{"version":"1.0.0","segments":[{"speaker":"Charles Goldfarb","startTime":10.77,"endTime":13.35,"body":"Welcome to the"},{"speaker":"Charles Goldfarb","startTime":10.77,"endTime":13.35,"body":"upper hand, where Chuck and"},{"speaker":"Charles Goldfarb","startTime":13.35,"endTime":14.49,"body":"Chris talk Hand Surgery."},{"speaker":"Chris Dy","startTime":14.79,"endTime":16.56,"body":"We are two hand"},{"speaker":"Chris Dy","startTime":14.79,"endTime":16.56,"body":"surgeons at Washington"},{"speaker":"Chris Dy","startTime":16.56,"endTime":19.62,"body":"University in St. Louis, here to"},{"speaker":"Chris Dy","startTime":16.56,"endTime":19.62,"body":"talk about all aspects of hand"},{"speaker":"Chris Dy","startTime":19.62,"endTime":21.48,"body":"surgery from technical to"},{"speaker":"Chris Dy","startTime":19.62,"endTime":21.48,"body":"personal."},{"speaker":"Charles Goldfarb","startTime":22.05,"endTime":24.33,"body":"Thank you for"},{"speaker":"Charles Goldfarb","startTime":22.05,"endTime":24.33,"body":"subscribing wherever you get"},{"speaker":"Charles Goldfarb","startTime":24.33,"endTime":25.23,"body":"your podcasts."},{"speaker":"Chris Dy","startTime":25.44,"endTime":27.66,"body":"And be sure to leave a"},{"speaker":"Chris Dy","startTime":25.44,"endTime":27.66,"body":"review, that helps us get the"},{"speaker":"Chris Dy","startTime":27.66,"endTime":28.14,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":28.2,"endTime":29.25,"body":"Oh, hey,"},{"speaker":"Charles Goldfarb","startTime":28.2,"endTime":29.25,"body":"Chris."},{"speaker":"Chris Dy","startTime":29.4,"endTime":30.03,"body":"Hey, Chuck."},{"speaker":"Charles Goldfarb","startTime":30.39,"endTime":30.9,"body":"How are you?"},{"speaker":"Chris Dy","startTime":31.47,"endTime":33.75,"body":"I am well, beautiful"},{"speaker":"Chris Dy","startTime":31.47,"endTime":33.75,"body":"day in St. Louis. I know that we"},{"speaker":"Chris Dy","startTime":33.75,"endTime":36.6,"body":"keep saying this on every"},{"speaker":"Chris Dy","startTime":33.75,"endTime":36.6,"body":"episode. But it is unseasonably"},{"speaker":"Chris Dy","startTime":36.6,"endTime":37.23,"body":"warm here."},{"speaker":"Charles Goldfarb","startTime":37.66,"endTime":40.87,"body":"It is one of"},{"speaker":"Charles Goldfarb","startTime":37.66,"endTime":40.87,"body":"those days. That is - simply"},{"speaker":"Charles Goldfarb","startTime":40.87,"endTime":43.54,"body":"spectacular. And I don't I know"},{"speaker":"Charles Goldfarb","startTime":40.87,"endTime":43.54,"body":"we don't want to talk"},{"speaker":"Charles Goldfarb","startTime":43.57,"endTime":46.63,"body":"potentially divisive politics."},{"speaker":"Charles Goldfarb","startTime":43.57,"endTime":46.63,"body":"But we're recording this on"},{"speaker":"Charles Goldfarb","startTime":46.63,"endTime":49.27,"body":"November 7, and there was news"},{"speaker":"Charles Goldfarb","startTime":46.63,"endTime":49.27,"body":"this morning."},{"speaker":"Chris Dy","startTime":50.7,"endTime":51.33,"body":"Really?"},{"speaker":"Charles Goldfarb","startTime":53.49,"endTime":55.02,"body":"A little bit,"},{"speaker":"Charles Goldfarb","startTime":53.49,"endTime":55.02,"body":"a little bit."},{"speaker":"Chris Dy","startTime":55.77,"endTime":58.56,"body":"Yeah, there were there"},{"speaker":"Chris Dy","startTime":55.77,"endTime":58.56,"body":"are some breaking news, you"},{"speaker":"Chris Dy","startTime":58.56,"endTime":61.14,"body":"know, something that was"},{"speaker":"Chris Dy","startTime":58.56,"endTime":61.14,"body":"probably a few days in the"},{"speaker":"Chris Dy","startTime":61.14,"endTime":63.54,"body":"making. Some would say longer."},{"speaker":"Chris Dy","startTime":61.14,"endTime":63.54,"body":"But"},{"speaker":"Charles Goldfarb","startTime":64.23,"endTime":67.26,"body":"yeah, it might"},{"speaker":"Charles Goldfarb","startTime":64.23,"endTime":67.26,"body":"be interesting, not today, might"},{"speaker":"Charles Goldfarb","startTime":67.26,"endTime":70.17,"body":"be interesting to talk about"},{"speaker":"Charles Goldfarb","startTime":67.26,"endTime":70.17,"body":"maybe even with an invited guest"},{"speaker":"Charles Goldfarb","startTime":70.17,"endTime":71.97,"body":"talk about some of the"},{"speaker":"Charles Goldfarb","startTime":70.17,"endTime":71.97,"body":"implications of a Biden"},{"speaker":"Charles Goldfarb","startTime":71.97,"endTime":78.33,"body":"presidency on medicine. You"},{"speaker":"Charles Goldfarb","startTime":71.97,"endTime":78.33,"body":"know, we certainly have there is"},{"speaker":"Charles Goldfarb","startTime":78.81,"endTime":82.11,"body":"there are multiple topics to"},{"speaker":"Charles Goldfarb","startTime":78.81,"endTime":82.11,"body":"discuss regarding nuts and"},{"speaker":"Charles Goldfarb","startTime":82.11,"endTime":86.49,"body":"bolts, including potential cuts"},{"speaker":"Charles Goldfarb","startTime":82.11,"endTime":86.49,"body":"in our reimbursement, the change"},{"speaker":"Charles Goldfarb","startTime":86.52,"endTime":93.03,"body":"in clinic, or, you know, clinic"},{"speaker":"Charles Goldfarb","startTime":86.52,"endTime":93.03,"body":"visit coding, there's lots of"},{"speaker":"Charles Goldfarb","startTime":93.03,"endTime":94.92,"body":"things we can talk about like"},{"speaker":"Charles Goldfarb","startTime":93.03,"endTime":94.92,"body":"that. Not the most exciting of"},{"speaker":"Charles Goldfarb","startTime":94.92,"endTime":97.2,"body":"topics, but we probably should"},{"speaker":"Charles Goldfarb","startTime":94.92,"endTime":97.2,"body":"delve into at least the"},{"speaker":"Charles Goldfarb","startTime":97.2,"endTime":99.12,"body":"potential implications of a"},{"speaker":"Charles Goldfarb","startTime":97.2,"endTime":99.12,"body":"Biden presidency."},{"speaker":"Chris Dy","startTime":99.63,"endTime":102.72,"body":"And I think that it"},{"speaker":"Chris Dy","startTime":99.63,"endTime":102.72,"body":"will differ for some of the"},{"speaker":"Chris Dy","startTime":102.72,"endTime":105.9,"body":"health policy related issues"},{"speaker":"Chris Dy","startTime":102.72,"endTime":105.9,"body":"based on how the senate turns"},{"speaker":"Chris Dy","startTime":105.9,"endTime":110.46,"body":"out, because the presidency of a"},{"speaker":"Chris Dy","startTime":105.9,"endTime":110.46,"body":"Biden, or the agenda of a Biden"},{"speaker":"Chris Dy","startTime":110.46,"endTime":113.49,"body":"presidency may look very"},{"speaker":"Chris Dy","startTime":110.46,"endTime":113.49,"body":"different based on whether the"},{"speaker":"Chris Dy","startTime":113.52,"endTime":116.07,"body":"democrats have control of both"},{"speaker":"Chris Dy","startTime":113.52,"endTime":116.07,"body":"chambers of Congress."},{"speaker":"Charles Goldfarb","startTime":116.48,"endTime":118.31,"body":"That is well"},{"speaker":"Charles Goldfarb","startTime":116.48,"endTime":118.31,"body":"said, and I know you are a"},{"speaker":"Charles Goldfarb","startTime":118.31,"endTime":123.08,"body":"health policy lover, so yeah,"},{"speaker":"Charles Goldfarb","startTime":118.31,"endTime":123.08,"body":"let's see what kind of what what"},{"speaker":"Charles Goldfarb","startTime":123.08,"endTime":125.75,"body":"pans out looks like, we're gonna"},{"speaker":"Charles Goldfarb","startTime":123.08,"endTime":125.75,"body":"be waiting till January to truly"},{"speaker":"Charles Goldfarb","startTime":125.75,"endTime":128.6,"body":"understand the makeup of the"},{"speaker":"Charles Goldfarb","startTime":125.75,"endTime":128.6,"body":"Senate. But It could be fun, I"},{"speaker":"Charles Goldfarb","startTime":128.6,"endTime":129.44,"body":"would look forward to that."},{"speaker":"Chris Dy","startTime":129.95,"endTime":132.8,"body":"And it'll be"},{"speaker":"Chris Dy","startTime":129.95,"endTime":132.8,"body":"interesting to see what what"},{"speaker":"Chris Dy","startTime":132.83,"endTime":136.94,"body":"both sides of Congress tried to"},{"speaker":"Chris Dy","startTime":132.83,"endTime":136.94,"body":"sneak in in a lame duck session,"},{"speaker":"Chris Dy","startTime":136.97,"endTime":140.78,"body":"potentially in the next couple"},{"speaker":"Chris Dy","startTime":136.97,"endTime":140.78,"body":"of weeks. So that may be"},{"speaker":"Chris Dy","startTime":140.78,"endTime":145.07,"body":"somewhere where you'll see some"},{"speaker":"Chris Dy","startTime":140.78,"endTime":145.07,"body":"activity. But, you know, I"},{"speaker":"Chris Dy","startTime":145.1,"endTime":147.53,"body":"honestly think the pandemic"},{"speaker":"Chris Dy","startTime":145.1,"endTime":147.53,"body":"should be the priority. But you"},{"speaker":"Chris Dy","startTime":147.53,"endTime":149.99,"body":"know, our views are probably"},{"speaker":"Chris Dy","startTime":147.53,"endTime":149.99,"body":"different than some of those in"},{"speaker":"Chris Dy","startTime":149.99,"endTime":150.47,"body":"DC."},{"speaker":"Charles Goldfarb","startTime":150.92,"endTime":153.65,"body":"Yeah. Well,"},{"speaker":"Charles Goldfarb","startTime":150.92,"endTime":153.65,"body":"let's hope so. I mean, here in"},{"speaker":"Charles Goldfarb","startTime":153.65,"endTime":159.59,"body":"St. Louis, we have stopped"},{"speaker":"Charles Goldfarb","startTime":153.65,"endTime":159.59,"body":"allowing elective inpatient"},{"speaker":"Charles Goldfarb","startTime":159.62,"endTime":163.55,"body":"surgery scheduling, thankfully,"},{"speaker":"Charles Goldfarb","startTime":159.62,"endTime":163.55,"body":"we're still allowed urgent"},{"speaker":"Charles Goldfarb","startTime":163.55,"endTime":166.04,"body":"surgeries, and we're still"},{"speaker":"Charles Goldfarb","startTime":163.55,"endTime":166.04,"body":"allowed outpatient surgeries,"},{"speaker":"Charles Goldfarb","startTime":166.04,"endTime":167.72,"body":"but things are really bad in St."},{"speaker":"Charles Goldfarb","startTime":166.04,"endTime":167.72,"body":"Louis right now."},{"speaker":"Chris Dy","startTime":168.86,"endTime":171.74,"body":"Yeah, and I think"},{"speaker":"Chris Dy","startTime":168.86,"endTime":171.74,"body":"that's being borne out in a lot"},{"speaker":"Chris Dy","startTime":171.74,"endTime":175.04,"body":"of parts of the country,"},{"speaker":"Chris Dy","startTime":171.74,"endTime":175.04,"body":"unfortunately, hopefully, we'll"},{"speaker":"Chris Dy","startTime":175.04,"endTime":177.44,"body":"be able to get our act together."},{"speaker":"Chris Dy","startTime":175.04,"endTime":177.44,"body":"I know that we do have some"},{"speaker":"Chris Dy","startTime":177.44,"endTime":180.17,"body":"listeners from overseas, who are"},{"speaker":"Chris Dy","startTime":177.44,"endTime":180.17,"body":"probably looking at us saying"},{"speaker":"Chris Dy","startTime":180.17,"endTime":182.6,"body":"what the heck is going on in the"},{"speaker":"Chris Dy","startTime":180.17,"endTime":182.6,"body":"States? So"},{"speaker":"Charles Goldfarb","startTime":183.38,"endTime":186.83,"body":"It's true, but"},{"speaker":"Charles Goldfarb","startTime":183.38,"endTime":186.83,"body":"we are certainly not alone."},{"speaker":"Charles Goldfarb","startTime":187.55,"endTime":191.18,"body":"There are many countries and"},{"speaker":"Charles Goldfarb","startTime":187.55,"endTime":191.18,"body":"some are, you know, I think I"},{"speaker":"Charles Goldfarb","startTime":191.18,"endTime":195.32,"body":"eye enviously, those who are"},{"speaker":"Charles Goldfarb","startTime":191.18,"endTime":195.32,"body":"taking this more seriously, but,"},{"speaker":"Charles Goldfarb","startTime":195.68,"endTime":197.96,"body":"you know, we're not alone in"},{"speaker":"Charles Goldfarb","startTime":195.68,"endTime":197.96,"body":"struggling. I'm not defending"},{"speaker":"Charles Goldfarb","startTime":197.96,"endTime":201.29,"body":"the policies of this"},{"speaker":"Charles Goldfarb","startTime":197.96,"endTime":201.29,"body":"administration. But we are not"},{"speaker":"Charles Goldfarb","startTime":201.29,"endTime":201.62,"body":"alone."},{"speaker":"Chris Dy","startTime":202.22,"endTime":205.73,"body":"Yes, yes. hearing the"},{"speaker":"Chris Dy","startTime":202.22,"endTime":205.73,"body":"news of what's going on in, you"},{"speaker":"Chris Dy","startTime":205.73,"endTime":210.95,"body":"know, in Europe is, it's"},{"speaker":"Chris Dy","startTime":205.73,"endTime":210.95,"body":"sobering. Yeah. So on a lighter"},{"speaker":"Chris Dy","startTime":210.95,"endTime":211.34,"body":"note,"},{"speaker":"Charles Goldfarb","startTime":211.41,"endTime":214.8,"body":"yeah. Sorry."},{"speaker":"Charles Goldfarb","startTime":211.41,"endTime":214.8,"body":"Sorry, we should just apologize"},{"speaker":"Charles Goldfarb","startTime":214.8,"endTime":215.46,"body":"and move on."},{"speaker":"Chris Dy","startTime":216.05,"endTime":219.71,"body":"Wow. So you started"},{"speaker":"Chris Dy","startTime":216.05,"endTime":219.71,"body":"off with American politics and"},{"speaker":"Chris Dy","startTime":219.71,"endTime":222.68,"body":"then segwayed into the pandemic,"},{"speaker":"Chris Dy","startTime":219.71,"endTime":222.68,"body":"way to go Chuck way to set the"},{"speaker":"Chris Dy","startTime":222.68,"endTime":224.87,"body":"stage for a breezy podcast"},{"speaker":"Chris Dy","startTime":222.68,"endTime":224.87,"body":"episode"},{"speaker":"Charles Goldfarb","startTime":225.3,"endTime":228.03,"body":"well, for all"},{"speaker":"Charles Goldfarb","startTime":225.3,"endTime":228.03,"body":"four of you who are still"},{"speaker":"Charles Goldfarb","startTime":228.03,"endTime":229.59,"body":"listening, we'll move on."},{"speaker":"Chris Dy","startTime":230.59,"endTime":233.11,"body":"Well, so we had a we"},{"speaker":"Chris Dy","startTime":230.59,"endTime":233.11,"body":"had a great review, we're always"},{"speaker":"Chris Dy","startTime":233.32,"endTime":236.74,"body":"thankful and appreciative for"},{"speaker":"Chris Dy","startTime":233.32,"endTime":236.74,"body":"the reviews that our listeners"},{"speaker":"Chris Dy","startTime":236.74,"endTime":241.21,"body":"leave. And this one was left a"},{"speaker":"Chris Dy","startTime":236.74,"endTime":241.21,"body":"couple of weeks ago on iTunes by"},{"speaker":"Chris Dy","startTime":241.21,"endTime":248.02,"body":"Court WSHR1 fantastic five star"},{"speaker":"Chris Dy","startTime":241.21,"endTime":248.02,"body":"review. Thank you for that. And"},{"speaker":"Chris Dy","startTime":248.05,"endTime":251.11,"body":"it says Chris and Chuck are"},{"speaker":"Chris Dy","startTime":248.05,"endTime":251.11,"body":"soothing, relaxed and engaging."},{"speaker":"Chris Dy","startTime":251.17,"endTime":254.05,"body":"Glad I found this podcast and"},{"speaker":"Chris Dy","startTime":251.17,"endTime":254.05,"body":"I've added it to my regular"},{"speaker":"Chris Dy","startTime":254.05,"endTime":259.21,"body":"rotation. Thank you. So we have"},{"speaker":"Chris Dy","startTime":254.05,"endTime":259.21,"body":"a cool feature, a listener grab"},{"speaker":"Chris Dy","startTime":259.21,"endTime":262.27,"body":"bag. So for anybody that is"},{"speaker":"Chris Dy","startTime":259.21,"endTime":262.27,"body":"listening and wants to send some"},{"speaker":"Chris Dy","startTime":262.27,"endTime":265.72,"body":"questions, either a follow up"},{"speaker":"Chris Dy","startTime":262.27,"endTime":265.72,"body":"from a prior episode, or just a"},{"speaker":"Chris Dy","startTime":265.72,"endTime":268.15,"body":"random question, you can send us"},{"speaker":"Chris Dy","startTime":265.72,"endTime":268.15,"body":"an email at hand"},{"speaker":"Chris Dy","startTime":268.15,"endTime":272.5,"body":"podcast@gmail.com. And this"},{"speaker":"Chris Dy","startTime":268.15,"endTime":272.5,"body":"question comes from Sina"},{"speaker":"Chris Dy","startTime":272.53,"endTime":275.53,"body":"Babazadeh. I hope I pronounced"},{"speaker":"Chris Dy","startTime":272.53,"endTime":275.53,"body":"that somewhat correctly. A"},{"speaker":"Chris Dy","startTime":275.53,"endTime":280.03,"body":"surgeon in Melbourne, Australia."},{"speaker":"Chris Dy","startTime":275.53,"endTime":280.03,"body":"So Sina is asking, is your"},{"speaker":"Chris Dy","startTime":280.03,"endTime":283.45,"body":"treatment algorithm the same for"},{"speaker":"Chris Dy","startTime":280.03,"endTime":283.45,"body":"both iatrorogenic and idiopathic"},{"speaker":"Chris Dy","startTime":283.45,"endTime":286.6,"body":"cases of Kienbock's disease?"},{"speaker":"Chris Dy","startTime":283.45,"endTime":286.6,"body":"This was a follow up from the"},{"speaker":"Chris Dy","startTime":286.6,"endTime":290.05,"body":"Steve Moran episode, or do you"},{"speaker":"Chris Dy","startTime":286.6,"endTime":290.05,"body":"tackle the iatrogenic ones"},{"speaker":"Chris Dy","startTime":290.05,"endTime":291.85,"body":"differently? So Chuck, what do"},{"speaker":"Chris Dy","startTime":290.05,"endTime":291.85,"body":"you think?"},{"speaker":"Charles Goldfarb","startTime":292.32,"endTime":297.36,"body":"I don't think"},{"speaker":"Charles Goldfarb","startTime":292.32,"endTime":297.36,"body":"my approach would differ."