body":"I do an SL I will still raise my"},{"speaker":"Chris Dy","startTime":797.79,"endTime":801.99,"body":"capsular flap in a way that I"},{"speaker":"Chris Dy","startTime":797.79,"endTime":801.99,"body":"have the blat capsula desus as a"},{"speaker":"Chris Dy","startTime":802.05,"endTime":803.91,"body":"as a bailout, dating"},{"speaker":"Charles Goldfarb","startTime":803.46,"endTime":806.031,"body":"myself, once"},{"speaker":"Charles Goldfarb","startTime":803.46,"endTime":806.031,"body":"again, I've written a lot about"},{"speaker":"Charles Goldfarb","startTime":806.09,"endTime":809.772,"body":"the Blatt and Dr. Gelberman was"},{"speaker":"Charles Goldfarb","startTime":806.09,"endTime":809.772,"body":"a fan of the black. Therefore I"},{"speaker":"Charles Goldfarb","startTime":809.83,"endTime":813.103,"body":"was a fan of the black never"},{"speaker":"Charles Goldfarb","startTime":809.83,"endTime":813.103,"body":"made all that much sense. I"},{"speaker":"Charles Goldfarb","startTime":813.162,"endTime":816.727,"body":"mean, the concept for those who"},{"speaker":"Charles Goldfarb","startTime":813.162,"endTime":816.727,"body":"hadn't even heard about it is"},{"speaker":"Charles Goldfarb","startTime":816.786,"endTime":820.176,"body":"attaching the capsule still"},{"speaker":"Charles Goldfarb","startTime":816.786,"endTime":820.176,"body":"based on the distal radius and"},{"speaker":"Charles Goldfarb","startTime":820.234,"endTime":823.683,"body":"creating a check rein to volar"},{"speaker":"Charles Goldfarb","startTime":820.234,"endTime":823.683,"body":"flexion of the skateboard in"},{"speaker":"Charles Goldfarb","startTime":823.741,"endTime":827.306,"body":"chronic SL instability. I guess"},{"speaker":"Charles Goldfarb","startTime":823.741,"endTime":827.306,"body":"it makes sense theoretically,"},{"speaker":"Charles Goldfarb","startTime":827.365,"endTime":830.58,"body":"but the tissue never seems"},{"speaker":"Charles Goldfarb","startTime":827.365,"endTime":830.58,"body":"strong enough to me. Well, I"},{"speaker":"Chris Dy","startTime":830.64,"endTime":832.71,"body":"mean, you know, I can"},{"speaker":"Chris Dy","startTime":830.64,"endTime":832.71,"body":"like all of those surgical"},{"speaker":"Chris Dy","startTime":832.71,"endTime":835.92,"body":"techniques for SL are trying to"},{"speaker":"Chris Dy","startTime":832.71,"endTime":835.92,"body":"avoid skateboard flexion. So"},{"speaker":"Chris Dy","startTime":836.34,"endTime":839.73,"body":"I've been known to use a blatte"},{"speaker":"Chris Dy","startTime":836.34,"endTime":839.73,"body":"when it didn't work out the way"},{"speaker":"Chris Dy","startTime":839.73,"endTime":843.03,"body":"that I expected it to. I think"},{"speaker":"Chris Dy","startTime":839.73,"endTime":843.03,"body":"it's a reasonable thing to do."},{"speaker":"Chris Dy","startTime":843.03,"endTime":846.96,"body":"But yeah, I agree you unless you"},{"speaker":"Chris Dy","startTime":843.03,"endTime":846.96,"body":"are truly very intentional on"},{"speaker":"Chris Dy","startTime":846.96,"endTime":849.69,"body":"the way in the tissue quality"},{"speaker":"Chris Dy","startTime":846.96,"endTime":849.69,"body":"can be suspect at"},{"speaker":"Charles Goldfarb","startTime":849.69,"endTime":852.84,"body":"times. Yeah,"},{"speaker":"Charles Goldfarb","startTime":849.69,"endTime":852.84,"body":"very well said. Totally. So I"},{"speaker":"Charles Goldfarb","startTime":852.84,"endTime":853.77,"body":"guess back"},{"speaker":"Chris Dy","startTime":853.77,"endTime":856.86,"body":"to the actual article,"},{"speaker":"Chris Dy","startTime":853.77,"endTime":856.86,"body":"what to do at hand surgery. One"},{"speaker":"Chris Dy","startTime":856.86,"endTime":859.41,"body":"thing that I found was"},{"speaker":"Chris Dy","startTime":856.86,"endTime":859.41,"body":"interesting is that Deb one went"},{"speaker":"Chris Dy","startTime":859.41,"endTime":863.7,"body":"on to discuss an article that"},{"speaker":"Chris Dy","startTime":859.41,"endTime":863.7,"body":"talked about actually gaining"},{"speaker":"Chris Dy","startTime":863.7,"endTime":868.44,"body":"motion after a PRC that has not"},{"speaker":"Chris Dy","startTime":863.7,"endTime":868.44,"body":"been my experience. I've"},{"speaker":"Chris Dy","startTime":868.44,"endTime":871.14,"body":"actually just maybe that's"},{"speaker":"Chris Dy","startTime":868.44,"endTime":871.14,"body":"because I just counsel patients"},{"speaker":"Chris Dy","startTime":871.29,"endTime":874.14,"body":"in a way where I'm setting"},{"speaker":"Chris Dy","startTime":871.29,"endTime":874.14,"body":"expectations low but I've told"},{"speaker":"Chris Dy","startTime":874.14,"endTime":876.42,"body":"them that they're not going to"},{"speaker":"Chris Dy","startTime":874.14,"endTime":876.42,"body":"gain motion at the very most"},{"speaker":"Chris Dy","startTime":876.42,"endTime":877.74,"body":"they're going to keep what they"},{"speaker":"Chris Dy","startTime":876.42,"endTime":877.74,"body":"have."},{"speaker":"Charles Goldfarb","startTime":878.58,"endTime":881.1,"body":"You know, and"},{"speaker":"Charles Goldfarb","startTime":878.58,"endTime":881.1,"body":"one of the authors that paper is"},{"speaker":"Charles Goldfarb","startTime":881.13,"endTime":885.99,"body":"a mod journal in surgery 2022"},{"speaker":"Charles Goldfarb","startTime":881.13,"endTime":885.99,"body":"one of the authors is Mark"},{"speaker":"Charles Goldfarb","startTime":885.99,"endTime":890.97,"body":"Cohen. He's, my guest is the"},{"speaker":"Charles Goldfarb","startTime":885.99,"endTime":890.97,"body":"senior author, but certainly"},{"speaker":"Charles Goldfarb","startTime":890.97,"endTime":895.14,"body":"just a small contributor to this"},{"speaker":"Charles Goldfarb","startTime":890.97,"endTime":895.14,"body":"paper. And Mark is the one who"},{"speaker":"Charles Goldfarb","startTime":895.17,"endTime":898.77,"body":"with Scott COEs and sort of did"},{"speaker":"Charles Goldfarb","startTime":895.17,"endTime":898.77,"body":"the original work comparing PRC"},{"speaker":"Charles Goldfarb","startTime":898.77,"endTime":901.74,"body":"and skateboard excision with For"},{"speaker":"Charles Goldfarb","startTime":898.77,"endTime":901.74,"body":"bone fusion, and my takeaway"},{"speaker":"Charles Goldfarb","startTime":901.74,"endTime":905.16,"body":"from that original paper is you"},{"speaker":"Charles Goldfarb","startTime":901.74,"endTime":905.16,"body":"do not gain motion. My real life"},{"speaker":"Charles Goldfarb","startTime":905.16,"endTime":908.94,"body":"experience is probably closer to"},{"speaker":"Charles Goldfarb","startTime":905.16,"endTime":908.94,"body":"this that you shouldn't promise"},{"speaker":"Charles Goldfarb","startTime":908.94,"endTime":912.3,"body":"again in motion, but you can get"},{"speaker":"Charles Goldfarb","startTime":908.94,"endTime":912.3,"body":"it. Is that fair?"},{"speaker":"Chris Dy","startTime":912.93,"endTime":914.64,"body":"I think that's fair. I"},{"speaker":"Chris Dy","startTime":912.93,"endTime":914.64,"body":"wouldn't promise it for sure."},{"speaker":"Chris Dy","startTime":914.64,"endTime":917.97,"body":"But I think maybe initially,"},{"speaker":"Chris Dy","startTime":914.64,"endTime":917.97,"body":"there's just some pain limits"},{"speaker":"Chris Dy","startTime":918.0,"endTime":920.37,"body":"pain base limits and their range"},{"speaker":"Chris Dy","startTime":918.0,"endTime":920.37,"body":"of motion if you improve their"},{"speaker":"Chris Dy","startTime":920.37,"endTime":924.03,"body":"pain by doing the PRC, you know,"},{"speaker":"Chris Dy","startTime":920.37,"endTime":924.03,"body":"and you're aggressive with"},{"speaker":"Chris Dy","startTime":924.03,"endTime":926.67,"body":"rehab, I don't know if you do"},{"speaker":"Chris Dy","startTime":924.03,"endTime":926.67,"body":"any formal rehab after PRC. But"},{"speaker":"Chris Dy","startTime":926.67,"endTime":928.68,"body":"I mean, I think that can"},{"speaker":"Chris Dy","startTime":926.67,"endTime":928.68,"body":"certainly help your case in"},{"speaker":"Chris Dy","startTime":928.68,"endTime":930.87,"body":"terms of gaining motion. Yeah,"},{"speaker":"Charles Goldfarb","startTime":930.96,"endTime":934.59,"body":"I don't always"},{"speaker":"Charles Goldfarb","startTime":930.96,"endTime":934.59,"body":"do formal rehab. But I do end up"},{"speaker":"Charles Goldfarb","startTime":934.59,"endTime":936.9,"body":"patients who especially those"},{"speaker":"Charles Goldfarb","startTime":934.59,"endTime":936.9,"body":"are obviously interested in."},{"speaker":"Chris Dy","startTime":937.98,"endTime":942.12,"body":"So the next, the next"},{"speaker":"Chris Dy","startTime":937.98,"endTime":942.12,"body":"article talks about our favorite"},{"speaker":"Chris Dy","startTime":942.12,"endTime":945.27,"body":"topic in the world, and one that"},{"speaker":"Chris Dy","startTime":942.12,"endTime":945.27,"body":"you are very well experienced in"},{"speaker":"Chris Dy","startTime":945.27,"endTime":949.26,"body":"conducting original randomized"},{"speaker":"Chris Dy","startTime":945.27,"endTime":949.26,"body":"controlled trials, CMC"},{"speaker":"Chris Dy","startTime":949.26,"endTime":954.9,"body":"arthritis. So she talks about"},{"speaker":"Chris Dy","startTime":949.26,"endTime":954.9,"body":"the results from the gene"},{"speaker":"Chris Dy","startTime":954.93,"endTime":959.19,"body":"Delson, your procedure of"},{"speaker":"Chris Dy","startTime":954.93,"endTime":959.19,"body":"suturing, the fcr and the APL"},{"speaker":"Chris Dy","startTime":959.19,"endTime":962.58,"body":"together, and the long term"},{"speaker":"Chris Dy","startTime":959.19,"endTime":962.58,"body":"results of you know, 12 to 14"},{"speaker":"Chris Dy","startTime":962.58,"endTime":967.35,"body":"years. So it's a simple surgery"},{"speaker":"Chris Dy","startTime":962.58,"endTime":967.35,"body":"in terms of being"},{"speaker":"Chris Dy","startTime":967.35,"endTime":971.16,"body":"straightforward with a low"},{"speaker":"Chris Dy","startTime":967.35,"endTime":971.16,"body":"tourniquet time. Has that"},{"speaker":"Chris Dy","startTime":971.16,"endTime":975.36,"body":"procedure kind of come into your"},{"speaker":"Chris Dy","startTime":971.16,"endTime":975.36,"body":"come into your treatment?"},{"speaker":"Chris Dy","startTime":975.36,"endTime":976.95,"body":"armamentarium? No,"},{"speaker":"Charles Goldfarb","startTime":976.95,"endTime":979.26,"body":"it hasn't. But"},{"speaker":"Charles Goldfarb","startTime":976.95,"endTime":979.26,"body":"it's not for any particularly"},{"speaker":"Charles Goldfarb","startTime":979.26,"endTime":983.37,"body":"good reason, I guess I would say"},{"speaker":"Charles Goldfarb","startTime":979.26,"endTime":983.37,"body":"demonstrating the nature of a"},{"speaker":"Charles Goldfarb","startTime":983.37,"endTime":987.75,"body":"surgeon's mind. It does make"},{"speaker":"Charles Goldfarb","startTime":983.37,"endTime":987.75,"body":"some sense to me. I've said this"},{"speaker":"Charles Goldfarb","startTime":987.75,"endTime":991.95,"body":"many time. Any, I think almost"},{"speaker":"Charles Goldfarb","startTime":987.75,"endTime":991.95,"body":"any procedure works in the CMC"},{"speaker":"Charles Goldfarb","startTime":991.95,"endTime":994.83,"body":"joint, you need to have your"},{"speaker":"Charles Goldfarb","startTime":991.95,"endTime":994.83,"body":"favorite procedure. Hopefully,"},{"speaker":"Charles Goldfarb","startTime":994.83,"endTime":997.47,"body":"it's cost effective. Hopefully,"},{"speaker":"Charles Goldfarb","startTime":994.83,"endTime":997.47,"body":"it's times you know,"},{"speaker":"Charles Goldfarb","startTime":997.47,"endTime":1000.83,"body":"appropriate. This is something"},{"speaker":"Charles Goldfarb","startTime":997.47,"endTime":1000.83,"body":"that I should consider. I've"},{"speaker":"Charles Goldfarb","startTime":1000.83,"endTime":1003.95,"body":"been pretty happy with in"},{"speaker":"Charles Goldfarb","startTime":1000.83,"endTime":1003.95,"body":"general brace, suspension"},{"speaker":"Charles Goldfarb","startTime":1003.95,"endTime":1011.12,"body":"plasti. But I think this is very"},{"speaker":"Charles Goldfarb","startTime":1003.95,"endTime":1011.12,"body":"fair. And if I do fewer CMC"},{"speaker":"Charles Goldfarb","startTime":1011.12,"endTime":1013.37,"body":"treatments, I'll be happier. I"},{"speaker":"Chris Dy","startTime":1013.37,"endTime":1015.47,"body":"think that you geared"},{"speaker":"Chris Dy","startTime":1013.37,"endTime":1015.47,"body":"your practice towards doing"},{"speaker":"Chris Dy","startTime":1015.47,"endTime":1020.93,"body":"fewer of them. But ya know, I"},{"speaker":"Chris Dy","startTime":1015.47,"endTime":1020.93,"body":"still, you know, I will do the"},{"speaker":"Chris Dy","startTime":1020.93,"endTime":1023.57,"body":"suture tape suspension. But then"},{"speaker":"Chris Dy","startTime":1020.93,"endTime":1023.57,"body":"every now and then there are"},{"speaker":"Chris Dy","startTime":1023.57,"endTime":1026.03,"body":"some technical issues with it."},{"speaker":"Chris Dy","startTime":1023.57,"endTime":1026.03,"body":"And I'm like, why am I still"},{"speaker":"Chris Dy","startTime":1026.03,"endTime":1029.27,"body":"doing this. But again, like the"},{"speaker":"Chris Dy","startTime":1026.03,"endTime":1029.27,"body":"track record of my practice, is"},{"speaker":"Chris Dy","startTime":1029.27,"endTime":1031.55,"body":"that it's worked pretty well. So"},{"speaker":"Chris Dy","startTime":1029.27,"endTime":1031.55,"body":"I just keep doing it."},{"speaker":"Charles Goldfarb","startTime":1032.03,"endTime":1033.86,"body":"Yeah. And"},{"speaker":"Charles Goldfarb","startTime":1032.03,"endTime":1033.86,"body":"that's for the younger"},{"speaker":"Charles Goldfarb","startTime":1033.86,"endTime":1037.07,"body":"listeners. I mean, that's one of"},{"speaker":"Charles Goldfarb","startTime":1033.86,"endTime":1037.07,"body":"the challenges we have, you"},{"speaker":"Charles Goldfarb","startTime":1037.07,"endTime":1039.89,"body":"know, you your personal"},{"speaker":"Charles Goldfarb","startTime":1037.07,"endTime":1039.89,"body":"experience plays a role in your"},{"speaker":"Charles Goldfarb","startTime":1039.89,"endTime":1042.56,"body":"surgical decision making, and"},{"speaker":"Charles Goldfarb","startTime":1039.89,"endTime":1042.56,"body":"that what you said is absolutely"},{"speaker":"Charles Goldfarb","startTime":1042.56,"endTime":1045.5,"body":"true. For me, the internal brace"},{"speaker":"Charles Goldfarb","startTime":1042.56,"endTime":1045.5,"body":"or this, the secret tapes,"},{"speaker":"Charles Goldfarb","startTime":1045.5,"endTime":1048.83,"body":"veggie policy has worked really"},{"speaker":"Charles Goldfarb","startTime":1045.5,"endTime":1048.83,"body":"well. And the literature that we"},{"speaker":"Charles Goldfarb","startTime":1048.83,"endTime":1052.61,"body":"have contributed in the last"},{"speaker":"Charles Goldfarb","startTime":1048.83,"endTime":1052.61,"body":"year to one retrospective study"},{"speaker":"Charles Goldfarb","startTime":1052.61,"endTime":1056.0,"body":"and one prospective randomized"},{"speaker":"Charles Goldfarb","startTime":1052.61,"endTime":1056.0,"body":"trial, which I think is coming"},{"speaker":"Charles Goldfarb","startTime":1056.0,"endTime":1059.03,"body":"out soon, basically show the"},{"speaker":"Charles Goldfarb","startTime":1056.0,"endTime":1059.03,"body":"results are very similar to"},{"speaker":"Charles Goldfarb","startTime":1059.03,"endTime":1059.81,"body":"anything else."