{"version":"1.0.0","segments":[{"speaker":"Charles Goldfarb","startTime":0.0,"endTime":7.08,"body":"Chuck, welcome"},{"speaker":"Charles Goldfarb","startTime":0.0,"endTime":7.08,"body":"to the Upper Hand Podcast, where"},{"speaker":"Charles Goldfarb","startTime":7.08,"endTime":8.82,"body":"Chuck and Chris talk hand"},{"speaker":"Charles Goldfarb","startTime":7.08,"endTime":8.82,"body":"surgery."},{"speaker":"Chris Dy","startTime":9.54,"endTime":11.46,"body":"We are two hand"},{"speaker":"Chris Dy","startTime":9.54,"endTime":11.46,"body":"surgeons at Washington"},{"speaker":"Chris Dy","startTime":11.46,"endTime":14.4,"body":"University in St Louis, here to"},{"speaker":"Chris Dy","startTime":11.46,"endTime":14.4,"body":"talk about all things hand"},{"speaker":"Chris Dy","startTime":14.4,"endTime":16.62,"body":"surgery related, from technical"},{"speaker":"Chris Dy","startTime":14.4,"endTime":16.62,"body":"to personal."},{"speaker":"Charles Goldfarb","startTime":17.16,"endTime":19.14,"body":"Please"},{"speaker":"Charles Goldfarb","startTime":17.16,"endTime":19.14,"body":"subscribe wherever you get your"},{"speaker":"Charles Goldfarb","startTime":19.14,"endTime":20.84,"body":"podcasts, and thank"},{"speaker":"Chris Dy","startTime":20.84,"endTime":23.3,"body":"you in advance for"},{"speaker":"Chris Dy","startTime":20.84,"endTime":23.3,"body":"leaving a review and a rating"},{"speaker":"Chris Dy","startTime":23.3,"endTime":26.0,"body":"that helps us get the word out."},{"speaker":"Chris Dy","startTime":23.3,"endTime":26.0,"body":"You can email us at"},{"speaker":"Chris Dy","startTime":26.0,"endTime":29.42,"body":"handpodcast@gmail.com so let's"},{"speaker":"Chris Dy","startTime":26.0,"endTime":29.42,"body":"get to the episode."},{"speaker":"Charles Goldfarb","startTime":30.02,"endTime":30.86,"body":"Oh, hey,"},{"speaker":"Charles Goldfarb","startTime":30.02,"endTime":30.86,"body":"Chris,"},{"speaker":"Chris Dy","startTime":31.04,"endTime":31.82,"body":"hey, Chuck. How are"},{"speaker":"Chris Dy","startTime":31.04,"endTime":31.82,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":32.18,"endTime":33.5,"body":"I'm great. How"},{"speaker":"Charles Goldfarb","startTime":32.18,"endTime":33.5,"body":"are you? I'm"},{"speaker":"Chris Dy","startTime":33.68,"endTime":36.02,"body":"good. We just keep"},{"speaker":"Chris Dy","startTime":33.68,"endTime":36.02,"body":"recording at different times of"},{"speaker":"Chris Dy","startTime":36.02,"endTime":39.2,"body":"the day and week. This is us on"},{"speaker":"Chris Dy","startTime":36.02,"endTime":39.2,"body":"a Thursday afternoon. You're"},{"speaker":"Chris Dy","startTime":39.2,"endTime":40.22,"body":"fresh out of clinic."},{"speaker":"Charles Goldfarb","startTime":40.88,"endTime":43.36,"body":"Oh yeah, I'm"},{"speaker":"Charles Goldfarb","startTime":40.88,"endTime":43.36,"body":"riding high right now. Clinic"},{"speaker":"Charles Goldfarb","startTime":43.36,"endTime":44.98,"body":"was fantastic."},{"speaker":"Chris Dy","startTime":45.04,"endTime":47.68,"body":"That's always when I'm"},{"speaker":"Chris Dy","startTime":45.04,"endTime":47.68,"body":"at my peak energy is right after"},{"speaker":"Chris Dy","startTime":47.68,"endTime":48.88,"body":"a day of clinic."},{"speaker":"Charles Goldfarb","startTime":49.54,"endTime":51.16,"body":"Yeah,"},{"speaker":"Charles Goldfarb","startTime":49.54,"endTime":51.16,"body":"thankfully it was, it was just a"},{"speaker":"Charles Goldfarb","startTime":51.16,"endTime":54.88,"body":"half day, and it was one of"},{"speaker":"Charles Goldfarb","startTime":51.16,"endTime":54.88,"body":"those clinics where it didn't"},{"speaker":"Charles Goldfarb","startTime":54.88,"endTime":57.34,"body":"seem like that many patients,"},{"speaker":"Charles Goldfarb","startTime":54.88,"endTime":57.34,"body":"but we started off with a bunch"},{"speaker":"Charles Goldfarb","startTime":57.34,"endTime":60.04,"body":"of new patients that were a"},{"speaker":"Charles Goldfarb","startTime":57.34,"endTime":60.04,"body":"little time intensive, and all"},{"speaker":"Charles Goldfarb","startTime":60.04,"endTime":62.22,"body":"of a sudden we're behind. And I"},{"speaker":"Charles Goldfarb","startTime":60.04,"endTime":62.22,"body":"don't, as you know, I don't"},{"speaker":"Charles Goldfarb","startTime":62.22,"endTime":66.0,"body":"really care for getting behind."},{"speaker":"Charles Goldfarb","startTime":62.22,"endTime":66.0,"body":"And so thankfully, we caught up,"},{"speaker":"Charles Goldfarb","startTime":66.0,"endTime":69.48,"body":"and it was a very productive"},{"speaker":"Charles Goldfarb","startTime":66.0,"endTime":69.48,"body":"clinic as far as booking. So"},{"speaker":"Chris Dy","startTime":70.56,"endTime":73.08,"body":"that's good. Yes, I"},{"speaker":"Chris Dy","startTime":70.56,"endTime":73.08,"body":"had a morning half day clinic at"},{"speaker":"Chris Dy","startTime":73.08,"endTime":76.26,"body":"one of our satellite locations,"},{"speaker":"Chris Dy","startTime":73.08,"endTime":76.26,"body":"and then hold myself up in an A"},{"speaker":"Chris Dy","startTime":76.44,"endTime":80.54,"body":"in a touchdown office to work on"},{"speaker":"Chris Dy","startTime":76.44,"endTime":80.54,"body":"a grant. So there was, it was,"},{"speaker":"Chris Dy","startTime":80.6,"endTime":84.02,"body":"I'm coming off of a different"},{"speaker":"Chris Dy","startTime":80.6,"endTime":84.02,"body":"kind of quote high, but my"},{"speaker":"Chris Dy","startTime":84.02,"endTime":86.24,"body":"clinic experience was"},{"speaker":"Chris Dy","startTime":84.02,"endTime":86.24,"body":"interesting this morning,"},{"speaker":"Chris Dy","startTime":86.24,"endTime":90.44,"body":"because hit it very hard. Did"},{"speaker":"Chris Dy","startTime":86.24,"endTime":90.44,"body":"you know half three, just over"},{"speaker":"Chris Dy","startTime":90.44,"endTime":94.22,"body":"three hours of clinic slots, saw"},{"speaker":"Chris Dy","startTime":90.44,"endTime":94.22,"body":"over 30 patients and zero"},{"speaker":"Chris Dy","startTime":94.22,"endTime":94.94,"body":"bookings?"},{"speaker":"Charles Goldfarb","startTime":96.38,"endTime":98.84,"body":"You know that"},{"speaker":"Charles Goldfarb","startTime":96.38,"endTime":98.84,"body":"was actually before you, before"},{"speaker":"Charles Goldfarb","startTime":98.84,"endTime":101.92,"body":"you just got into that? That was"},{"speaker":"Charles Goldfarb","startTime":98.84,"endTime":101.92,"body":"gonna be my next question. And"},{"speaker":"Charles Goldfarb","startTime":101.92,"endTime":104.92,"body":"you probably know the data, or"},{"speaker":"Charles Goldfarb","startTime":101.92,"endTime":104.92,"body":"can look at the data. First of"},{"speaker":"Charles Goldfarb","startTime":104.92,"endTime":107.98,"body":"all, I would say those days"},{"speaker":"Charles Goldfarb","startTime":104.92,"endTime":107.98,"body":"happen and they are difficult. I"},{"speaker":"Charles Goldfarb","startTime":108.4,"endTime":108.82,"body":"remember."},{"speaker":"Chris Dy","startTime":108.82,"endTime":110.86,"body":"I remember one of"},{"speaker":"Chris Dy","startTime":108.82,"endTime":110.86,"body":"those days happening when I was"},{"speaker":"Chris Dy","startTime":110.86,"endTime":114.4,"body":"in your fellow in clinic. You"},{"speaker":"Chris Dy","startTime":110.86,"endTime":114.4,"body":"were not the happiest. I"},{"speaker":"Chris Dy","startTime":114.4,"endTime":115.42,"body":"remember that,"},{"speaker":"Charles Goldfarb","startTime":115.6,"endTime":121.12,"body":"no, it just"},{"speaker":"Charles Goldfarb","startTime":115.6,"endTime":121.12,"body":"feels futile. I'm on a good run."},{"speaker":"Charles Goldfarb","startTime":121.24,"endTime":123.78,"body":"And I was going to say, what do"},{"speaker":"Charles Goldfarb","startTime":121.24,"endTime":123.78,"body":"you think your hit rate is? I"},{"speaker":"Charles Goldfarb","startTime":123.78,"endTime":127.86,"body":"mean, we we have data available,"},{"speaker":"Charles Goldfarb","startTime":123.78,"endTime":127.86,"body":"which is basically surgeries"},{"speaker":"Charles Goldfarb","startTime":127.86,"endTime":131.28,"body":"poor, you know, new patient"},{"speaker":"Charles Goldfarb","startTime":127.86,"endTime":131.28,"body":"visit to surgery ratio. But"},{"speaker":"Charles Goldfarb","startTime":131.46,"endTime":133.68,"body":"overall, what do you think your"},{"speaker":"Charles Goldfarb","startTime":131.46,"endTime":133.68,"body":"hit rate is? If you have a"},{"speaker":"Charles Goldfarb","startTime":133.68,"endTime":135.96,"body":"clinic of 60 patients, how many"},{"speaker":"Charles Goldfarb","startTime":133.68,"endTime":135.96,"body":"surgeries"},{"speaker":"Chris Dy","startTime":136.26,"endTime":138.66,"body":"I vary? I mean, I vary"},{"speaker":"Chris Dy","startTime":136.26,"endTime":138.66,"body":"all over the place. I mean,"},{"speaker":"Chris Dy","startTime":138.66,"endTime":141.14,"body":"there are days where I think I"},{"speaker":"Chris Dy","startTime":138.66,"endTime":141.14,"body":"break the system in terms of"},{"speaker":"Chris Dy","startTime":141.14,"endTime":145.76,"body":"trying to get my my team to book"},{"speaker":"Chris Dy","startTime":141.14,"endTime":145.76,"body":"cases, and they just look at me,"},{"speaker":"Chris Dy","startTime":145.76,"endTime":148.22,"body":"and I walk out of a room, and I"},{"speaker":"Chris Dy","startTime":145.76,"endTime":148.22,"body":"grab a sheet, I don't say"},{"speaker":"Chris Dy","startTime":148.22,"endTime":151.46,"body":"anything, and they just say no."},{"speaker":"Chris Dy","startTime":148.22,"endTime":151.46,"body":"And then there are days like"},{"speaker":"Chris Dy","startTime":151.46,"endTime":155.3,"body":"today where I was like, cleaning"},{"speaker":"Chris Dy","startTime":151.46,"endTime":155.3,"body":"up my pile of paperwork, and I"},{"speaker":"Chris Dy","startTime":155.3,"endTime":158.3,"body":"was like, Oh, I didn't book a"},{"speaker":"Chris Dy","startTime":155.3,"endTime":158.3,"body":"case. And I mean, I, you know,"},{"speaker":"Chris Dy","startTime":158.3,"endTime":160.54,"body":"obviously, like, you know,"},{"speaker":"Chris Dy","startTime":158.3,"endTime":160.54,"body":"surgeons like to operate, but I"},{"speaker":"Chris Dy","startTime":160.54,"endTime":163.24,"body":"think we have pretty reasonable"},{"speaker":"Chris Dy","startTime":160.54,"endTime":163.24,"body":"indications. And, you know, I"},{"speaker":"Chris Dy","startTime":163.24,"endTime":166.48,"body":"don't push indications by any"},{"speaker":"Chris Dy","startTime":163.24,"endTime":166.48,"body":"means. It just wasn't a day of"},{"speaker":"Chris Dy","startTime":166.48,"endTime":171.76,"body":"that, of that. So I think I"},{"speaker":"Chris Dy","startTime":166.48,"endTime":171.76,"body":"remember, and I'd be interested"},{"speaker":"Chris Dy","startTime":171.76,"endTime":174.52,"body":"to see what listeners have in"},{"speaker":"Chris Dy","startTime":171.76,"endTime":174.52,"body":"terms of metrics they follow,"},{"speaker":"Chris Dy","startTime":174.82,"endTime":178.36,"body":"just like the gross, you know,"},{"speaker":"Chris Dy","startTime":174.82,"endTime":178.36,"body":"surgery or new patient visits to"},{"speaker":"Chris Dy","startTime":178.36,"endTime":180.9,"body":"surgery bookings. I think mine"},{"speaker":"Chris Dy","startTime":178.36,"endTime":180.9,"body":"hovers into low two point"},{"speaker":"Chris Dy","startTime":180.9,"endTime":183.9,"body":"somethings. I don't know if that"},{"speaker":"Chris Dy","startTime":180.9,"endTime":183.9,"body":"feels right or not. I may be"},{"speaker":"Chris Dy","startTime":183.9,"endTime":186.3,"body":"completely pulling that out of"},{"speaker":"Chris Dy","startTime":183.9,"endTime":186.3,"body":"left field. Now"},{"speaker":"Charles Goldfarb","startTime":186.0,"endTime":189.15,"body":"I think yours"},{"speaker":"Charles Goldfarb","startTime":186.0,"endTime":189.15,"body":"probably does, and so does mine."},{"speaker":"Charles Goldfarb","startTime":189.15,"endTime":192.18,"body":"I think we're both probably"},{"speaker":"Charles Goldfarb","startTime":189.15,"endTime":192.18,"body":"lower than our partners in a lot"},{"speaker":"Charles Goldfarb","startTime":192.18,"endTime":197.55,"body":"of respects. I do it is funny"},{"speaker":"Charles Goldfarb","startTime":192.18,"endTime":197.55,"body":"when I have a really busy"},{"speaker":"Charles Goldfarb","startTime":197.55,"endTime":201.57,"body":"booking day, I apologize to"},{"speaker":"Charles Goldfarb","startTime":197.55,"endTime":201.57,"body":"nermina, and I just feel like"},{"speaker":"Charles Goldfarb","startTime":201.57,"endTime":204.09,"body":"you can only book so many cases"},{"speaker":"Charles Goldfarb","startTime":201.57,"endTime":204.09,"body":"without going crazy, and"},{"speaker":"Charles Goldfarb","startTime":204.09,"endTime":209.1,"body":"thankfully, she's resilient. But"},{"speaker":"Charles Goldfarb","startTime":204.09,"endTime":209.1,"body":"yeah, I it's an interesting"},{"speaker":"Charles Goldfarb","startTime":209.1,"endTime":211.5,"body":"metric, and it's certainly not"},{"speaker":"Charles Goldfarb","startTime":209.1,"endTime":211.5,"body":"the only one that matters, and"},{"speaker":"Charles Goldfarb","startTime":211.5,"endTime":213.54,"body":"you can have a great clinic"},{"speaker":"Charles Goldfarb","startTime":211.5,"endTime":213.54,"body":"without scheduling any cases."},{"speaker":"Charles Goldfarb","startTime":213.54,"endTime":216.81,"body":"But ultimately it's sort of,"},{"speaker":"Charles Goldfarb","startTime":213.54,"endTime":216.81,"body":"sort of the goal. My question"},{"speaker":"Charles Goldfarb","startTime":216.81,"endTime":221.43,"body":"for you is, can you book too"},{"speaker":"Charles Goldfarb","startTime":216.81,"endTime":221.43,"body":"many nerve cases in a single"},{"speaker":"Charles Goldfarb","startTime":221.43,"endTime":226.26,"body":"day. Meaning, if you had four"},{"speaker":"Charles Goldfarb","startTime":221.43,"endTime":226.26,"body":"cubic tunnels and a perineal"},{"speaker":"Charles Goldfarb","startTime":226.26,"endTime":230.19,"body":"decompression and a nerve, can"},{"speaker":"Charles Goldfarb","startTime":226.26,"endTime":230.19,"body":"you do too many or is that"},{"speaker":"Charles Goldfarb","startTime":230.19,"endTime":233.73,"body":"impossible? That wasn't"},{"speaker":"Charles Goldfarb","startTime":230.19,"endTime":233.73,"body":"completely clear. Let me try"},{"speaker":"Charles Goldfarb","startTime":233.73,"endTime":238.11,"body":"that one more time. Is it"},{"speaker":"Charles Goldfarb","startTime":233.73,"endTime":238.11,"body":"possible, not from a time"},{"speaker":"Charles Goldfarb","startTime":238.11,"endTime":242.58,"body":"perspective, but from a Chris Dy"},{"speaker":"Charles Goldfarb","startTime":238.11,"endTime":242.58,"body":"enjoying the day perspective, is"},{"speaker":"Charles Goldfarb","startTime":242.58,"endTime":246.27,"body":"it possible to put too many"},{"speaker":"Charles Goldfarb","startTime":242.58,"endTime":246.27,"body":"nerve cases on one day?"},{"speaker":"Chris Dy","startTime":247.32,"endTime":249.87,"body":"I think it depends on"},{"speaker":"Chris Dy","startTime":247.32,"endTime":249.87,"body":"what it is. Because I actually,"},{"speaker":"Chris Dy","startTime":249.87,"endTime":252.78,"body":"when I come out of the room, I"},{"speaker":"Chris Dy","startTime":249.87,"endTime":252.78,"body":"actually don't specify dates,"},{"speaker":"Chris Dy","startTime":252.84,"endTime":256.35,"body":"unless it's like a time"},{"speaker":"Chris Dy","startTime":252.84,"endTime":256.35,"body":"sensitive thing. So, you know, I"},{"speaker":"Chris Dy","startTime":256.35,"endTime":260.34,"body":"have, actually have told, you"},{"speaker":"Chris Dy","startTime":256.35,"endTime":260.34,"body":"know, our my team, when we're"},{"speaker":"Chris Dy","startTime":260.34,"endTime":263.79,"body":"scheduling cases, I can't do"},{"speaker":"Chris Dy","startTime":260.34,"endTime":263.79,"body":"more than four or five. Will"},{"speaker":"Chris Dy","startTime":263.79,"endTime":268.02,"body":"launch cases in a day, both for"},{"speaker":"Chris Dy","startTime":263.79,"endTime":268.02,"body":"my own stamina and also to make"},{"speaker":"Chris Dy","startTime":268.02,"endTime":272.25,"body":"sure I don't lose the second"},{"speaker":"Chris Dy","startTime":268.02,"endTime":272.25,"body":"anesthesia team when they have"},{"speaker":"Chris Dy","startTime":272.25,"endTime":275.94,"body":"two rooms. Because if I have a"},{"speaker":"Chris Dy","startTime":272.25,"endTime":275.94,"body":"if there's enough local cases,"},{"speaker":"Chris Dy","startTime":275.97,"endTime":279.9,"body":"they will just move them all"},{"speaker":"Chris Dy","startTime":275.97,"endTime":279.9,"body":"into one room, which is not an"},{"speaker":"Chris Dy","startTime":279.9,"endTime":282.9,"body":"ideal setup, because, you know,"},{"speaker":"Chris Dy","startTime":279.9,"endTime":282.9,"body":"as in our place, I have to go"},{"speaker":"Chris Dy","startTime":282.9,"endTime":286.38,"body":"out and do the blocks between"},{"speaker":"Chris Dy","startTime":282.9,"endTime":286.38,"body":"cases, which can really slow"},{"speaker":"Chris Dy","startTime":286.38,"endTime":289.2,"body":"things down. And then also, I"},{"speaker":"Chris Dy","startTime":286.38,"endTime":289.2,"body":"just don't have the energy on an"},{"speaker":"Chris Dy","startTime":289.2,"endTime":291.81,"body":"or day to do eight while on"},{"speaker":"Chris Dy","startTime":289.2,"endTime":291.81,"body":"cases. I know a lot of our"},{"speaker":"Chris Dy","startTime":291.81,"endTime":296.46,"body":"listeners do. I just, I can't,"},{"speaker":"Chris Dy","startTime":291.81,"endTime":296.46,"body":"like, I just can't, because"},{"speaker":"Chris Dy","startTime":296.46,"endTime":298.98,"body":"you're, you know, it's a bit of"},{"speaker":"Chris Dy","startTime":296.46,"endTime":298.98,"body":"a showmanship aspect on top of"},{"speaker":"Chris Dy","startTime":298.98,"endTime":301.83,"body":"the teaching part of it. There"},{"speaker":"Chris Dy","startTime":298.98,"endTime":301.83,"body":"are days where I can't do more"},{"speaker":"Chris Dy","startTime":301.83,"endTime":304.77,"body":"than three, or I probably can't"},{"speaker":"Chris Dy","startTime":301.83,"endTime":304.77,"body":"do more than four on their nerve"},{"speaker":"Chris Dy","startTime":304.77,"endTime":308.31,"body":"transpositions in one day. I"},{"speaker":"Chris Dy","startTime":304.77,"endTime":308.31,"body":"mean, I can, and I have done it"},{"speaker":"Chris Dy","startTime":308.31,"endTime":311.01,"body":"occasionally, but I look at the"},{"speaker":"Chris Dy","startTime":308.31,"endTime":311.01,"body":"schedule like, oh, well, I guess"},{"speaker":"Chris Dy","startTime":311.01,"endTime":313.71,"body":"it's a high rep day for the"},{"speaker":"Chris Dy","startTime":311.01,"endTime":313.71,"body":"resident or the fellow, which is"},{"speaker":"Chris Dy","startTime":313.71,"endTime":316.59,"body":"a good thing for them, but it"},{"speaker":"Chris Dy","startTime":313.71,"endTime":316.59,"body":"does get a little bit tedious."