},{"speaker":"Charles Goldfarb","startTime":298.08,"endTime":303.75,"body":"Certainly, if I recognized that"},{"speaker":"Charles Goldfarb","startTime":298.08,"endTime":303.75,"body":"I was the cause in whatever form"},{"speaker":"Charles Goldfarb","startTime":303.75,"endTime":309.57,"body":"or fashion, it does make me I"},{"speaker":"Charles Goldfarb","startTime":303.75,"endTime":309.57,"body":"think naturally feel more"},{"speaker":"Charles Goldfarb","startTime":310.08,"endTime":313.68,"body":"pressure and perhaps an"},{"speaker":"Charles Goldfarb","startTime":310.08,"endTime":313.68,"body":"inclination to treat more"},{"speaker":"Charles Goldfarb","startTime":313.68,"endTime":317.82,"body":"aggressively. But in theory, my"},{"speaker":"Charles Goldfarb","startTime":313.68,"endTime":317.82,"body":"principles would hold. If the"},{"speaker":"Charles Goldfarb","startTime":317.82,"endTime":323.58,"body":"lunate is avascular, but has"},{"speaker":"Charles Goldfarb","startTime":317.82,"endTime":323.58,"body":"maintained its shape and hasn't"},{"speaker":"Charles Goldfarb","startTime":323.58,"endTime":327.75,"body":"collapsed. I would treat it with"},{"speaker":"Charles Goldfarb","startTime":323.58,"endTime":327.75,"body":"a immobilization first. And if"},{"speaker":"Charles Goldfarb","startTime":327.75,"endTime":330.27,"body":"that failed, then I would treat"},{"speaker":"Charles Goldfarb","startTime":327.75,"endTime":330.27,"body":"it with a vascularizing"},{"speaker":"Charles Goldfarb","startTime":330.3,"endTime":333.96,"body":"procedure. Because I don't think"},{"speaker":"Charles Goldfarb","startTime":330.3,"endTime":333.96,"body":"my principles would change even"},{"speaker":"Charles Goldfarb","startTime":333.96,"endTime":336.3,"body":"though I'd feel differently"},{"speaker":"Charles Goldfarb","startTime":333.96,"endTime":336.3,"body":"about it. How about you"},{"speaker":"Chris Dy","startTime":336.84,"endTime":340.47,"body":"I think that all roads"},{"speaker":"Chris Dy","startTime":336.84,"endTime":340.47,"body":"will lead and you know, will"},{"speaker":"Chris Dy","startTime":340.47,"endTime":343.53,"body":"ultimately unite here, and I"},{"speaker":"Chris Dy","startTime":340.47,"endTime":343.53,"body":"agree, I wouldn't change the"},{"speaker":"Chris Dy","startTime":343.53,"endTime":345.69,"body":"treatment algorithm. Clearly"},{"speaker":"Chris Dy","startTime":343.53,"endTime":345.69,"body":"your discussion with the"},{"speaker":"Chris Dy","startTime":345.69,"endTime":348.06,"body":"patient's a little bit"},{"speaker":"Chris Dy","startTime":345.69,"endTime":348.06,"body":"different. And honestly, I, you"},{"speaker":"Chris Dy","startTime":348.06,"endTime":351.21,"body":"know, one of our other listeners"},{"speaker":"Chris Dy","startTime":348.06,"endTime":351.21,"body":"and colleagues, Rob Gray from"},{"speaker":"Chris Dy","startTime":351.21,"endTime":354.21,"body":"Chicago, pointed this out on"},{"speaker":"Chris Dy","startTime":351.21,"endTime":354.21,"body":"Twitter, perhaps with the"},{"speaker":"Chris Dy","startTime":354.21,"endTime":357.3,"body":"hypercoagulability that's being"},{"speaker":"Chris Dy","startTime":354.21,"endTime":357.3,"body":"seen with with COVID"},{"speaker":"Chris Dy","startTime":357.3,"endTime":361.95,"body":"manifestations, perhaps we're"},{"speaker":"Chris Dy","startTime":357.3,"endTime":361.95,"body":"gonna see a rush of Kienbock's"},{"speaker":"Chris Dy","startTime":361.95,"endTime":365.22,"body":"disease that comes up down the"},{"speaker":"Chris Dy","startTime":361.95,"endTime":365.22,"body":"line. But I agree if the shape"},{"speaker":"Chris Dy","startTime":365.22,"endTime":367.05,"body":"of the lunate hasn't changed,"},{"speaker":"Chris Dy","startTime":365.22,"endTime":367.05,"body":"I'm not doing anything"},{"speaker":"Chris Dy","startTime":367.05,"endTime":369.81,"body":"differently. Now, admittedly,"},{"speaker":"Chris Dy","startTime":367.05,"endTime":369.81,"body":"I'm not one of those fancy scope"},{"speaker":"Chris Dy","startTime":369.81,"endTime":373.59,"body":"guys like you. So my algorithm"},{"speaker":"Chris Dy","startTime":369.81,"endTime":373.59,"body":"is a little more straightforward"},{"speaker":"Chris Dy","startTime":373.62,"endTime":378.42,"body":"and a little a little less"},{"speaker":"Chris Dy","startTime":373.62,"endTime":378.42,"body":"sophisticated. Perhaps I don't"},{"speaker":"Chris Dy","startTime":378.42,"endTime":380.55,"body":"do the microsurgery of the joint"},{"speaker":"Chris Dy","startTime":378.42,"endTime":380.55,"body":"as you do."},{"speaker":"Charles Goldfarb","startTime":381.9,"endTime":384.39,"body":"A lot less"},{"speaker":"Charles Goldfarb","startTime":381.9,"endTime":384.39,"body":"sophisticated. I guess I would"},{"speaker":"Charles Goldfarb","startTime":384.39,"endTime":385.98,"body":"say without the scope involved."},{"speaker":"Chris Dy","startTime":388.05,"endTime":389.4,"body":"It's a good thing I"},{"speaker":"Chris Dy","startTime":388.05,"endTime":389.4,"body":"have partners."},{"speaker":"Charles Goldfarb","startTime":390.29,"endTime":393.2,"body":"So we're on"},{"speaker":"Charles Goldfarb","startTime":390.29,"endTime":393.2,"body":"the same page. That's perfect. I"},{"speaker":"Charles Goldfarb","startTime":393.2,"endTime":398.72,"body":"would ask, before we turn to the"},{"speaker":"Charles Goldfarb","startTime":393.2,"endTime":398.72,"body":"most exciting two minutes of"},{"speaker":"Charles Goldfarb","startTime":398.72,"endTime":402.8,"body":"this discussion, which is our"},{"speaker":"Charles Goldfarb","startTime":398.72,"endTime":402.8,"body":"listener survey plug. I want to"},{"speaker":"Charles Goldfarb","startTime":402.86,"endTime":407.24,"body":"read a message from a partner."},{"speaker":"Charles Goldfarb","startTime":402.86,"endTime":407.24,"body":"I've done this before qx MD. 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And also"},{"speaker":"Charles Goldfarb","startTime":428.21,"endTime":431.93,"body":"Calculate, which is another app,"},{"speaker":"Charles Goldfarb","startTime":432.05,"endTime":435.65,"body":"for over 500 easy to use"},{"speaker":"Charles Goldfarb","startTime":432.05,"endTime":435.65,"body":"decision support tools. So"},{"speaker":"Charles Goldfarb","startTime":435.8,"endTime":439.19,"body":"qxMD.com so and I'll be serious"},{"speaker":"Charles Goldfarb","startTime":435.8,"endTime":439.19,"body":"about this, and then let's move"},{"speaker":"Charles Goldfarb","startTime":439.19,"endTime":441.89,"body":"on I don't want to belabor it. I"},{"speaker":"Charles Goldfarb","startTime":439.19,"endTime":441.89,"body":"am still using the Read app and"},{"speaker":"Charles Goldfarb","startTime":441.89,"endTime":446.39,"body":"I find it I find it helpful, it"},{"speaker":"Charles Goldfarb","startTime":441.89,"endTime":446.39,"body":"does help me peruse certain"},{"speaker":"Charles Goldfarb","startTime":446.39,"endTime":449.99,"body":"topics and certain journals in a"},{"speaker":"Charles Goldfarb","startTime":446.39,"endTime":449.99,"body":"really easy fashion. So I don't"},{"speaker":"Charles Goldfarb","startTime":449.99,"endTime":451.76,"body":"want to belabor it, but just"},{"speaker":"Charles Goldfarb","startTime":449.99,"endTime":451.76,"body":"wanted to share that."},{"speaker":"Chris Dy","startTime":452.26,"endTime":455.62,"body":"Well, thank you to QX"},{"speaker":"Chris Dy","startTime":452.26,"endTime":455.62,"body":"MD for, for helping to promote"},{"speaker":"Chris Dy","startTime":455.62,"endTime":458.32,"body":"our podcast. And if anybody's"},{"speaker":"Chris Dy","startTime":455.62,"endTime":458.32,"body":"listening and wants to support"},{"speaker":"Chris Dy","startTime":458.32,"endTime":461.35,"body":"the podcast we'll certainly"},{"speaker":"Chris Dy","startTime":458.32,"endTime":461.35,"body":"listen to it. I know we've"},{"speaker":"Chris Dy","startTime":461.35,"endTime":464.47,"body":"talked before about conflicts of"},{"speaker":"Chris Dy","startTime":461.35,"endTime":464.47,"body":"interest in the past. And that's"},{"speaker":"Chris Dy","startTime":464.47,"endTime":469.96,"body":"obviously a concern for for us"},{"speaker":"Chris Dy","startTime":464.47,"endTime":469.96,"body":"both. But you know, we'll"},{"speaker":"Chris Dy","startTime":469.96,"endTime":477.28,"body":"listen. So we have been doing"},{"speaker":"Chris Dy","startTime":469.96,"endTime":477.28,"body":"this listener survey. And if"},{"speaker":"Chris Dy","startTime":477.28,"endTime":479.62,"body":"anybody would like to help us"},{"speaker":"Chris Dy","startTime":477.28,"endTime":479.62,"body":"out, we're trying to figure out"},{"speaker":"Chris Dy","startTime":479.62,"endTime":482.71,"body":"how to engage those of you that"},{"speaker":"Chris Dy","startTime":479.62,"endTime":482.71,"body":"have been kind enough to listen"},{"speaker":"Chris Dy","startTime":482.71,"endTime":486.4,"body":"to the podcast, we love doing"},{"speaker":"Chris Dy","startTime":482.71,"endTime":486.4,"body":"this. And then it makes it more"},{"speaker":"Chris Dy","startTime":486.4,"endTime":489.34,"body":"fun when we know what what"},{"speaker":"Chris Dy","startTime":486.4,"endTime":489.34,"body":"everybody wants out of the"},{"speaker":"Chris Dy","startTime":489.34,"endTime":493.24,"body":"podcast. So if you will look on"},{"speaker":"Chris Dy","startTime":489.34,"endTime":493.24,"body":"social and follow us on Twitter,"},{"speaker":"Chris Dy","startTime":493.24,"endTime":497.35,"body":"it's @handpodcast, there'll be"},{"speaker":"Chris Dy","startTime":493.24,"endTime":497.35,"body":"links to the listener survey."},{"speaker":"Chris Dy","startTime":497.62,"endTime":501.01,"body":"And you can also find that on"},{"speaker":"Chris Dy","startTime":497.62,"endTime":501.01,"body":"our podcast website,"},{"speaker":"Chris Dy","startTime":501.37,"endTime":508.93,"body":"theupperhandpodcast.wustl.edu."},{"speaker":"Chris Dy","startTime":501.37,"endTime":508.93,"body":"And also on that website, you"},{"speaker":"Chris Dy","startTime":508.93,"endTime":511.81,"body":"can find a link to a new feature"},{"speaker":"Chris Dy","startTime":508.93,"endTime":511.81,"body":"that we've been doing some"},{"speaker":"Chris Dy","startTime":511.81,"endTime":516.61,"body":"Journal Club content. So we've"},{"speaker":"Chris Dy","startTime":511.81,"endTime":516.61,"body":"been posting the recap of the"},{"speaker":"Chris Dy","startTime":516.61,"endTime":520.27,"body":"WashU hand fellowship Journal"},{"speaker":"Chris Dy","startTime":516.61,"endTime":520.27,"body":"Club every month. So Chuck, and"},{"speaker":"Chris Dy","startTime":520.27,"endTime":524.77,"body":"I kind of talk about the three"},{"speaker":"Chris Dy","startTime":520.27,"endTime":524.77,"body":"articles that we review that"},{"speaker":"Chris Dy","startTime":524.77,"endTime":529.54,"body":"morning, and kind of give our"},{"speaker":"Chris Dy","startTime":524.77,"endTime":529.54,"body":"quick takes on what the articles"},{"speaker":"Chris Dy","startTime":529.54,"endTime":531.91,"body":"mean, both, you know, from a"},{"speaker":"Chris Dy","startTime":529.54,"endTime":531.91,"body":"methodological perspective and"},{"speaker":"Chris Dy","startTime":531.91,"endTime":534.91,"body":"potentially in the greater"},{"speaker":"Chris Dy","startTime":531.91,"endTime":534.91,"body":"context. So please check that"},{"speaker":"Chris Dy","startTime":534.91,"endTime":538.03,"body":"out that YouTube channel is out"},{"speaker":"Chris Dy","startTime":534.91,"endTime":538.03,"body":"there. And it'd be great if"},{"speaker":"Chris Dy","startTime":538.03,"endTime":540.52,"body":"anybody has any feedback about"},{"speaker":"Chris Dy","startTime":538.03,"endTime":540.52,"body":"the journal articles too."},{"speaker":"Charles Goldfarb","startTime":541.41,"endTime":544.2,"body":"Perfect. So"},{"speaker":"Charles Goldfarb","startTime":541.41,"endTime":544.2,"body":"why don't if it's okay with you,"},{"speaker":"Charles Goldfarb","startTime":544.2,"endTime":548.82,"body":"I will summarize some of the"},{"speaker":"Charles Goldfarb","startTime":544.2,"endTime":548.82,"body":"early and I'm underlining and"},{"speaker":"Charles Goldfarb","startTime":548.82,"endTime":553.65,"body":"highlighting the word early"},{"speaker":"Charles Goldfarb","startTime":548.82,"endTime":553.65,"body":"survey results. So you know,"},{"speaker":"Charles Goldfarb","startTime":553.65,"endTime":559.77,"body":"it's interesting, our podcast,"},{"speaker":"Charles Goldfarb","startTime":553.65,"endTime":559.77,"body":"what the right word is publisher"},{"speaker":"Charles Goldfarb","startTime":560.61,"endTime":564.57,"body":"gives us basically weekly"},{"speaker":"Charles Goldfarb","startTime":560.61,"endTime":564.57,"body":"updates on our listenership. And"},{"speaker":"Charles Goldfarb","startTime":564.57,"endTime":568.68,"body":"so right now we get well over"},{"speaker":"Charles Goldfarb","startTime":564.57,"endTime":568.68,"body":"1000, well over 1000 downloads a"},{"speaker":"Charles Goldfarb","startTime":568.68,"endTime":572.4,"body":"week, but they they try to"},{"speaker":"Charles Goldfarb","startTime":568.68,"endTime":572.4,"body":"quantify what we can expect and"},{"speaker":"Charles Goldfarb","startTime":572.4,"endTime":574.83,"body":"how many listeners we have for"},{"speaker":"Charles Goldfarb","startTime":572.4,"endTime":574.83,"body":"each podcast. And we're about"},{"speaker":"Charles Goldfarb","startTime":574.83,"endTime":578.34,"body":"900 for each episode now. And"},{"speaker":"Charles Goldfarb","startTime":574.83,"endTime":578.34,"body":"again, the beautiful thing for"},{"speaker":"Charles Goldfarb","startTime":578.34,"endTime":581.13,"body":"Chris and I is that number"},{"speaker":"Charles Goldfarb","startTime":578.34,"endTime":581.13,"body":"continues to rise week over week"},{"speaker":"Charles Goldfarb","startTime":581.13,"endTime":584.91,"body":"and so we're grateful for those"},{"speaker":"Charles Goldfarb","startTime":581.13,"endTime":584.91,"body":"of you who are sharing. Now the"},{"speaker":"Charles Goldfarb","startTime":584.91,"endTime":585.72,"body":"disappointing part"},{"speaker":"Chris Dy","startTime":585.72,"endTime":588.12,"body":"So you're if you're if"},{"speaker":"Chris Dy","startTime":585.72,"endTime":588.12,"body":"you're on the WashU promotions"},{"speaker":"Chris Dy","startTime":588.12,"endTime":591.09,"body":"committee and you want to help"},{"speaker":"Chris Dy","startTime":588.12,"endTime":591.09,"body":"get me promoted to associate"},{"speaker":"Chris Dy","startTime":591.09,"endTime":595.29,"body":"professor. Just make sure that"},{"speaker":"Chris Dy","startTime":591.09,"endTime":595.29,"body":"you account for the social media"},{"speaker":"Chris Dy","startTime":595.29,"endTime":597.87,"body":"and podcasts that's in the"},{"speaker":"Chris Dy","startTime":595.29,"endTime":597.87,"body":"promotions and tenure process."},{"speaker":"Charles Goldfarb","startTime":598.77,"endTime":600.78,"body":"You know, that"},{"speaker":"Charles Goldfarb","startTime":598.77,"endTime":600.78,"body":"is such an interesting topic,"},{"speaker":"Charles Goldfarb","startTime":600.78,"endTime":604.74,"body":"and we definitely should discuss"},{"speaker":"Charles Goldfarb","startTime":600.78,"endTime":604.74,"body":"that at some point. Definitely"},{"speaker":"Charles Goldfarb","startTime":604.74,"endTime":608.37,"body":"the concept of social media and"},{"speaker":"Charles Goldfarb","startTime":604.74,"endTime":608.37,"body":"influence that can be provided."},{"speaker":"Charles Goldfarb","startTime":608.37,"endTime":614.88,"body":"But anyways, back on back on"},{"speaker":"Charles Goldfarb","startTime":608.37,"endTime":614.88,"body":"target. So we have 32 of 865"},{"speaker":"Charles Goldfarb","startTime":614.91,"endTime":617.94,"body":"regular listeners who took the"},{"speaker":"Charles Goldfarb","startTime":614.91,"endTime":617.94,"body":"time and we are so grateful for"},{"speaker":"Charles Goldfarb","startTime":617.94,"endTime":621.0,"body":"those 32 of you to fill out the"},{"speaker":"Charles Goldfarb","startTime":617.94,"endTime":621.0,"body":"survey, I'm a little"},{"speaker":"Charles Goldfarb","startTime":621.0,"endTime":624.63,"body":"disappointed to say that"},{"speaker":"Charles Goldfarb","startTime":621.0,"endTime":624.63,"body":"requests for more nerve topics"},{"speaker":"Charles Goldfarb","startTime":624.81,"endTime":629.94,"body":"does outweigh slightly by a hair"},{"speaker":"Charles Goldfarb","startTime":624.81,"endTime":629.94,"body":"recount possibly necessary."},{"speaker":"Chris Dy","startTime":631.37,"endTime":633.62,"body":"It's an expensive"},{"speaker":"Chris Dy","startTime":631.37,"endTime":633.62,"body":"recount, and you might end up"},{"speaker":"Chris Dy","startTime":633.62,"endTime":635.99,"body":"with less votes. so careful what"},{"speaker":"Chris Dy","startTime":633.62,"endTime":635.99,"body":"you ask for."},{"speaker":"Charles Goldfarb","startTime":636.45,"endTime":639.03,"body":"True. True. So"},{"speaker":"Charles Goldfarb","startTime":636.45,"endTime":639.03,"body":"we'll leave it we'll leave it"},{"speaker":"Charles Goldfarb","startTime":639.72,"endTime":643.29,"body":"But anyways, I think I don't"},{"speaker":"Charles Goldfarb","startTime":639.72,"endTime":643.29,"body":"want to get into the details of"},{"speaker":"Charles Goldfarb","startTime":643.29,"endTime":646.74,"body":"the survey results now. But I"},{"speaker":"Charles Goldfarb","startTime":643.29,"endTime":646.74,"body":"would like to and Chris and I"},{"speaker":"Charles Goldfarb","startTime":646.74,"endTime":650.88,"body":"both would like to do what we've"},{"speaker":"Charles Goldfarb","startTime":646.74,"endTime":650.88,"body":"been promising to do and that is"},{"speaker":"Charles Goldfarb","startTime":650.88,"endTime":656.76,"body":"send one lucky listener and one"},{"speaker":"Charles Goldfarb","startTime":650.88,"endTime":656.76,"body":"lucky one lucky survey finisher,"},{"speaker":"Charles Goldfarb","startTime":656.82,"endTime":661.08,"body":"a mug, an upper hand coffee mug."},{"speaker":"Charles Goldfarb","startTime":656.82,"endTime":661.08,"body":"These are unbelievable, in high"},{"speaker":"Charles Goldfarb","startTime":661.08,"endTime":664.8,"body":"demand and you can't get them"},{"speaker":"Charles Goldfarb","startTime":661.08,"endTime":664.8,"body":"anywhere. Except for here."