{"version":"1.0.0","segments":[{"speaker":"Charles Goldfarb","startTime":0.0,"endTime":5.089,"body":"Chuck, welcome"},{"speaker":"Charles Goldfarb","startTime":0.0,"endTime":5.089,"body":"to the Upper Hand Podcast, where"},{"speaker":"Charles Goldfarb","startTime":5.198,"endTime":8.88,"body":"Chuck and Chris talk hand 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":23.54,"body":"you in advance for"},{"speaker":"Chris Dy","startTime":20.84,"endTime":23.54,"body":"leaving a review and rating that"},{"speaker":"Chris Dy","startTime":23.54,"endTime":26.36,"body":"helps us get the word out. You"},{"speaker":"Chris Dy","startTime":23.54,"endTime":26.36,"body":"can email us at hand"},{"speaker":"Chris Dy","startTime":26.36,"endTime":29.42,"body":"podcast@gmail.com so let's get"},{"speaker":"Chris Dy","startTime":26.36,"endTime":29.42,"body":"to the episode."},{"speaker":"Charles Goldfarb","startTime":30.86,"endTime":31.94,"body":"Oh, hey Chris,"},{"speaker":"Chris Dy","startTime":31.94,"endTime":33.26,"body":"Hey Chuck, how are you?"},{"speaker":"Charles Goldfarb","startTime":33.26,"endTime":35.18,"body":"I'm great. How"},{"speaker":"Charles Goldfarb","startTime":33.26,"endTime":35.18,"body":"are you?"},{"speaker":"Chris Dy","startTime":35.18,"endTime":37.779,"body":"Great, its 2025"},{"speaker":"Chris Dy","startTime":35.18,"endTime":37.779,"body":"excited. New New Year. We're"},{"speaker":"Chris Dy","startTime":37.838,"endTime":41.205,"body":"officially in and we've given"},{"speaker":"Chris Dy","startTime":37.838,"endTime":41.205,"body":"all our predictions for the"},{"speaker":"Chris Dy","startTime":41.264,"endTime":44.809,"body":"future of hand surgery, and"},{"speaker":"Chris Dy","startTime":41.264,"endTime":44.809,"body":"we've dealt with Snowmageddon in"},{"speaker":"Chris Dy","startTime":44.868,"endTime":45.4,"body":"St Louis."},{"speaker":"Charles Goldfarb","startTime":46.0,"endTime":47.74,"body":"Oh my god, we"},{"speaker":"Charles Goldfarb","startTime":46.0,"endTime":47.74,"body":"have dealt with Snowmageddon."},{"speaker":"Charles Goldfarb","startTime":47.74,"endTime":51.52,"body":"We're getting more as we speak"},{"speaker":"Charles Goldfarb","startTime":47.74,"endTime":51.52,"body":"on January 10, you know, I was"},{"speaker":"Charles Goldfarb","startTime":51.52,"endTime":54.22,"body":"thinking about our future of"},{"speaker":"Charles Goldfarb","startTime":51.52,"endTime":54.22,"body":"hand surgery podcast, and the"},{"speaker":"Charles Goldfarb","startTime":54.34,"endTime":58.36,"body":"only thing we didn't discuss was"},{"speaker":"Charles Goldfarb","startTime":54.34,"endTime":58.36,"body":"artificial intelligence, and it"},{"speaker":"Charles Goldfarb","startTime":58.36,"endTime":61.08,"body":"really wasn't the purpose of"},{"speaker":"Charles Goldfarb","startTime":58.36,"endTime":61.08,"body":"that episode, but it's another"},{"speaker":"Charles Goldfarb","startTime":61.08,"endTime":63.6,"body":"interesting topic, which we"},{"speaker":"Charles Goldfarb","startTime":61.08,"endTime":63.6,"body":"could touch on today or another"},{"speaker":"Charles Goldfarb","startTime":63.6,"endTime":63.96,"body":"time."},{"speaker":"Chris Dy","startTime":63.96,"endTime":66.552,"body":"Yeah, we absolutely"},{"speaker":"Chris Dy","startTime":63.96,"endTime":66.552,"body":"should. I know, we've gotten"},{"speaker":"Chris Dy","startTime":66.606,"endTime":69.956,"body":"some great emails from listeners"},{"speaker":"Chris Dy","startTime":66.606,"endTime":69.956,"body":"about AI, and I think that we"},{"speaker":"Chris Dy","startTime":70.01,"endTime":72.927,"body":"should probably devote an"},{"speaker":"Chris Dy","startTime":70.01,"endTime":72.927,"body":"episode to it, to maybe even"},{"speaker":"Chris Dy","startTime":72.981,"endTime":76.384,"body":"have a guest again in terms of"},{"speaker":"Chris Dy","startTime":72.981,"endTime":76.384,"body":"discussing that, what's going on"},{"speaker":"Chris Dy","startTime":76.438,"endTime":79.679,"body":"in your world? Penny, I've got a"},{"speaker":"Chris Dy","startTime":76.438,"endTime":79.679,"body":"meeting coming up. I'm very"},{"speaker":"Chris Dy","startTime":79.733,"endTime":83.029,"body":"excited about by the time this"},{"speaker":"Chris Dy","startTime":79.733,"endTime":83.029,"body":"episode drops, it'll be on the"},{"speaker":"Chris Dy","startTime":83.083,"endTime":85.46,"body":"tail end of that meeting. But"},{"speaker":"Chris Dy","startTime":83.083,"endTime":85.46,"body":"how about you?"},{"speaker":"Charles Goldfarb","startTime":85.46,"endTime":88.267,"body":"Yeah well, I"},{"speaker":"Charles Goldfarb","startTime":85.46,"endTime":88.267,"body":"can't compete with a Hawaii"},{"speaker":"Charles Goldfarb","startTime":88.337,"endTime":92.688,"body":"meeting. There's no competing"},{"speaker":"Charles Goldfarb","startTime":88.337,"endTime":92.688,"body":"with that. No. Life is a quiet B"},{"speaker":"Charles Goldfarb","startTime":92.758,"endTime":97.179,"body":"School. Last four months, a lot"},{"speaker":"Charles Goldfarb","startTime":92.758,"endTime":97.179,"body":"of travel coming up, but all is"},{"speaker":"Charles Goldfarb","startTime":97.249,"endTime":101.32,"body":"well, had a great holiday with"},{"speaker":"Charles Goldfarb","startTime":97.249,"endTime":101.32,"body":"the family. Yeah? All good."},{"speaker":"Chris Dy","startTime":101.32,"endTime":103.459,"body":"Yeah its good."},{"speaker":"Chris Dy","startTime":101.32,"endTime":103.459,"body":"Somebody asked me recently about"},{"speaker":"Chris Dy","startTime":103.504,"endTime":106.417,"body":"my travel coming up, and I had a"},{"speaker":"Chris Dy","startTime":103.504,"endTime":106.417,"body":"hard time remembering it, which"},{"speaker":"Chris Dy","startTime":106.463,"endTime":109.376,"body":"is good in terms of work related"},{"speaker":"Chris Dy","startTime":106.463,"endTime":109.376,"body":"trips. I'm very happy right now"},{"speaker":"Chris Dy","startTime":109.421,"endTime":112.289,"body":"that I don't have a lot coming"},{"speaker":"Chris Dy","startTime":109.421,"endTime":112.289,"body":"up. We've got a big spring break"},{"speaker":"Chris Dy","startTime":112.334,"endTime":115.065,"body":"trip coming up in a couple of"},{"speaker":"Chris Dy","startTime":112.334,"endTime":115.065,"body":"months. But yes, it's a people"},{"speaker":"Chris Dy","startTime":115.111,"endTime":117.842,"body":"always ask, you know, you say"},{"speaker":"Chris Dy","startTime":115.111,"endTime":117.842,"body":"you're going to a meeting, and"},{"speaker":"Chris Dy","startTime":117.887,"endTime":120.391,"body":"they say where, and they"},{"speaker":"Chris Dy","startTime":117.887,"endTime":120.391,"body":"immediately judge you when you"},{"speaker":"Chris Dy","startTime":120.436,"endTime":122.803,"body":"say Hawaii, but it's the"},{"speaker":"Chris Dy","startTime":120.436,"endTime":122.803,"body":"American Society peripheral"},{"speaker":"Chris Dy","startTime":122.849,"endTime":125.716,"body":"nerve and also, concomitantly,"},{"speaker":"Chris Dy","startTime":122.849,"endTime":125.716,"body":"the American Association of hand"},{"speaker":"Chris Dy","startTime":125.762,"endTime":128.538,"body":"surgery. Although I'm not really"},{"speaker":"Chris Dy","startTime":125.762,"endTime":128.538,"body":"doing much for that meeting,"},{"speaker":"Chris Dy","startTime":128.584,"endTime":130.86,"body":"aside from a jointly program at"},{"speaker":"Chris Dy","startTime":128.584,"endTime":130.86,"body":"ICL with the aspn,"},{"speaker":"Charles Goldfarb","startTime":131.4,"endTime":133.62,"body":"I'm definitely"},{"speaker":"Charles Goldfarb","startTime":131.4,"endTime":133.62,"body":"judging, but all right, a little"},{"speaker":"Charles Goldfarb","startTime":133.62,"endTime":137.7,"body":"bit of a tangent. 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But"},{"speaker":"Charles Goldfarb","startTime":153.74,"endTime":158.0,"body":"occasionally I see Jesse. And I"},{"speaker":"Charles Goldfarb","startTime":153.74,"endTime":158.0,"body":"met and hung out with Jesse a"},{"speaker":"Charles Goldfarb","startTime":158.0,"endTime":162.22,"body":"bit when I did the Duke"},{"speaker":"Charles Goldfarb","startTime":158.0,"endTime":162.22,"body":"basketball camp, and that's been"},{"speaker":"Charles Goldfarb","startTime":162.22,"endTime":163.72,"body":"many years, like we had"},{"speaker":"Chris Dy","startTime":163.72,"endTime":166.6,"body":"tried, I forgot about"},{"speaker":"Chris Dy","startTime":163.72,"endTime":166.6,"body":"that. That is, that is some"},{"speaker":"Chris Dy","startTime":166.6,"endTime":170.8,"body":"grown person, uh, I've made it,"},{"speaker":"Chris Dy","startTime":166.6,"endTime":170.8,"body":"and I want to relive my, uh, my"},{"speaker":"Chris Dy","startTime":170.8,"endTime":171.7,"body":"childhood dreams,"},{"speaker":"Charles Goldfarb","startTime":171.88,"endTime":173.98,"body":"yeah. And the"},{"speaker":"Charles Goldfarb","startTime":171.88,"endTime":173.98,"body":"key is, I think you have to be"},{"speaker":"Charles Goldfarb","startTime":173.98,"endTime":176.08,"body":"at least 35 to do it. I was"},{"speaker":"Charles Goldfarb","startTime":173.98,"endTime":176.08,"body":"maybe 36"},{"speaker":"Chris Dy","startTime":176.56,"endTime":178.66,"body":"but I don't have"},{"speaker":"Chris Dy","startTime":176.56,"endTime":178.66,"body":"enough money to do it until"},{"speaker":"Chris Dy","startTime":178.66,"endTime":181.32,"body":"you're 35 or 36 if you do then"},{"speaker":"Charles Goldfarb","startTime":181.32,"endTime":184.14,"body":"that's exactly"},{"speaker":"Charles Goldfarb","startTime":181.32,"endTime":184.14,"body":"right. Anyways, talking about"},{"speaker":"Charles Goldfarb","startTime":184.14,"endTime":187.26,"body":"the travel I have thought about,"},{"speaker":"Charles Goldfarb","startTime":184.14,"endTime":187.26,"body":"I think you may have something"},{"speaker":"Charles Goldfarb","startTime":187.26,"endTime":190.56,"body":"like this in your office. He is"},{"speaker":"Charles Goldfarb","startTime":187.26,"endTime":190.56,"body":"like, sort of marketing this"},{"speaker":"Charles Goldfarb","startTime":190.56,"endTime":195.42,"body":"year long, massive calendar"},{"speaker":"Charles Goldfarb","startTime":190.56,"endTime":195.42,"body":"where you visualize what you do,"},{"speaker":"Charles Goldfarb","startTime":195.42,"endTime":198.24,"body":"right there. Yeah, five times"},{"speaker":"Charles Goldfarb","startTime":195.42,"endTime":198.24,"body":"that side."},{"speaker":"Chris Dy","startTime":198.96,"endTime":201.2,"body":"I used to have a"},{"speaker":"Chris Dy","startTime":198.96,"endTime":201.2,"body":"bigger one, but then somebody"},{"speaker":"Chris Dy","startTime":201.2,"endTime":202.52,"body":"made me move offices. And, yeah,"},{"speaker":"Chris Dy","startTime":201.2,"endTime":202.52,"body":"yeah,"},{"speaker":"Charles Goldfarb","startTime":204.08,"endTime":205.94,"body":"it's just"},{"speaker":"Charles Goldfarb","startTime":204.08,"endTime":205.94,"body":"interesting, because I do I"},{"speaker":"Charles Goldfarb","startTime":205.94,"endTime":209.6,"body":"struggle and like, I think my"},{"speaker":"Charles Goldfarb","startTime":205.94,"endTime":209.6,"body":"stress level is directly"},{"speaker":"Charles Goldfarb","startTime":209.6,"endTime":214.04,"body":"proportional to my grasp of what"},{"speaker":"Charles Goldfarb","startTime":209.6,"endTime":214.04,"body":"I have going on. So occasionally"},{"speaker":"Charles Goldfarb","startTime":214.04,"endTime":218.0,"body":"I go take these deep dives into"},{"speaker":"Charles Goldfarb","startTime":214.04,"endTime":218.0,"body":"what, where I'm traveling, how"},{"speaker":"Charles Goldfarb","startTime":218.0,"endTime":221.98,"body":"I'm prepared. Do I need my"},{"speaker":"Charles Goldfarb","startTime":218.0,"endTime":221.98,"body":"tickets and all that stuff. And"},{"speaker":"Charles Goldfarb","startTime":222.16,"endTime":224.98,"body":"there's many techniques to"},{"speaker":"Charles Goldfarb","startTime":222.16,"endTime":224.98,"body":"decrease the stress, but just"},{"speaker":"Charles Goldfarb","startTime":224.98,"endTime":227.8,"body":"organization and visualization"},{"speaker":"Charles Goldfarb","startTime":224.98,"endTime":227.8,"body":"help. Yeah,"},{"speaker":"Chris Dy","startTime":227.8,"endTime":230.68,"body":"no, I'm a big visual"},{"speaker":"Chris Dy","startTime":227.8,"endTime":230.68,"body":"person, so whether it's doing a"},{"speaker":"Chris Dy","startTime":230.68,"endTime":233.14,"body":"wall calendar for traveling, or"},{"speaker":"Chris Dy","startTime":230.68,"endTime":233.14,"body":"whether it's when I have my New"},{"speaker":"Chris Dy","startTime":233.14,"endTime":235.72,"body":"Year's resolutions like"},{"speaker":"Chris Dy","startTime":233.14,"endTime":235.72,"body":"literally checking a calendar"},{"speaker":"Chris Dy","startTime":235.72,"endTime":238.78,"body":"box, which we, which I did talk"},{"speaker":"Chris Dy","startTime":235.72,"endTime":238.78,"body":"about with a fellow recently,"},{"speaker":"Chris Dy","startTime":238.96,"endTime":243.0,"body":"Eric Jang, about his new year's"},{"speaker":"Chris Dy","startTime":238.96,"endTime":243.0,"body":"resolutions, and I'm big visual"},{"speaker":"Chris Dy","startTime":243.0,"endTime":246.84,"body":"person, so I think I don't know"},{"speaker":"Chris Dy","startTime":243.0,"endTime":246.84,"body":"you probably are at the point as"},{"speaker":"Chris Dy","startTime":246.84,"endTime":249.54,"body":"an executive now where you are"},{"speaker":"Chris Dy","startTime":246.84,"endTime":249.54,"body":"probably counting the number of"},{"speaker":"Chris Dy","startTime":249.54,"endTime":251.94,"body":"days you travel. I know a lot of"},{"speaker":"Chris Dy","startTime":249.54,"endTime":251.94,"body":"people who are big in the"},{"speaker":"Chris Dy","startTime":251.94,"endTime":255.06,"body":"executive space will say, I'm"},{"speaker":"Chris Dy","startTime":251.94,"endTime":255.06,"body":"only traveling X number of days"},{"speaker":"Chris Dy","startTime":255.06,"endTime":258.42,"body":"this year, and become much more"},{"speaker":"Chris Dy","startTime":255.06,"endTime":258.42,"body":"selective about which"},{"speaker":"Chris Dy","startTime":258.42,"endTime":261.86,"body":"opportunities they declined or"},{"speaker":"Chris Dy","startTime":258.42,"endTime":261.86,"body":"accept based on how much travel"},{"speaker":"Chris Dy","startTime":262.7,"endTime":266.24,"body":"they've already committed to."},{"speaker":"Chris Dy","startTime":262.7,"endTime":266.24,"body":"So, yeah, no, I need to see it."},{"speaker":"Chris Dy","startTime":266.36,"endTime":268.88,"body":"Whenever some trip comes up or"},{"speaker":"Chris Dy","startTime":266.36,"endTime":268.88,"body":"an invite comes in"},{"speaker":"Chris Dy","startTime":268.88,"endTime":272.06,"body":"automatically, the email is to"},{"speaker":"Chris Dy","startTime":268.88,"endTime":272.06,"body":"my admin saying, please put this"},{"speaker":"Chris Dy","startTime":272.06,"endTime":274.46,"body":"on Outlook. Please let the"},{"speaker":"Chris Dy","startTime":272.06,"endTime":274.46,"body":"clinical team know, and please"},{"speaker":"Chris Dy","startTime":274.46,"endTime":278.54,"body":"put it on the wall. Calendar."},{"speaker":"Chris Dy","startTime":274.46,"endTime":278.54,"body":"Has to happen. I need to see it"},{"speaker":"Chris Dy","startTime":278.54,"endTime":280.84,"body":"in a certain way, in multiple"},{"speaker":"Chris Dy","startTime":278.54,"endTime":280.84,"body":"that way, I still print out"},{"speaker":"Chris Dy","startTime":280.84,"endTime":282.7,"body":"things too. So I mean, yeah,"},{"speaker":"Chris Dy","startTime":280.84,"endTime":282.7,"body":"it's so"},{"speaker":"Charles Goldfarb","startTime":282.7,"endTime":284.56,"body":"interesting"},{"speaker":"Charles Goldfarb","startTime":282.7,"endTime":284.56,"body":"because you're not the only one"},{"speaker":"Charles Goldfarb","startTime":284.56,"endTime":288.82,"body":"who prints things out. I am old"},{"speaker":"Charles Goldfarb","startTime":284.56,"endTime":288.82,"body":"and do not print stuff out, but"},{"speaker":"Charles Goldfarb","startTime":288.82,"endTime":292.48,"body":"Lindley wall is another example."},{"speaker":"Charles Goldfarb","startTime":288.82,"endTime":292.48,"body":"She prints everything out or"},{"speaker":"Charles Goldfarb","startTime":292.48,"endTime":293.26,"body":"handwrites."},{"speaker":"Chris Dy","startTime":293.8,"endTime":297.82,"body":"I remember getting a"},{"speaker":"Chris Dy","startTime":293.8,"endTime":297.82,"body":"manuscript back from a, I'll"},{"speaker":"Chris Dy","startTime":297.82,"endTime":301.02,"body":"say, from Dr McKinnon, and I got"},{"speaker":"Chris Dy","startTime":297.82,"endTime":301.02,"body":"him. I just heard back from her."},{"speaker":"Chris Dy","startTime":301.02,"endTime":303.54,"body":"We were working together on a"},{"speaker":"Chris Dy","startTime":301.02,"endTime":303.54,"body":"paper. It was printed, it was in"},{"speaker":"Chris Dy","startTime":303.54,"endTime":306.6,"body":"red pencil. And I was like, this"},{"speaker":"Chris Dy","startTime":303.54,"endTime":306.6,"body":"is just like my childhood, like"},{"speaker":"Chris Dy","startTime":307.56,"endTime":310.86,"body":"I used to send my papers to give"},{"speaker":"Chris Dy","startTime":307.56,"endTime":310.86,"body":"my my older sister, who's an"},{"speaker":"Chris Dy","startTime":310.86,"endTime":314.4,"body":"amazing writer, I would give her"},{"speaker":"Chris Dy","startTime":310.86,"endTime":314.4,"body":"my papers to edit, and she made"},{"speaker":"Chris Dy","startTime":314.4,"endTime":316.68,"body":"me a much better writer, but it"},{"speaker":"Chris Dy","startTime":314.4,"endTime":316.68,"body":"would always come back in red"},{"speaker":"Chris Dy","startTime":317.4,"endTime":320.42,"body":"pen, so a little bit of PTSD,"},{"speaker":"Chris Dy","startTime":317.4,"endTime":320.42,"body":"but it may be better in the end,"},{"speaker":"Chris Dy","startTime":320.42,"endTime":323.06,"body":"and actually helped rewrite a"},{"speaker":"Chris Dy","startTime":320.42,"endTime":323.06,"body":"introduction for a medical"},{"speaker":"Chris Dy","startTime":323.06,"endTime":326.66,"body":"student yesterday, and I wrote"},{"speaker":"Chris Dy","startTime":323.06,"endTime":326.66,"body":"it out on the notepad and then"},{"speaker":"Chris Dy","startTime":326.66,"endTime":329.6,"body":"just typed it up because it just"},{"speaker":"Chris Dy","startTime":326.66,"endTime":329.6,"body":"the thoughts flow better for me"},{"speaker":"Chris Dy","startTime":329.66,"endTime":331.52,"body":"when I have pen in hand. That's"},{"speaker":"Charles Goldfarb","startTime":331.52,"endTime":333.86,"body":"so"},{"speaker":"Charles Goldfarb","startTime":331.52,"endTime":333.86,"body":"interesting. I think it's a this"},{"speaker":"Charles Goldfarb","startTime":333.86,"endTime":337.28,"body":"is a real to me. This is a super"},{"speaker":"Charles Goldfarb","startTime":333.86,"endTime":337.28,"body":"interesting topic because it's"},{"speaker":"Charles Goldfarb","startTime":337.28,"endTime":340.9,"body":"also about like, how do we"},{"speaker":"Charles Goldfarb","startTime":337.28,"endTime":340.9,"body":"absorb knowledge from a reading"},{"speaker":"Charles Goldfarb","startTime":340.9,"endTime":345.22,"body":"perspective, like, can you learn"},{"speaker":"Charles Goldfarb","startTime":340.9,"endTime":345.22,"body":"reading and highlighting on a"},{"speaker":"Charles Goldfarb","startTime":345.22,"endTime":349.54,"body":"PDF versus a printed document"},{"speaker":"Charles Goldfarb","startTime":345.22,"endTime":349.54,"body":"where you're marking it up? I"},{"speaker":"Charles Goldfarb","startTime":349.54,"endTime":353.98,"body":"actually have made myself"},{"speaker":"Charles Goldfarb","startTime":349.54,"endTime":353.98,"body":"transition to the PDF absorption"},{"speaker":"Charles Goldfarb","startTime":353.98,"endTime":357.34,"body":"model, and that's what I've done"},{"speaker":"Charles Goldfarb","startTime":353.98,"endTime":357.34,"body":"in school as well. But as I"},{"speaker":"Charles Goldfarb","startTime":357.34,"endTime":359.92,"body":"think I've mentioned before,"},{"speaker":"Charles Goldfarb","startTime":357.34,"endTime":359.92,"body":"again, I'm one of the older"},{"speaker":"Charles Goldfarb","startTime":359.92,"endTime":364.2,"body":"people in my class, and I'm one"},{"speaker":"Charles Goldfarb","startTime":359.92,"endTime":364.2,"body":"of the few people who uses an"},{"speaker":"Charles Goldfarb","startTime":364.2,"endTime":368.34,"body":"iPad and markup like that rather"},{"speaker":"Charles Goldfarb","startTime":364.2,"endTime":368.34,"body":"than looking at the printed"},{"speaker":"Charles Goldfarb","startTime":368.34,"endTime":368.88,"body":"version."