{"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":14.46,"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":28.2,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":28.5,"endTime":31.02,"body":"Oh, hey,"},{"speaker":"Charles Goldfarb","startTime":28.5,"endTime":31.02,"body":"Chris."},{"speaker":"Chris Dy","startTime":31.92,"endTime":32.73,"body":"Hello, Charles."},{"speaker":"Charles Goldfarb","startTime":33.12,"endTime":34.86,"body":"Trying to"},{"speaker":"Charles Goldfarb","startTime":33.12,"endTime":34.86,"body":"shake it up. Make it a little"},{"speaker":"Charles Goldfarb","startTime":34.86,"endTime":35.31,"body":"different."},{"speaker":"Chris Dy","startTime":35.0,"endTime":37.46,"body":"I think you totally"},{"speaker":"Chris Dy","startTime":35.0,"endTime":37.46,"body":"threw people off there. I think"},{"speaker":"Chris Dy","startTime":37.46,"endTime":39.53,"body":"they were, they thought they"},{"speaker":"Chris Dy","startTime":37.46,"endTime":39.53,"body":"were listening to NPR."},{"speaker":"Charles Goldfarb","startTime":39.86,"endTime":42.98,"body":"What podcasts"},{"speaker":"Charles Goldfarb","startTime":39.86,"endTime":42.98,"body":"are we listening to? All right."},{"speaker":"Charles Goldfarb","startTime":43.01,"endTime":44.9,"body":"Well, I'm excited to be with you"},{"speaker":"Charles Goldfarb","startTime":43.01,"endTime":44.9,"body":"today."},{"speaker":"Chris Dy","startTime":45.11,"endTime":47.72,"body":"This week will not be"},{"speaker":"Chris Dy","startTime":45.11,"endTime":47.72,"body":"Chuck's election-election"},{"speaker":"Chris Dy","startTime":47.75,"endTime":49.19,"body":"update, like last week's."},{"speaker":"Charles Goldfarb","startTime":49.739,"endTime":52.439,"body":"Yeah, if we"},{"speaker":"Charles Goldfarb","startTime":49.739,"endTime":52.439,"body":"lost you early last week."},{"speaker":"Charles Goldfarb","startTime":52.709,"endTime":53.579,"body":"Welcome back."},{"speaker":"Chris Dy","startTime":55.26,"endTime":56.97,"body":"Hey, why don't we talk"},{"speaker":"Chris Dy","startTime":55.26,"endTime":56.97,"body":"about the Supreme Court that'll"},{"speaker":"Chris Dy","startTime":56.97,"endTime":57.36,"body":"get people."},{"speaker":"Charles Goldfarb","startTime":57.63,"endTime":60.51,"body":"Oh yeah,"},{"speaker":"Charles Goldfarb","startTime":57.63,"endTime":60.51,"body":"great. I hope you've had a good"},{"speaker":"Charles Goldfarb","startTime":60.51,"endTime":64.23,"body":"week, and I am excited to be"},{"speaker":"Charles Goldfarb","startTime":60.51,"endTime":64.23,"body":"back with you. And what better"},{"speaker":"Charles Goldfarb","startTime":64.23,"endTime":71.19,"body":"way to start this podcast than a"},{"speaker":"Charles Goldfarb","startTime":64.23,"endTime":71.19,"body":"review. This one is from DMM314."},{"speaker":"Charles Goldfarb","startTime":71.43,"endTime":74.61,"body":"And it says great listening for"},{"speaker":"Charles Goldfarb","startTime":71.43,"endTime":74.61,"body":"physicians and therapists"},{"speaker":"Charles Goldfarb","startTime":74.64,"endTime":78.09,"body":"interested in upper extremity"},{"speaker":"Charles Goldfarb","startTime":74.64,"endTime":78.09,"body":"care. Love the interaction of"},{"speaker":"Charles Goldfarb","startTime":78.09,"endTime":83.97,"body":"Chris and Chuck, need more"},{"speaker":"Charles Goldfarb","startTime":78.09,"endTime":83.97,"body":"nerve. It pains me to read that"},{"speaker":"Charles Goldfarb","startTime":83.97,"endTime":86.37,"body":"one. But I have to share."},{"speaker":"Chris Dy","startTime":86.84,"endTime":89.09,"body":"Well, you know, when"},{"speaker":"Chris Dy","startTime":86.84,"endTime":89.09,"body":"we are structuring the episode,"},{"speaker":"Chris Dy","startTime":89.09,"endTime":91.7,"body":"It is no accident that I had you"},{"speaker":"Chris Dy","startTime":89.09,"endTime":91.7,"body":"read that one, because you would"},{"speaker":"Chris Dy","startTime":91.7,"endTime":95.78,"body":"have thought that I planted that"},{"speaker":"Chris Dy","startTime":91.7,"endTime":95.78,"body":"last sentence in there. So thank"},{"speaker":"Chris Dy","startTime":95.78,"endTime":99.86,"body":"you to DMM314 for acknowledging"},{"speaker":"Chris Dy","startTime":95.78,"endTime":99.86,"body":"the importance of the nerve"},{"speaker":"Chris Dy","startTime":99.89,"endTime":103.01,"body":"portion of our podcast and I'm"},{"speaker":"Chris Dy","startTime":99.89,"endTime":103.01,"body":"hoping that we will finally get"},{"speaker":"Chris Dy","startTime":103.01,"endTime":104.39,"body":"some more down the line."},{"speaker":"Charles Goldfarb","startTime":104.72,"endTime":107.51,"body":"We do, we have"},{"speaker":"Charles Goldfarb","startTime":104.72,"endTime":107.51,"body":"a little template of episodes"},{"speaker":"Charles Goldfarb","startTime":107.51,"endTime":110.42,"body":"and we have a few guests we want"},{"speaker":"Charles Goldfarb","startTime":107.51,"endTime":110.42,"body":"to invite but we do need to"},{"speaker":"Charles Goldfarb","startTime":110.63,"endTime":114.53,"body":"circle back for nerve I'll admit"},{"speaker":"Charles Goldfarb","startTime":110.63,"endTime":114.53,"body":"it we need to need to respond to"},{"speaker":"Charles Goldfarb","startTime":114.53,"endTime":116.3,"body":"the clamor for more nerve."},{"speaker":"Chris Dy","startTime":116.69,"endTime":118.94,"body":"You have to give the"},{"speaker":"Chris Dy","startTime":116.69,"endTime":118.94,"body":"people what they want. popular"},{"speaker":"Chris Dy","startTime":118.97,"endTime":121.79,"body":"vote indicates that more nerve"},{"speaker":"Chris Dy","startTime":118.97,"endTime":121.79,"body":"is needed."},{"speaker":"Charles Goldfarb","startTime":122.63,"endTime":124.55,"body":"I'm fine with"},{"speaker":"Charles Goldfarb","startTime":122.63,"endTime":124.55,"body":"that. But we're gonna hit some"},{"speaker":"Charles Goldfarb","startTime":124.55,"endTime":127.85,"body":"sports as well. Because that is"},{"speaker":"Charles Goldfarb","startTime":124.55,"endTime":127.85,"body":"very popular also."},{"speaker":"Chris Dy","startTime":128.63,"endTime":131.39,"body":"Ahh you know listener"},{"speaker":"Chris Dy","startTime":128.63,"endTime":131.39,"body":"survey says nerve more but yeah,"},{"speaker":"Chris Dy","startTime":131.39,"endTime":132.35,"body":"we'll do some sports too."},{"speaker":"Charles Goldfarb","startTime":132.71,"endTime":134.78,"body":"True. Yeah."},{"speaker":"Charles Goldfarb","startTime":132.71,"endTime":134.78,"body":"Speaking of listener survey,"},{"speaker":"Charles Goldfarb","startTime":134.78,"endTime":137.48,"body":"please, please, please go fill"},{"speaker":"Charles Goldfarb","startTime":134.78,"endTime":137.48,"body":"it out. If you haven't done so"},{"speaker":"Charles Goldfarb","startTime":137.48,"endTime":139.43,"body":"already. I thought one"},{"speaker":"Charles Goldfarb","startTime":137.48,"endTime":139.43,"body":"interesting fact is, you know,"},{"speaker":"Charles Goldfarb","startTime":139.43,"endTime":143.15,"body":"we gave we allowed for three"},{"speaker":"Charles Goldfarb","startTime":139.43,"endTime":143.15,"body":"categories of age, because we're"},{"speaker":"Charles Goldfarb","startTime":143.15,"endTime":145.91,"body":"just curious as to who's"},{"speaker":"Charles Goldfarb","startTime":143.15,"endTime":145.91,"body":"listening. And so one category"},{"speaker":"Charles Goldfarb","startTime":145.91,"endTime":149.6,"body":"was old, like Chuck, which is"},{"speaker":"Charles Goldfarb","startTime":145.91,"endTime":149.6,"body":"really old."},{"speaker":"Chris Dy","startTime":150.2,"endTime":151.76,"body":"I would not fix your"},{"speaker":"Chris Dy","startTime":150.2,"endTime":151.76,"body":"distal radius, Chuck."},{"speaker":"Charles Goldfarb","startTime":151.79,"endTime":155.51,"body":"You might just"},{"speaker":"Charles Goldfarb","startTime":151.79,"endTime":155.51,"body":"put me out of my misery if I"},{"speaker":"Charles Goldfarb","startTime":155.51,"endTime":158.81,"body":"came in with a distal radius"},{"speaker":"Charles Goldfarb","startTime":155.51,"endTime":158.81,"body":"fracture, is that an option? The"},{"speaker":"Charles Goldfarb","startTime":158.81,"endTime":162.29,"body":"second category was young, like"},{"speaker":"Charles Goldfarb","startTime":158.81,"endTime":162.29,"body":"Chris, and the third category"},{"speaker":"Charles Goldfarb","startTime":162.29,"endTime":167.51,"body":"was really young. And the"},{"speaker":"Charles Goldfarb","startTime":162.29,"endTime":167.51,"body":"biggest responders, the biggest"},{"speaker":"Charles Goldfarb","startTime":167.51,"endTime":170.48,"body":"group of responders to our"},{"speaker":"Charles Goldfarb","startTime":167.51,"endTime":170.48,"body":"survey, at least were even"},{"speaker":"Charles Goldfarb","startTime":170.48,"endTime":172.49,"body":"younger than Chris, which I"},{"speaker":"Charles Goldfarb","startTime":170.48,"endTime":172.49,"body":"thought was great. And we're"},{"speaker":"Charles Goldfarb","startTime":172.49,"endTime":175.34,"body":"appreciative. And maybe you guys"},{"speaker":"Charles Goldfarb","startTime":172.49,"endTime":175.34,"body":"just really want a mug?"},{"speaker":"Chris Dy","startTime":176.59,"endTime":180.1,"body":"I think so. But we"},{"speaker":"Chris Dy","startTime":176.59,"endTime":180.1,"body":"also, you know, I think that one"},{"speaker":"Chris Dy","startTime":180.1,"endTime":183.73,"body":"thing that we should say is that"},{"speaker":"Chris Dy","startTime":180.1,"endTime":183.73,"body":"if you're if you appreciate, you"},{"speaker":"Chris Dy","startTime":183.73,"endTime":185.95,"body":"know what, what we're doing, you"},{"speaker":"Chris Dy","startTime":183.73,"endTime":185.95,"body":"know, I think that our"},{"speaker":"Chris Dy","startTime":185.95,"endTime":188.74,"body":"fellowship is, is a great"},{"speaker":"Chris Dy","startTime":185.95,"endTime":188.74,"body":"opportunity to, you know, to"},{"speaker":"Chris Dy","startTime":188.74,"endTime":191.65,"body":"check out if you are in the"},{"speaker":"Chris Dy","startTime":188.74,"endTime":191.65,"body":"resident category, if you're"},{"speaker":"Chris Dy","startTime":191.65,"endTime":195.64,"body":"interested in hand surgery. You"},{"speaker":"Chris Dy","startTime":191.65,"endTime":195.64,"body":"know, we have great discussions"},{"speaker":"Chris Dy","startTime":195.64,"endTime":198.1,"body":"like this every Monday morning,"},{"speaker":"Chris Dy","startTime":195.64,"endTime":198.1,"body":"although it's a little harder on"},{"speaker":"Chris Dy","startTime":198.1,"endTime":202.45,"body":"a Monday morning, and"},{"speaker":"Chris Dy","startTime":198.1,"endTime":202.45,"body":"liveliness. But one of the"},{"speaker":"Chris Dy","startTime":202.45,"endTime":205.48,"body":"strengths of our group really is"},{"speaker":"Chris Dy","startTime":202.45,"endTime":205.48,"body":"the you know, the collegiality"},{"speaker":"Chris Dy","startTime":205.48,"endTime":209.44,"body":"and how much we enjoy talking"},{"speaker":"Chris Dy","startTime":205.48,"endTime":209.44,"body":"about things. So, if you're"},{"speaker":"Chris Dy","startTime":209.44,"endTime":212.2,"body":"younger than me, and you want to"},{"speaker":"Chris Dy","startTime":209.44,"endTime":212.2,"body":"check out the WashU fellowship,"},{"speaker":"Chris Dy","startTime":212.23,"endTime":212.83,"body":"please do."},{"speaker":"Charles Goldfarb","startTime":213.89,"endTime":217.28,"body":"I love that. I"},{"speaker":"Charles Goldfarb","startTime":213.89,"endTime":217.28,"body":"am going to blow your mind for a"},{"speaker":"Charles Goldfarb","startTime":217.28,"endTime":223.07,"body":"second here Dr. Dy. I, I don't"},{"speaker":"Charles Goldfarb","startTime":217.28,"endTime":223.07,"body":"think I'm thought of especially"},{"speaker":"Charles Goldfarb","startTime":223.07,"endTime":229.16,"body":"as a cultured, poem reading"},{"speaker":"Charles Goldfarb","startTime":223.07,"endTime":229.16,"body":"individual. I know, I know, you"},{"speaker":"Charles Goldfarb","startTime":229.16,"endTime":232.07,"body":"may think of me that way and"},{"speaker":"Charles Goldfarb","startTime":229.16,"endTime":232.07,"body":"appreciative of the arts, I"},{"speaker":"Charles Goldfarb","startTime":232.07,"endTime":234.44,"body":"think you probably should give"},{"speaker":"Charles Goldfarb","startTime":232.07,"endTime":234.44,"body":"me a little credit more credit"},{"speaker":"Charles Goldfarb","startTime":234.44,"endTime":239.96,"body":"than you do. But this is really"},{"speaker":"Charles Goldfarb","startTime":234.44,"endTime":239.96,"body":"interesting. So in my family, we"},{"speaker":"Charles Goldfarb","startTime":239.96,"endTime":244.7,"body":"had a poet many years ago."},{"speaker":"Charles Goldfarb","startTime":239.96,"endTime":244.7,"body":"Clearly that gene was not passed"},{"speaker":"Charles Goldfarb","startTime":244.7,"endTime":249.86,"body":"on. But my great grandpa great,"},{"speaker":"Charles Goldfarb","startTime":244.7,"endTime":249.86,"body":"great grandfather named Samuel"},{"speaker":"Charles Goldfarb","startTime":249.86,"endTime":252.56,"body":"Allman wrote a poem, which"},{"speaker":"Charles Goldfarb","startTime":249.86,"endTime":252.56,"body":"honestly is a big deal. It's"},{"speaker":"Charles Goldfarb","startTime":252.56,"endTime":256.61,"body":"called Youth. And given all the"},{"speaker":"Charles Goldfarb","startTime":252.56,"endTime":256.61,"body":"ageism you demonstrate towards"},{"speaker":"Charles Goldfarb","startTime":256.61,"endTime":260.99,"body":"me, I want to read the first"},{"speaker":"Charles Goldfarb","startTime":256.61,"endTime":260.99,"body":"line of that poem, if you will"},{"speaker":"Charles Goldfarb","startTime":260.99,"endTime":261.53,"body":"humor me."},{"speaker":"Chris Dy","startTime":261.83,"endTime":262.79,"body":"Yes, please."},{"speaker":"Charles Goldfarb","startTime":262.85,"endTime":265.79,"body":"Youth is not a"},{"speaker":"Charles Goldfarb","startTime":262.85,"endTime":265.79,"body":"time of life. It is a state of"},{"speaker":"Charles Goldfarb","startTime":265.79,"endTime":269.42,"body":"mind. It is not a matter of rosy"},{"speaker":"Charles Goldfarb","startTime":265.79,"endTime":269.42,"body":"cheeks, red lips and supple"},{"speaker":"Charles Goldfarb","startTime":269.42,"endTime":272.63,"body":"knees, it is a matter of the"},{"speaker":"Charles Goldfarb","startTime":269.42,"endTime":272.63,"body":"will a quality of the"},{"speaker":"Charles Goldfarb","startTime":272.63,"endTime":276.71,"body":"imagination, vigor of the"},{"speaker":"Charles Goldfarb","startTime":272.63,"endTime":276.71,"body":"emotions, it is the freshness of"},{"speaker":"Charles Goldfarb","startTime":276.71,"endTime":282.74,"body":"the deep spring of life. So I"},{"speaker":"Charles Goldfarb","startTime":276.71,"endTime":282.74,"body":"know that you realize that that"},{"speaker":"Charles Goldfarb","startTime":282.74,"endTime":287.75,"body":"articulate... gene was not"},{"speaker":"Charles Goldfarb","startTime":282.74,"endTime":287.75,"body":"passed on to me, but I just had"},{"speaker":"Charles Goldfarb","startTime":287.75,"endTime":289.34,"body":"to get that in here, had to get"},{"speaker":"Charles Goldfarb","startTime":287.75,"endTime":289.34,"body":"it in."},{"speaker":"Chris Dy","startTime":289.949,"endTime":291.269,"body":"You know, are you"},{"speaker":"Chris Dy","startTime":289.949,"endTime":291.269,"body":"going to try to make the"},{"speaker":"Chris Dy","startTime":291.269,"endTime":294.869,"body":"argument that activity level is"},{"speaker":"Chris Dy","startTime":291.269,"endTime":294.869,"body":"more important than age in terms"},{"speaker":"Chris Dy","startTime":294.869,"endTime":297.029,"body":"of indications for surgery, I"},{"speaker":"Chris Dy","startTime":294.869,"endTime":297.029,"body":"feel like you're going in that"},{"speaker":"Chris Dy","startTime":297.029,"endTime":297.359,"body":"direction"},{"speaker":"Charles Goldfarb","startTime":298.17,"endTime":299.61,"body":"He's really"},{"speaker":"Charles Goldfarb","startTime":298.17,"endTime":299.61,"body":"old, but"},{"speaker":"Chris Dy","startTime":299.61,"endTime":303.09,"body":"Your fountain of"},{"speaker":"Chris Dy","startTime":299.61,"endTime":303.09,"body":"youth, in your, in your hobbies"},{"speaker":"Chris Dy","startTime":303.09,"endTime":306.24,"body":"and your passions will"},{"speaker":"Chris Dy","startTime":303.09,"endTime":306.24,"body":"definitely push me towards"},{"speaker":"Chris Dy","startTime":306.24,"endTime":306.72,"body":"surgery."