},{"speaker":"Chris Dy","startTime":667.69,"endTime":669.97,"body":"Yeah, no, I forgot"},{"speaker":"Chris Dy","startTime":667.69,"endTime":669.97,"body":"about the line outside of your"},{"speaker":"Chris Dy","startTime":669.97,"endTime":674.23,"body":"basement door, trying to get. If"},{"speaker":"Chris Dy","startTime":669.97,"endTime":674.23,"body":"it weren't for that COVID"},{"speaker":"Chris Dy","startTime":674.23,"endTime":676.9,"body":"pandemic. they'd all be knocking"},{"speaker":"Chris Dy","startTime":674.23,"endTime":676.9,"body":"down your door trying to get it"},{"speaker":"Charles Goldfarb","startTime":677.08,"endTime":679.18,"body":"True, true. So"},{"speaker":"Charles Goldfarb","startTime":677.08,"endTime":679.18,"body":"what we thought we would do is"},{"speaker":"Charles Goldfarb","startTime":679.18,"endTime":680.02,"body":"do this live."},{"speaker":"Chris Dy","startTime":680.62,"endTime":683.29,"body":"Why don't you I'll"},{"speaker":"Chris Dy","startTime":680.62,"endTime":683.29,"body":"pick a number and then why don't"},{"speaker":"Chris Dy","startTime":683.29,"endTime":686.08,"body":"you read the first part of their"},{"speaker":"Chris Dy","startTime":683.29,"endTime":686.08,"body":"email address without the domain"},{"speaker":"Chris Dy","startTime":686.08,"endTime":686.44,"body":"name"},{"speaker":"Charles Goldfarb","startTime":686.95,"endTime":687.19,"body":"Perfect."},{"speaker":"Chris Dy","startTime":687.19,"endTime":690.13,"body":"that way but but hold"},{"speaker":"Chris Dy","startTime":687.19,"endTime":690.13,"body":"on before I say the number. I"},{"speaker":"Chris Dy","startTime":690.13,"endTime":693.1,"body":"want everybody to potentially"},{"speaker":"Chris Dy","startTime":690.13,"endTime":693.1,"body":"pull over the car. I don't want"},{"speaker":"Chris Dy","startTime":693.1,"endTime":695.35,"body":"anybody freaking out that they"},{"speaker":"Chris Dy","startTime":693.1,"endTime":695.35,"body":"won the coffee mug."},{"speaker":"Charles Goldfarb","startTime":695.65,"endTime":696.19,"body":"It's true."},{"speaker":"Chris Dy","startTime":696.22,"endTime":699.43,"body":"The upper hand podcast"},{"speaker":"Chris Dy","startTime":696.22,"endTime":699.43,"body":"is not liable for any traffic or"},{"speaker":"Chris Dy","startTime":699.43,"endTime":703.54,"body":"pedestrian accidents that may"},{"speaker":"Chris Dy","startTime":699.43,"endTime":703.54,"body":"occur during the live drawing of"},{"speaker":"Chris Dy","startTime":703.54,"endTime":706.78,"body":"this mug and lucky number 19."},{"speaker":"Charles Goldfarb","startTime":707.47,"endTime":711.22,"body":"lucky number"},{"speaker":"Charles Goldfarb","startTime":707.47,"endTime":711.22,"body":"19 is the winner. The first part"},{"speaker":"Charles Goldfarb","startTime":711.22,"endTime":716.74,"body":"of the email address is"},{"speaker":"Charles Goldfarb","startTime":711.22,"endTime":716.74,"body":"Rodesantos. Rode Santos."},{"speaker":"Charles Goldfarb","startTime":717.52,"endTime":722.29,"body":"Congratulations. We will send"},{"speaker":"Charles Goldfarb","startTime":717.52,"endTime":722.29,"body":"you an email and asking for your"},{"speaker":"Charles Goldfarb","startTime":722.29,"endTime":724.21,"body":"physical mailing address. And"},{"speaker":"Charles Goldfarb","startTime":722.29,"endTime":724.21,"body":"we'll get that out to you."},{"speaker":"Chris Dy","startTime":724.8,"endTime":728.04,"body":"All right, Dr. Miss"},{"speaker":"Chris Dy","startTime":724.8,"endTime":728.04,"body":"Mr. Santos, congratulations."},{"speaker":"Chris Dy","startTime":728.85,"endTime":731.37,"body":"Perfect. Or de Santos, perhaps"},{"speaker":"Charles Goldfarb","startTime":731.56,"endTime":735.1,"body":"we did have"},{"speaker":"Charles Goldfarb","startTime":731.56,"endTime":735.1,"body":"episode feedback, which I think"},{"speaker":"Charles Goldfarb","startTime":735.1,"endTime":740.41,"body":"was helpful. There was a request"},{"speaker":"Charles Goldfarb","startTime":735.1,"endTime":740.41,"body":"for more discussion on crps"},{"speaker":"Charles Goldfarb","startTime":740.41,"endTime":743.68,"body":"complex regional pain syndrome."},{"speaker":"Charles Goldfarb","startTime":740.41,"endTime":743.68,"body":"And Chris and I completely"},{"speaker":"Charles Goldfarb","startTime":743.68,"endTime":748.57,"body":"agree. And we had talked about"},{"speaker":"Charles Goldfarb","startTime":743.68,"endTime":748.57,"body":"timing of a therapist engaged"},{"speaker":"Charles Goldfarb","startTime":748.84,"endTime":752.86,"body":"podcast regarding crps, because"},{"speaker":"Charles Goldfarb","startTime":748.84,"endTime":752.86,"body":"we know how dependent we are on"},{"speaker":"Charles Goldfarb","startTime":752.86,"endTime":756.13,"body":"our partner therapist in the"},{"speaker":"Charles Goldfarb","startTime":752.86,"endTime":756.13,"body":"treatment of crps. So that is"},{"speaker":"Charles Goldfarb","startTime":756.13,"endTime":761.32,"body":"upcoming for sure. All right,"},{"speaker":"Charles Goldfarb","startTime":756.13,"endTime":761.32,"body":"well, let's jump into the heart"},{"speaker":"Charles Goldfarb","startTime":761.35,"endTime":764.83,"body":"of our podcast today that is"},{"speaker":"Charles Goldfarb","startTime":761.35,"endTime":764.83,"body":"distal radius fractures. And why"},{"speaker":"Charles Goldfarb","startTime":764.83,"endTime":768.28,"body":"don't we start just talking"},{"speaker":"Charles Goldfarb","startTime":764.83,"endTime":768.28,"body":"about how we think about non-op"},{"speaker":"Charles Goldfarb","startTime":768.55,"endTime":772.78,"body":"versus surgery and all that kind"},{"speaker":"Charles Goldfarb","startTime":768.55,"endTime":772.78,"body":"of stuff. So when you think"},{"speaker":"Charles Goldfarb","startTime":772.78,"endTime":777.64,"body":"about a patient who was reduced"},{"speaker":"Charles Goldfarb","startTime":772.78,"endTime":777.64,"body":"in the emergency room and sent"},{"speaker":"Charles Goldfarb","startTime":777.64,"endTime":781.21,"body":"to your clinic, what's your"},{"speaker":"Charles Goldfarb","startTime":777.64,"endTime":781.21,"body":"general protocol as far as how"},{"speaker":"Charles Goldfarb","startTime":781.21,"endTime":784.18,"body":"often you see them? When you"},{"speaker":"Charles Goldfarb","startTime":781.21,"endTime":784.18,"body":"change them from a plaster"},{"speaker":"Charles Goldfarb","startTime":784.18,"endTime":786.79,"body":"splint to a cast? How do you"},{"speaker":"Charles Goldfarb","startTime":784.18,"endTime":786.79,"body":"think about all that?"},{"speaker":"Chris Dy","startTime":786.0,"endTime":789.99,"body":"Um, you know, I tend"},{"speaker":"Chris Dy","startTime":786.0,"endTime":789.99,"body":"to think about it in terms of"},{"speaker":"Chris Dy","startTime":789.99,"endTime":793.05,"body":"whether the fracture is stable"},{"speaker":"Chris Dy","startTime":789.99,"endTime":793.05,"body":"or not, you know, whether it's a"},{"speaker":"Chris Dy","startTime":793.05,"endTime":795.72,"body":"fracture that has a risk of"},{"speaker":"Chris Dy","startTime":793.05,"endTime":795.72,"body":"displacement. And then the"},{"speaker":"Chris Dy","startTime":795.72,"endTime":799.41,"body":"second thing that I think about"},{"speaker":"Chris Dy","startTime":795.72,"endTime":799.41,"body":"the other big question is, will"},{"speaker":"Chris Dy","startTime":799.41,"endTime":802.41,"body":"this patient tolerate, you know,"},{"speaker":"Chris Dy","startTime":799.41,"endTime":802.41,"body":"inevitably, what might become a"},{"speaker":"Chris Dy","startTime":802.41,"endTime":807.9,"body":"malunion? And I think that there"},{"speaker":"Chris Dy","startTime":802.41,"endTime":807.9,"body":"are a lot of contributors to"},{"speaker":"Chris Dy","startTime":807.93,"endTime":810.99,"body":"that second question. And that's"},{"speaker":"Chris Dy","startTime":807.93,"endTime":810.99,"body":"when you have to really get to"},{"speaker":"Chris Dy","startTime":810.99,"endTime":815.88,"body":"know the patient. But if"},{"speaker":"Chris Dy","startTime":810.99,"endTime":815.88,"body":"somebody comes in reduced, I"},{"speaker":"Chris Dy","startTime":815.88,"endTime":818.79,"body":"typically will leave them in"},{"speaker":"Chris Dy","startTime":815.88,"endTime":818.79,"body":"their post reduction splint"},{"speaker":"Chris Dy","startTime":818.79,"endTime":823.56,"body":"provided that it's a reasonable,"},{"speaker":"Chris Dy","startTime":818.79,"endTime":823.56,"body":"reasonable alignment, and I'll"},{"speaker":"Chris Dy","startTime":823.56,"endTime":826.59,"body":"get an X ray or a fluoroscan to"},{"speaker":"Chris Dy","startTime":823.56,"endTime":826.59,"body":"confirm that and then I would"},{"speaker":"Chris Dy","startTime":827.16,"endTime":830.64,"body":"probably depending on how far"},{"speaker":"Chris Dy","startTime":827.16,"endTime":830.64,"body":"out they are. See them back in a"},{"speaker":"Chris Dy","startTime":830.64,"endTime":831.81,"body":"week? How about you?"},{"speaker":"Charles Goldfarb","startTime":832.41,"endTime":833.85,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":832.41,"endTime":833.85,"body":"that's really well said, the"},{"speaker":"Charles Goldfarb","startTime":833.85,"endTime":836.79,"body":"whole thing. So I typically see"},{"speaker":"Charles Goldfarb","startTime":833.85,"endTime":836.79,"body":"them ideally at one week, two"},{"speaker":"Charles Goldfarb","startTime":836.79,"endTime":839.76,"body":"weeks, three weeks, and then get"},{"speaker":"Charles Goldfarb","startTime":836.79,"endTime":839.76,"body":"them out of immobilization at"},{"speaker":"Charles Goldfarb","startTime":839.76,"endTime":844.44,"body":"five weeks. So I tend to leave"},{"speaker":"Charles Goldfarb","startTime":839.76,"endTime":844.44,"body":"them in their reduction plaster"},{"speaker":"Charles Goldfarb","startTime":844.44,"endTime":849.27,"body":"splint for three weeks, and then"},{"speaker":"Charles Goldfarb","startTime":844.44,"endTime":849.27,"body":"I take it out, and then I get a"},{"speaker":"Charles Goldfarb","startTime":849.27,"endTime":854.13,"body":"c-arm and then I put them in a"},{"speaker":"Charles Goldfarb","startTime":849.27,"endTime":854.13,"body":"fiber gap fiberglass cast. And I"},{"speaker":"Charles Goldfarb","startTime":854.13,"endTime":858.3,"body":"know that's a little debatable,"},{"speaker":"Charles Goldfarb","startTime":854.13,"endTime":858.3,"body":"as I recall, you get them out of"},{"speaker":"Charles Goldfarb","startTime":858.3,"endTime":861.81,"body":"the reduction immobilization at"},{"speaker":"Charles Goldfarb","startTime":858.3,"endTime":861.81,"body":"two weeks, is that right?"},{"speaker":"Chris Dy","startTime":862.47,"endTime":864.45,"body":"Well, you know, I'll"},{"speaker":"Chris Dy","startTime":862.47,"endTime":864.45,"body":"immobilize them, but you know,"},{"speaker":"Chris Dy","startTime":864.96,"endTime":869.43,"body":"typically, they're coming in in"},{"speaker":"Chris Dy","startTime":864.96,"endTime":869.43,"body":"some kind of sugar tong type"},{"speaker":"Chris Dy","startTime":869.43,"endTime":873.66,"body":"splint that goes above the elbow"},{"speaker":"Chris Dy","startTime":869.43,"endTime":873.66,"body":"to control the forearm. And what"},{"speaker":"Chris Dy","startTime":873.66,"endTime":877.26,"body":"I would usually do is have our"},{"speaker":"Chris Dy","startTime":873.66,"endTime":877.26,"body":"cast room Tech's cut down the"},{"speaker":"Chris Dy","startTime":877.29,"endTime":880.11,"body":"above elbow parts, so it's"},{"speaker":"Chris Dy","startTime":877.29,"endTime":880.11,"body":"essentially becomes a volar slab"},{"speaker":"Chris Dy","startTime":880.11,"endTime":884.73,"body":"and a dorsal slab at one week"},{"speaker":"Chris Dy","startTime":880.11,"endTime":884.73,"body":"and overwrap that with cast"},{"speaker":"Chris Dy","startTime":884.73,"endTime":887.22,"body":"material, with fiberglass cast"},{"speaker":"Chris Dy","startTime":884.73,"endTime":887.22,"body":"material, essentially converting"},{"speaker":"Chris Dy","startTime":887.22,"endTime":890.37,"body":"it into a short arm cast. And"},{"speaker":"Chris Dy","startTime":887.22,"endTime":890.37,"body":"that'll happen at the first"},{"speaker":"Chris Dy","startTime":890.37,"endTime":894.39,"body":"visit. And then I'll see them"},{"speaker":"Chris Dy","startTime":890.37,"endTime":894.39,"body":"back a week later, get x rays in"},{"speaker":"Chris Dy","startTime":894.69,"endTime":898.2,"body":"in that hybrid cast, and if it's"},{"speaker":"Chris Dy","startTime":894.69,"endTime":898.2,"body":"holding steady there, I'll have"},{"speaker":"Chris Dy","startTime":898.2,"endTime":900.99,"body":"them switch out to a formal cast"},{"speaker":"Chris Dy","startTime":898.2,"endTime":900.99,"body":"because I don't think that, you"},{"speaker":"Chris Dy","startTime":900.99,"endTime":903.75,"body":"know that small period of time"},{"speaker":"Chris Dy","startTime":900.99,"endTime":903.75,"body":"where you're switching from the"},{"speaker":"Chris Dy","startTime":903.78,"endTime":908.85,"body":"hybrid splint cast to a cast, a"},{"speaker":"Chris Dy","startTime":903.78,"endTime":908.85,"body":"formal cast is going to lead to"},{"speaker":"Chris Dy","startTime":908.85,"endTime":911.76,"body":"any displacement. And I think"},{"speaker":"Chris Dy","startTime":908.85,"endTime":911.76,"body":"it's lighter and more convenient"},{"speaker":"Chris Dy","startTime":911.76,"endTime":912.36,"body":"for patients."},{"speaker":"Charles Goldfarb","startTime":912.69,"endTime":914.52,"body":"So you think"},{"speaker":"Charles Goldfarb","startTime":912.69,"endTime":914.52,"body":"you can get them to two weeks,"},{"speaker":"Charles Goldfarb","startTime":914.52,"endTime":917.31,"body":"the fracture is sticky enough"},{"speaker":"Charles Goldfarb","startTime":914.52,"endTime":917.31,"body":"and it's safe save time. And"},{"speaker":"Charles Goldfarb","startTime":917.31,"endTime":920.16,"body":"then there's no doubt that"},{"speaker":"Charles Goldfarb","startTime":917.31,"endTime":920.16,"body":"patients like that transition."},{"speaker":"Charles Goldfarb","startTime":920.4,"endTime":922.59,"body":"And getting out of the heavy"},{"speaker":"Charles Goldfarb","startTime":920.4,"endTime":922.59,"body":"plaster, the uncomfortable"},{"speaker":"Charles Goldfarb","startTime":922.59,"endTime":925.71,"body":"plaster into fiberglass is a"},{"speaker":"Charles Goldfarb","startTime":922.59,"endTime":925.71,"body":"game changer. I just I don't"},{"speaker":"Charles Goldfarb","startTime":925.71,"endTime":929.43,"body":"know that I've been burned in"},{"speaker":"Charles Goldfarb","startTime":925.71,"endTime":929.43,"body":"changing before three weeks. But"},{"speaker":"Charles Goldfarb","startTime":930.09,"endTime":932.82,"body":"that's my protocol. And maybe I"},{"speaker":"Charles Goldfarb","startTime":930.09,"endTime":932.82,"body":"should think about moving it up"},{"speaker":"Charles Goldfarb","startTime":932.82,"endTime":933.21,"body":"a bit."},{"speaker":"Chris Dy","startTime":933.63,"endTime":935.46,"body":"Now certainly nobody"},{"speaker":"Chris Dy","startTime":933.63,"endTime":935.46,"body":"would fault you for that. I"},{"speaker":"Chris Dy","startTime":935.46,"endTime":938.01,"body":"mean, you know, that's the"},{"speaker":"Chris Dy","startTime":935.46,"endTime":938.01,"body":"classic tried and true protocol."},{"speaker":"Chris Dy","startTime":938.04,"endTime":941.01,"body":"Seeing them back every week, for"},{"speaker":"Chris Dy","startTime":938.04,"endTime":941.01,"body":"the first three weeks and"},{"speaker":"Chris Dy","startTime":941.01,"endTime":943.83,"body":"keeping them in their post"},{"speaker":"Chris Dy","startTime":941.01,"endTime":943.83,"body":"reduction immobilization."},{"speaker":"Chris Dy","startTime":944.49,"endTime":946.56,"body":"That's, you know, for anybody"},{"speaker":"Chris Dy","startTime":944.49,"endTime":946.56,"body":"that's a trainee that's"},{"speaker":"Chris Dy","startTime":946.56,"endTime":950.94,"body":"listening, that is the classic"},{"speaker":"Chris Dy","startTime":946.56,"endTime":950.94,"body":"way of doing it. I do get, I"},{"speaker":"Chris Dy","startTime":950.94,"endTime":953.46,"body":"have deviated from that because"},{"speaker":"Chris Dy","startTime":950.94,"endTime":953.46,"body":"of the reasons you stated in"},{"speaker":"Chris Dy","startTime":953.46,"endTime":955.32,"body":"terms of patient comfort. And"},{"speaker":"Chris Dy","startTime":953.46,"endTime":955.32,"body":"you know, there are some"},{"speaker":"Chris Dy","startTime":955.32,"endTime":958.11,"body":"reasonable studies showing that"},{"speaker":"Chris Dy","startTime":955.32,"endTime":958.11,"body":"if it hasn't displaced by two"},{"speaker":"Chris Dy","startTime":958.11,"endTime":960.06,"body":"weeks, that probably is the"},{"speaker":"Chris Dy","startTime":958.11,"endTime":960.06,"body":"point where it's going to be"},{"speaker":"Chris Dy","startTime":960.57,"endTime":963.09,"body":"reasonably maintain alignment."