},{"speaker":"Chris Dy","startTime":369.3,"endTime":371.58,"body":"So when you go to this"},{"speaker":"Chris Dy","startTime":369.3,"endTime":371.58,"body":"really interesting point, when"},{"speaker":"Chris Dy","startTime":371.58,"endTime":374.94,"body":"you go to a executive council"},{"speaker":"Chris Dy","startTime":371.58,"endTime":374.94,"body":"meeting or whatever for the hand"},{"speaker":"Chris Dy","startTime":374.94,"endTime":377.34,"body":"society, or everything else that"},{"speaker":"Chris Dy","startTime":374.94,"endTime":377.34,"body":"you do, a lot of times, those"},{"speaker":"Chris Dy","startTime":377.34,"endTime":379.62,"body":"agendas now are completely"},{"speaker":"Chris Dy","startTime":377.34,"endTime":379.62,"body":"electronic, and they say we're"},{"speaker":"Chris Dy","startTime":379.62,"endTime":382.34,"body":"not going to print them. Do you"},{"speaker":"Chris Dy","startTime":379.62,"endTime":382.34,"body":"still print them? Or do you just"},{"speaker":"Chris Dy","startTime":382.34,"endTime":383.12,"body":"go electronic? Oh,"},{"speaker":"Charles Goldfarb","startTime":383.12,"endTime":384.86,"body":"I haven't"},{"speaker":"Charles Goldfarb","startTime":383.12,"endTime":384.86,"body":"printed anything like that in 10"},{"speaker":"Charles Goldfarb","startTime":384.86,"endTime":387.26,"body":"years. Yeah. Do you still print"},{"speaker":"Chris Dy","startTime":387.98,"endTime":389.84,"body":"occasionally,"},{"speaker":"Chris Dy","startTime":387.98,"endTime":389.84,"body":"occasionally. Sometimes it's"},{"speaker":"Chris Dy","startTime":389.84,"endTime":392.18,"body":"because I forget to attach the"},{"speaker":"Chris Dy","startTime":389.84,"endTime":392.18,"body":"PDF to the outlook. It's all"},{"speaker":"Chris Dy","startTime":392.18,"endTime":396.8,"body":"thing, but, but, yeah, no, and"},{"speaker":"Chris Dy","startTime":392.18,"endTime":396.8,"body":"I've gotten grief from the"},{"speaker":"Chris Dy","startTime":396.8,"endTime":399.86,"body":"amazing Hand Therapist I work"},{"speaker":"Chris Dy","startTime":396.8,"endTime":399.86,"body":"with in clinic, Jamie find dice."},{"speaker":"Chris Dy","startTime":399.86,"endTime":402.28,"body":"She gives me grief, because"},{"speaker":"Chris Dy","startTime":399.86,"endTime":402.28,"body":"every time I read an OP note,"},{"speaker":"Chris Dy","startTime":402.28,"endTime":405.04,"body":"because I'm like, going to tell"},{"speaker":"Chris Dy","startTime":402.28,"endTime":405.04,"body":"her something, I will highlight"},{"speaker":"Chris Dy","startTime":405.04,"endTime":408.94,"body":"the text as I'm reading, and"},{"speaker":"Chris Dy","startTime":405.04,"endTime":408.94,"body":"somewhere, it's like a pet peeve"},{"speaker":"Chris Dy","startTime":408.94,"endTime":411.16,"body":"of hers or something, and I"},{"speaker":"Chris Dy","startTime":408.94,"endTime":411.16,"body":"didn't realize I was doing it."},{"speaker":"Chris Dy","startTime":411.16,"endTime":413.86,"body":"So I'm big highlighter, you"},{"speaker":"Chris Dy","startTime":411.16,"endTime":413.86,"body":"know, my I had to restrain"},{"speaker":"Chris Dy","startTime":413.86,"endTime":416.38,"body":"myself when I was in medical"},{"speaker":"Chris Dy","startTime":413.86,"endTime":416.38,"body":"school the number of different"},{"speaker":"Chris Dy","startTime":416.38,"endTime":418.48,"body":"highlighted sections, because"},{"speaker":"Chris Dy","startTime":416.38,"endTime":418.48,"body":"then the entire page was"},{"speaker":"Chris Dy","startTime":418.48,"endTime":419.74,"body":"highlighted when I was reading."},{"speaker":"Chris Dy","startTime":418.48,"endTime":419.74,"body":"So"},{"speaker":"Charles Goldfarb","startTime":420.4,"endTime":422.22,"body":"that's exactly"},{"speaker":"Charles Goldfarb","startTime":420.4,"endTime":422.22,"body":"right. I mean, there are some,"},{"speaker":"Charles Goldfarb","startTime":422.28,"endTime":427.02,"body":"and my kids obviously guided me."},{"speaker":"Charles Goldfarb","startTime":422.28,"endTime":427.02,"body":"There are some amazing apps for"},{"speaker":"Charles Goldfarb","startTime":427.02,"endTime":431.76,"body":"the iPad, I'm sure, for every"},{"speaker":"Charles Goldfarb","startTime":427.02,"endTime":431.76,"body":"trying device, that really allow"},{"speaker":"Charles Goldfarb","startTime":431.76,"endTime":435.54,"body":"you to mark it up, like it's"},{"speaker":"Charles Goldfarb","startTime":431.76,"endTime":435.54,"body":"like it's a printed document. So"},{"speaker":"Charles Goldfarb","startTime":435.6,"endTime":438.78,"body":"it's been great. I really like"},{"speaker":"Charles Goldfarb","startTime":435.6,"endTime":438.78,"body":"it. I've adjusted, I've adapted."},{"speaker":"Charles Goldfarb","startTime":438.78,"endTime":442.1,"body":"And the more you mark up, I"},{"speaker":"Charles Goldfarb","startTime":438.78,"endTime":442.1,"body":"think the more interactive you"},{"speaker":"Charles Goldfarb","startTime":442.1,"endTime":443.42,"body":"are, however you do it, the"},{"speaker":"Charles Goldfarb","startTime":442.1,"endTime":443.42,"body":"better"},{"speaker":"Chris Dy","startTime":443.96,"endTime":450.2,"body":"see that dog's getting"},{"speaker":"Chris Dy","startTime":443.96,"endTime":450.2,"body":"some new tricks. So we have some"},{"speaker":"Chris Dy","startTime":450.2,"endTime":453.68,"body":"really interesting cases to"},{"speaker":"Chris Dy","startTime":450.2,"endTime":453.68,"body":"discuss today. I've centered"},{"speaker":"Chris Dy","startTime":453.68,"endTime":456.08,"body":"around thumb, CMC, I know I sort"},{"speaker":"Chris Dy","startTime":453.68,"endTime":456.08,"body":"of surprised you with this"},{"speaker":"Chris Dy","startTime":456.08,"endTime":458.72,"body":"topic, with this request, but I"},{"speaker":"Chris Dy","startTime":456.08,"endTime":458.72,"body":"think it's been it's relevant. I"},{"speaker":"Chris Dy","startTime":458.72,"endTime":461.74,"body":"had some really interesting"},{"speaker":"Chris Dy","startTime":458.72,"endTime":461.74,"body":"questions to ask you about it,"},{"speaker":"Chris Dy","startTime":461.74,"endTime":464.5,"body":"but first, before we dive into"},{"speaker":"Chris Dy","startTime":461.74,"endTime":464.5,"body":"our clinical topic, we should"},{"speaker":"Chris Dy","startTime":464.5,"endTime":466.78,"body":"probably acknowledge our"},{"speaker":"Chris Dy","startTime":464.5,"endTime":466.78,"body":"wonderful sponsors and friends"},{"speaker":"Chris Dy","startTime":466.78,"endTime":467.74,"body":"over at practice link,"},{"speaker":"Charles Goldfarb","startTime":467.86,"endTime":469.78,"body":"absolutely,"},{"speaker":"Charles Goldfarb","startTime":467.86,"endTime":469.78,"body":"the upper hand is sponsored by"},{"speaker":"Charles Goldfarb","startTime":469.78,"endTime":473.5,"body":"practicelink.com the most widely"},{"speaker":"Charles Goldfarb","startTime":469.78,"endTime":473.5,"body":"used physician job search and"},{"speaker":"Charles Goldfarb","startTime":473.5,"endTime":475.66,"body":"career advancement resource."},{"speaker":"Chris Dy","startTime":475.9,"endTime":478.6,"body":"Becoming a physician"},{"speaker":"Chris Dy","startTime":475.9,"endTime":478.6,"body":"is hard. Finding the right job"},{"speaker":"Chris Dy","startTime":478.6,"endTime":480.82,"body":"doesn't have to be join practice"},{"speaker":"Chris Dy","startTime":478.6,"endTime":480.82,"body":"link, for free today at"},{"speaker":"Chris Dy","startTime":480.82,"endTime":486.72,"body":"www.practicelink.com/the upper"},{"speaker":"Chris Dy","startTime":480.82,"endTime":486.72,"body":"hand. Now, one thing I want to"},{"speaker":"Chris Dy","startTime":486.72,"endTime":490.74,"body":"ask the folks that are listening"},{"speaker":"Chris Dy","startTime":486.72,"endTime":490.74,"body":"or watching, before we dive into"},{"speaker":"Chris Dy","startTime":490.74,"endTime":494.16,"body":"the case, is, I grew up in"},{"speaker":"Chris Dy","startTime":490.74,"endTime":494.16,"body":"Florida, and I'm trying to"},{"speaker":"Chris Dy","startTime":494.16,"endTime":497.22,"body":"figure out how to deal with all"},{"speaker":"Chris Dy","startTime":494.16,"endTime":497.22,"body":"the snow. And the question I"},{"speaker":"Chris Dy","startTime":497.22,"endTime":499.68,"body":"have is, do you two questions"},{"speaker":"Chris Dy","startTime":497.22,"endTime":499.68,"body":"just to throw out there? You"},{"speaker":"Chris Dy","startTime":499.68,"endTime":502.08,"body":"don't have to answer tonight. I"},{"speaker":"Chris Dy","startTime":499.68,"endTime":502.08,"body":"just want people to tell me what"},{"speaker":"Chris Dy","startTime":502.08,"endTime":506.06,"body":"they think you think. Do you"},{"speaker":"Chris Dy","startTime":502.08,"endTime":506.06,"body":"salt your driveway, sidewalk,"},{"speaker":"Chris Dy","startTime":506.06,"endTime":510.5,"body":"etc, before the snow falls, or"},{"speaker":"Chris Dy","startTime":506.06,"endTime":510.5,"body":"do you wait until after the snow"},{"speaker":"Chris Dy","startTime":510.5,"endTime":514.1,"body":"falls, and then is there utility"},{"speaker":"Chris Dy","startTime":510.5,"endTime":514.1,"body":"in doing like a mid if you have"},{"speaker":"Chris Dy","startTime":514.82,"endTime":517.46,"body":"snowfall, and then you got to"},{"speaker":"Chris Dy","startTime":514.82,"endTime":517.46,"body":"break for a couple of hours"},{"speaker":"Chris Dy","startTime":517.52,"endTime":521.14,"body":"before the next wave? Should you"},{"speaker":"Chris Dy","startTime":517.52,"endTime":521.14,"body":"shovel before the next wave of"},{"speaker":"Chris Dy","startTime":521.14,"endTime":523.54,"body":"snow falls. So those are the"},{"speaker":"Chris Dy","startTime":521.14,"endTime":523.54,"body":"things that I've been struggling"},{"speaker":"Chris Dy","startTime":523.54,"endTime":526.3,"body":"with in the last week, trying to"},{"speaker":"Chris Dy","startTime":523.54,"endTime":526.3,"body":"figure out those"},{"speaker":"Charles Goldfarb","startTime":526.3,"endTime":528.1,"body":"are great"},{"speaker":"Charles Goldfarb","startTime":526.3,"endTime":528.1,"body":"questions. And I grew up in"},{"speaker":"Charles Goldfarb","startTime":528.1,"endTime":531.76,"body":"Alabama, so I'm not going to be"},{"speaker":"Charles Goldfarb","startTime":528.1,"endTime":531.76,"body":"the resource to help. This is an"},{"speaker":"Charles Goldfarb","startTime":531.82,"endTime":534.94,"body":"epic snowfall for St Louis,"},{"speaker":"Charles Goldfarb","startTime":531.82,"endTime":534.94,"body":"because for a couple of reasons."},{"speaker":"Charles Goldfarb","startTime":534.94,"endTime":538.48,"body":"One is typical that 24 hours"},{"speaker":"Charles Goldfarb","startTime":534.94,"endTime":538.48,"body":"later, it's 50 degrees and the"},{"speaker":"Charles Goldfarb","startTime":538.48,"endTime":541.8,"body":"snow is gone, and we have stacks"},{"speaker":"Charles Goldfarb","startTime":538.48,"endTime":541.8,"body":"of snow, which we never do, and"},{"speaker":"Charles Goldfarb","startTime":541.8,"endTime":544.26,"body":"now we're getting more snow. I"},{"speaker":"Charles Goldfarb","startTime":541.8,"endTime":544.26,"body":"don't know the answer to those"},{"speaker":"Charles Goldfarb","startTime":544.26,"endTime":547.5,"body":"questions. I don't have a"},{"speaker":"Charles Goldfarb","startTime":544.26,"endTime":547.5,"body":"snowblower. We marginally"},{"speaker":"Charles Goldfarb","startTime":547.5,"endTime":550.08,"body":"shoveled, but the reality is,"},{"speaker":"Charles Goldfarb","startTime":547.5,"endTime":550.08,"body":"we're sort of just ignoring it"},{"speaker":"Charles Goldfarb","startTime":550.08,"endTime":552.96,"body":"and hoping it goes away before"},{"speaker":"Charles Goldfarb","startTime":550.08,"endTime":552.96,"body":"neighbors complain or anything."},{"speaker":"Charles Goldfarb","startTime":553.14,"endTime":553.62,"body":"So it"},{"speaker":"Chris Dy","startTime":553.62,"endTime":556.98,"body":"was so gratifying to"},{"speaker":"Chris Dy","startTime":553.62,"endTime":556.98,"body":"shovel the driveway after, you"},{"speaker":"Chris Dy","startTime":556.98,"endTime":559.98,"body":"know, I had a case on the, you"},{"speaker":"Chris Dy","startTime":556.98,"endTime":559.98,"body":"know, the snow day that we have"},{"speaker":"Chris Dy","startTime":559.98,"endTime":563.24,"body":"was on Monday. I had a case that"},{"speaker":"Chris Dy","startTime":559.98,"endTime":563.24,"body":"went and then, fortunately, and"},{"speaker":"Chris Dy","startTime":563.24,"endTime":565.64,"body":"then my I came out of the case"},{"speaker":"Chris Dy","startTime":563.24,"endTime":565.64,"body":"and found that my clinic was"},{"speaker":"Chris Dy","startTime":565.64,"endTime":568.16,"body":"canceled, so I just knocked out"},{"speaker":"Chris Dy","startTime":565.64,"endTime":568.16,"body":"a bunch of stuff in the office."},{"speaker":"Chris Dy","startTime":568.22,"endTime":571.34,"body":"Had to buy a new snow shovel"},{"speaker":"Chris Dy","startTime":568.22,"endTime":571.34,"body":"because I fractured my first one"},{"speaker":"Chris Dy","startTime":573.14,"endTime":577.16,"body":"and learned that I needed"},{"speaker":"Chris Dy","startTime":573.14,"endTime":577.16,"body":"exactly they were my second"},{"speaker":"Chris Dy","startTime":577.16,"endTime":579.44,"body":"store. I was in luck, but I"},{"speaker":"Chris Dy","startTime":577.16,"endTime":579.44,"body":"bought two just in case."},{"speaker":"Charles Goldfarb","startTime":582.38,"endTime":583.78,"body":"Yes, let's"},{"speaker":"Chris Dy","startTime":583.78,"endTime":587.26,"body":"dive into our case. So"},{"speaker":"Chris Dy","startTime":583.78,"endTime":587.26,"body":"this is one that was sent in by"},{"speaker":"Chris Dy","startTime":587.26,"endTime":589.6,"body":"a listener, and for obvious"},{"speaker":"Chris Dy","startTime":587.26,"endTime":589.6,"body":"reasons, I'm not going to"},{"speaker":"Chris Dy","startTime":589.6,"endTime":593.68,"body":"disclose who, but we appreciate"},{"speaker":"Chris Dy","startTime":589.6,"endTime":593.68,"body":"you sending in a case. So this"},{"speaker":"Chris Dy","startTime":593.68,"endTime":596.44,"body":"is one in which there's a"},{"speaker":"Chris Dy","startTime":593.68,"endTime":596.44,"body":"younger patient, like young by"},{"speaker":"Chris Dy","startTime":596.44,"endTime":600.66,"body":"anybody's stretch of the"},{"speaker":"Chris Dy","startTime":596.44,"endTime":600.66,"body":"imagination, who had a. Pcectomy"},{"speaker":"Chris Dy","startTime":600.66,"endTime":603.96,"body":"and the suspension with a"},{"speaker":"Chris Dy","startTime":600.66,"endTime":603.96,"body":"tightrope. I don't know if"},{"speaker":"Chris Dy","startTime":603.96,"endTime":607.38,"body":"there's a way around discussing"},{"speaker":"Chris Dy","startTime":603.96,"endTime":607.38,"body":"the actual name of the implant,"},{"speaker":"Chris Dy","startTime":609.0,"endTime":613.32,"body":"but the pain and is still having"},{"speaker":"Chris Dy","startTime":609.0,"endTime":613.32,"body":"pain, and this is, you know, a"},{"speaker":"Chris Dy","startTime":613.32,"endTime":617.34,"body":"number of months later. The pain"},{"speaker":"Chris Dy","startTime":613.32,"endTime":617.34,"body":"is not necessarily at the"},{"speaker":"Chris Dy","startTime":617.82,"endTime":622.22,"body":"trapezium site, but is actually"},{"speaker":"Chris Dy","startTime":617.82,"endTime":622.22,"body":"just where the button is on the"},{"speaker":"Chris Dy","startTime":622.22,"endTime":627.08,"body":"second metacarpal. The question"},{"speaker":"Chris Dy","startTime":622.22,"endTime":627.08,"body":"is, you know, do you in terms"},{"speaker":"Chris Dy","startTime":627.08,"endTime":629.78,"body":"of, if you're going to do"},{"speaker":"Chris Dy","startTime":627.08,"endTime":629.78,"body":"something surgically, would"},{"speaker":"Chris Dy","startTime":629.78,"endTime":633.56,"body":"removing just the button"},{"speaker":"Chris Dy","startTime":629.78,"endTime":633.56,"body":"destabilize the construct? And"},{"speaker":"Chris Dy","startTime":633.56,"endTime":635.48,"body":"how would you go about that? I"},{"speaker":"Chris Dy","startTime":633.56,"endTime":635.48,"body":"mean, I don't have a lot of"},{"speaker":"Chris Dy","startTime":635.48,"endTime":637.7,"body":"experience with the tightrope,"},{"speaker":"Chris Dy","startTime":635.48,"endTime":637.7,"body":"so I'd love to hear your"},{"speaker":"Chris Dy","startTime":637.7,"endTime":639.8,"body":"thoughts. Chuck, yeah, so it's"},{"speaker":"Charles Goldfarb","startTime":639.8,"endTime":644.32,"body":"an interesting"},{"speaker":"Charles Goldfarb","startTime":639.8,"endTime":644.32,"body":"question. I'll start by saying I"},{"speaker":"Charles Goldfarb","startTime":644.32,"endTime":649.36,"body":"like the concept of the mini"},{"speaker":"Charles Goldfarb","startTime":644.32,"endTime":649.36,"body":"tight rope for CMC. You can use"},{"speaker":"Charles Goldfarb","startTime":649.36,"endTime":654.04,"body":"it for CMC arthritis. You can"},{"speaker":"Charles Goldfarb","startTime":649.36,"endTime":654.04,"body":"use it for instability."