},{"speaker":"Chris Dy","startTime":318.0,"endTime":320.64,"body":"Yeah. And like, months monster"},{"speaker":"Chris Dy","startTime":318.0,"endTime":320.64,"body":"nerve transfer cases, probably"},{"speaker":"Chris Dy","startTime":320.67,"endTime":323.01,"body":"just because the amount of time"},{"speaker":"Chris Dy","startTime":320.67,"endTime":323.01,"body":"you're not booking three or four"},{"speaker":"Chris Dy","startTime":323.01,"endTime":324.3,"body":"of those in a day usually. So"},{"speaker":"Charles Goldfarb","startTime":325.02,"endTime":327.24,"body":"yeah, it's"},{"speaker":"Charles Goldfarb","startTime":325.02,"endTime":327.24,"body":"interesting. I ulnar nerves are"},{"speaker":"Charles Goldfarb","startTime":327.24,"endTime":330.54,"body":"one of those that I try to cap,"},{"speaker":"Charles Goldfarb","startTime":327.24,"endTime":330.54,"body":"but Nermina doesn't listen to"},{"speaker":"Charles Goldfarb","startTime":330.54,"endTime":335.13,"body":"me, so I have done four or five"},{"speaker":"Charles Goldfarb","startTime":330.54,"endTime":335.13,"body":"in a day, and that's it. Just,"},{"speaker":"Charles Goldfarb","startTime":335.19,"endTime":338.4,"body":"it's not that my favorite case,"},{"speaker":"Charles Goldfarb","startTime":335.19,"endTime":338.4,"body":"as you know, and that's a lot."},{"speaker":"Charles Goldfarb","startTime":338.58,"endTime":341.97,"body":"And then, honestly, as much as,"},{"speaker":"Charles Goldfarb","startTime":338.58,"endTime":341.97,"body":"you know, I like wrist"},{"speaker":"Charles Goldfarb","startTime":341.97,"endTime":346.14,"body":"arthroscopy. I would say three"},{"speaker":"Charles Goldfarb","startTime":341.97,"endTime":346.14,"body":"is too many and four is"},{"speaker":"Charles Goldfarb","startTime":346.14,"endTime":349.68,"body":"definitely too many a day, not"},{"speaker":"Charles Goldfarb","startTime":346.14,"endTime":349.68,"body":"too many. It's just that I kind"},{"speaker":"Charles Goldfarb","startTime":349.68,"endTime":352.47,"body":"of, when I see that on the"},{"speaker":"Charles Goldfarb","startTime":349.68,"endTime":352.47,"body":"schedule, I'm like, wow, that's"},{"speaker":"Charles Goldfarb","startTime":352.47,"endTime":353.46,"body":"a lot. Yeah, it's"},{"speaker":"Chris Dy","startTime":353.46,"endTime":354.99,"body":"like, the fourth piece"},{"speaker":"Chris Dy","startTime":353.46,"endTime":354.99,"body":"of chocolate cake. You're like,"},{"speaker":"Chris Dy","startTime":354.99,"endTime":357.96,"body":"yeah, I can do it. I mean, I can"},{"speaker":"Chris Dy","startTime":354.99,"endTime":357.96,"body":"do it, but, you know, I don't"},{"speaker":"Chris Dy","startTime":358.23,"endTime":360.81,"body":"probably, you know, not enjoying"},{"speaker":"Chris Dy","startTime":358.23,"endTime":360.81,"body":"it as much as the first second"},{"speaker":"Chris Dy","startTime":360.81,"endTime":363.48,"body":"or third piece of cake or a"},{"speaker":"Chris Dy","startTime":360.81,"endTime":363.48,"body":"piece of pizza or whatever it is"},{"speaker":"Chris Dy","startTime":363.48,"endTime":365.88,"body":"that you're enjoying. Yeah?"},{"speaker":"Charles Goldfarb","startTime":367.17,"endTime":369.09,"body":"Why don't we"},{"speaker":"Charles Goldfarb","startTime":367.17,"endTime":369.09,"body":"thank our sponsors? Would that"},{"speaker":"Charles Goldfarb","startTime":369.36,"endTime":371.07,"body":"seems like a good time? Yeah,"},{"speaker":"Chris Dy","startTime":371.07,"endTime":373.44,"body":"we should thank"},{"speaker":"Chris Dy","startTime":371.07,"endTime":373.44,"body":"Practicelink. The upper hand is"},{"speaker":"Chris Dy","startTime":373.44,"endTime":376.98,"body":"sponsored by Practicelink.com"},{"speaker":"Chris Dy","startTime":373.44,"endTime":376.98,"body":"the most widely used physician"},{"speaker":"Chris Dy","startTime":376.98,"endTime":379.47,"body":"job search and career"},{"speaker":"Chris Dy","startTime":376.98,"endTime":379.47,"body":"advancement resource."},{"speaker":"Charles Goldfarb","startTime":379.65,"endTime":381.36,"body":"Becoming a"},{"speaker":"Charles Goldfarb","startTime":379.65,"endTime":381.36,"body":"physician is hard. Finding the"},{"speaker":"Charles Goldfarb","startTime":381.36,"endTime":385.62,"body":"right job doesn't have to be"},{"speaker":"Charles Goldfarb","startTime":381.36,"endTime":385.62,"body":"joinpracticelink.com I'm sorry,"},{"speaker":"Charles Goldfarb","startTime":386.1,"endTime":388.92,"body":"join practice link for free"},{"speaker":"Charles Goldfarb","startTime":386.1,"endTime":388.92,"body":"today at"},{"speaker":"Charles Goldfarb","startTime":389.79,"endTime":390.48,"body":"www.practicelink.com/theupperhand."},{"speaker":"Chris Dy","startTime":393.39,"endTime":395.43,"body":"Alright, yeah. So"},{"speaker":"Chris Dy","startTime":393.39,"endTime":395.43,"body":"after I finished in clinic, I"},{"speaker":"Chris Dy","startTime":395.43,"endTime":399.12,"body":"did hold myself up an office,"},{"speaker":"Chris Dy","startTime":395.43,"endTime":399.12,"body":"and I forced myself to write a"},{"speaker":"Chris Dy","startTime":399.12,"endTime":401.79,"body":"specific aims page that I've"},{"speaker":"Chris Dy","startTime":399.12,"endTime":401.79,"body":"been procrastinating on for a"},{"speaker":"Chris Dy","startTime":401.79,"endTime":404.88,"body":"while, and this is going to"},{"speaker":"Chris Dy","startTime":401.79,"endTime":404.88,"body":"resonate with very few people"},{"speaker":"Chris Dy","startTime":405.09,"endTime":408.33,"body":"who are listening. But I mean,"},{"speaker":"Chris Dy","startTime":405.09,"endTime":408.33,"body":"I've written so many grants in"},{"speaker":"Chris Dy","startTime":408.33,"endTime":411.03,"body":"the last two or three months,"},{"speaker":"Chris Dy","startTime":408.33,"endTime":411.03,"body":"for whatever reason, I decided"},{"speaker":"Chris Dy","startTime":411.03,"endTime":414.36,"body":"this was the moment to chase"},{"speaker":"Chris Dy","startTime":411.03,"endTime":414.36,"body":"different grants. So I think"},{"speaker":"Chris Dy","startTime":414.36,"endTime":418.86,"body":"since April, from April to"},{"speaker":"Chris Dy","startTime":414.36,"endTime":418.86,"body":"August, I'll have written six"},{"speaker":"Chris Dy","startTime":418.86,"endTime":423.66,"body":"grants various sizes, some for"},{"speaker":"Chris Dy","startTime":418.86,"endTime":423.66,"body":"very small mechanisms and some"},{"speaker":"Chris Dy","startTime":423.66,"endTime":427.44,"body":"for big mechanisms. So that"},{"speaker":"Chris Dy","startTime":423.66,"endTime":427.44,"body":"includes one NIHR, one grant"},{"speaker":"Chris Dy","startTime":427.92,"endTime":431.25,"body":"going for another one. And you"},{"speaker":"Chris Dy","startTime":427.92,"endTime":431.25,"body":"know, it's various foundation"},{"speaker":"Chris Dy","startTime":431.25,"endTime":434.31,"body":"grants, both internal grants and"},{"speaker":"Chris Dy","startTime":431.25,"endTime":434.31,"body":"kind of national grants. So"},{"speaker":"Chris Dy","startTime":434.31,"endTime":437.61,"body":"it's, I'm tired of writing, but"},{"speaker":"Chris Dy","startTime":434.31,"endTime":437.61,"body":"I keep realizing there I was,"},{"speaker":"Chris Dy","startTime":437.61,"endTime":441.06,"body":"like, this actually fits this"},{"speaker":"Chris Dy","startTime":437.61,"endTime":441.06,"body":"mechanism really well and we can"},{"speaker":"Chris Dy","startTime":441.06,"endTime":443.88,"body":"make this deadline. So here we"},{"speaker":"Chris Dy","startTime":441.06,"endTime":443.88,"body":"go again. It's"},{"speaker":"Charles Goldfarb","startTime":444.12,"endTime":446.1,"body":"well, you"},{"speaker":"Charles Goldfarb","startTime":444.12,"endTime":446.1,"body":"clearly have a talent for"},{"speaker":"Charles Goldfarb","startTime":446.1,"endTime":450.24,"body":"writing a good grant. No doubt"},{"speaker":"Charles Goldfarb","startTime":446.1,"endTime":450.24,"body":"about that. What would what hit"},{"speaker":"Charles Goldfarb","startTime":450.24,"endTime":452.91,"body":"rate would make you? Would you"},{"speaker":"Charles Goldfarb","startTime":450.24,"endTime":452.91,"body":"be satisfied with? I mean,"},{"speaker":"Charles Goldfarb","startTime":452.91,"endTime":456.6,"body":"obviously, you know you want the"},{"speaker":"Charles Goldfarb","startTime":452.91,"endTime":456.6,"body":"r1 of course, but excluding that"},{"speaker":"Charles Goldfarb","startTime":456.6,"endTime":459.75,"body":"one, if you got three of the"},{"speaker":"Charles Goldfarb","startTime":456.6,"endTime":459.75,"body":"five, would you be happy? Oh,"},{"speaker":"Chris Dy","startTime":459.75,"endTime":461.7,"body":"yeah, for sure. Three"},{"speaker":"Chris Dy","startTime":459.75,"endTime":461.7,"body":"out of five is great. I mean,"},{"speaker":"Chris Dy","startTime":461.7,"endTime":465.09,"body":"honestly, one out of five is"},{"speaker":"Chris Dy","startTime":461.7,"endTime":465.09,"body":"pretty solid. Two out of five is"},{"speaker":"Chris Dy","startTime":465.09,"endTime":468.15,"body":"pretty good. So it's almost like"},{"speaker":"Chris Dy","startTime":465.09,"endTime":468.15,"body":"baseball stats, in terms of your"},{"speaker":"Chris Dy","startTime":468.18,"endTime":471.03,"body":"batting average, if you're"},{"speaker":"Chris Dy","startTime":468.18,"endTime":471.03,"body":"hitting 300 you're doing really"},{"speaker":"Chris Dy","startTime":471.03,"endTime":475.17,"body":"well. So, I mean, it's really"},{"speaker":"Chris Dy","startTime":471.03,"endTime":475.17,"body":"hard, and it's an interesting"},{"speaker":"Chris Dy","startTime":475.17,"endTime":477.6,"body":"thing, because it's like, once"},{"speaker":"Chris Dy","startTime":475.17,"endTime":477.6,"body":"you get one grant, you become a"},{"speaker":"Chris Dy","startTime":477.6,"endTime":481.23,"body":"safer bet. And then just like,"},{"speaker":"Chris Dy","startTime":477.6,"endTime":481.23,"body":"keeps kind of coming, as long as"},{"speaker":"Chris Dy","startTime":481.23,"endTime":484.92,"body":"you know how to write a grant"},{"speaker":"Chris Dy","startTime":481.23,"endTime":484.92,"body":"well. But it's a, you know, it's"},{"speaker":"Chris Dy","startTime":484.92,"endTime":488.25,"body":"a very good exercise to think"},{"speaker":"Chris Dy","startTime":484.92,"endTime":488.25,"body":"about what you're doing"},{"speaker":"Chris Dy","startTime":488.25,"endTime":492.6,"body":"academically, research wise,"},{"speaker":"Chris Dy","startTime":488.25,"endTime":492.6,"body":"it's the ultimate BS Test in"},{"speaker":"Chris Dy","startTime":492.6,"endTime":495.63,"body":"terms of, you know, if you can't"},{"speaker":"Chris Dy","startTime":492.6,"endTime":495.63,"body":"explain what you're doing, you"},{"speaker":"Chris Dy","startTime":495.63,"endTime":498.18,"body":"know, in a very clear way to"},{"speaker":"Chris Dy","startTime":495.63,"endTime":498.18,"body":"smart people that aren't well"},{"speaker":"Chris Dy","startTime":498.18,"endTime":501.33,"body":"versed in your in your specific"},{"speaker":"Chris Dy","startTime":498.18,"endTime":501.33,"body":"field, and show them that this"},{"speaker":"Chris Dy","startTime":501.33,"endTime":505.65,"body":"is a good return on investment,"},{"speaker":"Chris Dy","startTime":501.33,"endTime":505.65,"body":"then you shouldn't be doing it."},{"speaker":"Chris Dy","startTime":505.68,"endTime":510.48,"body":"So, you know, it's, it's a"},{"speaker":"Chris Dy","startTime":505.68,"endTime":510.48,"body":"challenge, but you know, one"},{"speaker":"Chris Dy","startTime":510.48,"endTime":513.9,"body":"that I persist on, and I'm happy"},{"speaker":"Chris Dy","startTime":510.48,"endTime":513.9,"body":"that I just put my head down and"},{"speaker":"Chris Dy","startTime":513.93,"endTime":517.5,"body":"got the work done today. So I"},{"speaker":"Chris Dy","startTime":513.93,"endTime":517.5,"body":"did an interesting case that I"},{"speaker":"Chris Dy","startTime":517.5,"endTime":520.83,"body":"was hoping could be kind of the"},{"speaker":"Chris Dy","startTime":517.5,"endTime":520.83,"body":"crux of our conversation today,"},{"speaker":"Chris Dy","startTime":521.52,"endTime":525.27,"body":"it's the hand surgeon and hand"},{"speaker":"Chris Dy","startTime":521.52,"endTime":525.27,"body":"therapist, favorite diagnosis of"},{"speaker":"Chris Dy","startTime":525.27,"endTime":529.17,"body":"Jersey finger. And we talked"},{"speaker":"Chris Dy","startTime":525.27,"endTime":529.17,"body":"about, you know, kind of alluded"},{"speaker":"Chris Dy","startTime":529.17,"endTime":533.43,"body":"to this on prior episodes about"},{"speaker":"Chris Dy","startTime":529.17,"endTime":533.43,"body":"how, you know, the the classic"},{"speaker":"Chris Dy","startTime":533.43,"endTime":537.6,"body":"teaching is that that's a"},{"speaker":"Chris Dy","startTime":533.43,"endTime":537.6,"body":"surgical indication for a jersey"},{"speaker":"Chris Dy","startTime":537.6,"endTime":541.23,"body":"finger, and there are different,"},{"speaker":"Chris Dy","startTime":537.6,"endTime":541.23,"body":"different implications on"},{"speaker":"Chris Dy","startTime":541.23,"endTime":546.51,"body":"timing, but we talked about how,"},{"speaker":"Chris Dy","startTime":541.23,"endTime":546.51,"body":"how you know, your paper, your"},{"speaker":"Chris Dy","startTime":546.51,"endTime":548.79,"body":"case series that you worked on"},{"speaker":"Chris Dy","startTime":546.51,"endTime":548.79,"body":"with one of our former fellows,"},{"speaker":"Chris Dy","startTime":548.79,"endTime":552.09,"body":"Jocelyn Compton, demonstrated"},{"speaker":"Chris Dy","startTime":548.79,"endTime":552.09,"body":"that perhaps there's a role for"},{"speaker":"Chris Dy","startTime":552.09,"endTime":555.0,"body":"non operative treatment. So it"},{"speaker":"Chris Dy","startTime":552.09,"endTime":555.0,"body":"can you before I launch into"},{"speaker":"Chris Dy","startTime":555.0,"endTime":558.0,"body":"this case. You know, can you"},{"speaker":"Chris Dy","startTime":555.0,"endTime":558.0,"body":"kind of tell me your current"},{"speaker":"Chris Dy","startTime":558.0,"endTime":560.7,"body":"indications for surgery? Yeah."},{"speaker":"Charles Goldfarb","startTime":560.7,"endTime":562.77,"body":"So. And just"},{"speaker":"Charles Goldfarb","startTime":560.7,"endTime":562.77,"body":"for background, who those, for"},{"speaker":"Charles Goldfarb","startTime":562.77,"endTime":567.06,"body":"those listeners who haven't"},{"speaker":"Charles Goldfarb","startTime":562.77,"endTime":567.06,"body":"listened to the entire catalog"},{"speaker":"Charles Goldfarb","startTime":567.12,"endTime":571.68,"body":"of the upper hand podcast, first"},{"speaker":"Charles Goldfarb","startTime":567.12,"endTime":571.68,"body":"of all, shame on you. And second"},{"speaker":"Charles Goldfarb","startTime":571.68,"endTime":576.96,"body":"of all, kid, I kid, here's how I"},{"speaker":"Charles Goldfarb","startTime":571.68,"endTime":576.96,"body":"think about it. Most of us"},{"speaker":"Charles Goldfarb","startTime":576.96,"endTime":580.26,"body":"consider, most hand surgeons"},{"speaker":"Charles Goldfarb","startTime":576.96,"endTime":580.26,"body":"considered FDP avulsion, an"},{"speaker":"Charles Goldfarb","startTime":580.29,"endTime":583.35,"body":"absolute surgical indication."},{"speaker":"Charles Goldfarb","startTime":580.29,"endTime":583.35,"body":"And I'm not here to say that's"},{"speaker":"Charles Goldfarb","startTime":583.35,"endTime":588.57,"body":"wrong. I'm here to say that it's"},{"speaker":"Charles Goldfarb","startTime":583.35,"endTime":588.57,"body":"incumbent upon us as surgeons to"},{"speaker":"Charles Goldfarb","startTime":588.57,"endTime":590.55,"body":"make sure patients understand"},{"speaker":"Charles Goldfarb","startTime":588.57,"endTime":590.55,"body":"what they're getting into"},{"speaker":"Charles Goldfarb","startTime":590.55,"endTime":594.96,"body":"because it's a lot. It is. While"},{"speaker":"Charles Goldfarb","startTime":590.55,"endTime":594.96,"body":"the surgery itself, I would"},{"speaker":"Charles Goldfarb","startTime":594.96,"endTime":597.39,"body":"never call huge. It can be"},{"speaker":"Charles Goldfarb","startTime":594.96,"endTime":597.39,"body":"bigger than expected if you have"},{"speaker":"Charles Goldfarb","startTime":597.39,"endTime":600.87,"body":"to trace the tendon back into"},{"speaker":"Charles Goldfarb","startTime":597.39,"endTime":600.87,"body":"the palm. Thread it back out to"},{"speaker":"Charles Goldfarb","startTime":600.87,"endTime":605.07,"body":"the distal phalanx, and it can"},{"speaker":"Charles Goldfarb","startTime":600.87,"endTime":605.07,"body":"be a ton of therapy, and results"},{"speaker":"Charles Goldfarb","startTime":605.07,"endTime":608.79,"body":"are not guaranteed to be"},{"speaker":"Charles Goldfarb","startTime":605.07,"endTime":608.79,"body":"fantastic, and so all of that"},{"speaker":"Charles Goldfarb","startTime":608.79,"endTime":612.3,"body":"matters. If you happen to hit a"},{"speaker":"Charles Goldfarb","startTime":608.79,"endTime":612.3,"body":"home run, patients will come"},{"speaker":"Charles Goldfarb","startTime":612.3,"endTime":614.82,"body":"away thrilled. Otherwise, I"},{"speaker":"Charles Goldfarb","startTime":612.3,"endTime":614.82,"body":"would say most patients are"},{"speaker":"Charles Goldfarb","startTime":614.82,"endTime":618.03,"body":"happy after the surgery,"},{"speaker":"Charles Goldfarb","startTime":614.82,"endTime":618.03,"body":"assuming we avoid complications."