},{"speaker":"Charles Goldfarb","startTime":963.27,"endTime":964.86,"body":"I as you"},{"speaker":"Charles Goldfarb","startTime":963.27,"endTime":964.86,"body":"mentioned, to start, and we'll"},{"speaker":"Charles Goldfarb","startTime":964.86,"endTime":967.8,"body":"get into some of the details"},{"speaker":"Charles Goldfarb","startTime":964.86,"endTime":967.8,"body":"here. For me, the most"},{"speaker":"Charles Goldfarb","startTime":967.8,"endTime":972.03,"body":"challenging situation I have is"},{"speaker":"Charles Goldfarb","startTime":967.8,"endTime":972.03,"body":"when you see and so what I"},{"speaker":"Charles Goldfarb","startTime":972.03,"endTime":974.13,"body":"always do when a patient comes"},{"speaker":"Charles Goldfarb","startTime":972.03,"endTime":974.13,"body":"in is first of all, I try to"},{"speaker":"Charles Goldfarb","startTime":974.13,"endTime":976.59,"body":"look at the injury radiographs"},{"speaker":"Charles Goldfarb","startTime":974.13,"endTime":976.59,"body":"and the reduction radiographs"},{"speaker":"Charles Goldfarb","startTime":976.59,"endTime":980.19,"body":"because I think you learn a lot"},{"speaker":"Charles Goldfarb","startTime":976.59,"endTime":980.19,"body":"and then I obtain new typically"},{"speaker":"Charles Goldfarb","startTime":980.19,"endTime":983.1,"body":"c-arms, but sometimes plain"},{"speaker":"Charles Goldfarb","startTime":980.19,"endTime":983.1,"body":"radiographs, at that one week"},{"speaker":"Charles Goldfarb","startTime":983.1,"endTime":987.6,"body":"visit. So one week post injury"},{"speaker":"Charles Goldfarb","startTime":983.1,"endTime":987.6,"body":"post reduction visit. And the"},{"speaker":"Charles Goldfarb","startTime":987.6,"endTime":990.84,"body":"worst thing for me is when it"},{"speaker":"Charles Goldfarb","startTime":987.6,"endTime":990.84,"body":"looks pretty darn good in the ER"},{"speaker":"Charles Goldfarb","startTime":990.9,"endTime":995.88,"body":"after reduction, slightly worse"},{"speaker":"Charles Goldfarb","startTime":990.9,"endTime":995.88,"body":"at week one. And they come back"},{"speaker":"Charles Goldfarb","startTime":995.88,"endTime":998.19,"body":"at week two or week three, and"},{"speaker":"Charles Goldfarb","startTime":995.88,"endTime":998.19,"body":"it's just slowly gotten worse"},{"speaker":"Charles Goldfarb","startTime":998.22,"endTime":1002.33,"body":"it's that, you know, we that is"},{"speaker":"Charles Goldfarb","startTime":998.22,"endTime":1002.33,"body":"the physician and the patient"},{"speaker":"Charles Goldfarb","startTime":1002.33,"endTime":1006.53,"body":"invest in non operative care."},{"speaker":"Charles Goldfarb","startTime":1002.33,"endTime":1006.53,"body":"And this slow progression of"},{"speaker":"Charles Goldfarb","startTime":1006.53,"endTime":1008.81,"body":"worsening is really tough to"},{"speaker":"Charles Goldfarb","startTime":1006.53,"endTime":1008.81,"body":"deal with."},{"speaker":"Chris Dy","startTime":1008.0,"endTime":1012.02,"body":"And that's and I think"},{"speaker":"Chris Dy","startTime":1008.0,"endTime":1012.02,"body":"I agree with the heartache that"},{"speaker":"Chris Dy","startTime":1012.02,"endTime":1014.87,"body":"comes with that, and I've gone"},{"speaker":"Chris Dy","startTime":1012.02,"endTime":1014.87,"body":"through it. And I think that's"},{"speaker":"Chris Dy","startTime":1014.87,"endTime":1018.29,"body":"why it's so important to frame"},{"speaker":"Chris Dy","startTime":1014.87,"endTime":1018.29,"body":"the discussion early on that,"},{"speaker":"Chris Dy","startTime":1018.29,"endTime":1020.81,"body":"you know, we may change"},{"speaker":"Chris Dy","startTime":1018.29,"endTime":1020.81,"body":"treatment options, you know,"},{"speaker":"Chris Dy","startTime":1020.81,"endTime":1023.99,"body":"based on what it looks like, you"},{"speaker":"Chris Dy","startTime":1020.81,"endTime":1023.99,"body":"know, when you come back, and"},{"speaker":"Chris Dy","startTime":1023.99,"endTime":1026.36,"body":"then admitting to yourself when"},{"speaker":"Chris Dy","startTime":1023.99,"endTime":1026.36,"body":"it is displacing because that's"},{"speaker":"Chris Dy","startTime":1026.36,"endTime":1029.3,"body":"also a hard thing to do. Because"},{"speaker":"Chris Dy","startTime":1026.36,"endTime":1029.3,"body":"you know, the patient doesn't,"},{"speaker":"Chris Dy","startTime":1029.54,"endTime":1032.12,"body":"you know as already said, they"},{"speaker":"Chris Dy","startTime":1029.54,"endTime":1032.12,"body":"don't want surgery. But study"},{"speaker":"Chris Dy","startTime":1032.12,"endTime":1034.13,"body":"after study, and we'll go into"},{"speaker":"Chris Dy","startTime":1032.12,"endTime":1034.13,"body":"this in more detail have"},{"speaker":"Chris Dy","startTime":1034.13,"endTime":1037.28,"body":"demonstrated that the advantage"},{"speaker":"Chris Dy","startTime":1034.13,"endTime":1037.28,"body":"of surgery in many of these"},{"speaker":"Chris Dy","startTime":1037.28,"endTime":1042.77,"body":"cases is the earlier, earlier"},{"speaker":"Chris Dy","startTime":1037.28,"endTime":1042.77,"body":"mobilization. So as if you"},{"speaker":"Chris Dy","startTime":1042.77,"endTime":1044.81,"body":"follow a patient for two or"},{"speaker":"Chris Dy","startTime":1042.77,"endTime":1044.81,"body":"three weeks, you're really"},{"speaker":"Chris Dy","startTime":1044.84,"endTime":1048.02,"body":"eating into that advantage that"},{"speaker":"Chris Dy","startTime":1044.84,"endTime":1048.02,"body":"they may have gotten. One"},{"speaker":"Chris Dy","startTime":1048.02,"endTime":1050.21,"body":"question I wanted to ask you is"},{"speaker":"Chris Dy","startTime":1048.02,"endTime":1050.21,"body":"what about the patient with a"},{"speaker":"Chris Dy","startTime":1050.21,"endTime":1053.6,"body":"displaced fracture who comes in"},{"speaker":"Chris Dy","startTime":1050.21,"endTime":1053.6,"body":"a day or two later, and hasn't"},{"speaker":"Chris Dy","startTime":1053.6,"endTime":1056.33,"body":"had a closed reduction because"},{"speaker":"Chris Dy","startTime":1053.6,"endTime":1056.33,"body":"they went to an urgent care"},{"speaker":"Chris Dy","startTime":1056.33,"endTime":1059.96,"body":"center where they don't do that,"},{"speaker":"Chris Dy","startTime":1056.33,"endTime":1059.96,"body":"or because they went to an ER"},{"speaker":"Chris Dy","startTime":1059.96,"endTime":1063.71,"body":"facility where they where they"},{"speaker":"Chris Dy","startTime":1059.96,"endTime":1063.71,"body":"don't do closed reductions,"},{"speaker":"Chris Dy","startTime":1063.71,"endTime":1066.53,"body":"which I think is becoming more"},{"speaker":"Chris Dy","startTime":1063.71,"endTime":1066.53,"body":"and more common as urgent care"},{"speaker":"Chris Dy","startTime":1066.53,"endTime":1068.69,"body":"facilities have become more"},{"speaker":"Chris Dy","startTime":1066.53,"endTime":1068.69,"body":"prevalent in the States."},{"speaker":"Charles Goldfarb","startTime":1069.17,"endTime":1071.54,"body":"Yeah, it's so"},{"speaker":"Charles Goldfarb","startTime":1069.17,"endTime":1071.54,"body":"true, there is a role for urgent"},{"speaker":"Charles Goldfarb","startTime":1071.54,"endTime":1074.84,"body":"cares, and I do have urgent"},{"speaker":"Charles Goldfarb","startTime":1071.54,"endTime":1074.84,"body":"cares that share patients with"},{"speaker":"Charles Goldfarb","startTime":1074.84,"endTime":1080.72,"body":"me. So I'm grateful for that."},{"speaker":"Charles Goldfarb","startTime":1074.84,"endTime":1080.72,"body":"But it's an opportunity lost if"},{"speaker":"Charles Goldfarb","startTime":1080.72,"endTime":1083.63,"body":"the patient doesn't have a"},{"speaker":"Charles Goldfarb","startTime":1080.72,"endTime":1083.63,"body":"reduction when that patient"},{"speaker":"Charles Goldfarb","startTime":1083.63,"endTime":1087.56,"body":"would have benefited. And you"},{"speaker":"Charles Goldfarb","startTime":1083.63,"endTime":1087.56,"body":"know, worse than not doing it is"},{"speaker":"Charles Goldfarb","startTime":1087.56,"endTime":1090.71,"body":"what I think happens is"},{"speaker":"Charles Goldfarb","startTime":1087.56,"endTime":1090.71,"body":"sometimes the patient is quote"},{"speaker":"Charles Goldfarb","startTime":1090.71,"endTime":1094.25,"body":"unquote, reduced while the cast"},{"speaker":"Charles Goldfarb","startTime":1090.71,"endTime":1094.25,"body":"is being put on and I've talked"},{"speaker":"Charles Goldfarb","startTime":1094.25,"endTime":1096.92,"body":"to my team, and that's not a"},{"speaker":"Charles Goldfarb","startTime":1094.25,"endTime":1096.92,"body":"reduction. So in other words, if"},{"speaker":"Charles Goldfarb","startTime":1096.92,"endTime":1099.86,"body":"a patient comes in and they"},{"speaker":"Charles Goldfarb","startTime":1096.92,"endTime":1099.86,"body":"haven't been reduced, then I"},{"speaker":"Charles Goldfarb","startTime":1099.86,"endTime":1104.24,"body":"take off whatever splint they're"},{"speaker":"Charles Goldfarb","startTime":1099.86,"endTime":1104.24,"body":"in for new x rays and exam, if"},{"speaker":"Charles Goldfarb","startTime":1104.24,"endTime":1107.0,"body":"they had been reduced, the team"},{"speaker":"Charles Goldfarb","startTime":1104.24,"endTime":1107.0,"body":"is under instruction, don't"},{"speaker":"Charles Goldfarb","startTime":1107.0,"endTime":1109.58,"body":"touch the splint. But then"},{"speaker":"Charles Goldfarb","startTime":1107.0,"endTime":1109.58,"body":"sometimes you get these urgent"},{"speaker":"Charles Goldfarb","startTime":1109.58,"endTime":1112.07,"body":"care patients and we're picking"},{"speaker":"Charles Goldfarb","startTime":1109.58,"endTime":1112.07,"body":"on urgent cares a little bit but"},{"speaker":"Charles Goldfarb","startTime":1112.07,"endTime":1115.73,"body":"you get to urgent care patients."},{"speaker":"Charles Goldfarb","startTime":1112.07,"endTime":1115.73,"body":"The patient says yah well when"},{"speaker":"Charles Goldfarb","startTime":1115.73,"endTime":1118.37,"body":"they put the splint on they"},{"speaker":"Charles Goldfarb","startTime":1115.73,"endTime":1118.37,"body":"reduced me. And to me that's"},{"speaker":"Charles Goldfarb","startTime":1118.37,"endTime":1123.08,"body":"total total nonsense. And I'm my"},{"speaker":"Charles Goldfarb","startTime":1118.37,"endTime":1123.08,"body":"guess is that that urgent care"},{"speaker":"Charles Goldfarb","startTime":1123.08,"endTime":1126.17,"body":"is billing for that reduction,"},{"speaker":"Charles Goldfarb","startTime":1123.08,"endTime":1126.17,"body":"which is non existent and is"},{"speaker":"Charles Goldfarb","startTime":1126.17,"endTime":1129.65,"body":"very frustrating for me to hear."},{"speaker":"Charles Goldfarb","startTime":1126.17,"endTime":1129.65,"body":"So sorry, a little bit of a"},{"speaker":"Charles Goldfarb","startTime":1129.65,"endTime":1134.96,"body":"soapbox, I'll circle back to"},{"speaker":"Charles Goldfarb","startTime":1129.65,"endTime":1134.96,"body":"where we started, which is if a"},{"speaker":"Charles Goldfarb","startTime":1134.96,"endTime":1137.69,"body":"patient has a fracture, which"},{"speaker":"Charles Goldfarb","startTime":1134.96,"endTime":1137.69,"body":"would benefit from a closed"},{"speaker":"Charles Goldfarb","startTime":1137.69,"endTime":1141.38,"body":"reduction, how long will I you"},{"speaker":"Charles Goldfarb","startTime":1137.69,"endTime":1141.38,"body":"know, at what interval will I"},{"speaker":"Charles Goldfarb","startTime":1141.38,"endTime":1145.67,"body":"consider it. I will consider it"},{"speaker":"Charles Goldfarb","startTime":1141.38,"endTime":1145.67,"body":"at 48 hours, maybe even a little"},{"speaker":"Charles Goldfarb","startTime":1145.67,"endTime":1150.38,"body":"longer. But ideally it's 24"},{"speaker":"Charles Goldfarb","startTime":1145.67,"endTime":1150.38,"body":"hours because I think I can do a"},{"speaker":"Charles Goldfarb","startTime":1150.38,"endTime":1154.88,"body":"pretty painless hematoma block"},{"speaker":"Charles Goldfarb","startTime":1150.38,"endTime":1154.88,"body":"and relatively comfortably"},{"speaker":"Charles Goldfarb","startTime":1154.91,"endTime":1158.15,"body":"obtain a reduction in the right"},{"speaker":"Charles Goldfarb","startTime":1154.91,"endTime":1158.15,"body":"patient. So that's my general"},{"speaker":"Charles Goldfarb","startTime":1158.15,"endTime":1159.2,"body":"strategy. What about you?"},{"speaker":"Chris Dy","startTime":1159.77,"endTime":1161.96,"body":"Yeah, I think closed"},{"speaker":"Chris Dy","startTime":1159.77,"endTime":1161.96,"body":"reduction in the office is right"},{"speaker":"Chris Dy","startTime":1161.96,"endTime":1165.68,"body":"patient at the right time. You"},{"speaker":"Chris Dy","startTime":1161.96,"endTime":1165.68,"body":"know, and I agree probably 24"},{"speaker":"Chris Dy","startTime":1165.68,"endTime":1168.83,"body":"hours is my window as well. I"},{"speaker":"Chris Dy","startTime":1165.68,"endTime":1168.83,"body":"think you know, we I tend to be"},{"speaker":"Chris Dy","startTime":1168.83,"endTime":1171.35,"body":"a little more lenient with"},{"speaker":"Chris Dy","startTime":1168.83,"endTime":1171.35,"body":"things now, especially with"},{"speaker":"Chris Dy","startTime":1171.35,"endTime":1173.96,"body":"COVID. I don't want to send a"},{"speaker":"Chris Dy","startTime":1171.35,"endTime":1173.96,"body":"patient to the ER if I think I"},{"speaker":"Chris Dy","startTime":1173.96,"endTime":1176.87,"body":"can get a reasonable reduction."},{"speaker":"Chris Dy","startTime":1173.96,"endTime":1176.87,"body":"But you know, in the office, we"},{"speaker":"Chris Dy","startTime":1176.87,"endTime":1179.81,"body":"don't have access to anything"},{"speaker":"Chris Dy","startTime":1176.87,"endTime":1179.81,"body":"but lidocaine, so we don't have"},{"speaker":"Chris Dy","startTime":1179.81,"endTime":1183.38,"body":"any oral pain medication. We"},{"speaker":"Chris Dy","startTime":1179.81,"endTime":1183.38,"body":"clearly don't have any access to"},{"speaker":"Chris Dy","startTime":1183.38,"endTime":1186.65,"body":"sedation or anything like that."},{"speaker":"Chris Dy","startTime":1183.38,"endTime":1186.65,"body":"So you got to feel pretty good"},{"speaker":"Chris Dy","startTime":1186.65,"endTime":1189.71,"body":"about your ability to perform"},{"speaker":"Chris Dy","startTime":1186.65,"endTime":1189.71,"body":"this reduction. And then there"},{"speaker":"Chris Dy","startTime":1189.71,"endTime":1192.26,"body":"are the practical considerations"},{"speaker":"Chris Dy","startTime":1189.71,"endTime":1192.26,"body":"about honestly the rest of your"},{"speaker":"Chris Dy","startTime":1192.26,"endTime":1195.5,"body":"clinic. So if sometimes if"},{"speaker":"Chris Dy","startTime":1192.26,"endTime":1195.5,"body":"they're okay with waiting a"},{"speaker":"Chris Dy","startTime":1195.5,"endTime":1198.26,"body":"little bit longer, I know if I"},{"speaker":"Chris Dy","startTime":1195.5,"endTime":1198.26,"body":"know I have a space at the end"},{"speaker":"Chris Dy","startTime":1198.26,"endTime":1199.61,"body":"of my day, I may just do it then"},{"speaker":"Charles Goldfarb","startTime":1200.38,"endTime":1202.3,"body":"Yeah, really,"},{"speaker":"Charles Goldfarb","startTime":1200.38,"endTime":1202.3,"body":"I totally agree with everything"},{"speaker":"Charles Goldfarb","startTime":1202.3,"endTime":1205.0,"body":"you said the adolescent patient"},{"speaker":"Charles Goldfarb","startTime":1202.3,"endTime":1205.0,"body":"is always a very interesting"},{"speaker":"Charles Goldfarb","startTime":1205.0,"endTime":1207.76,"body":"conversation, whether it's"},{"speaker":"Charles Goldfarb","startTime":1205.0,"endTime":1207.76,"body":"distal radius or whatever, where"},{"speaker":"Charles Goldfarb","startTime":1207.76,"endTime":1210.79,"body":"you have to have buy in from the"},{"speaker":"Charles Goldfarb","startTime":1207.76,"endTime":1210.79,"body":"families. But in that classic"},{"speaker":"Charles Goldfarb","startTime":1210.79,"endTime":1213.52,"body":"distal radius fracture, it takes"},{"speaker":"Charles Goldfarb","startTime":1210.79,"endTime":1213.52,"body":"a patient who really wants to"},{"speaker":"Charles Goldfarb","startTime":1213.52,"endTime":1218.53,"body":"stay out of the operating room,"},{"speaker":"Charles Goldfarb","startTime":1213.52,"endTime":1218.53,"body":"and time and ability to make it"},{"speaker":"Charles Goldfarb","startTime":1218.53,"endTime":1221.5,"body":"happen. So I think it's a it's"},{"speaker":"Charles Goldfarb","startTime":1218.53,"endTime":1221.5,"body":"a, it's a really important"},{"speaker":"Charles Goldfarb","startTime":1221.5,"endTime":1225.31,"body":"point. And I think an ability to"},{"speaker":"Charles Goldfarb","startTime":1221.5,"endTime":1225.31,"body":"give a good hematoma block is"},{"speaker":"Charles Goldfarb","startTime":1225.31,"endTime":1226.21,"body":"obviously critical."},{"speaker":"Chris Dy","startTime":1227.21,"endTime":1230.75,"body":"So when you're looking"},{"speaker":"Chris Dy","startTime":1227.21,"endTime":1230.75,"body":"at those pre injury radiographs,"},{"speaker":"Chris Dy","startTime":1230.78,"endTime":1233.75,"body":"and even the post reduction"},{"speaker":"Chris Dy","startTime":1230.78,"endTime":1233.75,"body":"radiographs, how do you make the"},{"speaker":"Chris Dy","startTime":1233.75,"endTime":1238.16,"body":"decision about what you think is"},{"speaker":"Chris Dy","startTime":1233.75,"endTime":1238.16,"body":"going to be stable and hold?"