},{"speaker":"Chris Dy","startTime":1060.35,"endTime":1062.9,"body":"Right. It's"},{"speaker":"Chris Dy","startTime":1060.35,"endTime":1062.9,"body":"interesting, I've actually tried"},{"speaker":"Chris Dy","startTime":1062.9,"endTime":1065.99,"body":"to kind of talk to patients"},{"speaker":"Chris Dy","startTime":1062.9,"endTime":1065.99,"body":"about an old school lrti,"},{"speaker":"Chris Dy","startTime":1065.99,"endTime":1068.36,"body":"mainly, because if I know I have"},{"speaker":"Chris Dy","startTime":1065.99,"endTime":1068.36,"body":"a fellow on the rotation, I'm"},{"speaker":"Chris Dy","startTime":1068.36,"endTime":1071.42,"body":"trying to get them in lrti. And"},{"speaker":"Chris Dy","startTime":1068.36,"endTime":1071.42,"body":"even patients who have had an"},{"speaker":"Chris Dy","startTime":1071.42,"endTime":1074.45,"body":"lrti in the past me like, Hey,"},{"speaker":"Chris Dy","startTime":1071.42,"endTime":1074.45,"body":"do you want to do what you did"},{"speaker":"Chris Dy","startTime":1074.45,"endTime":1077.72,"body":"before? And they just don't go"},{"speaker":"Chris Dy","startTime":1074.45,"endTime":1077.72,"body":"for it. I do think there's"},{"speaker":"Chris Dy","startTime":1077.72,"endTime":1081.68,"body":"something about the pain aspect"},{"speaker":"Chris Dy","startTime":1077.72,"endTime":1081.68,"body":"of it, which, you know, going"},{"speaker":"Chris Dy","startTime":1081.68,"endTime":1084.89,"body":"across the wrist crease and"},{"speaker":"Chris Dy","startTime":1081.68,"endTime":1084.89,"body":"harvesting the tendon, there's"},{"speaker":"Chris Dy","startTime":1084.89,"endTime":1088.67,"body":"something to that that is not a"},{"speaker":"Chris Dy","startTime":1084.89,"endTime":1088.67,"body":"game changer. But it's notable"},{"speaker":"Chris Dy","startTime":1088.67,"endTime":1091.37,"body":"enough for patients where they"},{"speaker":"Chris Dy","startTime":1088.67,"endTime":1091.37,"body":"want the I think they want the"},{"speaker":"Chris Dy","startTime":1091.55,"endTime":1094.52,"body":"something that is not in lrti."},{"speaker":"Chris Dy","startTime":1091.55,"endTime":1094.52,"body":"Yep."},{"speaker":"Charles Goldfarb","startTime":1094.55,"endTime":1098.54,"body":"And then the"},{"speaker":"Charles Goldfarb","startTime":1094.55,"endTime":1098.54,"body":"rapid initiation of motion is"},{"speaker":"Charles Goldfarb","startTime":1098.54,"endTime":1102.44,"body":"really nice. Even though I the"},{"speaker":"Charles Goldfarb","startTime":1098.54,"endTime":1102.44,"body":"longer I do the suture tape. And"},{"speaker":"Charles Goldfarb","startTime":1102.44,"endTime":1106.64,"body":"I assume it's very similar to"},{"speaker":"Charles Goldfarb","startTime":1102.44,"endTime":1106.64,"body":"the suture suspension plasti we"},{"speaker":"Charles Goldfarb","startTime":1106.64,"endTime":1110.45,"body":"shouldn't promise rapid recovery"},{"speaker":"Charles Goldfarb","startTime":1106.64,"endTime":1110.45,"body":"in the sense that I don't think"},{"speaker":"Charles Goldfarb","startTime":1110.45,"endTime":1115.22,"body":"CG tape makes patients get over"},{"speaker":"Charles Goldfarb","startTime":1110.45,"endTime":1115.22,"body":"the hump that much faster. But"},{"speaker":"Charles Goldfarb","startTime":1115.22,"endTime":1118.28,"body":"life returns to normal more"},{"speaker":"Charles Goldfarb","startTime":1115.22,"endTime":1118.28,"body":"quickly because you're gonna"},{"speaker":"Charles Goldfarb","startTime":1118.28,"endTime":1121.1,"body":"removable brace at five to seven"},{"speaker":"Charles Goldfarb","startTime":1118.28,"endTime":1121.1,"body":"days."},{"speaker":"Chris Dy","startTime":1121.61,"endTime":1123.65,"body":"I think that's fair."},{"speaker":"Chris Dy","startTime":1121.61,"endTime":1123.65,"body":"And then we had a whole episode"},{"speaker":"Chris Dy","startTime":1123.65,"endTime":1127.01,"body":"if anybody's interested with"},{"speaker":"Chris Dy","startTime":1123.65,"endTime":1127.01,"body":"Macy about rehab after thumb,"},{"speaker":"Chris Dy","startTime":1127.01,"endTime":1129.71,"body":"CMC arthroplasty so you can go"},{"speaker":"Chris Dy","startTime":1127.01,"endTime":1129.71,"body":"back and pull that from the,"},{"speaker":"Chris Dy","startTime":1130.1,"endTime":1132.05,"body":"from the archives? And then"},{"speaker":"Charles Goldfarb","startTime":1132.17,"endTime":1133.7,"body":"and then your"},{"speaker":"Charles Goldfarb","startTime":1132.17,"endTime":1133.7,"body":"favorite I know you're gonna"},{"speaker":"Charles Goldfarb","startTime":1133.7,"endTime":1137.27,"body":"love the next topic."},{"speaker":"Charles Goldfarb","startTime":1133.7,"endTime":1137.27,"body":"denervation. Yeah, you"},{"speaker":"Chris Dy","startTime":1137.27,"endTime":1141.41,"body":"know, I've I've done"},{"speaker":"Chris Dy","startTime":1137.27,"endTime":1141.41,"body":"some of these and have had a"},{"speaker":"Chris Dy","startTime":1141.41,"endTime":1145.97,"body":"mixed bag. So far. I haven't had"},{"speaker":"Chris Dy","startTime":1141.41,"endTime":1145.97,"body":"to redo any operations. But I"},{"speaker":"Chris Dy","startTime":1145.97,"endTime":1148.67,"body":"think that it's something where"},{"speaker":"Chris Dy","startTime":1145.97,"endTime":1148.67,"body":"I think in the right patient,"},{"speaker":"Chris Dy","startTime":1148.67,"endTime":1150.83,"body":"it's a useful surgery, but you"},{"speaker":"Chris Dy","startTime":1148.67,"endTime":1150.83,"body":"have to counsel them"},{"speaker":"Chris Dy","startTime":1150.83,"endTime":1151.52,"body":"appropriately."},{"speaker":"Charles Goldfarb","startTime":1152.84,"endTime":1156.38,"body":"Yeah, what is"},{"speaker":"Charles Goldfarb","startTime":1152.84,"endTime":1156.38,"body":"your what is your counseling for"},{"speaker":"Charles Goldfarb","startTime":1156.38,"endTime":1157.55,"body":"that procedure look like?"},{"speaker":"Chris Dy","startTime":1157.97,"endTime":1159.95,"body":"Well, I think that"},{"speaker":"Chris Dy","startTime":1157.97,"endTime":1159.95,"body":"there's, you know, I talked to"},{"speaker":"Chris Dy","startTime":1159.95,"endTime":1162.2,"body":"them about that there's a very"},{"speaker":"Chris Dy","startTime":1159.95,"endTime":1162.2,"body":"reasonable chance that they're"},{"speaker":"Chris Dy","startTime":1162.2,"endTime":1164.3,"body":"going to have to have another"},{"speaker":"Chris Dy","startTime":1162.2,"endTime":1164.3,"body":"surgery within the next two to"},{"speaker":"Chris Dy","startTime":1164.3,"endTime":1167.24,"body":"five years. And, you know,"},{"speaker":"Chris Dy","startTime":1164.3,"endTime":1167.24,"body":"usually I'll try to put them"},{"speaker":"Chris Dy","startTime":1167.24,"endTime":1170.48,"body":"through a series of blocks ahead"},{"speaker":"Chris Dy","startTime":1167.24,"endTime":1170.48,"body":"of time to simulate what this"},{"speaker":"Chris Dy","startTime":1170.48,"endTime":1172.91,"body":"would be like. But I think it"},{"speaker":"Chris Dy","startTime":1170.48,"endTime":1172.91,"body":"truly is hard to get a number of"},{"speaker":"Chris Dy","startTime":1172.91,"endTime":1175.7,"body":"blocks that would truly"},{"speaker":"Chris Dy","startTime":1172.91,"endTime":1175.7,"body":"degenerate the joint for"},{"speaker":"Chris Dy","startTime":1175.7,"endTime":1181.13,"body":"especially for thumb, CMC. So I,"},{"speaker":"Chris Dy","startTime":1175.7,"endTime":1181.13,"body":"you know, I guess you this paper"},{"speaker":"Chris Dy","startTime":1181.13,"endTime":1184.13,"body":"that Deb talks about talks about"},{"speaker":"Chris Dy","startTime":1181.13,"endTime":1184.13,"body":"quicker return to activities,"},{"speaker":"Chris Dy","startTime":1184.13,"endTime":1186.92,"body":"it's probably because you're not"},{"speaker":"Chris Dy","startTime":1184.13,"endTime":1186.92,"body":"protecting anything. So as a"},{"speaker":"Chris Dy","startTime":1186.92,"endTime":1189.32,"body":"surgeon, you're going to let"},{"speaker":"Chris Dy","startTime":1186.92,"endTime":1189.32,"body":"them do more things right away."},{"speaker":"Chris Dy","startTime":1189.83,"endTime":1192.74,"body":"So probably there is some bias"},{"speaker":"Chris Dy","startTime":1189.83,"endTime":1192.74,"body":"in terms of, you know, what you"},{"speaker":"Chris Dy","startTime":1192.74,"endTime":1194.78,"body":"will allow people to do"},{"speaker":"Chris Dy","startTime":1192.74,"endTime":1194.78,"body":"afterwards, which will then"},{"speaker":"Chris Dy","startTime":1194.78,"endTime":1196.76,"body":"influence when they say they're"},{"speaker":"Chris Dy","startTime":1194.78,"endTime":1196.76,"body":"back to doing things."},{"speaker":"Charles Goldfarb","startTime":1197.3,"endTime":1199.19,"body":"Yeah. And in"},{"speaker":"Charles Goldfarb","startTime":1197.3,"endTime":1199.19,"body":"both of these studies, depth"},{"speaker":"Charles Goldfarb","startTime":1199.19,"endTime":1203.84,"body":"sites Have a less than 10%"},{"speaker":"Charles Goldfarb","startTime":1199.19,"endTime":1203.84,"body":"Revision rate at at least a year"},{"speaker":"Charles Goldfarb","startTime":1203.84,"endTime":1206.39,"body":"follow up. It's pretty good."},{"speaker":"Charles Goldfarb","startTime":1203.84,"endTime":1206.39,"body":"It'd be interesting to see what"},{"speaker":"Charles Goldfarb","startTime":1206.39,"endTime":1207.32,"body":"happens long term."},{"speaker":"Chris Dy","startTime":1209.09,"endTime":1210.86,"body":"Yeah, I think that is"},{"speaker":"Chris Dy","startTime":1209.09,"endTime":1210.86,"body":"pretty good. But I mean, I also"},{"speaker":"Chris Dy","startTime":1210.86,"endTime":1213.17,"body":"think there's probably something"},{"speaker":"Chris Dy","startTime":1210.86,"endTime":1213.17,"body":"in how you counsel patients and"},{"speaker":"Chris Dy","startTime":1213.17,"endTime":1215.27,"body":"whether they're willing to sign"},{"speaker":"Chris Dy","startTime":1213.17,"endTime":1215.27,"body":"up for another surgery right"},{"speaker":"Chris Dy","startTime":1215.27,"endTime":1220.61,"body":"away. So there's probably"},{"speaker":"Chris Dy","startTime":1215.27,"endTime":1220.61,"body":"something there that needs a"},{"speaker":"Chris Dy","startTime":1220.61,"endTime":1221.96,"body":"little bit further exploration."},{"speaker":"Charles Goldfarb","startTime":1222.53,"endTime":1224.87,"body":"Absolutely."},{"speaker":"Charles Goldfarb","startTime":1222.53,"endTime":1224.87,"body":"Absolutely. And then what about"},{"speaker":"Charles Goldfarb","startTime":1224.87,"endTime":1226.25,"body":"MCP joints?"},{"speaker":"Chris Dy","startTime":1227.09,"endTime":1229.07,"body":"Yeah, you know, this,"},{"speaker":"Chris Dy","startTime":1227.09,"endTime":1229.07,"body":"this is interesting. I mean, the"},{"speaker":"Chris Dy","startTime":1229.07,"endTime":1233.15,"body":"survival rates for these MCP"},{"speaker":"Chris Dy","startTime":1229.07,"endTime":1233.15,"body":"arthroplasties. In the Norwegian"},{"speaker":"Chris Dy","startTime":1233.15,"endTime":1237.26,"body":"register, were pretty darn good."},{"speaker":"Chris Dy","startTime":1233.15,"endTime":1237.26,"body":"I mean, 84%, at 20 years in"},{"speaker":"Chris Dy","startTime":1237.26,"endTime":1240.71,"body":"terms of you know, whether it"},{"speaker":"Chris Dy","startTime":1237.26,"endTime":1240.71,"body":"needs to be revised. I find that"},{"speaker":"Chris Dy","startTime":1240.71,"endTime":1243.62,"body":"to be quite good. I don't"},{"speaker":"Chris Dy","startTime":1240.71,"endTime":1243.62,"body":"personally do a lot of MP"},{"speaker":"Chris Dy","startTime":1243.62,"endTime":1247.13,"body":"arthroplasty. I send this to one"},{"speaker":"Chris Dy","startTime":1243.62,"endTime":1247.13,"body":"of our partners, Marty Boyer."},{"speaker":"Chris Dy","startTime":1247.67,"endTime":1251.33,"body":"Because he's really good at"},{"speaker":"Chris Dy","startTime":1247.67,"endTime":1251.33,"body":"doing MP and pap arthroplasties."},{"speaker":"Charles Goldfarb","startTime":1251.81,"endTime":1253.88,"body":"Yeah, I've"},{"speaker":"Charles Goldfarb","startTime":1251.81,"endTime":1253.88,"body":"taken the same approach I did a"},{"speaker":"Charles Goldfarb","startTime":1253.88,"endTime":1258.59,"body":"lot earlier in my career. It's"},{"speaker":"Charles Goldfarb","startTime":1253.88,"endTime":1258.59,"body":"funny, I saw a list of my most"},{"speaker":"Charles Goldfarb","startTime":1259.79,"endTime":1263.09,"body":"referenced articles from my"},{"speaker":"Charles Goldfarb","startTime":1259.79,"endTime":1263.09,"body":"career, you know, occasionally"},{"speaker":"Charles Goldfarb","startTime":1263.09,"endTime":1267.17,"body":"pops up on something he gets"},{"speaker":"Charles Goldfarb","startTime":1263.09,"endTime":1267.17,"body":"sent it. In Top Five is a paper"},{"speaker":"Charles Goldfarb","startTime":1267.17,"endTime":1270.23,"body":"I wrote during fellowship with"},{"speaker":"Charles Goldfarb","startTime":1267.17,"endTime":1270.23,"body":"Peter stern looking at outcomes"},{"speaker":"Charles Goldfarb","startTime":1270.23,"endTime":1275.63,"body":"from silicone MPR to plasti, for"},{"speaker":"Charles Goldfarb","startTime":1270.23,"endTime":1275.63,"body":"rheumatory, arthritis. And you"},{"speaker":"Charles Goldfarb","startTime":1275.63,"endTime":1280.07,"body":"know, it, it was one of this,"},{"speaker":"Charles Goldfarb","startTime":1275.63,"endTime":1280.07,"body":"there were a lot of articles"},{"speaker":"Charles Goldfarb","startTime":1280.07,"endTime":1282.2,"body":"like that when we just happen to"},{"speaker":"Charles Goldfarb","startTime":1280.07,"endTime":1282.2,"body":"have good follow up. And it"},{"speaker":"Charles Goldfarb","startTime":1282.2,"endTime":1285.05,"body":"talked about range of motion,"},{"speaker":"Charles Goldfarb","startTime":1282.2,"endTime":1285.05,"body":"etc. But these results are"},{"speaker":"Charles Goldfarb","startTime":1285.05,"endTime":1286.76,"body":"outstanding. It's"},{"speaker":"Chris Dy","startTime":1286.76,"endTime":1289.94,"body":"interesting how well"},{"speaker":"Chris Dy","startTime":1286.76,"endTime":1289.94,"body":"silicone does for you, because"},{"speaker":"Chris Dy","startTime":1289.94,"endTime":1293.33,"body":"it's a relatively non"},{"speaker":"Chris Dy","startTime":1289.94,"endTime":1293.33,"body":"sophisticated implant. I mean,"},{"speaker":"Chris Dy","startTime":1293.33,"endTime":1297.05,"body":"it's a spacer. And it does"},{"speaker":"Chris Dy","startTime":1293.33,"endTime":1297.05,"body":"pretty well both MP and pap"},{"speaker":"Chris Dy","startTime":1297.05,"endTime":1298.28,"body":"joints. Yeah,"},{"speaker":"Charles Goldfarb","startTime":1298.31,"endTime":1300.89,"body":"non"},{"speaker":"Charles Goldfarb","startTime":1298.31,"endTime":1300.89,"body":"sophisticated implant for non"},{"speaker":"Charles Goldfarb","startTime":1300.89,"endTime":1303.44,"body":"sophisticated surgeons that fits"},{"speaker":"Charles Goldfarb","startTime":1300.89,"endTime":1303.44,"body":"right up my alley."