},{"speaker":"Charles Goldfarb","startTime":307.02,"endTime":309.42,"body":"My goal is to"},{"speaker":"Charles Goldfarb","startTime":307.02,"endTime":309.42,"body":"change your mind and make you"},{"speaker":"Charles Goldfarb","startTime":309.42,"endTime":312.03,"body":"think I'm a surgical indicated"},{"speaker":"Charles Goldfarb","startTime":309.42,"endTime":312.03,"body":"patients."},{"speaker":"Chris Dy","startTime":314.16,"endTime":315.69,"body":"Just say you're an"},{"speaker":"Chris Dy","startTime":314.16,"endTime":315.69,"body":"elite athlete."},{"speaker":"Charles Goldfarb","startTime":317.339,"endTime":322.379,"body":"No one will"},{"speaker":"Charles Goldfarb","startTime":317.339,"endTime":322.379,"body":"believe that. All right, can you"},{"speaker":"Charles Goldfarb","startTime":322.409,"endTime":326.369,"body":"share with our listeners a case"},{"speaker":"Charles Goldfarb","startTime":322.409,"endTime":326.369,"body":"something of interest that you"},{"speaker":"Charles Goldfarb","startTime":326.369,"endTime":328.079,"body":"have, you know, seen or want to"},{"speaker":"Charles Goldfarb","startTime":326.369,"endTime":328.079,"body":"share?"},{"speaker":"Chris Dy","startTime":328.78,"endTime":331.03,"body":"Well, you know, I"},{"speaker":"Chris Dy","startTime":328.78,"endTime":331.03,"body":"mentioned a few weeks ago that"},{"speaker":"Chris Dy","startTime":331.03,"endTime":335.17,"body":"I'd done my first wide awake"},{"speaker":"Chris Dy","startTime":331.03,"endTime":335.17,"body":"nerve repair, which was"},{"speaker":"Chris Dy","startTime":335.17,"endTime":337.57,"body":"unexpected. And I asked the"},{"speaker":"Chris Dy","startTime":335.17,"endTime":337.57,"body":"patient if he wanted me to"},{"speaker":"Chris Dy","startTime":337.57,"endTime":341.11,"body":"repair it, and he said, Sure."},{"speaker":"Chris Dy","startTime":337.57,"endTime":341.11,"body":"And on top of some other"},{"speaker":"Chris Dy","startTime":341.11,"endTime":343.72,"body":"tendons, we repaired that and"},{"speaker":"Chris Dy","startTime":341.11,"endTime":343.72,"body":"you know, the wide awake"},{"speaker":"Chris Dy","startTime":344.02,"endTime":347.65,"body":"protocol really helped move"},{"speaker":"Chris Dy","startTime":344.02,"endTime":347.65,"body":"things along for him. So not to"},{"speaker":"Chris Dy","startTime":347.65,"endTime":350.32,"body":"make this too much of a wide"},{"speaker":"Chris Dy","startTime":347.65,"endTime":350.32,"body":"awake commercial, but, you know,"},{"speaker":"Chris Dy","startTime":350.32,"endTime":355.24,"body":"he is doing well, I would say an"},{"speaker":"Chris Dy","startTime":350.32,"endTime":355.24,"body":"optimistic patient. But you"},{"speaker":"Chris Dy","startTime":355.24,"endTime":358.3,"body":"know, doing the tendon you know"},{"speaker":"Chris Dy","startTime":355.24,"endTime":358.3,"body":"the, the tendon repairs, and the"},{"speaker":"Chris Dy","startTime":358.3,"endTime":361.51,"body":"nerve repair and local and"},{"speaker":"Chris Dy","startTime":358.3,"endTime":361.51,"body":"seeing how well he's flown"},{"speaker":"Chris Dy","startTime":361.51,"endTime":364.93,"body":"through, I probably will start"},{"speaker":"Chris Dy","startTime":361.51,"endTime":364.93,"body":"to open up some indications a"},{"speaker":"Chris Dy","startTime":364.93,"endTime":367.75,"body":"bit more. Have you changed"},{"speaker":"Chris Dy","startTime":364.93,"endTime":367.75,"body":"indications for wide awake"},{"speaker":"Chris Dy","startTime":367.75,"endTime":369.46,"body":"surgery at all, even in the last"},{"speaker":"Chris Dy","startTime":367.75,"endTime":369.46,"body":"few months,"},{"speaker":"Charles Goldfarb","startTime":370.2,"endTime":372.27,"body":"I haven't"},{"speaker":"Charles Goldfarb","startTime":370.2,"endTime":372.27,"body":"necessarily gotten more"},{"speaker":"Charles Goldfarb","startTime":372.27,"endTime":375.96,"body":"aggressive about what I do under"},{"speaker":"Charles Goldfarb","startTime":372.27,"endTime":375.96,"body":"local only I have gotten more"},{"speaker":"Charles Goldfarb","startTime":375.96,"endTime":380.04,"body":"aggressive about how frequently"},{"speaker":"Charles Goldfarb","startTime":375.96,"endTime":380.04,"body":"I offer it. And so that will"},{"speaker":"Charles Goldfarb","startTime":380.04,"endTime":383.67,"body":"continue. And I think the more I"},{"speaker":"Charles Goldfarb","startTime":380.04,"endTime":383.67,"body":"do, the more likely I am to"},{"speaker":"Charles Goldfarb","startTime":383.67,"endTime":387.57,"body":"expand my indications as you"},{"speaker":"Charles Goldfarb","startTime":383.67,"endTime":387.57,"body":"might predict. You know, as I as"},{"speaker":"Charles Goldfarb","startTime":387.57,"endTime":391.11,"body":"I sit here and think about our"},{"speaker":"Charles Goldfarb","startTime":387.57,"endTime":391.11,"body":"topic of the day, which is"},{"speaker":"Charles Goldfarb","startTime":391.14,"endTime":396.03,"body":"really some of the surgical"},{"speaker":"Charles Goldfarb","startTime":391.14,"endTime":396.03,"body":"pearls. In our approaches to"},{"speaker":"Charles Goldfarb","startTime":396.03,"endTime":399.51,"body":"distal radius fractures. It"},{"speaker":"Charles Goldfarb","startTime":396.03,"endTime":399.51,"body":"makes me think about people who"},{"speaker":"Charles Goldfarb","startTime":399.51,"endTime":403.59,"body":"have impacted our field, and one"},{"speaker":"Charles Goldfarb","startTime":399.51,"endTime":403.59,"body":"of my favorite sayings, which I"},{"speaker":"Charles Goldfarb","startTime":403.59,"endTime":406.83,"body":"attribute to Paul Mansky, but"},{"speaker":"Charles Goldfarb","startTime":403.59,"endTime":406.83,"body":"it's not Paul Mansky's quote,"},{"speaker":"Charles Goldfarb","startTime":407.16,"endTime":409.71,"body":"but you know, life is not about"},{"speaker":"Charles Goldfarb","startTime":407.16,"endTime":409.71,"body":"creating opportunities, but"},{"speaker":"Charles Goldfarb","startTime":409.71,"endTime":413.19,"body":"rather recognizing them. And so"},{"speaker":"Charles Goldfarb","startTime":409.71,"endTime":413.19,"body":"certainly Don Milan has"},{"speaker":"Charles Goldfarb","startTime":413.19,"endTime":417.66,"body":"popularized WALANT surgery, and"},{"speaker":"Charles Goldfarb","startTime":413.19,"endTime":417.66,"body":"we owe him a great debt of"},{"speaker":"Charles Goldfarb","startTime":417.66,"endTime":421.8,"body":"gratitude for that. George Orbay"},{"speaker":"Charles Goldfarb","startTime":417.66,"endTime":421.8,"body":"and the volar plate, which we"},{"speaker":"Charles Goldfarb","startTime":421.8,"endTime":423.75,"body":"have mentioned before, and will"},{"speaker":"Charles Goldfarb","startTime":421.8,"endTime":423.75,"body":"probably mention again, during"},{"speaker":"Charles Goldfarb","startTime":423.75,"endTime":426.48,"body":"this episode, and then our"},{"speaker":"Charles Goldfarb","startTime":423.75,"endTime":426.48,"body":"previous guest, Charlie Eaton"},{"speaker":"Charles Goldfarb","startTime":426.51,"endTime":429.21,"body":"with needle aponeurotomy, I"},{"speaker":"Charles Goldfarb","startTime":426.51,"endTime":429.21,"body":"think those three individuals,"},{"speaker":"Charles Goldfarb","startTime":429.39,"endTime":432.72,"body":"again, have just done a great"},{"speaker":"Charles Goldfarb","startTime":429.39,"endTime":432.72,"body":"deal to advance our field,"},{"speaker":"Charles Goldfarb","startTime":433.05,"endTime":438.21,"body":"whether by their own thought or"},{"speaker":"Charles Goldfarb","startTime":433.05,"endTime":438.21,"body":"just advancing what others have"},{"speaker":"Charles Goldfarb","startTime":438.21,"endTime":439.14,"body":"also discussed."},{"speaker":"Chris Dy","startTime":440.53,"endTime":442.9,"body":"Agree, Agree"},{"speaker":"Chris Dy","startTime":440.53,"endTime":442.9,"body":"completely. And I think that if"},{"speaker":"Chris Dy","startTime":442.93,"endTime":446.56,"body":"you know, anybody is looking for"},{"speaker":"Chris Dy","startTime":442.93,"endTime":446.56,"body":"an area to make a difference,"},{"speaker":"Chris Dy","startTime":446.83,"endTime":449.74,"body":"see where we struggle in terms"},{"speaker":"Chris Dy","startTime":446.83,"endTime":449.74,"body":"of you know, the, you know, if"},{"speaker":"Chris Dy","startTime":449.74,"endTime":452.83,"body":"you're a trainee, and you're in"},{"speaker":"Chris Dy","startTime":449.74,"endTime":452.83,"body":"clinic, and you're listening to"},{"speaker":"Chris Dy","startTime":452.89,"endTime":457.42,"body":"us fumble through a"},{"speaker":"Chris Dy","startTime":452.89,"endTime":457.42,"body":"conversation, question dogma, a"},{"speaker":"Chris Dy","startTime":457.42,"endTime":461.8,"body":"good paper, a good that, that"},{"speaker":"Chris Dy","startTime":457.42,"endTime":461.8,"body":"questions, dogma can go a long"},{"speaker":"Chris Dy","startTime":461.8,"endTime":465.07,"body":"way and change how we do things."},{"speaker":"Chris Dy","startTime":461.8,"endTime":465.07,"body":"And a lot of times, you know,"},{"speaker":"Chris Dy","startTime":465.07,"endTime":468.34,"body":"the, for example, the wide awake"},{"speaker":"Chris Dy","startTime":465.07,"endTime":468.34,"body":"stuff that Don Milan does, that"},{"speaker":"Chris Dy","startTime":468.34,"endTime":472.45,"body":"was a necessity because he"},{"speaker":"Chris Dy","startTime":468.34,"endTime":472.45,"body":"couldn't get theater time. And"},{"speaker":"Chris Dy","startTime":472.45,"endTime":474.79,"body":"perhaps there's going to be some"},{"speaker":"Chris Dy","startTime":472.45,"endTime":474.79,"body":"interesting innovation that"},{"speaker":"Chris Dy","startTime":474.79,"endTime":477.52,"body":"comes out of COVID. Because"},{"speaker":"Chris Dy","startTime":474.79,"endTime":477.52,"body":"we're all struggling to do"},{"speaker":"Chris Dy","startTime":477.52,"endTime":480.55,"body":"things in a different way."},{"speaker":"Chris Dy","startTime":477.52,"endTime":480.55,"body":"Perhaps our efficiencies will"},{"speaker":"Chris Dy","startTime":480.55,"endTime":481.27,"body":"get greater."},{"speaker":"Charles Goldfarb","startTime":482.05,"endTime":484.24,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":482.05,"endTime":484.24,"body":"that's well said. And it will be"},{"speaker":"Charles Goldfarb","startTime":484.24,"endTime":487.39,"body":"interesting to see, we may not"},{"speaker":"Charles Goldfarb","startTime":484.24,"endTime":487.39,"body":"know, what we have learned and"},{"speaker":"Charles Goldfarb","startTime":487.39,"endTime":491.92,"body":"what has changed in our surgical"},{"speaker":"Charles Goldfarb","startTime":487.39,"endTime":491.92,"body":"practices until well past COVID."},{"speaker":"Charles Goldfarb","startTime":491.95,"endTime":494.41,"body":"Whenever that may be, but I"},{"speaker":"Charles Goldfarb","startTime":491.95,"endTime":494.41,"body":"think it's a great point,"},{"speaker":"Charles Goldfarb","startTime":494.41,"endTime":498.16,"body":"necessity, and, and creativity."},{"speaker":"Charles Goldfarb","startTime":494.41,"endTime":498.16,"body":"And that's why engaging all"},{"speaker":"Charles Goldfarb","startTime":498.16,"endTime":502.42,"body":"aspects of, of people of"},{"speaker":"Charles Goldfarb","startTime":498.16,"endTime":502.42,"body":"different age and different"},{"speaker":"Charles Goldfarb","startTime":502.42,"endTime":505.69,"body":"backgrounds and different"},{"speaker":"Charles Goldfarb","startTime":502.42,"endTime":505.69,"body":"ethnicities is so important."},{"speaker":"Charles Goldfarb","startTime":505.69,"endTime":508.81,"body":"Because, you know, people think"},{"speaker":"Charles Goldfarb","startTime":505.69,"endTime":508.81,"body":"differently. And that's what we"},{"speaker":"Charles Goldfarb","startTime":508.81,"endTime":511.9,"body":"need. We don't need uniform"},{"speaker":"Charles Goldfarb","startTime":508.81,"endTime":511.9,"body":"thought that's just, we need,"},{"speaker":"Charles Goldfarb","startTime":512.17,"endTime":516.1,"body":"you know, an education that"},{"speaker":"Charles Goldfarb","startTime":512.17,"endTime":516.1,"body":"provides a background, and a set"},{"speaker":"Charles Goldfarb","startTime":516.1,"endTime":521.08,"body":"of tools and a set of knowledge"},{"speaker":"Charles Goldfarb","startTime":516.1,"endTime":521.08,"body":"to assure competency, but then"},{"speaker":"Charles Goldfarb","startTime":521.08,"endTime":523.78,"body":"we need creativity in our field"},{"speaker":"Charles Goldfarb","startTime":521.08,"endTime":523.78,"body":"to really make advances."},{"speaker":"Chris Dy","startTime":524.53,"endTime":526.54,"body":"And that's where it's"},{"speaker":"Chris Dy","startTime":524.53,"endTime":526.54,"body":"nice when you get to either"},{"speaker":"Chris Dy","startTime":526.66,"endTime":528.97,"body":"train somewhere or end up"},{"speaker":"Chris Dy","startTime":526.66,"endTime":528.97,"body":"working somewhere that's"},{"speaker":"Chris Dy","startTime":528.97,"endTime":531.13,"body":"different than where you, than"},{"speaker":"Chris Dy","startTime":528.97,"endTime":531.13,"body":"where you started your"},{"speaker":"Chris Dy","startTime":531.13,"endTime":531.73,"body":"residency."},{"speaker":"Charles Goldfarb","startTime":532.41,"endTime":534.12,"body":"Yeah, that is"},{"speaker":"Charles Goldfarb","startTime":532.41,"endTime":534.12,"body":"so important. We talked about"},{"speaker":"Charles Goldfarb","startTime":534.12,"endTime":536.82,"body":"that. We talked about that for"},{"speaker":"Charles Goldfarb","startTime":534.12,"endTime":536.82,"body":"hiring, you know, if you just"},{"speaker":"Charles Goldfarb","startTime":536.82,"endTime":540.45,"body":"you know, we know our own"},{"speaker":"Charles Goldfarb","startTime":536.82,"endTime":540.45,"body":"fellows best, but it's tricky"},{"speaker":"Charles Goldfarb","startTime":540.45,"endTime":542.7,"body":"hiring your own fellows because"},{"speaker":"Charles Goldfarb","startTime":540.45,"endTime":542.7,"body":"you don't want to become inbred."},{"speaker":"Charles Goldfarb","startTime":542.7,"endTime":544.98,"body":"It's just such an interesting"},{"speaker":"Charles Goldfarb","startTime":542.7,"endTime":544.98,"body":"thing. Because we bring someone"},{"speaker":"Charles Goldfarb","startTime":544.98,"endTime":547.38,"body":"in who has a different"},{"speaker":"Charles Goldfarb","startTime":544.98,"endTime":547.38,"body":"background, they just think"},{"speaker":"Charles Goldfarb","startTime":547.38,"endTime":550.44,"body":"about things differently. And"},{"speaker":"Charles Goldfarb","startTime":547.38,"endTime":550.44,"body":"that's a win for sure."},{"speaker":"Chris Dy","startTime":550.96,"endTime":554.68,"body":"I'm glad you your last"},{"speaker":"Chris Dy","startTime":550.96,"endTime":554.68,"body":"faculty hire too wasn't a former"},{"speaker":"Chris Dy","startTime":554.68,"endTime":554.89,"body":"fellow."},{"speaker":"Charles Goldfarb","startTime":556.43,"endTime":558.47,"body":"We were"},{"speaker":"Charles Goldfarb","startTime":556.43,"endTime":558.47,"body":"desperate, we were desparate."},{"speaker":"Chris Dy","startTime":560.07,"endTime":563.82,"body":"Thanks for keeping me"},{"speaker":"Chris Dy","startTime":560.07,"endTime":563.82,"body":"on board, Chuck. So that being"},{"speaker":"Chris Dy","startTime":563.82,"endTime":566.94,"body":"said, we usually have a grab bag"},{"speaker":"Chris Dy","startTime":563.82,"endTime":566.94,"body":"session and we welcome any"},{"speaker":"Chris Dy","startTime":566.94,"endTime":570.0,"body":"questions, feel free to post"},{"speaker":"Chris Dy","startTime":566.94,"endTime":570.0,"body":"them on social leave them in a"},{"speaker":"Chris Dy","startTime":570.0,"endTime":575.43,"body":"review or send it to us at"},{"speaker":"Chris Dy","startTime":570.0,"endTime":575.43,"body":"handpodcast@gmail.com. But in"},{"speaker":"Chris Dy","startTime":575.43,"endTime":578.7,"body":"lieu of a listener posted"},{"speaker":"Chris Dy","startTime":575.43,"endTime":578.7,"body":"question, I'd like to ask Chuck"},{"speaker":"Chris Dy","startTime":578.7,"endTime":580.92,"body":"to share the Goldfarb pearl of"},{"speaker":"Chris Dy","startTime":578.7,"endTime":580.92,"body":"the week."