},{"speaker":"Charles Goldfarb","startTime":1238.99,"endTime":1241.15,"body":"You know, so"},{"speaker":"Charles Goldfarb","startTime":1238.99,"endTime":1241.15,"body":"for me, and I think for most of"},{"speaker":"Charles Goldfarb","startTime":1241.15,"endTime":1245.59,"body":"us, the initial displacement"},{"speaker":"Charles Goldfarb","startTime":1241.15,"endTime":1245.59,"body":"tells me so much, because if"},{"speaker":"Charles Goldfarb","startTime":1245.59,"endTime":1249.28,"body":"that is severe, then I"},{"speaker":"Charles Goldfarb","startTime":1245.59,"endTime":1249.28,"body":"immediately I'm worried that"},{"speaker":"Charles Goldfarb","startTime":1249.28,"endTime":1252.31,"body":"whatever reduction no matter how"},{"speaker":"Charles Goldfarb","startTime":1249.28,"endTime":1252.31,"body":"wonderful was obtained in the"},{"speaker":"Charles Goldfarb","startTime":1252.31,"endTime":1256.21,"body":"emergency department that's at"},{"speaker":"Charles Goldfarb","startTime":1252.31,"endTime":1256.21,"body":"risk. But you know, classically,"},{"speaker":"Charles Goldfarb","startTime":1256.78,"endTime":1261.73,"body":"the La Fontaine criteria were"},{"speaker":"Charles Goldfarb","startTime":1256.78,"endTime":1261.73,"body":"have been quoted over many"},{"speaker":"Charles Goldfarb","startTime":1261.73,"endTime":1265.27,"body":"years. I think that was 1989. It"},{"speaker":"Charles Goldfarb","startTime":1261.73,"endTime":1265.27,"body":"was a relatively small study"},{"speaker":"Charles Goldfarb","startTime":1265.27,"endTime":1271.48,"body":"from Brussels, around 100"},{"speaker":"Charles Goldfarb","startTime":1265.27,"endTime":1271.48,"body":"patients. And those criteria are"},{"speaker":"Charles Goldfarb","startTime":1271.48,"endTime":1273.79,"body":"completely reasonable. They've"},{"speaker":"Charles Goldfarb","startTime":1271.48,"endTime":1273.79,"body":"stood the test of time now"},{"speaker":"Charles Goldfarb","startTime":1273.79,"endTime":1277.36,"body":"people have nitpicked at the La"},{"speaker":"Charles Goldfarb","startTime":1273.79,"endTime":1277.36,"body":"Fontaine criteria for an"},{"speaker":"Charles Goldfarb","startTime":1277.36,"endTime":1281.53,"body":"unstable fracture. Maybe we"},{"speaker":"Charles Goldfarb","startTime":1277.36,"endTime":1281.53,"body":"should go through them. But I"},{"speaker":"Charles Goldfarb","startTime":1281.53,"endTime":1284.05,"body":"think those are the basics and"},{"speaker":"Charles Goldfarb","startTime":1281.53,"endTime":1284.05,"body":"you can quibble with them. But"},{"speaker":"Charles Goldfarb","startTime":1284.05,"endTime":1286.3,"body":"those are the basics. How do you"},{"speaker":"Charles Goldfarb","startTime":1284.05,"endTime":1286.3,"body":"how do you think about it,"},{"speaker":"Chris Dy","startTime":1287.23,"endTime":1291.7,"body":"I also use them as a"},{"speaker":"Chris Dy","startTime":1287.23,"endTime":1291.7,"body":"framework. So for the listener"},{"speaker":"Chris Dy","startTime":1291.7,"endTime":1294.31,"body":"that may not be familiar with"},{"speaker":"Chris Dy","startTime":1291.7,"endTime":1294.31,"body":"the La Fontaine criteria. It's a"},{"speaker":"Chris Dy","startTime":1294.31,"endTime":1296.23,"body":"lot of the same stuff we"},{"speaker":"Chris Dy","startTime":1294.31,"endTime":1296.23,"body":"classically talk about in"},{"speaker":"Chris Dy","startTime":1296.23,"endTime":1298.45,"body":"orthopedics for radius"},{"speaker":"Chris Dy","startTime":1296.23,"endTime":1298.45,"body":"fractures, but it's dorsal"},{"speaker":"Chris Dy","startTime":1298.45,"endTime":1301.75,"body":"angulation, more than 20"},{"speaker":"Chris Dy","startTime":1298.45,"endTime":1301.75,"body":"degrees. Combination of that"},{"speaker":"Chris Dy","startTime":1301.75,"endTime":1306.79,"body":"metaphyseal cortex dorsally,"},{"speaker":"Chris Dy","startTime":1301.75,"endTime":1306.79,"body":"greater than 50%, or potentially"},{"speaker":"Chris Dy","startTime":1306.79,"endTime":1309.94,"body":"some combination towards the"},{"speaker":"Chris Dy","startTime":1306.79,"endTime":1309.94,"body":"joint, or the volar surface,"},{"speaker":"Chris Dy","startTime":1310.3,"endTime":1312.82,"body":"initial displacement more than a"},{"speaker":"Chris Dy","startTime":1310.3,"endTime":1312.82,"body":"millimeter or excuse me a"},{"speaker":"Chris Dy","startTime":1312.82,"endTime":1317.2,"body":"centimeter shortening on the"},{"speaker":"Chris Dy","startTime":1312.82,"endTime":1317.2,"body":"radial side of greater than five"},{"speaker":"Chris Dy","startTime":1317.2,"endTime":1320.32,"body":"millimeters and associated ulnar"},{"speaker":"Chris Dy","startTime":1317.2,"endTime":1320.32,"body":"fracture, it's not clear whether"},{"speaker":"Chris Dy","startTime":1320.32,"endTime":1324.25,"body":"that's a styloid, or a neck"},{"speaker":"Chris Dy","startTime":1320.32,"endTime":1324.25,"body":"fracture, and severe"},{"speaker":"Chris Dy","startTime":1324.25,"endTime":1327.46,"body":"osteoporosis. So our ability to"},{"speaker":"Chris Dy","startTime":1324.25,"endTime":1327.46,"body":"judge severe osteoporosis on a"},{"speaker":"Chris Dy","startTime":1327.46,"endTime":1331.54,"body":"plain film is quite limited. But"},{"speaker":"Chris Dy","startTime":1327.46,"endTime":1331.54,"body":"I like to take some things from"},{"speaker":"Chris Dy","startTime":1331.54,"endTime":1334.69,"body":"there. And then also, I think,"},{"speaker":"Chris Dy","startTime":1331.54,"endTime":1334.69,"body":"another one that is typically"},{"speaker":"Chris Dy","startTime":1334.69,"endTime":1337.87,"body":"included, I'm not sure if"},{"speaker":"Chris Dy","startTime":1334.69,"endTime":1337.87,"body":"LaFontaine did it himself, or"},{"speaker":"Chris Dy","startTime":1337.87,"endTime":1341.92,"body":"somebody else added it, is age."},{"speaker":"Chris Dy","startTime":1337.87,"endTime":1341.92,"body":"And having three or more of"},{"speaker":"Chris Dy","startTime":1341.92,"endTime":1346.36,"body":"those factors tends to be a risk"},{"speaker":"Chris Dy","startTime":1341.92,"endTime":1346.36,"body":"factor for loss of reduction at"},{"speaker":"Chris Dy","startTime":1346.36,"endTime":1346.96,"body":"follow up."},{"speaker":"Charles Goldfarb","startTime":1347.53,"endTime":1350.59,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":1347.53,"endTime":1350.59,"body":"thanks for sharing those, I"},{"speaker":"Charles Goldfarb","startTime":1350.59,"endTime":1352.78,"body":"totally agree. And again, that"},{"speaker":"Charles Goldfarb","startTime":1350.59,"endTime":1352.78,"body":"you can't quibble with these"},{"speaker":"Charles Goldfarb","startTime":1352.78,"endTime":1356.86,"body":"criteria. And lots of people"},{"speaker":"Charles Goldfarb","startTime":1352.78,"endTime":1356.86,"body":"over the years have tried to"},{"speaker":"Charles Goldfarb","startTime":1357.22,"endTime":1361.99,"body":"optimize or improve, I don't"},{"speaker":"Charles Goldfarb","startTime":1357.22,"endTime":1361.99,"body":"know that we can do much better."},{"speaker":"Charles Goldfarb","startTime":1362.98,"endTime":1365.59,"body":"It's been shown that radial"},{"speaker":"Charles Goldfarb","startTime":1362.98,"endTime":1365.59,"body":"shortening and dorsal"},{"speaker":"Charles Goldfarb","startTime":1365.59,"endTime":1368.8,"body":"combination are perhaps most"},{"speaker":"Charles Goldfarb","startTime":1365.59,"endTime":1368.8,"body":"associated with displacement."},{"speaker":"Charles Goldfarb","startTime":1369.04,"endTime":1372.4,"body":"And others have suggested the"},{"speaker":"Charles Goldfarb","startTime":1369.04,"endTime":1372.4,"body":"ulna fracture, whether that be"},{"speaker":"Charles Goldfarb","startTime":1372.46,"endTime":1376.75,"body":"distal ulna, or styloid, are not"},{"speaker":"Charles Goldfarb","startTime":1372.46,"endTime":1376.75,"body":"associated. But it's impossible"},{"speaker":"Charles Goldfarb","startTime":1376.75,"endTime":1380.53,"body":"to quibble with those criteria."},{"speaker":"Charles Goldfarb","startTime":1376.75,"endTime":1380.53,"body":"And I think they're helpful, but"},{"speaker":"Charles Goldfarb","startTime":1380.53,"endTime":1383.59,"body":"like everything, and you"},{"speaker":"Charles Goldfarb","startTime":1380.53,"endTime":1383.59,"body":"mentioned age, everything is age"},{"speaker":"Charles Goldfarb","startTime":1383.59,"endTime":1385.93,"body":"dependent. I think, you know,"},{"speaker":"Charles Goldfarb","startTime":1383.59,"endTime":1385.93,"body":"when volar plates, and we're"},{"speaker":"Charles Goldfarb","startTime":1385.93,"endTime":1388.15,"body":"going to spend some time in our"},{"speaker":"Charles Goldfarb","startTime":1385.93,"endTime":1388.15,"body":"next next episode talking about"},{"speaker":"Charles Goldfarb","startTime":1388.15,"endTime":1391.3,"body":"volar plating. When volar plates"},{"speaker":"Charles Goldfarb","startTime":1388.15,"endTime":1391.3,"body":"first came out, the pendulum"},{"speaker":"Charles Goldfarb","startTime":1391.3,"endTime":1395.11,"body":"swung so far, so fast towards"},{"speaker":"Charles Goldfarb","startTime":1391.3,"endTime":1395.11,"body":"everybody getting a volar plate,"},{"speaker":"Charles Goldfarb","startTime":1395.38,"endTime":1399.85,"body":"that it was clearly too far. Now"},{"speaker":"Charles Goldfarb","startTime":1395.38,"endTime":1399.85,"body":"we've swung back recognizing"},{"speaker":"Charles Goldfarb","startTime":1399.85,"endTime":1403.15,"body":"what Colle said many, many years"},{"speaker":"Charles Goldfarb","startTime":1399.85,"endTime":1403.15,"body":"ago that many patients even with"},{"speaker":"Charles Goldfarb","startTime":1403.15,"endTime":1406.27,"body":"displacement do fine. So it's"},{"speaker":"Charles Goldfarb","startTime":1403.15,"endTime":1406.27,"body":"hard. It's tough."},{"speaker":"Chris Dy","startTime":1407.5,"endTime":1409.9,"body":"Yeah, I agree that"},{"speaker":"Chris Dy","startTime":1407.5,"endTime":1409.9,"body":"many patients with displacement"},{"speaker":"Chris Dy","startTime":1409.9,"endTime":1414.49,"body":"will do fine. But it's mainly I"},{"speaker":"Chris Dy","startTime":1409.9,"endTime":1414.49,"body":"think these criteria are helpful"},{"speaker":"Chris Dy","startTime":1414.88,"endTime":1418.33,"body":"in counseling patients. So"},{"speaker":"Chris Dy","startTime":1414.88,"endTime":1418.33,"body":"saying, you know, A, you know,"},{"speaker":"Chris Dy","startTime":1418.33,"endTime":1422.11,"body":"this has a x, you know, chance"},{"speaker":"Chris Dy","startTime":1418.33,"endTime":1422.11,"body":"of displacing, or I think it's"},{"speaker":"Chris Dy","startTime":1422.11,"endTime":1424.09,"body":"going to hold or I don't think"},{"speaker":"Chris Dy","startTime":1422.11,"endTime":1424.09,"body":"it's going to hold based on the"},{"speaker":"Chris Dy","startTime":1424.09,"endTime":1428.05,"body":"way it looks on this x ray. And"},{"speaker":"Chris Dy","startTime":1424.09,"endTime":1428.05,"body":"what will be the implications,"},{"speaker":"Chris Dy","startTime":1428.08,"endTime":1431.71,"body":"if it, you know, heals in this"},{"speaker":"Chris Dy","startTime":1428.08,"endTime":1431.71,"body":"malunited position. And some of"},{"speaker":"Chris Dy","startTime":1431.71,"endTime":1435.94,"body":"these markers like the dorsal"},{"speaker":"Chris Dy","startTime":1431.71,"endTime":1435.94,"body":"angulation, you know, have been"},{"speaker":"Chris Dy","startTime":1435.94,"endTime":1439.36,"body":"demonstrated to have a negative"},{"speaker":"Chris Dy","startTime":1435.94,"endTime":1439.36,"body":"impact on objective measures"},{"speaker":"Chris Dy","startTime":1439.36,"endTime":1441.7,"body":"like grip strength, as well as"},{"speaker":"Chris Dy","startTime":1439.36,"endTime":1441.7,"body":"patient reported outcomes like"},{"speaker":"Chris Dy","startTime":1441.7,"endTime":1445.3,"body":"the dash. And one thing that I"},{"speaker":"Chris Dy","startTime":1441.7,"endTime":1445.3,"body":"like to look at on the lateral"},{"speaker":"Chris Dy","startTime":1445.3,"endTime":1449.02,"body":"film is whether the capitate is"},{"speaker":"Chris Dy","startTime":1445.3,"endTime":1449.02,"body":"centered over the radial shaft"},{"speaker":"Chris Dy","startTime":1449.02,"endTime":1451.75,"body":"extended the radial axis. And"},{"speaker":"Chris Dy","startTime":1449.02,"endTime":1451.75,"body":"that's been described by"},{"speaker":"Chris Dy","startTime":1451.75,"endTime":1454.06,"body":"McQueen's group as well as"},{"speaker":"Chris Dy","startTime":1451.75,"endTime":1454.06,"body":"examined by other groups,"},{"speaker":"Chris Dy","startTime":1454.6,"endTime":1457.39,"body":"looking at the relevance of"},{"speaker":"Chris Dy","startTime":1454.6,"endTime":1457.39,"body":"that, but that I think, is a"},{"speaker":"Chris Dy","startTime":1457.39,"endTime":1460.3,"body":"good way of knowing is the"},{"speaker":"Chris Dy","startTime":1457.39,"endTime":1460.3,"body":"carpus aligned over the forearm?"},{"speaker":"Chris Dy","startTime":1460.36,"endTime":1464.95,"body":"And is this something that is"},{"speaker":"Chris Dy","startTime":1460.36,"endTime":1464.95,"body":"going to be bothersome malunion?"},{"speaker":"Chris Dy","startTime":1464.98,"endTime":1468.58,"body":"Obviously, study after study has"},{"speaker":"Chris Dy","startTime":1464.98,"endTime":1468.58,"body":"shown that with increased age,"},{"speaker":"Chris Dy","startTime":1468.61,"endTime":1470.8,"body":"you can tolerate more patients"},{"speaker":"Chris Dy","startTime":1468.61,"endTime":1470.8,"body":"tolerate more."},{"speaker":"Charles Goldfarb","startTime":1471.64,"endTime":1474.55,"body":"Demand is"},{"speaker":"Charles Goldfarb","startTime":1471.64,"endTime":1474.55,"body":"typically less and, and patients"},{"speaker":"Charles Goldfarb","startTime":1475.0,"endTime":1477.94,"body":"accept more. So I guess when we"},{"speaker":"Charles Goldfarb","startTime":1475.0,"endTime":1477.94,"body":"think about it, I'm thinking on"},{"speaker":"Charles Goldfarb","startTime":1477.94,"endTime":1480.22,"body":"my feet here, I haven't really"},{"speaker":"Charles Goldfarb","startTime":1477.94,"endTime":1480.22,"body":"said this before, but there's"},{"speaker":"Charles Goldfarb","startTime":1480.22,"endTime":1483.97,"body":"really three things here, right?"},{"speaker":"Charles Goldfarb","startTime":1480.22,"endTime":1483.97,"body":"One is radiographic appearance."},{"speaker":"Charles Goldfarb","startTime":1484.21,"endTime":1486.7,"body":"And that's where you and I may"},{"speaker":"Charles Goldfarb","startTime":1484.21,"endTime":1486.7,"body":"get excited, but maybe"},{"speaker":"Charles Goldfarb","startTime":1486.7,"endTime":1492.25,"body":"inappropriately so. The next is"},{"speaker":"Charles Goldfarb","startTime":1486.7,"endTime":1492.25,"body":"functional outcomes, and how"},{"speaker":"Charles Goldfarb","startTime":1492.25,"endTime":1495.67,"body":"that's associated with"},{"speaker":"Charles Goldfarb","startTime":1492.25,"endTime":1495.67,"body":"radiographic appearance is up to"},{"speaker":"Charles Goldfarb","startTime":1495.67,"endTime":1498.34,"body":"debate and you know, that's what"},{"speaker":"Charles Goldfarb","startTime":1495.67,"endTime":1498.34,"body":"the literature's for. And the"},{"speaker":"Charles Goldfarb","startTime":1498.34,"endTime":1501.94,"body":"third thing is just what a"},{"speaker":"Charles Goldfarb","startTime":1498.34,"endTime":1501.94,"body":"patient wants, which is the"},{"speaker":"Charles Goldfarb","startTime":1501.94,"endTime":1505.93,"body":"trickiest of all, because that"},{"speaker":"Charles Goldfarb","startTime":1501.94,"endTime":1505.93,"body":"is, you know, we have to develop"},{"speaker":"Charles Goldfarb","startTime":1505.93,"endTime":1509.68,"body":"that patient relationship to"},{"speaker":"Charles Goldfarb","startTime":1505.93,"endTime":1509.68,"body":"understand. And so for me most"},{"speaker":"Charles Goldfarb","startTime":1509.68,"endTime":1513.7,"body":"practically, you know, we"},{"speaker":"Charles Goldfarb","startTime":1509.68,"endTime":1513.7,"body":"classically think about the"},{"speaker":"Charles Goldfarb","startTime":1513.73,"endTime":1517.75,"body":"Colle's fracture with that"},{"speaker":"Charles Goldfarb","startTime":1513.73,"endTime":1517.75,"body":"dinner fork deformity. And we"},{"speaker":"Charles Goldfarb","startTime":1517.75,"endTime":1521.59,"body":"know that deformity is well"},{"speaker":"Charles Goldfarb","startTime":1517.75,"endTime":1521.59,"body":"accepted by most patients, if"},{"speaker":"Charles Goldfarb","startTime":1521.59,"endTime":1525.07,"body":"they understand it. And when I"},{"speaker":"Charles Goldfarb","startTime":1521.59,"endTime":1525.07,"body":"say well accepted, I mean, well"},{"speaker":"Charles Goldfarb","startTime":1525.07,"endTime":1527.86,"body":"accepted functionally, we also"},{"speaker":"Charles Goldfarb","startTime":1525.07,"endTime":1527.86,"body":"have to make sure it's well"},{"speaker":"Charles Goldfarb","startTime":1527.86,"endTime":1532.09,"body":"accepted aesthetically. But for"},{"speaker":"Charles Goldfarb","startTime":1527.86,"endTime":1532.09,"body":"me, the bigger one is the loss"},{"speaker":"Charles Goldfarb","startTime":1532.09,"endTime":1536.53,"body":"of radial inclination, which"},{"speaker":"Charles Goldfarb","startTime":1532.09,"endTime":1536.53,"body":"creates a bit of a radial club"},{"speaker":"Charles Goldfarb","startTime":1536.53,"endTime":1539.77,"body":"hand type appearance that some"},{"speaker":"Charles Goldfarb","startTime":1536.53,"endTime":1539.77,"body":"patients are fine with, and some"},{"speaker":"Charles Goldfarb","startTime":1539.77,"endTime":1541.54,"body":"patients absolutely hate."