},{"speaker":"Charles Goldfarb","startTime":654.88,"endTime":658.0,"body":"Sometimes it can provide enough"},{"speaker":"Charles Goldfarb","startTime":654.88,"endTime":658.0,"body":"stability to kind of solve the"},{"speaker":"Charles Goldfarb","startTime":658.0,"endTime":662.1,"body":"problem. I never use it in a"},{"speaker":"Charles Goldfarb","startTime":658.0,"endTime":662.1,"body":"primary situation, but it is my"},{"speaker":"Charles Goldfarb","startTime":662.1,"endTime":666.0,"body":"go to of choice in a revision"},{"speaker":"Charles Goldfarb","startTime":662.1,"endTime":666.0,"body":"situation. The reason I don't"},{"speaker":"Charles Goldfarb","startTime":666.0,"endTime":670.02,"body":"use it in a primary situation is"},{"speaker":"Charles Goldfarb","startTime":666.0,"endTime":670.02,"body":"one it can be a little"},{"speaker":"Charles Goldfarb","startTime":670.08,"endTime":675.6,"body":"technically finicky to get the"},{"speaker":"Charles Goldfarb","startTime":670.08,"endTime":675.6,"body":"path directly correct between"},{"speaker":"Charles Goldfarb","startTime":675.6,"endTime":679.08,"body":"the base of the thumb metacarpal"},{"speaker":"Charles Goldfarb","startTime":675.6,"endTime":679.08,"body":"and the base of the second"},{"speaker":"Charles Goldfarb","startTime":679.08,"endTime":683.48,"body":"metacarpal, and that can be a"},{"speaker":"Charles Goldfarb","startTime":679.08,"endTime":683.48,"body":"little tricky, not that tricky,"},{"speaker":"Charles Goldfarb","startTime":683.48,"endTime":687.08,"body":"but can be a little tricky. And"},{"speaker":"Charles Goldfarb","startTime":683.48,"endTime":687.08,"body":"you want to not just hit the"},{"speaker":"Charles Goldfarb","startTime":687.08,"endTime":689.54,"body":"second metacarpal. You sort of"},{"speaker":"Charles Goldfarb","startTime":687.08,"endTime":689.54,"body":"want to hit the second"},{"speaker":"Charles Goldfarb","startTime":689.66,"endTime":694.22,"body":"metacarpal in a way that the"},{"speaker":"Charles Goldfarb","startTime":689.66,"endTime":694.22,"body":"button that will be on the ulnar"},{"speaker":"Charles Goldfarb","startTime":694.22,"endTime":697.28,"body":"side of the second metacarpal is"},{"speaker":"Charles Goldfarb","startTime":694.22,"endTime":697.28,"body":"not too dorsal,"},{"speaker":"Chris Dy","startTime":697.82,"endTime":700.36,"body":"right? So it's got to"},{"speaker":"Chris Dy","startTime":697.82,"endTime":700.36,"body":"be straight, ulnar and not"},{"speaker":"Chris Dy","startTime":700.36,"endTime":701.8,"body":"dorsal, right?"},{"speaker":"Charles Goldfarb","startTime":701.8,"endTime":703.84,"body":"And then you"},{"speaker":"Charles Goldfarb","startTime":701.8,"endTime":703.84,"body":"ideally even can bring some"},{"speaker":"Charles Goldfarb","startTime":703.84,"endTime":710.08,"body":"fascia over the top to prevent"},{"speaker":"Charles Goldfarb","startTime":703.84,"endTime":710.08,"body":"this problem. And so this is a"},{"speaker":"Charles Goldfarb","startTime":710.08,"endTime":715.84,"body":"problem. This is a recognized"},{"speaker":"Charles Goldfarb","startTime":710.08,"endTime":715.84,"body":"frustration with this technique."},{"speaker":"Charles Goldfarb","startTime":716.26,"endTime":719.56,"body":"And the reality is, I am fully"},{"speaker":"Charles Goldfarb","startTime":716.26,"endTime":719.56,"body":"supportive. Knock on wood. I've"},{"speaker":"Charles Goldfarb","startTime":719.56,"endTime":723.12,"body":"not had to do this, but we, the"},{"speaker":"Charles Goldfarb","startTime":719.56,"endTime":723.12,"body":"person, should absolutely take"},{"speaker":"Charles Goldfarb","startTime":723.12,"endTime":727.62,"body":"out the button, because I think"},{"speaker":"Charles Goldfarb","startTime":723.12,"endTime":727.62,"body":"that conceptually, you're"},{"speaker":"Charles Goldfarb","startTime":727.62,"endTime":731.22,"body":"looking for scar tissue, like"},{"speaker":"Charles Goldfarb","startTime":727.62,"endTime":731.22,"body":"you are with an internal brace,"},{"speaker":"Charles Goldfarb","startTime":731.22,"endTime":735.72,"body":"and like you are with a"},{"speaker":"Charles Goldfarb","startTime":731.22,"endTime":735.72,"body":"trapezium with pinning. You're"},{"speaker":"Charles Goldfarb","startTime":735.72,"endTime":739.44,"body":"just looking for scar tissue."},{"speaker":"Charles Goldfarb","startTime":735.72,"endTime":739.44,"body":"And usually that's sufficient."},{"speaker":"Chris Dy","startTime":740.22,"endTime":742.58,"body":"So it's, that's, I"},{"speaker":"Chris Dy","startTime":740.22,"endTime":742.58,"body":"mean, so a lot of great pearls"},{"speaker":"Chris Dy","startTime":742.58,"endTime":745.34,"body":"in there. And I don't have, you"},{"speaker":"Chris Dy","startTime":742.58,"endTime":745.34,"body":"know, I think I saw one of these"},{"speaker":"Chris Dy","startTime":745.34,"endTime":748.64,"body":"in residency, and then when I"},{"speaker":"Chris Dy","startTime":745.34,"endTime":748.64,"body":"got here, nobody was doing it"},{"speaker":"Chris Dy","startTime":748.64,"endTime":751.28,"body":"for fellowship, so I haven't"},{"speaker":"Chris Dy","startTime":748.64,"endTime":751.28,"body":"really seen it. It's interesting"},{"speaker":"Chris Dy","startTime":751.28,"endTime":753.8,"body":"that, and I'm aware of the"},{"speaker":"Chris Dy","startTime":751.28,"endTime":753.8,"body":"literature that she described"},{"speaker":"Chris Dy","startTime":753.86,"endTime":757.52,"body":"with this being an issue. I"},{"speaker":"Chris Dy","startTime":753.86,"endTime":757.52,"body":"mean, you know, you describe"},{"speaker":"Chris Dy","startTime":757.52,"endTime":760.46,"body":"that as your go to technique for"},{"speaker":"Chris Dy","startTime":757.52,"endTime":760.46,"body":"a revision. Does it matter what"},{"speaker":"Chris Dy","startTime":760.46,"endTime":762.82,"body":"was done the first time around?"},{"speaker":"Chris Dy","startTime":760.46,"endTime":762.82,"body":"Because then, when I talk to"},{"speaker":"Chris Dy","startTime":762.82,"endTime":764.92,"body":"patients about difference"},{"speaker":"Chris Dy","startTime":762.82,"endTime":764.92,"body":"between a suture, tape,"},{"speaker":"Chris Dy","startTime":764.92,"endTime":768.76,"body":"suspension, internal brace kind"},{"speaker":"Chris Dy","startTime":764.92,"endTime":768.76,"body":"of thing versus an lrti, I tell"},{"speaker":"Chris Dy","startTime":768.76,"endTime":772.12,"body":"them, you know, my backup is the"},{"speaker":"Chris Dy","startTime":768.76,"endTime":772.12,"body":"other one. I don't really even"},{"speaker":"Chris Dy","startTime":772.12,"endTime":774.7,"body":"put tight rope in the equation."},{"speaker":"Chris Dy","startTime":772.12,"endTime":774.7,"body":"I think I'm biased because of"},{"speaker":"Chris Dy","startTime":774.7,"endTime":777.64,"body":"how it was trained. But when is"},{"speaker":"Chris Dy","startTime":774.7,"endTime":777.64,"body":"this your go to like?"},{"speaker":"Charles Goldfarb","startTime":778.3,"endTime":783.3,"body":"So the benefit"},{"speaker":"Charles Goldfarb","startTime":778.3,"endTime":783.3,"body":"of using this technique, that is"},{"speaker":"Charles Goldfarb","startTime":783.3,"endTime":787.8,"body":"the mini tight rope technique,"},{"speaker":"Charles Goldfarb","startTime":783.3,"endTime":787.8,"body":"in a revision situation, is"},{"speaker":"Charles Goldfarb","startTime":787.8,"endTime":790.44,"body":"simplicity. So usually when"},{"speaker":"Charles Goldfarb","startTime":787.8,"endTime":790.44,"body":"you're doing revision, no matter"},{"speaker":"Charles Goldfarb","startTime":790.44,"endTime":795.24,"body":"what the primary surgery was,"},{"speaker":"Charles Goldfarb","startTime":790.44,"endTime":795.24,"body":"you have a bunch of scar tissue"},{"speaker":"Charles Goldfarb","startTime":795.36,"endTime":800.04,"body":"which exist where the trapezium"},{"speaker":"Charles Goldfarb","startTime":795.36,"endTime":800.04,"body":"used to be. And most of the time"},{"speaker":"Charles Goldfarb","startTime":800.04,"endTime":802.76,"body":"you're doing it because there's"},{"speaker":"Charles Goldfarb","startTime":800.04,"endTime":802.76,"body":"been proximal migration or"},{"speaker":"Charles Goldfarb","startTime":802.76,"endTime":807.62,"body":"subsidence of the thumb Ray. And"},{"speaker":"Charles Goldfarb","startTime":802.76,"endTime":807.62,"body":"so the good thing is you can"},{"speaker":"Charles Goldfarb","startTime":807.62,"endTime":811.7,"body":"still distract the thumb Ray"},{"speaker":"Charles Goldfarb","startTime":807.62,"endTime":811.7,"body":"distally, so you can reestablish"},{"speaker":"Charles Goldfarb","startTime":811.7,"endTime":815.6,"body":"that space. It's not like it's"},{"speaker":"Charles Goldfarb","startTime":811.7,"endTime":815.6,"body":"scarred in proximally. It's just"},{"speaker":"Charles Goldfarb","startTime":815.6,"endTime":819.2,"body":"scarred in and so if you go in"},{"speaker":"Charles Goldfarb","startTime":815.6,"endTime":819.2,"body":"and you try to do an lrti"},{"speaker":"Charles Goldfarb","startTime":819.2,"endTime":822.16,"body":"Second, or you go in and you try"},{"speaker":"Charles Goldfarb","startTime":819.2,"endTime":822.16,"body":"to do a super suture tape"},{"speaker":"Charles Goldfarb","startTime":822.16,"endTime":825.1,"body":"suspension plastic second, you"},{"speaker":"Charles Goldfarb","startTime":822.16,"endTime":825.1,"body":"got to take out all that scar"},{"speaker":"Charles Goldfarb","startTime":825.1,"endTime":827.98,"body":"tissue. You got to think a lot"},{"speaker":"Charles Goldfarb","startTime":825.1,"endTime":827.98,"body":"about the radial artery. So the"},{"speaker":"Charles Goldfarb","startTime":827.98,"endTime":831.88,"body":"beauty of this technique is you"},{"speaker":"Charles Goldfarb","startTime":827.98,"endTime":831.88,"body":"distract the thumb, and you fire"},{"speaker":"Charles Goldfarb","startTime":831.88,"endTime":834.82,"body":"your mini tight rope across the"},{"speaker":"Charles Goldfarb","startTime":831.88,"endTime":834.82,"body":"thumb, metacarpal to the index"},{"speaker":"Charles Goldfarb","startTime":834.82,"endTime":839.2,"body":"metacarpal, and you're done. And"},{"speaker":"Charles Goldfarb","startTime":834.82,"endTime":839.2,"body":"I have been super happy with"},{"speaker":"Charles Goldfarb","startTime":839.2,"endTime":840.78,"body":"this technique in the revision"},{"speaker":"Charles Goldfarb","startTime":839.2,"endTime":840.78,"body":"setting."},{"speaker":"Chris Dy","startTime":841.26,"endTime":843.18,"body":"Okay, well, that's"},{"speaker":"Chris Dy","startTime":841.26,"endTime":843.18,"body":"that's really good to know, and"},{"speaker":"Chris Dy","startTime":843.18,"endTime":847.2,"body":"that's actually a really good"},{"speaker":"Chris Dy","startTime":843.18,"endTime":847.2,"body":"segue to our next clinical"},{"speaker":"Chris Dy","startTime":847.2,"endTime":851.88,"body":"question. And before we do that,"},{"speaker":"Chris Dy","startTime":847.2,"endTime":851.88,"body":"I wanted to discuss our friends"},{"speaker":"Chris Dy","startTime":851.88,"endTime":855.84,"body":"over at checkpoint. They've got"},{"speaker":"Chris Dy","startTime":851.88,"endTime":855.84,"body":"on February 8, which is coming"},{"speaker":"Chris Dy","startTime":855.84,"endTime":859.5,"body":"up pretty quickly, checkpoint is"},{"speaker":"Chris Dy","startTime":855.84,"endTime":859.5,"body":"supporting the Ohio State"},{"speaker":"Chris Dy","startTime":859.56,"endTime":862.64,"body":"University upper extremity,"},{"speaker":"Chris Dy","startTime":859.56,"endTime":862.64,"body":"nerve and tendon surgical skills"},{"speaker":"Chris Dy","startTime":862.64,"endTime":865.28,"body":"course for fellows and"},{"speaker":"Chris Dy","startTime":862.64,"endTime":865.28,"body":"practicing surgeons. Of course,"},{"speaker":"Chris Dy","startTime":865.28,"endTime":868.28,"body":"faculty includes doctors Amy"},{"speaker":"Chris Dy","startTime":865.28,"endTime":868.28,"body":"Moore, Kyle eberlin And Holly"},{"speaker":"Chris Dy","startTime":868.28,"endTime":868.76,"body":"power."},{"speaker":"Charles Goldfarb","startTime":869.24,"endTime":871.28,"body":"To learn more"},{"speaker":"Charles Goldfarb","startTime":869.24,"endTime":871.28,"body":"about this program and to"},{"speaker":"Charles Goldfarb","startTime":871.28,"endTime":874.94,"body":"register, please visit nerve"},{"speaker":"Charles Goldfarb","startTime":871.28,"endTime":874.94,"body":"master.com you can also find the"},{"speaker":"Charles Goldfarb","startTime":874.94,"endTime":877.76,"body":"link to register in the upper"},{"speaker":"Charles Goldfarb","startTime":874.94,"endTime":877.76,"body":"hand podcast episode"},{"speaker":"Charles Goldfarb","startTime":877.76,"endTime":881.02,"body":"description. That's a cue to me"},{"speaker":"Charles Goldfarb","startTime":877.76,"endTime":881.02,"body":"to put that in Doctor, I was"},{"speaker":"Charles Goldfarb","startTime":881.02,"endTime":881.26,"body":"going"},{"speaker":"Chris Dy","startTime":881.02,"endTime":884.32,"body":"I was going to send"},{"speaker":"Chris Dy","startTime":881.02,"endTime":884.32,"body":"you the email, please do thanks Mecca"},{"speaker":"Charles Goldfarb","startTime":885.52,"endTime":887.278,"body":"Checkpoint,"},{"speaker":"Charles Goldfarb","startTime":885.52,"endTime":887.278,"body":"surgical driving innovation and"},{"speaker":"Charles Goldfarb","startTime":887.319,"endTime":889.854,"body":"nerve surgery. And I'm, in all"},{"speaker":"Charles Goldfarb","startTime":887.319,"endTime":889.854,"body":"seriousness, that's going to be"},{"speaker":"Charles Goldfarb","startTime":889.895,"endTime":891.04,"body":"a great course. Yeah, that's"},{"speaker":"Chris Dy","startTime":891.28,"endTime":893.56,"body":"going to be a great"},{"speaker":"Chris Dy","startTime":891.28,"endTime":893.56,"body":"course. I think that Dr Moore"},{"speaker":"Chris Dy","startTime":893.56,"endTime":896.62,"body":"has done a wonderful job, you"},{"speaker":"Chris Dy","startTime":893.56,"endTime":896.62,"body":"know, lining up the faculty. I"},{"speaker":"Chris Dy","startTime":896.62,"endTime":899.02,"body":"think it's second year in a row"},{"speaker":"Chris Dy","startTime":896.62,"endTime":899.02,"body":"they're doing it. And I think"},{"speaker":"Chris Dy","startTime":899.02,"endTime":901.32,"body":"it's going to be really."},{"speaker":"Chris Dy","startTime":899.02,"endTime":901.32,"body":"Beneficial. So especially if"},{"speaker":"Chris Dy","startTime":901.32,"endTime":904.2,"body":"you're a trainee interested in a"},{"speaker":"Chris Dy","startTime":901.32,"endTime":904.2,"body":"nerve, you should go check out"},{"speaker":"Chris Dy","startTime":904.2,"endTime":905.34,"body":"that course for"},{"speaker":"Charles Goldfarb","startTime":905.34,"endTime":908.76,"body":"sure. Let me"},{"speaker":"Charles Goldfarb","startTime":905.34,"endTime":908.76,"body":"share in anticipation of our"},{"speaker":"Charles Goldfarb","startTime":908.76,"endTime":912.12,"body":"next topic around CMC, I had an"},{"speaker":"Charles Goldfarb","startTime":908.76,"endTime":912.12,"body":"interesting patient within the"},{"speaker":"Charles Goldfarb","startTime":912.12,"endTime":915.78,"body":"last month that came in. She"},{"speaker":"Charles Goldfarb","startTime":912.12,"endTime":915.78,"body":"traveled a bit of a distance,"},{"speaker":"Charles Goldfarb","startTime":915.96,"endTime":921.38,"body":"and she had had surgery on one"},{"speaker":"Charles Goldfarb","startTime":915.96,"endTime":921.38,"body":"of her thumbs. She didn't know"},{"speaker":"Charles Goldfarb","startTime":921.38,"endTime":925.76,"body":"exactly what was done. It was"},{"speaker":"Charles Goldfarb","startTime":921.38,"endTime":925.76,"body":"about 18 months ago, and she was"},{"speaker":"Charles Goldfarb","startTime":925.76,"endTime":929.48,"body":"really happy. And I asked her"},{"speaker":"Charles Goldfarb","startTime":925.76,"endTime":929.48,"body":"what was done. She didn't know,"},{"speaker":"Charles Goldfarb","startTime":929.48,"endTime":932.24,"body":"but she shared a whole bunch of"},{"speaker":"Charles Goldfarb","startTime":929.48,"endTime":932.24,"body":"X rays. So I reviewed the X"},{"speaker":"Charles Goldfarb","startTime":932.24,"endTime":935.9,"body":"rays. It didn't look like a mini"},{"speaker":"Charles Goldfarb","startTime":932.24,"endTime":935.9,"body":"tight rope. It did not look like"},{"speaker":"Charles Goldfarb","startTime":935.9,"endTime":941.08,"body":"a it definitely wasn't an fcr or"},{"speaker":"Charles Goldfarb","startTime":935.9,"endTime":941.08,"body":"an lrti. So I was thinking it"},{"speaker":"Charles Goldfarb","startTime":941.08,"endTime":944.26,"body":"must have been a suture tape"},{"speaker":"Charles Goldfarb","startTime":941.08,"endTime":944.26,"body":"suspension plastic, although it"},{"speaker":"Charles Goldfarb","startTime":944.26,"endTime":947.8,"body":"also could have been a trapezium"},{"speaker":"Charles Goldfarb","startTime":944.26,"endTime":947.8,"body":"excision with pinning. But I"},{"speaker":"Charles Goldfarb","startTime":947.8,"endTime":949.72,"body":"didn't I asked her about pins."},{"speaker":"Charles Goldfarb","startTime":947.8,"endTime":949.72,"body":"Who"},{"speaker":"Chris Dy","startTime":949.72,"endTime":952.3,"body":"does that anymore?"},{"speaker":"Chris Dy","startTime":949.72,"endTime":952.3,"body":"Well, not in this country."},{"speaker":"Charles Goldfarb","startTime":953.38,"endTime":956.8,"body":"So I said, as"},{"speaker":"Charles Goldfarb","startTime":953.38,"endTime":956.8,"body":"she said, her doctor was almost"},{"speaker":"Charles Goldfarb","startTime":956.8,"endTime":960.12,"body":"apologetic, because there had"},{"speaker":"Charles Goldfarb","startTime":956.8,"endTime":960.12,"body":"been proximal migration of the"},{"speaker":"Charles Goldfarb","startTime":960.12,"endTime":963.48,"body":"thumb Ray, and it looked like"},{"speaker":"Charles Goldfarb","startTime":960.12,"endTime":963.48,"body":"there was bone on bone, based on"},{"speaker":"Charles Goldfarb","startTime":963.48,"endTime":967.44,"body":"the thumb metacarpal to the"},{"speaker":"Charles Goldfarb","startTime":963.48,"endTime":967.44,"body":"skateboard, and the X ray"},{"speaker":"Charles Goldfarb","startTime":967.44,"endTime":970.86,"body":"certainly looked that way. But"},{"speaker":"Charles Goldfarb","startTime":967.44,"endTime":970.86,"body":"she was totally pain free. She"},{"speaker":"Charles Goldfarb","startTime":970.86,"endTime":974.64,"body":"was happy she was pain free. But"},{"speaker":"Charles Goldfarb","startTime":970.86,"endTime":974.64,"body":"it's interesting, because I"},{"speaker":"Charles Goldfarb","startTime":974.64,"endTime":977.76,"body":"think she lost a little"},{"speaker":"Charles Goldfarb","startTime":974.64,"endTime":977.76,"body":"confidence in the other"},{"speaker":"Charles Goldfarb","startTime":977.82,"endTime":981.44,"body":"position, and so she was coming"},{"speaker":"Charles Goldfarb","startTime":977.82,"endTime":981.44,"body":"for another opinion. We talked"},{"speaker":"Charles Goldfarb","startTime":981.44,"endTime":984.32,"body":"about options and we talked"},{"speaker":"Charles Goldfarb","startTime":981.44,"endTime":984.32,"body":"about, basically, for me these"},{"speaker":"Charles Goldfarb","startTime":984.32,"endTime":988.22,"body":"days, there's two options. One"},{"speaker":"Charles Goldfarb","startTime":984.32,"endTime":988.22,"body":"is a standard lrti, which I told"},{"speaker":"Charles Goldfarb","startTime":988.22,"endTime":992.3,"body":"her specifically, in my mind,"},{"speaker":"Charles Goldfarb","startTime":988.22,"endTime":992.3,"body":"remains the gold standard. And"},{"speaker":"Charles Goldfarb","startTime":992.3,"endTime":995.54,"body":"the second option being the"},{"speaker":"Charles Goldfarb","startTime":992.3,"endTime":995.54,"body":"suture tape suspension plastic"},{"speaker":"Charles Goldfarb","startTime":996.02,"endTime":999.38,"body":"or tight rope. I'm sorry, not"},{"speaker":"Charles Goldfarb","startTime":996.02,"endTime":999.38,"body":"tight rope, suture tape"},{"speaker":"Charles Goldfarb","startTime":999.38,"endTime":1002.64,"body":"suspension plastic original"},{"speaker":"Charles Goldfarb","startTime":999.38,"endTime":1002.64,"body":"brace. It was a great"},{"speaker":"Charles Goldfarb","startTime":1002.64,"endTime":1008.04,"body":"conversation. But I think lrti"},{"speaker":"Charles Goldfarb","startTime":1002.64,"endTime":1008.04,"body":"still has a really important"},{"speaker":"Charles Goldfarb","startTime":1008.04,"endTime":1010.26,"body":"place in the treatment of thumb"},{"speaker":"Charles Goldfarb","startTime":1008.04,"endTime":1010.26,"body":"CMC arthritis. I"},{"speaker":"Chris Dy","startTime":1010.56,"endTime":1013.5,"body":"think it does too."