},{"speaker":"Chris Dy","startTime":1305.03,"endTime":1308.54,"body":"hardly the case. And"},{"speaker":"Chris Dy","startTime":1305.03,"endTime":1308.54,"body":"then the next topic is mallet"},{"speaker":"Chris Dy","startTime":1308.54,"endTime":1312.38,"body":"injuries. So the paper that that"},{"speaker":"Chris Dy","startTime":1308.54,"endTime":1312.38,"body":"was read here talked about"},{"speaker":"Chris Dy","startTime":1312.47,"endTime":1315.56,"body":"looking at patients treated non"},{"speaker":"Chris Dy","startTime":1312.47,"endTime":1315.56,"body":"operatively. And follow them for"},{"speaker":"Chris Dy","startTime":1315.56,"endTime":1321.41,"body":"mean of 12 years. Shocker. They"},{"speaker":"Chris Dy","startTime":1315.56,"endTime":1321.41,"body":"do pretty well. Yeah,"},{"speaker":"Charles Goldfarb","startTime":1321.41,"endTime":1324.38,"body":"it's, these"},{"speaker":"Charles Goldfarb","startTime":1321.41,"endTime":1324.38,"body":"are a part of my practice, for"},{"speaker":"Charles Goldfarb","startTime":1324.38,"endTime":1329.27,"body":"sure. And again, Dr. Wall, who"},{"speaker":"Charles Goldfarb","startTime":1324.38,"endTime":1329.27,"body":"we mentioned earlier, takes care"},{"speaker":"Charles Goldfarb","startTime":1329.27,"endTime":1331.46,"body":"of more kids these days than I"},{"speaker":"Charles Goldfarb","startTime":1329.27,"endTime":1331.46,"body":"do but take care of a lot of"},{"speaker":"Charles Goldfarb","startTime":1331.46,"endTime":1335.33,"body":"kids. And she has a pretty"},{"speaker":"Charles Goldfarb","startTime":1331.46,"endTime":1335.33,"body":"nihilistic approach. I have a"},{"speaker":"Charles Goldfarb","startTime":1335.33,"endTime":1338.66,"body":"hard time to join this"},{"speaker":"Charles Goldfarb","startTime":1335.33,"endTime":1338.66,"body":"subluxated. If there's a bony"},{"speaker":"Charles Goldfarb","startTime":1338.66,"endTime":1341.72,"body":"fragment is particularly large,"},{"speaker":"Charles Goldfarb","startTime":1338.66,"endTime":1341.72,"body":"I have a hard time doing"},{"speaker":"Charles Goldfarb","startTime":1341.72,"endTime":1342.14,"body":"nothing."},{"speaker":"Chris Dy","startTime":1343.58,"endTime":1347.9,"body":"So what is doing"},{"speaker":"Chris Dy","startTime":1343.58,"endTime":1347.9,"body":"nothing mean? Does that mean not"},{"speaker":"Chris Dy","startTime":1347.9,"endTime":1349.73,"body":"doing surgery? Or does that mean"},{"speaker":"Chris Dy","startTime":1347.9,"endTime":1349.73,"body":"not splinting?"},{"speaker":"Charles Goldfarb","startTime":1349.85,"endTime":1352.64,"body":"Thank you."},{"speaker":"Charles Goldfarb","startTime":1349.85,"endTime":1352.64,"body":"Good point. So yes, I think you"},{"speaker":"Charles Goldfarb","startTime":1352.64,"endTime":1356.36,"body":"splint for pain control,"},{"speaker":"Charles Goldfarb","startTime":1352.64,"endTime":1356.36,"body":"basically. I don't know that"},{"speaker":"Charles Goldfarb","startTime":1356.36,"endTime":1359.54,"body":"you're splinting to expect it to"},{"speaker":"Charles Goldfarb","startTime":1356.36,"endTime":1359.54,"body":"change outcome, but you kind of,"},{"speaker":"Charles Goldfarb","startTime":1360.41,"endTime":1364.52,"body":"for me, if I'm treating whether"},{"speaker":"Charles Goldfarb","startTime":1360.41,"endTime":1364.52,"body":"it's an osseous injury or soft"},{"speaker":"Charles Goldfarb","startTime":1364.52,"endTime":1368.6,"body":"tissue only mallet finger, and"},{"speaker":"Charles Goldfarb","startTime":1364.52,"endTime":1368.6,"body":"I'm going to go the non"},{"speaker":"Charles Goldfarb","startTime":1368.6,"endTime":1371.24,"body":"operative route. And these are"},{"speaker":"Charles Goldfarb","startTime":1368.6,"endTime":1371.24,"body":"conversations which take me a"},{"speaker":"Charles Goldfarb","startTime":1371.24,"endTime":1376.07,"body":"while. It's a it's a custom"},{"speaker":"Charles Goldfarb","startTime":1371.24,"endTime":1376.07,"body":"splint for six weeks. 24/7,"},{"speaker":"Charles Goldfarb","startTime":1376.07,"endTime":1379.58,"body":"basically, very different,"},{"speaker":"Charles Goldfarb","startTime":1376.07,"endTime":1379.58,"body":"obviously, than the operative"},{"speaker":"Charles Goldfarb","startTime":1379.58,"endTime":1380.96,"body":"approach. Yeah."},{"speaker":"Chris Dy","startTime":1380.96,"endTime":1382.43,"body":"And I think"},{"speaker":"Chris Dy","startTime":1380.96,"endTime":1382.43,"body":"conceptually is is very hard for"},{"speaker":"Chris Dy","startTime":1382.43,"endTime":1385.7,"body":"patients to understand that, you"},{"speaker":"Chris Dy","startTime":1382.43,"endTime":1385.7,"body":"know, in the indications for"},{"speaker":"Chris Dy","startTime":1385.7,"endTime":1389.18,"body":"surgery are very, very narrow"},{"speaker":"Chris Dy","startTime":1385.7,"endTime":1389.18,"body":"for me. But it's hard to"},{"speaker":"Chris Dy","startTime":1389.18,"endTime":1391.85,"body":"explain, like I said, it's a"},{"speaker":"Chris Dy","startTime":1389.18,"endTime":1391.85,"body":"conversation and like, Well, why"},{"speaker":"Chris Dy","startTime":1391.85,"endTime":1395.66,"body":"aren't you fixing this? Why"},{"speaker":"Chris Dy","startTime":1391.85,"endTime":1395.66,"body":"aren't we fixing the the tendon"},{"speaker":"Chris Dy","startTime":1395.66,"endTime":1398.12,"body":"that's torn? Why aren't you"},{"speaker":"Chris Dy","startTime":1395.66,"endTime":1398.12,"body":"fixing the bone that's broken?"},{"speaker":"Chris Dy","startTime":1398.15,"endTime":1401.54,"body":"And it's just very hard to say,"},{"speaker":"Chris Dy","startTime":1398.15,"endTime":1401.54,"body":"the papers show that there's"},{"speaker":"Chris Dy","startTime":1401.54,"endTime":1404.0,"body":"really no difference. Yeah,"},{"speaker":"Charles Goldfarb","startTime":1404.0,"endTime":1407.03,"body":"and in the"},{"speaker":"Charles Goldfarb","startTime":1404.0,"endTime":1407.03,"body":"adolescent population, which are"},{"speaker":"Charles Goldfarb","startTime":1407.06,"endTime":1410.81,"body":"where we find the majority of"},{"speaker":"Charles Goldfarb","startTime":1407.06,"endTime":1410.81,"body":"the bony mallets it's even"},{"speaker":"Charles Goldfarb","startTime":1410.81,"endTime":1414.5,"body":"harder, because you throw a"},{"speaker":"Charles Goldfarb","startTime":1410.81,"endTime":1414.5,"body":"parent in the mix. And that's"},{"speaker":"Charles Goldfarb","startTime":1414.5,"endTime":1417.65,"body":"why I don't have a problem with"},{"speaker":"Charles Goldfarb","startTime":1414.5,"endTime":1417.65,"body":"a close reduction and panning"},{"speaker":"Charles Goldfarb","startTime":1417.65,"endTime":1421.55,"body":"especially I did did one last"},{"speaker":"Charles Goldfarb","startTime":1417.65,"endTime":1421.55,"body":"week. And you know, the the"},{"speaker":"Charles Goldfarb","startTime":1421.55,"endTime":1424.55,"body":"fragment if we can improve the"},{"speaker":"Charles Goldfarb","startTime":1421.55,"endTime":1424.55,"body":"position of fragment, improve"},{"speaker":"Charles Goldfarb","startTime":1424.55,"endTime":1427.49,"body":"the joint alignment, I feel good"},{"speaker":"Charles Goldfarb","startTime":1424.55,"endTime":1427.49,"body":"about what we've accomplished."},{"speaker":"Chris Dy","startTime":1428.36,"endTime":1430.79,"body":"Yeah, no, I think"},{"speaker":"Chris Dy","startTime":1428.36,"endTime":1430.79,"body":"that's absolutely fair. You"},{"speaker":"Chris Dy","startTime":1430.79,"endTime":1434.42,"body":"know, it should be stated that"},{"speaker":"Chris Dy","startTime":1430.79,"endTime":1434.42,"body":"this article demonstrated that"},{"speaker":"Chris Dy","startTime":1434.45,"endTime":1437.15,"body":"patients go on to radiographic"},{"speaker":"Chris Dy","startTime":1434.45,"endTime":1437.15,"body":"arthritis, but it doesn't lead"},{"speaker":"Chris Dy","startTime":1437.15,"endTime":1439.64,"body":"to any clinical consequences,"},{"speaker":"Chris Dy","startTime":1437.15,"endTime":1439.64,"body":"and it's very much similar to"},{"speaker":"Chris Dy","startTime":1439.64,"endTime":1442.97,"body":"the distal radius literature"},{"speaker":"Chris Dy","startTime":1439.64,"endTime":1442.97,"body":"that you contributed to. Yep,"},{"speaker":"Charles Goldfarb","startTime":1443.03,"endTime":1449.0,"body":"I think that"},{"speaker":"Charles Goldfarb","startTime":1443.03,"endTime":1449.0,"body":"radiographic arthritis, and it's"},{"speaker":"Charles Goldfarb","startTime":1449.0,"endTime":1450.98,"body":"really interesting. I think"},{"speaker":"Charles Goldfarb","startTime":1449.0,"endTime":1450.98,"body":"we're going to learn more about"},{"speaker":"Charles Goldfarb","startTime":1450.98,"endTime":1454.31,"body":"the implications of that over"},{"speaker":"Charles Goldfarb","startTime":1450.98,"endTime":1454.31,"body":"time with some of these longer"},{"speaker":"Charles Goldfarb","startTime":1454.31,"endTime":1457.52,"body":"term follow up studies. But"},{"speaker":"Charles Goldfarb","startTime":1454.31,"endTime":1457.52,"body":"radiographic arthritis does not"},{"speaker":"Charles Goldfarb","startTime":1457.55,"endTime":1459.86,"body":"equal symptomatic arthritis."},{"speaker":"Charles Goldfarb","startTime":1457.55,"endTime":1459.86,"body":"Don't"},{"speaker":"Chris Dy","startTime":1459.86,"endTime":1461.72,"body":"sign us up for any"},{"speaker":"Chris Dy","startTime":1459.86,"endTime":1461.72,"body":"long term studies on mallet"},{"speaker":"Chris Dy","startTime":1461.72,"endTime":1462.47,"body":"fingers placed."},{"speaker":"Charles Goldfarb","startTime":1464.48,"endTime":1466.34,"body":"And no"},{"speaker":"Charles Goldfarb","startTime":1464.48,"endTime":1466.34,"body":"prospective randomized trial"},{"speaker":"Charles Goldfarb","startTime":1466.34,"endTime":1466.73,"body":"either."},{"speaker":"Chris Dy","startTime":1467.54,"endTime":1469.67,"body":"So before we move on"},{"speaker":"Chris Dy","startTime":1467.54,"endTime":1469.67,"body":"to disagrees fractures, we"},{"speaker":"Chris Dy","startTime":1469.67,"endTime":1472.52,"body":"should thank our sponsor"},{"speaker":"Chris Dy","startTime":1469.67,"endTime":1472.52,"body":"checkpoint surgical and they"},{"speaker":"Chris Dy","startTime":1472.52,"endTime":1475.46,"body":"recently hosted a webinar on"},{"speaker":"Chris Dy","startTime":1472.52,"endTime":1475.46,"body":"nerve base surgery and the"},{"speaker":"Chris Dy","startTime":1475.46,"endTime":1478.64,"body":"management of upper extremity"},{"speaker":"Chris Dy","startTime":1475.46,"endTime":1478.64,"body":"spasticity with your buddies Dr."},{"speaker":"Chris Dy","startTime":1478.64,"endTime":1482.72,"body":"Scott Kosan, and Eugene Park."},{"speaker":"Chris Dy","startTime":1478.64,"endTime":1482.72,"body":"They review the concepts of"},{"speaker":"Chris Dy","startTime":1482.72,"endTime":1485.18,"body":"nerve base procedures and"},{"speaker":"Chris Dy","startTime":1482.72,"endTime":1485.18,"body":"managing specificity and its"},{"speaker":"Chris Dy","startTime":1485.18,"endTime":1487.82,"body":"emerging role in the upper"},{"speaker":"Chris Dy","startTime":1485.18,"endTime":1487.82,"body":"extremities. In case"},{"speaker":"Charles Goldfarb","startTime":1487.82,"endTime":1490.67,"body":"you missed the"},{"speaker":"Charles Goldfarb","startTime":1487.82,"endTime":1490.67,"body":"live event I did Chris I missed"},{"speaker":"Charles Goldfarb","startTime":1490.67,"endTime":1493.73,"body":"it. It is now available to watch"},{"speaker":"Charles Goldfarb","startTime":1490.67,"endTime":1493.73,"body":"on demand. To view the recording"},{"speaker":"Charles Goldfarb","startTime":1493.73,"endTime":1496.82,"body":"and learn about upcoming"},{"speaker":"Charles Goldfarb","startTime":1493.73,"endTime":1496.82,"body":"educational programs supported"},{"speaker":"Charles Goldfarb","startTime":1496.82,"endTime":1501.44,"body":"by checkpoint surgical, please"},{"speaker":"Charles Goldfarb","startTime":1496.82,"endTime":1501.44,"body":"visit nerve master her.com"},{"speaker":"Chris Dy","startTime":1502.1,"endTime":1503.57,"body":"I'm pretty sure that's"},{"speaker":"Chris Dy","startTime":1502.1,"endTime":1503.57,"body":"bookmarked for you already."},{"speaker":"Chris Dy","startTime":1503.57,"endTime":1503.84,"body":"Right?"},{"speaker":"Charles Goldfarb","startTime":1504.05,"endTime":1507.5,"body":"Oh my god, I"},{"speaker":"Charles Goldfarb","startTime":1504.05,"endTime":1507.5,"body":"love the more nerve the better"},{"speaker":"Charles Goldfarb","startTime":1507.53,"endTime":1509.06,"body":"once I've logged innervation"},{"speaker":"Chris Dy","startTime":1510.889,"endTime":1514.459,"body":"anti nerve Come on"},{"speaker":"Chris Dy","startTime":1510.889,"endTime":1514.459,"body":"now. So speaking of doing"},{"speaker":"Chris Dy","startTime":1514.459,"endTime":1517.309,"body":"nothing for patients, this next"},{"speaker":"Chris Dy","startTime":1514.459,"endTime":1517.309,"body":"article is really interesting."},{"speaker":"Chris Dy","startTime":1517.309,"endTime":1521.329,"body":"It's something I've always"},{"speaker":"Chris Dy","startTime":1517.309,"endTime":1521.329,"body":"wanted to do it for this trial"},{"speaker":"Chris Dy","startTime":1521.329,"endTime":1525.439,"body":"group called the appropriately"},{"speaker":"Chris Dy","startTime":1521.329,"endTime":1525.439,"body":"called cast off group. What"},{"speaker":"Chris Dy","startTime":1525.439,"endTime":1530.059,"body":"about one week of plaster and"},{"speaker":"Chris Dy","startTime":1525.439,"endTime":1530.059,"body":"then going to an Ace wrap for"},{"speaker":"Chris Dy","startTime":1530.089,"endTime":1531.979,"body":"minimally displaced this arrays"},{"speaker":"Chris Dy","startTime":1530.089,"endTime":1531.979,"body":"fracture?"},{"speaker":"Charles Goldfarb","startTime":1533.03,"endTime":1535.58,"body":"I love my"},{"speaker":"Charles Goldfarb","startTime":1533.03,"endTime":1535.58,"body":"patient population. I really do."},{"speaker":"Charles Goldfarb","startTime":1535.58,"endTime":1538.16,"body":"I think we're lucky. We've"},{"speaker":"Charles Goldfarb","startTime":1535.58,"endTime":1538.16,"body":"talked about this in St. Louis,"},{"speaker":"Charles Goldfarb","startTime":1538.19,"endTime":1540.17,"body":"I do not think this would fly at"},{"speaker":"Charles Goldfarb","startTime":1538.19,"endTime":1540.17,"body":"all."},{"speaker":"Chris Dy","startTime":1541.25,"endTime":1543.83,"body":"I think it's are a"},{"speaker":"Chris Dy","startTime":1541.25,"endTime":1543.83,"body":"hard sell. I think I probably"},{"speaker":"Chris Dy","startTime":1543.83,"endTime":1546.56,"body":"could, I can't even do it for"},{"speaker":"Chris Dy","startTime":1543.83,"endTime":1546.56,"body":"metacarpal, which is also good"},{"speaker":"Chris Dy","startTime":1546.56,"endTime":1549.71,"body":"literature to go with just an"},{"speaker":"Chris Dy","startTime":1546.56,"endTime":1549.71,"body":"Ace wrap. I think it's just"},{"speaker":"Chris Dy","startTime":1549.71,"endTime":1552.68,"body":"hard. What about a kako? Brace"},{"speaker":"Chris Dy","startTime":1549.71,"endTime":1552.68,"body":"brace?"