},{"speaker":"Chris Dy","startTime":1542.53,"endTime":1545.17,"body":"Yeah, when they, you"},{"speaker":"Chris Dy","startTime":1542.53,"endTime":1545.17,"body":"know, when, when we go through"},{"speaker":"Chris Dy","startTime":1545.17,"endTime":1548.14,"body":"that initial discussion, I tell"},{"speaker":"Chris Dy","startTime":1545.17,"endTime":1548.14,"body":"them, look at the way your wrist"},{"speaker":"Chris Dy","startTime":1548.14,"endTime":1550.72,"body":"looks, now, some of the swelling"},{"speaker":"Chris Dy","startTime":1548.14,"endTime":1550.72,"body":"is going to go down, but that"},{"speaker":"Chris Dy","startTime":1550.72,"endTime":1553.45,"body":"bump, meaning the dorsal"},{"speaker":"Chris Dy","startTime":1550.72,"endTime":1553.45,"body":"prominence of the radius, and"},{"speaker":"Chris Dy","startTime":1553.45,"endTime":1556.36,"body":"then that bump, the increased"},{"speaker":"Chris Dy","startTime":1553.45,"endTime":1556.36,"body":"prominence of the ulnar head,"},{"speaker":"Chris Dy","startTime":1556.78,"endTime":1559.27,"body":"that's going to be the same,"},{"speaker":"Chris Dy","startTime":1556.78,"endTime":1559.27,"body":"your wrist is going to look like"},{"speaker":"Chris Dy","startTime":1559.27,"endTime":1562.03,"body":"that. And most people are"},{"speaker":"Chris Dy","startTime":1559.27,"endTime":1562.03,"body":"accepting of it, if you get"},{"speaker":"Chris Dy","startTime":1562.03,"endTime":1565.57,"body":"ahead of it, and tell them that"},{"speaker":"Chris Dy","startTime":1562.03,"endTime":1565.57,"body":"ahead of time. But there are"},{"speaker":"Chris Dy","startTime":1565.57,"endTime":1568.03,"body":"some people who say, I don't"},{"speaker":"Chris Dy","startTime":1565.57,"endTime":1568.03,"body":"like the way it looks. And you"},{"speaker":"Chris Dy","startTime":1568.03,"endTime":1571.36,"body":"know, that loss of radial"},{"speaker":"Chris Dy","startTime":1568.03,"endTime":1571.36,"body":"inclination. A lot of people"},{"speaker":"Chris Dy","startTime":1571.36,"endTime":1575.98,"body":"don't like that. And that is one"},{"speaker":"Chris Dy","startTime":1571.36,"endTime":1575.98,"body":"reason why patients sometimes"},{"speaker":"Chris Dy","startTime":1575.98,"endTime":1579.85,"body":"choose to move forward with"},{"speaker":"Chris Dy","startTime":1575.98,"endTime":1579.85,"body":"surgery. You know, I think that"},{"speaker":"Chris Dy","startTime":1579.85,"endTime":1584.98,"body":"in terms of the, in terms of the"},{"speaker":"Chris Dy","startTime":1579.85,"endTime":1584.98,"body":"patient demand. You know, one"},{"speaker":"Chris Dy","startTime":1584.98,"endTime":1587.92,"body":"way that, you know, I like to"},{"speaker":"Chris Dy","startTime":1584.98,"endTime":1587.92,"body":"describe this to patients, and"},{"speaker":"Chris Dy","startTime":1587.92,"endTime":1590.77,"body":"I'm not, I'm known for having"},{"speaker":"Chris Dy","startTime":1587.92,"endTime":1590.77,"body":"very poor analogies, but this"},{"speaker":"Chris Dy","startTime":1590.77,"endTime":1595.06,"body":"one seems to work is that, you"},{"speaker":"Chris Dy","startTime":1590.77,"endTime":1595.06,"body":"know, treatment with a cast or"},{"speaker":"Chris Dy","startTime":1595.06,"endTime":1597.73,"body":"immobilization versus surgery"},{"speaker":"Chris Dy","startTime":1595.06,"endTime":1597.73,"body":"for distal radius fracture, we"},{"speaker":"Chris Dy","startTime":1597.73,"endTime":1600.52,"body":"know that at a year, you're"},{"speaker":"Chris Dy","startTime":1597.73,"endTime":1600.52,"body":"probably going to end up in the"},{"speaker":"Chris Dy","startTime":1600.52,"endTime":1604.06,"body":"same place for many of these"},{"speaker":"Chris Dy","startTime":1600.52,"endTime":1604.06,"body":"fracture patterns. But do you"},{"speaker":"Chris Dy","startTime":1604.06,"endTime":1606.76,"body":"want to take the elevator,"},{"speaker":"Chris Dy","startTime":1604.06,"endTime":1606.76,"body":"surgery? Or do you want to take"},{"speaker":"Chris Dy","startTime":1606.76,"endTime":1611.17,"body":"the stairs? Because you're going"},{"speaker":"Chris Dy","startTime":1606.76,"endTime":1611.17,"body":"to get the advantage early on"},{"speaker":"Chris Dy","startTime":1611.17,"endTime":1611.8,"body":"with surgery?"},{"speaker":"Charles Goldfarb","startTime":1613.12,"endTime":1614.95,"body":"Well it's,"},{"speaker":"Charles Goldfarb","startTime":1613.12,"endTime":1614.95,"body":"it's definitely a good analogy"},{"speaker":"Charles Goldfarb","startTime":1614.98,"endTime":1616.57,"body":"and even weirder"},{"speaker":"Chris Dy","startTime":1616.57,"endTime":1618.37,"body":"For once, for once I"},{"speaker":"Chris Dy","startTime":1616.57,"endTime":1618.37,"body":"have a good analogy"},{"speaker":"Charles Goldfarb","startTime":1619.2,"endTime":1621.39,"body":"even within"},{"speaker":"Charles Goldfarb","startTime":1619.2,"endTime":1621.39,"body":"the surgical realm. I mean, the"},{"speaker":"Charles Goldfarb","startTime":1621.39,"endTime":1624.3,"body":"differences between, say, a"},{"speaker":"Charles Goldfarb","startTime":1621.39,"endTime":1624.3,"body":"closed reduction and pinning"},{"speaker":"Charles Goldfarb","startTime":1624.3,"endTime":1628.17,"body":"versus a volar plate, gets you"},{"speaker":"Charles Goldfarb","startTime":1624.3,"endTime":1628.17,"body":"there. And that difference is"},{"speaker":"Charles Goldfarb","startTime":1628.17,"endTime":1631.44,"body":"probably a little less than the"},{"speaker":"Charles Goldfarb","startTime":1628.17,"endTime":1631.44,"body":"non operative versus the volar"},{"speaker":"Charles Goldfarb","startTime":1631.44,"endTime":1636.84,"body":"plate. I think it's a good"},{"speaker":"Charles Goldfarb","startTime":1631.44,"endTime":1636.84,"body":"analogy. It's tricky, because"},{"speaker":"Charles Goldfarb","startTime":1637.59,"endTime":1640.41,"body":"patients often actually I was"},{"speaker":"Charles Goldfarb","startTime":1637.59,"endTime":1640.41,"body":"talking to a patient last night"},{"speaker":"Charles Goldfarb","startTime":1640.41,"endTime":1644.22,"body":"at 6pm, believe it or not, I'd"},{"speaker":"Charles Goldfarb","startTime":1640.41,"endTime":1644.22,"body":"seen him last week and they"},{"speaker":"Charles Goldfarb","startTime":1644.22,"endTime":1647.13,"body":"wanted to discuss something a"},{"speaker":"Charles Goldfarb","startTime":1644.22,"endTime":1647.13,"body":"little further. And it was kind"},{"speaker":"Charles Goldfarb","startTime":1647.13,"endTime":1649.77,"body":"of right in that perfect sweet"},{"speaker":"Charles Goldfarb","startTime":1647.13,"endTime":1649.77,"body":"spot for me as far as I had a"},{"speaker":"Charles Goldfarb","startTime":1649.77,"endTime":1653.61,"body":"few minutes. And they ended the"},{"speaker":"Charles Goldfarb","startTime":1649.77,"endTime":1653.61,"body":"conversation with what would you"},{"speaker":"Charles Goldfarb","startTime":1653.61,"endTime":1657.0,"body":"do if this was you or your"},{"speaker":"Charles Goldfarb","startTime":1653.61,"endTime":1657.0,"body":"family. And that's tricky for"},{"speaker":"Charles Goldfarb","startTime":1657.0,"endTime":1661.62,"body":"these fractures, because your"},{"speaker":"Charles Goldfarb","startTime":1657.0,"endTime":1661.62,"body":"needs and my needs. And my 65"},{"speaker":"Charles Goldfarb","startTime":1661.62,"endTime":1664.98,"body":"year old retired patient needs"},{"speaker":"Charles Goldfarb","startTime":1661.62,"endTime":1664.98,"body":"are all very different. But I"},{"speaker":"Charles Goldfarb","startTime":1664.98,"endTime":1669.51,"body":"struggle, because as soon as we"},{"speaker":"Charles Goldfarb","startTime":1664.98,"endTime":1669.51,"body":"tell a patient that if we take"},{"speaker":"Charles Goldfarb","startTime":1669.51,"endTime":1672.93,"body":"to the operating room, and if we"},{"speaker":"Charles Goldfarb","startTime":1669.51,"endTime":1672.93,"body":"put a volar plate on, I'm going"},{"speaker":"Charles Goldfarb","startTime":1672.93,"endTime":1675.87,"body":"to have you see therapy the next"},{"speaker":"Charles Goldfarb","startTime":1672.93,"endTime":1675.87,"body":"week and start moving their eyes"},{"speaker":"Charles Goldfarb","startTime":1675.87,"endTime":1677.97,"body":"light up, because they're"},{"speaker":"Charles Goldfarb","startTime":1675.87,"endTime":1677.97,"body":"starting to process that wow,"},{"speaker":"Charles Goldfarb","startTime":1678.03,"endTime":1681.3,"body":"you mean I don't have to be in a"},{"speaker":"Charles Goldfarb","startTime":1678.03,"endTime":1681.3,"body":"cast for five weeks. But for me,"},{"speaker":"Charles Goldfarb","startTime":1681.39,"endTime":1683.7,"body":"that's not always a surgical"},{"speaker":"Charles Goldfarb","startTime":1681.39,"endTime":1683.7,"body":"indication. It's a surgical"},{"speaker":"Charles Goldfarb","startTime":1683.7,"endTime":1687.75,"body":"benefit, but not an indication."},{"speaker":"Charles Goldfarb","startTime":1683.7,"endTime":1687.75,"body":"So I struggle with how to make"},{"speaker":"Charles Goldfarb","startTime":1687.75,"endTime":1691.95,"body":"patients aware of that benefit."},{"speaker":"Charles Goldfarb","startTime":1687.75,"endTime":1691.95,"body":"Because while it may, I may be"},{"speaker":"Charles Goldfarb","startTime":1691.95,"endTime":1694.92,"body":"talking in circles, but while it"},{"speaker":"Charles Goldfarb","startTime":1691.95,"endTime":1694.92,"body":"may be a good reason to think"},{"speaker":"Charles Goldfarb","startTime":1694.92,"endTime":1698.34,"body":"about surgery for a surgeon"},{"speaker":"Charles Goldfarb","startTime":1694.92,"endTime":1698.34,"body":"because he or she may need to"},{"speaker":"Charles Goldfarb","startTime":1698.34,"endTime":1701.49,"body":"get, may need to get back to the"},{"speaker":"Charles Goldfarb","startTime":1698.34,"endTime":1701.49,"body":"operating room, he himself or"},{"speaker":"Charles Goldfarb","startTime":1701.49,"endTime":1704.31,"body":"herself very quickly, for"},{"speaker":"Charles Goldfarb","startTime":1701.49,"endTime":1704.31,"body":"another patient. That's not a"},{"speaker":"Charles Goldfarb","startTime":1704.31,"endTime":1705.84,"body":"reason to do surgery, I don't"},{"speaker":"Charles Goldfarb","startTime":1704.31,"endTime":1705.84,"body":"think."},{"speaker":"Chris Dy","startTime":1707.01,"endTime":1708.99,"body":"Yeah, I mean, I think"},{"speaker":"Chris Dy","startTime":1707.01,"endTime":1708.99,"body":"that the I agree with you on"},{"speaker":"Chris Dy","startTime":1708.99,"endTime":1713.97,"body":"that, I'd say that it's not an"},{"speaker":"Chris Dy","startTime":1708.99,"endTime":1713.97,"body":"indication, but if you have a"},{"speaker":"Chris Dy","startTime":1713.97,"endTime":1717.63,"body":"fracture that you know,"},{"speaker":"Chris Dy","startTime":1713.97,"endTime":1717.63,"body":"radiographically is, you know,"},{"speaker":"Chris Dy","startTime":1717.63,"endTime":1722.49,"body":"displaced and at high risk for"},{"speaker":"Chris Dy","startTime":1717.63,"endTime":1722.49,"body":"instability. And you are able to"},{"speaker":"Chris Dy","startTime":1722.49,"endTime":1725.43,"body":"provide that benefit. I think it"},{"speaker":"Chris Dy","startTime":1722.49,"endTime":1725.43,"body":"influences the decision making"},{"speaker":"Chris Dy","startTime":1725.43,"endTime":1727.86,"body":"calculus, because you should you"},{"speaker":"Chris Dy","startTime":1725.43,"endTime":1727.86,"body":"have to share that with the"},{"speaker":"Chris Dy","startTime":1727.86,"endTime":1732.3,"body":"patient. You, I think clearly,"},{"speaker":"Chris Dy","startTime":1727.86,"endTime":1732.3,"body":"you know, we as surgeons can"},{"speaker":"Chris Dy","startTime":1732.78,"endTime":1736.35,"body":"frame things, however we would"},{"speaker":"Chris Dy","startTime":1732.78,"endTime":1736.35,"body":"like, can clearly influence"},{"speaker":"Chris Dy","startTime":1736.35,"endTime":1739.26,"body":"patients' opinions. And I think"},{"speaker":"Chris Dy","startTime":1736.35,"endTime":1739.26,"body":"that's the hard part, especially"},{"speaker":"Chris Dy","startTime":1739.26,"endTime":1741.45,"body":"if you know, for those of you"},{"speaker":"Chris Dy","startTime":1739.26,"endTime":1741.45,"body":"that are trainees and coming out"},{"speaker":"Chris Dy","startTime":1741.45,"endTime":1744.33,"body":"I mean, you'll realize you can"},{"speaker":"Chris Dy","startTime":1741.45,"endTime":1744.33,"body":"steer people wherever you want"},{"speaker":"Chris Dy","startTime":1744.33,"endTime":1746.7,"body":"to steer them for better or"},{"speaker":"Chris Dy","startTime":1744.33,"endTime":1746.7,"body":"worse. And you have to have, you"},{"speaker":"Chris Dy","startTime":1746.7,"endTime":1749.19,"body":"know, both the surgery person on"},{"speaker":"Chris Dy","startTime":1746.7,"endTime":1749.19,"body":"your shoulder and like the"},{"speaker":"Chris Dy","startTime":1749.19,"endTime":1752.01,"body":"non-op person on your shoulder"},{"speaker":"Chris Dy","startTime":1749.19,"endTime":1752.01,"body":"kind of say, you need to tell"},{"speaker":"Chris Dy","startTime":1752.01,"endTime":1755.49,"body":"him about both sides and what"},{"speaker":"Chris Dy","startTime":1752.01,"endTime":1755.49,"body":"you know, this term is going to"},{"speaker":"Chris Dy","startTime":1755.49,"endTime":1758.67,"body":"be loaded and I say it but the"},{"speaker":"Chris Dy","startTime":1755.49,"endTime":1758.67,"body":"fair and balanced perspective."},{"speaker":"Charles Goldfarb","startTime":1759.56,"endTime":1762.59,"body":"Yeah, for"},{"speaker":"Charles Goldfarb","startTime":1759.56,"endTime":1762.59,"body":"sure. I guess I would say in a"},{"speaker":"Charles Goldfarb","startTime":1762.59,"endTime":1766.85,"body":"patient where I believe surgery"},{"speaker":"Charles Goldfarb","startTime":1762.59,"endTime":1766.85,"body":"is the right move. And I don't"},{"speaker":"Charles Goldfarb","startTime":1766.88,"endTime":1769.7,"body":"you know, you and I have talked"},{"speaker":"Charles Goldfarb","startTime":1766.88,"endTime":1769.7,"body":"a lot about this. I generally"},{"speaker":"Charles Goldfarb","startTime":1769.7,"endTime":1772.4,"body":"counsel patients to help them"},{"speaker":"Charles Goldfarb","startTime":1769.7,"endTime":1772.4,"body":"make a decision but sometimes"},{"speaker":"Charles Goldfarb","startTime":1772.4,"endTime":1774.92,"body":"the patient wants you or I to"},{"speaker":"Charles Goldfarb","startTime":1772.4,"endTime":1774.92,"body":"make, help them make that"},{"speaker":"Charles Goldfarb","startTime":1774.92,"endTime":1778.01,"body":"decision or simply to make that"},{"speaker":"Charles Goldfarb","startTime":1774.92,"endTime":1778.01,"body":"decision for them. And for that"},{"speaker":"Charles Goldfarb","startTime":1778.01,"endTime":1780.65,"body":"patient where I think surgery is"},{"speaker":"Charles Goldfarb","startTime":1778.01,"endTime":1780.65,"body":"the right move and the patient"},{"speaker":"Charles Goldfarb","startTime":1780.65,"endTime":1786.11,"body":"is not quite convinced. I will"},{"speaker":"Charles Goldfarb","startTime":1780.65,"endTime":1786.11,"body":"say that early motion is a huge"},{"speaker":"Charles Goldfarb","startTime":1786.11,"endTime":1790.4,"body":"selling point as it should be. I"},{"speaker":"Charles Goldfarb","startTime":1786.11,"endTime":1790.4,"body":"mean your life post-surgically"},{"speaker":"Charles Goldfarb","startTime":1790.4,"endTime":1793.76,"body":"is completely altered in that"},{"speaker":"Charles Goldfarb","startTime":1790.4,"endTime":1793.76,"body":"first six week timeframe. It is"},{"speaker":"Charles Goldfarb","startTime":1793.76,"endTime":1798.74,"body":"so much easier to shower at five"},{"speaker":"Charles Goldfarb","startTime":1793.76,"endTime":1798.74,"body":"days to get a brace at five days"},{"speaker":"Charles Goldfarb","startTime":1798.74,"endTime":1802.55,"body":"and start gentle motion. And the"},{"speaker":"Charles Goldfarb","startTime":1798.74,"endTime":1802.55,"body":"concept of working on your"},{"speaker":"Charles Goldfarb","startTime":1802.55,"endTime":1806.09,"body":"motion while your fractures"},{"speaker":"Charles Goldfarb","startTime":1802.55,"endTime":1806.09,"body":"healing, rather than letting"},{"speaker":"Charles Goldfarb","startTime":1806.09,"endTime":1809.36,"body":"your fracture heal completely,"},{"speaker":"Charles Goldfarb","startTime":1806.09,"endTime":1809.36,"body":"and then starting motion is"},{"speaker":"Charles Goldfarb","startTime":1809.36,"endTime":1811.91,"body":"something that every patient can"},{"speaker":"Charles Goldfarb","startTime":1809.36,"endTime":1811.91,"body":"wrap their brain around."},{"speaker":"Chris Dy","startTime":1812.87,"endTime":1816.38,"body":"Yeah, and I think"},{"speaker":"Chris Dy","startTime":1812.87,"endTime":1816.38,"body":"that, um, you know, with, with"},{"speaker":"Chris Dy","startTime":1816.38,"endTime":1819.23,"body":"surgery, and I think it's"},{"speaker":"Chris Dy","startTime":1816.38,"endTime":1819.23,"body":"important to inform them about"},{"speaker":"Chris Dy","startTime":1819.23,"endTime":1822.05,"body":"the risks of potentially of the"},{"speaker":"Chris Dy","startTime":1819.23,"endTime":1822.05,"body":"complications, obviously. And I"},{"speaker":"Chris Dy","startTime":1822.05,"endTime":1825.56,"body":"think one of the things that we"},{"speaker":"Chris Dy","startTime":1822.05,"endTime":1825.56,"body":"talked about is risk to flexor"},{"speaker":"Chris Dy","startTime":1825.56,"endTime":1828.62,"body":"tendons and irritation from the"},{"speaker":"Chris Dy","startTime":1825.56,"endTime":1828.62,"body":"flexor tendons. How often do"},{"speaker":"Chris Dy","startTime":1828.62,"endTime":1832.1,"body":"you, what do you quote patients"},{"speaker":"Chris Dy","startTime":1828.62,"endTime":1832.1,"body":"in terms of second surgery for"},{"speaker":"Chris Dy","startTime":1832.1,"endTime":1833.24,"body":"removal of the implant?"},{"speaker":"Charles Goldfarb","startTime":1834.14,"endTime":1836.69,"body":"I think,"},{"speaker":"Charles Goldfarb","startTime":1834.14,"endTime":1836.69,"body":"right, so when we're talking"},{"speaker":"Charles Goldfarb","startTime":1836.69,"endTime":1841.97,"body":"about surgery, you know, I"},{"speaker":"Charles Goldfarb","startTime":1836.69,"endTime":1841.97,"body":"really honestly believe that for"},{"speaker":"Charles Goldfarb","startTime":1841.97,"endTime":1846.59,"body":"me, a volar approach to the"},{"speaker":"Charles Goldfarb","startTime":1841.97,"endTime":1846.59,"body":"distal radius, and a well placed"},{"speaker":"Charles Goldfarb","startTime":1846.59,"endTime":1850.97,"body":"plate is really a low risk"},{"speaker":"Charles Goldfarb","startTime":1846.59,"endTime":1850.97,"body":"intervention. And so the actual"},{"speaker":"Charles Goldfarb","startTime":1850.97,"endTime":1855.2,"body":"technical surgical risk are"},{"speaker":"Charles Goldfarb","startTime":1850.97,"endTime":1855.2,"body":"really low. I quote, infection"},{"speaker":"Charles Goldfarb","startTime":1855.2,"endTime":1859.04,"body":"rate, at least from our center"},{"speaker":"Charles Goldfarb","startTime":1855.2,"endTime":1859.04,"body":"of about one in 300. And I think"},{"speaker":"Charles Goldfarb","startTime":1859.07,"endTime":1862.61,"body":"other risks to tendons or"},{"speaker":"Charles Goldfarb","startTime":1859.07,"endTime":1862.61,"body":"nerves, etc, at the time of"},{"speaker":"Charles Goldfarb","startTime":1862.61,"endTime":1865.64,"body":"surgery are incredibly small."