},{"speaker":"Chris Dy","startTime":1010.56,"endTime":1013.5,"body":"And, you know, I just, I talked"},{"speaker":"Chris Dy","startTime":1013.5,"endTime":1016.26,"body":"about my bias, obviously, and"},{"speaker":"Chris Dy","startTime":1013.5,"endTime":1016.26,"body":"how it was trained. I did a lot"},{"speaker":"Chris Dy","startTime":1016.26,"endTime":1021.2,"body":"of LRT eyes and fellowship, a"},{"speaker":"Chris Dy","startTime":1016.26,"endTime":1021.2,"body":"lot of lrtis. And I still, you"},{"speaker":"Chris Dy","startTime":1021.2,"endTime":1024.32,"body":"know, will use it in certain"},{"speaker":"Chris Dy","startTime":1021.2,"endTime":1024.32,"body":"situations. I mean, I guess I'd"},{"speaker":"Chris Dy","startTime":1024.32,"endTime":1028.46,"body":"love to know your remaining"},{"speaker":"Chris Dy","startTime":1024.32,"endTime":1028.46,"body":"indications for an lrti in 2025"},{"speaker":"Charles Goldfarb","startTime":1029.54,"endTime":1032.12,"body":"and then we're"},{"speaker":"Charles Goldfarb","startTime":1029.54,"endTime":1032.12,"body":"going to talk a little about"},{"speaker":"Charles Goldfarb","startTime":1032.12,"endTime":1033.2,"body":"technical I hope as well."},{"speaker":"Chris Dy","startTime":1033.44,"endTime":1035.48,"body":"Oh, absolutely,"},{"speaker":"Chris Dy","startTime":1033.44,"endTime":1035.48,"body":"absolutely that this is just the"},{"speaker":"Chris Dy","startTime":1035.48,"endTime":1037.28,"body":"opening salvo. So"},{"speaker":"Charles Goldfarb","startTime":1037.279,"endTime":1039.619,"body":"as you know,"},{"speaker":"Charles Goldfarb","startTime":1037.279,"endTime":1039.619,"body":"we shared our experience in a"},{"speaker":"Charles Goldfarb","startTime":1039.619,"endTime":1043.719,"body":"prospective randomized trial"},{"speaker":"Charles Goldfarb","startTime":1039.619,"endTime":1043.719,"body":"looking at different techniques"},{"speaker":"Charles Goldfarb","startTime":1043.719,"endTime":1047.139,"body":"for CMC, and the bottom line is,"},{"speaker":"Charles Goldfarb","startTime":1043.719,"endTime":1047.139,"body":"they're about the same. There"},{"speaker":"Charles Goldfarb","startTime":1047.139,"endTime":1048.339,"body":"seem to be that's just, that's"},{"speaker":"Chris Dy","startTime":1048.339,"endTime":1050.859,"body":"just chuck flexing his"},{"speaker":"Chris Dy","startTime":1048.339,"endTime":1050.859,"body":"level of evidence on everybody."},{"speaker":"Chris Dy","startTime":1050.859,"endTime":1053.019,"body":"Look at that so impressive. Last"},{"speaker":"Charles Goldfarb","startTime":1053.02,"endTime":1058.06,"body":"time I ever,"},{"speaker":"Charles Goldfarb","startTime":1053.02,"endTime":1058.06,"body":"ever do that kind of study. The"},{"speaker":"Charles Goldfarb","startTime":1058.06,"endTime":1063.18,"body":"reality is, you know, I think"},{"speaker":"Charles Goldfarb","startTime":1058.06,"endTime":1063.18,"body":"the experience in the hands of"},{"speaker":"Charles Goldfarb","startTime":1063.18,"endTime":1066.84,"body":"the surgeon matters a lot, and"},{"speaker":"Charles Goldfarb","startTime":1063.18,"endTime":1066.84,"body":"there certainly is some relative"},{"speaker":"Charles Goldfarb","startTime":1066.84,"endTime":1070.2,"body":"pros and there are relative cons"},{"speaker":"Charles Goldfarb","startTime":1066.84,"endTime":1070.2,"body":"to each technique. I like the"},{"speaker":"Charles Goldfarb","startTime":1070.2,"endTime":1073.5,"body":"lrti. I don't do it that much"},{"speaker":"Charles Goldfarb","startTime":1070.2,"endTime":1073.5,"body":"anymore, because I really do"},{"speaker":"Charles Goldfarb","startTime":1073.5,"endTime":1076.32,"body":"like the suture tape suspension"},{"speaker":"Charles Goldfarb","startTime":1073.5,"endTime":1076.32,"body":"blasting because it's fast."},{"speaker":"Charles Goldfarb","startTime":1076.98,"endTime":1079.62,"body":"Patients are under anesthesia"},{"speaker":"Charles Goldfarb","startTime":1076.98,"endTime":1079.62,"body":"last time they start therapy"},{"speaker":"Charles Goldfarb","startTime":1079.62,"endTime":1083.12,"body":"within a week, and at six weeks,"},{"speaker":"Charles Goldfarb","startTime":1079.62,"endTime":1083.12,"body":"they're out of a splint. The"},{"speaker":"Charles Goldfarb","startTime":1083.12,"endTime":1086.9,"body":"only catch is, I am very careful"},{"speaker":"Charles Goldfarb","startTime":1083.12,"endTime":1086.9,"body":"not to tell patients they're"},{"speaker":"Charles Goldfarb","startTime":1086.9,"endTime":1090.74,"body":"going to be 100% sooner, so I"},{"speaker":"Charles Goldfarb","startTime":1086.9,"endTime":1090.74,"body":"don't think it's a faster"},{"speaker":"Charles Goldfarb","startTime":1090.74,"endTime":1094.1,"body":"overall recovery. It's just a"},{"speaker":"Charles Goldfarb","startTime":1090.74,"endTime":1094.1,"body":"faster return to daily"},{"speaker":"Charles Goldfarb","startTime":1094.1,"endTime":1098.72,"body":"activities with the removal"},{"speaker":"Charles Goldfarb","startTime":1094.1,"endTime":1098.72,"body":"price. So I don't push lrti on"},{"speaker":"Charles Goldfarb","startTime":1098.72,"endTime":1101.56,"body":"anyone, but there are patients"},{"speaker":"Charles Goldfarb","startTime":1098.72,"endTime":1101.56,"body":"who come in, and I go over the"},{"speaker":"Charles Goldfarb","startTime":1101.56,"endTime":1104.8,"body":"relative pros and cons, and they"},{"speaker":"Charles Goldfarb","startTime":1101.56,"endTime":1104.8,"body":"choose lrti, but I would say"},{"speaker":"Charles Goldfarb","startTime":1104.8,"endTime":1108.7,"body":"it's probably five to one, sutur"},{"speaker":"Charles Goldfarb","startTime":1104.8,"endTime":1108.7,"body":"Tate versus lrti. What about"},{"speaker":"Charles Goldfarb","startTime":1108.7,"endTime":1109.18,"body":"you? When was,"},{"speaker":"Chris Dy","startTime":1109.18,"endTime":1112.84,"body":"when was the last time"},{"speaker":"Chris Dy","startTime":1109.18,"endTime":1112.84,"body":"you did an lrti outside of the"},{"speaker":"Chris Dy","startTime":1112.96,"endTime":1114.1,"body":"RCT that you ran?"},{"speaker":"Charles Goldfarb","startTime":1115.42,"endTime":1118.12,"body":"Oh, probably"},{"speaker":"Charles Goldfarb","startTime":1115.42,"endTime":1118.12,"body":"six months ago. Okay. How"},{"speaker":"Chris Dy","startTime":1118.12,"endTime":1120.72,"body":"many LRT is you think"},{"speaker":"Chris Dy","startTime":1118.12,"endTime":1120.72,"body":"our residents and some fellows"},{"speaker":"Chris Dy","startTime":1120.72,"endTime":1124.5,"body":"have seen they don't see them"},{"speaker":"Chris Dy","startTime":1120.72,"endTime":1124.5,"body":"anymore. So that's actually in"},{"speaker":"Chris Dy","startTime":1124.5,"endTime":1126.96,"body":"the, you know, a little bit"},{"speaker":"Chris Dy","startTime":1124.5,"endTime":1126.96,"body":"tongue in cheek, but that is one"},{"speaker":"Chris Dy","startTime":1126.96,"endTime":1130.26,"body":"of my remaining indications, is"},{"speaker":"Chris Dy","startTime":1126.96,"endTime":1130.26,"body":"MFE, which other program"},{"speaker":"Chris Dy","startTime":1130.26,"endTime":1132.84,"body":"fellowship directors will know,"},{"speaker":"Chris Dy","startTime":1130.26,"endTime":1132.84,"body":"but maximizing your fellow"},{"speaker":"Chris Dy","startTime":1132.84,"endTime":1135.42,"body":"experience. And same thing for"},{"speaker":"Chris Dy","startTime":1132.84,"endTime":1135.42,"body":"the residents. But I think it's"},{"speaker":"Chris Dy","startTime":1135.42,"endTime":1137.76,"body":"an important procedure to learn"},{"speaker":"Chris Dy","startTime":1135.42,"endTime":1137.76,"body":"how to do, because it does"},{"speaker":"Chris Dy","startTime":1137.76,"endTime":1141.14,"body":"remain the gold standard, and I"},{"speaker":"Chris Dy","startTime":1137.76,"endTime":1141.14,"body":"probably need to work a little"},{"speaker":"Chris Dy","startTime":1141.14,"endTime":1145.22,"body":"more in indicating that in the"},{"speaker":"Chris Dy","startTime":1141.14,"endTime":1145.22,"body":"right patient. You know, I think"},{"speaker":"Chris Dy","startTime":1145.22,"endTime":1148.52,"body":"that one topic of discussion, I"},{"speaker":"Chris Dy","startTime":1145.22,"endTime":1148.52,"body":"think one thing we talked about"},{"speaker":"Chris Dy","startTime":1148.52,"endTime":1152.06,"body":"for the RCT that you ran was,"},{"speaker":"Chris Dy","startTime":1148.52,"endTime":1152.06,"body":"could you still do the same"},{"speaker":"Chris Dy","startTime":1152.06,"endTime":1155.78,"body":"rehab protocol you use for your"},{"speaker":"Chris Dy","startTime":1152.06,"endTime":1155.78,"body":"suture tape suspensions with the"},{"speaker":"Chris Dy","startTime":1155.78,"endTime":1158.72,"body":"lrti patients? And it was work"},{"speaker":"Chris Dy","startTime":1155.78,"endTime":1158.72,"body":"out of Utah, showing that, you"},{"speaker":"Chris Dy","startTime":1158.72,"endTime":1160.84,"body":"know, I think you can"},{"speaker":"Chris Dy","startTime":1158.72,"endTime":1160.84,"body":"potentially do that,"},{"speaker":"Charles Goldfarb","startTime":1161.8,"endTime":1164.38,"body":"yeah, or close"},{"speaker":"Charles Goldfarb","startTime":1161.8,"endTime":1164.38,"body":"enough. I mean, Utah looked at,"},{"speaker":"Charles Goldfarb","startTime":1164.38,"endTime":1167.98,"body":"I think, two weeks versus four"},{"speaker":"Charles Goldfarb","startTime":1164.38,"endTime":1167.98,"body":"weeks of casting, or was it four"},{"speaker":"Charles Goldfarb","startTime":1167.98,"endTime":1171.04,"body":"versus six? But they looked at a"},{"speaker":"Charles Goldfarb","startTime":1167.98,"endTime":1171.04,"body":"shorter cast immobilization"},{"speaker":"Charles Goldfarb","startTime":1171.04,"endTime":1174.04,"body":"period and demonstrated similar"},{"speaker":"Charles Goldfarb","startTime":1171.04,"endTime":1174.04,"body":"outcomes. So I think you"},{"speaker":"Charles Goldfarb","startTime":1174.04,"endTime":1178.54,"body":"probably can, but the key with"},{"speaker":"Charles Goldfarb","startTime":1174.04,"endTime":1178.54,"body":"the lrti is you have to have"},{"speaker":"Charles Goldfarb","startTime":1178.6,"endTime":1182.34,"body":"enough of a grasp of the tendon"},{"speaker":"Charles Goldfarb","startTime":1178.6,"endTime":1182.34,"body":"used to support the thumb"},{"speaker":"Charles Goldfarb","startTime":1182.34,"endTime":1185.28,"body":"metacarpal, and you do want a"},{"speaker":"Charles Goldfarb","startTime":1182.34,"endTime":1185.28,"body":"little scarring before you"},{"speaker":"Charles Goldfarb","startTime":1185.28,"endTime":1188.7,"body":"depend completely on your suture"},{"speaker":"Charles Goldfarb","startTime":1185.28,"endTime":1188.7,"body":"and completely on the tendon"},{"speaker":"Charles Goldfarb","startTime":1188.7,"endTime":1192.3,"body":"integrity to support the thumb."},{"speaker":"Charles Goldfarb","startTime":1188.7,"endTime":1192.3,"body":"That's why I like to go a little"},{"speaker":"Charles Goldfarb","startTime":1192.3,"endTime":1193.26,"body":"more slowly. Yeah,"},{"speaker":"Chris Dy","startTime":1193.26,"endTime":1195.18,"body":"no, I think that those"},{"speaker":"Chris Dy","startTime":1193.26,"endTime":1195.18,"body":"are absolutely good points. I"},{"speaker":"Chris Dy","startTime":1195.18,"endTime":1198.06,"body":"mean, I think that we oftentimes"},{"speaker":"Chris Dy","startTime":1195.18,"endTime":1198.06,"body":"forget to ask why, or explain"},{"speaker":"Chris Dy","startTime":1198.06,"endTime":1201.32,"body":"why. We slow down the protocol"},{"speaker":"Chris Dy","startTime":1198.06,"endTime":1201.32,"body":"when we talk. Our trainees. So"},{"speaker":"Chris Dy","startTime":1201.32,"endTime":1204.74,"body":"it's good for you to explain"},{"speaker":"Chris Dy","startTime":1201.32,"endTime":1204.74,"body":"that, you know, I think this is"},{"speaker":"Chris Dy","startTime":1204.8,"endTime":1208.1,"body":"an lrti. First off, my remaining"},{"speaker":"Chris Dy","startTime":1204.8,"endTime":1208.1,"body":"indications for TI is that"},{"speaker":"Chris Dy","startTime":1208.1,"endTime":1210.26,"body":"they've had one done on the"},{"speaker":"Chris Dy","startTime":1208.1,"endTime":1210.26,"body":"other side, and they really like"},{"speaker":"Chris Dy","startTime":1210.26,"endTime":1212.78,"body":"it. They don't want anything"},{"speaker":"Chris Dy","startTime":1210.26,"endTime":1212.78,"body":"different, which was one of the"},{"speaker":"Chris Dy","startTime":1212.78,"endTime":1216.26,"body":"reasons why I did one recently,"},{"speaker":"Chris Dy","startTime":1212.78,"endTime":1216.26,"body":"and then I use it in a revision"},{"speaker":"Chris Dy","startTime":1216.26,"endTime":1219.08,"body":"setting, or if you have the"},{"speaker":"Chris Dy","startTime":1216.26,"endTime":1219.08,"body":"discussion about the potential"},{"speaker":"Chris Dy","startTime":1219.08,"endTime":1221.14,"body":"options, and they offer"},{"speaker":"Chris Dy","startTime":1219.08,"endTime":1221.14,"body":"something that's completely"},{"speaker":"Chris Dy","startTime":1221.14,"endTime":1221.62,"body":"autologous."},{"speaker":"Charles Goldfarb","startTime":1222.4,"endTime":1225.76,"body":"Yeah, that's"},{"speaker":"Charles Goldfarb","startTime":1222.4,"endTime":1225.76,"body":"great. So let me, you know, I'm"},{"speaker":"Charles Goldfarb","startTime":1225.76,"endTime":1228.64,"body":"a history major. Let me, let me"},{"speaker":"Charles Goldfarb","startTime":1225.76,"endTime":1228.64,"body":"give a little history here. So"},{"speaker":"Charles Goldfarb","startTime":1228.64,"endTime":1232.18,"body":"Burton and Pellegrini from"},{"speaker":"Charles Goldfarb","startTime":1228.64,"endTime":1232.18,"body":"University of Rochester, first"},{"speaker":"Charles Goldfarb","startTime":1232.18,"endTime":1236.14,"body":"described the concept of the"},{"speaker":"Charles Goldfarb","startTime":1232.18,"endTime":1236.14,"body":"lrti, which stands for ligament"},{"speaker":"Charles Goldfarb","startTime":1237.04,"endTime":1240.9,"body":"replacement, tendon"},{"speaker":"Charles Goldfarb","startTime":1237.04,"endTime":1240.9,"body":"interposition, using either half"},{"speaker":"Charles Goldfarb","startTime":1240.96,"endTime":1246.84,"body":"or the entire fcr. I did some as"},{"speaker":"Charles Goldfarb","startTime":1240.96,"endTime":1246.84,"body":"a resident, but in fellowship in"},{"speaker":"Charles Goldfarb","startTime":1246.84,"endTime":1250.86,"body":"Cincinnati, we did a ton of"},{"speaker":"Charles Goldfarb","startTime":1246.84,"endTime":1250.86,"body":"these, and everyone sort of had"},{"speaker":"Charles Goldfarb","startTime":1250.86,"endTime":1254.64,"body":"the same protocol, which I think"},{"speaker":"Charles Goldfarb","startTime":1250.86,"endTime":1254.64,"body":"is really an amazing thing,"},{"speaker":"Charles Goldfarb","startTime":1254.64,"endTime":1257.7,"body":"where you're doing it the exact"},{"speaker":"Charles Goldfarb","startTime":1254.64,"endTime":1257.7,"body":"same way every time, and"},{"speaker":"Charles Goldfarb","startTime":1257.7,"endTime":1261.26,"body":"patients have really, really"},{"speaker":"Charles Goldfarb","startTime":1257.7,"endTime":1261.26,"body":"reliable, good results. And so"},{"speaker":"Charles Goldfarb","startTime":1261.38,"endTime":1264.44,"body":"it is a procedure we should, you"},{"speaker":"Charles Goldfarb","startTime":1261.38,"endTime":1264.44,"body":"know, every hand surgeon should"},{"speaker":"Charles Goldfarb","startTime":1264.44,"endTime":1267.56,"body":"know how to do, even though we"},{"speaker":"Charles Goldfarb","startTime":1264.44,"endTime":1267.56,"body":"may not choose to make it our"},{"speaker":"Charles Goldfarb","startTime":1267.56,"endTime":1268.7,"body":"first option."},{"speaker":"Chris Dy","startTime":1269.54,"endTime":1272.9,"body":"So I have fond and"},{"speaker":"Chris Dy","startTime":1269.54,"endTime":1272.9,"body":"traumatic memories of LRT eyes"},{"speaker":"Chris Dy","startTime":1272.9,"endTime":1275.42,"body":"and fellowship, because it is a"},{"speaker":"Chris Dy","startTime":1272.9,"endTime":1275.42,"body":"very technique, like you said,"},{"speaker":"Chris Dy","startTime":1275.42,"endTime":1278.42,"body":"like it's a very technically"},{"speaker":"Chris Dy","startTime":1275.42,"endTime":1278.42,"body":"specific procedure. It's do"},{"speaker":"Chris Dy","startTime":1278.42,"endTime":1280.78,"body":"this, do this, do this, do this,"},{"speaker":"Chris Dy","startTime":1278.42,"endTime":1280.78,"body":"do this. Should be the same way"},{"speaker":"Chris Dy","startTime":1280.78,"endTime":1284.68,"body":"every time. And I went back when"},{"speaker":"Chris Dy","startTime":1280.78,"endTime":1284.68,"body":"I had a couple of recent lrtis,"},{"speaker":"Chris Dy","startTime":1284.68,"endTime":1287.44,"body":"which I've had in the last few"},{"speaker":"Chris Dy","startTime":1284.68,"endTime":1287.44,"body":"weeks. I hadn't done it in a"},{"speaker":"Chris Dy","startTime":1287.44,"endTime":1290.5,"body":"long time. So I pulled up my"},{"speaker":"Chris Dy","startTime":1287.44,"endTime":1290.5,"body":"Google Docs from my fellowship"},{"speaker":"Chris Dy","startTime":1290.98,"endTime":1294.04,"body":"and read my fellowship notes,"},{"speaker":"Chris Dy","startTime":1290.98,"endTime":1294.04,"body":"which were very specific and"},{"speaker":"Chris Dy","startTime":1294.04,"endTime":1296.68,"body":"interestingly, very different"},{"speaker":"Chris Dy","startTime":1294.04,"endTime":1296.68,"body":"based on which attending I had"},{"speaker":"Chris Dy","startTime":1296.68,"endTime":1299.02,"body":"worked with, but the one, the"},{"speaker":"Chris Dy","startTime":1296.68,"endTime":1299.02,"body":"one that I remember the most,"},{"speaker":"Chris Dy","startTime":1299.02,"endTime":1301.66,"body":"and perhaps there was a little"},{"speaker":"Chris Dy","startTime":1299.02,"endTime":1301.66,"body":"bit of Stockholm Syndrome, but I"},{"speaker":"Chris Dy","startTime":1301.66,"endTime":1303.9,"body":"wanted to review my notes from"},{"speaker":"Chris Dy","startTime":1301.66,"endTime":1303.9,"body":"review my notes from Dr"},{"speaker":"Chris Dy","startTime":1303.9,"endTime":1306.9,"body":"government's rotation, and"},{"speaker":"Chris Dy","startTime":1303.9,"endTime":1306.9,"body":"reviewed all of those, and I"},{"speaker":"Chris Dy","startTime":1306.9,"endTime":1309.48,"body":"just remember how technical it"},{"speaker":"Chris Dy","startTime":1306.9,"endTime":1309.48,"body":"was. So let's start with the"},{"speaker":"Chris Dy","startTime":1309.48,"endTime":1314.64,"body":"technical aspects. So is in 2025"},{"speaker":"Chris Dy","startTime":1309.48,"endTime":1314.64,"body":"dorsal approach or Wagner"},{"speaker":"Chris Dy","startTime":1314.64,"endTime":1316.2,"body":"approach? Yeah,"},{"speaker":"Charles Goldfarb","startTime":1316.2,"endTime":1318.66,"body":"I am a big"},{"speaker":"Charles Goldfarb","startTime":1316.2,"endTime":1318.66,"body":"believer in the dorsal approach."