},{"speaker":"Charles Goldfarb","startTime":1555.05,"endTime":1557.93,"body":"Yeah, I mean,"},{"speaker":"Charles Goldfarb","startTime":1555.05,"endTime":1557.93,"body":"for the right patient, I just,"},{"speaker":"Charles Goldfarb","startTime":1557.96,"endTime":1563.0,"body":"you know, in the United States,"},{"speaker":"Charles Goldfarb","startTime":1557.96,"endTime":1563.0,"body":"that concept of loss reduction"},{"speaker":"Charles Goldfarb","startTime":1563.33,"endTime":1567.05,"body":"in the medical legal"},{"speaker":"Charles Goldfarb","startTime":1563.33,"endTime":1567.05,"body":"implications are just in the"},{"speaker":"Charles Goldfarb","startTime":1567.05,"endTime":1571.13,"body":"back of my mind fairly or"},{"speaker":"Charles Goldfarb","startTime":1567.05,"endTime":1571.13,"body":"unfairly. I want to treat the"},{"speaker":"Charles Goldfarb","startTime":1571.13,"endTime":1574.76,"body":"patient the right way. But I"},{"speaker":"Charles Goldfarb","startTime":1571.13,"endTime":1574.76,"body":"want to treat it in the, you"},{"speaker":"Charles Goldfarb","startTime":1574.76,"endTime":1577.01,"body":"know, the accepted domain"},{"speaker":"Charles Goldfarb","startTime":1574.76,"endTime":1577.01,"body":"medical legally,"},{"speaker":"Chris Dy","startTime":1577.55,"endTime":1580.31,"body":"do you think that this"},{"speaker":"Chris Dy","startTime":1577.55,"endTime":1580.31,"body":"paper gives you, you know,"},{"speaker":"Chris Dy","startTime":1580.34,"endTime":1582.86,"body":"reasonable standing to say, All"},{"speaker":"Chris Dy","startTime":1580.34,"endTime":1582.86,"body":"right, well, let's just you"},{"speaker":"Chris Dy","startTime":1582.86,"endTime":1585.86,"body":"know, there's a chance that"},{"speaker":"Chris Dy","startTime":1582.86,"endTime":1585.86,"body":"could displace, but no patients"},{"speaker":"Chris Dy","startTime":1585.86,"endTime":1590.36,"body":"displaced in this in this"},{"speaker":"Chris Dy","startTime":1585.86,"endTime":1590.36,"body":"series. I think it's nice. I"},{"speaker":"Chris Dy","startTime":1590.36,"endTime":1592.82,"body":"mean, I think for the right"},{"speaker":"Chris Dy","startTime":1590.36,"endTime":1592.82,"body":"patient for a minimally"},{"speaker":"Chris Dy","startTime":1592.82,"endTime":1595.82,"body":"displaced fracture that has a"},{"speaker":"Chris Dy","startTime":1592.82,"endTime":1595.82,"body":"very low chance of displacement"},{"speaker":"Chris Dy","startTime":1595.85,"endTime":1599.48,"body":"in my mind, I like a cockroach"},{"speaker":"Chris Dy","startTime":1595.85,"endTime":1599.48,"body":"brace brace. And, you know, kind"},{"speaker":"Chris Dy","startTime":1599.48,"endTime":1601.4,"body":"of tell them where it like a"},{"speaker":"Chris Dy","startTime":1599.48,"endTime":1601.4,"body":"cast, but it does change your"},{"speaker":"Chris Dy","startTime":1601.4,"endTime":1603.44,"body":"quality of life. I mean, it"},{"speaker":"Chris Dy","startTime":1601.4,"endTime":1603.44,"body":"allows them to shower more"},{"speaker":"Chris Dy","startTime":1603.44,"endTime":1607.07,"body":"readily doesn't have the expense"},{"speaker":"Chris Dy","startTime":1603.44,"endTime":1607.07,"body":"of going to therapy for a custom"},{"speaker":"Chris Dy","startTime":1607.07,"endTime":1611.24,"body":"splint. I think it's a very"},{"speaker":"Chris Dy","startTime":1607.07,"endTime":1611.24,"body":"reasonable thing. And I like"},{"speaker":"Chris Dy","startTime":1611.24,"endTime":1612.56,"body":"having to study in the"},{"speaker":"Chris Dy","startTime":1611.24,"endTime":1612.56,"body":"literature."},{"speaker":"Charles Goldfarb","startTime":1612.83,"endTime":1614.06,"body":"I think this"},{"speaker":"Charles Goldfarb","startTime":1612.83,"endTime":1614.06,"body":"studying literature is"},{"speaker":"Charles Goldfarb","startTime":1614.06,"endTime":1617.93,"body":"excellent. For me, it will help"},{"speaker":"Charles Goldfarb","startTime":1614.06,"endTime":1617.93,"body":"me move along the pathway,"},{"speaker":"Charles Goldfarb","startTime":1617.93,"endTime":1621.14,"body":"assuming additional literature"},{"speaker":"Charles Goldfarb","startTime":1617.93,"endTime":1621.14,"body":"supports this concept. It also"},{"speaker":"Charles Goldfarb","startTime":1621.14,"endTime":1624.98,"body":"gets to the point of with this"},{"speaker":"Charles Goldfarb","startTime":1621.14,"endTime":1624.98,"body":"type of nondisplaced, fracture"},{"speaker":"Charles Goldfarb","startTime":1624.98,"endTime":1628.28,"body":"or even others. I've been"},{"speaker":"Charles Goldfarb","startTime":1624.98,"endTime":1628.28,"body":"schooled that I see the patient"},{"speaker":"Charles Goldfarb","startTime":1628.28,"endTime":1631.79,"body":"that week one, week two, week"},{"speaker":"Charles Goldfarb","startTime":1628.28,"endTime":1631.79,"body":"three, week five, and I'm a new"},{"speaker":"Charles Goldfarb","startTime":1631.79,"endTime":1634.28,"body":"agent radiographs each time now"},{"speaker":"Charles Goldfarb","startTime":1631.79,"endTime":1634.28,"body":"there are certain fractures that"},{"speaker":"Charles Goldfarb","startTime":1634.28,"endTime":1637.55,"body":"need that, but I probably overdo"},{"speaker":"Charles Goldfarb","startTime":1634.28,"endTime":1637.55,"body":"it, I probably bring back"},{"speaker":"Charles Goldfarb","startTime":1637.55,"endTime":1640.4,"body":"patients more frequently than I"},{"speaker":"Charles Goldfarb","startTime":1637.55,"endTime":1640.4,"body":"need. Because the concept here"},{"speaker":"Charles Goldfarb","startTime":1640.4,"endTime":1644.57,"body":"is the initial traumas, always"},{"speaker":"Charles Goldfarb","startTime":1640.4,"endTime":1644.57,"body":"the worst trauma. If the patient"},{"speaker":"Charles Goldfarb","startTime":1644.57,"endTime":1648.2,"body":"is smart about not overusing the"},{"speaker":"Charles Goldfarb","startTime":1644.57,"endTime":1648.2,"body":"hand, he or she should be fine."},{"speaker":"Chris Dy","startTime":1649.16,"endTime":1651.41,"body":"I think that's true."},{"speaker":"Chris Dy","startTime":1649.16,"endTime":1651.41,"body":"And I tend to tell patients"},{"speaker":"Chris Dy","startTime":1651.41,"endTime":1653.54,"body":"about the ones that I'm a little"},{"speaker":"Chris Dy","startTime":1651.41,"endTime":1653.54,"body":"concerned about displacement."},{"speaker":"Chris Dy","startTime":1653.57,"endTime":1657.38,"body":"And I think that I don't see"},{"speaker":"Chris Dy","startTime":1653.57,"endTime":1657.38,"body":"them serially after two weeks,"},{"speaker":"Chris Dy","startTime":1658.07,"endTime":1661.13,"body":"kind of go to the one two, and"},{"speaker":"Chris Dy","startTime":1658.07,"endTime":1661.13,"body":"then six weeks, you know,"},{"speaker":"Chris Dy","startTime":1661.13,"endTime":1664.19,"body":"relative to the date of when I"},{"speaker":"Chris Dy","startTime":1661.13,"endTime":1664.19,"body":"start seeing them. But I think"},{"speaker":"Chris Dy","startTime":1664.19,"endTime":1666.35,"body":"it's absolutely fair. I mean, I"},{"speaker":"Chris Dy","startTime":1664.19,"endTime":1666.35,"body":"struggle with the ones that I"},{"speaker":"Chris Dy","startTime":1666.44,"endTime":1668.54,"body":"you know, trying to understand,"},{"speaker":"Chris Dy","startTime":1666.44,"endTime":1668.54,"body":"which are the ones that are"},{"speaker":"Chris Dy","startTime":1668.54,"endTime":1670.64,"body":"going to displace, because we"},{"speaker":"Chris Dy","startTime":1668.54,"endTime":1670.64,"body":"have the kind of the classic"},{"speaker":"Chris Dy","startTime":1670.64,"endTime":1674.54,"body":"LaFontaine criteria, but there"},{"speaker":"Chris Dy","startTime":1670.64,"endTime":1674.54,"body":"was a paper out of Canada that"},{"speaker":"Chris Dy","startTime":1674.54,"endTime":1677.39,"body":"kind of refuted a lot of that"},{"speaker":"Chris Dy","startTime":1674.54,"endTime":1677.39,"body":"saying that really more, it's"},{"speaker":"Chris Dy","startTime":1677.39,"endTime":1679.79,"body":"the age and the initial"},{"speaker":"Chris Dy","startTime":1677.39,"endTime":1679.79,"body":"displacement, that are the"},{"speaker":"Chris Dy","startTime":1679.79,"endTime":1683.51,"body":"bigger predictors. You know,"},{"speaker":"Chris Dy","startTime":1679.79,"endTime":1683.51,"body":"there's this paper that Deb goes"},{"speaker":"Chris Dy","startTime":1683.51,"endTime":1686.33,"body":"on to talk about here in terms"},{"speaker":"Chris Dy","startTime":1683.51,"endTime":1686.33,"body":"of, you know, marginal,"},{"speaker":"Chris Dy","startTime":1686.33,"endTime":1689.03,"body":"secondary displacement being a"},{"speaker":"Chris Dy","startTime":1686.33,"endTime":1689.03,"body":"significant predictor of late"},{"speaker":"Chris Dy","startTime":1689.03,"endTime":1692.6,"body":"displacement. This seems to be"},{"speaker":"Chris Dy","startTime":1689.03,"endTime":1692.6,"body":"the concept of you know, if you"},{"speaker":"Chris Dy","startTime":1692.6,"endTime":1694.64,"body":"see him back, and they displace"},{"speaker":"Chris Dy","startTime":1692.6,"endTime":1694.64,"body":"a little bit, they're just going"},{"speaker":"Chris Dy","startTime":1694.64,"endTime":1698.03,"body":"to continue to slide and"},{"speaker":"Chris Dy","startTime":1694.64,"endTime":1698.03,"body":"continue to display. So has that"},{"speaker":"Chris Dy","startTime":1698.03,"endTime":1699.68,"body":"been your experience? It has"},{"speaker":"Charles Goldfarb","startTime":1699.68,"endTime":1701.24,"body":"been my"},{"speaker":"Charles Goldfarb","startTime":1699.68,"endTime":1701.24,"body":"experience, and I think it's"},{"speaker":"Charles Goldfarb","startTime":1701.24,"endTime":1704.36,"body":"true in this location, and"},{"speaker":"Charles Goldfarb","startTime":1701.24,"endTime":1704.36,"body":"potentially with other fractures"},{"speaker":"Charles Goldfarb","startTime":1704.36,"endTime":1709.25,"body":"as well. That and it's the"},{"speaker":"Charles Goldfarb","startTime":1704.36,"endTime":1709.25,"body":"classic, frustrating situation"},{"speaker":"Charles Goldfarb","startTime":1709.25,"endTime":1711.23,"body":"where you have a long"},{"speaker":"Charles Goldfarb","startTime":1709.25,"endTime":1711.23,"body":"conversation with the patient,"},{"speaker":"Charles Goldfarb","startTime":1711.44,"endTime":1714.83,"body":"operative, non operative, we"},{"speaker":"Charles Goldfarb","startTime":1711.44,"endTime":1714.83,"body":"decide on non operative, you"},{"speaker":"Charles Goldfarb","startTime":1714.83,"endTime":1717.38,"body":"say, I'm gonna see you back in a"},{"speaker":"Charles Goldfarb","startTime":1714.83,"endTime":1717.38,"body":"week or whatever the number is,"},{"speaker":"Charles Goldfarb","startTime":1717.53,"endTime":1720.8,"body":"repeat the X ray, and it's a"},{"speaker":"Charles Goldfarb","startTime":1717.53,"endTime":1720.8,"body":"little worse. And then you're on"},{"speaker":"Charles Goldfarb","startTime":1720.8,"endTime":1724.34,"body":"this slippery slope of do we"},{"speaker":"Charles Goldfarb","startTime":1720.8,"endTime":1724.34,"body":"change based, you know, based on"},{"speaker":"Charles Goldfarb","startTime":1724.34,"endTime":1726.77,"body":"their parents today? Do we watch"},{"speaker":"Charles Goldfarb","startTime":1724.34,"endTime":1726.77,"body":"it for one more week, and then"},{"speaker":"Charles Goldfarb","startTime":1726.77,"endTime":1728.81,"body":"all of a sudden you start"},{"speaker":"Charles Goldfarb","startTime":1726.77,"endTime":1728.81,"body":"healing gets really"},{"speaker":"Chris Dy","startTime":1728.81,"endTime":1731.03,"body":"tricky. It's"},{"speaker":"Chris Dy","startTime":1728.81,"endTime":1731.03,"body":"frustrating, because I think a"},{"speaker":"Chris Dy","startTime":1731.03,"endTime":1733.64,"body":"lot of the if you're going to"},{"speaker":"Chris Dy","startTime":1731.03,"endTime":1733.64,"body":"have surgery, the benefit of"},{"speaker":"Chris Dy","startTime":1733.64,"endTime":1737.21,"body":"surgery is the earlier recovery,"},{"speaker":"Chris Dy","startTime":1733.64,"endTime":1737.21,"body":"you know, earlier returned to"},{"speaker":"Chris Dy","startTime":1737.21,"endTime":1741.08,"body":"function. And the longer you"},{"speaker":"Chris Dy","startTime":1737.21,"endTime":1741.08,"body":"wait, you know, the less of"},{"speaker":"Chris Dy","startTime":1741.08,"endTime":1744.74,"body":"that, you know, benefit you're"},{"speaker":"Chris Dy","startTime":1741.08,"endTime":1744.74,"body":"realizing. So it's challenging,"},{"speaker":"Chris Dy","startTime":1744.77,"endTime":1747.8,"body":"because, you know, you see him"},{"speaker":"Chris Dy","startTime":1744.77,"endTime":1747.8,"body":"back, one, two, sometimes three"},{"speaker":"Chris Dy","startTime":1747.8,"endTime":1749.93,"body":"weeks, and you're like, Alright,"},{"speaker":"Chris Dy","startTime":1747.8,"endTime":1749.93,"body":"now it's dissuasive, wherever we"},{"speaker":"Chris Dy","startTime":1749.93,"endTime":1752.57,"body":"should really talk about"},{"speaker":"Chris Dy","startTime":1749.93,"endTime":1752.57,"body":"surgery. It's like, Wow, man, I"},{"speaker":"Chris Dy","startTime":1752.57,"endTime":1755.03,"body":"just lost three weeks of"},{"speaker":"Chris Dy","startTime":1752.57,"endTime":1755.03,"body":"recovery. Yep."},{"speaker":"Charles Goldfarb","startTime":1755.03,"endTime":1756.71,"body":"And I'm"},{"speaker":"Charles Goldfarb","startTime":1755.03,"endTime":1756.71,"body":"actually dealing with that exact"},{"speaker":"Charles Goldfarb","startTime":1756.71,"endTime":1759.65,"body":"situation right now. So not only"},{"speaker":"Charles Goldfarb","startTime":1756.71,"endTime":1759.65,"body":"do you have the long first"},{"speaker":"Charles Goldfarb","startTime":1759.65,"endTime":1762.62,"body":"conversation, you're having the"},{"speaker":"Charles Goldfarb","startTime":1759.65,"endTime":1762.62,"body":"long second and third"},{"speaker":"Charles Goldfarb","startTime":1762.62,"endTime":1763.61,"body":"conversations."},{"speaker":"Chris Dy","startTime":1763.82,"endTime":1766.49,"body":"It should be noted"},{"speaker":"Chris Dy","startTime":1763.82,"endTime":1766.49,"body":"that Chuck talks about how long"},{"speaker":"Chris Dy","startTime":1766.49,"endTime":1769.55,"body":"he has to talk to people quite a"},{"speaker":"Chris Dy","startTime":1766.49,"endTime":1769.55,"body":"bit, but they are long"},{"speaker":"Chris Dy","startTime":1769.55,"endTime":1771.74,"body":"conversations that will"},{"speaker":"Chris Dy","startTime":1769.55,"endTime":1771.74,"body":"certainly change a clinic for"},{"speaker":"Chris Dy","startTime":1771.74,"endTime":1772.79,"body":"you, for"},{"speaker":"Charles Goldfarb","startTime":1772.79,"endTime":1775.43,"body":"sure. And then"},{"speaker":"Charles Goldfarb","startTime":1772.79,"endTime":1775.43,"body":"goes on to talk about the"},{"speaker":"Charles Goldfarb","startTime":1775.64,"endTime":1779.81,"body":"Frostfire Trial Group that"},{"speaker":"Charles Goldfarb","startTime":1775.64,"endTime":1779.81,"body":"combined randomized"},{"speaker":"Charles Goldfarb","startTime":1779.84,"endTime":1783.26,"body":"observational study in surgery"},{"speaker":"Charles Goldfarb","startTime":1779.84,"endTime":1783.26,"body":"for fractures in the distal"},{"speaker":"Charles Goldfarb","startTime":1783.26,"endTime":1785.78,"body":"radius of the elderly. I'm going"},{"speaker":"Charles Goldfarb","startTime":1783.26,"endTime":1785.78,"body":"to stop because I'm exhausted."},{"speaker":"Charles Goldfarb","startTime":1786.17,"endTime":1786.38,"body":"Well,"},{"speaker":"Chris Dy","startTime":1786.38,"endTime":1788.48,"body":"you know, elderly"},{"speaker":"Chris Dy","startTime":1786.38,"endTime":1788.48,"body":"Chuck is over 60 years so you're"},{"speaker":"Chris Dy","startTime":1788.48,"endTime":1791.6,"body":"not far from that apparently, at"},{"speaker":"Chris Dy","startTime":1788.48,"endTime":1791.6,"body":"least I didn't call you"},{"speaker":"Chris Dy","startTime":1791.6,"endTime":1793.13,"body":"geriatric. Sure."},{"speaker":"Charles Goldfarb","startTime":1793.37,"endTime":1796.79,"body":"I am. way away"},{"speaker":"Charles Goldfarb","startTime":1793.37,"endTime":1796.79,"body":"from that. I"},{"speaker":"Chris Dy","startTime":1796.88,"endTime":1799.88,"body":"think that the"},{"speaker":"Chris Dy","startTime":1796.88,"endTime":1799.88,"body":"dissonance between radiographic"},{"speaker":"Chris Dy","startTime":1799.88,"endTime":1802.28,"body":"and functional outcomes is not"},{"speaker":"Chris Dy","startTime":1799.88,"endTime":1802.28,"body":"surprising, but it's very"},{"speaker":"Chris Dy","startTime":1802.28,"endTime":1804.89,"body":"frustrating as somebody who"},{"speaker":"Chris Dy","startTime":1802.28,"endTime":1804.89,"body":"asked to counsel people about"},{"speaker":"Chris Dy","startTime":1804.89,"endTime":1805.4,"body":"what to do."