},{"speaker":"Charles Goldfarb","startTime":581.59,"endTime":582.79,"body":"Yeah, so"},{"speaker":"Charles Goldfarb","startTime":581.59,"endTime":582.79,"body":"here's my pearl of the week"},{"speaker":"Charles Goldfarb","startTime":582.79,"endTime":585.34,"body":"which has been a question but"},{"speaker":"Charles Goldfarb","startTime":582.79,"endTime":585.34,"body":"not an official submitted"},{"speaker":"Charles Goldfarb","startTime":585.34,"endTime":588.88,"body":"question. But you know, there's"},{"speaker":"Charles Goldfarb","startTime":585.34,"endTime":588.88,"body":"a lot in the literature and this"},{"speaker":"Charles Goldfarb","startTime":588.88,"endTime":591.37,"body":"is a little controversial, but"},{"speaker":"Charles Goldfarb","startTime":588.88,"endTime":591.37,"body":"I'm going to share my personal"},{"speaker":"Charles Goldfarb","startTime":591.37,"endTime":593.2,"body":"beliefs. There's a lot in the"},{"speaker":"Charles Goldfarb","startTime":591.37,"endTime":593.2,"body":"literature about the"},{"speaker":"Charles Goldfarb","startTime":593.26,"endTime":596.92,"body":"percutaneous treatment of"},{"speaker":"Charles Goldfarb","startTime":593.26,"endTime":596.92,"body":"scaphoid fractures, and some of"},{"speaker":"Charles Goldfarb","startTime":596.92,"endTime":600.55,"body":"that it relates to Joe Slade and"},{"speaker":"Charles Goldfarb","startTime":596.92,"endTime":600.55,"body":"his groundbreaking work he did"},{"speaker":"Charles Goldfarb","startTime":601.81,"endTime":605.71,"body":"many years ago regarding the"},{"speaker":"Charles Goldfarb","startTime":601.81,"endTime":605.71,"body":"treatment of scaphoid fractures."},{"speaker":"Charles Goldfarb","startTime":606.07,"endTime":609.31,"body":"And I know that there are plenty"},{"speaker":"Charles Goldfarb","startTime":606.07,"endTime":609.31,"body":"of people out there, I believe"},{"speaker":"Charles Goldfarb","startTime":609.31,"endTime":613.48,"body":"that still do percutaneous"},{"speaker":"Charles Goldfarb","startTime":609.31,"endTime":613.48,"body":"scaphoids. And so I will just"},{"speaker":"Charles Goldfarb","startTime":613.51,"endTime":617.11,"body":"say that I don't like it. I"},{"speaker":"Charles Goldfarb","startTime":613.51,"endTime":617.11,"body":"don't do it. I don't think it's"},{"speaker":"Charles Goldfarb","startTime":617.11,"endTime":620.02,"body":"the right thing to do for a"},{"speaker":"Charles Goldfarb","startTime":617.11,"endTime":620.02,"body":"couple of reasons. First of all,"},{"speaker":"Charles Goldfarb","startTime":620.26,"endTime":623.08,"body":"whether you go dorsal or volar,"},{"speaker":"Charles Goldfarb","startTime":620.26,"endTime":623.08,"body":"we know that there are tendons"},{"speaker":"Charles Goldfarb","startTime":623.11,"endTime":627.49,"body":"in play for certain, and perhaps"},{"speaker":"Charles Goldfarb","startTime":623.11,"endTime":627.49,"body":"cutaneous nerves. And the other"},{"speaker":"Charles Goldfarb","startTime":627.49,"endTime":630.55,"body":"reason I don't do it is because"},{"speaker":"Charles Goldfarb","startTime":627.49,"endTime":630.55,"body":"we can make such a small"},{"speaker":"Charles Goldfarb","startTime":630.55,"endTime":634.78,"body":"incision, especially for a"},{"speaker":"Charles Goldfarb","startTime":630.55,"endTime":634.78,"body":"dorsal approach, and really know"},{"speaker":"Charles Goldfarb","startTime":634.78,"endTime":638.59,"body":"exactly what we're seeing, keep"},{"speaker":"Charles Goldfarb","startTime":634.78,"endTime":638.59,"body":"the important stuff safe, and"},{"speaker":"Charles Goldfarb","startTime":638.62,"endTime":641.74,"body":"really put the K wire starting"},{"speaker":"Charles Goldfarb","startTime":638.62,"endTime":641.74,"body":"point exactly where it needs to"},{"speaker":"Charles Goldfarb","startTime":641.74,"endTime":646.93,"body":"be. So the morbidity is minimal."},{"speaker":"Charles Goldfarb","startTime":641.74,"endTime":646.93,"body":"And the precision for the"},{"speaker":"Charles Goldfarb","startTime":646.93,"endTime":651.28,"body":"surgery is so great when we do a"},{"speaker":"Charles Goldfarb","startTime":646.93,"endTime":651.28,"body":"little mini open. So my pearl of"},{"speaker":"Charles Goldfarb","startTime":651.28,"endTime":653.23,"body":"the week is really just an"},{"speaker":"Charles Goldfarb","startTime":651.28,"endTime":653.23,"body":"opinion of the week, but I"},{"speaker":"Charles Goldfarb","startTime":653.23,"endTime":656.35,"body":"really like a mini open rather"},{"speaker":"Charles Goldfarb","startTime":653.23,"endTime":656.35,"body":"than, and by mini open I mean, a"},{"speaker":"Charles Goldfarb","startTime":656.35,"endTime":659.89,"body":"centimeter and a half, rather"},{"speaker":"Charles Goldfarb","startTime":656.35,"endTime":659.89,"body":"than a percutaneous treatment of"},{"speaker":"Charles Goldfarb","startTime":659.89,"endTime":661.96,"body":"a scaphoid fracture. Does that"},{"speaker":"Charles Goldfarb","startTime":659.89,"endTime":661.96,"body":"resonate?"},{"speaker":"Chris Dy","startTime":662.71,"endTime":664.57,"body":"Yeah, I think to"},{"speaker":"Chris Dy","startTime":662.71,"endTime":664.57,"body":"summarize, you know,"},{"speaker":"Chris Dy","startTime":664.57,"endTime":667.57,"body":"percutaneous scaphoid fracture"},{"speaker":"Chris Dy","startTime":664.57,"endTime":667.57,"body":"fixation in my book would be"},{"speaker":"Chris Dy","startTime":667.6,"endTime":673.27,"body":"it's all good until it's not."},{"speaker":"Chris Dy","startTime":667.6,"endTime":673.27,"body":"Because it might work well, lots"},{"speaker":"Chris Dy","startTime":673.27,"endTime":675.7,"body":"of times. But you know, there"},{"speaker":"Chris Dy","startTime":673.27,"endTime":675.7,"body":"can be some potentially"},{"speaker":"Chris Dy","startTime":675.7,"endTime":679.45,"body":"devastating issues. And I hope"},{"speaker":"Chris Dy","startTime":675.7,"endTime":679.45,"body":"that a listener feels strongly"},{"speaker":"Chris Dy","startTime":679.45,"endTime":681.58,"body":"about this and wants to prove"},{"speaker":"Chris Dy","startTime":679.45,"endTime":681.58,"body":"Chuck wrong. That could be"},{"speaker":"Chris Dy","startTime":681.58,"endTime":685.0,"body":"another recurring segment, prove"},{"speaker":"Chris Dy","startTime":681.58,"endTime":685.0,"body":"Chuck and Chris wrong. We would"},{"speaker":"Chris Dy","startTime":685.0,"endTime":685.81,"body":"welcome that."},{"speaker":"Charles Goldfarb","startTime":686.26,"endTime":687.85,"body":"Yeah, that"},{"speaker":"Charles Goldfarb","startTime":686.26,"endTime":687.85,"body":"would be great. That'd be great."},{"speaker":"Charles Goldfarb","startTime":687.85,"endTime":690.49,"body":"And you can certainly take a"},{"speaker":"Charles Goldfarb","startTime":687.85,"endTime":690.49,"body":"first stab at that over Twitter."},{"speaker":"Charles Goldfarb","startTime":690.7,"endTime":694.0,"body":"And I think Chris and I are"},{"speaker":"Charles Goldfarb","startTime":690.7,"endTime":694.0,"body":"delving a little bit into"},{"speaker":"Charles Goldfarb","startTime":694.0,"endTime":697.42,"body":"Instagram. I'm a, I've always"},{"speaker":"Charles Goldfarb","startTime":694.0,"endTime":697.42,"body":"been on Instagram. Not always,"},{"speaker":"Charles Goldfarb","startTime":697.42,"endTime":699.91,"body":"but I've been on Instagram for a"},{"speaker":"Charles Goldfarb","startTime":697.42,"endTime":699.91,"body":"while, but just as a passive"},{"speaker":"Charles Goldfarb","startTime":699.91,"endTime":704.95,"body":"observer, and I've started a new"},{"speaker":"Charles Goldfarb","startTime":699.91,"endTime":704.95,"body":"account. And for my congenital"},{"speaker":"Charles Goldfarb","startTime":704.95,"endTime":708.64,"body":"work, but I you know, now I"},{"speaker":"Charles Goldfarb","startTime":704.95,"endTime":708.64,"body":"think Chris has as well. And so,"},{"speaker":"Charles Goldfarb","startTime":708.85,"endTime":712.99,"body":"you know, I think we might need"},{"speaker":"Charles Goldfarb","startTime":708.85,"endTime":712.99,"body":"to make an upper hand Instagram"},{"speaker":"Charles Goldfarb","startTime":713.26,"endTime":713.98,"body":"account. What do you think?"},{"speaker":"Chris Dy","startTime":713.98,"endTime":715.93,"body":"We've been gently"},{"speaker":"Chris Dy","startTime":713.98,"endTime":715.93,"body":"prodding our social media"},{"speaker":"Chris Dy","startTime":715.93,"endTime":717.4,"body":"director to do that."},{"speaker":"Charles Goldfarb","startTime":717.55,"endTime":719.44,"body":"I think I"},{"speaker":"Charles Goldfarb","startTime":717.55,"endTime":719.44,"body":"think it'll be easier. I think"},{"speaker":"Charles Goldfarb","startTime":719.44,"endTime":721.87,"body":"it's really easy to do, given"},{"speaker":"Charles Goldfarb","startTime":719.44,"endTime":721.87,"body":"you can link the two but yeah,"},{"speaker":"Charles Goldfarb","startTime":721.87,"endTime":723.7,"body":"maybe I don't know, we haven't"},{"speaker":"Charles Goldfarb","startTime":721.87,"endTime":723.7,"body":"talked about that. I'm not"},{"speaker":"Charles Goldfarb","startTime":723.7,"endTime":725.38,"body":"trying to put any pressure on"},{"speaker":"Charles Goldfarb","startTime":723.7,"endTime":725.38,"body":"you. You have a few things on"},{"speaker":"Charles Goldfarb","startTime":725.38,"endTime":725.83,"body":"your plate."},{"speaker":"Chris Dy","startTime":726.1,"endTime":728.41,"body":"Also. Chuck, you are"},{"speaker":"Chris Dy","startTime":726.1,"endTime":728.41,"body":"on the gram, you are"},{"speaker":"Chris Dy","startTime":728.89,"endTime":730.21,"body":"@thecongenitalhand. Is that"},{"speaker":"Chris Dy","startTime":728.89,"endTime":730.21,"body":"right?"},{"speaker":"Charles Goldfarb","startTime":730.48,"endTime":732.4,"body":"Yeah. So I"},{"speaker":"Charles Goldfarb","startTime":730.48,"endTime":732.4,"body":"couldn't just do congenital"},{"speaker":"Charles Goldfarb","startTime":732.4,"endTime":735.55,"body":"hand, which is my Twitter"},{"speaker":"Charles Goldfarb","startTime":732.4,"endTime":735.55,"body":"handle. So it's the congenital"},{"speaker":"Charles Goldfarb","startTime":735.55,"endTime":735.94,"body":"hand"},{"speaker":"Chris Dy","startTime":736.0,"endTime":738.7,"body":"because there're so"},{"speaker":"Chris Dy","startTime":736.0,"endTime":738.7,"body":"many people out there dying to"},{"speaker":"Chris Dy","startTime":738.73,"endTime":741.49,"body":"share content about congenital"},{"speaker":"Chris Dy","startTime":738.73,"endTime":741.49,"body":"hands. I mean, you know."},{"speaker":"Charles Goldfarb","startTime":741.7,"endTime":745.03,"body":"It's a huge"},{"speaker":"Charles Goldfarb","startTime":741.7,"endTime":745.03,"body":"area of interest on on every"},{"speaker":"Charles Goldfarb","startTime":745.03,"endTime":746.17,"body":"social media platform."},{"speaker":"Chris Dy","startTime":746.54,"endTime":750.62,"body":"Yes, so I have. I have"},{"speaker":"Chris Dy","startTime":746.54,"endTime":750.62,"body":"rejoined because a wise older"},{"speaker":"Chris Dy","startTime":750.62,"endTime":754.46,"body":"partner of mine told us that"},{"speaker":"Chris Dy","startTime":750.62,"endTime":754.46,"body":"Instagram is where, you know,"},{"speaker":"Chris Dy","startTime":754.88,"endTime":758.18,"body":"the younger trainees are"},{"speaker":"Chris Dy","startTime":754.88,"endTime":758.18,"body":"flocking to. And honestly, our"},{"speaker":"Chris Dy","startTime":758.18,"endTime":761.09,"body":"listener survey suggests that"},{"speaker":"Chris Dy","startTime":758.18,"endTime":761.09,"body":"people that listen to the"},{"speaker":"Chris Dy","startTime":761.09,"endTime":764.87,"body":"podcast are even younger than"},{"speaker":"Chris Dy","startTime":761.09,"endTime":764.87,"body":"me. So reluctantly, I have"},{"speaker":"Chris Dy","startTime":764.87,"endTime":769.31,"body":"dusted off my Instagram account"},{"speaker":"Chris Dy","startTime":764.87,"endTime":769.31,"body":"after four years of inactivity"},{"speaker":"Chris Dy","startTime":769.88,"endTime":773.99,"body":"in the name of our podcast and"},{"speaker":"Chris Dy","startTime":769.88,"endTime":773.99,"body":"promoting some of our some of"},{"speaker":"Chris Dy","startTime":773.99,"endTime":775.49,"body":"our fellowship material. So."},{"speaker":"Charles Goldfarb","startTime":775.79,"endTime":777.77,"body":"And I saw your"},{"speaker":"Charles Goldfarb","startTime":775.79,"endTime":777.77,"body":"post from this morning a little"},{"speaker":"Charles Goldfarb","startTime":777.77,"endTime":779.06,"body":"Christmas tree farming."},{"speaker":"Chris Dy","startTime":779.51,"endTime":781.94,"body":"Yeah, you know, we it"},{"speaker":"Chris Dy","startTime":779.51,"endTime":781.94,"body":"was it was more of a, you know,"},{"speaker":"Chris Dy","startTime":781.94,"endTime":785.78,"body":"a photo opportunity. You know,"},{"speaker":"Chris Dy","startTime":781.94,"endTime":785.78,"body":"nothing quite like family"},{"speaker":"Chris Dy","startTime":785.78,"endTime":789.65,"body":"photos. I didn't I managed to"},{"speaker":"Chris Dy","startTime":785.78,"endTime":789.65,"body":"avoid sharing a picture of"},{"speaker":"Chris Dy","startTime":789.65,"endTime":792.35,"body":"myself in those wonderful"},{"speaker":"Chris Dy","startTime":789.65,"endTime":792.35,"body":"Christmas tree pajamas. You'll"},{"speaker":"Chris Dy","startTime":792.35,"endTime":794.75,"body":"have to wait with bated breath"},{"speaker":"Chris Dy","startTime":792.35,"endTime":794.75,"body":"for that one."},{"speaker":"Charles Goldfarb","startTime":794.81,"endTime":797.57,"body":"Oh, god please"},{"speaker":"Charles Goldfarb","startTime":794.81,"endTime":797.57,"body":"no, just leave it with the kids."},{"speaker":"Chris Dy","startTime":799.46,"endTime":801.53,"body":"I figured that, you"},{"speaker":"Chris Dy","startTime":799.46,"endTime":801.53,"body":"know, you got to give the people"},{"speaker":"Chris Dy","startTime":801.53,"endTime":802.46,"body":"what they want. So"},{"speaker":"Charles Goldfarb","startTime":802.52,"endTime":804.65,"body":"Yeah what we,"},{"speaker":"Charles Goldfarb","startTime":802.52,"endTime":804.65,"body":"don't give us what we don't"},{"speaker":"Charles Goldfarb","startTime":804.65,"endTime":804.98,"body":"want."},{"speaker":"Chris Dy","startTime":805.34,"endTime":808.88,"body":"It might break"},{"speaker":"Chris Dy","startTime":805.34,"endTime":808.88,"body":"Instagram. So that's kind of why"},{"speaker":"Chris Dy","startTime":808.88,"endTime":809.75,"body":"I held back. So"},{"speaker":"Charles Goldfarb","startTime":810.5,"endTime":811.31,"body":"Viral"},{"speaker":"Chris Dy","startTime":811.52,"endTime":812.48,"body":"Viral the wrong way."},{"speaker":"Charles Goldfarb","startTime":813.68,"endTime":818.18,"body":"Alright, well,"},{"speaker":"Charles Goldfarb","startTime":813.68,"endTime":818.18,"body":"let's jump into the technical"},{"speaker":"Charles Goldfarb","startTime":818.57,"endTime":821.84,"body":"part of distal radius fractures."},{"speaker":"Charles Goldfarb","startTime":818.57,"endTime":821.84,"body":"And we ended our last episode"},{"speaker":"Charles Goldfarb","startTime":821.84,"endTime":825.08,"body":"talking about some of the"},{"speaker":"Charles Goldfarb","startTime":821.84,"endTime":825.08,"body":"indications of treatment of a"},{"speaker":"Charles Goldfarb","startTime":825.08,"endTime":827.69,"body":"distal radius fracture from a"},{"speaker":"Charles Goldfarb","startTime":825.08,"endTime":827.69,"body":"volar approach. But let's, if"},{"speaker":"Charles Goldfarb","startTime":827.69,"endTime":830.03,"body":"it's okay with you. Let's jump"},{"speaker":"Charles Goldfarb","startTime":827.69,"endTime":830.03,"body":"right into the how we do it."