},{"speaker":"Charles Goldfarb","startTime":1862.61,"endTime":1865.64,"body":"And so I do talk about"},{"speaker":"Charles Goldfarb","startTime":1865.64,"endTime":1870.08,"body":"stiffness. And I do talk about"},{"speaker":"Charles Goldfarb","startTime":1865.64,"endTime":1870.08,"body":"the potential need to remove a"},{"speaker":"Charles Goldfarb","startTime":1870.08,"endTime":1873.71,"body":"plate and the risk of plate"},{"speaker":"Charles Goldfarb","startTime":1870.08,"endTime":1873.71,"body":"irritation of tendons, whether"},{"speaker":"Charles Goldfarb","startTime":1873.71,"endTime":1876.77,"body":"the plate is irritating them"},{"speaker":"Charles Goldfarb","startTime":1873.71,"endTime":1876.77,"body":"volarly, or potentially a"},{"speaker":"Charles Goldfarb","startTime":1876.77,"endTime":1879.98,"body":"technical issue leading to"},{"speaker":"Charles Goldfarb","startTime":1876.77,"endTime":1879.98,"body":"dorsal tendon irritation"},{"speaker":"Charles Goldfarb","startTime":1880.01,"endTime":1884.21,"body":"postoperatively, I quote"},{"speaker":"Charles Goldfarb","startTime":1880.01,"endTime":1884.21,"body":"patients between one in 10 and"},{"speaker":"Charles Goldfarb","startTime":1884.21,"endTime":1887.69,"body":"one in 20 plates needing to be"},{"speaker":"Charles Goldfarb","startTime":1884.21,"endTime":1887.69,"body":"removed, whether I know that at"},{"speaker":"Charles Goldfarb","startTime":1887.69,"endTime":1890.54,"body":"the time of surgery, or we"},{"speaker":"Charles Goldfarb","startTime":1887.69,"endTime":1890.54,"body":"figure that out later. What do"},{"speaker":"Charles Goldfarb","startTime":1890.54,"endTime":1891.38,"body":"you tell patients?"},{"speaker":"Chris Dy","startTime":1891.93,"endTime":1894.69,"body":"I say one in 20, but I"},{"speaker":"Chris Dy","startTime":1891.93,"endTime":1894.69,"body":"also tell them that there are"},{"speaker":"Chris Dy","startTime":1894.69,"endTime":1897.72,"body":"case reports of flexor tendon"},{"speaker":"Chris Dy","startTime":1894.69,"endTime":1897.72,"body":"irritation and rupture, you"},{"speaker":"Chris Dy","startTime":1897.72,"endTime":1900.72,"body":"know, 5-10 years after initial"},{"speaker":"Chris Dy","startTime":1897.72,"endTime":1900.72,"body":"volar plate placement, which is"},{"speaker":"Chris Dy","startTime":1900.72,"endTime":1903.33,"body":"the kind of scary part about it."},{"speaker":"Chris Dy","startTime":1900.72,"endTime":1903.33,"body":"You know, I think that, you"},{"speaker":"Chris Dy","startTime":1903.33,"endTime":1905.88,"body":"know, as you mentioned earlier,"},{"speaker":"Chris Dy","startTime":1903.33,"endTime":1905.88,"body":"the indications for volar"},{"speaker":"Chris Dy","startTime":1905.88,"endTime":1909.24,"body":"plating have changed the, you"},{"speaker":"Chris Dy","startTime":1905.88,"endTime":1909.24,"body":"know, the pendulum swings a lot."},{"speaker":"Chris Dy","startTime":1909.54,"endTime":1912.33,"body":"I think we sweat, settled into a"},{"speaker":"Chris Dy","startTime":1909.54,"endTime":1912.33,"body":"sweet spot. But you know, there"},{"speaker":"Chris Dy","startTime":1912.33,"endTime":1915.57,"body":"were many, there are many cases"},{"speaker":"Chris Dy","startTime":1912.33,"endTime":1915.57,"body":"where, you know, these plates"},{"speaker":"Chris Dy","startTime":1915.57,"endTime":1920.13,"body":"were just being quote thrown in."},{"speaker":"Chris Dy","startTime":1915.57,"endTime":1920.13,"body":"And I think if they're used in a"},{"speaker":"Chris Dy","startTime":1920.13,"endTime":1924.0,"body":"haphazard or slapstick fashion,"},{"speaker":"Chris Dy","startTime":1920.13,"endTime":1924.0,"body":"it can be a problem. I mean, a"},{"speaker":"Chris Dy","startTime":1924.0,"endTime":1927.78,"body":"volar plate is not a panacea, a"},{"speaker":"Chris Dy","startTime":1924.0,"endTime":1927.78,"body":"volar plate is a tool, and you"},{"speaker":"Chris Dy","startTime":1927.78,"endTime":1930.57,"body":"got to use it well, and you got"},{"speaker":"Chris Dy","startTime":1927.78,"endTime":1930.57,"body":"to know what what you can get"},{"speaker":"Chris Dy","startTime":1930.6,"endTime":1933.66,"body":"out of the plate, you can't use"},{"speaker":"Chris Dy","startTime":1930.6,"endTime":1933.66,"body":"rely on the plate too much for"},{"speaker":"Chris Dy","startTime":1933.93,"endTime":1937.8,"body":"for reduction, because when you"},{"speaker":"Chris Dy","startTime":1933.93,"endTime":1937.8,"body":"do that, that's when it leads to"},{"speaker":"Chris Dy","startTime":1937.8,"endTime":1940.23,"body":"a prominent plate. And I think"},{"speaker":"Chris Dy","startTime":1937.8,"endTime":1940.23,"body":"we'll get into that in a little"},{"speaker":"Chris Dy","startTime":1940.23,"endTime":1942.99,"body":"more detail when we do our"},{"speaker":"Chris Dy","startTime":1940.23,"endTime":1942.99,"body":"episode on the technical aspects"},{"speaker":"Chris Dy","startTime":1942.99,"endTime":1945.96,"body":"of the surgery. But that's one"},{"speaker":"Chris Dy","startTime":1942.99,"endTime":1945.96,"body":"thing where I tell people, you"},{"speaker":"Chris Dy","startTime":1945.96,"endTime":1950.52,"body":"know, the plate may irritate the"},{"speaker":"Chris Dy","startTime":1945.96,"endTime":1950.52,"body":"tendons way down the line. And"},{"speaker":"Chris Dy","startTime":1950.52,"endTime":1952.8,"body":"we'll just have to hope that it"},{"speaker":"Chris Dy","startTime":1950.52,"endTime":1952.8,"body":"doesn't. And I'll do everything"},{"speaker":"Chris Dy","startTime":1952.8,"endTime":1956.67,"body":"in my power to put that plate in"},{"speaker":"Chris Dy","startTime":1952.8,"endTime":1956.67,"body":"a location where it is really"},{"speaker":"Chris Dy","startTime":1956.67,"endTime":1958.41,"body":"minimal risk for the flexor"},{"speaker":"Chris Dy","startTime":1956.67,"endTime":1958.41,"body":"tendons."},{"speaker":"Charles Goldfarb","startTime":1958.44,"endTime":1961.38,"body":"Yeah, again,"},{"speaker":"Charles Goldfarb","startTime":1958.44,"endTime":1961.38,"body":"well said. The, we're gonna,"},{"speaker":"Charles Goldfarb","startTime":1961.41,"endTime":1965.16,"body":"we're going to have an episode"},{"speaker":"Charles Goldfarb","startTime":1961.41,"endTime":1965.16,"body":"on distal radius fractures and"},{"speaker":"Charles Goldfarb","startTime":1965.16,"endTime":1967.68,"body":"the role of therapy, because I"},{"speaker":"Charles Goldfarb","startTime":1965.16,"endTime":1967.68,"body":"think that is something that"},{"speaker":"Charles Goldfarb","startTime":1967.68,"endTime":1970.38,"body":"just is really not as"},{"speaker":"Charles Goldfarb","startTime":1967.68,"endTime":1970.38,"body":"straightforward as it may seem,"},{"speaker":"Charles Goldfarb","startTime":1970.38,"endTime":1974.58,"body":"but does every patient of yours"},{"speaker":"Charles Goldfarb","startTime":1970.38,"endTime":1974.58,"body":"that has a distal radius"},{"speaker":"Charles Goldfarb","startTime":1974.58,"endTime":1977.1,"body":"fracture, whether treated"},{"speaker":"Charles Goldfarb","startTime":1974.58,"endTime":1977.1,"body":"surgically or non surgically,"},{"speaker":"Charles Goldfarb","startTime":1977.28,"endTime":1980.37,"body":"does pretty much every patient"},{"speaker":"Charles Goldfarb","startTime":1977.28,"endTime":1980.37,"body":"see therapy at least once?"},{"speaker":"Chris Dy","startTime":1981.2,"endTime":1984.83,"body":"Mmm, you know I think"},{"speaker":"Chris Dy","startTime":1981.2,"endTime":1984.83,"body":"it kind of it's, if they have"},{"speaker":"Chris Dy","startTime":1984.83,"endTime":1988.13,"body":"surgery, yes. If they don't have"},{"speaker":"Chris Dy","startTime":1984.83,"endTime":1988.13,"body":"surgery, it's dependent."},{"speaker":"Chris Dy","startTime":1988.16,"endTime":1990.62,"body":"Honestly, COVID has changed"},{"speaker":"Chris Dy","startTime":1988.16,"endTime":1990.62,"body":"clinic flows a little bit, you"},{"speaker":"Chris Dy","startTime":1990.62,"endTime":1994.4,"body":"know, we've gotten our hand"},{"speaker":"Chris Dy","startTime":1990.62,"endTime":1994.4,"body":"therapist followers back in the"},{"speaker":"Chris Dy","startTime":1994.4,"endTime":1998.45,"body":"clinic. And that has helped"},{"speaker":"Chris Dy","startTime":1994.4,"endTime":1998.45,"body":"because when they are back in"},{"speaker":"Chris Dy","startTime":1998.45,"endTime":2001.39,"body":"the clinic, I can have them see"},{"speaker":"Chris Dy","startTime":1998.45,"endTime":2001.39,"body":"the patient who has just come"},{"speaker":"Chris Dy","startTime":2001.39,"endTime":2004.3,"body":"out of the cast and show them"},{"speaker":"Chris Dy","startTime":2001.39,"endTime":2004.3,"body":"some exercises. You know, I can"},{"speaker":"Chris Dy","startTime":2004.3,"endTime":2007.72,"body":"do that to a certain extent, but"},{"speaker":"Chris Dy","startTime":2004.3,"endTime":2007.72,"body":"I don't have the expertise that"},{"speaker":"Chris Dy","startTime":2007.72,"endTime":2010.6,"body":"our therapists colleagues have."},{"speaker":"Chris Dy","startTime":2007.72,"endTime":2010.6,"body":"But when they're not in the"},{"speaker":"Chris Dy","startTime":2010.6,"endTime":2013.66,"body":"clinic with us, I typically do"},{"speaker":"Chris Dy","startTime":2010.6,"endTime":2013.66,"body":"send them up for one visit, if I"},{"speaker":"Chris Dy","startTime":2013.66,"endTime":2017.26,"body":"feel like they're not going to"},{"speaker":"Chris Dy","startTime":2013.66,"endTime":2017.26,"body":"do it on their own. An important"},{"speaker":"Chris Dy","startTime":2017.26,"endTime":2020.92,"body":"caveat is that patient who you"},{"speaker":"Chris Dy","startTime":2017.26,"endTime":2020.92,"body":"are treating non operatively."},{"speaker":"Chris Dy","startTime":2020.95,"endTime":2023.56,"body":"And they come back, and they've"},{"speaker":"Chris Dy","startTime":2020.95,"endTime":2023.56,"body":"just got sausage fingers, and"},{"speaker":"Chris Dy","startTime":2023.56,"endTime":2028.33,"body":"you see, you know, signals and"},{"speaker":"Chris Dy","startTime":2023.56,"endTime":2028.33,"body":"red flags right away for that"},{"speaker":"Chris Dy","startTime":2028.33,"endTime":2030.49,"body":"crps type patient, like we"},{"speaker":"Chris Dy","startTime":2028.33,"endTime":2030.49,"body":"talked about a couple of weeks"},{"speaker":"Chris Dy","startTime":2030.49,"endTime":2034.0,"body":"ago, that's the patient that"},{"speaker":"Chris Dy","startTime":2030.49,"endTime":2034.0,"body":"goes to therapy right away. How"},{"speaker":"Chris Dy","startTime":2034.0,"endTime":2034.36,"body":"about you?"},{"speaker":"Charles Goldfarb","startTime":2034.87,"endTime":2036.94,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":2034.87,"endTime":2036.94,"body":"Well, I was gonna say something"},{"speaker":"Charles Goldfarb","startTime":2036.94,"endTime":2039.67,"body":"different. But I want to circle"},{"speaker":"Charles Goldfarb","startTime":2036.94,"endTime":2039.67,"body":"back to what you just said, when"},{"speaker":"Charles Goldfarb","startTime":2039.67,"endTime":2042.04,"body":"I see a patient in the clinic."},{"speaker":"Charles Goldfarb","startTime":2039.67,"endTime":2042.04,"body":"And let's say they're one week"},{"speaker":"Charles Goldfarb","startTime":2042.04,"endTime":2045.28,"body":"out from a treatment in the"},{"speaker":"Charles Goldfarb","startTime":2042.04,"endTime":2045.28,"body":"emergency room with a closed"},{"speaker":"Charles Goldfarb","startTime":2045.28,"endTime":2048.28,"body":"reduction, and that patient is"},{"speaker":"Charles Goldfarb","startTime":2045.28,"endTime":2048.28,"body":"having trouble getting finger"},{"speaker":"Charles Goldfarb","startTime":2048.28,"endTime":2051.34,"body":"motion back. Because really, if"},{"speaker":"Charles Goldfarb","startTime":2048.28,"endTime":2051.34,"body":"the patient comes in at one"},{"speaker":"Charles Goldfarb","startTime":2051.34,"endTime":2053.71,"body":"week, and their finger motion's"},{"speaker":"Charles Goldfarb","startTime":2051.34,"endTime":2053.71,"body":"perfect, and I'm not assessing"},{"speaker":"Charles Goldfarb","startTime":2053.71,"endTime":2055.72,"body":"wrist or forearm, right, because"},{"speaker":"Charles Goldfarb","startTime":2053.71,"endTime":2055.72,"body":"they're immobilized, but that"},{"speaker":"Charles Goldfarb","startTime":2055.72,"endTime":2061.18,"body":"finger motion is perfect. I feel"},{"speaker":"Charles Goldfarb","startTime":2055.72,"endTime":2061.18,"body":"good. However, if they are just"},{"speaker":"Charles Goldfarb","startTime":2061.18,"endTime":2064.9,"body":"doing that little tiny flex"},{"speaker":"Charles Goldfarb","startTime":2061.18,"endTime":2064.9,"body":"extension move, it makes me"},{"speaker":"Charles Goldfarb","startTime":2064.9,"endTime":2067.99,"body":"nervous immediately. And I"},{"speaker":"Charles Goldfarb","startTime":2064.9,"endTime":2067.99,"body":"almost turn into a jerk. And I"},{"speaker":"Charles Goldfarb","startTime":2067.99,"endTime":2070.96,"body":"really kind of read them the"},{"speaker":"Charles Goldfarb","startTime":2067.99,"endTime":2070.96,"body":"riot act about it's incredibly"},{"speaker":"Charles Goldfarb","startTime":2070.96,"endTime":2073.99,"body":"important that you own this, and"},{"speaker":"Charles Goldfarb","startTime":2070.96,"endTime":2073.99,"body":"you have to be working on not"},{"speaker":"Charles Goldfarb","startTime":2073.99,"endTime":2076.51,"body":"just moving the fingers. I think"},{"speaker":"Charles Goldfarb","startTime":2073.99,"endTime":2076.51,"body":"that's important where our"},{"speaker":"Charles Goldfarb","startTime":2076.51,"endTime":2079.12,"body":"instructions have to be literal."},{"speaker":"Charles Goldfarb","startTime":2076.51,"endTime":2079.12,"body":"It's not just moving the"},{"speaker":"Charles Goldfarb","startTime":2079.12,"endTime":2082.18,"body":"fingers. It's making a full fist"},{"speaker":"Charles Goldfarb","startTime":2079.12,"endTime":2082.18,"body":"and fully straightening your"},{"speaker":"Charles Goldfarb","startTime":2082.18,"endTime":2086.35,"body":"fingers because to me, that is a"},{"speaker":"Charles Goldfarb","startTime":2082.18,"endTime":2086.35,"body":"huge warning sign for a less"},{"speaker":"Charles Goldfarb","startTime":2086.35,"endTime":2087.73,"body":"than optimal outcome."},{"speaker":"Chris Dy","startTime":2088.33,"endTime":2091.06,"body":"Yeah, I tell them they"},{"speaker":"Chris Dy","startTime":2088.33,"endTime":2091.06,"body":"should be touching the cast. You"},{"speaker":"Chris Dy","startTime":2091.06,"endTime":2094.66,"body":"know, I think that that's one"},{"speaker":"Chris Dy","startTime":2091.06,"endTime":2094.66,"body":"thing that they understand. And"},{"speaker":"Chris Dy","startTime":2094.66,"endTime":2098.62,"body":"I think that you bring up a good"},{"speaker":"Chris Dy","startTime":2094.66,"endTime":2098.62,"body":"point as one thing that probably"},{"speaker":"Chris Dy","startTime":2098.62,"endTime":2102.73,"body":"steers me to surgery in some"},{"speaker":"Chris Dy","startTime":2098.62,"endTime":2102.73,"body":"patients. As surgeons, we like"},{"speaker":"Chris Dy","startTime":2102.73,"endTime":2106.69,"body":"predictable. We like reliable. I"},{"speaker":"Chris Dy","startTime":2102.73,"endTime":2106.69,"body":"know what what's going to happen"},{"speaker":"Chris Dy","startTime":2106.69,"endTime":2111.22,"body":"typically after volar plating."},{"speaker":"Chris Dy","startTime":2106.69,"endTime":2111.22,"body":"There are more wildcards,"},{"speaker":"Chris Dy","startTime":2111.22,"endTime":2113.95,"body":"although it is still somewhat"},{"speaker":"Chris Dy","startTime":2111.22,"endTime":2113.95,"body":"predictable with non operative"},{"speaker":"Chris Dy","startTime":2113.95,"endTime":2117.22,"body":"or cast management for distal"},{"speaker":"Chris Dy","startTime":2113.95,"endTime":2117.22,"body":"radius fractures. And in certain"},{"speaker":"Chris Dy","startTime":2117.22,"endTime":2120.37,"body":"patients and in certain patient"},{"speaker":"Chris Dy","startTime":2117.22,"endTime":2120.37,"body":"physician relationships, you"},{"speaker":"Chris Dy","startTime":2120.37,"endTime":2125.17,"body":"want that reliability. Because"},{"speaker":"Chris Dy","startTime":2120.37,"endTime":2125.17,"body":"sometimes they're, they're going"},{"speaker":"Chris Dy","startTime":2125.17,"endTime":2128.77,"body":"to have a hard time accepting"},{"speaker":"Chris Dy","startTime":2125.17,"endTime":2128.77,"body":"uncertainty. And sometimes I do"},{"speaker":"Charles Goldfarb","startTime":2128.0,"endTime":2132.74,"body":"I think you're"},{"speaker":"Charles Goldfarb","startTime":2128.0,"endTime":2132.74,"body":"right. And again, it's about"},{"speaker":"Charles Goldfarb","startTime":2128.77,"endTime":2128.98,"body":"too."