},{"speaker":"Charles Goldfarb","startTime":1806.21,"endTime":1809.12,"body":"I think that's"},{"speaker":"Charles Goldfarb","startTime":1806.21,"endTime":1809.12,"body":"right. I mean, the so just to be"},{"speaker":"Charles Goldfarb","startTime":1809.12,"endTime":1812.36,"body":"a little specific, because this"},{"speaker":"Charles Goldfarb","startTime":1809.12,"endTime":1812.36,"body":"is an impressive study, 166"},{"speaker":"Charles Goldfarb","startTime":1812.36,"endTime":1816.35,"body":"patients randomized to"},{"speaker":"Charles Goldfarb","startTime":1812.36,"endTime":1816.35,"body":"treatment, and 134 were"},{"speaker":"Charles Goldfarb","startTime":1816.35,"endTime":1822.44,"body":"observed. And so 113 treaty with"},{"speaker":"Charles Goldfarb","startTime":1816.35,"endTime":1822.44,"body":"volar plates 187, close"},{"speaker":"Charles Goldfarb","startTime":1822.44,"endTime":1826.76,"body":"reduction only, significantly"},{"speaker":"Charles Goldfarb","startTime":1822.44,"endTime":1826.76,"body":"worse alignment at one year,"},{"speaker":"Charles Goldfarb","startTime":1827.03,"endTime":1830.45,"body":"although no difference in"},{"speaker":"Charles Goldfarb","startTime":1827.03,"endTime":1830.45,"body":"patient reported pain or"},{"speaker":"Charles Goldfarb","startTime":1830.45,"endTime":1835.13,"body":"function between plating and"},{"speaker":"Charles Goldfarb","startTime":1830.45,"endTime":1835.13,"body":"close reduction groups. Wow. I"},{"speaker":"Chris Dy","startTime":1835.16,"endTime":1837.86,"body":"it's, you know, again,"},{"speaker":"Chris Dy","startTime":1835.16,"endTime":1837.86,"body":"that that doesn't surprise me."},{"speaker":"Chris Dy","startTime":1837.89,"endTime":1841.7,"body":"But I think a lot of this has to"},{"speaker":"Chris Dy","startTime":1837.89,"endTime":1841.7,"body":"do with and I don't, I can't, I"},{"speaker":"Chris Dy","startTime":1841.7,"endTime":1844.97,"body":"don't know, where where was this"},{"speaker":"Chris Dy","startTime":1841.7,"endTime":1844.97,"body":"study performed, you know, which"},{"speaker":"Chris Dy","startTime":1844.97,"endTime":1846.23,"body":"country I"},{"speaker":"Charles Goldfarb","startTime":1846.26,"endTime":1848.12,"body":"don't, maybe I"},{"speaker":"Charles Goldfarb","startTime":1846.26,"endTime":1848.12,"body":"can, because"},{"speaker":"Chris Dy","startTime":1848.12,"endTime":1850.94,"body":"I think in at least in"},{"speaker":"Chris Dy","startTime":1848.12,"endTime":1850.94,"body":"St. Louis, in the US, I think"},{"speaker":"Chris Dy","startTime":1850.94,"endTime":1855.62,"body":"it's very challenging to, for"},{"speaker":"Chris Dy","startTime":1850.94,"endTime":1855.62,"body":"patients to accept the"},{"speaker":"Chris Dy","startTime":1855.62,"endTime":1860.0,"body":"appearance of their wrist. Even"},{"speaker":"Chris Dy","startTime":1855.62,"endTime":1860.0,"body":"if you tell them about it, it's"},{"speaker":"Chris Dy","startTime":1860.0,"endTime":1862.31,"body":"always going to look crooked,"},{"speaker":"Chris Dy","startTime":1860.0,"endTime":1862.31,"body":"they hate the prominence of the"},{"speaker":"Chris Dy","startTime":1862.34,"endTime":1867.62,"body":"ulnar head in most cases. And I"},{"speaker":"Chris Dy","startTime":1862.34,"endTime":1867.62,"body":"really struggle with the"},{"speaker":"Chris Dy","startTime":1867.62,"endTime":1871.01,"body":"counseling here. Because while I"},{"speaker":"Chris Dy","startTime":1867.62,"endTime":1871.01,"body":"tell them kind of from a"},{"speaker":"Chris Dy","startTime":1871.01,"endTime":1874.04,"body":"functional perspective, what the"},{"speaker":"Chris Dy","startTime":1871.01,"endTime":1874.04,"body":"what to expect and how, you"},{"speaker":"Chris Dy","startTime":1874.04,"endTime":1878.54,"body":"know, surgery might have a role."},{"speaker":"Chris Dy","startTime":1874.04,"endTime":1878.54,"body":"I think patients have a hard"},{"speaker":"Chris Dy","startTime":1878.54,"endTime":1881.27,"body":"time seeing a crooked wrist and"},{"speaker":"Chris Dy","startTime":1878.54,"endTime":1881.27,"body":"be okay with it."},{"speaker":"Charles Goldfarb","startTime":1882.02,"endTime":1883.91,"body":"I think that's"},{"speaker":"Charles Goldfarb","startTime":1882.02,"endTime":1883.91,"body":"true. And, you know, the patient"},{"speaker":"Charles Goldfarb","startTime":1883.91,"endTime":1887.45,"body":"population matters for sure."},{"speaker":"Charles Goldfarb","startTime":1883.91,"endTime":1887.45,"body":"East Coast, you know, Mid"},{"speaker":"Charles Goldfarb","startTime":1887.45,"endTime":1890.48,"body":"America, where you and I are"},{"speaker":"Charles Goldfarb","startTime":1887.45,"endTime":1890.48,"body":"mate, we may have it even easier"},{"speaker":"Charles Goldfarb","startTime":1890.48,"endTime":1894.53,"body":"than our friends on the coast in"},{"speaker":"Charles Goldfarb","startTime":1890.48,"endTime":1894.53,"body":"the United States. And certainly"},{"speaker":"Charles Goldfarb","startTime":1894.53,"endTime":1897.71,"body":"I don't have a great experience"},{"speaker":"Charles Goldfarb","startTime":1894.53,"endTime":1897.71,"body":"with international patients. But"},{"speaker":"Charles Goldfarb","startTime":1897.95,"endTime":1901.43,"body":"all of this is relevant to the"},{"speaker":"Charles Goldfarb","startTime":1897.95,"endTime":1901.43,"body":"to the discussion we should be"},{"speaker":"Charles Goldfarb","startTime":1901.43,"endTime":1903.62,"body":"having with our patients. It"},{"speaker":"Chris Dy","startTime":1903.62,"endTime":1906.56,"body":"is and you know, I"},{"speaker":"Chris Dy","startTime":1903.62,"endTime":1906.56,"body":"think both you and I are guilty"},{"speaker":"Chris Dy","startTime":1906.56,"endTime":1909.98,"body":"of the masochistic activity of"},{"speaker":"Chris Dy","startTime":1906.56,"endTime":1909.98,"body":"reading our own online reviews,"},{"speaker":"Chris Dy","startTime":1910.01,"endTime":1915.44,"body":"and I got torched in which I had"},{"speaker":"Chris Dy","startTime":1910.01,"endTime":1915.44,"body":"this very, I think reasonable"},{"speaker":"Chris Dy","startTime":1915.44,"endTime":1918.86,"body":"conversation about you know, non"},{"speaker":"Chris Dy","startTime":1915.44,"endTime":1918.86,"body":"op versus operative treatment of"},{"speaker":"Chris Dy","startTime":1918.89,"endTime":1922.13,"body":"disarray as fracture and just"},{"speaker":"Chris Dy","startTime":1918.89,"endTime":1922.13,"body":"got absolutely slammed saying I"},{"speaker":"Chris Dy","startTime":1922.13,"endTime":1925.04,"body":"came in and he asked me what I"},{"speaker":"Chris Dy","startTime":1922.13,"endTime":1925.04,"body":"wanted to do. Why didn't he just"},{"speaker":"Chris Dy","startTime":1925.04,"endTime":1927.65,"body":"tell me this is he's a doctor,"},{"speaker":"Chris Dy","startTime":1925.04,"endTime":1927.65,"body":"why don't you just tell me what"},{"speaker":"Chris Dy","startTime":1927.68,"endTime":1930.71,"body":"what I should have had done and"},{"speaker":"Chris Dy","startTime":1927.68,"endTime":1930.71,"body":"Oh, my God, man, strategy, this"},{"speaker":"Chris Dy","startTime":1930.74,"endTime":1933.71,"body":"kind of hippie dippie shared"},{"speaker":"Chris Dy","startTime":1930.74,"endTime":1933.71,"body":"decision making Doctor based on"},{"speaker":"Chris Dy","startTime":1933.71,"endTime":1936.38,"body":"evidence, and she's just taking"},{"speaker":"Chris Dy","startTime":1933.71,"endTime":1936.38,"body":"the old paternalistic approach"},{"speaker":"Chris Dy","startTime":1936.41,"endTime":1939.32,"body":"be like you need surgery, you"},{"speaker":"Chris Dy","startTime":1936.41,"endTime":1939.32,"body":"don't need surgery. Yeah,"},{"speaker":"Charles Goldfarb","startTime":1939.32,"endTime":1941.6,"body":"I think that"},{"speaker":"Charles Goldfarb","startTime":1939.32,"endTime":1941.6,"body":"only happens in Mid America, and"},{"speaker":"Charles Goldfarb","startTime":1941.6,"endTime":1945.41,"body":"only happens rarely even here."},{"speaker":"Charles Goldfarb","startTime":1941.6,"endTime":1945.41,"body":"But you gotta read the room."},{"speaker":"Chris Dy","startTime":1947.0,"endTime":1951.05,"body":"Clearly, clearly, I"},{"speaker":"Chris Dy","startTime":1947.0,"endTime":1951.05,"body":"was wrong. And I can't obviously"},{"speaker":"Chris Dy","startTime":1951.05,"endTime":1953.57,"body":"can't do anything about that"},{"speaker":"Chris Dy","startTime":1951.05,"endTime":1953.57,"body":"review, unfortunately."},{"speaker":"Charles Goldfarb","startTime":1954.95,"endTime":1958.7,"body":"Um, the next"},{"speaker":"Charles Goldfarb","startTime":1954.95,"endTime":1958.7,"body":"section is interesting. Dead"},{"speaker":"Charles Goldfarb","startTime":1958.73,"endTime":1962.15,"body":"discusses skateboard fractures."},{"speaker":"Charles Goldfarb","startTime":1958.73,"endTime":1962.15,"body":"And she begins by discussing the"},{"speaker":"Charles Goldfarb","startTime":1962.15,"endTime":1967.73,"body":"whole concept of essentially"},{"speaker":"Charles Goldfarb","startTime":1962.15,"endTime":1967.73,"body":"artificial intelligence, both in"},{"speaker":"Charles Goldfarb","startTime":1967.73,"endTime":1971.3,"body":"the sense of diagnosing"},{"speaker":"Charles Goldfarb","startTime":1967.73,"endTime":1971.3,"body":"skateboard fractures. And then"},{"speaker":"Charles Goldfarb","startTime":1971.96,"endTime":1976.46,"body":"the concept of robotic assisted"},{"speaker":"Charles Goldfarb","startTime":1971.96,"endTime":1976.46,"body":"versus freehand placement of the"},{"speaker":"Charles Goldfarb","startTime":1976.46,"endTime":1979.76,"body":"guidewire. And we all know this"},{"speaker":"Charles Goldfarb","startTime":1976.46,"endTime":1979.76,"body":"is coming is one of the reasons"},{"speaker":"Charles Goldfarb","startTime":1979.76,"endTime":1982.07,"body":"I'm excited about our graduation"},{"speaker":"Charles Goldfarb","startTime":1979.76,"endTime":1982.07,"body":"speaker who we mentioned"},{"speaker":"Charles Goldfarb","startTime":1982.07,"endTime":1986.12,"body":"earlier. Really interesting"},{"speaker":"Charles Goldfarb","startTime":1982.07,"endTime":1986.12,"body":"stuff. I mean, we're going to be"},{"speaker":"Charles Goldfarb","startTime":1986.51,"endTime":1990.83,"body":"using AI for both diagnostic and"},{"speaker":"Charles Goldfarb","startTime":1986.51,"endTime":1990.83,"body":"technical purposes. It's just a"},{"speaker":"Charles Goldfarb","startTime":1990.83,"endTime":1991.61,"body":"matter of when."},{"speaker":"Chris Dy","startTime":1992.48,"endTime":1994.31,"body":"Yeah, no, I think the"},{"speaker":"Chris Dy","startTime":1992.48,"endTime":1994.31,"body":"diagnostic thing is, I mean,"},{"speaker":"Chris Dy","startTime":1994.31,"endTime":1997.13,"body":"it's already it's already here."},{"speaker":"Chris Dy","startTime":1994.31,"endTime":1997.13,"body":"I think that, you know,"},{"speaker":"Chris Dy","startTime":1997.13,"endTime":2000.58,"body":"radiologists, I think, are wise"},{"speaker":"Chris Dy","startTime":1997.13,"endTime":2000.58,"body":"to be on top of this, because it"},{"speaker":"Chris Dy","startTime":2001.06,"endTime":2003.13,"body":"I don't think it's going to"},{"speaker":"Chris Dy","startTime":2001.06,"endTime":2003.13,"body":"replace them. But it may, you"},{"speaker":"Chris Dy","startTime":2003.13,"endTime":2006.31,"body":"know, expand their capabilities"},{"speaker":"Chris Dy","startTime":2003.13,"endTime":2006.31,"body":"in terms of, you know,"},{"speaker":"Chris Dy","startTime":2007.0,"endTime":2013.54,"body":"diagnostic diagnosis of many"},{"speaker":"Chris Dy","startTime":2007.0,"endTime":2013.54,"body":"different things. I, I struggle"},{"speaker":"Chris Dy","startTime":2013.54,"endTime":2017.17,"body":"with robotic assisted because it"},{"speaker":"Chris Dy","startTime":2013.54,"endTime":2017.17,"body":"did show that it takes longer,"},{"speaker":"Chris Dy","startTime":2017.17,"endTime":2020.23,"body":"but I mean, over time, that"},{"speaker":"Chris Dy","startTime":2017.17,"endTime":2020.23,"body":"probably is going to, it's going"},{"speaker":"Chris Dy","startTime":2020.23,"endTime":2023.92,"body":"to change. I mean, I can't think"},{"speaker":"Chris Dy","startTime":2020.23,"endTime":2023.92,"body":"of anything worse than having a"},{"speaker":"Chris Dy","startTime":2023.92,"endTime":2027.4,"body":"robot help me put a pin guide"},{"speaker":"Chris Dy","startTime":2023.92,"endTime":2027.4,"body":"wire in for a skateboard."},{"speaker":"Chris Dy","startTime":2027.91,"endTime":2028.84,"body":"Skateboard screw."},{"speaker":"Charles Goldfarb","startTime":2029.56,"endTime":2031.36,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":2029.56,"endTime":2031.36,"body":"you and I are gonna be waiting a"},{"speaker":"Charles Goldfarb","startTime":2031.36,"endTime":2034.99,"body":"while before a point employing"},{"speaker":"Charles Goldfarb","startTime":2031.36,"endTime":2034.99,"body":"that technology. What"},{"speaker":"Chris Dy","startTime":2034.99,"endTime":2036.82,"body":"else? What else? Am I"},{"speaker":"Chris Dy","startTime":2034.99,"endTime":2036.82,"body":"going to harass our fellows? I"},{"speaker":"Chris Dy","startTime":2036.82,"endTime":2037.06,"body":"mean,"},{"speaker":"Charles Goldfarb","startTime":2039.07,"endTime":2040.96,"body":"put a little"},{"speaker":"Charles Goldfarb","startTime":2039.07,"endTime":2040.96,"body":"pressure on them, not the robot."},{"speaker":"Charles Goldfarb","startTime":2040.99,"endTime":2043.96,"body":"Yeah, I don't know. This. Is"},{"speaker":"Charles Goldfarb","startTime":2040.99,"endTime":2043.96,"body":"this a little crazy? I think an"},{"speaker":"Charles Goldfarb","startTime":2043.96,"endTime":2048.55,"body":"experienced surgeon can"},{"speaker":"Charles Goldfarb","startTime":2043.96,"endTime":2048.55,"body":"typically do this pretty quickly"},{"speaker":"Charles Goldfarb","startTime":2048.55,"endTime":2050.47,"body":"from the dorsal approach. Yeah,"},{"speaker":"Charles Goldfarb","startTime":2048.55,"endTime":2050.47,"body":"I"},{"speaker":"Chris Dy","startTime":2050.469,"endTime":2052.929,"body":"think so. But I think"},{"speaker":"Chris Dy","startTime":2050.469,"endTime":2052.929,"body":"over time, it'll be interesting"},{"speaker":"Chris Dy","startTime":2052.929,"endTime":2056.079,"body":"to see in hand surgery where the"},{"speaker":"Chris Dy","startTime":2052.929,"endTime":2056.079,"body":"robot eventually gets used. It"},{"speaker":"Chris Dy","startTime":2056.079,"endTime":2058.569,"body":"hasn't really creeped into"},{"speaker":"Chris Dy","startTime":2056.079,"endTime":2058.569,"body":"anything, you know, what we do,"},{"speaker":"Chris Dy","startTime":2058.569,"endTime":2061.389,"body":"but I have seen papers about,"},{"speaker":"Chris Dy","startTime":2058.569,"endTime":2061.389,"body":"you know, robotic assisted nerve"},{"speaker":"Chris Dy","startTime":2061.389,"endTime":2063.909,"body":"cooperations, which I think"},{"speaker":"Chris Dy","startTime":2061.389,"endTime":2063.909,"body":"there might be a role for that."},{"speaker":"Chris Dy","startTime":2064.869,"endTime":2068.499,"body":"Maybe particularly in kind of"},{"speaker":"Chris Dy","startTime":2064.869,"endTime":2068.499,"body":"some of the more difficult areas"},{"speaker":"Chris Dy","startTime":2068.499,"endTime":2071.079,"body":"to do micro like when you're"},{"speaker":"Chris Dy","startTime":2068.499,"endTime":2071.079,"body":"deep in the neck for plexes. And"},{"speaker":"Chris Dy","startTime":2071.079,"endTime":2074.109,"body":"when you're when you're not when"},{"speaker":"Chris Dy","startTime":2071.079,"endTime":2074.109,"body":"it's not flat on the table, like"},{"speaker":"Chris Dy","startTime":2074.109,"endTime":2076.719,"body":"a digital nerve. So maybe"},{"speaker":"Chris Dy","startTime":2074.109,"endTime":2076.719,"body":"there's a role for that. I've"},{"speaker":"Chris Dy","startTime":2076.719,"endTime":2080.589,"body":"seen kind of robotic assisted."