},{"speaker":"Chris Dy","startTime":831.02,"endTime":833.09,"body":"Yeah, so what we can"},{"speaker":"Chris Dy","startTime":831.02,"endTime":833.09,"body":"do is, um, you know, kind of"},{"speaker":"Chris Dy","startTime":833.09,"endTime":836.3,"body":"gently prod each other on the"},{"speaker":"Chris Dy","startTime":833.09,"endTime":836.3,"body":"fine details, you know, like we"},{"speaker":"Chris Dy","startTime":836.3,"endTime":839.39,"body":"were, you know, like you were a"},{"speaker":"Chris Dy","startTime":836.3,"endTime":839.39,"body":"resident and working with, with"},{"speaker":"Chris Dy","startTime":839.39,"endTime":842.0,"body":"one of us kind of asking, Why"},{"speaker":"Chris Dy","startTime":839.39,"endTime":842.0,"body":"exactly, do you do the things"},{"speaker":"Chris Dy","startTime":842.0,"endTime":842.3,"body":"you do?"},{"speaker":"Charles Goldfarb","startTime":843.62,"endTime":845.42,"body":"All right."},{"speaker":"Charles Goldfarb","startTime":843.62,"endTime":845.42,"body":"What Why don't we start with"},{"speaker":"Charles Goldfarb","startTime":845.45,"endTime":848.45,"body":"your approach? How do you think"},{"speaker":"Charles Goldfarb","startTime":845.45,"endTime":848.45,"body":"about your approach? Do you"},{"speaker":"Charles Goldfarb","startTime":848.45,"endTime":851.18,"body":"cross the wrist crease? How do"},{"speaker":"Charles Goldfarb","startTime":848.45,"endTime":851.18,"body":"you address the palmar cutaneous"},{"speaker":"Charles Goldfarb","startTime":851.18,"endTime":853.94,"body":"branch? How do you address the"},{"speaker":"Charles Goldfarb","startTime":851.18,"endTime":853.94,"body":"FCR tendons? So how did you get"},{"speaker":"Charles Goldfarb","startTime":853.94,"endTime":854.93,"body":"down to the radius."},{"speaker":"Chris Dy","startTime":855.65,"endTime":858.56,"body":"So I make a skin"},{"speaker":"Chris Dy","startTime":855.65,"endTime":858.56,"body":"incision over the volar aspect"},{"speaker":"Chris Dy","startTime":858.56,"endTime":862.1,"body":"of the distal forearm centered"},{"speaker":"Chris Dy","startTime":858.56,"endTime":862.1,"body":"over the FCR. And you can"},{"speaker":"Chris Dy","startTime":862.1,"endTime":866.06,"body":"typically palpate that and"},{"speaker":"Chris Dy","startTime":862.1,"endTime":866.06,"body":"sometimes see it and skinnier"},{"speaker":"Chris Dy","startTime":866.06,"endTime":870.44,"body":"patients. Skin incision directly"},{"speaker":"Chris Dy","startTime":866.06,"endTime":870.44,"body":"over that, and then I will"},{"speaker":"Chris Dy","startTime":870.47,"endTime":875.09,"body":"identify the volar FCR sheath,"},{"speaker":"Chris Dy","startTime":870.47,"endTime":875.09,"body":"divide that sheath, retract the"},{"speaker":"Chris Dy","startTime":875.09,"endTime":879.86,"body":"FCR tendon in the midline, or"},{"speaker":"Chris Dy","startTime":875.09,"endTime":879.86,"body":"ulnar direction and divide the"},{"speaker":"Chris Dy","startTime":879.86,"endTime":883.31,"body":"dorsal FCR sheath acknowledging"},{"speaker":"Chris Dy","startTime":879.86,"endTime":883.31,"body":"the fact that you need to keep"},{"speaker":"Chris Dy","startTime":883.34,"endTime":886.82,"body":"in, in line with the in situ c"},{"speaker":"Chris Dy","startTime":883.34,"endTime":886.82,"body":"urse of the FCR not the r"},{"speaker":"Chris Dy","startTime":886.82,"endTime":889.34,"body":"tracted course because if you d"},{"speaker":"Chris Dy","startTime":886.82,"endTime":889.34,"body":", you're going to get a little t"},{"speaker":"Chris Dy","startTime":889.34,"endTime":891.32,"body":"o close to the palmer c"},{"speaker":"Chris Dy","startTime":889.34,"endTime":891.32,"body":"taneous branch in the median n"},{"speaker":"Chris Dy","startTime":891.32,"endTime":894.02,"body":"rve. I know there are a number o"},{"speaker":"Chris Dy","startTime":891.32,"endTime":894.02,"body":"studies demonstrating that y"},{"speaker":"Chris Dy","startTime":895.1,"endTime":898.25,"body":"u know that palmar cutaneous b"},{"speaker":"Chris Dy","startTime":895.1,"endTime":898.25,"body":"anch can either be within that s"},{"speaker":"Chris Dy","startTime":898.25,"endTime":900.23,"body":"eath or even a little bit r"},{"speaker":"Chris Dy","startTime":898.25,"endTime":900.23,"body":"dial to the sheath. So you a"},{"speaker":"Chris Dy","startTime":900.23,"endTime":904.55,"body":"ways have to look out for it b"},{"speaker":"Chris Dy","startTime":900.23,"endTime":904.55,"body":"cause injury to that nerve can b"},{"speaker":"Chris Dy","startTime":904.55,"endTime":907.64,"body":", can be devastating in some c"},{"speaker":"Chris Dy","startTime":904.55,"endTime":907.64,"body":"ses, and honestly, just a"},{"speaker":"Chris Dy","startTime":907.64,"endTime":910.49,"body":"noying in many others. How do y"},{"speaker":"Chris Dy","startTime":907.64,"endTime":910.49,"body":"u do it from there?"},{"speaker":"Charles Goldfarb","startTime":911.02,"endTime":912.97,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":911.02,"endTime":912.97,"body":"I would, I would echo two"},{"speaker":"Charles Goldfarb","startTime":912.97,"endTime":915.94,"body":"points. First, let's talk"},{"speaker":"Charles Goldfarb","startTime":912.97,"endTime":915.94,"body":"briefly about the palmar"},{"speaker":"Charles Goldfarb","startTime":915.94,"endTime":919.15,"body":"cutaneous branch, there's two"},{"speaker":"Charles Goldfarb","startTime":915.94,"endTime":919.15,"body":"studies that look at that. The"},{"speaker":"Charles Goldfarb","startTime":919.15,"endTime":922.84,"body":"first was by a former fellow of"},{"speaker":"Charles Goldfarb","startTime":919.15,"endTime":922.84,"body":"ours, Kevin Lutsky, with his"},{"speaker":"Charles Goldfarb","startTime":922.84,"endTime":926.44,"body":"group in Philadelphia. And that"},{"speaker":"Charles Goldfarb","startTime":922.84,"endTime":926.44,"body":"was, I think, the first paper"},{"speaker":"Charles Goldfarb","startTime":926.44,"endTime":929.56,"body":"that really emphasize it, hey,"},{"speaker":"Charles Goldfarb","startTime":926.44,"endTime":929.56,"body":"if you're going through the FCR"},{"speaker":"Charles Goldfarb","startTime":929.56,"endTime":932.53,"body":"sheet, be aware that the palmar"},{"speaker":"Charles Goldfarb","startTime":929.56,"endTime":932.53,"body":"cutaneous branch and median"},{"speaker":"Charles Goldfarb","startTime":932.53,"endTime":936.76,"body":"nerve can be on top of, can be"},{"speaker":"Charles Goldfarb","startTime":932.53,"endTime":936.76,"body":"in, or can be directly beneath"},{"speaker":"Charles Goldfarb","startTime":936.76,"endTime":941.08,"body":"the FCR tendon. And there's a"},{"speaker":"Charles Goldfarb","startTime":936.76,"endTime":941.08,"body":"more recent study by the folks"},{"speaker":"Charles Goldfarb","startTime":941.08,"endTime":943.78,"body":"from New York, Luke Catalano and"},{"speaker":"Charles Goldfarb","startTime":941.08,"endTime":943.78,"body":"Steve Glickel, and Alton Barron"},{"speaker":"Charles Goldfarb","startTime":943.78,"endTime":946.63,"body":"which really highlighted the"},{"speaker":"Charles Goldfarb","startTime":943.78,"endTime":946.63,"body":"same thing. And so I the"},{"speaker":"Charles Goldfarb","startTime":946.63,"endTime":949.51,"body":"message, there is clear, if"},{"speaker":"Charles Goldfarb","startTime":946.63,"endTime":949.51,"body":"you're going to do anything with"},{"speaker":"Charles Goldfarb","startTime":949.51,"endTime":953.77,"body":"the FCR tendon, you, you cannot"},{"speaker":"Charles Goldfarb","startTime":949.51,"endTime":953.77,"body":"do it blindly or wildly, you"},{"speaker":"Charles Goldfarb","startTime":953.77,"endTime":955.09,"body":"have to be aware of that nerve."},{"speaker":"Chris Dy","startTime":955.499,"endTime":958.289,"body":"So do you go looking"},{"speaker":"Chris Dy","startTime":955.499,"endTime":958.289,"body":"for that nerve? Or do you just"},{"speaker":"Chris Dy","startTime":958.319,"endTime":960.929,"body":"say, you know, look for it in"},{"speaker":"Chris Dy","startTime":958.319,"endTime":960.929,"body":"the field? And if we don't see"},{"speaker":"Chris Dy","startTime":960.929,"endTime":961.589,"body":"it great."},{"speaker":"Charles Goldfarb","startTime":963.37,"endTime":964.9,"body":"Yeah, I"},{"speaker":"Charles Goldfarb","startTime":963.37,"endTime":964.9,"body":"typically look for it in the"},{"speaker":"Charles Goldfarb","startTime":964.9,"endTime":967.36,"body":"field. Although if there's"},{"speaker":"Charles Goldfarb","startTime":964.9,"endTime":967.36,"body":"something about the patient that"},{"speaker":"Charles Goldfarb","startTime":967.36,"endTime":970.12,"body":"makes me particularly concerned,"},{"speaker":"Charles Goldfarb","startTime":967.36,"endTime":970.12,"body":"or if I want to show the anatomy"},{"speaker":"Charles Goldfarb","startTime":970.12,"endTime":972.82,"body":"to a resident, it's really two"},{"speaker":"Charles Goldfarb","startTime":970.12,"endTime":972.82,"body":"spreads of the scissors. And I"},{"speaker":"Charles Goldfarb","startTime":972.82,"endTime":975.34,"body":"think the key is, it's five"},{"speaker":"Charles Goldfarb","startTime":972.82,"endTime":975.34,"body":"centimeters proximal to the"},{"speaker":"Charles Goldfarb","startTime":975.34,"endTime":978.61,"body":"wrist crease, typically where"},{"speaker":"Charles Goldfarb","startTime":975.34,"endTime":978.61,"body":"you can find it most easily at"},{"speaker":"Charles Goldfarb","startTime":978.61,"endTime":981.55,"body":"the branch point. And it's"},{"speaker":"Charles Goldfarb","startTime":978.61,"endTime":981.55,"body":"really not hard to find. And"},{"speaker":"Charles Goldfarb","startTime":981.55,"endTime":983.8,"body":"once you find it, it's easier to"},{"speaker":"Charles Goldfarb","startTime":981.55,"endTime":983.8,"body":"keep it safe. But I don't make"},{"speaker":"Charles Goldfarb","startTime":983.8,"endTime":984.52,"body":"that a routine."},{"speaker":"Chris Dy","startTime":985.08,"endTime":987.54,"body":"Yeah, yeah. And"},{"speaker":"Chris Dy","startTime":985.08,"endTime":987.54,"body":"sometimes one of the things I"},{"speaker":"Chris Dy","startTime":987.54,"endTime":990.36,"body":"like to emphasize to the"},{"speaker":"Chris Dy","startTime":987.54,"endTime":990.36,"body":"residents who are rotating with"},{"speaker":"Chris Dy","startTime":990.39,"endTime":993.03,"body":"us who are not going into hand"},{"speaker":"Chris Dy","startTime":990.39,"endTime":993.03,"body":"is that look, there are certain"},{"speaker":"Chris Dy","startTime":993.03,"endTime":995.91,"body":"structures that you are going to"},{"speaker":"Chris Dy","startTime":993.03,"endTime":995.91,"body":"encounter on call either as a"},{"speaker":"Chris Dy","startTime":995.91,"endTime":999.69,"body":"resident or as an attending,"},{"speaker":"Chris Dy","startTime":995.91,"endTime":999.69,"body":"that you need to know how to"},{"speaker":"Chris Dy","startTime":999.69,"endTime":1003.26,"body":"find things quickly. So you"},{"speaker":"Chris Dy","startTime":999.69,"endTime":1003.26,"body":"know, you need to know how to"},{"speaker":"Chris Dy","startTime":1003.26,"endTime":1006.02,"body":"find the median nerve quickly."},{"speaker":"Chris Dy","startTime":1003.26,"endTime":1006.02,"body":"And at that level, it is yep,"},{"speaker":"Chris Dy","startTime":1006.02,"endTime":1009.89,"body":"subcutaneous. So it's good to"},{"speaker":"Chris Dy","startTime":1006.02,"endTime":1009.89,"body":"show that to them, and then show"},{"speaker":"Chris Dy","startTime":1009.89,"endTime":1012.2,"body":"them where that palmar cutaneous"},{"speaker":"Chris Dy","startTime":1009.89,"endTime":1012.2,"body":"branch is coming off of the"},{"speaker":"Chris Dy","startTime":1012.2,"endTime":1015.44,"body":"radial side of the median nerve."},{"speaker":"Chris Dy","startTime":1012.2,"endTime":1015.44,"body":"And like you said, If you choose"},{"speaker":"Chris Dy","startTime":1015.44,"endTime":1017.81,"body":"to go find it, it is a couple of"},{"speaker":"Chris Dy","startTime":1015.44,"endTime":1017.81,"body":"spreads of the tenotomies, and"},{"speaker":"Chris Dy","startTime":1017.81,"endTime":1019.58,"body":"it's a good thing to"},{"speaker":"Chris Dy","startTime":1017.81,"endTime":1019.58,"body":"demonstrate."},{"speaker":"Charles Goldfarb","startTime":1020.12,"endTime":1022.76,"body":"Yeah, and the"},{"speaker":"Charles Goldfarb","startTime":1020.12,"endTime":1022.76,"body":"second thing is, I really"},{"speaker":"Charles Goldfarb","startTime":1022.76,"endTime":1028.16,"body":"dislike crossing the wrist"},{"speaker":"Charles Goldfarb","startTime":1022.76,"endTime":1028.16,"body":"crease. So it's easy enough to"},{"speaker":"Charles Goldfarb","startTime":1028.16,"endTime":1030.65,"body":"cross the wrist crease and go"},{"speaker":"Charles Goldfarb","startTime":1028.16,"endTime":1030.65,"body":"over the thenar eminence. And"},{"speaker":"Charles Goldfarb","startTime":1030.65,"endTime":1035.06,"body":"certainly I do that, you know,"},{"speaker":"Charles Goldfarb","startTime":1030.65,"endTime":1035.06,"body":"clearly, we do that with volar"},{"speaker":"Charles Goldfarb","startTime":1035.06,"endTime":1037.73,"body":"approach to the scaphoid. But"},{"speaker":"Charles Goldfarb","startTime":1035.06,"endTime":1037.73,"body":"anytime you cross that wrist"},{"speaker":"Charles Goldfarb","startTime":1037.73,"endTime":1039.8,"body":"crease, even if you do it at an"},{"speaker":"Charles Goldfarb","startTime":1037.73,"endTime":1039.8,"body":"angle, which of course you"},{"speaker":"Charles Goldfarb","startTime":1039.8,"endTime":1043.01,"body":"should to minimize the risk of"},{"speaker":"Charles Goldfarb","startTime":1039.8,"endTime":1043.01,"body":"significant scarring and a"},{"speaker":"Charles Goldfarb","startTime":1043.01,"endTime":1047.03,"body":"contracture, it just causes pain"},{"speaker":"Charles Goldfarb","startTime":1043.01,"endTime":1047.03,"body":"and a slower recovery. And the"},{"speaker":"Charles Goldfarb","startTime":1047.03,"endTime":1050.63,"body":"same holds on the ulnar side of"},{"speaker":"Charles Goldfarb","startTime":1047.03,"endTime":1050.63,"body":"the wrist. If I'm decompressing,"},{"speaker":"Charles Goldfarb","startTime":1050.63,"endTime":1053.51,"body":"which I rarely do. But if I'm"},{"speaker":"Charles Goldfarb","startTime":1050.63,"endTime":1053.51,"body":"decompressing the distal ulnar"},{"speaker":"Charles Goldfarb","startTime":1053.51,"endTime":1056.3,"body":"tunnel, I really don't like to"},{"speaker":"Charles Goldfarb","startTime":1053.51,"endTime":1056.3,"body":"cross the wrist crease there"},{"speaker":"Charles Goldfarb","startTime":1056.3,"endTime":1059.6,"body":"either. I just think that's"},{"speaker":"Charles Goldfarb","startTime":1056.3,"endTime":1059.6,"body":"really important to me. Although"},{"speaker":"Charles Goldfarb","startTime":1059.6,"endTime":1060.74,"body":"if you have to do it, you have"},{"speaker":"Charles Goldfarb","startTime":1059.6,"endTime":1060.74,"body":"to do it."},{"speaker":"Chris Dy","startTime":1061.35,"endTime":1063.75,"body":"Yeah. And that that"},{"speaker":"Chris Dy","startTime":1061.35,"endTime":1063.75,"body":"does tend to be an area of"},{"speaker":"Chris Dy","startTime":1063.78,"endTime":1069.12,"body":"painful and prominent scars. You"},{"speaker":"Chris Dy","startTime":1063.78,"endTime":1069.12,"body":"know, for example, if you are"},{"speaker":"Chris Dy","startTime":1069.12,"endTime":1072.15,"body":"crossing the wrist crease for"},{"speaker":"Chris Dy","startTime":1069.12,"endTime":1072.15,"body":"even an extended carpal tunnel,"},{"speaker":"Chris Dy","startTime":1072.81,"endTime":1076.5,"body":"even taking it at a zigzag to"},{"speaker":"Chris Dy","startTime":1072.81,"endTime":1076.5,"body":"avoid crossing it perpendicular"},{"speaker":"Chris Dy","startTime":1076.5,"endTime":1078.96,"body":"and to keep yourself away from"},{"speaker":"Chris Dy","startTime":1076.5,"endTime":1078.96,"body":"the palmar cutaneous branch."