},{"speaker":"Charles Goldfarb","startTime":1318.66,"endTime":1321.74,"body":"I have nothing against the"},{"speaker":"Charles Goldfarb","startTime":1318.66,"endTime":1321.74,"body":"Wagner approach, or the Wagner"},{"speaker":"Charles Goldfarb","startTime":1321.74,"endTime":1323.3,"body":"approach. How you say it?"},{"speaker":"Chris Dy","startTime":1324.44,"endTime":1327.74,"body":"The Birmingham boy"},{"speaker":"Chris Dy","startTime":1324.44,"endTime":1327.74,"body":"calls it a Wagner approach."},{"speaker":"Charles Goldfarb","startTime":1328.58,"endTime":1330.5,"body":"The benefit of"},{"speaker":"Charles Goldfarb","startTime":1328.58,"endTime":1330.5,"body":"the dorsal approach, as I think"},{"speaker":"Charles Goldfarb","startTime":1330.5,"endTime":1335.12,"body":"we've talked about, is, I think"},{"speaker":"Charles Goldfarb","startTime":1330.5,"endTime":1335.12,"body":"the chances of irritating the"},{"speaker":"Charles Goldfarb","startTime":1335.24,"endTime":1338.66,"body":"either superficial branch of the"},{"speaker":"Charles Goldfarb","startTime":1335.24,"endTime":1338.66,"body":"radial nerve or the LA BC, is"},{"speaker":"Charles Goldfarb","startTime":1338.66,"endTime":1341.32,"body":"far less. And so there's less"},{"speaker":"Charles Goldfarb","startTime":1338.66,"endTime":1341.32,"body":"nerve complaints when you go"},{"speaker":"Charles Goldfarb","startTime":1341.32,"endTime":1345.46,"body":"straight dorsal. But the Wagner"},{"speaker":"Charles Goldfarb","startTime":1341.32,"endTime":1345.46,"body":"approach is elegant. It gives"},{"speaker":"Charles Goldfarb","startTime":1345.46,"endTime":1348.28,"body":"you a bigger approach. And"},{"speaker":"Charles Goldfarb","startTime":1345.46,"endTime":1348.28,"body":"there's certainly nothing wrong"},{"speaker":"Charles Goldfarb","startTime":1348.28,"endTime":1348.58,"body":"with it."},{"speaker":"Chris Dy","startTime":1348.58,"endTime":1350.86,"body":"Yeah, we talked about"},{"speaker":"Chris Dy","startTime":1348.58,"endTime":1350.86,"body":"this in a recent episode, but I"},{"speaker":"Chris Dy","startTime":1350.86,"endTime":1353.68,"body":"think that if you're trying to"},{"speaker":"Chris Dy","startTime":1350.86,"endTime":1353.68,"body":"do the kind of Genie Delson,"},{"speaker":"Chris Dy","startTime":1353.68,"endTime":1356.62,"body":"your suspension plastic that"},{"speaker":"Chris Dy","startTime":1353.68,"endTime":1356.62,"body":"way, I think a Wagner is the way"},{"speaker":"Chris Dy","startTime":1356.62,"endTime":1359.44,"body":"to go. It's very hard to do from"},{"speaker":"Chris Dy","startTime":1356.62,"endTime":1359.44,"body":"a dorsal approach. But yeah, I"},{"speaker":"Chris Dy","startTime":1359.44,"endTime":1364.08,"body":"also would dorsal. So the"},{"speaker":"Chris Dy","startTime":1359.44,"endTime":1364.08,"body":"technical aspects of removing"},{"speaker":"Chris Dy","startTime":1364.08,"endTime":1367.08,"body":"the trapezium, I think, are no"},{"speaker":"Chris Dy","startTime":1364.08,"endTime":1367.08,"body":"different. Do you do anything"},{"speaker":"Chris Dy","startTime":1367.08,"endTime":1369.96,"body":"differently in terms of other"},{"speaker":"Chris Dy","startTime":1367.08,"endTime":1369.96,"body":"than telling your resident"},{"speaker":"Chris Dy","startTime":1369.96,"endTime":1372.96,"body":"fellow to really protect the fcr"},{"speaker":"Chris Dy","startTime":1369.96,"endTime":1372.96,"body":"as you're doing this,"},{"speaker":"Charles Goldfarb","startTime":1374.7,"endTime":1377.94,"body":"protect the"},{"speaker":"Charles Goldfarb","startTime":1374.7,"endTime":1377.94,"body":"fcr, protect the radio artery."},{"speaker":"Charles Goldfarb","startTime":1378.12,"endTime":1380.66,"body":"As I've said, I went through a"},{"speaker":"Charles Goldfarb","startTime":1378.12,"endTime":1380.66,"body":"phase where I didn't identify"},{"speaker":"Charles Goldfarb","startTime":1380.66,"endTime":1383.6,"body":"the radar. I identify the radial"},{"speaker":"Charles Goldfarb","startTime":1380.66,"endTime":1383.6,"body":"artery every time I use"},{"speaker":"Charles Goldfarb","startTime":1383.6,"endTime":1389.84,"body":"hominins, put a Homan in the"},{"speaker":"Charles Goldfarb","startTime":1383.6,"endTime":1389.84,"body":"scape o trapezial joint, and"},{"speaker":"Charles Goldfarb","startTime":1389.84,"endTime":1392.84,"body":"carefully lever it, because you"},{"speaker":"Charles Goldfarb","startTime":1389.84,"endTime":1392.84,"body":"can traumatize the radial"},{"speaker":"Charles Goldfarb","startTime":1392.84,"endTime":1397.1,"body":"artery. And then I elevate soft"},{"speaker":"Charles Goldfarb","startTime":1392.84,"endTime":1397.1,"body":"tissues dorsally, bolily,"},{"speaker":"Charles Goldfarb","startTime":1397.28,"endTime":1402.52,"body":"obviously expose the trapezio"},{"speaker":"Charles Goldfarb","startTime":1397.28,"endTime":1402.52,"body":"metacarpal joint. I have done it"},{"speaker":"Charles Goldfarb","startTime":1402.52,"endTime":1407.02,"body":"every which way. I typically now"},{"speaker":"Charles Goldfarb","startTime":1402.52,"endTime":1407.02,"body":"do not try to excise the"},{"speaker":"Charles Goldfarb","startTime":1407.02,"endTime":1411.58,"body":"trapezium in total. Rather, I"},{"speaker":"Charles Goldfarb","startTime":1407.02,"endTime":1411.58,"body":"subdivide it with an osteotome"},{"speaker":"Charles Goldfarb","startTime":1411.58,"endTime":1416.02,"body":"and then take it out. What's"},{"speaker":"Charles Goldfarb","startTime":1411.58,"endTime":1416.02,"body":"your current technique? Kind"},{"speaker":"Chris Dy","startTime":1416.02,"endTime":1418.18,"body":"of depends on who I'm"},{"speaker":"Chris Dy","startTime":1416.02,"endTime":1418.18,"body":"working with and how I'm feeling"},{"speaker":"Chris Dy","startTime":1418.18,"endTime":1422.94,"body":"that day excising the trapezium."},{"speaker":"Chris Dy","startTime":1418.18,"endTime":1422.94,"body":"The principles are same. I do"},{"speaker":"Chris Dy","startTime":1422.94,"endTime":1426.06,"body":"identify the radial artery. I"},{"speaker":"Chris Dy","startTime":1422.94,"endTime":1426.06,"body":"like the Homans, but before"},{"speaker":"Chris Dy","startTime":1426.06,"endTime":1429.12,"body":"doing the Homans, it's, for me,"},{"speaker":"Chris Dy","startTime":1426.06,"endTime":1429.12,"body":"it's a sharp dissection with a"},{"speaker":"Chris Dy","startTime":1429.12,"endTime":1432.0,"body":"scalpel. Or, you know, depending"},{"speaker":"Chris Dy","startTime":1429.12,"endTime":1432.0,"body":"on what the trainee prefers."},{"speaker":"Chris Dy","startTime":1432.0,"endTime":1435.36,"body":"They can also use a the cautery"},{"speaker":"Chris Dy","startTime":1432.0,"endTime":1435.36,"body":"to get the periosum in the"},{"speaker":"Chris Dy","startTime":1435.36,"endTime":1438.84,"body":"capsule off so the dorsal part"},{"speaker":"Chris Dy","startTime":1435.36,"endTime":1438.84,"body":"and the initial kind of, as you"},{"speaker":"Chris Dy","startTime":1438.84,"endTime":1444.2,"body":"go to the mid axial line can be"},{"speaker":"Chris Dy","startTime":1438.84,"endTime":1444.2,"body":"with the knife or the Bovie. And"},{"speaker":"Chris Dy","startTime":1444.2,"endTime":1447.8,"body":"then that's making sure to find"},{"speaker":"Chris Dy","startTime":1444.2,"endTime":1447.8,"body":"the radial artery. And then also"},{"speaker":"Chris Dy","startTime":1447.8,"endTime":1450.68,"body":"dissect out the radial artery,"},{"speaker":"Chris Dy","startTime":1447.8,"endTime":1450.68,"body":"because as you come on the"},{"speaker":"Chris Dy","startTime":1450.68,"endTime":1453.2,"body":"different sides of it, you can"},{"speaker":"Chris Dy","startTime":1450.68,"endTime":1453.2,"body":"also encounter some branches"},{"speaker":"Chris Dy","startTime":1453.2,"endTime":1456.98,"body":"that you need to be mindful of,"},{"speaker":"Chris Dy","startTime":1453.2,"endTime":1456.98,"body":"as you know. And then I'll use a"},{"speaker":"Chris Dy","startTime":1457.28,"endTime":1459.86,"body":"the number nine freer, or as our"},{"speaker":"Chris Dy","startTime":1457.28,"endTime":1459.86,"body":"partner Marty calls it, the"},{"speaker":"Chris Dy","startTime":1459.86,"endTime":1463.36,"body":"Dingman, and use the sharp end"},{"speaker":"Chris Dy","startTime":1459.86,"endTime":1463.36,"body":"to kind of get over the edge."},{"speaker":"Chris Dy","startTime":1463.42,"endTime":1467.38,"body":"And then the rule is, as you get"},{"speaker":"Chris Dy","startTime":1463.42,"endTime":1467.38,"body":"vola, nothing sharp. And I'll"},{"speaker":"Chris Dy","startTime":1467.38,"endTime":1470.68,"body":"use a McLaren after starting the"},{"speaker":"Chris Dy","startTime":1467.38,"endTime":1470.68,"body":"dissection with the home and"},{"speaker":"Chris Dy","startTime":1470.68,"endTime":1473.14,"body":"parking the home, and use the"},{"speaker":"Chris Dy","startTime":1470.68,"endTime":1473.14,"body":"McLaren to get around the"},{"speaker":"Chris Dy","startTime":1473.14,"endTime":1476.44,"body":"bottom. And once you're around,"},{"speaker":"Chris Dy","startTime":1473.14,"endTime":1476.44,"body":"kind of the bottom, and I think"},{"speaker":"Chris Dy","startTime":1476.44,"endTime":1479.38,"body":"that's, you know, the reason to"},{"speaker":"Chris Dy","startTime":1476.44,"endTime":1479.38,"body":"use the McLaren is just to avoid"},{"speaker":"Chris Dy","startTime":1479.38,"endTime":1482.34,"body":"any risk of the fcr. And that's"},{"speaker":"Chris Dy","startTime":1479.38,"endTime":1482.34,"body":"when we decide whether we're"},{"speaker":"Chris Dy","startTime":1482.34,"endTime":1487.26,"body":"going to excise on block or"},{"speaker":"Chris Dy","startTime":1482.34,"endTime":1487.26,"body":"we're going to piecemeal. I very"},{"speaker":"Chris Dy","startTime":1487.26,"endTime":1490.86,"body":"rarely take out an osteotome. I"},{"speaker":"Chris Dy","startTime":1487.26,"endTime":1490.86,"body":"do like the challenge to our"},{"speaker":"Chris Dy","startTime":1490.86,"endTime":1494.16,"body":"trainees to remove on block, and"},{"speaker":"Chris Dy","startTime":1490.86,"endTime":1494.16,"body":"then eventually we just end up"},{"speaker":"Chris Dy","startTime":1494.16,"endTime":1496.32,"body":"taking out piecemeal most of the"},{"speaker":"Chris Dy","startTime":1494.16,"endTime":1496.32,"body":"time, although, I will say"},{"speaker":"Chris Dy","startTime":1496.92,"endTime":1499.38,"body":"recent fellow, current fellow,"},{"speaker":"Chris Dy","startTime":1496.92,"endTime":1499.38,"body":"Eric Jang, has done a great job"},{"speaker":"Chris Dy","startTime":1499.38,"endTime":1502.28,"body":"getting a call. Out on block,"},{"speaker":"Chris Dy","startTime":1499.38,"endTime":1502.28,"body":"and he told me that you take it"},{"speaker":"Chris Dy","startTime":1502.28,"endTime":1506.0,"body":"out on block. So it's"},{"speaker":"Chris Dy","startTime":1502.28,"endTime":1506.0,"body":"interesting that there perhaps"},{"speaker":"Chris Dy","startTime":1506.0,"endTime":1507.38,"body":"has been some deviation that's"},{"speaker":"Charles Goldfarb","startTime":1508.04,"endTime":1510.02,"body":"so interesting"},{"speaker":"Charles Goldfarb","startTime":1508.04,"endTime":1510.02,"body":"I'm going to share. I'm going to"},{"speaker":"Charles Goldfarb","startTime":1510.02,"endTime":1513.08,"body":"try something new for our"},{"speaker":"Charles Goldfarb","startTime":1510.02,"endTime":1513.08,"body":"YouTube watchers. I'm going to"},{"speaker":"Charles Goldfarb","startTime":1513.08,"endTime":1516.8,"body":"share my screen open really a"},{"speaker":"Charles Goldfarb","startTime":1513.08,"endTime":1516.8,"body":"random site to show what a"},{"speaker":"Charles Goldfarb","startTime":1516.8,"endTime":1520.36,"body":"maglari is, for those who don't"},{"speaker":"Charles Goldfarb","startTime":1516.8,"endTime":1520.36,"body":"know. And this site is just the"},{"speaker":"Charles Goldfarb","startTime":1520.36,"endTime":1523.24,"body":"first one metatarsal elevator,"},{"speaker":"Charles Goldfarb","startTime":1520.36,"endTime":1523.24,"body":"yep, right. It's a foot and"},{"speaker":"Charles Goldfarb","startTime":1523.24,"endTime":1529.36,"body":"ankle tool that's a little bit"},{"speaker":"Charles Goldfarb","startTime":1523.24,"endTime":1529.36,"body":"sharp on the tip, and it can be"},{"speaker":"Charles Goldfarb","startTime":1529.66,"endTime":1535.78,"body":"really helpful. So I was doing a"},{"speaker":"Charles Goldfarb","startTime":1529.66,"endTime":1535.78,"body":"CMC with Eric on recently, and"},{"speaker":"Charles Goldfarb","startTime":1535.78,"endTime":1540.22,"body":"he said he is working with you,"},{"speaker":"Charles Goldfarb","startTime":1535.78,"endTime":1540.22,"body":"and you love the maglamary. And"},{"speaker":"Charles Goldfarb","startTime":1540.52,"endTime":1543.0,"body":"he you know, I said, Well, we"},{"speaker":"Charles Goldfarb","startTime":1540.52,"endTime":1543.0,"body":"can use the magamerie, but we"},{"speaker":"Charles Goldfarb","startTime":1543.0,"endTime":1547.8,"body":"didn't use the McLaren. I"},{"speaker":"Charles Goldfarb","startTime":1543.0,"endTime":1547.8,"body":"explained why. And I think the"},{"speaker":"Charles Goldfarb","startTime":1547.8,"endTime":1553.26,"body":"mcglamery tool is very good in"},{"speaker":"Charles Goldfarb","startTime":1547.8,"endTime":1553.26,"body":"experienced hands. I think it is"},{"speaker":"Charles Goldfarb","startTime":1553.26,"endTime":1557.7,"body":"a tough thing to take a trainee"},{"speaker":"Charles Goldfarb","startTime":1553.26,"endTime":1557.7,"body":"through, in my opinion, which is"},{"speaker":"Charles Goldfarb","startTime":1557.7,"endTime":1560.46,"body":"one of the reasons I don't use"},{"speaker":"Charles Goldfarb","startTime":1557.7,"endTime":1560.46,"body":"it that often. It's fair,"},{"speaker":"Charles Goldfarb","startTime":1560.46,"endTime":1561.0,"body":"absolutely."},{"speaker":"Chris Dy","startTime":1561.0,"endTime":1564.14,"body":"And I think the other"},{"speaker":"Chris Dy","startTime":1561.0,"endTime":1564.14,"body":"thing I'll say is I every time,"},{"speaker":"Chris Dy","startTime":1564.2,"endTime":1566.48,"body":"never say never, never say,"},{"speaker":"Chris Dy","startTime":1564.2,"endTime":1566.48,"body":"always, but always. I will put a"},{"speaker":"Chris Dy","startTime":1566.48,"endTime":1570.14,"body":"pin in the I'll put a 62k wire"},{"speaker":"Chris Dy","startTime":1566.48,"endTime":1570.14,"body":"in the trapezium and check on X"},{"speaker":"Chris Dy","startTime":1570.14,"endTime":1573.44,"body":"ray, because you don't want to"},{"speaker":"Chris Dy","startTime":1570.14,"endTime":1573.44,"body":"be that person takes out the"},{"speaker":"Chris Dy","startTime":1573.44,"endTime":1576.56,"body":"wrong bone. And sometimes the"},{"speaker":"Chris Dy","startTime":1573.44,"endTime":1576.56,"body":"anatomy can be challenging. If"},{"speaker":"Chris Dy","startTime":1576.56,"endTime":1579.68,"body":"there's some, if there's, you"},{"speaker":"Chris Dy","startTime":1576.56,"endTime":1579.68,"body":"know, dorsal migration of the"},{"speaker":"Chris Dy","startTime":1579.68,"endTime":1582.76,"body":"base of the metacarpal, etc. You"},{"speaker":"Chris Dy","startTime":1579.68,"endTime":1582.76,"body":"just want to be sure this, this"},{"speaker":"Chris Dy","startTime":1582.76,"endTime":1587.14,"body":"surgery is a three shot on three"},{"speaker":"Chris Dy","startTime":1582.76,"endTime":1587.14,"body":"shots on the floor, and that's"},{"speaker":"Chris Dy","startTime":1587.14,"endTime":1589.84,"body":"the first shot is just making"},{"speaker":"Chris Dy","startTime":1587.14,"endTime":1589.84,"body":"sure that we got that the right"},{"speaker":"Chris Dy","startTime":1589.84,"endTime":1594.1,"body":"bone. And then also, I'll use"},{"speaker":"Chris Dy","startTime":1589.84,"endTime":1594.1,"body":"that, if I'm doing a suture"},{"speaker":"Chris Dy","startTime":1594.1,"endTime":1597.22,"body":"tape, I'll use that as a gage of"},{"speaker":"Chris Dy","startTime":1594.1,"endTime":1597.22,"body":"the bone quality, just getting a"},{"speaker":"Chris Dy","startTime":1597.22,"endTime":1599.56,"body":"sense of how good the bone is,"},{"speaker":"Chris Dy","startTime":1597.22,"endTime":1599.56,"body":"potentially. And so whether, and"},{"speaker":"Chris Dy","startTime":1599.56,"endTime":1601.62,"body":"this is just for workflow,"},{"speaker":"Chris Dy","startTime":1599.56,"endTime":1601.62,"body":"whether to open the kit or not,"},{"speaker":"Chris Dy","startTime":1601.68,"endTime":1605.52,"body":"if we're doing a suture tape,"},{"speaker":"Chris Dy","startTime":1601.68,"endTime":1605.52,"body":"but, but yeah, so then trapezium"},{"speaker":"Chris Dy","startTime":1605.52,"endTime":1606.12,"body":"is out,"},{"speaker":"Charles Goldfarb","startTime":1607.38,"endTime":1609.12,"body":"yeah, so,"},{"speaker":"Charles Goldfarb","startTime":1607.38,"endTime":1609.12,"body":"well, first of all, I've never"},{"speaker":"Charles Goldfarb","startTime":1609.12,"endTime":1612.3,"body":"used the CRM. I just don't think"},{"speaker":"Charles Goldfarb","startTime":1609.12,"endTime":1612.3,"body":"it's, it's helpful for me."},{"speaker":"Charles Goldfarb","startTime":1612.3,"endTime":1615.42,"body":"Obviously, I'm not being"},{"speaker":"Charles Goldfarb","startTime":1612.3,"endTime":1615.42,"body":"critical in any way, judgy,"},{"speaker":"Charles Goldfarb","startTime":1615.42,"endTime":1617.52,"body":"maybe, but not critical. No."},{"speaker":"Chris Dy","startTime":1617.52,"endTime":1621.32,"body":"CRM idea. I was down"},{"speaker":"Chris Dy","startTime":1617.52,"endTime":1621.32,"body":"the hall when I got the when I"},{"speaker":"Chris Dy","startTime":1621.32,"endTime":1625.28,"body":"heard the call in a different"},{"speaker":"Chris Dy","startTime":1621.32,"endTime":1625.28,"body":"institution. So,"},{"speaker":"Charles Goldfarb","startTime":1625.88,"endTime":1628.04,"body":"yeah, no, I"},{"speaker":"Charles Goldfarb","startTime":1625.88,"endTime":1628.04,"body":"believe it. I do think if you're"},{"speaker":"Charles Goldfarb","startTime":1628.04,"endTime":1632.0,"body":"not going to use a CRM, you need"},{"speaker":"Charles Goldfarb","startTime":1628.04,"endTime":1632.0,"body":"to be obviously, 100% confident"},{"speaker":"Charles Goldfarb","startTime":1632.0,"endTime":1634.22,"body":"of what you're doing, which some"},{"speaker":"Charles Goldfarb","startTime":1632.0,"endTime":1634.22,"body":"listeners are going to be like,"},{"speaker":"Charles Goldfarb","startTime":1634.22,"endTime":1638.06,"body":"wait a second, you took out some"},{"speaker":"Charles Goldfarb","startTime":1634.22,"endTime":1638.06,"body":"someone, not you, not I, took"},{"speaker":"Charles Goldfarb","startTime":1638.06,"endTime":1640.84,"body":"out the wrong bone, or took out"},{"speaker":"Charles Goldfarb","startTime":1638.06,"endTime":1640.84,"body":"the distal half of the scaphoid."