},{"speaker":"Chris Dy","startTime":2076.719,"endTime":2080.589,"body":"This is crazy, but phrenic nerve"},{"speaker":"Chris Dy","startTime":2080.769,"endTime":2084.969,"body":"dissection of robotic assisted"},{"speaker":"Chris Dy","startTime":2080.769,"endTime":2084.969,"body":"intercostal nerve dissection,"},{"speaker":"Chris Dy","startTime":2084.969,"endTime":2086.979,"body":"which I think would be really"},{"speaker":"Chris Dy","startTime":2084.969,"endTime":2086.979,"body":"cool, because intercostals are"},{"speaker":"Chris Dy","startTime":2086.979,"endTime":2089.499,"body":"pretty frustrating stuff that"},{"speaker":"Chris Dy","startTime":2086.979,"endTime":2089.499,"body":"you don't do on the regular"},{"speaker":"Chris Dy","startTime":2089.499,"endTime":2093.759,"body":"truck. But it'd be interesting"},{"speaker":"Chris Dy","startTime":2089.499,"endTime":2093.759,"body":"to see where robots land I will"},{"speaker":"Chris Dy","startTime":2093.759,"endTime":2096.399,"body":"certainly will use this paper."},{"speaker":"Chris Dy","startTime":2093.759,"endTime":2096.399,"body":"You know, the next time I'm"},{"speaker":"Chris Dy","startTime":2096.399,"endTime":2098.889,"body":"talking to a resident or fellow"},{"speaker":"Chris Dy","startTime":2096.399,"endTime":2098.889,"body":"about when they're putting in"},{"speaker":"Chris Dy","startTime":2098.889,"endTime":2100.599,"body":"their guidewire I'll tell them"},{"speaker":"Chris Dy","startTime":2098.889,"endTime":2100.599,"body":"where we're About could do it"},{"speaker":"Chris Dy","startTime":2100.599,"endTime":2100.989,"body":"better?"},{"speaker":"Charles Goldfarb","startTime":2102.879,"endTime":2104.649,"body":"We'll say"},{"speaker":"Charles Goldfarb","startTime":2102.879,"endTime":2104.649,"body":"thank you very much. Yeah,"},{"speaker":"Chris Dy","startTime":2104.65,"endTime":2106.84,"body":"exactly. This is this"},{"speaker":"Chris Dy","startTime":2104.65,"endTime":2106.84,"body":"is part of my teaching strategy."},{"speaker":"Charles Goldfarb","startTime":2108.79,"endTime":2111.91,"body":"So the"},{"speaker":"Charles Goldfarb","startTime":2108.79,"endTime":2111.91,"body":"metacarpal fractures section is"},{"speaker":"Charles Goldfarb","startTime":2111.91,"endTime":2117.49,"body":"really, we already touched on it"},{"speaker":"Charles Goldfarb","startTime":2111.91,"endTime":2117.49,"body":"essentially, there are, there's"},{"speaker":"Charles Goldfarb","startTime":2117.52,"endTime":2123.94,"body":"a good study which looked at 37"},{"speaker":"Charles Goldfarb","startTime":2117.52,"endTime":2123.94,"body":"metacarpal shaft fractures of"},{"speaker":"Charles Goldfarb","startTime":2123.94,"endTime":2127.84,"body":"the digits, not the thumb. They"},{"speaker":"Charles Goldfarb","startTime":2123.94,"endTime":2127.84,"body":"didn't meet surgical criteria"},{"speaker":"Charles Goldfarb","startTime":2127.84,"endTime":2131.92,"body":"followed over six weeks, and"},{"speaker":"Charles Goldfarb","startTime":2127.84,"endTime":2131.92,"body":"really only one had a change of"},{"speaker":"Charles Goldfarb","startTime":2131.92,"endTime":2136.03,"body":"alignment requiring surgery. So"},{"speaker":"Charles Goldfarb","startTime":2131.92,"endTime":2136.03,"body":"that gets to our point earlier,"},{"speaker":"Charles Goldfarb","startTime":2136.03,"endTime":2139.6,"body":"how to mobilize patients what"},{"speaker":"Charles Goldfarb","startTime":2136.03,"endTime":2139.6,"body":"what's the expectation, and then"},{"speaker":"Charles Goldfarb","startTime":2139.6,"endTime":2142.75,"body":"Deb talks about changes in"},{"speaker":"Charles Goldfarb","startTime":2139.6,"endTime":2142.75,"body":"practice over time and the"},{"speaker":"Charles Goldfarb","startTime":2142.78,"endTime":2145.84,"body":"increasing evidence about the"},{"speaker":"Charles Goldfarb","startTime":2142.78,"endTime":2145.84,"body":"need for following these"},{"speaker":"Charles Goldfarb","startTime":2145.84,"endTime":2148.27,"body":"patients and how it's just hard"},{"speaker":"Charles Goldfarb","startTime":2145.84,"endTime":2148.27,"body":"to change practice."},{"speaker":"Chris Dy","startTime":2148.78,"endTime":2151.06,"body":"It really is, I mean,"},{"speaker":"Chris Dy","startTime":2148.78,"endTime":2151.06,"body":"I guess I want to talk about the"},{"speaker":"Chris Dy","startTime":2151.06,"endTime":2154.51,"body":"first paper, I mean, I don't"},{"speaker":"Chris Dy","startTime":2151.06,"endTime":2154.51,"body":"know the last time I saw"},{"speaker":"Chris Dy","startTime":2154.51,"endTime":2159.04,"body":"metacarpal back that changed it"},{"speaker":"Chris Dy","startTime":2154.51,"endTime":2159.04,"body":"to the point where it eventually"},{"speaker":"Chris Dy","startTime":2159.04,"endTime":2161.59,"body":"was more of a surgical"},{"speaker":"Chris Dy","startTime":2159.04,"endTime":2161.59,"body":"conversation to the point where"},{"speaker":"Chris Dy","startTime":2161.62,"endTime":2164.05,"body":"I actually see them. And then I"},{"speaker":"Chris Dy","startTime":2161.62,"endTime":2164.05,"body":"see them in six weeks, I don't"},{"speaker":"Chris Dy","startTime":2164.05,"endTime":2166.12,"body":"see them back, you know, I used"},{"speaker":"Chris Dy","startTime":2164.05,"endTime":2166.12,"body":"to like was starting out with"},{"speaker":"Chris Dy","startTime":2166.12,"endTime":2168.82,"body":"see them at a week or so just to"},{"speaker":"Chris Dy","startTime":2166.12,"endTime":2168.82,"body":"check alignment again, I've"},{"speaker":"Chris Dy","startTime":2168.82,"endTime":2169.45,"body":"stopped doing it."},{"speaker":"Charles Goldfarb","startTime":2169.99,"endTime":2172.75,"body":"The only time"},{"speaker":"Charles Goldfarb","startTime":2169.99,"endTime":2172.75,"body":"I see them back one week later,"},{"speaker":"Charles Goldfarb","startTime":2172.75,"endTime":2175.81,"body":"and it's often in the adolescent"},{"speaker":"Charles Goldfarb","startTime":2172.75,"endTime":2175.81,"body":"population is if the"},{"speaker":"Charles Goldfarb","startTime":2175.81,"endTime":2179.05,"body":"radiographic alignment looks"},{"speaker":"Charles Goldfarb","startTime":2175.81,"endTime":2179.05,"body":"pretty good. But the finger"},{"speaker":"Charles Goldfarb","startTime":2179.05,"endTime":2181.96,"body":"looks a little deviated or"},{"speaker":"Charles Goldfarb","startTime":2179.05,"endTime":2181.96,"body":"rotated. I wonder whether it's"},{"speaker":"Charles Goldfarb","startTime":2181.96,"endTime":2184.99,"body":"just swelling. So then I Mobizen"},{"speaker":"Charles Goldfarb","startTime":2181.96,"endTime":2184.99,"body":"for a week and bring it back"},{"speaker":"Charles Goldfarb","startTime":2184.99,"endTime":2188.71,"body":"very different than what you're"},{"speaker":"Charles Goldfarb","startTime":2184.99,"endTime":2188.71,"body":"saying. I 100% agree. I don't"},{"speaker":"Charles Goldfarb","startTime":2188.71,"endTime":2191.53,"body":"think these tendons displace"},{"speaker":"Charles Goldfarb","startTime":2188.71,"endTime":2191.53,"body":"further overtime in the"},{"speaker":"Charles Goldfarb","startTime":2191.53,"endTime":2193.42,"body":"reasonable patient. So"},{"speaker":"Chris Dy","startTime":2193.42,"endTime":2195.88,"body":"then when you see them"},{"speaker":"Chris Dy","startTime":2193.42,"endTime":2195.88,"body":"say we see them a week or so"},{"speaker":"Chris Dy","startTime":2195.88,"endTime":2198.67,"body":"after their injury radiographs"},{"speaker":"Chris Dy","startTime":2195.88,"endTime":2198.67,"body":"look reasonable when you see"},{"speaker":"Chris Dy","startTime":2198.67,"endTime":2199.09,"body":"them again,"},{"speaker":"Charles Goldfarb","startTime":2199.93,"endTime":2201.46,"body":"depends on the"},{"speaker":"Charles Goldfarb","startTime":2199.93,"endTime":2201.46,"body":"patient depends on what our"},{"speaker":"Charles Goldfarb","startTime":2201.46,"endTime":2205.51,"body":"management is, are we casting?"},{"speaker":"Charles Goldfarb","startTime":2201.46,"endTime":2205.51,"body":"Almost never. Is it a removable"},{"speaker":"Charles Goldfarb","startTime":2205.51,"endTime":2208.84,"body":"brace? Is it buddy tapes alone?"},{"speaker":"Charles Goldfarb","startTime":2205.51,"endTime":2208.84,"body":"So the fracture pattern affects"},{"speaker":"Charles Goldfarb","startTime":2208.84,"endTime":2213.01,"body":"all of that. But yeah, I"},{"speaker":"Charles Goldfarb","startTime":2208.84,"endTime":2213.01,"body":"probably see him back twice. And"},{"speaker":"Charles Goldfarb","startTime":2213.01,"endTime":2213.94,"body":"that's probably it."},{"speaker":"Chris Dy","startTime":2214.51,"endTime":2217.0,"body":"You know, because one"},{"speaker":"Chris Dy","startTime":2214.51,"endTime":2217.0,"body":"of these papers showed that one"},{"speaker":"Chris Dy","startTime":2217.0,"endTime":2218.26,"body":"out of five never come back."},{"speaker":"Charles Goldfarb","startTime":2219.28,"endTime":2220.54,"body":"They're"},{"speaker":"Charles Goldfarb","startTime":2219.28,"endTime":2220.54,"body":"smarter than we are."},{"speaker":"Chris Dy","startTime":2221.86,"endTime":2223.99,"body":"I think that's fair. I"},{"speaker":"Chris Dy","startTime":2221.86,"endTime":2223.99,"body":"mean, if you put them in, if"},{"speaker":"Chris Dy","startTime":2223.99,"endTime":2227.41,"body":"it's if you're a patient, and"},{"speaker":"Chris Dy","startTime":2223.99,"endTime":2227.41,"body":"your doctor just says put an Ace"},{"speaker":"Chris Dy","startTime":2227.41,"endTime":2230.56,"body":"wrap on it, or you know, buddy"},{"speaker":"Chris Dy","startTime":2227.41,"endTime":2230.56,"body":"take like you're like this is"},{"speaker":"Chris Dy","startTime":2230.56,"endTime":2233.5,"body":"not a big deal. Why don't you"},{"speaker":"Chris Dy","startTime":2230.56,"endTime":2233.5,"body":"need to come back? Most people"},{"speaker":"Chris Dy","startTime":2233.5,"endTime":2238.24,"body":"would say I'm gonna let you"},{"speaker":"Chris Dy","startTime":2233.5,"endTime":2238.24,"body":"drive on the peds section."},{"speaker":"Chris Dy","startTime":2239.23,"endTime":2239.98,"body":"Absolutely."},{"speaker":"Charles Goldfarb","startTime":2240.01,"endTime":2245.32,"body":"So, Deb, Deb"},{"speaker":"Charles Goldfarb","startTime":2240.01,"endTime":2245.32,"body":"is a pediatric cancers. And in"},{"speaker":"Charles Goldfarb","startTime":2245.32,"endTime":2248.86,"body":"large part, I know she does"},{"speaker":"Charles Goldfarb","startTime":2245.32,"endTime":2248.86,"body":"adult as well, like I do. But"},{"speaker":"Charles Goldfarb","startTime":2248.86,"endTime":2253.39,"body":"she discusses pediatric trigger"},{"speaker":"Charles Goldfarb","startTime":2248.86,"endTime":2253.39,"body":"finger. And she gets to a recent"},{"speaker":"Charles Goldfarb","startTime":2253.39,"endTime":2255.85,"body":"study, which looks at"},{"speaker":"Charles Goldfarb","startTime":2253.39,"endTime":2255.85,"body":"presentation, natural history"},{"speaker":"Charles Goldfarb","startTime":2255.85,"endTime":2259.3,"body":"and treatment of idiopathic"},{"speaker":"Charles Goldfarb","startTime":2255.85,"endTime":2259.3,"body":"pediatric trigger finger in a"},{"speaker":"Charles Goldfarb","startTime":2259.3,"endTime":2265.24,"body":"large number of children. And"},{"speaker":"Charles Goldfarb","startTime":2259.3,"endTime":2265.24,"body":"reports that 30% of those"},{"speaker":"Charles Goldfarb","startTime":2265.24,"endTime":2269.65,"body":"patients had resolution and the"},{"speaker":"Charles Goldfarb","startTime":2265.24,"endTime":2269.65,"body":"vast majority of those results"},{"speaker":"Charles Goldfarb","startTime":2269.65,"endTime":2273.49,"body":"within one year. And then the"},{"speaker":"Charles Goldfarb","startTime":2269.65,"endTime":2273.49,"body":"question in splinting did not"},{"speaker":"Charles Goldfarb","startTime":2273.49,"endTime":2276.37,"body":"affect things. And that is"},{"speaker":"Charles Goldfarb","startTime":2273.49,"endTime":2276.37,"body":"different than most of the"},{"speaker":"Charles Goldfarb","startTime":2276.37,"endTime":2279.04,"body":"literature. I certainly will use"},{"speaker":"Charles Goldfarb","startTime":2276.37,"endTime":2279.04,"body":"splints in an effort to try to"},{"speaker":"Charles Goldfarb","startTime":2279.04,"endTime":2283.69,"body":"avoid surgery in pediatric"},{"speaker":"Charles Goldfarb","startTime":2279.04,"endTime":2283.69,"body":"trigger finger. What's"},{"speaker":"Charles Goldfarb","startTime":2283.69,"endTime":2286.09,"body":"interesting, I think we're"},{"speaker":"Charles Goldfarb","startTime":2283.69,"endTime":2286.09,"body":"what's really interesting for"},{"speaker":"Charles Goldfarb","startTime":2286.09,"endTime":2289.69,"body":"someone like me is if you come"},{"speaker":"Charles Goldfarb","startTime":2286.09,"endTime":2289.69,"body":"to surgery for a pediatric"},{"speaker":"Charles Goldfarb","startTime":2289.69,"endTime":2293.38,"body":"trigger finger, is it treatment,"},{"speaker":"Charles Goldfarb","startTime":2289.69,"endTime":2293.38,"body":"just like an adult, a one polio"},{"speaker":"Charles Goldfarb","startTime":2293.38,"endTime":2298.54,"body":"release alone? Or do you excise"},{"speaker":"Charles Goldfarb","startTime":2293.38,"endTime":2298.54,"body":"a slip of the FDS? In my hands,"},{"speaker":"Charles Goldfarb","startTime":2298.63,"endTime":2302.23,"body":"I excise a slip of the FDS. I"},{"speaker":"Charles Goldfarb","startTime":2298.63,"endTime":2302.23,"body":"think it doesn't add significant"},{"speaker":"Charles Goldfarb","startTime":2302.23,"endTime":2306.4,"body":"to the surgery, the morbidity or"},{"speaker":"Charles Goldfarb","startTime":2302.23,"endTime":2306.4,"body":"the expectations, and I think it"},{"speaker":"Charles Goldfarb","startTime":2306.4,"endTime":2308.14,"body":"decreases the risk of"},{"speaker":"Charles Goldfarb","startTime":2306.4,"endTime":2308.14,"body":"recurrence."},{"speaker":"Chris Dy","startTime":2309.07,"endTime":2311.89,"body":"But that wasn't the"},{"speaker":"Chris Dy","startTime":2309.07,"endTime":2311.89,"body":"case in this paper. That was not"},{"speaker":"Charles Goldfarb","startTime":2311.89,"endTime":2313.75,"body":"the case in"},{"speaker":"Charles Goldfarb","startTime":2311.89,"endTime":2313.75,"body":"this paper. Very similar"},{"speaker":"Charles Goldfarb","startTime":2313.75,"endTime":2315.37,"body":"outcome. So really helpful."},{"speaker":"Chris Dy","startTime":2315.88,"endTime":2318.58,"body":"Yeah, I mean, this"},{"speaker":"Chris Dy","startTime":2315.88,"endTime":2318.58,"body":"bottom line symptom resolution"},{"speaker":"Chris Dy","startTime":2318.58,"endTime":2323.59,"body":"after surgery is very, very"},{"speaker":"Chris Dy","startTime":2318.58,"endTime":2323.59,"body":"good. 98 99% Whether you excise"},{"speaker":"Chris Dy","startTime":2323.59,"endTime":2327.58,"body":"a slip or not. I think it should"},{"speaker":"Chris Dy","startTime":2323.59,"endTime":2327.58,"body":"be said that this is not trigger"},{"speaker":"Chris Dy","startTime":2327.58,"endTime":2332.77,"body":"thumb. This is non thumb digit"},{"speaker":"Chris Dy","startTime":2327.58,"endTime":2332.77,"body":"triggering. So, you know, do you"},{"speaker":"Chris Dy","startTime":2332.77,"endTime":2335.11,"body":"think about those conditions"},{"speaker":"Chris Dy","startTime":2332.77,"endTime":2335.11,"body":"differently? Clearly, there's a"},{"speaker":"Chris Dy","startTime":2335.11,"endTime":2336.01,"body":"distinction there, right?"