},{"speaker":"Chris Dy","startTime":1079.23,"endTime":1082.29,"body":"That is the area that patients"},{"speaker":"Chris Dy","startTime":1079.23,"endTime":1082.29,"body":"will complain about. And then"},{"speaker":"Chris Dy","startTime":1082.29,"endTime":1085.95,"body":"with regards to the approach for"},{"speaker":"Chris Dy","startTime":1082.29,"endTime":1085.95,"body":"distal radius fracture, you"},{"speaker":"Chris Dy","startTime":1085.95,"endTime":1089.01,"body":"know, if you are that distal,"},{"speaker":"Chris Dy","startTime":1085.95,"endTime":1089.01,"body":"you do need to be mindful of the"},{"speaker":"Chris Dy","startTime":1089.01,"endTime":1092.73,"body":"palmar branch or the radial"},{"speaker":"Chris Dy","startTime":1089.01,"endTime":1092.73,"body":"artery coming over the FCR if"},{"speaker":"Chris Dy","startTime":1092.73,"endTime":1098.19,"body":"you are getting that distal. So"},{"speaker":"Chris Dy","startTime":1092.73,"endTime":1098.19,"body":"how do you how do you then"},{"speaker":"Chris Dy","startTime":1098.19,"endTime":1101.61,"body":"proceed deep to that after"},{"speaker":"Chris Dy","startTime":1098.19,"endTime":1101.61,"body":"you've gotten the dorsal FCR"},{"speaker":"Chris Dy","startTime":1101.61,"endTime":1102.39,"body":"sheath divided?"},{"speaker":"Charles Goldfarb","startTime":1103.74,"endTime":1107.46,"body":"I typically"},{"speaker":"Charles Goldfarb","startTime":1103.74,"endTime":1107.46,"body":"retract the FCR tendon radially."},{"speaker":"Charles Goldfarb","startTime":1107.49,"endTime":1110.4,"body":"Although People always ask Can"},{"speaker":"Charles Goldfarb","startTime":1107.49,"endTime":1110.4,"body":"you retract it ulnarly, of"},{"speaker":"Charles Goldfarb","startTime":1110.4,"endTime":1112.65,"body":"course you can, it doesn't"},{"speaker":"Charles Goldfarb","startTime":1110.4,"endTime":1112.65,"body":"really matter to me which way we"},{"speaker":"Charles Goldfarb","startTime":1112.65,"endTime":1115.71,"body":"retract it. Sometimes it lends"},{"speaker":"Charles Goldfarb","startTime":1112.65,"endTime":1115.71,"body":"itself one direction or another,"},{"speaker":"Charles Goldfarb","startTime":1115.8,"endTime":1119.4,"body":"but I typically retract it"},{"speaker":"Charles Goldfarb","startTime":1115.8,"endTime":1119.4,"body":"radially. And then I use a"},{"speaker":"Charles Goldfarb","startTime":1119.43,"endTime":1125.85,"body":"finger or a raytech to elevate"},{"speaker":"Charles Goldfarb","startTime":1119.43,"endTime":1125.85,"body":"the soft tissues, including the"},{"speaker":"Charles Goldfarb","startTime":1125.88,"endTime":1130.11,"body":"FPL tendon and sometimes the FPL"},{"speaker":"Charles Goldfarb","startTime":1125.88,"endTime":1130.11,"body":"muscle belly to expose expose"},{"speaker":"Charles Goldfarb","startTime":1130.11,"endTime":1135.24,"body":"the pronator quadratus. And then"},{"speaker":"Charles Goldfarb","startTime":1130.11,"endTime":1135.24,"body":"from there, I tend to make a"},{"speaker":"Charles Goldfarb","startTime":1135.24,"endTime":1140.13,"body":"linear or longitudinal incision"},{"speaker":"Charles Goldfarb","startTime":1135.24,"endTime":1140.13,"body":"in the pronator quadratus,"},{"speaker":"Charles Goldfarb","startTime":1140.13,"endTime":1143.22,"body":"leaving a little cuff on the"},{"speaker":"Charles Goldfarb","startTime":1140.13,"endTime":1143.22,"body":"radial side for potential"},{"speaker":"Charles Goldfarb","startTime":1143.22,"endTime":1147.45,"body":"repair. And then I use Hohmann"},{"speaker":"Charles Goldfarb","startTime":1143.22,"endTime":1147.45,"body":"retractors from there. I don't"},{"speaker":"Charles Goldfarb","startTime":1147.45,"endTime":1151.68,"body":"make an L shaped incision in the"},{"speaker":"Charles Goldfarb","startTime":1147.45,"endTime":1151.68,"body":"pronator. I just haven't found"},{"speaker":"Charles Goldfarb","startTime":1151.68,"endTime":1155.04,"body":"that necessary. I tried to"},{"speaker":"Charles Goldfarb","startTime":1151.68,"endTime":1155.04,"body":"elevate the pronator sub"},{"speaker":"Charles Goldfarb","startTime":1155.22,"endTime":1159.15,"body":"periosteally if there's"},{"speaker":"Charles Goldfarb","startTime":1155.22,"endTime":1159.15,"body":"periosteum available, and then I"},{"speaker":"Charles Goldfarb","startTime":1159.15,"endTime":1162.45,"body":"use Hohmann retractors, as I"},{"speaker":"Charles Goldfarb","startTime":1159.15,"endTime":1162.45,"body":"said, How do you approach the"},{"speaker":"Charles Goldfarb","startTime":1162.45,"endTime":1163.59,"body":"deep the deeper side?"},{"speaker":"Chris Dy","startTime":1164.29,"endTime":1167.38,"body":"So I'll typically pull"},{"speaker":"Chris Dy","startTime":1164.29,"endTime":1167.38,"body":"the FCR tendon and retract it"},{"speaker":"Chris Dy","startTime":1167.5,"endTime":1172.48,"body":"ulnarly. So I almost always do"},{"speaker":"Chris Dy","startTime":1167.5,"endTime":1172.48,"body":"it that way. I can't remember"},{"speaker":"Chris Dy","startTime":1172.48,"endTime":1174.97,"body":"one where I went radially"},{"speaker":"Chris Dy","startTime":1172.48,"endTime":1174.97,"body":"although that question does come"},{"speaker":"Chris Dy","startTime":1174.97,"endTime":1178.99,"body":"up. I'll then take a Freer"},{"speaker":"Chris Dy","startTime":1174.97,"endTime":1178.99,"body":"elevator and then use that to"},{"speaker":"Chris Dy","startTime":1178.99,"endTime":1183.07,"body":"dissect to the radial aspect of"},{"speaker":"Chris Dy","startTime":1178.99,"endTime":1183.07,"body":"the shaft of the radius and then"},{"speaker":"Chris Dy","startTime":1183.07,"endTime":1185.65,"body":"replace that with a Hohmann"},{"speaker":"Chris Dy","startTime":1183.07,"endTime":1185.65,"body":"retractor that I parked there"},{"speaker":"Chris Dy","startTime":1185.65,"endTime":1187.66,"body":"and that allows me to retract"},{"speaker":"Chris Dy","startTime":1185.65,"endTime":1187.66,"body":"the radial artery out of the"},{"speaker":"Chris Dy","startTime":1187.66,"endTime":1193.27,"body":"way. So with that placed, I then"},{"speaker":"Chris Dy","startTime":1187.66,"endTime":1193.27,"body":"take a raytech around my finger"},{"speaker":"Chris Dy","startTime":1193.27,"endTime":1195.94,"body":"and bluntly dissect the long"},{"speaker":"Chris Dy","startTime":1193.27,"endTime":1195.94,"body":"flexors off of the pronator"},{"speaker":"Chris Dy","startTime":1195.94,"endTime":1199.06,"body":"quadratus and replace that with"},{"speaker":"Chris Dy","startTime":1195.94,"endTime":1199.06,"body":"an Army Navy type retractor,"},{"speaker":"Chris Dy","startTime":1199.06,"endTime":1201.73,"body":"reminding whoever's doing the"},{"speaker":"Chris Dy","startTime":1199.06,"endTime":1201.73,"body":"retracting that you're pulling"},{"speaker":"Chris Dy","startTime":1201.73,"endTime":1205.39,"body":"on the median nerve as well. So"},{"speaker":"Chris Dy","startTime":1201.73,"endTime":1205.39,"body":"be mindful of that. And then for"},{"speaker":"Chris Dy","startTime":1205.39,"endTime":1207.67,"body":"the pronator quadratus, I mean,"},{"speaker":"Chris Dy","startTime":1205.39,"endTime":1207.67,"body":"I'd like your thoughts on this,"},{"speaker":"Chris Dy","startTime":1207.67,"endTime":1211.12,"body":"I kind of go back and forth in"},{"speaker":"Chris Dy","startTime":1207.67,"endTime":1211.12,"body":"terms of when pronator quadratus"},{"speaker":"Chris Dy","startTime":1211.12,"endTime":1214.96,"body":"repair is indicated if ever, if"},{"speaker":"Chris Dy","startTime":1211.12,"endTime":1214.96,"body":"it is a situation in which I"},{"speaker":"Chris Dy","startTime":1214.96,"endTime":1219.01,"body":"think I'm going to repair the"},{"speaker":"Chris Dy","startTime":1214.96,"endTime":1219.01,"body":"pronator quadratus, I will"},{"speaker":"Chris Dy","startTime":1219.22,"endTime":1223.18,"body":"divide the brachioradialis"},{"speaker":"Chris Dy","startTime":1219.22,"endTime":1223.18,"body":"tendon longitudinally, so"},{"speaker":"Chris Dy","startTime":1223.18,"endTime":1226.72,"body":"splitting it longitudinally"},{"speaker":"Chris Dy","startTime":1223.18,"endTime":1226.72,"body":"along the radial shaft of the"},{"speaker":"Chris Dy","startTime":1226.72,"endTime":1229.39,"body":"radius. And then that'll allow"},{"speaker":"Chris Dy","startTime":1226.72,"endTime":1229.39,"body":"me to A, release to"},{"speaker":"Chris Dy","startTime":1229.39,"endTime":1232.87,"body":"brachioradialis, but then I can"},{"speaker":"Chris Dy","startTime":1229.39,"endTime":1232.87,"body":"then take that volar limb of the"},{"speaker":"Chris Dy","startTime":1232.87,"endTime":1235.99,"body":"BR and elevate it with the"},{"speaker":"Chris Dy","startTime":1232.87,"endTime":1235.99,"body":"pronator quadratus. So at the"},{"speaker":"Chris Dy","startTime":1235.99,"endTime":1239.23,"body":"end of the case, if I wanted to"},{"speaker":"Chris Dy","startTime":1235.99,"endTime":1239.23,"body":"repair it, I have a more"},{"speaker":"Chris Dy","startTime":1239.23,"endTime":1244.0,"body":"reliable tendon cuff on the"},{"speaker":"Chris Dy","startTime":1239.23,"endTime":1244.0,"body":"pronator quadratus to put back"},{"speaker":"Chris Dy","startTime":1244.0,"endTime":1244.69,"body":"if I wanted to."},{"speaker":"Charles Goldfarb","startTime":1245.41,"endTime":1247.42,"body":"That's super"},{"speaker":"Charles Goldfarb","startTime":1245.41,"endTime":1247.42,"body":"interesting. Couple of comments."},{"speaker":"Charles Goldfarb","startTime":1247.42,"endTime":1251.05,"body":"First, I appreciate your comment"},{"speaker":"Charles Goldfarb","startTime":1247.42,"endTime":1251.05,"body":"about avoiding over retraction"},{"speaker":"Charles Goldfarb","startTime":1251.05,"endTime":1254.23,"body":"on the median nerve. I will"},{"speaker":"Charles Goldfarb","startTime":1251.05,"endTime":1254.23,"body":"remember early early in my"},{"speaker":"Charles Goldfarb","startTime":1254.23,"endTime":1258.16,"body":"career. So we're talking 2003,"},{"speaker":"Charles Goldfarb","startTime":1254.23,"endTime":1258.16,"body":"2004, when I first started doing"},{"speaker":"Charles Goldfarb","startTime":1258.16,"endTime":1262.12,"body":"this procedure, that I am guilty"},{"speaker":"Charles Goldfarb","startTime":1258.16,"endTime":1262.12,"body":"of having over retracted on a"},{"speaker":"Charles Goldfarb","startTime":1262.12,"endTime":1266.23,"body":"patient's median nerve and crps"},{"speaker":"Charles Goldfarb","startTime":1262.12,"endTime":1266.23,"body":"developed, and that scarred me"},{"speaker":"Charles Goldfarb","startTime":1266.23,"endTime":1269.02,"body":"as it should have. And I've been"},{"speaker":"Charles Goldfarb","startTime":1266.23,"endTime":1269.02,"body":"super careful of that ever"},{"speaker":"Charles Goldfarb","startTime":1269.02,"endTime":1272.41,"body":"since. And I hope the listeners,"},{"speaker":"Charles Goldfarb","startTime":1269.02,"endTime":1272.41,"body":"especially younger listeners"},{"speaker":"Charles Goldfarb","startTime":1272.41,"endTime":1276.79,"body":"will never have that happen to"},{"speaker":"Charles Goldfarb","startTime":1272.41,"endTime":1276.79,"body":"them. Second of all, it's"},{"speaker":"Charles Goldfarb","startTime":1276.79,"endTime":1279.1,"body":"interesting what you say about"},{"speaker":"Charles Goldfarb","startTime":1276.79,"endTime":1279.1,"body":"repairing the pronator, I tend"},{"speaker":"Charles Goldfarb","startTime":1279.1,"endTime":1282.19,"body":"to repair the pronator if it's"},{"speaker":"Charles Goldfarb","startTime":1279.1,"endTime":1282.19,"body":"easy to repair, and if it's easy"},{"speaker":"Charles Goldfarb","startTime":1282.19,"endTime":1285.34,"body":"to repair, I don't need the"},{"speaker":"Charles Goldfarb","startTime":1282.19,"endTime":1285.34,"body":"assistance of the BR to do that."},{"speaker":"Charles Goldfarb","startTime":1285.34,"endTime":1288.97,"body":"And so I'm repairing fascia to"},{"speaker":"Charles Goldfarb","startTime":1285.34,"endTime":1288.97,"body":"fascia, I think is just for me"},{"speaker":"Charles Goldfarb","startTime":1288.97,"endTime":1293.17,"body":"I, putting a couple of monocle"},{"speaker":"Charles Goldfarb","startTime":1288.97,"endTime":1293.17,"body":"sutures in is easy when it comes"},{"speaker":"Charles Goldfarb","startTime":1293.17,"endTime":1296.08,"body":"together nicely. I don't think"},{"speaker":"Charles Goldfarb","startTime":1293.17,"endTime":1296.08,"body":"it's necessary because I don't"},{"speaker":"Charles Goldfarb","startTime":1296.08,"endTime":1299.47,"body":"really think it protects against"},{"speaker":"Charles Goldfarb","startTime":1296.08,"endTime":1299.47,"body":"future tendon issues. Because"},{"speaker":"Charles Goldfarb","startTime":1299.47,"endTime":1302.74,"body":"the part of the plate that sits"},{"speaker":"Charles Goldfarb","startTime":1299.47,"endTime":1302.74,"body":"distal to the pronator is the"},{"speaker":"Charles Goldfarb","startTime":1302.74,"endTime":1305.5,"body":"part of the plate that's going"},{"speaker":"Charles Goldfarb","startTime":1302.74,"endTime":1305.5,"body":"to cause the problem. So I'll do"},{"speaker":"Charles Goldfarb","startTime":1305.5,"endTime":1309.25,"body":"it if it's easy. And if it comes"},{"speaker":"Charles Goldfarb","startTime":1305.5,"endTime":1309.25,"body":"together nicely, I don't think"},{"speaker":"Charles Goldfarb","startTime":1309.25,"endTime":1311.89,"body":"patients lose anything when we"},{"speaker":"Charles Goldfarb","startTime":1309.25,"endTime":1311.89,"body":"don't do that repair."},{"speaker":"Chris Dy","startTime":1312.37,"endTime":1314.17,"body":"That brings up a good"},{"speaker":"Chris Dy","startTime":1312.37,"endTime":1314.17,"body":"point. I mean, so what is the"},{"speaker":"Chris Dy","startTime":1314.17,"endTime":1316.99,"body":"part of the plate and this will"},{"speaker":"Chris Dy","startTime":1314.17,"endTime":1316.99,"body":"be manufacturer dependent and as"},{"speaker":"Chris Dy","startTime":1316.99,"endTime":1319.63,"body":"well as physician dependent, you"},{"speaker":"Chris Dy","startTime":1316.99,"endTime":1319.63,"body":"know, where you put the plate,"},{"speaker":"Chris Dy","startTime":1319.63,"endTime":1324.01,"body":"but I typically find that it's"},{"speaker":"Chris Dy","startTime":1319.63,"endTime":1324.01,"body":"that distal row on the radial,"},{"speaker":"Chris Dy","startTime":1324.01,"endTime":1327.7,"body":"you know the too radial, most"},{"speaker":"Chris Dy","startTime":1324.01,"endTime":1327.7,"body":"distal row screws, if you have,"},{"speaker":"Chris Dy","startTime":1327.79,"endTime":1331.3,"body":"you know, either the plate too"},{"speaker":"Chris Dy","startTime":1327.79,"endTime":1331.3,"body":"distal, or you have prominent"},{"speaker":"Chris Dy","startTime":1331.3,"endTime":1333.55,"body":"screw heads because they haven't"},{"speaker":"Chris Dy","startTime":1331.3,"endTime":1333.55,"body":"locked into the locking"},{"speaker":"Chris Dy","startTime":1333.55,"endTime":1336.34,"body":"mechanism. Well, that's the area"},{"speaker":"Chris Dy","startTime":1333.55,"endTime":1336.34,"body":"of the plate that is going to"},{"speaker":"Chris Dy","startTime":1336.34,"endTime":1340.84,"body":"potentially cause FPL and other"},{"speaker":"Chris Dy","startTime":1336.34,"endTime":1340.84,"body":"flexor tendon issues, and that"},{"speaker":"Chris Dy","startTime":1340.84,"endTime":1344.71,"body":"is the part of the plate that"},{"speaker":"Chris Dy","startTime":1340.84,"endTime":1344.71,"body":"you want covered. If any part of"},{"speaker":"Chris Dy","startTime":1344.71,"endTime":1345.04,"body":"the plate."