},{"speaker":"Charles Goldfarb","startTime":618.42,"endTime":621.87,"body":"Thrilled is probably uncommon,"},{"speaker":"Charles Goldfarb","startTime":618.42,"endTime":621.87,"body":"at least in my personal"},{"speaker":"Charles Goldfarb","startTime":621.87,"endTime":624.9,"body":"experience. So I always have"},{"speaker":"Charles Goldfarb","startTime":621.87,"endTime":624.9,"body":"that conversation with the"},{"speaker":"Charles Goldfarb","startTime":624.9,"endTime":629.79,"body":"patient. I try to be honest with"},{"speaker":"Charles Goldfarb","startTime":624.9,"endTime":629.79,"body":"them. I don't try to talk them"},{"speaker":"Charles Goldfarb","startTime":629.79,"endTime":632.46,"body":"into surgery, although I"},{"speaker":"Charles Goldfarb","startTime":629.79,"endTime":632.46,"body":"explained that that's, I guess I"},{"speaker":"Charles Goldfarb","startTime":632.46,"endTime":635.64,"body":"would say, still, the standard"},{"speaker":"Charles Goldfarb","startTime":632.46,"endTime":635.64,"body":"of care is to repair the FDP."},{"speaker":"Charles Goldfarb","startTime":635.94,"endTime":636.18,"body":"Yeah. I"},{"speaker":"Chris Dy","startTime":636.26,"endTime":638.66,"body":"talk about how that's"},{"speaker":"Chris Dy","startTime":636.26,"endTime":638.66,"body":"the textbook. Yeah. You know,"},{"speaker":"Chris Dy","startTime":638.66,"endTime":641.86,"body":"how long do you tell them it"},{"speaker":"Chris Dy","startTime":638.66,"endTime":641.86,"body":"takes to get to, quote, happy,"},{"speaker":"Chris Dy","startTime":642.58,"endTime":648.7,"body":"16 weeks, four months, so four"},{"speaker":"Chris Dy","startTime":642.58,"endTime":648.7,"body":"months of therapy and to get to"},{"speaker":"Chris Dy","startTime":648.7,"endTime":652.54,"body":"happy. And then what's the rough"},{"speaker":"Chris Dy","startTime":648.7,"endTime":652.54,"body":"method, understanding that not"},{"speaker":"Chris Dy","startTime":652.54,"endTime":655.72,"body":"all the cases are the same."},{"speaker":"Chris Dy","startTime":652.54,"endTime":655.72,"body":"What's the rough PPC that you"},{"speaker":"Chris Dy","startTime":655.72,"endTime":656.02,"body":"get?"},{"speaker":"Charles Goldfarb","startTime":657.1,"endTime":659.02,"body":"I think if you"},{"speaker":"Charles Goldfarb","startTime":657.1,"endTime":659.02,"body":"get a distal Palmer crease"},{"speaker":"Charles Goldfarb","startTime":659.02,"endTime":662.52,"body":"measurement of one centimeter,"},{"speaker":"Charles Goldfarb","startTime":659.02,"endTime":662.52,"body":"you should be"},{"speaker":"Chris Dy","startTime":662.58,"endTime":665.58,"body":"happy. I was thrilled."},{"speaker":"Chris Dy","startTime":662.58,"endTime":665.58,"body":"I'd be thrilled with one"},{"speaker":"Chris Dy","startTime":665.58,"endTime":667.2,"body":"centimeter if"},{"speaker":"Charles Goldfarb","startTime":667.2,"endTime":668.94,"body":"I mean,"},{"speaker":"Charles Goldfarb","startTime":667.2,"endTime":668.94,"body":"honestly, I think that's one way"},{"speaker":"Charles Goldfarb","startTime":668.94,"endTime":671.82,"body":"to think about the other way to"},{"speaker":"Charles Goldfarb","startTime":668.94,"endTime":671.82,"body":"think about it is maintaining"},{"speaker":"Charles Goldfarb","startTime":671.82,"endTime":676.2,"body":"PIP full motion and getting a 30"},{"speaker":"Charles Goldfarb","startTime":671.82,"endTime":676.2,"body":"degree arc of distal joint"},{"speaker":"Charles Goldfarb","startTime":676.2,"endTime":678.66,"body":"motion would probably make me"},{"speaker":"Charles Goldfarb","startTime":676.2,"endTime":678.66,"body":"pretty happy. So"},{"speaker":"Chris Dy","startTime":678.66,"endTime":682.4,"body":"if you had PIP motion."},{"speaker":"Chris Dy","startTime":678.66,"endTime":682.4,"body":"If you had somebody that had"},{"speaker":"Chris Dy","startTime":682.4,"endTime":688.22,"body":"good superficialis, motored,"},{"speaker":"Chris Dy","startTime":682.4,"endTime":688.22,"body":"active flexion, would you tell"},{"speaker":"Chris Dy","startTime":688.22,"endTime":689.12,"body":"them to leave it alone?"},{"speaker":"Charles Goldfarb","startTime":690.62,"endTime":693.08,"body":"I would give"},{"speaker":"Charles Goldfarb","startTime":690.62,"endTime":693.08,"body":"them the option of leaving it"},{"speaker":"Charles Goldfarb","startTime":693.08,"endTime":696.8,"body":"alone and explain why. If it was"},{"speaker":"Charles Goldfarb","startTime":693.08,"endTime":696.8,"body":"my finger, I think that's what I"},{"speaker":"Charles Goldfarb","startTime":696.8,"endTime":699.2,"body":"would request. I really do,"},{"speaker":"Charles Goldfarb","startTime":696.8,"endTime":699.2,"body":"especially if it was the ring"},{"speaker":"Charles Goldfarb","startTime":699.2,"endTime":701.98,"body":"finger. And we know the ring"},{"speaker":"Charles Goldfarb","startTime":699.2,"endTime":701.98,"body":"fingers, most common because of"},{"speaker":"Charles Goldfarb","startTime":701.98,"endTime":705.58,"body":"vascularity and the like, I"},{"speaker":"Charles Goldfarb","startTime":701.98,"endTime":705.58,"body":"think, for the ring finger, I"},{"speaker":"Charles Goldfarb","startTime":705.58,"endTime":709.12,"body":"mean especially non dominant"},{"speaker":"Charles Goldfarb","startTime":705.58,"endTime":709.12,"body":"ring finger, but probably even"},{"speaker":"Charles Goldfarb","startTime":709.12,"endTime":714.1,"body":"dominant ring finger, if with my"},{"speaker":"Charles Goldfarb","startTime":709.12,"endTime":714.1,"body":"occupation and my difficulties"},{"speaker":"Charles Goldfarb","startTime":714.1,"endTime":718.12,"body":"going to therapy recently, you"},{"speaker":"Charles Goldfarb","startTime":714.1,"endTime":718.12,"body":"know, strengthened with my lack"},{"speaker":"Charles Goldfarb","startTime":718.12,"endTime":722.04,"body":"of therapy for my Knee, I would,"},{"speaker":"Charles Goldfarb","startTime":718.12,"endTime":722.04,"body":"I would not have mine repaired,"},{"speaker":"Charles Goldfarb","startTime":725.58,"endTime":726.3,"body":"would you"},{"speaker":"Chris Dy","startTime":727.5,"endTime":731.1,"body":"so, I mean, if you"},{"speaker":"Chris Dy","startTime":727.5,"endTime":731.1,"body":"what about this? So what if it"},{"speaker":"Chris Dy","startTime":731.1,"endTime":733.08,"body":"was your small finger? Does that"},{"speaker":"Chris Dy","startTime":731.1,"endTime":733.08,"body":"make a difference?"},{"speaker":"Charles Goldfarb","startTime":735.3,"endTime":737.64,"body":"I think it"},{"speaker":"Charles Goldfarb","startTime":735.3,"endTime":737.64,"body":"does make it. I mean, I think"},{"speaker":"Charles Goldfarb","startTime":737.64,"endTime":740.9,"body":"both ring and small matter for"},{"speaker":"Charles Goldfarb","startTime":737.64,"endTime":740.9,"body":"strength. And you know, we both"},{"speaker":"Charles Goldfarb","startTime":740.9,"endTime":744.74,"body":"occasionally need strength in"},{"speaker":"Charles Goldfarb","startTime":740.9,"endTime":744.74,"body":"the or and in life, that's the"},{"speaker":"Charles Goldfarb","startTime":744.74,"endTime":750.86,"body":"reason to repair the FTP, so a"},{"speaker":"Charles Goldfarb","startTime":744.74,"endTime":750.86,"body":"dominant hand, FDP, ring and"},{"speaker":"Charles Goldfarb","startTime":750.86,"endTime":754.46,"body":"small finger, to me, are more"},{"speaker":"Charles Goldfarb","startTime":750.86,"endTime":754.46,"body":"important than index and middle"},{"speaker":"Charles Goldfarb","startTime":754.46,"endTime":756.68,"body":"finger. Is that what you're"},{"speaker":"Charles Goldfarb","startTime":754.46,"endTime":756.68,"body":"getting at? Yeah,"},{"speaker":"Chris Dy","startTime":756.68,"endTime":758.6,"body":"yeah, no, I would"},{"speaker":"Chris Dy","startTime":756.68,"endTime":758.6,"body":"agree. And, you know, I guess,"},{"speaker":"Chris Dy","startTime":758.6,"endTime":762.04,"body":"you know, usually the way that"},{"speaker":"Chris Dy","startTime":758.6,"endTime":762.04,"body":"I've approached this in the last"},{"speaker":"Chris Dy","startTime":762.04,"endTime":764.38,"body":"couple years is that, you know,"},{"speaker":"Chris Dy","startTime":762.04,"endTime":764.38,"body":"if there's somebody who has"},{"speaker":"Chris Dy","startTime":764.74,"endTime":769.36,"body":"reasonable, you know, Pip"},{"speaker":"Chris Dy","startTime":764.74,"endTime":769.36,"body":"flexion, I really try to tell"},{"speaker":"Chris Dy","startTime":769.36,"endTime":773.02,"body":"them, like, Let's optimize that."},{"speaker":"Chris Dy","startTime":769.36,"endTime":773.02,"body":"You know, as long as your you"},{"speaker":"Chris Dy","startTime":773.02,"endTime":775.72,"body":"know, stump hasn't retracted and"},{"speaker":"Chris Dy","startTime":773.02,"endTime":775.72,"body":"come very painful. I mean,"},{"speaker":"Chris Dy","startTime":775.72,"endTime":778.42,"body":"there's probably not a role for"},{"speaker":"Chris Dy","startTime":775.72,"endTime":778.42,"body":"surgery. And if it becomes"},{"speaker":"Chris Dy","startTime":778.42,"endTime":780.84,"body":"painful, that's a different kind"},{"speaker":"Chris Dy","startTime":778.42,"endTime":780.84,"body":"of surgery with a much different"},{"speaker":"Chris Dy","startTime":780.84,"endTime":784.98,"body":"kind of outcome. So this was an"},{"speaker":"Chris Dy","startTime":780.84,"endTime":784.98,"body":"interesting case, though. So"},{"speaker":"Chris Dy","startTime":784.98,"endTime":790.02,"body":"this is an very active person,"},{"speaker":"Chris Dy","startTime":784.98,"endTime":790.02,"body":"perhaps chronologically older"},{"speaker":"Chris Dy","startTime":790.02,"endTime":794.88,"body":"than you, physiologically,"},{"speaker":"Chris Dy","startTime":790.02,"endTime":794.88,"body":"pretty young. And this person"},{"speaker":"Chris Dy","startTime":794.88,"endTime":798.6,"body":"injured themselves playing"},{"speaker":"Chris Dy","startTime":794.88,"endTime":798.6,"body":"soccer, grabbing a jersey. It's"},{"speaker":"Chris Dy","startTime":798.6,"endTime":803.24,"body":"interestingly enough. Wow. So"},{"speaker":"Chris Dy","startTime":798.6,"endTime":803.24,"body":"you know, it was the, it was the"},{"speaker":"Chris Dy","startTime":803.24,"endTime":807.86,"body":"small finger on their dominant"},{"speaker":"Chris Dy","startTime":803.24,"endTime":807.86,"body":"hand, still working, still"},{"speaker":"Chris Dy","startTime":808.34,"endTime":813.98,"body":"athletically, quite active. And"},{"speaker":"Chris Dy","startTime":808.34,"endTime":813.98,"body":"came to our Injury Clinic, and I"},{"speaker":"Chris Dy","startTime":814.04,"endTime":817.22,"body":"the, you know, the physiatry"},{"speaker":"Chris Dy","startTime":814.04,"endTime":817.22,"body":"colleague of ours came over and"},{"speaker":"Chris Dy","startTime":817.22,"endTime":819.8,"body":"said, Can you see his patient? I"},{"speaker":"Chris Dy","startTime":817.22,"endTime":819.8,"body":"said, Of course. I went in. I"},{"speaker":"Chris Dy","startTime":819.8,"endTime":822.1,"body":"was like, well, started going"},{"speaker":"Chris Dy","startTime":819.8,"endTime":822.1,"body":"into the spiel of, here are the"},{"speaker":"Chris Dy","startTime":822.1,"endTime":827.74,"body":"options, blah, blah, blah. And"},{"speaker":"Chris Dy","startTime":822.1,"endTime":827.74,"body":"then I looked at his X ray, and"},{"speaker":"Chris Dy","startTime":827.74,"endTime":831.46,"body":"of course, the piece had"},{"speaker":"Chris Dy","startTime":827.74,"endTime":831.46,"body":"retracted back to guess where,"},{"speaker":"Chris Dy","startTime":832.0,"endTime":835.96,"body":"right at the PIP joint, to the"},{"speaker":"Chris Dy","startTime":832.0,"endTime":835.96,"body":"point where it was a it was"},{"speaker":"Chris Dy","startTime":835.96,"endTime":839.32,"body":"interfering with superficialis"},{"speaker":"Chris Dy","startTime":835.96,"endTime":839.32,"body":"function. So what do you do"},{"speaker":"Chris Dy","startTime":839.32,"endTime":842.34,"body":"then? Because he's got no PIP"},{"speaker":"Chris Dy","startTime":839.32,"endTime":842.34,"body":"flexion either."},{"speaker":"Charles Goldfarb","startTime":843.42,"endTime":846.18,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":843.42,"endTime":846.18,"body":"that's totally different in the"},{"speaker":"Charles Goldfarb","startTime":846.18,"endTime":850.02,"body":"sense that a bony avulsion, and"},{"speaker":"Charles Goldfarb","startTime":846.18,"endTime":850.02,"body":"I think, to me, bony avulsions"},{"speaker":"Charles Goldfarb","startTime":850.08,"endTime":854.04,"body":"are different, because if it's a"},{"speaker":"Charles Goldfarb","startTime":850.08,"endTime":854.04,"body":"sizable enough fragment that"},{"speaker":"Charles Goldfarb","startTime":854.04,"endTime":857.04,"body":"you're actually looking to"},{"speaker":"Charles Goldfarb","startTime":854.04,"endTime":857.04,"body":"repair the bone, I think it"},{"speaker":"Charles Goldfarb","startTime":857.04,"endTime":861.02,"body":"heals in a very different way."},{"speaker":"Charles Goldfarb","startTime":857.04,"endTime":861.02,"body":"Am I was this a big enough piece"},{"speaker":"Charles Goldfarb","startTime":861.02,"endTime":863.18,"body":"that you think you could get the"},{"speaker":"Charles Goldfarb","startTime":861.02,"endTime":863.18,"body":"bone to heal? I"},{"speaker":"Chris Dy","startTime":863.18,"endTime":865.46,"body":"didn't think so. I"},{"speaker":"Chris Dy","startTime":863.18,"endTime":865.46,"body":"mean, honestly, it's a, it's,"},{"speaker":"Chris Dy","startTime":865.46,"endTime":868.16,"body":"it's one of those pieces where,"},{"speaker":"Chris Dy","startTime":865.46,"endTime":868.16,"body":"like, I don't think I can get"},{"speaker":"Chris Dy","startTime":868.16,"endTime":872.36,"body":"solid fixation in that piece,"},{"speaker":"Chris Dy","startTime":868.16,"endTime":872.36,"body":"but it was, it was a piece,"},{"speaker":"Chris Dy","startTime":872.36,"endTime":875.9,"body":"like, a sizable piece, but not"},{"speaker":"Chris Dy","startTime":872.36,"endTime":875.9,"body":"sizable enough where I was,"},{"speaker":"Chris Dy","startTime":875.9,"endTime":878.06,"body":"like, we could fix that, and"},{"speaker":"Chris Dy","startTime":875.9,"endTime":878.06,"body":"it'll, you know, reliably do"},{"speaker":"Chris Dy","startTime":878.06,"endTime":880.54,"body":"well. Because I think, you know,"},{"speaker":"Chris Dy","startTime":878.06,"endTime":880.54,"body":"for those that aren't as well"},{"speaker":"Chris Dy","startTime":880.54,"endTime":882.88,"body":"initiated. I mean, you know, so"},{"speaker":"Chris Dy","startTime":880.54,"endTime":882.88,"body":"bone to bone healing is much"},{"speaker":"Chris Dy","startTime":882.88,"endTime":886.3,"body":"more reliable. Tendon to tendon"},{"speaker":"Chris Dy","startTime":882.88,"endTime":886.3,"body":"healing, while finicky, is is"},{"speaker":"Chris Dy","startTime":886.3,"endTime":888.88,"body":"reliable. But I think that"},{"speaker":"Chris Dy","startTime":886.3,"endTime":888.88,"body":"tendon bone interface, as we've"},{"speaker":"Chris Dy","startTime":888.88,"endTime":891.88,"body":"seen with like rotator cuff and"},{"speaker":"Chris Dy","startTime":888.88,"endTime":891.88,"body":"everything, is just, you know,"},{"speaker":"Chris Dy","startTime":891.88,"endTime":895.54,"body":"it's really tough, you know. So"},{"speaker":"Chris Dy","startTime":891.88,"endTime":895.54,"body":"I think when you've got a purely"},{"speaker":"Chris Dy","startTime":895.54,"endTime":899.26,"body":"avulsion injury without the bone"},{"speaker":"Chris Dy","startTime":895.54,"endTime":899.26,"body":"fragment, I think that's a real,"},{"speaker":"Chris Dy","startTime":899.26,"endTime":901.26,"body":"real challenge. Much. I mean,"},{"speaker":"Chris Dy","startTime":899.26,"endTime":901.26,"body":"what's your What are your"},{"speaker":"Chris Dy","startTime":901.26,"endTime":901.62,"body":"thoughts on"},{"speaker":"Charles Goldfarb","startTime":901.62,"endTime":904.08,"body":"that? Yeah, so"},{"speaker":"Charles Goldfarb","startTime":901.62,"endTime":904.08,"body":"I think the scenario you present"},{"speaker":"Charles Goldfarb","startTime":904.08,"endTime":908.4,"body":"so small fragment, bony"},{"speaker":"Charles Goldfarb","startTime":904.08,"endTime":908.4,"body":"avulsion, approximately migrated"},{"speaker":"Charles Goldfarb","startTime":908.4,"endTime":911.22,"body":"to the PIP joint, means you need"},{"speaker":"Charles Goldfarb","startTime":908.4,"endTime":911.22,"body":"to do surgery, because you got"},{"speaker":"Charles Goldfarb","startTime":911.22,"endTime":914.58,"body":"to give them some finger motion."},{"speaker":"Charles Goldfarb","startTime":911.22,"endTime":914.58,"body":"So your options are, go in and"},{"speaker":"Charles Goldfarb","startTime":914.58,"endTime":920.16,"body":"just take out the bony fragment,"},{"speaker":"Charles Goldfarb","startTime":914.58,"endTime":920.16,"body":"ie cut the FDP tendon short and"},{"speaker":"Charles Goldfarb","startTime":920.16,"endTime":923.12,"body":"leave him with an FDS only"},{"speaker":"Charles Goldfarb","startTime":920.16,"endTime":923.12,"body":"finger, and I think he would"},{"speaker":"Charles Goldfarb","startTime":923.12,"endTime":927.62,"body":"rapidly get back PFP motion, or"},{"speaker":"Charles Goldfarb","startTime":923.12,"endTime":927.62,"body":"if you're going to the or do you"},{"speaker":"Charles Goldfarb","startTime":927.62,"endTime":930.74,"body":"go ahead and do the repair? And"},{"speaker":"Charles Goldfarb","startTime":927.62,"endTime":930.74,"body":"my my gut here would be, if I'm"},{"speaker":"Charles Goldfarb","startTime":930.74,"endTime":933.44,"body":"going to the or I'm going to do"},{"speaker":"Charles Goldfarb","startTime":930.74,"endTime":933.44,"body":"the repair, right?"