},{"speaker":"Charles Goldfarb","startTime":1641.62,"endTime":1648.1,"body":"Yeah, it can happen. So"},{"speaker":"Charles Goldfarb","startTime":1641.62,"endTime":1648.1,"body":"trapezium is out, and now for"},{"speaker":"Charles Goldfarb","startTime":1648.1,"endTime":1652.84,"body":"me, you know you identify the"},{"speaker":"Charles Goldfarb","startTime":1648.1,"endTime":1652.84,"body":"fcr, I would say 99% of the time"},{"speaker":"Charles Goldfarb","startTime":1652.96,"endTime":1655.84,"body":"you can get a good sense of the"},{"speaker":"Charles Goldfarb","startTime":1652.96,"endTime":1655.84,"body":"quality fcr. With severe"},{"speaker":"Charles Goldfarb","startTime":1655.84,"endTime":1659.2,"body":"arthritis, the fcr can be"},{"speaker":"Charles Goldfarb","startTime":1655.84,"endTime":1659.2,"body":"affected. So you always have to"},{"speaker":"Charles Goldfarb","startTime":1659.2,"endTime":1662.7,"body":"be ready to pivot, whether,"},{"speaker":"Charles Goldfarb","startTime":1659.2,"endTime":1662.7,"body":"again, not, not really"},{"speaker":"Charles Goldfarb","startTime":1662.7,"endTime":1666.72,"body":"necessary, then my next step is"},{"speaker":"Charles Goldfarb","startTime":1662.7,"endTime":1666.72,"body":"to harvest the fcr. So"},{"speaker":"Chris Dy","startTime":1667.2,"endTime":1669.78,"body":"how do you now? Well,"},{"speaker":"Chris Dy","startTime":1667.2,"endTime":1669.78,"body":"first off, how frequently and"},{"speaker":"Chris Dy","startTime":1669.78,"endTime":1672.78,"body":"how many times has the fcr not"},{"speaker":"Chris Dy","startTime":1669.78,"endTime":1672.78,"body":"been reasonable quality,"},{"speaker":"Charles Goldfarb","startTime":1673.26,"endTime":1676.8,"body":"incredibly,"},{"speaker":"Charles Goldfarb","startTime":1673.26,"endTime":1676.8,"body":"rarely, once or twice in 20"},{"speaker":"Charles Goldfarb","startTime":1676.8,"endTime":1677.16,"body":"years."},{"speaker":"Chris Dy","startTime":1677.82,"endTime":1680.66,"body":"Okay, perfect. So"},{"speaker":"Chris Dy","startTime":1677.82,"endTime":1680.66,"body":"then, how are you going about"},{"speaker":"Chris Dy","startTime":1680.72,"endTime":1683.42,"body":"initially, like, how? What do"},{"speaker":"Chris Dy","startTime":1680.72,"endTime":1683.42,"body":"you tell patients? Earns a"},{"speaker":"Chris Dy","startTime":1683.42,"endTime":1686.18,"body":"number of incisions, where the"},{"speaker":"Chris Dy","startTime":1683.42,"endTime":1686.18,"body":"incisions are going to be, etc,"},{"speaker":"Chris Dy","startTime":1686.18,"endTime":1687.32,"body":"for getting your fcr out"},{"speaker":"Charles Goldfarb","startTime":1687.68,"endTime":1690.08,"body":"right. So"},{"speaker":"Charles Goldfarb","startTime":1687.68,"endTime":1690.08,"body":"longitudinal, dorsal incision,"},{"speaker":"Charles Goldfarb","startTime":1690.08,"endTime":1694.46,"body":"for the exposure for the joint"},{"speaker":"Charles Goldfarb","startTime":1690.08,"endTime":1694.46,"body":"and the trapezium, I make one"},{"speaker":"Charles Goldfarb","startTime":1694.46,"endTime":1697.28,"body":"additional incision, and that"},{"speaker":"Charles Goldfarb","startTime":1694.46,"endTime":1697.28,"body":"additional incision I use the"},{"speaker":"Charles Goldfarb","startTime":1697.28,"endTime":1701.74,"body":"width of my palm, which is about"},{"speaker":"Charles Goldfarb","startTime":1697.28,"endTime":1701.74,"body":"10 centimeters. I start at the"},{"speaker":"Charles Goldfarb","startTime":1702.22,"endTime":1705.4,"body":"risk crease, and then at the"},{"speaker":"Charles Goldfarb","startTime":1702.22,"endTime":1705.4,"body":"kind of directly over the fcr"},{"speaker":"Charles Goldfarb","startTime":1705.4,"endTime":1709.36,"body":"proximal to my little finger. So"},{"speaker":"Charles Goldfarb","startTime":1705.4,"endTime":1709.36,"body":"roughly here I make a small"},{"speaker":"Charles Goldfarb","startTime":1709.36,"endTime":1713.74,"body":"transverse incision. I'll just"},{"speaker":"Charles Goldfarb","startTime":1709.36,"endTime":1713.74,"body":"keep going. I spread after the"},{"speaker":"Charles Goldfarb","startTime":1713.74,"endTime":1716.62,"body":"incision, I spread down identify"},{"speaker":"Charles Goldfarb","startTime":1713.74,"endTime":1716.62,"body":"the fcr that's usually at the"},{"speaker":"Charles Goldfarb","startTime":1716.62,"endTime":1721.74,"body":"level where the fcr tendon is"},{"speaker":"Charles Goldfarb","startTime":1716.62,"endTime":1721.74,"body":"visible as it originates from"},{"speaker":"Charles Goldfarb","startTime":1721.74,"endTime":1722.16,"body":"muscle"},{"speaker":"Chris Dy","startTime":1723.18,"endTime":1726.18,"body":"attendance junction."},{"speaker":"Chris Dy","startTime":1723.18,"endTime":1726.18,"body":"Thank you. I"},{"speaker":"Charles Goldfarb","startTime":1727.02,"endTime":1730.98,"body":"isolate it. I"},{"speaker":"Charles Goldfarb","startTime":1727.02,"endTime":1730.98,"body":"100% confirm I have the fcr by"},{"speaker":"Charles Goldfarb","startTime":1731.04,"endTime":1735.9,"body":"working back into the hole that"},{"speaker":"Charles Goldfarb","startTime":1731.04,"endTime":1735.9,"body":"is the original incision. Once"},{"speaker":"Charles Goldfarb","startTime":1735.9,"endTime":1738.3,"body":"I'm positive I cut it there."},{"speaker":"Charles Goldfarb","startTime":1735.9,"endTime":1738.3,"body":"What do you do?"},{"speaker":"Chris Dy","startTime":1739.02,"endTime":1743.24,"body":"I do it differently."},{"speaker":"Chris Dy","startTime":1739.02,"endTime":1743.24,"body":"So a First off, yeah, I was love"},{"speaker":"Chris Dy","startTime":1743.24,"endTime":1745.52,"body":"it when surgeons say things"},{"speaker":"Chris Dy","startTime":1743.24,"endTime":1745.52,"body":"based on the width of their"},{"speaker":"Chris Dy","startTime":1745.52,"endTime":1751.28,"body":"hand. There was a surgeon in"},{"speaker":"Chris Dy","startTime":1745.52,"endTime":1751.28,"body":"residency who swore that the"},{"speaker":"Chris Dy","startTime":1751.28,"endTime":1754.04,"body":"radial nerve was always the"},{"speaker":"Chris Dy","startTime":1751.28,"endTime":1754.04,"body":"width of his hand above the"},{"speaker":"Chris Dy","startTime":1754.04,"endTime":1758.48,"body":"lateral epicondyle. Like so"},{"speaker":"Chris Dy","startTime":1754.04,"endTime":1758.48,"body":"repeatable, so accurate, sure,"},{"speaker":"Chris Dy","startTime":1759.5,"endTime":1764.8,"body":"but I will make a a about a"},{"speaker":"Chris Dy","startTime":1759.5,"endTime":1764.8,"body":"three centimeter longitudinal"},{"speaker":"Chris Dy","startTime":1764.8,"endTime":1767.74,"body":"incision over the fcr just"},{"speaker":"Chris Dy","startTime":1764.8,"endTime":1767.74,"body":"proximal to the risk crease,"},{"speaker":"Chris Dy","startTime":1768.22,"endTime":1771.82,"body":"identify my fcr there, do your"},{"speaker":"Chris Dy","startTime":1768.22,"endTime":1771.82,"body":"various checks to ensure it is"},{"speaker":"Chris Dy","startTime":1771.82,"endTime":1775.36,"body":"indeed the fcr same as yours,"},{"speaker":"Chris Dy","startTime":1771.82,"endTime":1775.36,"body":"but also including making sure"},{"speaker":"Chris Dy","startTime":1775.36,"endTime":1778.66,"body":"none of the fingers are moving,"},{"speaker":"Chris Dy","startTime":1775.36,"endTime":1778.66,"body":"because you don't want to be"},{"speaker":"Chris Dy","startTime":1778.66,"endTime":1783.9,"body":"that person either. And then I'd"},{"speaker":"Chris Dy","startTime":1778.66,"endTime":1783.9,"body":"make a, you know, I'd like to"},{"speaker":"Chris Dy","startTime":1783.9,"endTime":1786.12,"body":"get it, you know, in terms of"},{"speaker":"Chris Dy","startTime":1783.9,"endTime":1786.12,"body":"transecting it, I agree with"},{"speaker":"Chris Dy","startTime":1786.12,"endTime":1788.88,"body":"transacting at the musculotend"},{"speaker":"Chris Dy","startTime":1786.12,"endTime":1788.88,"body":"in this junction. I will make a"},{"speaker":"Chris Dy","startTime":1788.88,"endTime":1792.48,"body":"couple of small transverse"},{"speaker":"Chris Dy","startTime":1788.88,"endTime":1792.48,"body":"counter incisions, you know, to"},{"speaker":"Chris Dy","startTime":1793.92,"endTime":1798.42,"body":"to free up the fcr tendon. And"},{"speaker":"Chris Dy","startTime":1793.92,"endTime":1798.42,"body":"then the more proximal counter"},{"speaker":"Chris Dy","startTime":1798.42,"endTime":1801.5,"body":"incision is where I divide the"},{"speaker":"Chris Dy","startTime":1798.42,"endTime":1801.5,"body":"F. Our tendon in the recent"},{"speaker":"Chris Dy","startTime":1801.5,"endTime":1803.78,"body":"case, I was really because I was"},{"speaker":"Chris Dy","startTime":1801.5,"endTime":1803.78,"body":"like, I probably didn't need"},{"speaker":"Chris Dy","startTime":1803.78,"endTime":1806.36,"body":"this second counter incision,"},{"speaker":"Chris Dy","startTime":1803.78,"endTime":1806.36,"body":"but, and because I didn't need"},{"speaker":"Chris Dy","startTime":1806.36,"endTime":1809.0,"body":"all the length, I just didn't"},{"speaker":"Chris Dy","startTime":1806.36,"endTime":1809.0,"body":"ever want to run out of length"},{"speaker":"Chris Dy","startTime":1809.0,"endTime":1811.58,"body":"on this one. And so, yeah, I"},{"speaker":"Chris Dy","startTime":1809.0,"endTime":1811.58,"body":"repaint the penalty of cutting"},{"speaker":"Chris Dy","startTime":1811.58,"endTime":1815.66,"body":"the cutting the tendon, so I"},{"speaker":"Chris Dy","startTime":1811.58,"endTime":1815.66,"body":"will then make sure it's"},{"speaker":"Chris Dy","startTime":1815.66,"endTime":1819.32,"body":"completely free through the"},{"speaker":"Chris Dy","startTime":1815.66,"endTime":1819.32,"body":"incisions, and then divide it to"},{"speaker":"Chris Dy","startTime":1819.32,"endTime":1822.16,"body":"approximate the musculotend in"},{"speaker":"Chris Dy","startTime":1819.32,"endTime":1822.16,"body":"this junction, pull it into the"},{"speaker":"Chris Dy","startTime":1822.16,"endTime":1827.32,"body":"main to the to the volar wrist"},{"speaker":"Chris Dy","startTime":1822.16,"endTime":1827.32,"body":"incision, and then try to pull"},{"speaker":"Chris Dy","startTime":1827.32,"endTime":1832.36,"body":"it through from the from the"},{"speaker":"Chris Dy","startTime":1827.32,"endTime":1832.36,"body":"from the dorsal thumb incision,"},{"speaker":"Chris Dy","startTime":1832.84,"endTime":1835.3,"body":"you know, just by freeing it up"},{"speaker":"Chris Dy","startTime":1832.84,"endTime":1835.3,"body":"and then pulling on the fcr"},{"speaker":"Chris Dy","startTime":1835.3,"endTime":1838.42,"body":"there, I remember Dr gelberman,"},{"speaker":"Chris Dy","startTime":1835.3,"endTime":1838.42,"body":"at least in my notes. So there"},{"speaker":"Chris Dy","startTime":1838.42,"endTime":1841.02,"body":"may be something lost in"},{"speaker":"Chris Dy","startTime":1838.42,"endTime":1841.02,"body":"translation, he would make a"},{"speaker":"Chris Dy","startTime":1841.02,"endTime":1843.18,"body":"separate he would try to at"},{"speaker":"Chris Dy","startTime":1841.02,"endTime":1843.18,"body":"least have a separate"},{"speaker":"Chris Dy","startTime":1843.18,"endTime":1847.02,"body":"subcutaneous tunnel in passing"},{"speaker":"Chris Dy","startTime":1843.18,"endTime":1847.02,"body":"an instrument from the main"},{"speaker":"Chris Dy","startTime":1847.02,"endTime":1849.84,"body":"dorsal incision into the volar"},{"speaker":"Chris Dy","startTime":1847.02,"endTime":1849.84,"body":"incision. And I have not found"},{"speaker":"Chris Dy","startTime":1849.84,"endTime":1851.16,"body":"that necessary in practice."},{"speaker":"Charles Goldfarb","startTime":1851.88,"endTime":1853.68,"body":"I will say"},{"speaker":"Charles Goldfarb","startTime":1851.88,"endTime":1853.68,"body":"that the benefit of the Wagner"},{"speaker":"Charles Goldfarb","startTime":1853.68,"endTime":1857.46,"body":"incision is when you curve volar"},{"speaker":"Charles Goldfarb","startTime":1853.68,"endTime":1857.46,"body":"along the wrist crease, you get"},{"speaker":"Charles Goldfarb","startTime":1857.46,"endTime":1861.92,"body":"a second access point to the fcr"},{"speaker":"Charles Goldfarb","startTime":1857.46,"endTime":1861.92,"body":"tendon. But I will strongly say"},{"speaker":"Charles Goldfarb","startTime":1861.92,"endTime":1865.82,"body":"that I don't think you need it"},{"speaker":"Charles Goldfarb","startTime":1861.92,"endTime":1865.82,"body":"for me. One small incision, 10"},{"speaker":"Charles Goldfarb","startTime":1866.18,"endTime":1868.94,"body":"centimeters proximal to risk."},{"speaker":"Charles Goldfarb","startTime":1866.18,"endTime":1868.94,"body":"Freeze the width of my hand."},{"speaker":"Chris Dy","startTime":1870.26,"endTime":1872.12,"body":"Everybody, go measure"},{"speaker":"Chris Dy","startTime":1870.26,"endTime":1872.12,"body":"the width of your hand. I"},{"speaker":"Chris Dy","startTime":1872.12,"endTime":1874.76,"body":"should. So actually did that in"},{"speaker":"Chris Dy","startTime":1872.12,"endTime":1874.76,"body":"residency. I measured the width"},{"speaker":"Chris Dy","startTime":1874.76,"endTime":1876.92,"body":"of my hand because I kept"},{"speaker":"Chris Dy","startTime":1874.76,"endTime":1876.92,"body":"asking, like, how is my hand"},{"speaker":"Chris Dy","startTime":1876.92,"endTime":1879.86,"body":"compared to Dr so and so, I'll"},{"speaker":"Chris Dy","startTime":1876.92,"endTime":1879.86,"body":"say, Dr Hotchkiss. How does it"},{"speaker":"Chris Dy","startTime":1879.86,"endTime":1881.38,"body":"compare to Dr HOTCH gets his"},{"speaker":"Chris Dy","startTime":1879.86,"endTime":1881.38,"body":"aunt Well,"},{"speaker":"Charles Goldfarb","startTime":1881.92,"endTime":1883.42,"body":"you know, it's"},{"speaker":"Charles Goldfarb","startTime":1881.92,"endTime":1883.42,"body":"funny, because I was talking"},{"speaker":"Charles Goldfarb","startTime":1883.42,"endTime":1886.12,"body":"about this the other day."},{"speaker":"Charles Goldfarb","startTime":1883.42,"endTime":1886.12,"body":"Michelle Carlson, Michelle"},{"speaker":"Charles Goldfarb","startTime":1886.12,"endTime":1889.66,"body":"Gerwin, when she wrote the"},{"speaker":"Charles Goldfarb","startTime":1886.12,"endTime":1889.66,"body":"paper, talked about where the"},{"speaker":"Charles Goldfarb","startTime":1889.66,"endTime":1892.12,"body":"radial nerve came in, tearily,"},{"speaker":"Charles Goldfarb","startTime":1889.66,"endTime":1892.12,"body":"and it was 10 centimeters"},{"speaker":"Charles Goldfarb","startTime":1892.12,"endTime":1895.54,"body":"proximal to lateral epicondyle"},{"speaker":"Charles Goldfarb","startTime":1892.12,"endTime":1895.54,"body":"and I this week said, you know,"},{"speaker":"Charles Goldfarb","startTime":1895.54,"endTime":1899.74,"body":"in a kid, you can't count on 10"},{"speaker":"Charles Goldfarb","startTime":1895.54,"endTime":1899.74,"body":"centimeters, but it's a valid,"},{"speaker":"Charles Goldfarb","startTime":1899.74,"endTime":1903.9,"body":"valid point. But for me in the"},{"speaker":"Charles Goldfarb","startTime":1899.74,"endTime":1903.9,"body":"or it works every"},{"speaker":"Chris Dy","startTime":1903.9,"endTime":1907.86,"body":"time in my hands,"},{"speaker":"Chris Dy","startTime":1903.9,"endTime":1907.86,"body":"yeah. So you"},{"speaker":"Charles Goldfarb","startTime":1907.86,"endTime":1910.86,"body":"harvest the"},{"speaker":"Charles Goldfarb","startTime":1907.86,"endTime":1910.86,"body":"whole tendon, not a Hemi tendon,"},{"speaker":"Charles Goldfarb","startTime":1910.86,"endTime":1913.74,"body":"or half a tendon. I think if"},{"speaker":"Charles Goldfarb","startTime":1910.86,"endTime":1913.74,"body":"people who take half the tendon,"},{"speaker":"Charles Goldfarb","startTime":1913.8,"endTime":1916.44,"body":"absolutely have to have the"},{"speaker":"Charles Goldfarb","startTime":1913.8,"endTime":1916.44,"body":"counter incision. If you're"},{"speaker":"Charles Goldfarb","startTime":1916.44,"endTime":1918.72,"body":"taking the whole tendon, which"},{"speaker":"Charles Goldfarb","startTime":1916.44,"endTime":1918.72,"body":"is what I do, I don't think you"},{"speaker":"Charles Goldfarb","startTime":1918.72,"endTime":1920.58,"body":"need, you don't always need the"},{"speaker":"Charles Goldfarb","startTime":1918.72,"endTime":1920.58,"body":"counter incision."},{"speaker":"Chris Dy","startTime":1920.58,"endTime":1922.32,"body":"Why do you take the"},{"speaker":"Chris Dy","startTime":1920.58,"endTime":1922.32,"body":"whole tenant on half of the"},{"speaker":"Chris Dy","startTime":1922.32,"endTime":1924.38,"body":"tendon? Because tendon? Because"},{"speaker":"Chris Dy","startTime":1922.32,"endTime":1924.38,"body":"I end up taking the whole"},{"speaker":"Chris Dy","startTime":1924.38,"endTime":1926.18,"body":"tendon, and sometimes I end up"},{"speaker":"Chris Dy","startTime":1924.38,"endTime":1926.18,"body":"using half"},{"speaker":"Charles Goldfarb","startTime":1926.18,"endTime":1928.46,"body":"of the"},{"speaker":"Charles Goldfarb","startTime":1926.18,"endTime":1928.46,"body":"tendons. I take it and use it. I"},{"speaker":"Charles Goldfarb","startTime":1928.46,"endTime":1930.5,"body":"just think it's easier and"},{"speaker":"Charles Goldfarb","startTime":1928.46,"endTime":1930.5,"body":"faster. And I don't think"},{"speaker":"Charles Goldfarb","startTime":1930.5,"endTime":1933.74,"body":"patients complain ever about the"},{"speaker":"Charles Goldfarb","startTime":1930.5,"endTime":1933.74,"body":"lack of the fcr,"},{"speaker":"Chris Dy","startTime":1934.52,"endTime":1936.44,"body":"right? Do you think"},{"speaker":"Chris Dy","startTime":1934.52,"endTime":1936.44,"body":"it? Do you think taking less"},{"speaker":"Chris Dy","startTime":1936.44,"endTime":1938.96,"body":"tendon would potentially lead to"},{"speaker":"Chris Dy","startTime":1936.44,"endTime":1938.96,"body":"less soreness? Because I think"},{"speaker":"Chris Dy","startTime":1938.96,"endTime":1941.38,"body":"that is one complaint that I've"},{"speaker":"Chris Dy","startTime":1938.96,"endTime":1941.38,"body":"least heard historically"},{"speaker":"Chris Dy","startTime":1941.38,"endTime":1943.18,"body":"reported about the fcr. It"},{"speaker":"Charles Goldfarb","startTime":1943.18,"endTime":1945.88,"body":"could,"},{"speaker":"Charles Goldfarb","startTime":1943.18,"endTime":1945.88,"body":"absolutely could. Um, don't"},{"speaker":"Charles Goldfarb","startTime":1945.88,"endTime":1947.98,"body":"know, I just don't get"},{"speaker":"Charles Goldfarb","startTime":1945.88,"endTime":1947.98,"body":"complaints about it. And then"},{"speaker":"Charles Goldfarb","startTime":1947.98,"endTime":1950.92,"body":"maybe that's because I mobilized"},{"speaker":"Charles Goldfarb","startTime":1947.98,"endTime":1950.92,"body":"for four weeks in the cast. You"},{"speaker":"Charles Goldfarb","startTime":1950.92,"endTime":1953.02,"body":"know, they would ask, or they"},{"speaker":"Charles Goldfarb","startTime":1950.92,"endTime":1953.02,"body":"would ask,"},{"speaker":"Chris Dy","startTime":1955.78,"endTime":1958.0,"body":"all right, so then, so"},{"speaker":"Chris Dy","startTime":1955.78,"endTime":1958.0,"body":"we've got the fcr into the main"},{"speaker":"Chris Dy","startTime":1958.0,"endTime":1960.22,"body":"incision, whether that's a"},{"speaker":"Chris Dy","startTime":1958.0,"endTime":1960.22,"body":"Wagner or a dorsal approach,"},{"speaker":"Chris Dy","startTime":1960.52,"endTime":1961.92,"body":"whatnot. So"},{"speaker":"Charles Goldfarb","startTime":1963.0,"endTime":1967.02,"body":"I take a 2.5"},{"speaker":"Charles Goldfarb","startTime":1963.0,"endTime":1967.02,"body":"millimeter drill bit and we have"},{"speaker":"Charles Goldfarb","startTime":1967.02,"endTime":1972.3,"body":"a little set. Where's it? 2.5"},{"speaker":"Charles Goldfarb","startTime":1967.02,"endTime":1972.3,"body":"3.5 4.0 and 4.5 I usually we"},{"speaker":"Chris Dy","startTime":1972.3,"endTime":1974.88,"body":"used to have a little"},{"speaker":"Chris Dy","startTime":1972.3,"endTime":1974.88,"body":"set at my place, and now, since"},{"speaker":"Chris Dy","startTime":1974.88,"endTime":1977.88,"body":"I didn't use it for so long,"},{"speaker":"Chris Dy","startTime":1974.88,"endTime":1977.88,"body":"they sent it away, which was no"},{"speaker":"Chris Dy","startTime":1977.88,"endTime":1980.96,"body":"painful point of contention,"},{"speaker":"Chris Dy","startTime":1977.88,"endTime":1980.96,"body":"which I will bring up next time"},{"speaker":"Chris Dy","startTime":1980.96,"endTime":1984.14,"body":"I do an fcr at that R, A, L, R,"},{"speaker":"Chris Dy","startTime":1980.96,"endTime":1984.14,"body":"T. I at that place. Yeah."