},{"speaker":"Charles Goldfarb","startTime":1345.82,"endTime":1349.03,"body":"Yeah, the"},{"speaker":"Charles Goldfarb","startTime":1345.82,"endTime":1349.03,"body":"manufacturer you know, I've for"},{"speaker":"Charles Goldfarb","startTime":1349.03,"endTime":1351.82,"body":"many years, I have said that,"},{"speaker":"Charles Goldfarb","startTime":1349.03,"endTime":1351.82,"body":"you know, the plates are very,"},{"speaker":"Charles Goldfarb","startTime":1351.82,"endTime":1354.55,"body":"very similar. And clearly"},{"speaker":"Charles Goldfarb","startTime":1351.82,"endTime":1354.55,"body":"they're very similar, but there"},{"speaker":"Charles Goldfarb","startTime":1354.55,"endTime":1361.81,"body":"are differences. And I prefer a"},{"speaker":"Charles Goldfarb","startTime":1354.55,"endTime":1361.81,"body":"thin plate. And I prefer a plate"},{"speaker":"Charles Goldfarb","startTime":1361.84,"endTime":1367.57,"body":"that I don't like the plates"},{"speaker":"Charles Goldfarb","startTime":1361.84,"endTime":1367.57,"body":"that have a big angle volarly,"},{"speaker":"Charles Goldfarb","startTime":1367.57,"endTime":1370.36,"body":"you know, going from straight to"},{"speaker":"Charles Goldfarb","startTime":1367.57,"endTime":1370.36,"body":"angled volarly because at the"},{"speaker":"Charles Goldfarb","startTime":1370.36,"endTime":1373.09,"body":"morphology the distal radius is"},{"speaker":"Charles Goldfarb","startTime":1370.36,"endTime":1373.09,"body":"somewhat variable. And I think"},{"speaker":"Charles Goldfarb","startTime":1373.09,"endTime":1376.81,"body":"the one principle I have is"},{"speaker":"Charles Goldfarb","startTime":1373.09,"endTime":1376.81,"body":"unless the fracture really calls"},{"speaker":"Charles Goldfarb","startTime":1376.81,"endTime":1380.2,"body":"for it, don't go distal to the"},{"speaker":"Charles Goldfarb","startTime":1376.81,"endTime":1380.2,"body":"watershed line. And so the"},{"speaker":"Charles Goldfarb","startTime":1380.2,"endTime":1383.35,"body":"pronator comes right up adjacent"},{"speaker":"Charles Goldfarb","startTime":1380.2,"endTime":1383.35,"body":"to the watershed line definitely"},{"speaker":"Charles Goldfarb","startTime":1383.35,"endTime":1385.66,"body":"doesn't cross the watershed"},{"speaker":"Charles Goldfarb","startTime":1383.35,"endTime":1385.66,"body":"lines, and there's a gap between"},{"speaker":"Charles Goldfarb","startTime":1385.66,"endTime":1388.63,"body":"them or sometimes the pronator"},{"speaker":"Charles Goldfarb","startTime":1385.66,"endTime":1388.63,"body":"is right at the watershed. And I"},{"speaker":"Charles Goldfarb","startTime":1388.63,"endTime":1391.54,"body":"think avoiding going distal to"},{"speaker":"Charles Goldfarb","startTime":1388.63,"endTime":1391.54,"body":"that is the key. And you're"},{"speaker":"Charles Goldfarb","startTime":1391.54,"endTime":1394.39,"body":"right. When screws sit nicely"},{"speaker":"Charles Goldfarb","startTime":1391.54,"endTime":1394.39,"body":"into the plate, it makes it"},{"speaker":"Charles Goldfarb","startTime":1394.39,"endTime":1400.09,"body":"easier to remove the screw"},{"speaker":"Charles Goldfarb","startTime":1394.39,"endTime":1400.09,"body":"issue. But it's tricky. And I"},{"speaker":"Charles Goldfarb","startTime":1400.09,"endTime":1402.88,"body":"think there are benefits to"},{"speaker":"Charles Goldfarb","startTime":1400.09,"endTime":1402.88,"body":"certain plates at certain times."},{"speaker":"Charles Goldfarb","startTime":1402.88,"endTime":1406.57,"body":"I'm not sold on any of them"},{"speaker":"Charles Goldfarb","startTime":1402.88,"endTime":1406.57,"body":"necessarily or or against any of"},{"speaker":"Charles Goldfarb","startTime":1406.57,"endTime":1409.66,"body":"them necessarily. But the plate"},{"speaker":"Charles Goldfarb","startTime":1406.57,"endTime":1409.66,"body":"matters."},{"speaker":"Chris Dy","startTime":1410.86,"endTime":1413.53,"body":"Yeah, I agree. And,"},{"speaker":"Chris Dy","startTime":1410.86,"endTime":1413.53,"body":"you know, one interesting study"},{"speaker":"Chris Dy","startTime":1413.53,"endTime":1417.01,"body":"that I read as part of this JBJS"},{"speaker":"Chris Dy","startTime":1413.53,"endTime":1417.01,"body":"update was one study that looked"},{"speaker":"Chris Dy","startTime":1417.01,"endTime":1421.06,"body":"at the actual kind of volar"},{"speaker":"Chris Dy","startTime":1417.01,"endTime":1421.06,"body":"cortical angle of the distal"},{"speaker":"Chris Dy","startTime":1421.06,"endTime":1424.18,"body":"radius in an uninjured distal"},{"speaker":"Chris Dy","startTime":1421.06,"endTime":1424.18,"body":"radius setting. And there's a"},{"speaker":"Chris Dy","startTime":1424.18,"endTime":1428.68,"body":"wide range that you have there."},{"speaker":"Chris Dy","startTime":1424.18,"endTime":1428.68,"body":"And that range exceeds what most"},{"speaker":"Chris Dy","startTime":1428.68,"endTime":1432.91,"body":"manufacturer's plates have. So"},{"speaker":"Chris Dy","startTime":1428.68,"endTime":1432.91,"body":"there are situations which many"},{"speaker":"Chris Dy","startTime":1432.91,"endTime":1436.75,"body":"of us use the plate as a"},{"speaker":"Chris Dy","startTime":1432.91,"endTime":1436.75,"body":"reduction guide. And that can be"},{"speaker":"Chris Dy","startTime":1436.75,"endTime":1439.24,"body":"a little bit tricky. If the"},{"speaker":"Chris Dy","startTime":1436.75,"endTime":1439.24,"body":"plate doesn't match the"},{"speaker":"Chris Dy","startTime":1439.24,"endTime":1442.18,"body":"patient's physiologic anatomy,"},{"speaker":"Chris Dy","startTime":1439.24,"endTime":1442.18,"body":"or they've already had a dis"},{"speaker":"Chris Dy","startTime":1442.18,"endTime":1444.82,"body":"radius fracture and have"},{"speaker":"Chris Dy","startTime":1442.18,"endTime":1444.82,"body":"refractured and all your markers"},{"speaker":"Chris Dy","startTime":1444.82,"endTime":1447.43,"body":"are off there. I think that's"},{"speaker":"Chris Dy","startTime":1444.82,"endTime":1447.43,"body":"where sometimes we can get in"},{"speaker":"Chris Dy","startTime":1447.43,"endTime":1452.26,"body":"trouble is if we don't endeavor"},{"speaker":"Chris Dy","startTime":1447.43,"endTime":1452.26,"body":"to get a, almost a reduction you"},{"speaker":"Chris Dy","startTime":1452.26,"endTime":1455.29,"body":"exactly want from the get go and"},{"speaker":"Chris Dy","startTime":1452.26,"endTime":1455.29,"body":"then you rely on the plate to"},{"speaker":"Chris Dy","startTime":1455.29,"endTime":1455.77,"body":"help you."},{"speaker":"Charles Goldfarb","startTime":1456.7,"endTime":1458.38,"body":"Right. And"},{"speaker":"Charles Goldfarb","startTime":1456.7,"endTime":1458.38,"body":"that, of course is the danger of"},{"speaker":"Charles Goldfarb","startTime":1458.38,"endTime":1461.02,"body":"just using a standard volar"},{"speaker":"Charles Goldfarb","startTime":1458.38,"endTime":1461.02,"body":"plate rather than a fragment"},{"speaker":"Charles Goldfarb","startTime":1461.02,"endTime":1463.93,"body":"specific play, which we can talk"},{"speaker":"Charles Goldfarb","startTime":1461.02,"endTime":1463.93,"body":"about. And I have traditionally"},{"speaker":"Charles Goldfarb","startTime":1463.93,"endTime":1466.39,"body":"been a person who likes the"},{"speaker":"Charles Goldfarb","startTime":1463.93,"endTime":1466.39,"body":"volar plate for almost every"},{"speaker":"Charles Goldfarb","startTime":1466.39,"endTime":1470.29,"body":"distal radius fracture. I don't"},{"speaker":"Charles Goldfarb","startTime":1466.39,"endTime":1470.29,"body":"do fragment specific fixation"},{"speaker":"Charles Goldfarb","startTime":1470.29,"endTime":1473.68,"body":"very often, but I will obviously"},{"speaker":"Charles Goldfarb","startTime":1470.29,"endTime":1473.68,"body":"and I will go dorsal sometimes,"},{"speaker":"Charles Goldfarb","startTime":1474.07,"endTime":1479.05,"body":"but you're right, I think"},{"speaker":"Charles Goldfarb","startTime":1474.07,"endTime":1479.05,"body":"depending on the hardware can be"},{"speaker":"Charles Goldfarb","startTime":1479.05,"endTime":1482.83,"body":"helpful and can make osteotomies"},{"speaker":"Charles Goldfarb","startTime":1479.05,"endTime":1482.83,"body":"you know, more straightforward,"},{"speaker":"Charles Goldfarb","startTime":1483.07,"endTime":1486.25,"body":"but for a fracture itself. I"},{"speaker":"Charles Goldfarb","startTime":1483.07,"endTime":1486.25,"body":"don't like necessarily to depend"},{"speaker":"Charles Goldfarb","startTime":1486.25,"endTime":1490.75,"body":"on the hardware as much. You"},{"speaker":"Charles Goldfarb","startTime":1486.25,"endTime":1490.75,"body":"know, easier said than done, but"},{"speaker":"Charles Goldfarb","startTime":1490.75,"endTime":1494.2,"body":"I don't I don't like to depend"},{"speaker":"Charles Goldfarb","startTime":1490.75,"endTime":1494.2,"body":"on it. So do you as a matter of"},{"speaker":"Charles Goldfarb","startTime":1494.2,"endTime":1496.99,"body":"routine release the"},{"speaker":"Charles Goldfarb","startTime":1494.2,"endTime":1496.99,"body":"brachioradialis tendon at the"},{"speaker":"Charles Goldfarb","startTime":1496.99,"endTime":1498.13,"body":"floor of the first compartment?"},{"speaker":"Chris Dy","startTime":1499.48,"endTime":1501.61,"body":"Not as a matter"},{"speaker":"Chris Dy","startTime":1499.48,"endTime":1501.61,"body":"routine if I know, you know,"},{"speaker":"Chris Dy","startTime":1501.61,"endTime":1505.15,"body":"there's a lot of shortening on"},{"speaker":"Chris Dy","startTime":1501.61,"endTime":1505.15,"body":"the initial x rays. You know, if"},{"speaker":"Chris Dy","startTime":1505.15,"endTime":1507.79,"body":"I think that that's going to be"},{"speaker":"Chris Dy","startTime":1505.15,"endTime":1507.79,"body":"something that's gonna hold us"},{"speaker":"Chris Dy","startTime":1507.79,"endTime":1510.25,"body":"back, I have a low threshold to"},{"speaker":"Chris Dy","startTime":1507.79,"endTime":1510.25,"body":"release it. But I would say it's"},{"speaker":"Chris Dy","startTime":1510.25,"endTime":1513.1,"body":"probably one out of 10 times,"},{"speaker":"Chris Dy","startTime":1510.25,"endTime":1513.1,"body":"sometimes I just want to show"},{"speaker":"Chris Dy","startTime":1513.1,"endTime":1515.35,"body":"the anatomy of the"},{"speaker":"Chris Dy","startTime":1513.1,"endTime":1515.35,"body":"brachioradialis to the trainee,"},{"speaker":"Chris Dy","startTime":1515.47,"endTime":1517.18,"body":"and then we'll release it along"},{"speaker":"Chris Dy","startTime":1515.47,"endTime":1517.18,"body":"the way."},{"speaker":"Charles Goldfarb","startTime":1517.96,"endTime":1520.03,"body":"Yeah, I see it"},{"speaker":"Charles Goldfarb","startTime":1517.96,"endTime":1520.03,"body":"the same way you do. And"},{"speaker":"Charles Goldfarb","startTime":1520.03,"endTime":1522.97,"body":"certainly some of our partners"},{"speaker":"Charles Goldfarb","startTime":1520.03,"endTime":1522.97,"body":"always release it, just like"},{"speaker":"Charles Goldfarb","startTime":1522.97,"endTime":1526.45,"body":"they never repair the BR, I'm"},{"speaker":"Charles Goldfarb","startTime":1522.97,"endTime":1526.45,"body":"sorry, never repair the pronator"},{"speaker":"Charles Goldfarb","startTime":1526.45,"endTime":1530.74,"body":"quadratus, but I'm a little"},{"speaker":"Charles Goldfarb","startTime":1526.45,"endTime":1530.74,"body":"flexible there, I will release"},{"speaker":"Charles Goldfarb","startTime":1530.74,"endTime":1534.79,"body":"it, especially if I'm struggling"},{"speaker":"Charles Goldfarb","startTime":1530.74,"endTime":1534.79,"body":"with the styloid fragment, if"},{"speaker":"Charles Goldfarb","startTime":1534.79,"endTime":1537.79,"body":"it's a separate fragment,"},{"speaker":"Charles Goldfarb","startTime":1534.79,"endTime":1537.79,"body":"obviously, if I'm considering a"},{"speaker":"Charles Goldfarb","startTime":1537.79,"endTime":1540.94,"body":"radial column plate, I would"},{"speaker":"Charles Goldfarb","startTime":1537.79,"endTime":1540.94,"body":"release it for exposure, but I"},{"speaker":"Charles Goldfarb","startTime":1540.94,"endTime":1542.35,"body":"don't make it a matter of"},{"speaker":"Charles Goldfarb","startTime":1540.94,"endTime":1542.35,"body":"routine."},{"speaker":"Chris Dy","startTime":1543.01,"endTime":1544.87,"body":"And it's also I think"},{"speaker":"Chris Dy","startTime":1543.01,"endTime":1544.87,"body":"it's a good landmark to have"},{"speaker":"Chris Dy","startTime":1544.87,"endTime":1547.81,"body":"sometimes, because if the"},{"speaker":"Chris Dy","startTime":1544.87,"endTime":1547.81,"body":"fractured fragment on that"},{"speaker":"Chris Dy","startTime":1547.81,"endTime":1552.22,"body":"radial side is rotated, or even"},{"speaker":"Chris Dy","startTime":1547.81,"endTime":1552.22,"body":"kind of pronator supinated, and"},{"speaker":"Chris Dy","startTime":1552.22,"endTime":1555.55,"body":"you're trying to put a radial"},{"speaker":"Chris Dy","startTime":1552.22,"endTime":1555.55,"body":"column plate on, having that"},{"speaker":"Chris Dy","startTime":1555.58,"endTime":1558.49,"body":"intact and looking at that flat"},{"speaker":"Chris Dy","startTime":1555.58,"endTime":1558.49,"body":"tendon can help you judge"},{"speaker":"Chris Dy","startTime":1558.52,"endTime":1561.64,"body":"rotational alignment. And also,"},{"speaker":"Chris Dy","startTime":1558.52,"endTime":1561.64,"body":"if you're trying to put a radial"},{"speaker":"Chris Dy","startTime":1561.64,"endTime":1564.22,"body":"column plate on, tells you kind"},{"speaker":"Chris Dy","startTime":1561.64,"endTime":1564.22,"body":"of where the flat surface or the"},{"speaker":"Chris Dy","startTime":1564.22,"endTime":1568.66,"body":"radial side of the radius is to"},{"speaker":"Chris Dy","startTime":1564.22,"endTime":1568.66,"body":"put the plate on. So it can be a"},{"speaker":"Chris Dy","startTime":1568.66,"endTime":1572.41,"body":"useful guide, but again, low"},{"speaker":"Chris Dy","startTime":1568.66,"endTime":1572.41,"body":"threshold to release it. So"},{"speaker":"Chris Dy","startTime":1572.41,"endTime":1575.77,"body":"question for you, how do you get"},{"speaker":"Chris Dy","startTime":1572.41,"endTime":1575.77,"body":"the reduction? So you know, a"},{"speaker":"Chris Dy","startTime":1575.77,"endTime":1579.52,"body":"lot of people do this"},{"speaker":"Chris Dy","startTime":1575.77,"endTime":1579.52,"body":"differently. Are you typically"},{"speaker":"Chris Dy","startTime":1580.84,"endTime":1584.38,"body":"lining it up, holding it there"},{"speaker":"Chris Dy","startTime":1580.84,"endTime":1584.38,"body":"and then having a plate placed?"},{"speaker":"Chris Dy","startTime":1584.41,"endTime":1587.8,"body":"Or are you using a K wire to"},{"speaker":"Chris Dy","startTime":1584.41,"endTime":1587.8,"body":"assist reduction? How do you do"},{"speaker":"Chris Dy","startTime":1587.8,"endTime":1588.16,"body":"that?"},{"speaker":"Charles Goldfarb","startTime":1588.14,"endTime":1590.09,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":1588.14,"endTime":1590.09,"body":"this is a great conversation"},{"speaker":"Charles Goldfarb","startTime":1589.92,"endTime":1667.8,"body":"How many times have you"},{"speaker":"Charles Goldfarb","startTime":1589.92,"endTime":1667.8,"body":"irradiated your thumb holding"},{"speaker":"Charles Goldfarb","startTime":1590.09,"endTime":1592.97,"body":"point we may see this somewhat"},{"speaker":"Charles Goldfarb","startTime":1590.09,"endTime":1592.97,"body":"differently. And obviously there"},{"speaker":"Charles Goldfarb","startTime":1592.97,"endTime":1595.79,"body":"are differences based on the"},{"speaker":"Charles Goldfarb","startTime":1592.97,"endTime":1595.79,"body":"type of fracture, but my routine"},{"speaker":"Charles Goldfarb","startTime":1595.79,"endTime":1600.98,"body":"is, is very much the same each"},{"speaker":"Charles Goldfarb","startTime":1595.79,"endTime":1600.98,"body":"case, I achieve a manual"},{"speaker":"Charles Goldfarb","startTime":1600.98,"endTime":1604.73,"body":"reduction, both through, first"},{"speaker":"Charles Goldfarb","startTime":1600.98,"endTime":1604.73,"body":"of all, you know irrigation. And"},{"speaker":"Charles Goldfarb","startTime":1604.73,"endTime":1606.98,"body":"if there's a big step off, you"},{"speaker":"Charles Goldfarb","startTime":1604.73,"endTime":1606.98,"body":"know, clean out the fracture"},{"speaker":"Charles Goldfarb","startTime":1606.98,"endTime":1610.94,"body":"site, but mainly manual"},{"speaker":"Charles Goldfarb","startTime":1606.98,"endTime":1610.94,"body":"reduction, including flexion of"},{"speaker":"Charles Goldfarb","startTime":1610.94,"endTime":1614.24,"body":"the wrist. Once I've done that,"},{"speaker":"Charles Goldfarb","startTime":1610.94,"endTime":1614.24,"body":"and I feel pretty good about"},{"speaker":"Charles Goldfarb","startTime":1614.24,"endTime":1618.14,"body":"what the volar cortex looks like"},{"speaker":"Charles Goldfarb","startTime":1614.24,"endTime":1618.14,"body":"I bring the C arm in, I contin"},{"speaker":"Charles Goldfarb","startTime":1618.14,"endTime":1621.71,"body":"e to flex the wrist and hold"},{"speaker":"Charles Goldfarb","startTime":1618.14,"endTime":1621.71,"body":"y thumb on the fracture, and I g"},{"speaker":"Charles Goldfarb","startTime":1621.71,"endTime":1625.64,"body":"t a C arm. Mainly looking"},{"speaker":"Charles Goldfarb","startTime":1621.71,"endTime":1625.64,"body":"t the lateral, I do an anatomi"},{"speaker":"Charles Goldfarb","startTime":1625.64,"endTime":1628.55,"body":"lateral