},{"speaker":"Chris Dy","startTime":933.44,"endTime":936.14,"body":"So I agreed with that,"},{"speaker":"Chris Dy","startTime":933.44,"endTime":936.14,"body":"and started to have that"},{"speaker":"Chris Dy","startTime":936.14,"endTime":938.66,"body":"discussion. What's your sense on"},{"speaker":"Chris Dy","startTime":936.14,"endTime":938.66,"body":"timing,"},{"speaker":"Charles Goldfarb","startTime":940.76,"endTime":946.48,"body":"if An avulsion"},{"speaker":"Charles Goldfarb","startTime":940.76,"endTime":946.48,"body":"is into the palm, I think you"},{"speaker":"Charles Goldfarb","startTime":946.54,"endTime":950.2,"body":"absolutely have to do that in"},{"speaker":"Charles Goldfarb","startTime":946.54,"endTime":950.2,"body":"the first three weeks, if you"},{"speaker":"Charles Goldfarb","startTime":950.2,"endTime":952.6,"body":"don't, and I've been guilty of"},{"speaker":"Charles Goldfarb","startTime":950.2,"endTime":952.6,"body":"that, and that's in the"},{"speaker":"Charles Goldfarb","startTime":952.6,"endTime":955.12,"body":"literature. But if you, if you"},{"speaker":"Charles Goldfarb","startTime":952.6,"endTime":955.12,"body":"try to be aggressive, even in"},{"speaker":"Charles Goldfarb","startTime":955.12,"endTime":960.7,"body":"kids, three weeks is, you know,"},{"speaker":"Charles Goldfarb","startTime":955.12,"endTime":960.7,"body":"it's a pretty good landmark. I"},{"speaker":"Charles Goldfarb","startTime":960.7,"endTime":963.9,"body":"think what you can do is just"},{"speaker":"Charles Goldfarb","startTime":960.7,"endTime":963.9,"body":"make the whole finger stiff and"},{"speaker":"Charles Goldfarb","startTime":963.9,"endTime":968.46,"body":"so it but in this situation, I"},{"speaker":"Charles Goldfarb","startTime":963.9,"endTime":968.46,"body":"think you probably can go even a"},{"speaker":"Charles Goldfarb","startTime":968.46,"endTime":970.8,"body":"little bit longer. I don't know"},{"speaker":"Charles Goldfarb","startTime":968.46,"endTime":970.8,"body":"how much longer, four weeks,"},{"speaker":"Charles Goldfarb","startTime":970.8,"endTime":974.52,"body":"maybe, because you're not asking"},{"speaker":"Charles Goldfarb","startTime":970.8,"endTime":974.52,"body":"that much of the muscle belly,"},{"speaker":"Charles Goldfarb","startTime":974.58,"endTime":976.62,"body":"but I don't think I'd go longer"},{"speaker":"Charles Goldfarb","startTime":974.58,"endTime":976.62,"body":"than four weeks."},{"speaker":"Chris Dy","startTime":976.98,"endTime":979.5,"body":"Yeah, so this was"},{"speaker":"Chris Dy","startTime":976.98,"endTime":979.5,"body":"interesting. I mean, I really"},{"speaker":"Chris Dy","startTime":979.5,"endTime":981.86,"body":"like this guy, and identify a"},{"speaker":"Chris Dy","startTime":979.5,"endTime":981.86,"body":"lot with him. I mean, I like all"},{"speaker":"Chris Dy","startTime":981.86,"endTime":984.86,"body":"my patients, of course. I mean,"},{"speaker":"Chris Dy","startTime":981.86,"endTime":984.86,"body":"I identify with him in a lot of"},{"speaker":"Chris Dy","startTime":984.86,"endTime":987.14,"body":"ways, in terms of, you know,"},{"speaker":"Chris Dy","startTime":984.86,"endTime":987.14,"body":"just really wanting to, you"},{"speaker":"Chris Dy","startTime":987.14,"endTime":992.12,"body":"know, grab in terms of life. So"},{"speaker":"Chris Dy","startTime":987.14,"endTime":992.12,"body":"I start talking about surgery,"},{"speaker":"Chris Dy","startTime":992.12,"endTime":994.88,"body":"and you know what that looks"},{"speaker":"Chris Dy","startTime":992.12,"endTime":994.88,"body":"like, and what the options are,"},{"speaker":"Chris Dy","startTime":994.88,"endTime":999.8,"body":"and he's like, Well, you know,"},{"speaker":"Chris Dy","startTime":994.88,"endTime":999.8,"body":"that's great, but, you know, I'm"},{"speaker":"Chris Dy","startTime":999.8,"endTime":1003.84,"body":"leaving tomorrow on this trip."},{"speaker":"Chris Dy","startTime":999.8,"endTime":1003.84,"body":"And I won't go into details for"},{"speaker":"Chris Dy","startTime":1003.84,"endTime":1006.6,"body":"privacy reasons, but it's one of"},{"speaker":"Chris Dy","startTime":1003.84,"endTime":1006.6,"body":"those, like, trip of a lifetime"},{"speaker":"Chris Dy","startTime":1006.6,"endTime":1010.26,"body":"kind of things where it's like,"},{"speaker":"Chris Dy","startTime":1006.6,"endTime":1010.26,"body":"yeah, that sounds awesome. I was"},{"speaker":"Chris Dy","startTime":1010.26,"endTime":1014.34,"body":"like, Well, I'm supposed to tell"},{"speaker":"Chris Dy","startTime":1010.26,"endTime":1014.34,"body":"you that you should have surgery"},{"speaker":"Chris Dy","startTime":1014.34,"endTime":1017.46,"body":"within the next few weeks, but"},{"speaker":"Chris Dy","startTime":1014.34,"endTime":1017.46,"body":"that sounds like a great trip."},{"speaker":"Chris Dy","startTime":1018.06,"endTime":1021.56,"body":"So what would you tell them in"},{"speaker":"Chris Dy","startTime":1018.06,"endTime":1021.56,"body":"terms of, would you immobilize"},{"speaker":"Chris Dy","startTime":1021.56,"endTime":1023.96,"body":"him at that point? Honestly, my"},{"speaker":"Chris Dy","startTime":1021.56,"endTime":1023.96,"body":"thought was like, well, maybe"},{"speaker":"Chris Dy","startTime":1023.96,"endTime":1026.24,"body":"that piece will dislodge and we"},{"speaker":"Chris Dy","startTime":1023.96,"endTime":1026.24,"body":"won't have to do anything, so"},{"speaker":"Chris Dy","startTime":1026.24,"endTime":1027.62,"body":"I'm not going to immobilize you."},{"speaker":"Charles Goldfarb","startTime":1027.38,"endTime":1029.961,"body":"Well, I think,"},{"speaker":"Charles Goldfarb","startTime":1027.38,"endTime":1029.961,"body":"you know, I never mind these"},{"speaker":"Charles Goldfarb","startTime":1030.021,"endTime":1033.624,"body":"scenarios. Because A, yeah,"},{"speaker":"Charles Goldfarb","startTime":1030.021,"endTime":1033.624,"body":"maybe the maybe it dislodges and"},{"speaker":"Charles Goldfarb","startTime":1033.684,"endTime":1037.286,"body":"retracts more approximately, or"},{"speaker":"Charles Goldfarb","startTime":1033.684,"endTime":1037.286,"body":"he comes back at four weeks,"},{"speaker":"Charles Goldfarb","startTime":1037.346,"endTime":1040.948,"body":"five weeks, six weeks. And you"},{"speaker":"Charles Goldfarb","startTime":1037.346,"endTime":1040.948,"body":"don't, you know you probably,"},{"speaker":"Charles Goldfarb","startTime":1041.008,"endTime":1044.731,"body":"you go in potentially with the"},{"speaker":"Charles Goldfarb","startTime":1041.008,"endTime":1044.731,"body":"option of repairing the tenant,"},{"speaker":"Charles Goldfarb","startTime":1044.791,"endTime":1048.393,"body":"but, but doesn't really stretch"},{"speaker":"Charles Goldfarb","startTime":1044.791,"endTime":1048.393,"body":"to where you need it to. You"},{"speaker":"Charles Goldfarb","startTime":1048.453,"endTime":1051.996,"body":"just take out the FDP tendon and"},{"speaker":"Charles Goldfarb","startTime":1048.453,"endTime":1051.996,"body":"leave him with an FDS only"},{"speaker":"Charles Goldfarb","startTime":1052.056,"endTime":1055.658,"body":"finger and and maybe you can"},{"speaker":"Charles Goldfarb","startTime":1052.056,"endTime":1055.658,"body":"manipulate him in the or to get"},{"speaker":"Charles Goldfarb","startTime":1055.718,"endTime":1057.7,"body":"his VIP joint moving again. Yeah."},{"speaker":"Chris Dy","startTime":1057.82,"endTime":1060.72,"body":"So, I mean, so we come"},{"speaker":"Chris Dy","startTime":1057.82,"endTime":1060.72,"body":"to the conclusion, we've agreed"},{"speaker":"Chris Dy","startTime":1060.72,"endTime":1064.08,"body":"that we're going to let him go"},{"speaker":"Chris Dy","startTime":1060.72,"endTime":1064.08,"body":"and come back when he's back"},{"speaker":"Chris Dy","startTime":1064.08,"endTime":1067.86,"body":"from his awesome trip. Would you"},{"speaker":"Chris Dy","startTime":1064.08,"endTime":1067.86,"body":"give him any mobilization or any"},{"speaker":"Chris Dy","startTime":1067.86,"endTime":1069.24,"body":"particular exercises to do?"},{"speaker":"Charles Goldfarb","startTime":1070.38,"endTime":1072.48,"body":"Sure? I would."},{"speaker":"Charles Goldfarb","startTime":1070.38,"endTime":1072.48,"body":"I would probably have him see"},{"speaker":"Charles Goldfarb","startTime":1072.48,"endTime":1075.24,"body":"therapy. I don't think he needs"},{"speaker":"Charles Goldfarb","startTime":1072.48,"endTime":1075.24,"body":"a splint, but if you wanted one,"},{"speaker":"Charles Goldfarb","startTime":1075.24,"endTime":1078.54,"body":"I'm not against it, but I'd have"},{"speaker":"Charles Goldfarb","startTime":1075.24,"endTime":1078.54,"body":"therapy. Either I or I'd ask"},{"speaker":"Charles Goldfarb","startTime":1078.54,"endTime":1081.5,"body":"therapy to instruct him on how"},{"speaker":"Charles Goldfarb","startTime":1078.54,"endTime":1081.5,"body":"to try to get some at least PIP"},{"speaker":"Charles Goldfarb","startTime":1081.5,"endTime":1084.02,"body":"motion. I don't really care"},{"speaker":"Charles Goldfarb","startTime":1081.5,"endTime":1084.02,"body":"about VIP motion, but at least"},{"speaker":"Charles Goldfarb","startTime":1084.02,"endTime":1086.18,"body":"and try to get some PIP motion"},{"speaker":"Charles Goldfarb","startTime":1084.02,"endTime":1086.18,"body":"back in flexion."},{"speaker":"Chris Dy","startTime":1086.84,"endTime":1090.26,"body":"Yeah, that's what we"},{"speaker":"Chris Dy","startTime":1086.84,"endTime":1090.26,"body":"did. So, you know, before we get"},{"speaker":"Chris Dy","startTime":1090.26,"endTime":1094.76,"body":"to the next part of our we"},{"speaker":"Chris Dy","startTime":1090.26,"endTime":1094.76,"body":"should thank our next sponsor."},{"speaker":"Charles Goldfarb","startTime":1095.3,"endTime":1100.66,"body":"Absolutely we"},{"speaker":"Charles Goldfarb","startTime":1095.3,"endTime":1100.66,"body":"should thank our sponsor,"},{"speaker":"Charles Goldfarb","startTime":1100.66,"endTime":1105.46,"body":"checkpoint surgical, along with"},{"speaker":"Charles Goldfarb","startTime":1100.66,"endTime":1105.46,"body":"SSH, are hosting a live webinar"},{"speaker":"Charles Goldfarb","startTime":1105.46,"endTime":1110.86,"body":"on july 24 at 8pm Eastern"},{"speaker":"Charles Goldfarb","startTime":1105.46,"endTime":1110.86,"body":"Daylight Time, join doctors"},{"speaker":"Charles Goldfarb","startTime":1111.04,"endTime":1116.56,"body":"Michael Houseman, Steven Kohler"},{"speaker":"Charles Goldfarb","startTime":1111.04,"endTime":1116.56,"body":"and azul Shah as they discuss"},{"speaker":"Charles Goldfarb","startTime":1116.62,"endTime":1120.46,"body":"nerve disaster preparedness,"},{"speaker":"Charles Goldfarb","startTime":1116.62,"endTime":1120.46,"body":"prevention and response, how"},{"speaker":"Chris Dy","startTime":1121.72,"endTime":1124.34,"body":"to handle the"},{"speaker":"Chris Dy","startTime":1121.72,"endTime":1124.34,"body":"unexpected. Iatrogenic injury."},{"speaker":"Chris Dy","startTime":1124.399,"endTime":1128.032,"body":"Look at that dramatic pause. So"},{"speaker":"Chris Dy","startTime":1124.399,"endTime":1128.032,"body":"to learn more and register is"},{"speaker":"Chris Dy","startTime":1128.092,"endTime":1131.665,"body":"nerve master.com so before we"},{"speaker":"Chris Dy","startTime":1128.092,"endTime":1131.665,"body":"get into the rest of that this"},{"speaker":"Chris Dy","startTime":1131.724,"endTime":1135.357,"body":"case, first off, I think that's"},{"speaker":"Chris Dy","startTime":1131.724,"endTime":1135.357,"body":"gonna be a great webinar. And"},{"speaker":"Chris Dy","startTime":1135.417,"endTime":1139.05,"body":"Second off, the number of people"},{"speaker":"Chris Dy","startTime":1135.417,"endTime":1139.05,"body":"that have randomly texted or"},{"speaker":"Chris Dy","startTime":1139.109,"endTime":1142.861,"body":"sent me a whatsapp based on the"},{"speaker":"Chris Dy","startTime":1139.109,"endTime":1142.861,"body":"speed in which people listen to"},{"speaker":"Chris Dy","startTime":1142.92,"endTime":1146.315,"body":"our podcast. Is hilarious. I"},{"speaker":"Chris Dy","startTime":1142.92,"endTime":1146.315,"body":"don't know if you've got any"},{"speaker":"Chris Dy","startTime":1146.375,"endTime":1150.007,"body":"feedback from that. No, tell me"},{"speaker":"Chris Dy","startTime":1146.375,"endTime":1150.007,"body":"more. Yeah. So our former our"},{"speaker":"Chris Dy","startTime":1150.067,"endTime":1153.819,"body":"former medical student, believe"},{"speaker":"Chris Dy","startTime":1150.067,"endTime":1153.819,"body":"it or not, turned eventual hand"},{"speaker":"Chris Dy","startTime":1153.878,"endTime":1157.749,"body":"surgeon, Agnes Dardis, texted me"},{"speaker":"Chris Dy","startTime":1153.878,"endTime":1157.749,"body":"talking about the speed in which"},{"speaker":"Chris Dy","startTime":1157.809,"endTime":1161.561,"body":"she listens to the podcast. And"},{"speaker":"Chris Dy","startTime":1157.809,"endTime":1161.561,"body":"I haven't heard from Agnes in a"},{"speaker":"Chris Dy","startTime":1161.62,"endTime":1165.134,"body":"while. She was a med student"},{"speaker":"Chris Dy","startTime":1161.62,"endTime":1165.134,"body":"here. Rock star ended up going"},{"speaker":"Chris Dy","startTime":1165.193,"endTime":1169.005,"body":"to Penn for her residency, did a"},{"speaker":"Chris Dy","startTime":1165.193,"endTime":1169.005,"body":"hand surgery fellowship, and is"},{"speaker":"Chris Dy","startTime":1169.064,"endTime":1172.518,"body":"now in practice so and I see her"},{"speaker":"Chris Dy","startTime":1169.064,"endTime":1172.518,"body":"every now and then at the"},{"speaker":"Chris Dy","startTime":1172.578,"endTime":1176.33,"body":"meetings. And then I had one of"},{"speaker":"Chris Dy","startTime":1172.578,"endTime":1176.33,"body":"our good one of my good friends"},{"speaker":"Chris Dy","startTime":1176.389,"endTime":1179.248,"body":"from the Philippines, who"},{"speaker":"Chris Dy","startTime":1176.389,"endTime":1179.248,"body":"invited me over to the"},{"speaker":"Chris Dy","startTime":1179.308,"endTime":1182.881,"body":"orthopedic meeting there. He"},{"speaker":"Chris Dy","startTime":1179.308,"endTime":1182.881,"body":"texted me saying he did. He had"},{"speaker":"Chris Dy","startTime":1182.94,"endTime":1186.692,"body":"no idea there was anything but"},{"speaker":"Chris Dy","startTime":1182.94,"endTime":1186.692,"body":"1x speed. So, yeah, you know, it"},{"speaker":"Chris Dy","startTime":1186.752,"endTime":1190.563,"body":"was just a funny reminder about"},{"speaker":"Chris Dy","startTime":1186.752,"endTime":1190.563,"body":"how little things affect people."},{"speaker":"Chris Dy","startTime":1190.623,"endTime":1191.04,"body":"It's so"},{"speaker":"Charles Goldfarb","startTime":1191.34,"endTime":1194.76,"body":"it is so funny"},{"speaker":"Charles Goldfarb","startTime":1191.34,"endTime":1194.76,"body":"that I personally am selective."},{"speaker":"Charles Goldfarb","startTime":1194.82,"endTime":1197.82,"body":"I mean, I don't ever listen to"},{"speaker":"Charles Goldfarb","startTime":1194.82,"endTime":1197.82,"body":"anything at normal speed. But is"},{"speaker":"Charles Goldfarb","startTime":1197.82,"endTime":1201.56,"body":"it a certain podcast or a one"},{"speaker":"Charles Goldfarb","startTime":1197.82,"endTime":1201.56,"body":"point? Two, 1.5 is probably most"},{"speaker":"Charles Goldfarb","startTime":1201.56,"endTime":1204.5,"body":"common. And if I really just"},{"speaker":"Charles Goldfarb","startTime":1201.56,"endTime":1204.5,"body":"need to get through something, I"},{"speaker":"Charles Goldfarb","startTime":1204.5,"endTime":1209.18,"body":"go like, 1.822 times speed can"},{"speaker":"Charles Goldfarb","startTime":1204.5,"endTime":1209.18,"body":"be hard, unless it's like a work"},{"speaker":"Charles Goldfarb","startTime":1209.18,"endTime":1213.74,"body":"required listening, and then I"},{"speaker":"Charles Goldfarb","startTime":1209.18,"endTime":1213.74,"body":"may go two times speed. That's"},{"speaker":"Chris Dy","startTime":1213.74,"endTime":1215.3,"body":"aggressive. I mean,"},{"speaker":"Chris Dy","startTime":1213.74,"endTime":1215.3,"body":"for all of our required"},{"speaker":"Chris Dy","startTime":1215.3,"endTime":1217.94,"body":"trainings, I look for the speed"},{"speaker":"Chris Dy","startTime":1215.3,"endTime":1217.94,"body":"up button, and it's never there."},{"speaker":"Chris Dy","startTime":1218.84,"endTime":1221.5,"body":"Time to open the second laptop"},{"speaker":"Chris Dy","startTime":1218.84,"endTime":1221.5,"body":"so I can click through. You"},{"speaker":"Chris Dy","startTime":1221.5,"endTime":1222.52,"body":"didn't hear me say that? HR,"},{"speaker":"Charles Goldfarb","startTime":1223.66,"endTime":1227.44,"body":"the, it's very"},{"speaker":"Charles Goldfarb","startTime":1223.66,"endTime":1227.44,"body":"funny. The Chris and I, full"},{"speaker":"Charles Goldfarb","startTime":1227.44,"endTime":1231.46,"body":"disclosure are, it's we're doing"},{"speaker":"Charles Goldfarb","startTime":1227.44,"endTime":1231.46,"body":"our podcast, obviously, but we"},{"speaker":"Charles Goldfarb","startTime":1231.46,"endTime":1233.86,"body":"don't have our video on because"},{"speaker":"Charles Goldfarb","startTime":1231.46,"endTime":1233.86,"body":"we're having internet troubles."