},{"speaker":"Charles Goldfarb","startTime":1984.44,"endTime":1987.14,"body":"So basically,"},{"speaker":"Charles Goldfarb","startTime":1984.44,"endTime":1987.14,"body":"you want to be in the plane of"},{"speaker":"Charles Goldfarb","startTime":1987.14,"endTime":1992.6,"body":"the thumbnail. You want to drill"},{"speaker":"Charles Goldfarb","startTime":1987.14,"endTime":1992.6,"body":"a couple of centimeters proximal"},{"speaker":"Charles Goldfarb","startTime":1992.66,"endTime":1997.16,"body":"to the base of the thumb."},{"speaker":"Charles Goldfarb","startTime":1992.66,"endTime":1997.16,"body":"Metacarpal. I drill straight in"},{"speaker":"Charles Goldfarb","startTime":1997.46,"endTime":2002.52,"body":"in Dorset of volar. Once I get"},{"speaker":"Charles Goldfarb","startTime":1997.46,"endTime":2002.52,"body":"into the medullary canal. I pull"},{"speaker":"Charles Goldfarb","startTime":2002.52,"endTime":2006.66,"body":"back, drop my hand, and I try to"},{"speaker":"Charles Goldfarb","startTime":2002.52,"endTime":2006.66,"body":"exit at the vola articular"},{"speaker":"Charles Goldfarb","startTime":2006.66,"endTime":2011.7,"body":"surface of the metacarpal. And"},{"speaker":"Charles Goldfarb","startTime":2006.66,"endTime":2011.7,"body":"once you do your first drill"},{"speaker":"Charles Goldfarb","startTime":2011.7,"endTime":2015.12,"body":"bit, you quickly do a second and"},{"speaker":"Charles Goldfarb","startTime":2011.7,"endTime":2015.12,"body":"third drill bit, 4.0 is almost"},{"speaker":"Charles Goldfarb","startTime":2015.12,"endTime":2019.68,"body":"always sufficiently big enough"},{"speaker":"Charles Goldfarb","startTime":2015.12,"endTime":2019.68,"body":"to pass your tendon. So talk"},{"speaker":"Chris Dy","startTime":2019.68,"endTime":2021.92,"body":"about the you talked"},{"speaker":"Chris Dy","startTime":2019.68,"endTime":2021.92,"body":"about the McLaren and how it's"},{"speaker":"Chris Dy","startTime":2021.92,"endTime":2024.44,"body":"hard to, you know, have somebody"},{"speaker":"Chris Dy","startTime":2021.92,"endTime":2024.44,"body":"else do it through somebody"},{"speaker":"Chris Dy","startTime":2024.44,"endTime":2027.62,"body":"else's hands. I find that to be"},{"speaker":"Chris Dy","startTime":2024.44,"endTime":2027.62,"body":"really hard, the drop, the"},{"speaker":"Chris Dy","startTime":2027.86,"endTime":2031.1,"body":"initial dorsal volar drop, and"},{"speaker":"Chris Dy","startTime":2027.86,"endTime":2031.1,"body":"get, you know, so it's like we"},{"speaker":"Chris Dy","startTime":2031.1,"endTime":2034.1,"body":"could do it, they can do it, but"},{"speaker":"Chris Dy","startTime":2031.1,"endTime":2034.1,"body":"me trusting them to do it"},{"speaker":"Chris Dy","startTime":2034.1,"endTime":2036.5,"body":"without having done that case a"},{"speaker":"Chris Dy","startTime":2034.1,"endTime":2036.5,"body":"lot. So I make two separate"},{"speaker":"Chris Dy","startTime":2036.5,"endTime":2039.62,"body":"drills. I do two separate"},{"speaker":"Chris Dy","startTime":2036.5,"endTime":2039.62,"body":"passes, Dorset and roller, and"},{"speaker":"Chris Dy","startTime":2039.62,"endTime":2041.92,"body":"then through the articular"},{"speaker":"Chris Dy","startTime":2039.62,"endTime":2041.92,"body":"surface to, you know, just to"},{"speaker":"Chris Dy","startTime":2041.92,"endTime":2045.64,"body":"open the measured layer canal."},{"speaker":"Chris Dy","startTime":2041.92,"endTime":2045.64,"body":"And do you often you go to a"},{"speaker":"Chris Dy","startTime":2045.64,"endTime":2046.6,"body":"four? Oh, every time."},{"speaker":"Charles Goldfarb","startTime":2047.38,"endTime":2049.0,"body":"Yeah. I mean,"},{"speaker":"Charles Goldfarb","startTime":2047.38,"endTime":2049.0,"body":"if I'm using the whole tenant, I"},{"speaker":"Charles Goldfarb","startTime":2049.0,"endTime":2052.72,"body":"go to a four. Oh, and I guess if"},{"speaker":"Charles Goldfarb","startTime":2049.0,"endTime":2052.72,"body":"someone was really small, as in"},{"speaker":"Charles Goldfarb","startTime":2052.72,"endTime":2055.66,"body":"metacarpal width, I'd be a"},{"speaker":"Charles Goldfarb","startTime":2052.72,"endTime":2055.66,"body":"little careful. But no, I do."},{"speaker":"Charles Goldfarb","startTime":2055.66,"endTime":2059.62,"body":"And I think the other technical"},{"speaker":"Charles Goldfarb","startTime":2055.66,"endTime":2059.62,"body":"Pearl is that drill hole cannot"},{"speaker":"Charles Goldfarb","startTime":2059.62,"endTime":2062.76,"body":"be directly adjacent to the base"},{"speaker":"Charles Goldfarb","startTime":2059.62,"endTime":2062.76,"body":"of the metacarpal, because you"},{"speaker":"Charles Goldfarb","startTime":2062.76,"endTime":2065.16,"body":"can break through that bone. So"},{"speaker":"Charles Goldfarb","startTime":2062.76,"endTime":2065.16,"body":"you have to go, that was my"},{"speaker":"Chris Dy","startTime":2065.16,"endTime":2067.68,"body":"next question is, how"},{"speaker":"Chris Dy","startTime":2065.16,"endTime":2067.68,"body":"do you ensure that your tunnel"},{"speaker":"Chris Dy","startTime":2067.68,"endTime":2070.38,"body":"is big enough for when you're"},{"speaker":"Chris Dy","startTime":2067.68,"endTime":2070.38,"body":"drilling and moving up in those"},{"speaker":"Chris Dy","startTime":2070.38,"endTime":2074.16,"body":"drill sizes, and then also when"},{"speaker":"Chris Dy","startTime":2070.38,"endTime":2074.16,"body":"you're passing a tendon? It may"},{"speaker":"Chris Dy","startTime":2074.16,"endTime":2075.0,"body":"be a little tight,"},{"speaker":"Charles Goldfarb","startTime":2075.42,"endTime":2079.74,"body":"yeah, I wish I"},{"speaker":"Charles Goldfarb","startTime":2075.42,"endTime":2079.74,"body":"could say exact measurement, but"},{"speaker":"Charles Goldfarb","startTime":2079.74,"endTime":2081.74,"body":"I think if you're two or three"},{"speaker":"Charles Goldfarb","startTime":2079.74,"endTime":2081.74,"body":"centimeters, probably"},{"speaker":"Chris Dy","startTime":2081.86,"endTime":2083.78,"body":"the width of your the"},{"speaker":"Chris Dy","startTime":2081.86,"endTime":2083.78,"body":"width of your pinky finger,"},{"speaker":"Charles Goldfarb","startTime":2084.5,"endTime":2086.72,"body":"maybe that."},{"speaker":"Charles Goldfarb","startTime":2084.5,"endTime":2086.72,"body":"Maybe that's it. I'll look next"},{"speaker":"Charles Goldfarb","startTime":2086.72,"endTime":2090.44,"body":"time. Yeah, I think you have to"},{"speaker":"Charles Goldfarb","startTime":2086.72,"endTime":2090.44,"body":"be careful, because otherwise,"},{"speaker":"Charles Goldfarb","startTime":2090.44,"endTime":2093.2,"body":"then you got a more challenging"},{"speaker":"Charles Goldfarb","startTime":2090.44,"endTime":2093.2,"body":"issue if you break through the"},{"speaker":"Charles Goldfarb","startTime":2093.2,"endTime":2095.9,"body":"bone. Which, which can happen."},{"speaker":"Charles Goldfarb","startTime":2093.2,"endTime":2095.9,"body":"But knock on wood, I don't"},{"speaker":"Charles Goldfarb","startTime":2095.9,"endTime":2096.74,"body":"recall it happening."},{"speaker":"Chris Dy","startTime":2097.28,"endTime":2100.66,"body":"Right, right? Yeah. So"},{"speaker":"Chris Dy","startTime":2097.28,"endTime":2100.66,"body":"you're using. The whole tendon."},{"speaker":"Chris Dy","startTime":2100.66,"endTime":2103.42,"body":"How do you pass the tendon"},{"speaker":"Chris Dy","startTime":2100.66,"endTime":2103.42,"body":"through the tunnel and which"},{"speaker":"Chris Dy","startTime":2103.42,"endTime":2105.34,"body":"direction do you pass it in?"},{"speaker":"Chris Dy","startTime":2103.42,"endTime":2105.34,"body":"Right?"},{"speaker":"Charles Goldfarb","startTime":2105.34,"endTime":2108.16,"body":"So to me, this"},{"speaker":"Charles Goldfarb","startTime":2105.34,"endTime":2108.16,"body":"is the buttsiest part of the"},{"speaker":"Charles Goldfarb","startTime":2108.16,"endTime":2112.48,"body":"procedure, because I want to be"},{"speaker":"Charles Goldfarb","startTime":2108.16,"endTime":2112.48,"body":"I want to not open things that"},{"speaker":"Charles Goldfarb","startTime":2112.54,"endTime":2116.26,"body":"we don't really need. So trying"},{"speaker":"Charles Goldfarb","startTime":2112.54,"endTime":2116.26,"body":"to save money and not waste too"},{"speaker":"Charles Goldfarb","startTime":2116.26,"endTime":2122.88,"body":"much time. So you know that your"},{"speaker":"Charles Goldfarb","startTime":2116.26,"endTime":2122.88,"body":"fcr tendon is attaching to the"},{"speaker":"Charles Goldfarb","startTime":2123.0,"endTime":2126.42,"body":"volar base of the second"},{"speaker":"Charles Goldfarb","startTime":2123.0,"endTime":2126.42,"body":"metacarpal. And the whole"},{"speaker":"Charles Goldfarb","startTime":2126.42,"endTime":2129.66,"body":"concept of the procedure is you"},{"speaker":"Charles Goldfarb","startTime":2126.42,"endTime":2129.66,"body":"come, you bring the tendon from"},{"speaker":"Charles Goldfarb","startTime":2129.66,"endTime":2134.46,"body":"deep exiting out the dorsal"},{"speaker":"Charles Goldfarb","startTime":2129.66,"endTime":2134.46,"body":"aspect of your thumb metacarpal."},{"speaker":"Charles Goldfarb","startTime":2134.64,"endTime":2138.24,"body":"So now you've linked your thumb"},{"speaker":"Charles Goldfarb","startTime":2134.64,"endTime":2138.24,"body":"metacarpal to its deep second"},{"speaker":"Charles Goldfarb","startTime":2138.24,"endTime":2142.16,"body":"metacarpal insertion. And how"},{"speaker":"Charles Goldfarb","startTime":2138.24,"endTime":2142.16,"body":"you get it through. I usually"},{"speaker":"Charles Goldfarb","startTime":2142.22,"endTime":2147.02,"body":"have a whip stitch in the cut"},{"speaker":"Charles Goldfarb","startTime":2142.22,"endTime":2147.02,"body":"end of the fcr, long enough that"},{"speaker":"Charles Goldfarb","startTime":2147.02,"endTime":2151.22,"body":"I can sort of pull it through"},{"speaker":"Charles Goldfarb","startTime":2147.02,"endTime":2151.22,"body":"and hopefully wiggle it through"},{"speaker":"Charles Goldfarb","startTime":2151.22,"endTime":2154.34,"body":"without too much difficulty. I"},{"speaker":"Charles Goldfarb","startTime":2151.22,"endTime":2154.34,"body":"don't know of a simplistic"},{"speaker":"Charles Goldfarb","startTime":2154.34,"endTime":2157.34,"body":"approach. I'd love to hear a"},{"speaker":"Charles Goldfarb","startTime":2154.34,"endTime":2157.34,"body":"pearl from you, but that's the"},{"speaker":"Charles Goldfarb","startTime":2157.34,"endTime":2159.14,"body":"funciest part of the procedure."},{"speaker":"Charles Goldfarb","startTime":2157.34,"endTime":2159.14,"body":"Yeah,"},{"speaker":"Chris Dy","startTime":2159.14,"endTime":2161.92,"body":"I just opened the"},{"speaker":"Chris Dy","startTime":2159.14,"endTime":2161.92,"body":"Houston suture passer because"},{"speaker":"Chris Dy","startTime":2161.92,"endTime":2164.98,"body":"it's just easier. And I get it."},{"speaker":"Chris Dy","startTime":2161.92,"endTime":2164.98,"body":"I get what you're saying in"},{"speaker":"Chris Dy","startTime":2164.98,"endTime":2170.02,"body":"terms of cost, but also time of"},{"speaker":"Chris Dy","startTime":2164.98,"endTime":2170.02,"body":"the or so, the whip stitch, I"},{"speaker":"Chris Dy","startTime":2170.02,"endTime":2173.38,"body":"think, is super helpful. And"},{"speaker":"Chris Dy","startTime":2170.02,"endTime":2173.38,"body":"then I use the whip stitch and"},{"speaker":"Chris Dy","startTime":2173.38,"endTime":2175.96,"body":"kind of tubularize the the end"},{"speaker":"Chris Dy","startTime":2173.38,"endTime":2175.96,"body":"of the tendon. And I've"},{"speaker":"Chris Dy","startTime":2175.96,"endTime":2178.84,"body":"probably, at that point already"},{"speaker":"Chris Dy","startTime":2175.96,"endTime":2178.84,"body":"gotten run rid of the muscular,"},{"speaker":"Chris Dy","startTime":2178.84,"endTime":2182.76,"body":"whatever muscular attachments"},{"speaker":"Chris Dy","startTime":2178.84,"endTime":2182.76,"body":"are there, whip stitch it, and"},{"speaker":"Chris Dy","startTime":2182.76,"endTime":2185.88,"body":"then pass the whip stitch"},{"speaker":"Chris Dy","startTime":2182.76,"endTime":2185.88,"body":"through with the so I passed the"},{"speaker":"Chris Dy","startTime":2186.12,"endTime":2189.36,"body":"Hewson suture passer. You could"},{"speaker":"Chris Dy","startTime":2186.12,"endTime":2189.36,"body":"honestly just use, like a viral"},{"speaker":"Chris Dy","startTime":2189.36,"endTime":2192.0,"body":"and loop it around, or whatever"},{"speaker":"Chris Dy","startTime":2189.36,"endTime":2192.0,"body":"sutra that you have, and loop it"},{"speaker":"Chris Dy","startTime":2192.0,"endTime":2194.46,"body":"around and put the loop through"},{"speaker":"Chris Dy","startTime":2192.0,"endTime":2194.46,"body":"from dorsal exiting the"},{"speaker":"Chris Dy","startTime":2194.46,"endTime":2199.86,"body":"articular surface, pass your"},{"speaker":"Chris Dy","startTime":2194.46,"endTime":2199.86,"body":"other stitch. Use that passing"},{"speaker":"Chris Dy","startTime":2199.86,"endTime":2203.3,"body":"stitch to bring the tendon from"},{"speaker":"Chris Dy","startTime":2199.86,"endTime":2203.3,"body":"articular surface out dorsally."},{"speaker":"Chris Dy","startTime":2205.16,"endTime":2211.28,"body":"And then I use a smooth, non"},{"speaker":"Chris Dy","startTime":2205.16,"endTime":2211.28,"body":"tooth forcep to help wiggle that"},{"speaker":"Chris Dy","startTime":2211.28,"endTime":2213.98,"body":"through little irrigation,"},{"speaker":"Chris Dy","startTime":2211.28,"endTime":2213.98,"body":"little prayer, make sure the"},{"speaker":"Chris Dy","startTime":2213.98,"endTime":2214.82,"body":"tunnel is big enough."},{"speaker":"Charles Goldfarb","startTime":2215.0,"endTime":2217.7,"body":"Yeah. All"},{"speaker":"Charles Goldfarb","startTime":2215.0,"endTime":2217.7,"body":"true. All true. And then from"},{"speaker":"Charles Goldfarb","startTime":2217.7,"endTime":2221.5,"body":"there, you now have your tendon"},{"speaker":"Charles Goldfarb","startTime":2217.7,"endTime":2221.5,"body":"exiting dorsally. And while I'm"},{"speaker":"Charles Goldfarb","startTime":2221.5,"endTime":2225.52,"body":"distracting the thumb, I use a"},{"speaker":"Charles Goldfarb","startTime":2221.5,"endTime":2225.52,"body":"two oebon to either grab the"},{"speaker":"Charles Goldfarb","startTime":2225.52,"endTime":2228.94,"body":"tendon itself as deep as"},{"speaker":"Charles Goldfarb","startTime":2225.52,"endTime":2228.94,"body":"possible, or some bowler capsule"},{"speaker":"Charles Goldfarb","startTime":2228.94,"endTime":2233.62,"body":"you don't want to take too huge"},{"speaker":"Charles Goldfarb","startTime":2228.94,"endTime":2233.62,"body":"of a bite. And then I suture"},{"speaker":"Charles Goldfarb","startTime":2233.62,"endTime":2238.0,"body":"tendon to tendon as deep as"},{"speaker":"Charles Goldfarb","startTime":2233.62,"endTime":2238.0,"body":"possible I can do. And that can"},{"speaker":"Charles Goldfarb","startTime":2238.0,"endTime":2242.16,"body":"be a little tricky as well, but"},{"speaker":"Charles Goldfarb","startTime":2238.0,"endTime":2242.16,"body":"one or two sutures there anchor"},{"speaker":"Charles Goldfarb","startTime":2242.16,"endTime":2245.04,"body":"the thumb in a distracted"},{"speaker":"Charles Goldfarb","startTime":2242.16,"endTime":2245.04,"body":"position. Do you loop your"},{"speaker":"Charles Goldfarb","startTime":2245.04,"endTime":2249.6,"body":"tendon at all? I do not. I Well,"},{"speaker":"Charles Goldfarb","startTime":2245.04,"endTime":2249.6,"body":"I'm not sure if I know what you"},{"speaker":"Charles Goldfarb","startTime":2249.6,"endTime":2252.54,"body":"mean by loop. But first I just I"},{"speaker":"Charles Goldfarb","startTime":2249.6,"endTime":2252.54,"body":"suture, tended to tender, tended"},{"speaker":"Charles Goldfarb","startTime":2252.54,"endTime":2255.3,"body":"to capsule. And then I do my"},{"speaker":"Charles Goldfarb","startTime":2252.54,"endTime":2255.3,"body":"favorite suture of all, the"},{"speaker":"Charles Goldfarb","startTime":2255.3,"endTime":2256.14,"body":"dolphin stitch, the"},{"speaker":"Chris Dy","startTime":2257.34,"endTime":2260.54,"body":"Haven stitch, the PTSD"},{"speaker":"Chris Dy","startTime":2257.34,"endTime":2260.54,"body":"from the dolphin stitch. And"},{"speaker":"Chris Dy","startTime":2260.54,"endTime":2263.12,"body":"fellowship with you. And"},{"speaker":"Chris Dy","startTime":2260.54,"endTime":2263.12,"body":"Galbraith, oh, it's"},{"speaker":"Charles Goldfarb","startTime":2263.12,"endTime":2265.88,"body":"great. So for"},{"speaker":"Charles Goldfarb","startTime":2263.12,"endTime":2265.88,"body":"those who aren't familiar with"},{"speaker":"Charles Goldfarb","startTime":2265.88,"endTime":2267.08,"body":"the dolphins, I hate"},{"speaker":"Unknown","startTime":2267.2,"endTime":2270.62,"body":"it so much. It is"},{"speaker":"Unknown","startTime":2267.2,"endTime":2270.62,"body":"awful. It's so unnecessary."