view. So trying to"},{"speaker":"Charles Goldfarb","startTime":1625.64,"endTime":1628.55,"body":"atch the inclination of the dis"},{"speaker":"Charles Goldfarb","startTime":1628.55,"endTime":1631.58,"body":"al radius with my angle of the"},{"speaker":"Charles Goldfarb","startTime":1628.55,"endTime":1631.58,"body":"ray. And then I'll get one"},{"speaker":"Charles Goldfarb","startTime":1631.58,"endTime":1637.04,"body":"ry to get one, you know, PA view"},{"speaker":"Charles Goldfarb","startTime":1631.58,"endTime":1637.04,"body":"And then if I'm happy there, I"},{"speaker":"Charles Goldfarb","startTime":1637.04,"endTime":1641.24,"body":"slide the plate in leaving"},{"speaker":"Charles Goldfarb","startTime":1637.04,"endTime":1641.24,"body":"the wrist flexed. And my first"},{"speaker":"Charles Goldfarb","startTime":1641.24,"endTime":1643.52,"body":"crew goes in the sl"},{"speaker":"Charles Goldfarb","startTime":1641.24,"endTime":1643.52,"body":"ding hole proximally. So the"},{"speaker":"Charles Goldfarb","startTime":1643.52,"endTime":1647.84,"body":"bigger screws for mos"},{"speaker":"Charles Goldfarb","startTime":1643.52,"endTime":1647.84,"body":"plate manufacturers, and the"},{"speaker":"Charles Goldfarb","startTime":1647.84,"endTime":1650.9,"body":"I put one distal screw and"},{"speaker":"Charles Goldfarb","startTime":1647.84,"endTime":1650.9,"body":"again, variable based on fractur"},{"speaker":"Charles Goldfarb","startTime":1651.32,"endTime":1655.34,"body":"type. I don't like K wires,"},{"speaker":"Charles Goldfarb","startTime":1651.32,"endTime":1655.34,"body":"don't, nothing against K wires"},{"speaker":"Charles Goldfarb","startTime":1655.34,"endTime":1658.28,"body":"in this situation, but that's"},{"speaker":"Charles Goldfarb","startTime":1655.34,"endTime":1658.28,"body":"ust not my routine. So that's t"},{"speaker":"Charles Goldfarb","startTime":1658.31,"endTime":1661.97,"body":"e basic approach that I have usi"},{"speaker":"Charles Goldfarb","startTime":1658.31,"endTime":1661.97,"body":"g wrist flexion and the manual r"},{"speaker":"Charles Goldfarb","startTime":1662.15,"endTime":1663.47,"body":"duction as my ke"},{"speaker":"Charles Goldfarb","startTime":1667.8,"endTime":1671.58,"body":"that reduction the whole time? I"},{"speaker":"Charles Goldfarb","startTime":1667.8,"endTime":1671.58,"body":"say that but honestly it is a"},{"speaker":"Charles Goldfarb","startTime":1671.58,"endTime":1672.54,"body":"consideration, right?"},{"speaker":"Charles Goldfarb","startTime":1672.75,"endTime":1678.24,"body":"So, you know, I pass down a lot"},{"speaker":"Charles Goldfarb","startTime":1672.75,"endTime":1678.24,"body":"of surgery to trainees, one"},{"speaker":"Charles Goldfarb","startTime":1678.24,"endTime":1682.5,"body":"thing I never pass down is"},{"speaker":"Charles Goldfarb","startTime":1678.24,"endTime":1682.5,"body":"control the C arm. Because I"},{"speaker":"Charles Goldfarb","startTime":1682.5,"endTime":1686.46,"body":"think that is incredibly"},{"speaker":"Charles Goldfarb","startTime":1682.5,"endTime":1686.46,"body":"important and great imaging"},{"speaker":"Charles Goldfarb","startTime":1686.67,"endTime":1689.58,"body":"depends on having done it"},{"speaker":"Charles Goldfarb","startTime":1686.67,"endTime":1689.58,"body":"before. And so I control the"},{"speaker":"Charles Goldfarb","startTime":1689.58,"endTime":1692.34,"body":"imaging, I control my own"},{"speaker":"Charles Goldfarb","startTime":1689.58,"endTime":1692.34,"body":"radiation and I keep their hands"},{"speaker":"Charles Goldfarb","startTime":1692.34,"endTime":1694.71,"body":"away. And I think that serves"},{"speaker":"Charles Goldfarb","startTime":1692.34,"endTime":1694.71,"body":"many purposes, you know,"},{"speaker":"Charles Goldfarb","startTime":1694.71,"endTime":1698.94,"body":"including keeping their hands"},{"speaker":"Charles Goldfarb","startTime":1694.71,"endTime":1698.94,"body":"away. And I try to do one single"},{"speaker":"Charles Goldfarb","startTime":1698.94,"endTime":1702.93,"body":"shot for each picture and I do"},{"speaker":"Charles Goldfarb","startTime":1698.94,"endTime":1702.93,"body":"pretty well at that. But you're"},{"speaker":"Charles Goldfarb","startTime":1702.93,"endTime":1704.22,"body":"right I am radiating myself."},{"speaker":"Chris Dy","startTime":1704.48,"endTime":1709.46,"body":"So I when I started in"},{"speaker":"Chris Dy","startTime":1704.48,"endTime":1709.46,"body":"practice, you didn't give me any"},{"speaker":"Chris Dy","startTime":1709.46,"endTime":1715.01,"body":"trainees. So, I had to do things"},{"speaker":"Chris Dy","startTime":1709.46,"endTime":1715.01,"body":"myself. So, and also I saw this"},{"speaker":"Chris Dy","startTime":1715.01,"endTime":1717.38,"body":"was the way that I had seen a"},{"speaker":"Chris Dy","startTime":1715.01,"endTime":1717.38,"body":"lot of distal radius fractures"},{"speaker":"Chris Dy","startTime":1717.38,"endTime":1720.38,"body":"done in residency. So, I do like"},{"speaker":"Chris Dy","startTime":1717.38,"endTime":1720.38,"body":"using a K wire, but I do get a"},{"speaker":"Chris Dy","startTime":1720.38,"endTime":1723.53,"body":"manual reduction as you"},{"speaker":"Chris Dy","startTime":1720.38,"endTime":1723.53,"body":"mentioned, I think that the keys"},{"speaker":"Chris Dy","startTime":1723.53,"endTime":1728.72,"body":"for the manual reduction are as"},{"speaker":"Chris Dy","startTime":1723.53,"endTime":1728.72,"body":"you mentioned, you know flexing"},{"speaker":"Chris Dy","startTime":1728.72,"endTime":1731.54,"body":"your wrist, but first using"},{"speaker":"Chris Dy","startTime":1728.72,"endTime":1731.54,"body":"extension of the wrist to"},{"speaker":"Chris Dy","startTime":1731.54,"endTime":1736.55,"body":"disengage you disengage the"},{"speaker":"Chris Dy","startTime":1731.54,"endTime":1736.55,"body":"fragment using your thumb or"},{"speaker":"Chris Dy","startTime":1736.55,"endTime":1740.9,"body":"whatever instruments you want to"},{"speaker":"Chris Dy","startTime":1736.55,"endTime":1740.9,"body":"act as a lever arm and then"},{"speaker":"Chris Dy","startTime":1740.9,"endTime":1743.72,"body":"reducing their fracture holding"},{"speaker":"Chris Dy","startTime":1740.9,"endTime":1743.72,"body":"it flexed and then honestly"},{"speaker":"Chris Dy","startTime":1743.72,"endTime":1748.37,"body":"having whoever is on you know"},{"speaker":"Chris Dy","startTime":1743.72,"endTime":1748.37,"body":"able to do it, pull traction and"},{"speaker":"Chris Dy","startTime":1748.4,"endTime":1751.01,"body":"ulnarly deviate the wrist to"},{"speaker":"Chris Dy","startTime":1748.4,"endTime":1751.01,"body":"help get that length and"},{"speaker":"Chris Dy","startTime":1751.01,"endTime":1754.04,"body":"inclination restored. And then"},{"speaker":"Chris Dy","startTime":1751.01,"endTime":1754.04,"body":"while I am holding the"},{"speaker":"Chris Dy","startTime":1754.04,"endTime":1757.79,"body":"reduction, you know, for example"},{"speaker":"Chris Dy","startTime":1754.04,"endTime":1757.79,"body":"with my thumb and somebody else"},{"speaker":"Chris Dy","startTime":1757.79,"endTime":1761.96,"body":"is flexing the wrist, you know,"},{"speaker":"Chris Dy","startTime":1757.79,"endTime":1761.96,"body":"pulling traction and ulnarly"},{"speaker":"Chris Dy","startTime":1761.99,"endTime":1765.5,"body":"deviating I will put a"},{"speaker":"Chris Dy","startTime":1761.99,"endTime":1765.5,"body":"percutaneous wire on the,"},{"speaker":"Chris Dy","startTime":1765.8,"endTime":1773.18,"body":"through the radial styloid and"},{"speaker":"Chris Dy","startTime":1765.8,"endTime":1773.18,"body":"oblique retrograde angle, and"},{"speaker":"Chris Dy","startTime":1773.18,"endTime":1776.12,"body":"then on the far side enga"},{"speaker":"Chris Dy","startTime":1773.18,"endTime":1776.12,"body":"ing the metaphysis of the dista"},{"speaker":"Chris Dy","startTime":1776.12,"endTime":1779.24,"body":"radius across the fractur"},{"speaker":"Chris Dy","startTime":1776.12,"endTime":1779.24,"body":". Now I understand what you're"},{"speaker":"Chris Dy","startTime":1779.24,"endTime":1782.75,"body":"oing to say about the proximit"},{"speaker":"Chris Dy","startTime":1779.24,"endTime":1782.75,"body":"of the superficial radial n"},{"speaker":"Chris Dy","startTime":1782.75,"endTime":1786.56,"body":"rve and whether that's I know"},{"speaker":"Chris Dy","startTime":1782.75,"endTime":1786.56,"body":"ou were worried about it. But y"},{"speaker":"Chris Dy","startTime":1786.56,"endTime":1790.7,"body":"u know, I think that knowing the"},{"speaker":"Chris Dy","startTime":1786.56,"endTime":1790.7,"body":"pattern of the anatomy there, if"},{"speaker":"Chris Dy","startTime":1790.7,"endTime":1797.15,"body":"you are truly in on the radia"},{"speaker":"Chris Dy","startTime":1790.7,"endTime":1797.15,"body":"on the most radial aspect of"},{"speaker":"Chris Dy","startTime":1797.15,"endTime":1801.17,"body":"he styloid you should be dista"},{"speaker":"Chris Dy","startTime":1797.15,"endTime":1801.17,"body":"to the branch point of the sup"},{"speaker":"Chris Dy","startTime":1801.17,"endTime":1804.32,"body":"rficial radial nerve. And th"},{"speaker":"Chris Dy","startTime":1801.17,"endTime":1804.32,"body":"t is something that I worr"},{"speaker":"Chris Dy","startTime":1804.32,"endTime":1807.5,"body":"about getting burned on. B"},{"speaker":"Chris Dy","startTime":1804.32,"endTime":1807.5,"body":"t I found that having that re"},{"speaker":"Chris Dy","startTime":1807.5,"endTime":1809.0,"body":"uction held by the K wire fre"},{"speaker":"Charles Goldfarb","startTime":1809.0,"endTime":1810.77,"body":"I like a"},{"speaker":"Charles Goldfarb","startTime":1809.0,"endTime":1810.77,"body":"couple things you said a lot."},{"speaker":"Charles Goldfarb","startTime":1811.25,"endTime":1814.67,"body":"First of all, it is overly"},{"speaker":"Charles Goldfarb","startTime":1811.25,"endTime":1814.67,"body":"simplistic to think that you can"},{"speaker":"Charles Goldfarb","startTime":1814.67,"endTime":1817.76,"body":"flex the wrist and put dorsal"},{"speaker":"Charles Goldfarb","startTime":1814.67,"endTime":1817.76,"body":"pressure on the volar cortex"},{"speaker":"Charles Goldfarb","startTime":1817.76,"endTime":1820.49,"body":"with your thumb and obtain a"},{"speaker":"Charles Goldfarb","startTime":1817.76,"endTime":1820.49,"body":"reduction in every patient. So I"},{"speaker":"Charles Goldfarb","startTime":1820.49,"endTime":1824.27,"body":"like the concept of properly"},{"speaker":"Charles Goldfarb","startTime":1820.49,"endTime":1824.27,"body":"applied traction, and ulnar"},{"speaker":"Charles Goldfarb","startTime":1824.27,"endTime":1827.06,"body":"deviation. And those are really"},{"speaker":"Charles Goldfarb","startTime":1824.27,"endTime":1827.06,"body":"important steps. So thank you"},{"speaker":"Charles Goldfarb","startTime":1827.06,"endTime":1831.2,"body":"for mentioning those. Second of"},{"speaker":"Charles Goldfarb","startTime":1827.06,"endTime":1831.2,"body":"all, I like how you emphasize"},{"speaker":"Charles Goldfarb","startTime":1831.2,"endTime":1834.62,"body":"that when you use a K wire, or"},{"speaker":"Charles Goldfarb","startTime":1831.2,"endTime":1834.62,"body":"maybe you always use the K wire,"},{"speaker":"Charles Goldfarb","startTime":1834.62,"endTime":1836.81,"body":"but you're you're doing it"},{"speaker":"Charles Goldfarb","startTime":1834.62,"endTime":1836.81,"body":"through the radial styloid"},{"speaker":"Charles Goldfarb","startTime":1836.93,"endTime":1840.59,"body":"you're not necessarily using a K"},{"speaker":"Charles Goldfarb","startTime":1836.93,"endTime":1840.59,"body":"where through your plate. Did I"},{"speaker":"Charles Goldfarb","startTime":1840.59,"endTime":1841.61,"body":"interpret that correctly?"},{"speaker":"Chris Dy","startTime":1842.36,"endTime":1842.84,"body":"Correct."},{"speaker":"Charles Goldfarb","startTime":1843.23,"endTime":1845.84,"body":"Okay. And I do"},{"speaker":"Charles Goldfarb","startTime":1843.23,"endTime":1845.84,"body":"that sometimes, because I think"},{"speaker":"Charles Goldfarb","startTime":1845.87,"endTime":1849.98,"body":"especially when you have a"},{"speaker":"Charles Goldfarb","startTime":1845.87,"endTime":1849.98,"body":"fracture, a two or three part"},{"speaker":"Charles Goldfarb","startTime":1849.98,"endTime":1852.89,"body":"fracture, when that radial"},{"speaker":"Charles Goldfarb","startTime":1849.98,"endTime":1852.89,"body":"styloid is its own independent"},{"speaker":"Charles Goldfarb","startTime":1852.89,"endTime":1856.55,"body":"piece and is not really tied in,"},{"speaker":"Charles Goldfarb","startTime":1852.89,"endTime":1856.55,"body":"that can be huge. And I totally"},{"speaker":"Charles Goldfarb","startTime":1856.55,"endTime":1858.77,"body":"agree that doing that"},{"speaker":"Charles Goldfarb","startTime":1856.55,"endTime":1858.77,"body":"percutaneously is a very"},{"speaker":"Charles Goldfarb","startTime":1858.77,"endTime":1864.17,"body":"reasonable thing to do. Yeah, I"},{"speaker":"Charles Goldfarb","startTime":1858.77,"endTime":1864.17,"body":"think those are the key steps."},{"speaker":"Charles Goldfarb","startTime":1864.17,"endTime":1868.97,"body":"And we you know, occasionally"},{"speaker":"Charles Goldfarb","startTime":1864.17,"endTime":1868.97,"body":"I'll worry about inter articular"},{"speaker":"Charles Goldfarb","startTime":1868.97,"endTime":1872.78,"body":"components, I did a study a long"},{"speaker":"Charles Goldfarb","startTime":1868.97,"endTime":1872.78,"body":"time ago, looking at whether you"},{"speaker":"Charles Goldfarb","startTime":1872.78,"endTime":1876.41,"body":"can assume that volar cortical"},{"speaker":"Charles Goldfarb","startTime":1872.78,"endTime":1876.41,"body":"alignment and good C arm,"},{"speaker":"Charles Goldfarb","startTime":1876.41,"endTime":1879.5,"body":"radiographic appearance, give"},{"speaker":"Charles Goldfarb","startTime":1876.41,"endTime":1879.5,"body":"you good information about"},{"speaker":"Charles Goldfarb","startTime":1879.62,"endTime":1883.01,"body":"interarticular displacement. And"},{"speaker":"Charles Goldfarb","startTime":1879.62,"endTime":1883.01,"body":"the lesson I took from that is"},{"speaker":"Charles Goldfarb","startTime":1883.01,"endTime":1886.64,"body":"it does and so while I put a"},{"speaker":"Charles Goldfarb","startTime":1883.01,"endTime":1886.64,"body":"scope in a wrist last week to"},{"speaker":"Charles Goldfarb","startTime":1886.64,"endTime":1889.61,"body":"make sure I was happy with the"},{"speaker":"Charles Goldfarb","startTime":1886.64,"endTime":1889.61,"body":"reduction, I don't do that very"},{"speaker":"Charles Goldfarb","startTime":1889.61,"endTime":1890.03,"body":"often."},{"speaker":"Chris Dy","startTime":1890.3,"endTime":1893.96,"body":"Yeah, I I follow that."},{"speaker":"Chris Dy","startTime":1890.3,"endTime":1893.96,"body":"And I think that adding a scope,"},{"speaker":"Chris Dy","startTime":1894.32,"endTime":1897.14,"body":"adding a scope tends to be more"},{"speaker":"Chris Dy","startTime":1894.32,"endTime":1897.14,"body":"technical triumph, although I"},{"speaker":"Chris Dy","startTime":1897.14,"endTime":1899.36,"body":"know that there are a lot of"},{"speaker":"Chris Dy","startTime":1897.14,"endTime":1899.36,"body":"advocates for the scope. And"},{"speaker":"Chris Dy","startTime":1899.39,"endTime":1902.87,"body":"some of it is honestly, my, my"},{"speaker":"Chris Dy","startTime":1899.39,"endTime":1902.87,"body":"facility with the scope is not"},{"speaker":"Chris Dy","startTime":1902.87,"endTime":1906.74,"body":"that of other people. You know,"},{"speaker":"Chris Dy","startTime":1902.87,"endTime":1906.74,"body":"one thing that other people will"},{"speaker":"Chris Dy","startTime":1906.74,"endTime":1910.04,"body":"use as a, you know, actual"},{"speaker":"Chris Dy","startTime":1906.74,"endTime":1910.04,"body":"traction setups, one of our"},{"speaker":"Chris Dy","startTime":1910.04,"endTime":1913.07,"body":"partners will use a traction"},{"speaker":"Chris Dy","startTime":1910.04,"endTime":1913.07,"body":"setup off the end of the hand"},{"speaker":"Chris Dy","startTime":1913.07,"endTime":1916.85,"body":"table, which and I did not see"},{"speaker":"Chris Dy","startTime":1913.07,"endTime":1916.85,"body":"in training, but I can see the"},{"speaker":"Chris Dy","startTime":1916.85,"endTime":1919.28,"body":"value. It's just another thing"},{"speaker":"Chris Dy","startTime":1916.85,"endTime":1919.28,"body":"to add to the setup, which I"},{"speaker":"Chris Dy","startTime":1919.28,"endTime":1920.72,"body":"don't think you absolutely need."