},{"speaker":"Charles Goldfarb","startTime":1233.86,"endTime":1236.14,"body":"And that the, you know, the"},{"speaker":"Charles Goldfarb","startTime":1233.86,"endTime":1236.14,"body":"internet is such an interesting"},{"speaker":"Charles Goldfarb","startTime":1236.14,"endTime":1239.92,"body":"thing. I'm, you know, it gets so"},{"speaker":"Charles Goldfarb","startTime":1236.14,"endTime":1239.92,"body":"frustrating where I hopefully"},{"speaker":"Charles Goldfarb","startTime":1239.92,"endTime":1242.28,"body":"we're succeeding with the"},{"speaker":"Charles Goldfarb","startTime":1239.92,"endTime":1242.28,"body":"podcast without being able to"},{"speaker":"Charles Goldfarb","startTime":1242.28,"endTime":1245.16,"body":"see one another, and we do play"},{"speaker":"Charles Goldfarb","startTime":1242.28,"endTime":1245.16,"body":"off visual cues, so it is a"},{"speaker":"Charles Goldfarb","startTime":1245.16,"endTime":1246.12,"body":"little awkward."},{"speaker":"Chris Dy","startTime":1246.48,"endTime":1248.28,"body":"Yeah, this is weird. I"},{"speaker":"Chris Dy","startTime":1246.48,"endTime":1248.28,"body":"mean, looking at the black"},{"speaker":"Chris Dy","startTime":1248.28,"endTime":1252.48,"body":"Charles Goldfarb box, they make"},{"speaker":"Chris Dy","startTime":1248.28,"endTime":1252.48,"body":"eye contact. No, that's not that"},{"speaker":"Chris Dy","startTime":1252.48,"endTime":1254.82,"body":"weird. But, you know, it"},{"speaker":"Chris Dy","startTime":1252.48,"endTime":1254.82,"body":"definitely makes a difference."},{"speaker":"Chris Dy","startTime":1254.82,"endTime":1257.52,"body":"So we are, we are truly"},{"speaker":"Chris Dy","startTime":1254.82,"endTime":1257.52,"body":"mastering the art form of radio"},{"speaker":"Chris Dy","startTime":1257.52,"endTime":1258.12,"body":"at this point."},{"speaker":"Charles Goldfarb","startTime":1258.54,"endTime":1260.72,"body":"It is radio."},{"speaker":"Charles Goldfarb","startTime":1258.54,"endTime":1260.72,"body":"It's taking us back. Take us"},{"speaker":"Charles Goldfarb","startTime":1260.72,"endTime":1264.32,"body":"back. So should we talk about"},{"speaker":"Charles Goldfarb","startTime":1260.72,"endTime":1264.32,"body":"how we would fix an FTP"},{"speaker":"Charles Goldfarb","startTime":1264.32,"endTime":1265.94,"body":"avulsion? Yeah,"},{"speaker":"Chris Dy","startTime":1266.24,"endTime":1267.98,"body":"I think that's, I"},{"speaker":"Chris Dy","startTime":1266.24,"endTime":1267.98,"body":"think that's probably what I"},{"speaker":"Chris Dy","startTime":1267.98,"endTime":1271.4,"body":"wanted to get to with this"},{"speaker":"Chris Dy","startTime":1267.98,"endTime":1271.4,"body":"episode, is that people, when we"},{"speaker":"Chris Dy","startTime":1271.4,"endTime":1273.98,"body":"get feedback about the pod,"},{"speaker":"Chris Dy","startTime":1271.4,"endTime":1273.98,"body":"really like the technical"},{"speaker":"Chris Dy","startTime":1273.98,"endTime":1277.82,"body":"aspects of it. So, you know, why"},{"speaker":"Chris Dy","startTime":1273.98,"endTime":1277.82,"body":"don't we dig in and kind of talk"},{"speaker":"Chris Dy","startTime":1277.82,"endTime":1281.74,"body":"about the different options"},{"speaker":"Chris Dy","startTime":1277.82,"endTime":1281.74,"body":"here? So surgical incision"},{"speaker":"Chris Dy","startTime":1281.74,"endTime":1284.14,"body":"planning. I mean, yeah, so, I"},{"speaker":"Chris Dy","startTime":1281.74,"endTime":1284.14,"body":"mean, I think there are"},{"speaker":"Chris Dy","startTime":1284.14,"endTime":1287.56,"body":"different ways to do it. You"},{"speaker":"Chris Dy","startTime":1284.14,"endTime":1287.56,"body":"could do a Bruner zigzag just"},{"speaker":"Chris Dy","startTime":1287.56,"endTime":1290.92,"body":"across the entire, you know,"},{"speaker":"Chris Dy","startTime":1287.56,"endTime":1290.92,"body":"volar aspect, or polymer aspect"},{"speaker":"Chris Dy","startTime":1290.92,"endTime":1294.04,"body":"of the finger. For this one, I"},{"speaker":"Chris Dy","startTime":1290.92,"endTime":1294.04,"body":"chose to go kind of a zigzag"},{"speaker":"Chris Dy","startTime":1294.04,"endTime":1298.3,"body":"across the dip crease and then"},{"speaker":"Chris Dy","startTime":1294.04,"endTime":1298.3,"body":"between the dip crease and a pip"},{"speaker":"Chris Dy","startTime":1298.3,"endTime":1301.68,"body":"crease. I did a mid axial along"},{"speaker":"Chris Dy","startTime":1298.3,"endTime":1301.68,"body":"the radial side so as to avoid"},{"speaker":"Chris Dy","startTime":1301.68,"endTime":1305.04,"body":"the being on the ulnar side of"},{"speaker":"Chris Dy","startTime":1301.68,"endTime":1305.04,"body":"the small finger. And then did a"},{"speaker":"Chris Dy","startTime":1305.04,"endTime":1308.1,"body":"zag across the PIP crease. So"},{"speaker":"Chris Dy","startTime":1305.04,"endTime":1308.1,"body":"it's a combo zigzag, kind of mid"},{"speaker":"Chris Dy","startTime":1308.1,"endTime":1310.5,"body":"axial approach. How do you"},{"speaker":"Chris Dy","startTime":1308.1,"endTime":1310.5,"body":"typically think about"},{"speaker":"Charles Goldfarb","startTime":1311.28,"endTime":1315.42,"body":"it? I like"},{"speaker":"Charles Goldfarb","startTime":1311.28,"endTime":1315.42,"body":"that. I try to minimize, you"},{"speaker":"Charles Goldfarb","startTime":1315.42,"endTime":1317.28,"body":"know, I don't feel like I have"},{"speaker":"Charles Goldfarb","startTime":1315.42,"endTime":1317.28,"body":"to open the whole finger"},{"speaker":"Charles Goldfarb","startTime":1317.28,"endTime":1320.42,"body":"sometimes. And so if we've"},{"speaker":"Charles Goldfarb","startTime":1317.28,"endTime":1320.42,"body":"gotten an ultrasound for some"},{"speaker":"Charles Goldfarb","startTime":1320.42,"endTime":1324.92,"body":"reason, or we can feel the A"},{"speaker":"Charles Goldfarb","startTime":1320.42,"endTime":1324.92,"body":"vols tendon more proximally. I"},{"speaker":"Charles Goldfarb","startTime":1324.92,"endTime":1329.96,"body":"don't mind doing a sort of a"},{"speaker":"Charles Goldfarb","startTime":1324.92,"endTime":1329.96,"body":"zigzag across the D, I P flexion"},{"speaker":"Charles Goldfarb","startTime":1329.96,"endTime":1332.66,"body":"crease, and then making an"},{"speaker":"Charles Goldfarb","startTime":1329.96,"endTime":1332.66,"body":"incision more proximally and"},{"speaker":"Charles Goldfarb","startTime":1332.66,"endTime":1336.02,"body":"trying to pass the tendon"},{"speaker":"Charles Goldfarb","startTime":1332.66,"endTime":1336.02,"body":"through the sheath without"},{"speaker":"Charles Goldfarb","startTime":1336.02,"endTime":1339.08,"body":"exposing everything. Now, of"},{"speaker":"Charles Goldfarb","startTime":1336.02,"endTime":1339.08,"body":"course, I don't mind exposing"},{"speaker":"Charles Goldfarb","startTime":1339.08,"endTime":1342.1,"body":"things if I have to, but I think"},{"speaker":"Charles Goldfarb","startTime":1339.08,"endTime":1342.1,"body":"in principle, I agree with what"},{"speaker":"Charles Goldfarb","startTime":1342.1,"endTime":1342.52,"body":"you said."},{"speaker":"Chris Dy","startTime":1342.88,"endTime":1344.74,"body":"No, I totally agree. I"},{"speaker":"Chris Dy","startTime":1342.88,"endTime":1344.74,"body":"mean, if you don't have to make"},{"speaker":"Chris Dy","startTime":1344.74,"endTime":1348.46,"body":"the extra incisions, you know,"},{"speaker":"Chris Dy","startTime":1344.74,"endTime":1348.46,"body":"don't make them, you know. So I"},{"speaker":"Chris Dy","startTime":1348.46,"endTime":1350.8,"body":"knew where the piece was parked,"},{"speaker":"Chris Dy","startTime":1348.46,"endTime":1350.8,"body":"and I knew I was going to have"},{"speaker":"Chris Dy","startTime":1350.8,"endTime":1353.44,"body":"to thread it through. So I just"},{"speaker":"Chris Dy","startTime":1350.8,"endTime":1353.44,"body":"went ahead and saved myself the"},{"speaker":"Chris Dy","startTime":1353.44,"endTime":1358.12,"body":"frustration of trying to be cute"},{"speaker":"Chris Dy","startTime":1353.44,"endTime":1358.12,"body":"on this one so exposed to skin"},{"speaker":"Chris Dy","startTime":1358.12,"endTime":1361.92,"body":"flaps and lo and behold. I mean,"},{"speaker":"Chris Dy","startTime":1358.12,"endTime":1361.92,"body":"you can feel the peace just kind"},{"speaker":"Chris Dy","startTime":1361.92,"endTime":1367.8,"body":"of parked right over the the FDS"},{"speaker":"Chris Dy","startTime":1361.92,"endTime":1367.8,"body":"insertion, you know. So I, I"},{"speaker":"Chris Dy","startTime":1368.16,"endTime":1371.28,"body":"think I've tried to become more"},{"speaker":"Chris Dy","startTime":1368.16,"endTime":1371.28,"body":"judicious based on your what"},{"speaker":"Chris Dy","startTime":1371.28,"endTime":1373.8,"body":"we've talked about and what, you"},{"speaker":"Chris Dy","startTime":1371.28,"endTime":1373.8,"body":"know, others have told us about"},{"speaker":"Chris Dy","startTime":1373.8,"endTime":1376.02,"body":"kind of when, when and where to"},{"speaker":"Chris Dy","startTime":1373.8,"endTime":1376.02,"body":"open your pulleys. I mean,"},{"speaker":"Chris Dy","startTime":1376.02,"endTime":1378.6,"body":"that's more appropriate or"},{"speaker":"Chris Dy","startTime":1376.02,"endTime":1378.6,"body":"relevant to, like, a, you know,"},{"speaker":"Chris Dy","startTime":1378.6,"endTime":1382.58,"body":"zone two injury. But I decided I"},{"speaker":"Chris Dy","startTime":1378.6,"endTime":1382.58,"body":"was going to have to open the a"},{"speaker":"Chris Dy","startTime":1382.58,"endTime":1386.36,"body":"three pulley in order to get"},{"speaker":"Chris Dy","startTime":1382.58,"endTime":1386.36,"body":"this, this puppy out. So, so I"},{"speaker":"Chris Dy","startTime":1386.36,"endTime":1390.2,"body":"got the piece out. And, you"},{"speaker":"Chris Dy","startTime":1386.36,"endTime":1390.2,"body":"know, it was stuck down to the"},{"speaker":"Chris Dy","startTime":1390.2,"endTime":1393.2,"body":"superficialis slips right when"},{"speaker":"Chris Dy","startTime":1390.2,"endTime":1393.2,"body":"they are, you know about to"},{"speaker":"Chris Dy","startTime":1393.2,"endTime":1397.28,"body":"insert on the base of the middle"},{"speaker":"Chris Dy","startTime":1393.2,"endTime":1397.28,"body":"phallic. So, you know, what do"},{"speaker":"Chris Dy","startTime":1397.28,"endTime":1398.06,"body":"you do at this point?"},{"speaker":"Charles Goldfarb","startTime":1400.04,"endTime":1403.18,"body":"So first of"},{"speaker":"Charles Goldfarb","startTime":1400.04,"endTime":1403.18,"body":"all, yeah, I think if you either"},{"speaker":"Charles Goldfarb","startTime":1403.18,"endTime":1406.42,"body":"for the case you're describing,"},{"speaker":"Charles Goldfarb","startTime":1403.18,"endTime":1406.42,"body":"or if the tendon is a vulst all"},{"speaker":"Charles Goldfarb","startTime":1406.42,"endTime":1410.74,"body":"the way into the palm, you know,"},{"speaker":"Charles Goldfarb","startTime":1406.42,"endTime":1410.74,"body":"it's tricky, passing tendons"},{"speaker":"Charles Goldfarb","startTime":1410.74,"endTime":1416.14,"body":"back under the various pulleys."},{"speaker":"Charles Goldfarb","startTime":1410.74,"endTime":1416.14,"body":"In this case, you know, I think"},{"speaker":"Charles Goldfarb","startTime":1416.5,"endTime":1419.74,"body":"I would basically, the first"},{"speaker":"Charles Goldfarb","startTime":1416.5,"endTime":1419.74,"body":"thing I would do is put a"},{"speaker":"Charles Goldfarb","startTime":1419.8,"endTime":1425.46,"body":"tagging suture, which really"},{"speaker":"Charles Goldfarb","startTime":1419.8,"endTime":1425.46,"body":"would be my core kind of stitch,"},{"speaker":"Charles Goldfarb","startTime":1425.46,"endTime":1431.28,"body":"potentially, and I would excise"},{"speaker":"Charles Goldfarb","startTime":1425.46,"endTime":1431.28,"body":"the bony fragment. And then the"},{"speaker":"Charles Goldfarb","startTime":1431.28,"endTime":1435.96,"body":"next step would be, probably"},{"speaker":"Charles Goldfarb","startTime":1431.28,"endTime":1435.96,"body":"using a mosquito of some type,"},{"speaker":"Charles Goldfarb","startTime":1436.14,"endTime":1441.44,"body":"just gently dilating the pulleys"},{"speaker":"Charles Goldfarb","startTime":1436.14,"endTime":1441.44,"body":"distal to where I was, and then"},{"speaker":"Charles Goldfarb","startTime":1441.44,"endTime":1446.42,"body":"make an effort to pass the"},{"speaker":"Charles Goldfarb","startTime":1441.44,"endTime":1446.42,"body":"tendon beneath the pulleys in"},{"speaker":"Charles Goldfarb","startTime":1446.42,"endTime":1450.08,"body":"hopefully a very simple fashion."},{"speaker":"Charles Goldfarb","startTime":1446.42,"endTime":1450.08,"body":"But it's never easy."},{"speaker":"Chris Dy","startTime":1451.16,"endTime":1454.4,"body":"So what makes you"},{"speaker":"Chris Dy","startTime":1451.16,"endTime":1454.4,"body":"decide to remove the bony"},{"speaker":"Chris Dy","startTime":1454.4,"endTime":1457.46,"body":"fragment is it when you know"},{"speaker":"Chris Dy","startTime":1454.4,"endTime":1457.46,"body":"it's just so small you're not"},{"speaker":"Chris Dy","startTime":1457.46,"endTime":1460.48,"body":"going to be able to repair it,"},{"speaker":"Chris Dy","startTime":1457.46,"endTime":1460.48,"body":"or, you know, do any sort of"},{"speaker":"Chris Dy","startTime":1460.48,"endTime":1463.48,"body":"bony apposition, and just be"},{"speaker":"Chris Dy","startTime":1460.48,"endTime":1463.48,"body":"able to, you know, kind of say,"},{"speaker":"Chris Dy","startTime":1463.48,"endTime":1465.94,"body":"alright, call a spade a spade,"},{"speaker":"Chris Dy","startTime":1463.48,"endTime":1465.94,"body":"use the core stitch, dilate the"},{"speaker":"Chris Dy","startTime":1465.94,"endTime":1467.32,"body":"a four and get it underneath."},{"speaker":"Charles Goldfarb","startTime":1467.86,"endTime":1469.78,"body":"Yeah. I think"},{"speaker":"Charles Goldfarb","startTime":1467.86,"endTime":1469.78,"body":"if there's any chance there's"},{"speaker":"Charles Goldfarb","startTime":1469.78,"endTime":1472.6,"body":"enough bone that I think the"},{"speaker":"Charles Goldfarb","startTime":1469.78,"endTime":1472.6,"body":"bone is to our advantage and"},{"speaker":"Charles Goldfarb","startTime":1472.6,"endTime":1476.86,"body":"will heal, then either a I'll"},{"speaker":"Charles Goldfarb","startTime":1472.6,"endTime":1476.86,"body":"concentrate on bony fixation"},{"speaker":"Charles Goldfarb","startTime":1476.92,"endTime":1479.56,"body":"and, and that's the, you know,"},{"speaker":"Charles Goldfarb","startTime":1476.92,"endTime":1479.56,"body":"there's a classification for the"},{"speaker":"Charles Goldfarb","startTime":1479.56,"endTime":1483.42,"body":"type of bony fragment, you know,"},{"speaker":"Charles Goldfarb","startTime":1479.56,"endTime":1483.42,"body":"fracture. And I can't cite that"},{"speaker":"Charles Goldfarb","startTime":1483.42,"endTime":1486.12,"body":"off the top of my head, but, but"},{"speaker":"Charles Goldfarb","startTime":1483.42,"endTime":1486.12,"body":"if there's enough bone there,"},{"speaker":"Charles Goldfarb","startTime":1486.12,"endTime":1488.94,"body":"and you can put a couple of"},{"speaker":"Charles Goldfarb","startTime":1486.12,"endTime":1488.94,"body":"screws in, that's great. If"},{"speaker":"Charles Goldfarb","startTime":1488.94,"endTime":1491.28,"body":"there's enough bone there, where"},{"speaker":"Charles Goldfarb","startTime":1488.94,"endTime":1491.28,"body":"you think it will help the"},{"speaker":"Charles Goldfarb","startTime":1491.28,"endTime":1494.16,"body":"healing, and you even put a"},{"speaker":"Charles Goldfarb","startTime":1491.28,"endTime":1494.16,"body":"suture anchor beneath the bone,"},{"speaker":"Charles Goldfarb","startTime":1494.34,"endTime":1498.0,"body":"and then weave the tendon, using"},{"speaker":"Charles Goldfarb","startTime":1494.34,"endTime":1498.0,"body":"the suture anchor to really have"},{"speaker":"Charles Goldfarb","startTime":1498.0,"endTime":1502.04,"body":"the tendon support the bone. But"},{"speaker":"Charles Goldfarb","startTime":1498.0,"endTime":1502.04,"body":"a. The bone healing to be there,"},{"speaker":"Charles Goldfarb","startTime":1502.04,"endTime":1504.8,"body":"then I would do that. But it's"},{"speaker":"Charles Goldfarb","startTime":1502.04,"endTime":1504.8,"body":"really, yes, it's the size of"},{"speaker":"Charles Goldfarb","startTime":1504.8,"endTime":1505.4,"body":"the fragment,"},{"speaker":"Chris Dy","startTime":1506.36,"endTime":1508.1,"body":"yeah. So for me, for"},{"speaker":"Chris Dy","startTime":1506.36,"endTime":1508.1,"body":"this case, I mean, it was the"},{"speaker":"Chris Dy","startTime":1508.1,"endTime":1510.86,"body":"latter of what you described. I"},{"speaker":"Chris Dy","startTime":1508.1,"endTime":1510.86,"body":"mean, so, you know, trying to"},{"speaker":"Chris Dy","startTime":1510.98,"endTime":1514.1,"body":"think that, you know, trust me,"},{"speaker":"Chris Dy","startTime":1510.98,"endTime":1514.1,"body":"I would have loved to put some"},{"speaker":"Chris Dy","startTime":1514.1,"endTime":1517.76,"body":"kind of even teeny, tiny screw"},{"speaker":"Chris Dy","startTime":1514.1,"endTime":1517.76,"body":"in there, you know, to help but"},{"speaker":"Chris Dy","startTime":1517.76,"endTime":1520.6,"body":"I was thinking that the bone"},{"speaker":"Chris Dy","startTime":1517.76,"endTime":1520.6,"body":"heat, the bone would help with"},{"speaker":"Chris Dy","startTime":1520.6,"endTime":1523.96,"body":"healing. So I ended up opening"},{"speaker":"Chris Dy","startTime":1520.6,"endTime":1523.96,"body":"the proximal aspect of a four"},{"speaker":"Chris Dy","startTime":1523.96,"endTime":1526.6,"body":"and then being able to get that"},{"speaker":"Chris Dy","startTime":1523.96,"endTime":1526.6,"body":"bony fragment underneath,"},{"speaker":"Chris Dy","startTime":1526.6,"endTime":1529.24,"body":"actually, you know, came to"},{"speaker":"Chris Dy","startTime":1526.6,"endTime":1529.24,"body":"length pretty easily. So I had,"},{"speaker":"Chris Dy","startTime":1529.42,"endTime":1532.96,"body":"I had it opposed, and at this"},{"speaker":"Chris Dy","startTime":1529.42,"endTime":1532.96,"body":"point, you know, what are your"},{"speaker":"Chris Dy","startTime":1532.96,"endTime":1536.32,"body":"technically, what's you've, you"},{"speaker":"Chris Dy","startTime":1532.96,"endTime":1536.32,"body":"know, we talked about using an"},{"speaker":"Chris Dy","startTime":1536.32,"endTime":1539.62,"body":"anchor. So what kind of anchor"},{"speaker":"Chris Dy","startTime":1536.32,"endTime":1539.62,"body":"Are you calling for? And not to"},{"speaker":"Chris Dy","startTime":1539.62,"endTime":1541.86,"body":"go with trade names, so like,"},{"speaker":"Chris Dy","startTime":1539.62,"endTime":1541.86,"body":"roughly what size or what kind"},{"speaker":"Chris Dy","startTime":1541.86,"endTime":1543.12,"body":"of sutures loaded into it."