},{"speaker":"Charles Goldfarb","startTime":2336.19,"endTime":2338.23,"body":"Well, yes, I"},{"speaker":"Charles Goldfarb","startTime":2336.19,"endTime":2338.23,"body":"think about them differently"},{"speaker":"Charles Goldfarb","startTime":2338.23,"endTime":2342.01,"body":"far, far, far, far more common"},{"speaker":"Charles Goldfarb","startTime":2338.23,"endTime":2342.01,"body":"sugar thumbs, there is good"},{"speaker":"Charles Goldfarb","startTime":2342.01,"endTime":2344.62,"body":"literature suggest that many of"},{"speaker":"Charles Goldfarb","startTime":2342.01,"endTime":2344.62,"body":"those will resolve and I"},{"speaker":"Charles Goldfarb","startTime":2344.62,"endTime":2348.43,"body":"certainly don't usually operate"},{"speaker":"Charles Goldfarb","startTime":2344.62,"endTime":2348.43,"body":"those at the first visit. Sugar"},{"speaker":"Charles Goldfarb","startTime":2348.43,"endTime":2353.14,"body":"fingers, I am less confident"},{"speaker":"Charles Goldfarb","startTime":2348.43,"endTime":2353.14,"body":"about the resolution. As I"},{"speaker":"Charles Goldfarb","startTime":2353.14,"endTime":2356.29,"body":"mentioned, I will use a splint"},{"speaker":"Charles Goldfarb","startTime":2353.14,"endTime":2356.29,"body":"and a pediatric trigger finger."},{"speaker":"Charles Goldfarb","startTime":2357.37,"endTime":2360.43,"body":"And I typically see the"},{"speaker":"Charles Goldfarb","startTime":2357.37,"endTime":2360.43,"body":"pediatric trigger finger back at"},{"speaker":"Charles Goldfarb","startTime":2360.43,"endTime":2363.97,"body":"three months kind of see how"},{"speaker":"Charles Goldfarb","startTime":2360.43,"endTime":2363.97,"body":"things are going. And I think"},{"speaker":"Charles Goldfarb","startTime":2363.97,"endTime":2366.49,"body":"you're right, the the numbers"},{"speaker":"Charles Goldfarb","startTime":2363.97,"endTime":2366.49,"body":"are higher than I would have"},{"speaker":"Charles Goldfarb","startTime":2366.49,"endTime":2369.73,"body":"expected about resolution with"},{"speaker":"Charles Goldfarb","startTime":2366.49,"endTime":2369.73,"body":"or without FDS, slip excision."},{"speaker":"Charles Goldfarb","startTime":2370.66,"endTime":2373.9,"body":"And another there's another"},{"speaker":"Charles Goldfarb","startTime":2370.66,"endTime":2373.9,"body":"institution that also practices"},{"speaker":"Charles Goldfarb","startTime":2373.9,"endTime":2377.02,"body":"that. So I think it's worth"},{"speaker":"Charles Goldfarb","startTime":2373.9,"endTime":2377.02,"body":"considering what what you hate"},{"speaker":"Charles Goldfarb","startTime":2377.02,"endTime":2380.59,"body":"though, especially in a kid and"},{"speaker":"Charles Goldfarb","startTime":2377.02,"endTime":2380.59,"body":"my experience has been without"},{"speaker":"Charles Goldfarb","startTime":2380.59,"endTime":2383.14,"body":"that slip excision. There's a"},{"speaker":"Charles Goldfarb","startTime":2380.59,"endTime":2383.14,"body":"higher risk of recurrence, but I"},{"speaker":"Charles Goldfarb","startTime":2383.14,"endTime":2386.08,"body":"need to respect the literature"},{"speaker":"Charles Goldfarb","startTime":2383.14,"endTime":2386.08,"body":"and have that conversation with"},{"speaker":"Charles Goldfarb","startTime":2386.08,"endTime":2386.71,"body":"families."},{"speaker":"Chris Dy","startTime":2387.13,"endTime":2390.4,"body":"And it's fair. I will"},{"speaker":"Chris Dy","startTime":2387.13,"endTime":2390.4,"body":"say just as an aside, I was very"},{"speaker":"Chris Dy","startTime":2390.4,"endTime":2393.16,"body":"proud of the return on"},{"speaker":"Chris Dy","startTime":2390.4,"endTime":2393.16,"body":"investment from our private"},{"speaker":"Chris Dy","startTime":2393.16,"endTime":2396.01,"body":"school education. Because I was"},{"speaker":"Chris Dy","startTime":2393.16,"endTime":2396.01,"body":"in a pool throwing a ball with"},{"speaker":"Chris Dy","startTime":2396.01,"endTime":2399.76,"body":"my son and I thought he jammed"},{"speaker":"Chris Dy","startTime":2396.01,"endTime":2399.76,"body":"his finger where you know when"},{"speaker":"Chris Dy","startTime":2399.76,"endTime":2402.25,"body":"he was 10 Catch the ball. He"},{"speaker":"Chris Dy","startTime":2399.76,"endTime":2402.25,"body":"said is your finger okay? He's"},{"speaker":"Chris Dy","startTime":2402.25,"endTime":2406.78,"body":"like, you know, Dad, the thumb"},{"speaker":"Chris Dy","startTime":2402.25,"endTime":2406.78,"body":"is not a finger. So press so"},{"speaker":"Chris Dy","startTime":2406.78,"endTime":2407.41,"body":"impressed."},{"speaker":"Charles Goldfarb","startTime":2407.62,"endTime":2409.18,"body":"Do you think"},{"speaker":"Charles Goldfarb","startTime":2407.62,"endTime":2409.18,"body":"he learned that at school and"},{"speaker":"Charles Goldfarb","startTime":2409.18,"endTime":2409.84,"body":"not at home?"},{"speaker":"Chris Dy","startTime":2410.2,"endTime":2411.43,"body":"I think he learned"},{"speaker":"Chris Dy","startTime":2410.2,"endTime":2411.43,"body":"that at school because we have"},{"speaker":"Chris Dy","startTime":2411.43,"endTime":2414.73,"body":"not gone into that level of"},{"speaker":"Chris Dy","startTime":2411.43,"endTime":2414.73,"body":"depth of human anatomy at home."},{"speaker":"Charles Goldfarb","startTime":2415.809,"endTime":2417.399,"body":"Bravo, bravo."},{"speaker":"Chris Dy","startTime":2418.93,"endTime":2421.3,"body":"So ganglion cysts, my"},{"speaker":"Chris Dy","startTime":2418.93,"endTime":2421.3,"body":"favorite time, every time"},{"speaker":"Chris Dy","startTime":2421.3,"endTime":2423.58,"body":"there's a ganglion on my"},{"speaker":"Chris Dy","startTime":2421.3,"endTime":2423.58,"body":"schedule. One of the MA's looks"},{"speaker":"Chris Dy","startTime":2423.58,"endTime":2426.34,"body":"to me says, your favorite"},{"speaker":"Chris Dy","startTime":2423.58,"endTime":2426.34,"body":"ganglions."},{"speaker":"Charles Goldfarb","startTime":2426.67,"endTime":2430.63,"body":"Dammit. Yeah,"},{"speaker":"Charles Goldfarb","startTime":2426.67,"endTime":2430.63,"body":"giggling is not that exciting."},{"speaker":"Charles Goldfarb","startTime":2430.66,"endTime":2433.51,"body":"You know, for some patients,"},{"speaker":"Charles Goldfarb","startTime":2430.66,"endTime":2433.51,"body":"they're just a bump. For some"},{"speaker":"Charles Goldfarb","startTime":2433.51,"endTime":2436.9,"body":"patients, there are pain"},{"speaker":"Charles Goldfarb","startTime":2433.51,"endTime":2436.9,"body":"generator, it's very hard for us"},{"speaker":"Charles Goldfarb","startTime":2436.9,"endTime":2441.43,"body":"as surgeons to distinguish what"},{"speaker":"Charles Goldfarb","startTime":2436.9,"endTime":2441.43,"body":"the what the reference was 150"},{"speaker":"Charles Goldfarb","startTime":2441.43,"endTime":2445.48,"body":"for children, basically, in the"},{"speaker":"Charles Goldfarb","startTime":2441.43,"endTime":2445.48,"body":"hand, they're more likely to"},{"speaker":"Charles Goldfarb","startTime":2445.48,"endTime":2448.6,"body":"resolve than they are on the"},{"speaker":"Charles Goldfarb","startTime":2445.48,"endTime":2448.6,"body":"wrist. And they present with"},{"speaker":"Charles Goldfarb","startTime":2448.6,"endTime":2452.65,"body":"assist, it's been present for"},{"speaker":"Charles Goldfarb","startTime":2448.6,"endTime":2452.65,"body":"more than a year, it's less"},{"speaker":"Charles Goldfarb","startTime":2452.65,"endTime":2456.25,"body":"likely to resolve so there is a"},{"speaker":"Charles Goldfarb","startTime":2452.65,"endTime":2456.25,"body":"chance of resolution, so sending"},{"speaker":"Charles Goldfarb","startTime":2456.25,"endTime":2458.35,"body":"the patient away and telling"},{"speaker":"Charles Goldfarb","startTime":2456.25,"endTime":2458.35,"body":"them to try to live with it and"},{"speaker":"Charles Goldfarb","startTime":2458.35,"endTime":2461.44,"body":"see what happens is absolutely"},{"speaker":"Charles Goldfarb","startTime":2458.35,"endTime":2461.44,"body":"appropriate. Yeah,"},{"speaker":"Chris Dy","startTime":2461.44,"endTime":2463.24,"body":"no, I think this is a"},{"speaker":"Chris Dy","startTime":2461.44,"endTime":2463.24,"body":"good counseling thing for me,"},{"speaker":"Chris Dy","startTime":2463.24,"endTime":2466.48,"body":"because you know, it's just more"},{"speaker":"Chris Dy","startTime":2463.24,"endTime":2466.48,"body":"fodder to say leave it alone. To"},{"speaker":"Chris Dy","startTime":2466.48,"endTime":2469.72,"body":"most patients. That is not"},{"speaker":"Chris Dy","startTime":2466.48,"endTime":2469.72,"body":"acceptable to some patients, as"},{"speaker":"Chris Dy","startTime":2469.9,"endTime":2472.27,"body":"you know, they conceptually have"},{"speaker":"Chris Dy","startTime":2469.9,"endTime":2472.27,"body":"a hard time leaving something"},{"speaker":"Chris Dy","startTime":2472.27,"endTime":2475.42,"body":"alone. If it's painful, that"},{"speaker":"Chris Dy","startTime":2472.27,"endTime":2475.42,"body":"definitely steers my"},{"speaker":"Chris Dy","startTime":2475.42,"endTime":2478.33,"body":"conversation in my approach, but"},{"speaker":"Chris Dy","startTime":2475.42,"endTime":2478.33,"body":"for the non painful ones, this"},{"speaker":"Chris Dy","startTime":2478.33,"endTime":2484.57,"body":"is helpful. The other topic that"},{"speaker":"Chris Dy","startTime":2478.33,"endTime":2484.57,"body":"is a least favorite is the"},{"speaker":"Chris Dy","startTime":2484.6,"endTime":2487.75,"body":"adolescent risk pain. So I'd"},{"speaker":"Chris Dy","startTime":2484.6,"endTime":2487.75,"body":"like you to tell me what to do"},{"speaker":"Chris Dy","startTime":2487.75,"endTime":2489.37,"body":"with patients with adolescent"},{"speaker":"Chris Dy","startTime":2487.75,"endTime":2489.37,"body":"risk paid"},{"speaker":"Charles Goldfarb","startTime":2490.96,"endTime":2493.39,"body":"ino is a"},{"speaker":"Charles Goldfarb","startTime":2490.96,"endTime":2493.39,"body":"difficult, difficult issue."},{"speaker":"Charles Goldfarb","startTime":2493.39,"endTime":2496.21,"body":"There's so much that can be"},{"speaker":"Charles Goldfarb","startTime":2493.39,"endTime":2496.21,"body":"wrapped up into adolescent risk"},{"speaker":"Charles Goldfarb","startTime":2496.21,"endTime":2500.86,"body":"pain, I think our obligation as"},{"speaker":"Charles Goldfarb","startTime":2496.21,"endTime":2500.86,"body":"clinicians is to really take"},{"speaker":"Charles Goldfarb","startTime":2500.89,"endTime":2506.5,"body":"every complaint seriously. And"},{"speaker":"Charles Goldfarb","startTime":2500.89,"endTime":2506.5,"body":"do our darndest to rule out"},{"speaker":"Charles Goldfarb","startTime":2507.43,"endTime":2511.87,"body":"clear pathology and to address"},{"speaker":"Charles Goldfarb","startTime":2507.43,"endTime":2511.87,"body":"it, if identified. That still"},{"speaker":"Charles Goldfarb","startTime":2511.87,"endTime":2515.11,"body":"leaves a large number of kids"},{"speaker":"Charles Goldfarb","startTime":2511.87,"endTime":2515.11,"body":"that come in with this"},{"speaker":"Charles Goldfarb","startTime":2515.11,"endTime":2518.08,"body":"complaint, that have pain, which"},{"speaker":"Charles Goldfarb","startTime":2515.11,"endTime":2518.08,"body":"is difficult to explain."},{"speaker":"Charles Goldfarb","startTime":2518.44,"endTime":2522.04,"body":"Sometimes it's generalized"},{"speaker":"Charles Goldfarb","startTime":2518.44,"endTime":2522.04,"body":"ligamentous laxity, sometimes"},{"speaker":"Charles Goldfarb","startTime":2522.04,"endTime":2525.58,"body":"you can't identify an issue at"},{"speaker":"Charles Goldfarb","startTime":2522.04,"endTime":2525.58,"body":"all. You don't want to waste a"},{"speaker":"Charles Goldfarb","startTime":2525.58,"endTime":2530.14,"body":"Washington say I don't like to"},{"speaker":"Charles Goldfarb","startTime":2525.58,"endTime":2530.14,"body":"waste resources, which means"},{"speaker":"Charles Goldfarb","startTime":2530.14,"endTime":2533.53,"body":"therapy, etc. But therapy is"},{"speaker":"Charles Goldfarb","startTime":2530.14,"endTime":2533.53,"body":"often a part of my approach to"},{"speaker":"Charles Goldfarb","startTime":2533.53,"endTime":2536.68,"body":"treating these kids. But I agree"},{"speaker":"Charles Goldfarb","startTime":2533.53,"endTime":2536.68,"body":"that, you know, we have to think"},{"speaker":"Charles Goldfarb","startTime":2536.68,"endTime":2540.07,"body":"about depression and anxiety, we"},{"speaker":"Charles Goldfarb","startTime":2536.68,"endTime":2540.07,"body":"have to have honest conversation"},{"speaker":"Charles Goldfarb","startTime":2540.79,"endTime":2546.07,"body":"with a family. And this review"},{"speaker":"Charles Goldfarb","startTime":2540.79,"endTime":2546.07,"body":"by Watson at all does do a good"},{"speaker":"Charles Goldfarb","startTime":2546.07,"endTime":2547.63,"body":"job with the topic."},{"speaker":"Chris Dy","startTime":2548.8,"endTime":2551.47,"body":"Yeah, no, I, I"},{"speaker":"Chris Dy","startTime":2548.8,"endTime":2551.47,"body":"probably end up getting using"},{"speaker":"Chris Dy","startTime":2551.47,"endTime":2555.19,"body":"more resources than then truly"},{"speaker":"Chris Dy","startTime":2551.47,"endTime":2555.19,"body":"necessary. Mainly to say, you"},{"speaker":"Chris Dy","startTime":2555.19,"endTime":2558.43,"body":"know, there's nothing that I as"},{"speaker":"Chris Dy","startTime":2555.19,"endTime":2558.43,"body":"a surgeon can do in this"},{"speaker":"Chris Dy","startTime":2558.43,"endTime":2561.97,"body":"particular situation. So it's"},{"speaker":"Chris Dy","startTime":2558.43,"endTime":2561.97,"body":"MRI therapy, that kind of thing."},{"speaker":"Chris Dy","startTime":2561.97,"endTime":2565.39,"body":"And ultimately, it's it's"},{"speaker":"Chris Dy","startTime":2561.97,"endTime":2565.39,"body":"challenging to tell the patient"},{"speaker":"Chris Dy","startTime":2565.39,"endTime":2568.51,"body":"in the parent, there's nothing"},{"speaker":"Chris Dy","startTime":2565.39,"endTime":2568.51,"body":"to do unless you have honestly"},{"speaker":"Chris Dy","startTime":2568.51,"endTime":2570.52,"body":"an MRI that demonstrates"},{"speaker":"Chris Dy","startTime":2568.51,"endTime":2570.52,"body":"nothing's going on."},{"speaker":"Charles Goldfarb","startTime":2571.45,"endTime":2573.16,"body":"Yeah, and that"},{"speaker":"Charles Goldfarb","startTime":2571.45,"endTime":2573.16,"body":"can be helpful, even though"},{"speaker":"Charles Goldfarb","startTime":2573.19,"endTime":2577.0,"body":"neither of us probably love"},{"speaker":"Charles Goldfarb","startTime":2573.19,"endTime":2577.0,"body":"that. All right, bring us home."