},{"speaker":"Charles Goldfarb","startTime":2132.74,"endTime":2135.83,"body":"reading the patient,"},{"speaker":"Charles Goldfarb","startTime":2132.74,"endTime":2135.83,"body":"understanding what he or she"},{"speaker":"Charles Goldfarb","startTime":2135.83,"endTime":2140.33,"body":"most prioritizes. And while you"},{"speaker":"Charles Goldfarb","startTime":2135.83,"endTime":2140.33,"body":"know, fracture work, in some"},{"speaker":"Charles Goldfarb","startTime":2140.33,"endTime":2145.25,"body":"respects is easier in the clinic"},{"speaker":"Charles Goldfarb","startTime":2140.33,"endTime":2145.25,"body":"than a vague wrist pain patient,"},{"speaker":"Charles Goldfarb","startTime":2145.49,"endTime":2148.4,"body":"there's still intricacies to"},{"speaker":"Charles Goldfarb","startTime":2145.49,"endTime":2148.4,"body":"trying to get the information"},{"speaker":"Charles Goldfarb","startTime":2148.64,"endTime":2152.63,"body":"you need, in a time efficient"},{"speaker":"Charles Goldfarb","startTime":2148.64,"endTime":2152.63,"body":"fashion from that patient to"},{"speaker":"Charles Goldfarb","startTime":2152.63,"endTime":2156.8,"body":"best help them because every"},{"speaker":"Charles Goldfarb","startTime":2152.63,"endTime":2156.8,"body":"patient, three or four different"},{"speaker":"Charles Goldfarb","startTime":2156.8,"endTime":2160.01,"body":"patients may have the same"},{"speaker":"Charles Goldfarb","startTime":2156.8,"endTime":2160.01,"body":"fracture, and you may treat them"},{"speaker":"Charles Goldfarb","startTime":2160.01,"endTime":2162.71,"body":"slightly differently based on"},{"speaker":"Charles Goldfarb","startTime":2160.01,"endTime":2162.71,"body":"the needs of the patient. And"},{"speaker":"Charles Goldfarb","startTime":2162.71,"endTime":2165.59,"body":"that's that's an art that gets"},{"speaker":"Charles Goldfarb","startTime":2162.71,"endTime":2165.59,"body":"to the art of medicine and and"},{"speaker":"Charles Goldfarb","startTime":2165.59,"endTime":2167.9,"body":"how do you develop that patient"},{"speaker":"Charles Goldfarb","startTime":2165.59,"endTime":2167.9,"body":"relationship and get the"},{"speaker":"Charles Goldfarb","startTime":2167.9,"endTime":2169.25,"body":"information out of them that you"},{"speaker":"Charles Goldfarb","startTime":2167.9,"endTime":2169.25,"body":"need."},{"speaker":"Chris Dy","startTime":2168.67,"endTime":2170.92,"body":"Yeah, a few a few"},{"speaker":"Chris Dy","startTime":2168.67,"endTime":2170.92,"body":"comments, as we come to a close"},{"speaker":"Chris Dy","startTime":2170.92,"endTime":2173.29,"body":"here for what you just said,"},{"speaker":"Chris Dy","startTime":2170.92,"endTime":2173.29,"body":"that's one of the things I tell"},{"speaker":"Chris Dy","startTime":2173.29,"endTime":2176.2,"body":"the trainees at the beginning of"},{"speaker":"Chris Dy","startTime":2173.29,"endTime":2176.2,"body":"the rotation. I was like, I will"},{"speaker":"Chris Dy","startTime":2176.2,"endTime":2178.9,"body":"tell you what the board answer"},{"speaker":"Chris Dy","startTime":2176.2,"endTime":2178.9,"body":"s when we walk out of the room,"},{"speaker":"Chris Dy","startTime":2178.9,"endTime":2181.81,"body":"nd then I will tell you why I am"},{"speaker":"Chris Dy","startTime":2178.9,"endTime":2181.81,"body":"deviating from the board answer"},{"speaker":"Chris Dy","startTime":2181.81,"endTime":2185.32,"body":"because there are reasons why."},{"speaker":"Chris Dy","startTime":2181.81,"endTime":2185.32,"body":"And it's not always because we"},{"speaker":"Chris Dy","startTime":2185.32,"endTime":2187.84,"body":"like to do surgery, you know,"},{"speaker":"Chris Dy","startTime":2185.32,"endTime":2187.84,"body":"there are important things that"},{"speaker":"Chris Dy","startTime":2187.84,"endTime":2189.64,"body":"come in play. And one of the"},{"speaker":"Chris Dy","startTime":2187.84,"endTime":2189.64,"body":"things that you've mentioned"},{"speaker":"Chris Dy","startTime":2189.64,"endTime":2192.46,"body":"before is you know, people need"},{"speaker":"Chris Dy","startTime":2189.64,"endTime":2192.46,"body":"to work. You know, and I think"},{"speaker":"Chris Dy","startTime":2192.46,"endTime":2196.06,"body":"that sometimes, you know,"},{"speaker":"Chris Dy","startTime":2192.46,"endTime":2196.06,"body":"especially in the COVID era, you"},{"speaker":"Chris Dy","startTime":2196.06,"endTime":2198.55,"body":"know, if you can get somebody"},{"speaker":"Chris Dy","startTime":2196.06,"endTime":2198.55,"body":"back to work a few months"},{"speaker":"Chris Dy","startTime":2198.55,"endTime":2201.1,"body":"earlier, that's going to be"},{"speaker":"Chris Dy","startTime":2198.55,"endTime":2201.1,"body":"incredibly beneficial for them."},{"speaker":"Chris Dy","startTime":2201.73,"endTime":2205.54,"body":"And then the last thing I would"},{"speaker":"Chris Dy","startTime":2201.73,"endTime":2205.54,"body":"say is that, you know, many of"},{"speaker":"Chris Dy","startTime":2205.54,"endTime":2209.47,"body":"our listeners know this, but"},{"speaker":"Chris Dy","startTime":2205.54,"endTime":2209.47,"body":"volar plate is but one option to"},{"speaker":"Chris Dy","startTime":2209.47,"endTime":2211.45,"body":"treat a distal radius fracture"},{"speaker":"Chris Dy","startTime":2209.47,"endTime":2211.45,"body":"surgically. And there are"},{"speaker":"Chris Dy","startTime":2211.45,"endTime":2215.2,"body":"specific fractures that we will"},{"speaker":"Chris Dy","startTime":2211.45,"endTime":2215.2,"body":"talk about in a future episode"},{"speaker":"Chris Dy","startTime":2215.2,"endTime":2218.44,"body":"where we go either dorsal or we"},{"speaker":"Chris Dy","startTime":2215.2,"endTime":2218.44,"body":"use fragment specific type"},{"speaker":"Chris Dy","startTime":2218.44,"endTime":2221.95,"body":"strategies. So do you have"},{"speaker":"Chris Dy","startTime":2218.44,"endTime":2221.95,"body":"anything to add as we close out?"},{"speaker":"Charles Goldfarb","startTime":2224.44,"endTime":2226.51,"body":"Yeah, we"},{"speaker":"Charles Goldfarb","startTime":2224.44,"endTime":2226.51,"body":"talked about the generally"},{"speaker":"Charles Goldfarb","startTime":2226.51,"endTime":2229.45,"body":"widely accepted criteria, and"},{"speaker":"Charles Goldfarb","startTime":2226.51,"endTime":2229.45,"body":"those are important. And we"},{"speaker":"Charles Goldfarb","startTime":2229.45,"endTime":2233.5,"body":"could spend hours talking about"},{"speaker":"Charles Goldfarb","startTime":2229.45,"endTime":2233.5,"body":"those, the one fracture that"},{"speaker":"Charles Goldfarb","startTime":2233.8,"endTime":2236.38,"body":"gets the most has gotten the"},{"speaker":"Charles Goldfarb","startTime":2233.8,"endTime":2236.38,"body":"most attention over the last"},{"speaker":"Charles Goldfarb","startTime":2236.38,"endTime":2239.17,"body":"year or two is that volar, ulnar"},{"speaker":"Charles Goldfarb","startTime":2236.38,"endTime":2239.17,"body":"corner fracture, and I think"},{"speaker":"Charles Goldfarb","startTime":2239.17,"endTime":2241.75,"body":"both of us recognize that that"},{"speaker":"Charles Goldfarb","startTime":2239.17,"endTime":2241.75,"body":"is a fracture that needs to be"},{"speaker":"Charles Goldfarb","startTime":2241.75,"endTime":2246.04,"body":"treated surgically, and with"},{"speaker":"Charles Goldfarb","startTime":2241.75,"endTime":2246.04,"body":"great care. So that is something"},{"speaker":"Charles Goldfarb","startTime":2246.04,"endTime":2249.52,"body":"that I would add to that"},{"speaker":"Charles Goldfarb","startTime":2246.04,"endTime":2249.52,"body":"surgical indications or surgical"},{"speaker":"Charles Goldfarb","startTime":2249.52,"endTime":2252.31,"body":"instability issue. The other"},{"speaker":"Charles Goldfarb","startTime":2249.52,"endTime":2252.31,"body":"one, which we didn't really hit"},{"speaker":"Charles Goldfarb","startTime":2252.31,"endTime":2255.46,"body":"on was intra-articular"},{"speaker":"Charles Goldfarb","startTime":2252.31,"endTime":2255.46,"body":"displacement, whether that's a"},{"speaker":"Charles Goldfarb","startTime":2255.49,"endTime":2259.18,"body":"die-punch fragment, whether it's"},{"speaker":"Charles Goldfarb","startTime":2255.49,"endTime":2259.18,"body":"a gap of two or more millimeters"},{"speaker":"Charles Goldfarb","startTime":2259.18,"endTime":2262.6,"body":"or worse than a gap, whether"},{"speaker":"Charles Goldfarb","startTime":2259.18,"endTime":2262.6,"body":"it's a step in the articular"},{"speaker":"Charles Goldfarb","startTime":2262.6,"endTime":2266.38,"body":"surface, those are all super"},{"speaker":"Charles Goldfarb","startTime":2262.6,"endTime":2266.38,"body":"important things. And again,"},{"speaker":"Charles Goldfarb","startTime":2266.38,"endTime":2270.04,"body":"we'll hit on those again, in the"},{"speaker":"Charles Goldfarb","startTime":2266.38,"endTime":2270.04,"body":"future, I guess I would say one"},{"speaker":"Charles Goldfarb","startTime":2270.04,"endTime":2273.82,"body":"of the things that has served me"},{"speaker":"Charles Goldfarb","startTime":2270.04,"endTime":2273.82,"body":"well, is how I counsel patients"},{"speaker":"Charles Goldfarb","startTime":2273.85,"endTime":2277.9,"body":"about recovery. And I say two"},{"speaker":"Charles Goldfarb","startTime":2273.85,"endTime":2277.9,"body":"things to every patient. First,"},{"speaker":"Charles Goldfarb","startTime":2277.9,"endTime":2282.46,"body":"I say expect a year, expect a"},{"speaker":"Charles Goldfarb","startTime":2277.9,"endTime":2282.46,"body":"year to get as good as you're"},{"speaker":"Charles Goldfarb","startTime":2282.46,"endTime":2285.28,"body":"going to be now at six months or"},{"speaker":"Charles Goldfarb","startTime":2282.46,"endTime":2285.28,"body":"even at four months, you're"},{"speaker":"Charles Goldfarb","startTime":2285.28,"endTime":2288.52,"body":"gonna be pretty darn good. But"},{"speaker":"Charles Goldfarb","startTime":2285.28,"endTime":2288.52,"body":"you will continue to improve as"},{"speaker":"Charles Goldfarb","startTime":2288.52,"endTime":2292.24,"body":"far as motion and strength and"},{"speaker":"Charles Goldfarb","startTime":2288.52,"endTime":2292.24,"body":"overall satisfaction with this"},{"speaker":"Charles Goldfarb","startTime":2292.24,"endTime":2295.06,"body":"injury, whether surgical or non"},{"speaker":"Charles Goldfarb","startTime":2292.24,"endTime":2295.06,"body":"surgical, up to a year. So"},{"speaker":"Charles Goldfarb","startTime":2295.06,"endTime":2298.06,"body":"that's one point I stress from"},{"speaker":"Charles Goldfarb","startTime":2295.06,"endTime":2298.06,"body":"day one. And I've been super"},{"speaker":"Charles Goldfarb","startTime":2298.06,"endTime":2300.88,"body":"happy to have done that. The"},{"speaker":"Charles Goldfarb","startTime":2298.06,"endTime":2300.88,"body":"other point I stress is that the"},{"speaker":"Charles Goldfarb","startTime":2300.88,"endTime":2303.85,"body":"pain on the thumb side of the"},{"speaker":"Charles Goldfarb","startTime":2300.88,"endTime":2303.85,"body":"wrist, ie the distal radius"},{"speaker":"Charles Goldfarb","startTime":2303.85,"endTime":2307.39,"body":"fracture will go away. And"},{"speaker":"Charles Goldfarb","startTime":2303.85,"endTime":2307.39,"body":"that'll go away at six weeks"},{"speaker":"Charles Goldfarb","startTime":2307.42,"endTime":2312.94,"body":"ish. The ulnar sided pain"},{"speaker":"Charles Goldfarb","startTime":2307.42,"endTime":2312.94,"body":"persists for much longer. And I"},{"speaker":"Charles Goldfarb","startTime":2312.94,"endTime":2316.36,"body":"stress that as well and those"},{"speaker":"Charles Goldfarb","startTime":2312.94,"endTime":2316.36,"body":"two points, simplistic as they"},{"speaker":"Charles Goldfarb","startTime":2316.36,"endTime":2318.73,"body":"are, and everyone's probably"},{"speaker":"Charles Goldfarb","startTime":2316.36,"endTime":2318.73,"body":"rolling their eyes like yeah,"},{"speaker":"Charles Goldfarb","startTime":2318.76,"endTime":2321.49,"body":"obviously, those have served me"},{"speaker":"Charles Goldfarb","startTime":2318.76,"endTime":2321.49,"body":"really well with patient"},{"speaker":"Charles Goldfarb","startTime":2321.49,"endTime":2322.12,"body":"education."},{"speaker":"Chris Dy","startTime":2322.66,"endTime":2325.78,"body":"One other, I agree"},{"speaker":"Chris Dy","startTime":2322.66,"endTime":2325.78,"body":"100%, one other thing that I"},{"speaker":"Chris Dy","startTime":2325.78,"endTime":2328.75,"body":"drop in mainly because of my"},{"speaker":"Chris Dy","startTime":2325.78,"endTime":2328.75,"body":"bias is that with these really"},{"speaker":"Chris Dy","startTime":2328.75,"endTime":2333.31,"body":"bad expected malunions, you"},{"speaker":"Chris Dy","startTime":2328.75,"endTime":2333.31,"body":"know, with a lot of dorsal"},{"speaker":"Chris Dy","startTime":2333.37,"endTime":2335.83,"body":"placement, I do counsel them"},{"speaker":"Chris Dy","startTime":2333.37,"endTime":2335.83,"body":"about the risk of carpal tunnel"},{"speaker":"Chris Dy","startTime":2335.83,"endTime":2338.89,"body":"syndrome down the line. And that"},{"speaker":"Chris Dy","startTime":2335.83,"endTime":2338.89,"body":"is a much easier thing to deal"},{"speaker":"Chris Dy","startTime":2338.89,"endTime":2341.68,"body":"with, obviously a carpal tunnel"},{"speaker":"Chris Dy","startTime":2338.89,"endTime":2341.68,"body":"release as opposed to a fracture"},{"speaker":"Chris Dy","startTime":2341.68,"endTime":2345.46,"body":"surgery that can be done under"},{"speaker":"Chris Dy","startTime":2341.68,"endTime":2345.46,"body":"local etc. But if you look in"},{"speaker":"Chris Dy","startTime":2345.46,"endTime":2347.98,"body":"some of the tables, on some"},{"speaker":"Chris Dy","startTime":2345.46,"endTime":2347.98,"body":"papers, you can find some"},{"speaker":"Chris Dy","startTime":2347.98,"endTime":2351.34,"body":"reasonable, you know, incidence"},{"speaker":"Chris Dy","startTime":2347.98,"endTime":2351.34,"body":"data and it tends to be around"},{"speaker":"Chris Dy","startTime":2351.34,"endTime":2355.27,"body":"15 to 20% with these, with these"},{"speaker":"Chris Dy","startTime":2351.34,"endTime":2355.27,"body":"expected malunions. So that's"},{"speaker":"Chris Dy","startTime":2355.27,"endTime":2358.33,"body":"just something to keep in mind."},{"speaker":"Chris Dy","startTime":2355.27,"endTime":2358.33,"body":"Because if you don't tell them"},{"speaker":"Chris Dy","startTime":2358.33,"endTime":2361.39,"body":"they may wonder why you know why"},{"speaker":"Chris Dy","startTime":2358.33,"endTime":2361.39,"body":"they have this numbness and"},{"speaker":"Chris Dy","startTime":2361.39,"endTime":2363.19,"body":"tingling three or six months"},{"speaker":"Chris Dy","startTime":2361.39,"endTime":2363.19,"body":"down the line."},{"speaker":"Charles Goldfarb","startTime":2363.82,"endTime":2365.23,"body":"That's"},{"speaker":"Charles Goldfarb","startTime":2363.82,"endTime":2365.23,"body":"perfect. And you know, like"},{"speaker":"Charles Goldfarb","startTime":2365.23,"endTime":2369.34,"body":"everything with Chris it, the"},{"speaker":"Charles Goldfarb","startTime":2365.23,"endTime":2369.34,"body":"bony structures exists to"},{"speaker":"Charles Goldfarb","startTime":2369.34,"endTime":2374.44,"body":"support our nerves. And so that"},{"speaker":"Charles Goldfarb","startTime":2369.34,"endTime":2374.44,"body":"is a great topic to end on nerve"},{"speaker":"Charles Goldfarb","startTime":2374.44,"endTime":2377.14,"body":"surgery in the setting of distal"},{"speaker":"Charles Goldfarb","startTime":2374.44,"endTime":2377.14,"body":"radius fractures."},{"speaker":"Chris Dy","startTime":2377.57,"endTime":2380.42,"body":"You're welcome, mister"},{"speaker":"Chris Dy","startTime":2377.57,"endTime":2380.42,"body":"\"I wrote all the crps articles"},{"speaker":"Chris Dy","startTime":2380.42,"endTime":2381.86,"body":"on distal radius fractures.\""},{"speaker":"Charles Goldfarb","startTime":2382.85,"endTime":2385.4,"body":"All right, I"},{"speaker":"Charles Goldfarb","startTime":2382.85,"endTime":2385.4,"body":"know you are in hospital and you"},{"speaker":"Charles Goldfarb","startTime":2385.4,"endTime":2388.16,"body":"are working. So thanks for"},{"speaker":"Charles Goldfarb","startTime":2385.4,"endTime":2388.16,"body":"joining me this morning and have"},{"speaker":"Charles Goldfarb","startTime":2388.16,"endTime":2388.67,"body":"a good day."},{"speaker":"Chris Dy","startTime":2389.03,"endTime":2390.26,"body":"All right take care."},{"speaker":"Chris Dy","startTime":2389.03,"endTime":2390.26,"body":"Bye bye."},{"speaker":"Charles Goldfarb","startTime":2390.8,"endTime":2392.81,"body":"Hey, Chris."},{"speaker":"Charles Goldfarb","startTime":2390.8,"endTime":2392.81,"body":"That was fun. Let's do it again"},{"speaker":"Charles Goldfarb","startTime":2392.81,"endTime":2393.29,"body":"real soon."},{"speaker":"Chris Dy","startTime":2393.56,"endTime":2396.11,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":2393.56,"endTime":2396.11,"body":"sure to check us out on Twitter"},{"speaker":"Chris Dy","startTime":2396.35,"endTime":2398.51,"body":"@handpodcast. Hey Chuck, what's"},{"speaker":"Chris Dy","startTime":2396.35,"endTime":2398.51,"body":"your Twitter handle?"},{"speaker":"Charles Goldfarb","startTime":2398.87,"endTime":2401.72,"body":"Mine is"},{"speaker":"Charles Goldfarb","startTime":2398.87,"endTime":2401.72,"body":"@congenitalhand. What about you?"},{"speaker":"Chris Dy","startTime":2401.87,"endTime":2405.23,"body":"Mine is @ChrisDyMD"},{"speaker":"Chris Dy","startTime":2401.87,"endTime":2405.23,"body":"spelled d y. And if you'd like"},{"speaker":"Chris Dy","startTime":2405.23,"endTime":2409.1,"body":"to email us, you can reach us at"},{"speaker":"Chris Dy","startTime":2405.23,"endTime":2409.1,"body":"handpodcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":2409.66,"endTime":2411.79,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":2409.66,"endTime":2411.79,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2411.79,"endTime":2412.9,"body":"get your podcasts"},{"speaker":"Chris Dy","startTime":2412.93,"endTime":2415.15,"body":"and be sure to leave a"},{"speaker":"Chris Dy","startTime":2412.93,"endTime":2415.15,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2415.15,"endTime":2415.54,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":2415.93,"endTime":2418.24,"body":"Special thanks"},{"speaker":"Charles Goldfarb","startTime":2415.93,"endTime":2418.24,"body":"to Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":2418.24,"endTime":2422.23,"body":"music. And remember, keep the"},{"speaker":"Charles Goldfarb","startTime":2418.24,"endTime":2422.23,"body":"upper hand. Come back next time"}]}