},{"speaker":"Charles Goldfarb","startTime":1543.42,"endTime":1546.3,"body":"Yeah. Let's"},{"speaker":"Charles Goldfarb","startTime":1543.42,"endTime":1546.3,"body":"talk first about passing the"},{"speaker":"Charles Goldfarb","startTime":1546.3,"endTime":1550.86,"body":"tendon under the pulley. And so,"},{"speaker":"Charles Goldfarb","startTime":1546.3,"endTime":1550.86,"body":"you know, when I was a trainee,"},{"speaker":"Charles Goldfarb","startTime":1551.22,"endTime":1553.74,"body":"Dr government, you know,"},{"speaker":"Charles Goldfarb","startTime":1551.22,"endTime":1553.74,"body":"described using a pediatric"},{"speaker":"Charles Goldfarb","startTime":1553.74,"endTime":1555.96,"body":"feeding tube as the ultimate"},{"speaker":"Charles Goldfarb","startTime":1553.74,"endTime":1555.96,"body":"solution. You'd always have a"},{"speaker":"Charles Goldfarb","startTime":1555.96,"endTime":1558.66,"body":"feeding pediatric feeding tube."},{"speaker":"Charles Goldfarb","startTime":1555.96,"endTime":1558.66,"body":"I think if I asked for a"},{"speaker":"Charles Goldfarb","startTime":1558.66,"endTime":1562.7,"body":"pediatric feeding tube today, I"},{"speaker":"Charles Goldfarb","startTime":1558.66,"endTime":1562.7,"body":"would get, you know, a look of"},{"speaker":"Charles Goldfarb","startTime":1563.3,"endTime":1564.08,"body":"disdain. I"},{"speaker":"Chris Dy","startTime":1564.02,"endTime":1566.0,"body":"don't know. So even at"},{"speaker":"Chris Dy","startTime":1564.02,"endTime":1566.0,"body":"the peds hospital,"},{"speaker":"Charles Goldfarb","startTime":1567.5,"endTime":1572.252,"body":"even at the"},{"speaker":"Charles Goldfarb","startTime":1567.5,"endTime":1572.252,"body":"pedshospital, I think I would. I"},{"speaker":"Charles Goldfarb","startTime":1572.36,"endTime":1578.408,"body":"like those tendon passer I"},{"speaker":"Charles Goldfarb","startTime":1572.36,"endTime":1578.408,"body":"guess, devices which have the"},{"speaker":"Charles Goldfarb","startTime":1578.516,"endTime":1579.92,"body":"long, curved,"},{"speaker":"Chris Dy","startTime":1581.48,"endTime":1583.84,"body":"I don't even know"},{"speaker":"Chris Dy","startTime":1581.48,"endTime":1583.84,"body":"what's call it. Your passer is"},{"speaker":"Chris Dy","startTime":1583.84,"endTime":1586.54,"body":"not a very expensive thing,"},{"speaker":"Chris Dy","startTime":1583.84,"endTime":1586.54,"body":"right? So it must not be"},{"speaker":"Chris Dy","startTime":1586.54,"endTime":1590.08,"body":"trademarked. But is that what"},{"speaker":"Chris Dy","startTime":1586.54,"endTime":1590.08,"body":"you're talking about? The thing"},{"speaker":"Chris Dy","startTime":1590.08,"endTime":1591.58,"body":"that's got a long loop on it?"},{"speaker":"Charles Goldfarb","startTime":1591.58,"endTime":1594.118,"body":"No, not so"},{"speaker":"Charles Goldfarb","startTime":1591.58,"endTime":1594.118,"body":"that I would call it Houghston"},{"speaker":"Charles Goldfarb","startTime":1594.18,"endTime":1598.141,"body":"suture passer. That is not what"},{"speaker":"Charles Goldfarb","startTime":1594.18,"endTime":1598.141,"body":"I was thinking. Although I think"},{"speaker":"Charles Goldfarb","startTime":1598.203,"endTime":1601.67,"body":"that could work if you put"},{"speaker":"Charles Goldfarb","startTime":1598.203,"endTime":1601.67,"body":"suture on the Hougston suture"},{"speaker":"Charles Goldfarb","startTime":1601.732,"endTime":1605.57,"body":"pasture I like, but they're more"},{"speaker":"Charles Goldfarb","startTime":1601.732,"endTime":1605.57,"body":"expensive than you think. No,"},{"speaker":"Charles Goldfarb","startTime":1605.632,"endTime":1609.594,"body":"it's like a mosquito, but has a"},{"speaker":"Charles Goldfarb","startTime":1605.632,"endTime":1609.594,"body":"long bill, or whatever you might"},{"speaker":"Charles Goldfarb","startTime":1609.656,"endTime":1613.556,"body":"call it, that it's curved, that"},{"speaker":"Charles Goldfarb","startTime":1609.656,"endTime":1613.556,"body":"allows you to it just gives you"},{"speaker":"Charles Goldfarb","startTime":1613.618,"endTime":1617.58,"body":"the curve is helpful, and that"},{"speaker":"Charles Goldfarb","startTime":1613.618,"endTime":1617.58,"body":"can be helpful for passing. Maybe"},{"speaker":"Chris Dy","startTime":1617.58,"endTime":1619.2,"body":"I'll look it up and"},{"speaker":"Charles Goldfarb","startTime":1621.18,"endTime":1623.6,"body":"put it in the"},{"speaker":"Charles Goldfarb","startTime":1621.18,"endTime":1623.6,"body":"show notes. So that we don't"},{"speaker":"Charles Goldfarb","startTime":1623.6,"endTime":1625.88,"body":"come across as complete idiots"},{"speaker":"Charles Goldfarb","startTime":1623.6,"endTime":1625.88,"body":"to everyone. So"},{"speaker":"Chris Dy","startTime":1626.06,"endTime":1628.52,"body":"I think I know which"},{"speaker":"Chris Dy","startTime":1626.06,"endTime":1628.52,"body":"one you're talking about. I, you"},{"speaker":"Chris Dy","startTime":1628.52,"endTime":1630.8,"body":"know, whenever I do a tenant"},{"speaker":"Chris Dy","startTime":1628.52,"endTime":1630.8,"body":"transfer, I call for two"},{"speaker":"Chris Dy","startTime":1630.8,"endTime":1633.32,"body":"different instruments. One of"},{"speaker":"Chris Dy","startTime":1630.8,"endTime":1633.32,"body":"them, I think they call that the"},{"speaker":"Chris Dy","startTime":1633.32,"endTime":1636.02,"body":"tendon passer. That's got that"},{"speaker":"Chris Dy","startTime":1633.32,"endTime":1636.02,"body":"nose on it, you know, that"},{"speaker":"Chris Dy","startTime":1636.02,"endTime":1638.24,"body":"usually pass the tenant through."},{"speaker":"Chris Dy","startTime":1636.02,"endTime":1638.24,"body":"That's, you know, the sub q"},{"speaker":"Chris Dy","startTime":1638.24,"endTime":1640.84,"body":"tunnel, or whatever. Then the"},{"speaker":"Chris Dy","startTime":1638.24,"endTime":1640.84,"body":"other one, I think, is called"},{"speaker":"Chris Dy","startTime":1640.84,"endTime":1644.5,"body":"the interlacer, the interweaver,"},{"speaker":"Chris Dy","startTime":1640.84,"endTime":1644.5,"body":"and I usually affectionately"},{"speaker":"Chris Dy","startTime":1644.5,"endTime":1647.02,"body":"call that one the pig sticker"},{"speaker":"Chris Dy","startTime":1644.5,"endTime":1647.02,"body":"when you're doing your pulvertaf"},{"speaker":"Chris Dy","startTime":1647.02,"endTime":1649.06,"body":"weave. So I know which one"},{"speaker":"Chris Dy","startTime":1647.02,"endTime":1649.06,"body":"you're you're talking about."},{"speaker":"Chris Dy","startTime":1649.66,"endTime":1650.2,"body":"Yes,"},{"speaker":"Charles Goldfarb","startTime":1650.2,"endTime":1652.72,"body":"for sure. And"},{"speaker":"Charles Goldfarb","startTime":1650.2,"endTime":1652.72,"body":"then there's also the tendon"},{"speaker":"Charles Goldfarb","startTime":1652.72,"endTime":1655.18,"body":"stripper, which I have no idea"},{"speaker":"Charles Goldfarb","startTime":1652.72,"endTime":1655.18,"body":"if that's the appropriate name"},{"speaker":"Charles Goldfarb","startTime":1655.18,"endTime":1658.36,"body":"or not, to harvest a tendon"},{"speaker":"Charles Goldfarb","startTime":1655.18,"endTime":1658.36,"body":"graft. Very different. Yes,"},{"speaker":"Chris Dy","startTime":1658.42,"endTime":1661.08,"body":"sometimes used to"},{"speaker":"Chris Dy","startTime":1658.42,"endTime":1661.08,"body":"harvest nerve graft. And I do"},{"speaker":"Chris Dy","startTime":1661.08,"endTime":1665.16,"body":"not like that modified. Some"},{"speaker":"Chris Dy","startTime":1661.08,"endTime":1665.16,"body":"people have modified attendance"},{"speaker":"Chris Dy","startTime":1665.16,"endTime":1668.76,"body":"driven a harvest seral nerve."},{"speaker":"Chris Dy","startTime":1665.16,"endTime":1668.76,"body":"And I don't love it. I think"},{"speaker":"Chris Dy","startTime":1668.76,"endTime":1671.88,"body":"it's too high stakes. And that"},{"speaker":"Chris Dy","startTime":1668.76,"endTime":1671.88,"body":"when you get into those anatomic"},{"speaker":"Chris Dy","startTime":1671.88,"endTime":1674.58,"body":"variants and then you lose this"},{"speaker":"Chris Dy","startTime":1671.88,"endTime":1674.58,"body":"nerve graft, I mean, no way,"},{"speaker":"Chris Dy","startTime":1675.36,"endTime":1678.54,"body":"anywho. So we that's how you"},{"speaker":"Chris Dy","startTime":1675.36,"endTime":1678.54,"body":"would pass it through."},{"speaker":"Charles Goldfarb","startTime":1679.08,"endTime":1682.88,"body":"Yeah. So I do"},{"speaker":"Charles Goldfarb","startTime":1679.08,"endTime":1682.88,"body":"always put a core type stitch."},{"speaker":"Charles Goldfarb","startTime":1683.06,"endTime":1686.78,"body":"And again, sometimes it's very"},{"speaker":"Charles Goldfarb","startTime":1683.06,"endTime":1686.78,"body":"easy. I think it's very hard to"},{"speaker":"Charles Goldfarb","startTime":1686.78,"endTime":1690.62,"body":"go from a one through a four. So"},{"speaker":"Charles Goldfarb","startTime":1686.78,"endTime":1690.62,"body":"usually you have to get"},{"speaker":"Charles Goldfarb","startTime":1690.62,"endTime":1693.26,"body":"something at the a three level,"},{"speaker":"Charles Goldfarb","startTime":1690.62,"endTime":1693.26,"body":"pass through the first stage,"},{"speaker":"Charles Goldfarb","startTime":1693.5,"endTime":1696.14,"body":"take it out, pass through the"},{"speaker":"Charles Goldfarb","startTime":1693.5,"endTime":1696.14,"body":"second stage. And then what I"},{"speaker":"Charles Goldfarb","startTime":1696.14,"endTime":1699.5,"body":"typically do is, once you're"},{"speaker":"Charles Goldfarb","startTime":1696.14,"endTime":1699.5,"body":"past a four, I do use a 25 gage"},{"speaker":"Charles Goldfarb","startTime":1699.5,"endTime":1702.82,"body":"needle through the a four"},{"speaker":"Charles Goldfarb","startTime":1699.5,"endTime":1702.82,"body":"pulley, through the tendon,"},{"speaker":"Charles Goldfarb","startTime":1702.82,"endTime":1705.34,"body":"through the a four pulley, just"},{"speaker":"Charles Goldfarb","startTime":1702.82,"endTime":1705.34,"body":"to hold it there. While I think"},{"speaker":"Charles Goldfarb","startTime":1705.34,"endTime":1707.74,"body":"about my repair, they're so sad"},{"speaker":"Chris Dy","startTime":1707.74,"endTime":1709.72,"body":"if it doesn't, if it"},{"speaker":"Chris Dy","startTime":1707.74,"endTime":1709.72,"body":"retracts."},{"speaker":"Charles Goldfarb","startTime":1711.16,"endTime":1713.56,"body":"Yes, refeeding"},{"speaker":"Charles Goldfarb","startTime":1711.16,"endTime":1713.56,"body":"work is not my favorite thing,"},{"speaker":"Charles Goldfarb","startTime":1713.62,"endTime":1716.44,"body":"although I, you know, like we"},{"speaker":"Charles Goldfarb","startTime":1713.62,"endTime":1716.44,"body":"all, I occasionally have to do"},{"speaker":"Charles Goldfarb","startTime":1716.44,"endTime":1717.58,"body":"it. Do you?"},{"speaker":"Chris Dy","startTime":1717.58,"endTime":1720.78,"body":"Do you ever have to go"},{"speaker":"Chris Dy","startTime":1717.58,"endTime":1720.78,"body":"back to the A one pulley to get"},{"speaker":"Chris Dy","startTime":1720.78,"endTime":1723.42,"body":"that thing out of there, or are"},{"speaker":"Chris Dy","startTime":1720.78,"endTime":1723.42,"body":"you not, typically not operating"},{"speaker":"Chris Dy","startTime":1723.42,"endTime":1726.24,"body":"and trying to re trying to get"},{"speaker":"Chris Dy","startTime":1723.42,"endTime":1726.24,"body":"these tendons fixed. If somebody"},{"speaker":"Chris Dy","startTime":1726.24,"endTime":1727.62,"body":"has is retracted back to the"},{"speaker":"Charles Goldfarb","startTime":1727.8,"endTime":1730.08,"body":"palm, no, I"},{"speaker":"Charles Goldfarb","startTime":1727.8,"endTime":1730.08,"body":"think absolutely, whether it be"},{"speaker":"Charles Goldfarb","startTime":1730.14,"endTime":1734.1,"body":"avulsion, or whether it be a"},{"speaker":"Charles Goldfarb","startTime":1730.14,"endTime":1734.1,"body":"zone two injury, absolutely back"},{"speaker":"Charles Goldfarb","startTime":1734.1,"endTime":1738.48,"body":"at the A one level. Sometimes I"},{"speaker":"Charles Goldfarb","startTime":1734.1,"endTime":1738.48,"body":"it, you know, it is what it is."},{"speaker":"Charles Goldfarb","startTime":1738.48,"endTime":1741.02,"body":"If you're going to repair it,"},{"speaker":"Charles Goldfarb","startTime":1738.48,"endTime":1741.02,"body":"you go find it and do what you"},{"speaker":"Charles Goldfarb","startTime":1741.02,"endTime":1746.54,"body":"got to do, and then to your"},{"speaker":"Charles Goldfarb","startTime":1741.02,"endTime":1746.54,"body":"question on anchors. So I think"},{"speaker":"Charles Goldfarb","startTime":1746.54,"endTime":1750.8,"body":"if we're thinking about how we"},{"speaker":"Charles Goldfarb","startTime":1746.54,"endTime":1750.8,"body":"can repair FTP avulsion, with or"},{"speaker":"Charles Goldfarb","startTime":1750.8,"endTime":1755.78,"body":"without bone to back to the"},{"speaker":"Charles Goldfarb","startTime":1750.8,"endTime":1755.78,"body":"distal phalanx, I think there's"},{"speaker":"Charles Goldfarb","startTime":1755.78,"endTime":1759.62,"body":"sort of two basic options,"},{"speaker":"Charles Goldfarb","startTime":1755.78,"endTime":1759.62,"body":"either you're going to use a"},{"speaker":"Charles Goldfarb","startTime":1759.62,"endTime":1763.24,"body":"suture anchor, or you're going"},{"speaker":"Charles Goldfarb","startTime":1759.62,"endTime":1763.24,"body":"to try to pass past the tendon,"},{"speaker":"Charles Goldfarb","startTime":1763.3,"endTime":1767.2,"body":"I'm sorry, pass the suture"},{"speaker":"Charles Goldfarb","startTime":1763.3,"endTime":1767.2,"body":"through bone and secured in some"},{"speaker":"Charles Goldfarb","startTime":1767.2,"endTime":1770.74,"body":"form or fashion on the dorsal"},{"speaker":"Charles Goldfarb","startTime":1767.2,"endTime":1770.74,"body":"side of the bone? Is that those"},{"speaker":"Charles Goldfarb","startTime":1770.74,"endTime":1772.36,"body":"two groupings fair? Yeah,"},{"speaker":"Chris Dy","startTime":1772.42,"endTime":1775.0,"body":"I think that's the"},{"speaker":"Chris Dy","startTime":1772.42,"endTime":1775.0,"body":"broad category of groupings."},{"speaker":"Charles Goldfarb","startTime":1775.78,"endTime":1779.38,"body":"I went through"},{"speaker":"Charles Goldfarb","startTime":1775.78,"endTime":1779.38,"body":"a stage where I still don't like"},{"speaker":"Charles Goldfarb","startTime":1779.38,"endTime":1781.92,"body":"buttons. Occasionally I'll use"},{"speaker":"Charles Goldfarb","startTime":1779.38,"endTime":1781.92,"body":"them, but I don't like buttons."},{"speaker":"Charles Goldfarb","startTime":1781.92,"endTime":1784.44,"body":"And for those listeners who"},{"speaker":"Charles Goldfarb","startTime":1781.92,"endTime":1784.44,"body":"haven't used a button, the idea"},{"speaker":"Charles Goldfarb","startTime":1784.44,"endTime":1788.4,"body":"is that you take a Keith needle"},{"speaker":"Charles Goldfarb","startTime":1784.44,"endTime":1788.4,"body":"or some kind of process to drill"},{"speaker":"Charles Goldfarb","startTime":1788.4,"endTime":1791.64,"body":"through the distal phalanx,"},{"speaker":"Charles Goldfarb","startTime":1788.4,"endTime":1791.64,"body":"bringing your suture dorsally,"},{"speaker":"Charles Goldfarb","startTime":1791.76,"endTime":1794.64,"body":"whether it be through the nail"},{"speaker":"Charles Goldfarb","startTime":1791.76,"endTime":1794.64,"body":"or proximal to the nail, and"},{"speaker":"Charles Goldfarb","startTime":1794.64,"endTime":1799.08,"body":"then you basically tie the"},{"speaker":"Charles Goldfarb","startTime":1794.64,"endTime":1799.08,"body":"tendon through its suture down"},{"speaker":"Charles Goldfarb","startTime":1799.08,"endTime":1802.1,"body":"to the button, and. The button"},{"speaker":"Charles Goldfarb","startTime":1799.08,"endTime":1802.1,"body":"prevents the tendon. I'm sorry,"},{"speaker":"Charles Goldfarb","startTime":1802.22,"endTime":1806.12,"body":"oh, the button prevents the"},{"speaker":"Charles Goldfarb","startTime":1802.22,"endTime":1806.12,"body":"suture from being on skin where"},{"speaker":"Charles Goldfarb","startTime":1806.12,"endTime":1809.84,"body":"it won't do well. Instead you're"},{"speaker":"Charles Goldfarb","startTime":1806.12,"endTime":1809.84,"body":"tying on the button. And that"},{"speaker":"Charles Goldfarb","startTime":1809.84,"endTime":1812.78,"body":"used to be really popular. I"},{"speaker":"Charles Goldfarb","startTime":1809.84,"endTime":1812.78,"body":"just think it's hard to those"},{"speaker":"Charles Goldfarb","startTime":1812.78,"endTime":1813.92,"body":"buttons are hard to deal with."},{"speaker":"Chris Dy","startTime":1815.18,"endTime":1819.56,"body":"I completely agree,"},{"speaker":"Chris Dy","startTime":1815.18,"endTime":1819.56,"body":"and my neuroses make sure that"},{"speaker":"Chris Dy","startTime":1819.56,"endTime":1824.02,"body":"there's always a button around"},{"speaker":"Chris Dy","startTime":1819.56,"endTime":1824.02,"body":"at the surgery center. So last"},{"speaker":"Chris Dy","startTime":1824.02,"endTime":1826.24,"body":"time I had asked for a button"},{"speaker":"Chris Dy","startTime":1824.02,"endTime":1826.24,"body":"was probably two or three years"},{"speaker":"Chris Dy","startTime":1826.24,"endTime":1828.7,"body":"prior, and then I walk in in the"},{"speaker":"Chris Dy","startTime":1826.24,"endTime":1828.7,"body":"morning, I was like, you also"},{"speaker":"Chris Dy","startTime":1828.7,"endTime":1833.74,"body":"have that button, right? Just"},{"speaker":"Chris Dy","startTime":1828.7,"endTime":1833.74,"body":"making sure, but yeah, no, I"},{"speaker":"Chris Dy","startTime":1833.74,"endTime":1837.04,"body":"agree. I think that's that's not"},{"speaker":"Chris Dy","startTime":1833.74,"endTime":1837.04,"body":"the first option for me."