},{"speaker":"Chris Dy","startTime":2577.39,"endTime":2579.79,"body":"So the last paper I"},{"speaker":"Chris Dy","startTime":2577.39,"endTime":2579.79,"body":"want to talk about is actually"},{"speaker":"Chris Dy","startTime":2579.79,"endTime":2583.96,"body":"one of my favorite papers in"},{"speaker":"Chris Dy","startTime":2579.79,"endTime":2583.96,"body":"this whole section. My godchild,"},{"speaker":"Chris Dy","startTime":2583.96,"endTime":2586.87,"body":"who's a friend of I think both"},{"speaker":"Chris Dy","startTime":2583.96,"endTime":2586.87,"body":"of ours over at Emory and has"},{"speaker":"Chris Dy","startTime":2586.87,"endTime":2590.65,"body":"done quite a bit with the you"},{"speaker":"Chris Dy","startTime":2586.87,"endTime":2590.65,"body":"know, really revamping that hand"},{"speaker":"Chris Dy","startTime":2590.65,"endTime":2595.99,"body":"surgery group in Atlanta. They"},{"speaker":"Chris Dy","startTime":2590.65,"endTime":2595.99,"body":"did an RCT on patients for DISA"},{"speaker":"Chris Dy","startTime":2595.99,"endTime":2600.1,"body":"radius fractures and whether"},{"speaker":"Chris Dy","startTime":2595.99,"endTime":2600.1,"body":"they got a six day stereotypes"},{"speaker":"Chris Dy","startTime":2600.1,"endTime":2602.56,"body":"like a Medrol dose pack when I"},{"speaker":"Chris Dy","startTime":2600.1,"endTime":2602.56,"body":"asked Mike and it actually is"},{"speaker":"Chris Dy","startTime":2602.56,"endTime":2606.64,"body":"just a straight up Medrol dose"},{"speaker":"Chris Dy","startTime":2602.56,"endTime":2606.64,"body":"pack, showing significantly"},{"speaker":"Chris Dy","startTime":2606.67,"endTime":2610.69,"body":"decreased use of opioids, which"},{"speaker":"Chris Dy","startTime":2606.67,"endTime":2610.69,"body":"is really impressive. What do"},{"speaker":"Chris Dy","startTime":2610.69,"endTime":2613.54,"body":"you think about this because I"},{"speaker":"Chris Dy","startTime":2610.69,"endTime":2613.54,"body":"think dogmatically as surgeons,"},{"speaker":"Chris Dy","startTime":2613.54,"endTime":2616.21,"body":"we tend to stay away from"},{"speaker":"Chris Dy","startTime":2613.54,"endTime":2616.21,"body":"steroids because of the concern"},{"speaker":"Chris Dy","startTime":2616.21,"endTime":2619.93,"body":"for wound healing issues. But"},{"speaker":"Chris Dy","startTime":2616.21,"endTime":2619.93,"body":"steroids, I think, are pretty"},{"speaker":"Chris Dy","startTime":2619.93,"endTime":2622.6,"body":"benign, at least at this dose,"},{"speaker":"Chris Dy","startTime":2619.93,"endTime":2622.6,"body":"and may have some really nice"},{"speaker":"Chris Dy","startTime":2622.6,"endTime":2623.17,"body":"benefits."},{"speaker":"Charles Goldfarb","startTime":2623.86,"endTime":2626.83,"body":"I think it's"},{"speaker":"Charles Goldfarb","startTime":2623.86,"endTime":2626.83,"body":"fair to say, I mean, again, I"},{"speaker":"Charles Goldfarb","startTime":2626.83,"endTime":2629.98,"body":"just had a conversation about"},{"speaker":"Charles Goldfarb","startTime":2626.83,"endTime":2629.98,"body":"Americans and the use of"},{"speaker":"Charles Goldfarb","startTime":2629.98,"endTime":2633.76,"body":"narcotics postoperatively, we"},{"speaker":"Charles Goldfarb","startTime":2629.98,"endTime":2633.76,"body":"clearly overuse them, we clearly"},{"speaker":"Charles Goldfarb","startTime":2633.85,"endTime":2636.58,"body":"continue to over prescribe them."},{"speaker":"Charles Goldfarb","startTime":2633.85,"endTime":2636.58,"body":"Although I think we're far"},{"speaker":"Charles Goldfarb","startTime":2636.58,"endTime":2639.85,"body":"better today than we had been"},{"speaker":"Charles Goldfarb","startTime":2636.58,"endTime":2639.85,"body":"historically, it's pretty"},{"speaker":"Charles Goldfarb","startTime":2639.85,"endTime":2642.97,"body":"compelling evidence that a short"},{"speaker":"Charles Goldfarb","startTime":2639.85,"endTime":2642.97,"body":"course of steroids will decrease"},{"speaker":"Charles Goldfarb","startTime":2642.97,"endTime":2645.85,"body":"the narcotic use, and perhaps"},{"speaker":"Charles Goldfarb","startTime":2642.97,"endTime":2645.85,"body":"its most important, and those"},{"speaker":"Charles Goldfarb","startTime":2645.85,"endTime":2648.28,"body":"that were worried about needing"},{"speaker":"Charles Goldfarb","startTime":2645.85,"endTime":2648.28,"body":"narcotics."},{"speaker":"Chris Dy","startTime":2648.85,"endTime":2652.0,"body":"Yeah. So I texted Mike"},{"speaker":"Chris Dy","startTime":2648.85,"endTime":2652.0,"body":"about this paper. And I asked"},{"speaker":"Chris Dy","startTime":2652.0,"endTime":2654.28,"body":"him, you know, this is what"},{"speaker":"Chris Dy","startTime":2652.0,"endTime":2654.28,"body":"you're doing now? He said, Yes."},{"speaker":"Chris Dy","startTime":2654.28,"endTime":2656.62,"body":"And for all of our shoulders,"},{"speaker":"Chris Dy","startTime":2654.28,"endTime":2656.62,"body":"and he said it got the New Year"},{"speaker":"Chris Dy","startTime":2656.62,"endTime":2660.49,"body":"Award from the, from the ACS,"},{"speaker":"Chris Dy","startTime":2656.62,"endTime":2660.49,"body":"and I said, I heard it near. So"},{"speaker":"Chris Dy","startTime":2660.49,"endTime":2664.03,"body":"it's a pretty big deal that they"},{"speaker":"Chris Dy","startTime":2660.49,"endTime":2664.03,"body":"got that. And he said, no wound"},{"speaker":"Chris Dy","startTime":2664.03,"endTime":2666.19,"body":"healing issues, no infections,"},{"speaker":"Chris Dy","startTime":2664.03,"endTime":2666.19,"body":"anything like that. And he's"},{"speaker":"Chris Dy","startTime":2666.19,"endTime":2670.09,"body":"doing in all of his CMCS as"},{"speaker":"Chris Dy","startTime":2666.19,"endTime":2670.09,"body":"well. So pretty impressive."},{"speaker":"Chris Dy","startTime":2670.3,"endTime":2670.78,"body":"Yeah,"},{"speaker":"Charles Goldfarb","startTime":2670.9,"endTime":2673.03,"body":"I remember we"},{"speaker":"Charles Goldfarb","startTime":2670.9,"endTime":2673.03,"body":"reviewed a paper I believe in"},{"speaker":"Charles Goldfarb","startTime":2673.03,"endTime":2678.7,"body":"this in this forum that looked"},{"speaker":"Charles Goldfarb","startTime":2673.03,"endTime":2678.7,"body":"at flexor tenosynovitis and the"},{"speaker":"Charles Goldfarb","startTime":2678.7,"endTime":2684.16,"body":"use of steroids in resolution"},{"speaker":"Charles Goldfarb","startTime":2678.7,"endTime":2684.16,"body":"and it didn't have any negative"},{"speaker":"Charles Goldfarb","startTime":2684.16,"endTime":2688.06,"body":"effect on healing and led to"},{"speaker":"Charles Goldfarb","startTime":2684.16,"endTime":2688.06,"body":"rapid resolution. So you know,"},{"speaker":"Charles Goldfarb","startTime":2688.66,"endTime":2692.98,"body":"steroids are super interesting"},{"speaker":"Charles Goldfarb","startTime":2688.66,"endTime":2692.98,"body":"topic. And this is one more"},{"speaker":"Charles Goldfarb","startTime":2692.98,"endTime":2695.62,"body":"piece of information for us to"},{"speaker":"Charles Goldfarb","startTime":2692.98,"endTime":2695.62,"body":"consider. Yeah,"},{"speaker":"Chris Dy","startTime":2695.62,"endTime":2697.75,"body":"I do use it"},{"speaker":"Chris Dy","startTime":2695.62,"endTime":2697.75,"body":"anecdotally to get some patients"},{"speaker":"Chris Dy","startTime":2697.75,"endTime":2700.3,"body":"over the hump just seem to be"},{"speaker":"Chris Dy","startTime":2697.75,"endTime":2700.3,"body":"struggling quite a bit. with"},{"speaker":"Chris Dy","startTime":2700.33,"endTime":2703.21,"body":"pain more than most patients,"},{"speaker":"Chris Dy","startTime":2700.33,"endTime":2703.21,"body":"and it's hard because I think"},{"speaker":"Chris Dy","startTime":2703.21,"endTime":2706.51,"body":"until you've been in practice"},{"speaker":"Chris Dy","startTime":2703.21,"endTime":2706.51,"body":"long enough to know what the"},{"speaker":"Chris Dy","startTime":2706.51,"endTime":2709.33,"body":"bell curve looks like for most"},{"speaker":"Chris Dy","startTime":2706.51,"endTime":2709.33,"body":"patients, which fortunately now"},{"speaker":"Chris Dy","startTime":2709.33,"endTime":2713.59,"body":"I haven't. You don't know when"},{"speaker":"Chris Dy","startTime":2709.33,"endTime":2713.59,"body":"when to pull the trigger on"},{"speaker":"Chris Dy","startTime":2713.59,"endTime":2715.99,"body":"something like this, but I do"},{"speaker":"Chris Dy","startTime":2713.59,"endTime":2715.99,"body":"like this paper and, you know,"},{"speaker":"Chris Dy","startTime":2715.99,"endTime":2719.35,"body":"kudos to Mike and the group for"},{"speaker":"Chris Dy","startTime":2715.99,"endTime":2719.35,"body":"for doing what seems to be a"},{"speaker":"Chris Dy","startTime":2719.35,"endTime":2721.66,"body":"very challenging study, but it's"},{"speaker":"Chris Dy","startTime":2719.35,"endTime":2721.66,"body":"very meaningful."},{"speaker":"Charles Goldfarb","startTime":2721.99,"endTime":2724.03,"body":"Before we"},{"speaker":"Charles Goldfarb","startTime":2721.99,"endTime":2724.03,"body":"close tell me how you think"},{"speaker":"Charles Goldfarb","startTime":2724.03,"endTime":2726.88,"body":"about the use of steroid dose"},{"speaker":"Charles Goldfarb","startTime":2724.03,"endTime":2726.88,"body":"packs in clinic, how often are"},{"speaker":"Charles Goldfarb","startTime":2726.88,"endTime":2729.37,"body":"you doing them, and what's the"},{"speaker":"Charles Goldfarb","startTime":2726.88,"endTime":2729.37,"body":"most common scenario."},{"speaker":"Chris Dy","startTime":2730.39,"endTime":2732.61,"body":"So actually, I end up"},{"speaker":"Chris Dy","startTime":2730.39,"endTime":2732.61,"body":"seeing a fair number of people"},{"speaker":"Chris Dy","startTime":2732.61,"endTime":2735.31,"body":"who I think have cervical"},{"speaker":"Chris Dy","startTime":2732.61,"endTime":2735.31,"body":"radiculopathy, just by nature of"},{"speaker":"Chris Dy","startTime":2735.31,"endTime":2738.73,"body":"my practice. So I actually will"},{"speaker":"Chris Dy","startTime":2735.31,"endTime":2738.73,"body":"use the server, I will use that"},{"speaker":"Chris Dy","startTime":2738.76,"endTime":2741.1,"body":"a steroid dose pack actually go"},{"speaker":"Chris Dy","startTime":2738.76,"endTime":2741.1,"body":"a little bit higher than a"},{"speaker":"Chris Dy","startTime":2741.1,"endTime":2746.44,"body":"Medrol, I'll do an 80 7060. So"},{"speaker":"Chris Dy","startTime":2741.1,"endTime":2746.44,"body":"and so as you know, which is a"},{"speaker":"Chris Dy","startTime":2746.44,"endTime":2749.38,"body":"big dose, but can really nip"},{"speaker":"Chris Dy","startTime":2746.44,"endTime":2749.38,"body":"some of that stuff in the bud."},{"speaker":"Chris Dy","startTime":2749.74,"endTime":2752.68,"body":"So it ends up being people with"},{"speaker":"Chris Dy","startTime":2749.74,"endTime":2752.68,"body":"like suspected cervical Riddick,"},{"speaker":"Chris Dy","startTime":2752.68,"endTime":2756.82,"body":"because it gets takes a while to"},{"speaker":"Chris Dy","startTime":2752.68,"endTime":2756.82,"body":"get them into physiatry. or"},{"speaker":"Chris Dy","startTime":2756.82,"endTime":2760.15,"body":"patients who are kind of in that"},{"speaker":"Chris Dy","startTime":2756.82,"endTime":2760.15,"body":"person to Cherner camp. And"},{"speaker":"Chris Dy","startTime":2760.15,"endTime":2762.79,"body":"there's pretty good literature"},{"speaker":"Chris Dy","startTime":2760.15,"endTime":2762.79,"body":"demonstrating if you start it"},{"speaker":"Chris Dy","startTime":2762.82,"endTime":2765.1,"body":"early enough, which oftentimes"},{"speaker":"Chris Dy","startTime":2762.82,"endTime":2765.1,"body":"patients aren't with me early"},{"speaker":"Chris Dy","startTime":2765.1,"endTime":2767.77,"body":"enough. But if you start it"},{"speaker":"Chris Dy","startTime":2765.1,"endTime":2767.77,"body":"early, may actually help quite a"},{"speaker":"Chris Dy","startTime":2767.77,"endTime":2770.14,"body":"bit with some of those symptoms."},{"speaker":"Chris Dy","startTime":2767.77,"endTime":2770.14,"body":"When are you using them?"},{"speaker":"Charles Goldfarb","startTime":2771.58,"endTime":2774.1,"body":"I think the"},{"speaker":"Charles Goldfarb","startTime":2771.58,"endTime":2774.1,"body":"way you said it's Well, I'd"},{"speaker":"Charles Goldfarb","startTime":2774.1,"endTime":2778.15,"body":"never actually do the big guns,"},{"speaker":"Charles Goldfarb","startTime":2774.1,"endTime":2778.15,"body":"big dose, you know, when I use"},{"speaker":"Charles Goldfarb","startTime":2778.15,"endTime":2783.58,"body":"is really a Medrol dose pack."},{"speaker":"Charles Goldfarb","startTime":2778.15,"endTime":2783.58,"body":"And uncommonly I would say once"},{"speaker":"Charles Goldfarb","startTime":2783.58,"endTime":2787.12,"body":"or twice a year and I asked you"},{"speaker":"Charles Goldfarb","startTime":2783.58,"endTime":2787.12,"body":"interest because maybe I should"},{"speaker":"Charles Goldfarb","startTime":2787.12,"endTime":2790.84,"body":"be using it more just to help"},{"speaker":"Charles Goldfarb","startTime":2787.12,"endTime":2790.84,"body":"with swelling and just bouncing"},{"speaker":"Charles Goldfarb","startTime":2790.84,"endTime":2794.53,"body":"back. I need to I need to think"},{"speaker":"Charles Goldfarb","startTime":2790.84,"endTime":2794.53,"body":"about how to use it more"},{"speaker":"Charles Goldfarb","startTime":2795.22,"endTime":2797.38,"body":"efficaciously I guess. There"},{"speaker":"Chris Dy","startTime":2797.38,"endTime":2799.84,"body":"we go. Some fodder for"},{"speaker":"Chris Dy","startTime":2797.38,"endTime":2799.84,"body":"conversation and future"},{"speaker":"Chris Dy","startTime":2799.84,"endTime":2802.63,"body":"discussion. All right. Well,"},{"speaker":"Chris Dy","startTime":2799.84,"endTime":2802.63,"body":"thank you, Mike, for that"},{"speaker":"Chris Dy","startTime":2802.63,"endTime":2805.57,"body":"article. And thank you, Deb for"},{"speaker":"Chris Dy","startTime":2802.63,"endTime":2805.57,"body":"writing this. What's new"},{"speaker":"Chris Dy","startTime":2805.57,"endTime":2808.81,"body":"enhancer? I'm excited to see who"},{"speaker":"Chris Dy","startTime":2805.57,"endTime":2808.81,"body":"has this lovely honor and"},{"speaker":"Chris Dy","startTime":2808.81,"endTime":2810.22,"body":"opportunity next year."},{"speaker":"Charles Goldfarb","startTime":2810.34,"endTime":2812.05,"body":"Yeah, looking"},{"speaker":"Charles Goldfarb","startTime":2810.34,"endTime":2812.05,"body":"forward to it. It's a great job."},{"speaker":"Charles Goldfarb","startTime":2812.05,"endTime":2817.39,"body":"I debit. A big, big task as you"},{"speaker":"Charles Goldfarb","startTime":2812.05,"endTime":2817.39,"body":"well know and glad to have the"},{"speaker":"Charles Goldfarb","startTime":2817.39,"endTime":2819.97,"body":"opportunity to carefully review"},{"speaker":"Charles Goldfarb","startTime":2817.39,"endTime":2819.97,"body":"this manuscript and learn more"},{"speaker":"Charles Goldfarb","startTime":2819.97,"endTime":2821.08,"body":"about our literature."},{"speaker":"Chris Dy","startTime":2821.95,"endTime":2825.13,"body":"All right, until next"},{"speaker":"Chris Dy","startTime":2821.95,"endTime":2825.13,"body":"time, take care. Hey,"},{"speaker":"Charles Goldfarb","startTime":2825.13,"endTime":2827.17,"body":"Chris, that"},{"speaker":"Charles Goldfarb","startTime":2825.13,"endTime":2827.17,"body":"was fun. Let's do it again real"},{"speaker":"Charles Goldfarb","startTime":2827.17,"endTime":2828.46,"body":"soon. Sounds"},{"speaker":"Chris Dy","startTime":2828.07,"endTime":2830.511,"body":"good. Well, be sure to"},{"speaker":"Chris Dy","startTime":2828.07,"endTime":2830.511,"body":"email us with topics,"},{"speaker":"Chris Dy","startTime":2830.566,"endTime":2834.34,"body":"suggestions and feedback, you"},{"speaker":"Chris Dy","startTime":2830.566,"endTime":2834.34,"body":"can reach us at handpodcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":2835.0,"endTime":2837.13,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":2835.0,"endTime":2837.13,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2837.13,"endTime":2838.78,"body":"get your podcast. And"},{"speaker":"Chris Dy","startTime":2838.78,"endTime":2841.33,"body":"be sure to leave a"},{"speaker":"Chris Dy","startTime":2838.78,"endTime":2841.33,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2841.33,"endTime":2841.78,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":2842.5,"endTime":2845.05,"body":"Special thanks"},{"speaker":"Charles Goldfarb","startTime":2842.5,"endTime":2845.05,"body":"to Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":2845.05,"endTime":2846.4,"body":"music. And"},{"speaker":"Chris Dy","startTime":2846.4,"endTime":2848.5,"body":"remember, keep the"},{"speaker":"Chris Dy","startTime":2846.4,"endTime":2848.5,"body":"upper hand come back next time"}]}