},{"speaker":"Charles Goldfarb","startTime":2271.22,"endTime":2273.14,"body":"So the"},{"speaker":"Charles Goldfarb","startTime":2271.22,"endTime":2273.14,"body":"dolphin. So to do a dolphin"},{"speaker":"Charles Goldfarb","startTime":2273.14,"endTime":2276.92,"body":"stitch and appreciate its"},{"speaker":"Charles Goldfarb","startTime":2273.14,"endTime":2276.92,"body":"magnificence when you"},{"speaker":"Chris Dy","startTime":2277.16,"endTime":2280.28,"body":"This is like, this is"},{"speaker":"Chris Dy","startTime":2277.16,"endTime":2280.28,"body":"really like, hand surgeon, like,"},{"speaker":"Chris Dy","startTime":2280.52,"endTime":2282.76,"body":"nerdiness, right here the"},{"speaker":"Chris Dy","startTime":2280.52,"endTime":2282.76,"body":"dolphin stitch. It's"},{"speaker":"Charles Goldfarb","startTime":2282.76,"endTime":2284.68,"body":"a way to"},{"speaker":"Charles Goldfarb","startTime":2282.76,"endTime":2284.68,"body":"accomplish an anchovy or a"},{"speaker":"Charles Goldfarb","startTime":2284.68,"endTime":2288.76,"body":"balling up with a tendon, and"},{"speaker":"Charles Goldfarb","startTime":2284.68,"endTime":2288.76,"body":"put it into the space where the"},{"speaker":"Charles Goldfarb","startTime":2288.76,"endTime":2291.7,"body":"trapezium used to be. And so"},{"speaker":"Charles Goldfarb","startTime":2288.76,"endTime":2291.7,"body":"basically you put, usually, in"},{"speaker":"Charles Goldfarb","startTime":2291.7,"endTime":2294.16,"body":"this case, I put two stitches"},{"speaker":"Charles Goldfarb","startTime":2291.7,"endTime":2294.16,"body":"in. So the first stitch is done,"},{"speaker":"Charles Goldfarb","startTime":2294.16,"endTime":2297.22,"body":"cut short, and that's 10 into"},{"speaker":"Charles Goldfarb","startTime":2294.16,"endTime":2297.22,"body":"tenon. And then I put another"},{"speaker":"Charles Goldfarb","startTime":2297.22,"endTime":2300.78,"body":"deep stitch in, 10 into tenon,"},{"speaker":"Charles Goldfarb","startTime":2297.22,"endTime":2300.78,"body":"and I leave the needle attached"},{"speaker":"Charles Goldfarb","startTime":2300.78,"endTime":2303.54,"body":"to the long end of the suture,"},{"speaker":"Charles Goldfarb","startTime":2300.78,"endTime":2303.54,"body":"and then, essentially, I hold"},{"speaker":"Charles Goldfarb","startTime":2303.54,"endTime":2306.9,"body":"the tendon up, and I kind of"},{"speaker":"Charles Goldfarb","startTime":2303.54,"endTime":2306.9,"body":"whip in and out, exactly like a"},{"speaker":"Charles Goldfarb","startTime":2306.9,"endTime":2312.18,"body":"dolphin. And then at the end,"},{"speaker":"Charles Goldfarb","startTime":2306.9,"endTime":2312.18,"body":"you have your suture, and you"},{"speaker":"Charles Goldfarb","startTime":2312.18,"endTime":2315.84,"body":"have your tendon, and you can"},{"speaker":"Charles Goldfarb","startTime":2312.18,"endTime":2315.84,"body":"just scrunch your tendon down"},{"speaker":"Charles Goldfarb","startTime":2316.02,"endTime":2319.26,"body":"into the wound, and you have a"},{"speaker":"Charles Goldfarb","startTime":2316.02,"endTime":2319.26,"body":"beautiful anchovy. And then you"},{"speaker":"Charles Goldfarb","startTime":2319.26,"endTime":2321.14,"body":"can close your capsule and get"},{"speaker":"Charles Goldfarb","startTime":2319.26,"endTime":2321.14,"body":"out of dodge."},{"speaker":"Chris Dy","startTime":2321.86,"endTime":2327.62,"body":"So I was going to ask"},{"speaker":"Chris Dy","startTime":2321.86,"endTime":2327.62,"body":"you, do you use a suture anchor?"},{"speaker":"Chris Dy","startTime":2327.62,"endTime":2330.02,"body":"In this case, it sounds like you"},{"speaker":"Chris Dy","startTime":2327.62,"endTime":2330.02,"body":"don't, if you're minimizing"},{"speaker":"Chris Dy","startTime":2330.02,"endTime":2330.5,"body":"cost."},{"speaker":"Charles Goldfarb","startTime":2331.4,"endTime":2337.22,"body":"Oh, my God,"},{"speaker":"Charles Goldfarb","startTime":2331.4,"endTime":2337.22,"body":"yes, I do not, because I clearly"},{"speaker":"Charles Goldfarb","startTime":2337.22,"endTime":2340.3,"body":"am more cost conscious than you,"},{"speaker":"Charles Goldfarb","startTime":2337.22,"endTime":2340.3,"body":"even though I'm not sure you use"},{"speaker":"Charles Goldfarb","startTime":2340.3,"endTime":2343.9,"body":"an anchor. I know our partners"},{"speaker":"Charles Goldfarb","startTime":2340.3,"endTime":2343.9,"body":"use anchors. I used"},{"speaker":"Chris Dy","startTime":2343.9,"endTime":2345.88,"body":"an I mean, I use an"},{"speaker":"Chris Dy","startTime":2343.9,"endTime":2345.88,"body":"anchor because that's how I was,"},{"speaker":"Chris Dy","startTime":2346.06,"endTime":2349.06,"body":"at least the procedure I"},{"speaker":"Chris Dy","startTime":2346.06,"endTime":2349.06,"body":"remember the most, whether it"},{"speaker":"Chris Dy","startTime":2349.06,"endTime":2352.9,"body":"was embellished in my and burned"},{"speaker":"Chris Dy","startTime":2349.06,"endTime":2352.9,"body":"in my brain, for so many"},{"speaker":"Chris Dy","startTime":2352.9,"endTime":2356.08,"body":"reasons, I use an anchor and"},{"speaker":"Chris Dy","startTime":2352.9,"endTime":2356.08,"body":"then I accomplish the what"},{"speaker":"Chris Dy","startTime":2356.08,"endTime":2359.86,"body":"you're doing with the dolphin"},{"speaker":"Chris Dy","startTime":2356.08,"endTime":2359.86,"body":"stitch, with one of the one of"},{"speaker":"Chris Dy","startTime":2359.86,"endTime":2362.58,"body":"the sutures coming out of that"},{"speaker":"Chris Dy","startTime":2359.86,"endTime":2362.58,"body":"anchor, and just cinch"},{"speaker":"Charles Goldfarb","startTime":2362.58,"endTime":2364.62,"body":"it down. Wait,"},{"speaker":"Charles Goldfarb","startTime":2362.58,"endTime":2364.62,"body":"be clear, where are you putting"},{"speaker":"Charles Goldfarb","startTime":2364.62,"endTime":2365.1,"body":"your anchor?"},{"speaker":"Chris Dy","startTime":2366.06,"endTime":2370.98,"body":"So the anchor is at"},{"speaker":"Chris Dy","startTime":2366.06,"endTime":2370.98,"body":"the the trapezoid. Okay, so it's"},{"speaker":"Chris Dy","startTime":2370.98,"endTime":2374.1,"body":"a the cheapest anchor in the"},{"speaker":"Chris Dy","startTime":2370.98,"endTime":2374.1,"body":"set. It's an old anchor. I don't"},{"speaker":"Chris Dy","startTime":2374.1,"endTime":2376.74,"body":"even realize. I'm surprised I"},{"speaker":"Chris Dy","startTime":2374.1,"endTime":2376.74,"body":"still make it, to be honest with"},{"speaker":"Chris Dy","startTime":2376.74,"endTime":2382.46,"body":"you, it's got a two Oh, at the"},{"speaker":"Chris Dy","startTime":2376.74,"endTime":2382.46,"body":"bond or suture in there, and I"},{"speaker":"Chris Dy","startTime":2382.46,"endTime":2386.06,"body":"use one of the needles to, I"},{"speaker":"Chris Dy","startTime":2382.46,"endTime":2386.06,"body":"will physically roll the the"},{"speaker":"Chris Dy","startTime":2386.06,"endTime":2389.84,"body":"tendon up with the tooth less"},{"speaker":"Chris Dy","startTime":2386.06,"endTime":2389.84,"body":"forcep inside of it, and then"},{"speaker":"Chris Dy","startTime":2389.84,"endTime":2392.96,"body":"have the have somebody pass the"},{"speaker":"Chris Dy","startTime":2389.84,"endTime":2392.96,"body":"suture through a couple of"},{"speaker":"Chris Dy","startTime":2392.96,"endTime":2396.8,"body":"times, and then remove the"},{"speaker":"Chris Dy","startTime":2392.96,"endTime":2396.8,"body":"forceps. And then you just cinch"},{"speaker":"Chris Dy","startTime":2396.8,"endTime":2399.2,"body":"it down with your finger,"},{"speaker":"Chris Dy","startTime":2396.8,"endTime":2399.2,"body":"because you've got your other"},{"speaker":"Chris Dy","startTime":2399.2,"endTime":2401.44,"body":"part of the suture. Coming out"},{"speaker":"Chris Dy","startTime":2399.2,"endTime":2401.44,"body":"of the anchor as your post."},{"speaker":"Chris Dy","startTime":2402.4,"endTime":2402.88,"body":"Yeah,"},{"speaker":"Charles Goldfarb","startTime":2403.0,"endTime":2405.28,"body":"that's great."},{"speaker":"Charles Goldfarb","startTime":2403.0,"endTime":2405.28,"body":"So an expensive way"},{"speaker":"Chris Dy","startTime":2405.28,"endTime":2407.26,"body":"to do an lrti,"},{"speaker":"Chris Dy","startTime":2405.28,"endTime":2407.26,"body":"apparently, with a Houston"},{"speaker":"Chris Dy","startTime":2407.26,"endTime":2408.28,"body":"suture passer and an anchor"},{"speaker":"Charles Goldfarb","startTime":2408.52,"endTime":2412.48,"body":"and the CR so"},{"speaker":"Charles Goldfarb","startTime":2408.52,"endTime":2412.48,"body":"my procedure, the TAC, you"},{"speaker":"Chris Dy","startTime":2412.78,"endTime":2416.38,"body":"don't take a CRM at"},{"speaker":"Chris Dy","startTime":2412.78,"endTime":2416.38,"body":"the end. Nothing to confirm what"},{"speaker":"Chris Dy","startTime":2416.38,"endTime":2420.6,"body":"that you did, what you're"},{"speaker":"Chris Dy","startTime":2416.38,"endTime":2420.6,"body":"supposed to do, that you've got"},{"speaker":"Chris Dy","startTime":2420.6,"endTime":2423.96,"body":"suspension without anybody"},{"speaker":"Chris Dy","startTime":2420.6,"endTime":2423.96,"body":"holding the thumb. Nope,"},{"speaker":"Charles Goldfarb","startTime":2424.08,"endTime":2426.84,"body":"I can see that"},{"speaker":"Charles Goldfarb","startTime":2424.08,"endTime":2426.84,"body":"and feel that and be confident"},{"speaker":"Charles Goldfarb","startTime":2426.84,"endTime":2430.74,"body":"in that. Oh, my God, if someone"},{"speaker":"Charles Goldfarb","startTime":2426.84,"endTime":2430.74,"body":"from Blue Cross Blue Shield is"},{"speaker":"Charles Goldfarb","startTime":2430.74,"endTime":2435.6,"body":"listening, there's the Goldfarb"},{"speaker":"Charles Goldfarb","startTime":2430.74,"endTime":2435.6,"body":"technique about $120 and there's"},{"speaker":"Charles Goldfarb","startTime":2435.6,"endTime":2437.16,"body":"the D technique coming in at"},{"speaker":"Charles Goldfarb","startTime":2435.6,"endTime":2437.16,"body":"1500"},{"speaker":"Chris Dy","startTime":2438.42,"endTime":2440.36,"body":"No, it is not. I will"},{"speaker":"Chris Dy","startTime":2438.42,"endTime":2440.36,"body":"look, I will show you the"},{"speaker":"Chris Dy","startTime":2440.36,"endTime":2443.78,"body":"receipts from our logs, at least"},{"speaker":"Chris Dy","startTime":2440.36,"endTime":2443.78,"body":"what we what the hospital"},{"speaker":"Chris Dy","startTime":2443.78,"endTime":2447.92,"body":"charges for the the cheapest"},{"speaker":"Chris Dy","startTime":2443.78,"endTime":2447.92,"body":"sutra anchor in the set. Yeah."},{"speaker":"Chris Dy","startTime":2447.92,"endTime":2451.46,"body":"And then question for you, how"},{"speaker":"Chris Dy","startTime":2447.92,"endTime":2451.46,"body":"often you check an X rays after"},{"speaker":"Chris Dy","startTime":2451.46,"endTime":2453.44,"body":"this, like in the office?"},{"speaker":"Charles Goldfarb","startTime":2453.56,"endTime":2455.9,"body":"Yeah, that's"},{"speaker":"Charles Goldfarb","startTime":2453.56,"endTime":2455.9,"body":"fair. I used to get one at six"},{"speaker":"Charles Goldfarb","startTime":2455.9,"endTime":2458.6,"body":"weeks and get one at one year,"},{"speaker":"Charles Goldfarb","startTime":2455.9,"endTime":2458.6,"body":"when I made everyone come back"},{"speaker":"Charles Goldfarb","startTime":2458.6,"endTime":2463.18,"body":"at one year. I don't get any X"},{"speaker":"Charles Goldfarb","startTime":2458.6,"endTime":2463.18,"body":"rays after if there's a concern"},{"speaker":"Charles Goldfarb","startTime":2463.42,"endTime":2467.02,"body":"about painful impingement, I"},{"speaker":"Charles Goldfarb","startTime":2463.42,"endTime":2467.02,"body":"will get a mini C arm or a"},{"speaker":"Charles Goldfarb","startTime":2467.02,"endTime":2469.48,"body":"standard x ray. But I don't"},{"speaker":"Charles Goldfarb","startTime":2467.02,"endTime":2469.48,"body":"routinely X ray, do you?"},{"speaker":"Chris Dy","startTime":2470.68,"endTime":2474.04,"body":"I try not to for the"},{"speaker":"Chris Dy","startTime":2470.68,"endTime":2474.04,"body":"same reasons, but it will"},{"speaker":"Chris Dy","startTime":2474.04,"endTime":2477.28,"body":"obviously very low threshold to"},{"speaker":"Chris Dy","startTime":2474.04,"endTime":2477.28,"body":"get one if there is a concern"},{"speaker":"Chris Dy","startTime":2477.58,"endTime":2480.48,"body":"aside from the routine post"},{"speaker":"Chris Dy","startTime":2477.58,"endTime":2480.48,"body":"operative discomfort, and if"},{"speaker":"Chris Dy","startTime":2480.48,"endTime":2483.66,"body":"they do as expected in terms of"},{"speaker":"Chris Dy","startTime":2480.48,"endTime":2483.66,"body":"normal trajectory of recovery,"},{"speaker":"Chris Dy","startTime":2483.66,"endTime":2485.52,"body":"then no X rays. Yes,"},{"speaker":"Charles Goldfarb","startTime":2485.52,"endTime":2488.76,"body":"it's funny."},{"speaker":"Charles Goldfarb","startTime":2485.52,"endTime":2488.76,"body":"When I was a younger man, I was"},{"speaker":"Charles Goldfarb","startTime":2488.76,"endTime":2494.64,"body":"involved with the aaos, the"},{"speaker":"Charles Goldfarb","startTime":2488.76,"endTime":2494.64,"body":"Academy's CPG for CMC, so"},{"speaker":"Charles Goldfarb","startTime":2494.64,"endTime":2497.76,"body":"clinical practice guideline for"},{"speaker":"Charles Goldfarb","startTime":2494.64,"endTime":2497.76,"body":"the CMC joint, and we were"},{"speaker":"Charles Goldfarb","startTime":2497.76,"endTime":2501.56,"body":"discussing kind of what needed"},{"speaker":"Charles Goldfarb","startTime":2497.76,"endTime":2501.56,"body":"to be included in the clinical"},{"speaker":"Charles Goldfarb","startTime":2501.56,"endTime":2504.68,"body":"practice guideline. And"},{"speaker":"Charles Goldfarb","startTime":2501.56,"endTime":2504.68,"body":"discussion of X rays came up at"},{"speaker":"Charles Goldfarb","startTime":2504.68,"endTime":2508.28,"body":"the time, I was adamant about at"},{"speaker":"Charles Goldfarb","startTime":2504.68,"endTime":2508.28,"body":"least getting a couple X rays"},{"speaker":"Charles Goldfarb","startTime":2508.28,"endTime":2510.92,"body":"while I followed the patients"},{"speaker":"Charles Goldfarb","startTime":2508.28,"endTime":2510.92,"body":"over the years preoperatively,"},{"speaker":"Charles Goldfarb","startTime":2510.92,"endTime":2513.56,"body":"and it became clear that the"},{"speaker":"Charles Goldfarb","startTime":2510.92,"endTime":2513.56,"body":"more experienced people in the"},{"speaker":"Charles Goldfarb","startTime":2513.56,"endTime":2517.1,"body":"room barely got X rays pre op."},{"speaker":"Charles Goldfarb","startTime":2513.56,"endTime":2517.1,"body":"You don't, you know, you know"},{"speaker":"Charles Goldfarb","startTime":2517.1,"endTime":2521.56,"body":"the diagnosis you're treating"},{"speaker":"Charles Goldfarb","startTime":2517.1,"endTime":2521.56,"body":"the diagnosis. I do get 1x ray"},{"speaker":"Charles Goldfarb","startTime":2521.56,"endTime":2524.14,"body":"pre op? I don't think it's"},{"speaker":"Charles Goldfarb","startTime":2521.56,"endTime":2524.14,"body":"necessary, but just the whole"},{"speaker":"Charles Goldfarb","startTime":2524.14,"endTime":2528.22,"body":"need for X rays to assess or"},{"speaker":"Charles Goldfarb","startTime":2524.14,"endTime":2528.22,"body":"confirm just seems less"},{"speaker":"Charles Goldfarb","startTime":2528.22,"endTime":2529.36,"body":"important to me over time."},{"speaker":"Chris Dy","startTime":2529.78,"endTime":2532.66,"body":"Yeah, so I'll get an x"},{"speaker":"Chris Dy","startTime":2529.78,"endTime":2532.66,"body":"ray if it's coming to surgery."},{"speaker":"Chris Dy","startTime":2532.66,"endTime":2534.88,"body":"I'll say it's for pre operative"},{"speaker":"Chris Dy","startTime":2532.66,"endTime":2534.88,"body":"planning. I will do it when"},{"speaker":"Chris Dy","startTime":2534.88,"endTime":2537.64,"body":"they're on the way out the door,"},{"speaker":"Chris Dy","startTime":2534.88,"endTime":2537.64,"body":"and I will do it in the formal X"},{"speaker":"Chris Dy","startTime":2537.64,"endTime":2540.42,"body":"ray system so that if any"},{"speaker":"Chris Dy","startTime":2537.64,"endTime":2540.42,"body":"insurer questions, it is there"},{"speaker":"Chris Dy","startTime":2540.42,"endTime":2543.06,"body":"for them to see, and they don't"},{"speaker":"Chris Dy","startTime":2540.42,"endTime":2543.06,"body":"have to dig into my CRMs or into"},{"speaker":"Chris Dy","startTime":2543.06,"endTime":2543.9,"body":"my note to find it."},{"speaker":"Charles Goldfarb","startTime":2544.26,"endTime":2546.18,"body":"Yeah, that's"},{"speaker":"Charles Goldfarb","startTime":2544.26,"endTime":2546.18,"body":"fair. It's probably smart. It's"},{"speaker":"Charles Goldfarb","startTime":2546.36,"endTime":2551.04,"body":"probably smart. So again, lrti"},{"speaker":"Charles Goldfarb","startTime":2546.36,"endTime":2551.04,"body":"is a gold standard. I strongly"},{"speaker":"Charles Goldfarb","startTime":2551.04,"endTime":2554.22,"body":"feel it's it maintains this"},{"speaker":"Charles Goldfarb","startTime":2551.04,"endTime":2554.22,"body":"position there. It's a great"},{"speaker":"Charles Goldfarb","startTime":2554.22,"endTime":2558.66,"body":"operation. I think a lot of"},{"speaker":"Charles Goldfarb","startTime":2554.22,"endTime":2558.66,"body":"people still do it. Maybe, maybe"},{"speaker":"Charles Goldfarb","startTime":2558.66,"endTime":2562.34,"body":"a study down the road could be"},{"speaker":"Charles Goldfarb","startTime":2558.66,"endTime":2562.34,"body":"looking at some large databases"},{"speaker":"Charles Goldfarb","startTime":2562.34,"endTime":2564.56,"body":"to understand but no"},{"speaker":"Chris Dy","startTime":2564.56,"endTime":2567.5,"body":"more studies on LRTs,"},{"speaker":"Chris Dy","startTime":2564.56,"endTime":2567.5,"body":"please. I think that was from"},{"speaker":"Chris Dy","startTime":2567.5,"endTime":2571.28,"body":"you. So yeah, we can we talked"},{"speaker":"Chris Dy","startTime":2567.5,"endTime":2571.28,"body":"about 3030, minutes about lrtis,"},{"speaker":"Chris Dy","startTime":2571.28,"endTime":2574.52,"body":"but we'd love to hear how"},{"speaker":"Chris Dy","startTime":2571.28,"endTime":2574.52,"body":"listeners do it. Send us a note"},{"speaker":"Chris Dy","startTime":2574.52,"endTime":2577.88,"body":"hand podcast@gmail.com or leave"},{"speaker":"Chris Dy","startTime":2574.52,"endTime":2577.88,"body":"it in a review and let us know."},{"speaker":"Charles Goldfarb","startTime":2578.3,"endTime":2581.86,"body":"Have a great"},{"speaker":"Charles Goldfarb","startTime":2578.3,"endTime":2581.86,"body":"day. All right, you too. Hey,"},{"speaker":"Charles Goldfarb","startTime":2581.86,"endTime":2584.32,"body":"Chris, that was fun. Let's do it"},{"speaker":"Charles Goldfarb","startTime":2581.86,"endTime":2584.32,"body":"again real soon."},{"speaker":"Chris Dy","startTime":2584.8,"endTime":2587.02,"body":"Sounds good? Well, be"},{"speaker":"Chris Dy","startTime":2584.8,"endTime":2587.02,"body":"sure to email us with topic"},{"speaker":"Chris Dy","startTime":2587.02,"endTime":2589.42,"body":"suggestions and feedback. You"},{"speaker":"Chris Dy","startTime":2587.02,"endTime":2589.42,"body":"can reach us at hand"},{"speaker":"Chris Dy","startTime":2589.42,"endTime":2590.02,"body":"podcast@gmail.com"},{"speaker":"Charles Goldfarb","startTime":2591.7,"endTime":2593.86,"body":"and remember,"},{"speaker":"Charles Goldfarb","startTime":2591.7,"endTime":2593.86,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2593.86,"endTime":2594.82,"body":"get your podcast,"},{"speaker":"Chris Dy","startTime":2595.24,"endTime":2598.12,"body":"and be sure to leave a"},{"speaker":"Chris Dy","startTime":2595.24,"endTime":2598.12,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2598.12,"endTime":2599.74,"body":"word out. Special,"},{"speaker":"Charles Goldfarb","startTime":2599.74,"endTime":2601.8,"body":"thanks to"},{"speaker":"Charles Goldfarb","startTime":2599.74,"endTime":2601.8,"body":"Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":2601.8,"endTime":2603.48,"body":"music, and remember,"},{"speaker":"Chris Dy","startTime":2603.48,"endTime":2605.34,"body":"keep the upper hand."},{"speaker":"Chris Dy","startTime":2603.48,"endTime":2605.34,"body":"Come back next time you."}]}