},{"speaker":"Charles Goldfarb","startTime":1837.28,"endTime":1840.54,"body":"No for me"},{"speaker":"Charles Goldfarb","startTime":1837.28,"endTime":1840.54,"body":"either, but That's old school"},{"speaker":"Charles Goldfarb","startTime":1840.54,"endTime":1844.02,"body":"hand surgery. It was always a"},{"speaker":"Charles Goldfarb","startTime":1840.54,"endTime":1844.02,"body":"button. I went through a stage"},{"speaker":"Charles Goldfarb","startTime":1844.02,"endTime":1848.58,"body":"where I passed the suture"},{"speaker":"Charles Goldfarb","startTime":1844.02,"endTime":1848.58,"body":"through the bone, and I made a"},{"speaker":"Charles Goldfarb","startTime":1848.58,"endTime":1852.6,"body":"small incision, and I tied the"},{"speaker":"Charles Goldfarb","startTime":1848.58,"endTime":1852.6,"body":"suture down to the bone,"},{"speaker":"Charles Goldfarb","startTime":1852.96,"endTime":1857.46,"body":"proximal to the germinal matrix"},{"speaker":"Charles Goldfarb","startTime":1852.96,"endTime":1857.46,"body":"and sort of distal to the"},{"speaker":"Charles Goldfarb","startTime":1857.7,"endTime":1862.64,"body":"terminal tendon insertion. And I"},{"speaker":"Charles Goldfarb","startTime":1857.7,"endTime":1862.64,"body":"thought it's a great solution."},{"speaker":"Charles Goldfarb","startTime":1863.36,"endTime":1867.8,"body":"The reality is, it's not. And"},{"speaker":"Charles Goldfarb","startTime":1863.36,"endTime":1867.8,"body":"because it seems to the suture"},{"speaker":"Charles Goldfarb","startTime":1867.8,"endTime":1871.16,"body":"there seems to cause problems."},{"speaker":"Charles Goldfarb","startTime":1867.8,"endTime":1871.16,"body":"And I had to go back and take"},{"speaker":"Charles Goldfarb","startTime":1871.16,"endTime":1873.92,"body":"suture out occasionally, even"},{"speaker":"Charles Goldfarb","startTime":1871.16,"endTime":1873.92,"body":"though the tendon will heal, it"},{"speaker":"Charles Goldfarb","startTime":1873.92,"endTime":1876.02,"body":"just to me, seemed like it"},{"speaker":"Charles Goldfarb","startTime":1873.92,"endTime":1876.02,"body":"caused problems,"},{"speaker":"Chris Dy","startTime":1876.2,"endTime":1878.06,"body":"right? It'll be a"},{"speaker":"Chris Dy","startTime":1876.2,"endTime":1878.06,"body":"suture of any sort of caliber"},{"speaker":"Chris Dy","startTime":1878.06,"endTime":1881.2,"body":"that's going to be strong enough"},{"speaker":"Chris Dy","startTime":1878.06,"endTime":1881.2,"body":"and not absorbable, enough to"},{"speaker":"Chris Dy","startTime":1881.86,"endTime":1885.88,"body":"get a tendon to as a core suture"},{"speaker":"Chris Dy","startTime":1881.86,"endTime":1885.88,"body":"for a flexor tendon. I can see"},{"speaker":"Chris Dy","startTime":1885.88,"endTime":1887.32,"body":"how that was going to irritate"},{"speaker":"Chris Dy","startTime":1885.88,"endTime":1887.32,"body":"things,"},{"speaker":"Charles Goldfarb","startTime":1887.86,"endTime":1889.9,"body":"right? Which"},{"speaker":"Charles Goldfarb","startTime":1887.86,"endTime":1889.9,"body":"leaves us with the last option,"},{"speaker":"Charles Goldfarb","startTime":1889.9,"endTime":1893.86,"body":"which is the expensive option,"},{"speaker":"Charles Goldfarb","startTime":1889.9,"endTime":1893.86,"body":"but I think it honestly is the"},{"speaker":"Charles Goldfarb","startTime":1893.86,"endTime":1897.22,"body":"best option, which is a really"},{"speaker":"Charles Goldfarb","startTime":1893.86,"endTime":1897.22,"body":"small suture anchor, right?"},{"speaker":"Chris Dy","startTime":1897.22,"endTime":1899.2,"body":"So, I mean, you know,"},{"speaker":"Chris Dy","startTime":1897.22,"endTime":1899.2,"body":"I thought about this, and you"},{"speaker":"Chris Dy","startTime":1899.2,"endTime":1902.58,"body":"know, you have different kinds"},{"speaker":"Chris Dy","startTime":1899.2,"endTime":1902.58,"body":"of small suture anchor options,"},{"speaker":"Chris Dy","startTime":1902.88,"endTime":1906.96,"body":"some of which are loaded with"},{"speaker":"Chris Dy","startTime":1902.88,"endTime":1906.96,"body":"like a 2o type stitch of"},{"speaker":"Chris Dy","startTime":1906.96,"endTime":1910.68,"body":"caliber, and others that come"},{"speaker":"Chris Dy","startTime":1906.96,"endTime":1910.68,"body":"with a 3o type stitch. And"},{"speaker":"Chris Dy","startTime":1910.74,"endTime":1914.52,"body":"they're small, though, and then"},{"speaker":"Chris Dy","startTime":1910.74,"endTime":1914.52,"body":"you honestly your quarter of"},{"speaker":"Chris Dy","startTime":1914.52,"endTime":1917.28,"body":"bone, especially if you've"},{"speaker":"Chris Dy","startTime":1914.52,"endTime":1917.28,"body":"already had a bone fragment, is"},{"speaker":"Chris Dy","startTime":1917.28,"endTime":1920.36,"body":"very small in terms of the"},{"speaker":"Chris Dy","startTime":1917.28,"endTime":1920.36,"body":"robustness of the bone. And you"},{"speaker":"Chris Dy","startTime":1920.36,"endTime":1924.2,"body":"certainly don't want to have an"},{"speaker":"Chris Dy","startTime":1920.36,"endTime":1924.2,"body":"anchor tickling the the germinal"},{"speaker":"Chris Dy","startTime":1924.2,"endTime":1928.58,"body":"or sterile matrix. So you the"},{"speaker":"Chris Dy","startTime":1924.2,"endTime":1928.58,"body":"room for error here, and you're"},{"speaker":"Chris Dy","startTime":1928.58,"endTime":1932.06,"body":"into small finger in this case."},{"speaker":"Chris Dy","startTime":1928.58,"endTime":1932.06,"body":"So it's a small bone."},{"speaker":"Charles Goldfarb","startTime":1933.2,"endTime":1935.36,"body":"Yeah, I would"},{"speaker":"Charles Goldfarb","startTime":1933.2,"endTime":1935.36,"body":"say that historically,"},{"speaker":"Charles Goldfarb","startTime":1935.42,"endTime":1938.12,"body":"sutrankers were tough because"},{"speaker":"Charles Goldfarb","startTime":1935.42,"endTime":1938.12,"body":"you had to put them in"},{"speaker":"Charles Goldfarb","startTime":1938.12,"endTime":1941.32,"body":"obliquely. They were just too"},{"speaker":"Charles Goldfarb","startTime":1938.12,"endTime":1941.32,"body":"long. Now there are small"},{"speaker":"Charles Goldfarb","startTime":1941.32,"endTime":1944.08,"body":"drinkers with good holding"},{"speaker":"Charles Goldfarb","startTime":1941.32,"endTime":1944.08,"body":"power, 2.2 millimeters. For"},{"speaker":"Charles Goldfarb","startTime":1944.08,"endTime":1947.38,"body":"example, that generally okay,"},{"speaker":"Charles Goldfarb","startTime":1944.08,"endTime":1947.38,"body":"but with a little finger and"},{"speaker":"Charles Goldfarb","startTime":1947.38,"endTime":1951.58,"body":"with the with the bone issue,"},{"speaker":"Charles Goldfarb","startTime":1947.38,"endTime":1951.58,"body":"like bowler bone being absent,"},{"speaker":"Charles Goldfarb","startTime":1951.76,"endTime":1955.06,"body":"it's trickier, no doubt about"},{"speaker":"Charles Goldfarb","startTime":1951.76,"endTime":1955.06,"body":"it, it won't always work. In"},{"speaker":"Charles Goldfarb","startTime":1955.06,"endTime":1957.7,"body":"that case, I probably would"},{"speaker":"Charles Goldfarb","startTime":1955.06,"endTime":1957.7,"body":"drill through and use a button,"},{"speaker":"Charles Goldfarb","startTime":1957.76,"endTime":1959.5,"body":"I guess is that what you ended"},{"speaker":"Charles Goldfarb","startTime":1957.76,"endTime":1959.5,"body":"up doing."},{"speaker":"Chris Dy","startTime":1959.68,"endTime":1963.18,"body":"So you know, this was"},{"speaker":"Chris Dy","startTime":1959.68,"endTime":1963.18,"body":"not the most cost conscious of"},{"speaker":"Chris Dy","startTime":1963.18,"endTime":1968.28,"body":"cases you did. So I well, so I"},{"speaker":"Chris Dy","startTime":1963.18,"endTime":1968.28,"body":"went and I tried to use an"},{"speaker":"Chris Dy","startTime":1968.28,"endTime":1972.06,"body":"anchor. And, you know, when you"},{"speaker":"Chris Dy","startTime":1968.28,"endTime":1972.06,"body":"put the anchor in, you, and I"},{"speaker":"Chris Dy","startTime":1972.06,"endTime":1975.12,"body":"was in the bone bed, right, the"},{"speaker":"Chris Dy","startTime":1972.06,"endTime":1975.12,"body":"the cancellous bed, where the"},{"speaker":"Chris Dy","startTime":1975.12,"endTime":1978.6,"body":"the fragment had evolved, I put"},{"speaker":"Chris Dy","startTime":1975.12,"endTime":1978.6,"body":"the anchor in. And, you know, we"},{"speaker":"Chris Dy","startTime":1978.6,"endTime":1981.08,"body":"do all tests. You know,"},{"speaker":"Chris Dy","startTime":1978.6,"endTime":1981.08,"body":"everybody hands off of the hand,"},{"speaker":"Chris Dy","startTime":1981.08,"endTime":1984.92,"body":"and you pull on the anchor to"},{"speaker":"Chris Dy","startTime":1981.08,"endTime":1984.92,"body":"see if Is it strong enough, and"},{"speaker":"Chris Dy","startTime":1984.92,"endTime":1988.1,"body":"it passed the test. Was"},{"speaker":"Chris Dy","startTime":1984.92,"endTime":1988.1,"body":"thrilled, you know, this is"},{"speaker":"Chris Dy","startTime":1988.1,"endTime":1991.52,"body":"perfect. I'm gonna have a great"},{"speaker":"Chris Dy","startTime":1988.1,"endTime":1991.52,"body":"repair and not have a button. So"},{"speaker":"Chris Dy","startTime":1991.52,"endTime":1996.2,"body":"then we go and start passing our"},{"speaker":"Chris Dy","startTime":1991.52,"endTime":1996.2,"body":"core suture, you know, using the"},{"speaker":"Chris Dy","startTime":1996.2,"endTime":2000.96,"body":"sutures that are loaded in here,"},{"speaker":"Chris Dy","startTime":1996.2,"endTime":2000.96,"body":"kind of weaving around the bone"},{"speaker":"Chris Dy","startTime":2000.96,"endTime":2003.36,"body":"fragment leaving the bone so it"},{"speaker":"Chris Dy","startTime":2000.96,"endTime":2003.36,"body":"could kind of tuck down and"},{"speaker":"Chris Dy","startTime":2003.36,"endTime":2007.44,"body":"cinch down to heal down. And as"},{"speaker":"Chris Dy","startTime":2003.36,"endTime":2007.44,"body":"soon as we start doing that, the"},{"speaker":"Chris Dy","startTime":2007.44,"endTime":2011.46,"body":"acre just falls out. And then,"},{"speaker":"Chris Dy","startTime":2007.44,"endTime":2011.46,"body":"you know, the F bombs come out,"},{"speaker":"Chris Dy","startTime":2011.46,"endTime":2014.1,"body":"and, you know, whatever,"},{"speaker":"Chris Dy","startTime":2011.46,"endTime":2014.1,"body":"whatever. But you know, so then"},{"speaker":"Chris Dy","startTime":2014.1,"endTime":2017.52,"body":"I'm like, All right, go get the"},{"speaker":"Chris Dy","startTime":2014.1,"endTime":2017.52,"body":"button. And then as they're"},{"speaker":"Chris Dy","startTime":2017.52,"endTime":2019.98,"body":"getting the button, I look at"},{"speaker":"Chris Dy","startTime":2017.52,"endTime":2019.98,"body":"the rep. I'm like, you have that"},{"speaker":"Chris Dy","startTime":2019.98,"endTime":2025.16,"body":"other one that we talked about."},{"speaker":"Chris Dy","startTime":2019.98,"endTime":2025.16,"body":"It was the smaller one that I"},{"speaker":"Chris Dy","startTime":2025.16,"endTime":2030.92,"body":"was let's just, you know, see,"},{"speaker":"Chris Dy","startTime":2025.16,"endTime":2030.92,"body":"so while they're retrieving"},{"speaker":"Chris Dy","startTime":2030.92,"endTime":2033.08,"body":"that, they went ahead and get"},{"speaker":"Chris Dy","startTime":2030.92,"endTime":2033.08,"body":"the button. I'm like, Alright,"},{"speaker":"Chris Dy","startTime":2033.08,"endTime":2035.96,"body":"let me just be reasonable and"},{"speaker":"Chris Dy","startTime":2033.08,"endTime":2035.96,"body":"say, Alright, let's just get the"},{"speaker":"Chris Dy","startTime":2035.96,"endTime":2038.84,"body":"button and, you know, see how"},{"speaker":"Chris Dy","startTime":2035.96,"endTime":2038.84,"body":"this holds. So I'm starting to"},{"speaker":"Chris Dy","startTime":2038.84,"endTime":2042.88,"body":"process for the button. And, you"},{"speaker":"Chris Dy","startTime":2038.84,"endTime":2042.88,"body":"know, I don't know how you do"},{"speaker":"Chris Dy","startTime":2042.88,"endTime":2045.28,"body":"it, but, you know, it'd been a"},{"speaker":"Chris Dy","startTime":2042.88,"endTime":2045.28,"body":"while for me, I used the Keith"},{"speaker":"Chris Dy","startTime":2045.28,"endTime":2047.74,"body":"needles, and I actually used the"},{"speaker":"Chris Dy","startTime":2045.28,"endTime":2047.74,"body":"K wire driver to get the Keith"},{"speaker":"Chris Dy","startTime":2047.74,"endTime":2050.62,"body":"needles in position. I like to"},{"speaker":"Chris Dy","startTime":2047.74,"endTime":2050.62,"body":"go over the nail plate itself."},{"speaker":"Chris Dy","startTime":2051.64,"endTime":2054.58,"body":"And we didn't have the felt"},{"speaker":"Chris Dy","startTime":2051.64,"endTime":2054.58,"body":"that, you know, sometimes the"},{"speaker":"Chris Dy","startTime":2054.58,"endTime":2057.58,"body":"children's hospitals will have"},{"speaker":"Chris Dy","startTime":2054.58,"endTime":2057.58,"body":"to sit between the button and"},{"speaker":"Chris Dy","startTime":2057.58,"endTime":2061.68,"body":"the nail. So we used a couple of"},{"speaker":"Chris Dy","startTime":2057.58,"endTime":2061.68,"body":"telfas stacked together and then"},{"speaker":"Chris Dy","startTime":2061.68,"endTime":2064.5,"body":"tied it down, and we had good"},{"speaker":"Chris Dy","startTime":2061.68,"endTime":2064.5,"body":"apposition. I was very, very"},{"speaker":"Chris Dy","startTime":2064.5,"endTime":2067.26,"body":"happy with it, but yeah, kind of"},{"speaker":"Chris Dy","startTime":2064.5,"endTime":2067.26,"body":"knew the patient was probably"},{"speaker":"Chris Dy","startTime":2067.26,"endTime":2071.4,"body":"going to test the limits a"},{"speaker":"Chris Dy","startTime":2067.26,"endTime":2071.4,"body":"little bit. So before I really"},{"speaker":"Chris Dy","startTime":2071.4,"endTime":2073.8,"body":"tied everything, you know,"},{"speaker":"Chris Dy","startTime":2071.4,"endTime":2073.8,"body":"perfectly down, I was like, let"},{"speaker":"Chris Dy","startTime":2073.8,"endTime":2076.86,"body":"me just see that small anchor."},{"speaker":"Chris Dy","startTime":2073.8,"endTime":2076.86,"body":"So the small anchor actually"},{"speaker":"Chris Dy","startTime":2076.86,"endTime":2079.8,"body":"held pretty well, and then I use"},{"speaker":"Chris Dy","startTime":2076.86,"endTime":2079.8,"body":"that to just be a belt and"},{"speaker":"Chris Dy","startTime":2079.8,"endTime":2083.96,"body":"suspenders, you know, because I"},{"speaker":"Chris Dy","startTime":2079.8,"endTime":2083.96,"body":"figured this, this could get a"},{"speaker":"Chris Dy","startTime":2083.96,"endTime":2087.26,"body":"little bit dicey in terms of"},{"speaker":"Chris Dy","startTime":2083.96,"endTime":2087.26,"body":"apposition and making sure the"},{"speaker":"Chris Dy","startTime":2087.26,"endTime":2091.22,"body":"tendon heals well down the bone."},{"speaker":"Chris Dy","startTime":2087.26,"endTime":2091.22,"body":"So, again, not the most cost"},{"speaker":"Chris Dy","startTime":2091.22,"endTime":2095.54,"body":"conscious of things, but, you"},{"speaker":"Chris Dy","startTime":2091.22,"endTime":2095.54,"body":"know, I was really happy with"},{"speaker":"Chris Dy","startTime":2095.54,"endTime":2096.68,"body":"the fixation at the end."},{"speaker":"Charles Goldfarb","startTime":2097.7,"endTime":2099.32,"body":"Yeah. I mean,"},{"speaker":"Charles Goldfarb","startTime":2097.7,"endTime":2099.32,"body":"it sounds like one of those"},{"speaker":"Charles Goldfarb","startTime":2099.32,"endTime":2102.64,"body":"cases. I will. Say it is"},{"speaker":"Charles Goldfarb","startTime":2099.32,"endTime":2102.64,"body":"frustrating as those events are,"},{"speaker":"Charles Goldfarb","startTime":2102.82,"endTime":2106.48,"body":"you are much happier it happened"},{"speaker":"Charles Goldfarb","startTime":2102.82,"endTime":2106.48,"body":"in the operating room than when"},{"speaker":"Charles Goldfarb","startTime":2106.48,"endTime":2109.06,"body":"the patient first goes to"},{"speaker":"Charles Goldfarb","startTime":2106.48,"endTime":2109.06,"body":"therapy. So no doubt about that."},{"speaker":"Charles Goldfarb","startTime":2109.36,"endTime":2113.68,"body":"Oh yeah for sure. And do you"},{"speaker":"Charles Goldfarb","startTime":2109.36,"endTime":2113.68,"body":"try? You may not have much of a"},{"speaker":"Charles Goldfarb","startTime":2113.68,"endTime":2117.4,"body":"choice in this case. Do you put"},{"speaker":"Charles Goldfarb","startTime":2113.68,"endTime":2117.4,"body":"your anchors in heading"},{"speaker":"Charles Goldfarb","startTime":2117.4,"endTime":2120.66,"body":"distally? Do you put your"},{"speaker":"Charles Goldfarb","startTime":2117.4,"endTime":2120.66,"body":"anchors in at 90 degrees to the"},{"speaker":"Charles Goldfarb","startTime":2120.66,"endTime":2123.36,"body":"bone, or do you try to do the"},{"speaker":"Charles Goldfarb","startTime":2120.66,"endTime":2123.36,"body":"dead man's angle? I think we may"},{"speaker":"Charles Goldfarb","startTime":2123.36,"endTime":2125.52,"body":"have talked about this in the"},{"speaker":"Charles Goldfarb","startTime":2123.36,"endTime":2125.52,"body":"past, but I don't recall what"},{"speaker":"Charles Goldfarb","startTime":2125.52,"endTime":2125.64,"body":"you"},{"speaker":"Chris Dy","startTime":2125.64,"endTime":2127.74,"body":"do. I like the dead"},{"speaker":"Chris Dy","startTime":2125.64,"endTime":2127.74,"body":"man's angle. It wasn't a great"},{"speaker":"Chris Dy","startTime":2127.74,"endTime":2131.58,"body":"option for me. I just basically"},{"speaker":"Chris Dy","startTime":2127.74,"endTime":2131.58,"body":"took a, I think I ended up"},{"speaker":"Chris Dy","startTime":2131.58,"endTime":2134.88,"body":"taking, like a small gage needle"},{"speaker":"Chris Dy","startTime":2131.58,"endTime":2134.88,"body":"and just kind of sounded out the"},{"speaker":"Chris Dy","startTime":2134.88,"endTime":2137.4,"body":"bone. And I was like, Alright,"},{"speaker":"Chris Dy","startTime":2134.88,"endTime":2137.4,"body":"this is probably the best place."},{"speaker":"Chris Dy","startTime":2137.4,"endTime":2140.72,"body":"So it ended up being kind of"},{"speaker":"Chris Dy","startTime":2137.4,"endTime":2140.72,"body":"somewhere in between the first"},{"speaker":"Chris Dy","startTime":2140.72,"endTime":2143.3,"body":"two options, not a dead man's"},{"speaker":"Chris Dy","startTime":2140.72,"endTime":2143.3,"body":"not, you know, full on"},{"speaker":"Chris Dy","startTime":2143.3,"endTime":2146.54,"body":"perpendicular. And I definitely"},{"speaker":"Chris Dy","startTime":2143.3,"endTime":2146.54,"body":"checked the nail and I couldn't"},{"speaker":"Chris Dy","startTime":2146.54,"endTime":2150.44,"body":"see it. So, you know, that's a"},{"speaker":"Chris Dy","startTime":2146.54,"endTime":2150.44,"body":"good thing. And I guess I had a"},{"speaker":"Chris Dy","startTime":2150.44,"endTime":2153.2,"body":"question for you for the last"},{"speaker":"Chris Dy","startTime":2150.44,"endTime":2153.2,"body":"thing. How do you, you know,"},{"speaker":"Chris Dy","startTime":2153.2,"endTime":2156.92,"body":"I've opened a three and I"},{"speaker":"Chris Dy","startTime":2153.2,"endTime":2156.92,"body":"confirmed that, you know, the"},{"speaker":"Chris Dy","startTime":2156.92,"endTime":2161.86,"body":"superficial slips were intact."},{"speaker":"Chris Dy","startTime":2156.92,"endTime":2161.86,"body":"How do you keep the glide there."},{"speaker":"Chris Dy","startTime":2161.92,"endTime":2165.7,"body":"Do you just leave the pulley"},{"speaker":"Chris Dy","startTime":2161.92,"endTime":2165.7,"body":"open? Or, you know, what else"},{"speaker":"Chris Dy","startTime":2165.7,"endTime":2167.98,"body":"can you do to ensure that you"},{"speaker":"Chris Dy","startTime":2165.7,"endTime":2167.98,"body":"get good glide between your"},{"speaker":"Chris Dy","startTime":2167.98,"endTime":2169.36,"body":"Profundus and superficialis?"},{"speaker":"Charles Goldfarb","startTime":2171.1,"endTime":2173.949,"body":"I don't think"},{"speaker":"Charles Goldfarb","startTime":2171.1,"endTime":2173.949,"body":"I've thought of that as a"},{"speaker":"Charles Goldfarb","startTime":2174.022,"endTime":2177.821,"body":"significant issue. I think you"},{"speaker":"Charles Goldfarb","startTime":2174.022,"endTime":2177.821,"body":"know, you know I have"},{"speaker":"Charles Goldfarb","startTime":2177.894,"endTime":2182.423,"body":"occasionally, have occasionally"},{"speaker":"Charles Goldfarb","startTime":2177.894,"endTime":2182.423,"body":"used the pulley underneath the"},{"speaker":"Charles Goldfarb","startTime":2182.496,"endTime":2186.734,"body":"FDS and or FDP if I worried"},{"speaker":"Charles Goldfarb","startTime":2182.496,"endTime":2186.734,"body":"about a gliding surface with a"},{"speaker":"Charles Goldfarb","startTime":2186.807,"endTime":2191.409,"body":"fracture or something. In this"},{"speaker":"Charles Goldfarb","startTime":2186.807,"endTime":2191.409,"body":"case, I think it'll be okay. Are"},{"speaker":"Charles Goldfarb","startTime":2191.482,"endTime":2195.72,"body":"you concerned that they won't"},{"speaker":"Charles Goldfarb","startTime":2191.482,"endTime":2195.72,"body":"glide against one another? I"},{"speaker":"Chris Dy","startTime":2195.78,"endTime":2198.36,"body":"mean, that's just I,"},{"speaker":"Chris Dy","startTime":2195.78,"endTime":2198.36,"body":"you know, my my concern is,"},{"speaker":"Chris Dy","startTime":2198.36,"endTime":2200.72,"body":"honestly, for a lot of this case"},{"speaker":"Chris Dy","startTime":2198.36,"endTime":2200.72,"body":"was, let's just make sure we"},{"speaker":"Chris Dy","startTime":2200.72,"endTime":2204.08,"body":"keep His FDS moving. So that was"},{"speaker":"Chris Dy","startTime":2200.72,"endTime":2204.08,"body":"the biggest thing for me. So I"},{"speaker":"Chris Dy","startTime":2204.08,"endTime":2207.8,"body":"actually used when I elevated,"},{"speaker":"Chris Dy","startTime":2204.08,"endTime":2207.8,"body":"when I, quote, vented or opened"},{"speaker":"Chris Dy","startTime":2207.8,"endTime":2210.62,"body":"the pulley. I did it with the"},{"speaker":"Chris Dy","startTime":2207.8,"endTime":2210.62,"body":"bias so that it was almost like"},{"speaker":"Chris Dy","startTime":2210.62,"endTime":2213.14,"body":"a like an L shaped window, or"},{"speaker":"Chris Dy","startTime":2210.62,"endTime":2213.14,"body":"not an L shaped but like a"},{"speaker":"Chris Dy","startTime":2213.14,"endTime":2216.38,"body":"window, so that I could flop it"},{"speaker":"Chris Dy","startTime":2213.14,"endTime":2216.38,"body":"back down. And I actually ended"},{"speaker":"Chris Dy","startTime":2216.38,"endTime":2218.96,"body":"up tucking it between the FDS"},{"speaker":"Chris Dy","startTime":2216.38,"endTime":2218.96,"body":"and the FTP, kind of like you"},{"speaker":"Chris Dy","startTime":2218.96,"endTime":2221.66,"body":"described, just to get some kind"},{"speaker":"Chris Dy","startTime":2218.96,"endTime":2221.66,"body":"of glide. And you're definitely"},{"speaker":"Chris Dy","startTime":2221.66,"endTime":2223.72,"body":"making a sacrifice in terms of"},{"speaker":"Chris Dy","startTime":2221.66,"endTime":2223.72,"body":"sacrifice in terms of"},{"speaker":"Chris Dy","startTime":2223.72,"endTime":2225.94,"body":"acknowledging that you're going"},{"speaker":"Chris Dy","startTime":2223.72,"endTime":2225.94,"body":"to get some Bose triggering"},{"speaker":"Chris Dy","startTime":2225.94,"endTime":2228.4,"body":"there, potentially. But again,"},{"speaker":"Chris Dy","startTime":2225.94,"endTime":2228.4,"body":"at the end of the day, if I'm"},{"speaker":"Chris Dy","startTime":2228.4,"endTime":2231.52,"body":"getting getting them gliding,"},{"speaker":"Chris Dy","startTime":2228.4,"endTime":2231.52,"body":"I'm much happier."},{"speaker":"Charles Goldfarb","startTime":2232.42,"endTime":2234.28,"body":"Yeah, I"},{"speaker":"Charles Goldfarb","startTime":2232.42,"endTime":2234.28,"body":"haven't done that particular"},{"speaker":"Charles Goldfarb","startTime":2234.28,"endTime":2238.48,"body":"trick here. I think your therapy"},{"speaker":"Charles Goldfarb","startTime":2234.28,"endTime":2238.48,"body":"would be focused on your PIP"},{"speaker":"Charles Goldfarb","startTime":2238.54,"endTime":2241.56,"body":"flexion, for sure, and then"},{"speaker":"Charles Goldfarb","startTime":2238.54,"endTime":2241.56,"body":"obviously a gentle progression"},{"speaker":"Charles Goldfarb","startTime":2241.56,"endTime":2245.28,"body":"of your distal joint flexion."},{"speaker":"Charles Goldfarb","startTime":2241.56,"endTime":2245.28,"body":"But, yeah, I think that in all"},{"speaker":"Charles Goldfarb","startTime":2245.28,"endTime":2247.92,"body":"likelihood, would would help"},{"speaker":"Charles Goldfarb","startTime":2245.28,"endTime":2247.92,"body":"decrease scarring, especially"},{"speaker":"Charles Goldfarb","startTime":2247.92,"endTime":2250.32,"body":"given that the bone was rubbing"},{"speaker":"Charles Goldfarb","startTime":2247.92,"endTime":2250.32,"body":"there, most likely, and"},{"speaker":"Charles Goldfarb","startTime":2250.32,"endTime":2253.8,"body":"obviously blocking your FDS. So"},{"speaker":"Charles Goldfarb","startTime":2250.32,"endTime":2253.8,"body":"doing something different makes"},{"speaker":"Charles Goldfarb","startTime":2253.8,"endTime":2255.6,"body":"some sense, and certainly easy"},{"speaker":"Charles Goldfarb","startTime":2253.8,"endTime":2255.6,"body":"enough to do"},{"speaker":"Chris Dy","startTime":2256.56,"endTime":2258.9,"body":"therapy we have so"},{"speaker":"Chris Dy","startTime":2256.56,"endTime":2258.9,"body":"post op mobilization. I mean, I"},{"speaker":"Chris Dy","startTime":2258.9,"endTime":2261.44,"body":"went with a dorsal blocking"},{"speaker":"Chris Dy","startTime":2258.9,"endTime":2261.44,"body":"splint, form based ring and"},{"speaker":"Chris Dy","startTime":2261.44,"endTime":2264.2,"body":"small finger. Do you do anything"},{"speaker":"Chris Dy","startTime":2261.44,"endTime":2264.2,"body":"differently? Yeah,"},{"speaker":"Charles Goldfarb","startTime":2264.2,"endTime":2267.56,"body":"and I would"},{"speaker":"Charles Goldfarb","startTime":2264.2,"endTime":2267.56,"body":"agree completely for this. I"},{"speaker":"Charles Goldfarb","startTime":2267.56,"endTime":2271.7,"body":"probably would do active PIP"},{"speaker":"Charles Goldfarb","startTime":2267.56,"endTime":2271.7,"body":"motion. I probably would not,"},{"speaker":"Charles Goldfarb","startTime":2271.94,"endTime":2274.28,"body":"especially given the bone issue,"},{"speaker":"Charles Goldfarb","startTime":2271.94,"endTime":2274.28,"body":"not do a lot of aggressive,"},{"speaker":"Charles Goldfarb","startTime":2274.28,"endTime":2278.78,"body":"active DIP joint motion"},{"speaker":"Charles Goldfarb","startTime":2274.28,"endTime":2278.78,"body":"initially. So be a passive"},{"speaker":"Charles Goldfarb","startTime":2278.78,"endTime":2280.9,"body":"protocol for the first six"},{"speaker":"Chris Dy","startTime":2281.14,"endTime":2283.3,"body":"weeks. Yeah, that's"},{"speaker":"Chris Dy","startTime":2281.14,"endTime":2283.3,"body":"the protocol that that we're"},{"speaker":"Chris Dy","startTime":2283.3,"endTime":2286.06,"body":"going with. So, I mean, I"},{"speaker":"Chris Dy","startTime":2283.3,"endTime":2286.06,"body":"honestly, it was one of those"},{"speaker":"Chris Dy","startTime":2286.06,"endTime":2289.3,"body":"cases where, like, all right,"},{"speaker":"Chris Dy","startTime":2286.06,"endTime":2289.3,"body":"you know, one of the things I"},{"speaker":"Chris Dy","startTime":2289.3,"endTime":2292.3,"body":"think is hardest when you're"},{"speaker":"Chris Dy","startTime":2289.3,"endTime":2292.3,"body":"starting as faculty, and even"},{"speaker":"Chris Dy","startTime":2292.3,"endTime":2294.4,"body":"now, like, you know, I still,"},{"speaker":"Chris Dy","startTime":2292.3,"endTime":2294.4,"body":"you know, trying to figure out,"},{"speaker":"Chris Dy","startTime":2294.4,"endTime":2298.54,"body":"like, where's the sweet spot on"},{"speaker":"Chris Dy","startTime":2294.4,"endTime":2298.54,"body":"when to do, when to stop, and"},{"speaker":"Chris Dy","startTime":2298.54,"endTime":2301.08,"body":"when to just say, alright, we're"},{"speaker":"Chris Dy","startTime":2298.54,"endTime":2301.08,"body":"going to accept the result that"},{"speaker":"Chris Dy","startTime":2301.08,"endTime":2304.14,"body":"we know is going to be good."},{"speaker":"Chris Dy","startTime":2301.08,"endTime":2304.14,"body":"And, you know, I think that's"},{"speaker":"Chris Dy","startTime":2304.14,"endTime":2306.54,"body":"where it definitely gets tricky."},{"speaker":"Charles Goldfarb","startTime":2307.26,"endTime":2309.6,"body":"I think that's"},{"speaker":"Charles Goldfarb","startTime":2307.26,"endTime":2309.6,"body":"really important, and it's"},{"speaker":"Charles Goldfarb","startTime":2309.6,"endTime":2314.16,"body":"something that only time can"},{"speaker":"Charles Goldfarb","startTime":2309.6,"endTime":2314.16,"body":"teach us all. And you know, when"},{"speaker":"Charles Goldfarb","startTime":2314.16,"endTime":2318.54,"body":"is meticulous perfectionist the"},{"speaker":"Charles Goldfarb","startTime":2314.16,"endTime":2318.54,"body":"right approach, and when will"},{"speaker":"Charles Goldfarb","startTime":2318.54,"endTime":2321.68,"body":"that actually potentially not be"},{"speaker":"Charles Goldfarb","startTime":2318.54,"endTime":2321.68,"body":"the best thing for the patient"},{"speaker":"Charles Goldfarb","startTime":2321.68,"endTime":2325.58,"body":"is really tricky. I would add"},{"speaker":"Charles Goldfarb","startTime":2321.68,"endTime":2325.58,"body":"that this technique of using a"},{"speaker":"Charles Goldfarb","startTime":2325.58,"endTime":2330.14,"body":"suture anchor for bony repair is"},{"speaker":"Charles Goldfarb","startTime":2325.58,"endTime":2330.14,"body":"obviously not isolated to the"},{"speaker":"Charles Goldfarb","startTime":2330.14,"endTime":2334.04,"body":"FDP, and I have used it for"},{"speaker":"Charles Goldfarb","startTime":2330.14,"endTime":2334.04,"body":"recently, in the last two weeks,"},{"speaker":"Charles Goldfarb","startTime":2334.04,"endTime":2339.86,"body":"for bone avulsion from the"},{"speaker":"Charles Goldfarb","startTime":2334.04,"endTime":2339.86,"body":"medial epicondylar epithesis, so"},{"speaker":"Charles Goldfarb","startTime":2339.86,"endTime":2347.08,"body":"a functional UCL injury in a 11"},{"speaker":"Charles Goldfarb","startTime":2339.86,"endTime":2347.08,"body":"year old. I've used it for a UCL"},{"speaker":"Charles Goldfarb","startTime":2347.14,"endTime":2350.14,"body":"of the thumb, where there's a"},{"speaker":"Charles Goldfarb","startTime":2347.14,"endTime":2350.14,"body":"small bony fragment, and I left"},{"speaker":"Charles Goldfarb","startTime":2350.14,"endTime":2352.6,"body":"the bone in both of these"},{"speaker":"Charles Goldfarb","startTime":2350.14,"endTime":2352.6,"body":"situations for the reasons you"},{"speaker":"Charles Goldfarb","startTime":2352.6,"endTime":2355.9,"body":"said, because it'll bony healing"},{"speaker":"Charles Goldfarb","startTime":2352.6,"endTime":2355.9,"body":"is only a good thing. And you"},{"speaker":"Charles Goldfarb","startTime":2355.9,"endTime":2358.06,"body":"can really make a beautiful X"},{"speaker":"Charles Goldfarb","startTime":2355.9,"endTime":2358.06,"body":"ray with this."},{"speaker":"Chris Dy","startTime":2358.24,"endTime":2360.18,"body":"Yeah, you definitely"},{"speaker":"Chris Dy","startTime":2358.24,"endTime":2360.18,"body":"can. If you lasso that thing and"},{"speaker":"Chris Dy","startTime":2360.18,"endTime":2362.7,"body":"kind of walk it down. It looks"},{"speaker":"Chris Dy","startTime":2360.18,"endTime":2362.7,"body":"great. Can look"},{"speaker":"Charles Goldfarb","startTime":2362.7,"endTime":2365.28,"body":"great. So,"},{"speaker":"Charles Goldfarb","startTime":2362.7,"endTime":2365.28,"body":"yeah, it's funny. You know, it's"},{"speaker":"Charles Goldfarb","startTime":2365.94,"endTime":2367.98,"body":"some varieties of spice of life."},{"speaker":"Charles Goldfarb","startTime":2365.94,"endTime":2367.98,"body":"That's"},{"speaker":"Chris Dy","startTime":2367.98,"endTime":2370.32,"body":"right, that's right."},{"speaker":"Chris Dy","startTime":2367.98,"endTime":2370.32,"body":"Well, no great discussion."},{"speaker":"Chris Dy","startTime":2370.38,"endTime":2373.74,"body":"Hopefully. You know, those of"},{"speaker":"Chris Dy","startTime":2370.38,"endTime":2373.74,"body":"you that were listening enjoyed"},{"speaker":"Chris Dy","startTime":2373.74,"endTime":2376.44,"body":"that. If you have any other"},{"speaker":"Chris Dy","startTime":2373.74,"endTime":2376.44,"body":"suggestions for kind of"},{"speaker":"Chris Dy","startTime":2376.44,"endTime":2379.2,"body":"technical topics, please feel"},{"speaker":"Chris Dy","startTime":2376.44,"endTime":2379.2,"body":"free to email us"},{"speaker":"Chris Dy","startTime":2379.26,"endTime":2380.1,"body":"handpodcast@gmail.com"},{"speaker":"Charles Goldfarb","startTime":2381.9,"endTime":2384.14,"body":"Awesome."},{"speaker":"Charles Goldfarb","startTime":2381.9,"endTime":2384.14,"body":"Thanks for sharing, and that was"},{"speaker":"Charles Goldfarb","startTime":2384.14,"endTime":2385.7,"body":"fun. Other than the internet"},{"speaker":"Charles Goldfarb","startTime":2384.14,"endTime":2385.7,"body":"challenges,"},{"speaker":"Chris Dy","startTime":2386.54,"endTime":2389.48,"body":"all right, it's 2024"},{"speaker":"Chris Dy","startTime":2386.54,"endTime":2389.48,"body":"that's the way of life. That's"},{"speaker":"Chris Dy","startTime":2389.48,"endTime":2389.84,"body":"right."},{"speaker":"Charles Goldfarb","startTime":2389.9,"endTime":2392.96,"body":"Alright. Have"},{"speaker":"Charles Goldfarb","startTime":2389.9,"endTime":2392.96,"body":"a good evening. You too. Hey,"},{"speaker":"Charles Goldfarb","startTime":2392.96,"endTime":2395.42,"body":"Chris, that was fun. Let's do it"},{"speaker":"Charles Goldfarb","startTime":2392.96,"endTime":2395.42,"body":"again real soon."},{"speaker":"Chris Dy","startTime":2395.9,"endTime":2398.06,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":2395.9,"endTime":2398.06,"body":"sure to email us with topic"},{"speaker":"Chris Dy","startTime":2398.06,"endTime":2400.24,"body":"suggestions and feedback. You"},{"speaker":"Chris Dy","startTime":2398.06,"endTime":2400.24,"body":"can reach us. At"},{"speaker":"Chris Dy","startTime":2400.24,"endTime":2401.08,"body":"handpodcast@gmail.com"},{"speaker":"Charles Goldfarb","startTime":2402.82,"endTime":2404.98,"body":"and remember,"},{"speaker":"Charles Goldfarb","startTime":2402.82,"endTime":2404.98,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2404.98,"endTime":2405.94,"body":"get your podcast,"},{"speaker":"Chris Dy","startTime":2406.36,"endTime":2409.24,"body":"and be sure to leave a"},{"speaker":"Chris Dy","startTime":2406.36,"endTime":2409.24,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2409.24,"endTime":2410.86,"body":"word out. Special,"},{"speaker":"Charles Goldfarb","startTime":2410.86,"endTime":2412.9,"body":"thanks to"},{"speaker":"Charles Goldfarb","startTime":2410.86,"endTime":2412.9,"body":"Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":2412.9,"endTime":2414.16,"body":"music. And"},{"speaker":"Chris Dy","startTime":2414.16,"endTime":2416.32,"body":"remember, keep the"},{"speaker":"Chris Dy","startTime":2414.16,"endTime":2416.32,"body":"upper hand. Come back next time"},{"speaker":"Chris Dy","startTime":2416.32,"endTime":2416.44,"body":"you"}]}