},{"speaker":"Charles Goldfarb","startTime":1921.59,"endTime":1922.91,"body":"It's so"},{"speaker":"Charles Goldfarb","startTime":1921.59,"endTime":1922.91,"body":"interesting that you say that"},{"speaker":"Charles Goldfarb","startTime":1922.91,"endTime":1924.89,"body":"because I was talking about that"},{"speaker":"Charles Goldfarb","startTime":1922.91,"endTime":1924.89,"body":"during, I had a couple distal"},{"speaker":"Charles Goldfarb","startTime":1924.89,"endTime":1928.61,"body":"radiuses, distal radii, this"},{"speaker":"Charles Goldfarb","startTime":1924.89,"endTime":1928.61,"body":"week, I was referencing a"},{"speaker":"Charles Goldfarb","startTime":1928.61,"endTime":1930.92,"body":"previous giant in orthopedic"},{"speaker":"Charles Goldfarb","startTime":1928.61,"endTime":1930.92,"body":"surgery at Washington"},{"speaker":"Charles Goldfarb","startTime":1930.92,"endTime":1936.05,"body":"University, Dr. Ford, and Dr."},{"speaker":"Charles Goldfarb","startTime":1930.92,"endTime":1936.05,"body":"Ford had a board the Ford board."},{"speaker":"Charles Goldfarb","startTime":1936.23,"endTime":1940.58,"body":"And it was a essentially a"},{"speaker":"Charles Goldfarb","startTime":1936.23,"endTime":1940.58,"body":"plywood construction that took"},{"speaker":"Charles Goldfarb","startTime":1940.58,"endTime":1945.23,"body":"the place of a hand table. And"},{"speaker":"Charles Goldfarb","startTime":1940.58,"endTime":1945.23,"body":"you basically rested the hand on"},{"speaker":"Charles Goldfarb","startTime":1945.23,"endTime":1948.74,"body":"this table, it had finger traps"},{"speaker":"Charles Goldfarb","startTime":1945.23,"endTime":1948.74,"body":"and a weight built in. And so it"},{"speaker":"Charles Goldfarb","startTime":1948.74,"endTime":1951.98,"body":"did exactly what you were"},{"speaker":"Charles Goldfarb","startTime":1948.74,"endTime":1951.98,"body":"suggesting. And those types of"},{"speaker":"Charles Goldfarb","startTime":1951.98,"endTime":1955.94,"body":"setups can be really useful,"},{"speaker":"Charles Goldfarb","startTime":1951.98,"endTime":1955.94,"body":"especially when you have limited"},{"speaker":"Charles Goldfarb","startTime":1955.94,"endTime":1959.9,"body":"hands. And for those who like"},{"speaker":"Charles Goldfarb","startTime":1955.94,"endTime":1959.9,"body":"pinning distal radius fractures,"},{"speaker":"Charles Goldfarb","startTime":1959.93,"endTime":1962.66,"body":"it can really make things very"},{"speaker":"Charles Goldfarb","startTime":1959.93,"endTime":1962.66,"body":"simple and straightforward. I do"},{"speaker":"Charles Goldfarb","startTime":1962.66,"endTime":1965.66,"body":"still think there's a role for"},{"speaker":"Charles Goldfarb","startTime":1962.66,"endTime":1965.66,"body":"pinning selected destroy radius"},{"speaker":"Charles Goldfarb","startTime":1965.66,"endTime":1968.57,"body":"fractures. Not really what we're"},{"speaker":"Charles Goldfarb","startTime":1965.66,"endTime":1968.57,"body":"here to talk about today. But"},{"speaker":"Charles Goldfarb","startTime":1968.72,"endTime":1973.55,"body":"But I think traction setups can"},{"speaker":"Charles Goldfarb","startTime":1968.72,"endTime":1973.55,"body":"be useful, especially when hands"},{"speaker":"Charles Goldfarb","startTime":1973.55,"endTime":1974.15,"body":"are limited."},{"speaker":"Chris Dy","startTime":1975.47,"endTime":1977.48,"body":"So you mentioned"},{"speaker":"Chris Dy","startTime":1975.47,"endTime":1977.48,"body":"putting in the oblong screw in"},{"speaker":"Chris Dy","startTime":1977.48,"endTime":1982.88,"body":"the shaft? How do you fine tune"},{"speaker":"Chris Dy","startTime":1977.48,"endTime":1982.88,"body":"the proximal to distal position"},{"speaker":"Chris Dy","startTime":1982.91,"endTime":1986.3,"body":"of the plate, and when are you"},{"speaker":"Chris Dy","startTime":1982.91,"endTime":1986.3,"body":"satisfied with the position of"},{"speaker":"Chris Dy","startTime":1986.3,"endTime":1986.87,"body":"that plate."},{"speaker":"Charles Goldfarb","startTime":1988.91,"endTime":1991.4,"body":"So it's really"},{"speaker":"Charles Goldfarb","startTime":1988.91,"endTime":1991.4,"body":"important if you are going to"},{"speaker":"Charles Goldfarb","startTime":1991.4,"endTime":1995.6,"body":"use the oblong hole, that your"},{"speaker":"Charles Goldfarb","startTime":1991.4,"endTime":1995.6,"body":"initial placement of the plate"},{"speaker":"Charles Goldfarb","startTime":1995.6,"endTime":1999.98,"body":"is both centered on the shaft"},{"speaker":"Charles Goldfarb","startTime":1995.6,"endTime":1999.98,"body":"but also has a general"},{"speaker":"Charles Goldfarb","startTime":2000.01,"endTime":2004.81,"body":"approximation of the proximal,"},{"speaker":"Charles Goldfarb","startTime":2000.01,"endTime":2004.81,"body":"distal. And for me, that means"},{"speaker":"Charles Goldfarb","startTime":2004.93,"endTime":2008.14,"body":"putting that plate right up"},{"speaker":"Charles Goldfarb","startTime":2004.93,"endTime":2008.14,"body":"towards the watershed line, but"},{"speaker":"Charles Goldfarb","startTime":2008.14,"endTime":2012.82,"body":"not passing it, making sure the"},{"speaker":"Charles Goldfarb","startTime":2008.14,"endTime":2012.82,"body":"reduction is not, you know,"},{"speaker":"Charles Goldfarb","startTime":2012.82,"endTime":2015.25,"body":"you're not shortened with your"},{"speaker":"Charles Goldfarb","startTime":2012.82,"endTime":2015.25,"body":"reduction, because then you'll"},{"speaker":"Charles Goldfarb","startTime":2015.28,"endTime":2018.4,"body":"you know, you won't ever have it"},{"speaker":"Charles Goldfarb","startTime":2015.28,"endTime":2018.4,"body":"right. And I think it's"},{"speaker":"Charles Goldfarb","startTime":2018.4,"endTime":2021.97,"body":"experience. And sometimes I do"},{"speaker":"Charles Goldfarb","startTime":2018.4,"endTime":2021.97,"body":"better than others. But I like"},{"speaker":"Charles Goldfarb","startTime":2021.97,"endTime":2024.49,"body":"that approach. And it works for"},{"speaker":"Charles Goldfarb","startTime":2021.97,"endTime":2024.49,"body":"me. And obviously I know it"},{"speaker":"Charles Goldfarb","startTime":2024.49,"endTime":2027.64,"body":"works for many people, but it"},{"speaker":"Charles Goldfarb","startTime":2024.49,"endTime":2027.64,"body":"does require experience and you"},{"speaker":"Charles Goldfarb","startTime":2027.64,"endTime":2029.53,"body":"don't want to drill a bunch of"},{"speaker":"Charles Goldfarb","startTime":2027.64,"endTime":2029.53,"body":"holes and realize you don't have"},{"speaker":"Charles Goldfarb","startTime":2029.53,"endTime":2030.61,"body":"the plate in the right place."},{"speaker":"Chris Dy","startTime":2031.69,"endTime":2035.05,"body":"Yeah, and I think that"},{"speaker":"Chris Dy","startTime":2031.69,"endTime":2035.05,"body":"as I've, you know, even my early"},{"speaker":"Chris Dy","startTime":2035.05,"endTime":2038.35,"body":"years of practice, as I've"},{"speaker":"Chris Dy","startTime":2035.05,"endTime":2038.35,"body":"gotten better at this and done"},{"speaker":"Chris Dy","startTime":2038.35,"endTime":2041.38,"body":"more, I think it shows you the"},{"speaker":"Chris Dy","startTime":2038.35,"endTime":2041.38,"body":"importance of that initial"},{"speaker":"Chris Dy","startTime":2041.38,"endTime":2044.98,"body":"reduction. Because I don't want"},{"speaker":"Chris Dy","startTime":2041.38,"endTime":2044.98,"body":"to rely on the plate too much. I"},{"speaker":"Chris Dy","startTime":2044.98,"endTime":2047.32,"body":"know there are a lot of bells"},{"speaker":"Chris Dy","startTime":2044.98,"endTime":2047.32,"body":"and whistles built into these"},{"speaker":"Chris Dy","startTime":2047.32,"endTime":2051.61,"body":"plates to help you. But I think"},{"speaker":"Chris Dy","startTime":2047.32,"endTime":2051.61,"body":"it's important to get that"},{"speaker":"Chris Dy","startTime":2051.61,"endTime":2057.01,"body":"reduction as close as you can"},{"speaker":"Chris Dy","startTime":2051.61,"endTime":2057.01,"body":"initially. How do you proceed"},{"speaker":"Chris Dy","startTime":2057.01,"endTime":2060.4,"body":"distally with your sequence of"},{"speaker":"Chris Dy","startTime":2057.01,"endTime":2060.4,"body":"screw fixation, you know, are"},{"speaker":"Chris Dy","startTime":2060.4,"endTime":2063.16,"body":"you using a cortical screw to"},{"speaker":"Chris Dy","startTime":2060.4,"endTime":2063.16,"body":"help bring a plate down the"},{"speaker":"Chris Dy","startTime":2063.16,"endTime":2065.74,"body":"bone? Is that something that no"},{"speaker":"Chris Dy","startTime":2063.16,"endTime":2065.74,"body":"longer has a role in your"},{"speaker":"Chris Dy","startTime":2065.74,"endTime":2066.43,"body":"practice?"},{"speaker":"Charles Goldfarb","startTime":2067.23,"endTime":2068.91,"body":"So great"},{"speaker":"Charles Goldfarb","startTime":2067.23,"endTime":2068.91,"body":"questions. I'll throw in a"},{"speaker":"Charles Goldfarb","startTime":2068.91,"endTime":2072.66,"body":"little history for those who"},{"speaker":"Charles Goldfarb","startTime":2068.91,"endTime":2072.66,"body":"like history. So as I think we"},{"speaker":"Charles Goldfarb","startTime":2072.66,"endTime":2075.21,"body":"mentioned long ago, and we've"},{"speaker":"Charles Goldfarb","startTime":2072.66,"endTime":2075.21,"body":"mentioned today already, George"},{"speaker":"Charles Goldfarb","startTime":2075.21,"endTime":2078.9,"body":"Orbay really revolutionized the"},{"speaker":"Charles Goldfarb","startTime":2075.21,"endTime":2078.9,"body":"treatment of distal radius"},{"speaker":"Charles Goldfarb","startTime":2078.9,"endTime":2084.84,"body":"fractures by popularizing the"},{"speaker":"Charles Goldfarb","startTime":2078.9,"endTime":2084.84,"body":"volar approach, and also by his"},{"speaker":"Charles Goldfarb","startTime":2084.84,"endTime":2087.87,"body":"plate, the hand innovations"},{"speaker":"Charles Goldfarb","startTime":2084.84,"endTime":2087.87,"body":"plate and that original plate"},{"speaker":"Charles Goldfarb","startTime":2087.9,"endTime":2091.83,"body":"there were locking screws which"},{"speaker":"Charles Goldfarb","startTime":2087.9,"endTime":2091.83,"body":"is part of the evolution or"},{"speaker":"Charles Goldfarb","startTime":2091.83,"endTime":2095.91,"body":"revolution. There were locking"},{"speaker":"Charles Goldfarb","startTime":2091.83,"endTime":2095.91,"body":"pegs and there were non locking"},{"speaker":"Charles Goldfarb","startTime":2095.91,"endTime":2099.99,"body":"screws. As I recall, I think all"},{"speaker":"Charles Goldfarb","startTime":2095.91,"endTime":2099.99,"body":"three were options. I will say,"},{"speaker":"Charles Goldfarb","startTime":2099.99,"endTime":2106.29,"body":"so that was published I believe"},{"speaker":"Charles Goldfarb","startTime":2099.99,"endTime":2106.29,"body":"in March of 2002. In February of"},{"speaker":"Charles Goldfarb","startTime":2106.29,"endTime":2111.09,"body":"2002, the Cincinnati group"},{"speaker":"Charles Goldfarb","startTime":2106.29,"endTime":2111.09,"body":"published a paper about volar"},{"speaker":"Charles Goldfarb","startTime":2111.12,"endTime":2114.75,"body":"plates for dorsally displaced"},{"speaker":"Charles Goldfarb","startTime":2111.12,"endTime":2114.75,"body":"distal radius fractures. And so"},{"speaker":"Charles Goldfarb","startTime":2114.75,"endTime":2118.2,"body":"the Cincinnati group obviously"},{"speaker":"Charles Goldfarb","startTime":2114.75,"endTime":2118.2,"body":"did it first, but they use the"},{"speaker":"Charles Goldfarb","startTime":2118.2,"endTime":2121.65,"body":"old fashioned, I think it was"},{"speaker":"Charles Goldfarb","startTime":2118.2,"endTime":2121.65,"body":"synthes plates, which were not"},{"speaker":"Charles Goldfarb","startTime":2121.65,"endTime":2125.7,"body":"fancy at all, and didn't have"},{"speaker":"Charles Goldfarb","startTime":2121.65,"endTime":2125.7,"body":"the benefits of the locking"},{"speaker":"Charles Goldfarb","startTime":2125.7,"endTime":2129.93,"body":"technology that Orbay really did"},{"speaker":"Charles Goldfarb","startTime":2125.7,"endTime":2129.93,"body":"so much to advance our field. So"},{"speaker":"Charles Goldfarb","startTime":2129.93,"endTime":2135.51,"body":"for me, I will still use a non"},{"speaker":"Charles Goldfarb","startTime":2129.93,"endTime":2135.51,"body":"locking screw, getting back to"},{"speaker":"Charles Goldfarb","startTime":2135.51,"endTime":2139.02,"body":"what you alluded to earlier in"},{"speaker":"Charles Goldfarb","startTime":2135.51,"endTime":2139.02,"body":"those patients where I am going"},{"speaker":"Charles Goldfarb","startTime":2139.02,"endTime":2142.44,"body":"to use the plate to help with my"},{"speaker":"Charles Goldfarb","startTime":2139.02,"endTime":2142.44,"body":"reduction, so pulling down that"},{"speaker":"Charles Goldfarb","startTime":2142.44,"endTime":2145.59,"body":"distal fragment towards the"},{"speaker":"Charles Goldfarb","startTime":2142.44,"endTime":2145.59,"body":"plate. And that does require"},{"speaker":"Charles Goldfarb","startTime":2145.62,"endTime":2148.95,"body":"bicortical fixation. So we do"},{"speaker":"Charles Goldfarb","startTime":2145.62,"endTime":2148.95,"body":"that very carefully to avoid"},{"speaker":"Charles Goldfarb","startTime":2148.95,"endTime":2152.52,"body":"plunging, and often it's a"},{"speaker":"Charles Goldfarb","startTime":2148.95,"endTime":2152.52,"body":"temporary screw. So I'll do a"},{"speaker":"Charles Goldfarb","startTime":2152.52,"endTime":2155.94,"body":"non locking screw assist with my"},{"speaker":"Charles Goldfarb","startTime":2152.52,"endTime":2155.94,"body":"reduction, if I'm struggling,"},{"speaker":"Charles Goldfarb","startTime":2156.12,"endTime":2159.54,"body":"add a couple of locking screws"},{"speaker":"Charles Goldfarb","startTime":2156.12,"endTime":2159.54,"body":"and then replace that non"},{"speaker":"Charles Goldfarb","startTime":2159.54,"endTime":2164.01,"body":"locking screw with a shorter"},{"speaker":"Charles Goldfarb","startTime":2159.54,"endTime":2164.01,"body":"locking screw. Do you see it"},{"speaker":"Charles Goldfarb","startTime":2164.01,"endTime":2166.41,"body":"differently? Do you ever use"},{"speaker":"Charles Goldfarb","startTime":2164.01,"endTime":2166.41,"body":"that non locking screw to assist"},{"speaker":"Charles Goldfarb","startTime":2166.41,"endTime":2168.63,"body":"your reduction or is that"},{"speaker":"Charles Goldfarb","startTime":2166.41,"endTime":2168.63,"body":"something you rarely consider"},{"speaker":"Chris Dy","startTime":2169.32,"endTime":2173.37,"body":"I do it but I'm not"},{"speaker":"Chris Dy","startTime":2169.32,"endTime":2173.37,"body":"relying on it, I will use it to"},{"speaker":"Chris Dy","startTime":2173.37,"endTime":2176.67,"body":"help get that plate tucked in a"},{"speaker":"Chris Dy","startTime":2173.37,"endTime":2176.67,"body":"little bit better just to fine"},{"speaker":"Chris Dy","startTime":2176.67,"endTime":2179.79,"body":"tune it. But I there, I know"},{"speaker":"Chris Dy","startTime":2176.67,"endTime":2179.79,"body":"there are surgeons who really"},{"speaker":"Chris Dy","startTime":2179.79,"endTime":2182.97,"body":"bank on that, that screw"},{"speaker":"Chris Dy","startTime":2179.79,"endTime":2182.97,"body":"fixation to really bring it down"},{"speaker":"Chris Dy","startTime":2182.97,"endTime":2185.82,"body":"and align things. And I don't"},{"speaker":"Chris Dy","startTime":2182.97,"endTime":2185.82,"body":"love that, mainly because there"},{"speaker":"Chris Dy","startTime":2185.82,"endTime":2188.13,"body":"are a couple of things that are"},{"speaker":"Chris Dy","startTime":2185.82,"endTime":2188.13,"body":"out of your control as a"},{"speaker":"Chris Dy","startTime":2188.13,"endTime":2191.85,"body":"surgeon, one of them is bone"},{"speaker":"Chris Dy","startTime":2188.13,"endTime":2191.85,"body":"uality. And in some, in a se"},{"speaker":"Chris Dy","startTime":2191.85,"endTime":2194.73,"body":"ment of population, you know,"},{"speaker":"Chris Dy","startTime":2191.85,"endTime":2194.73,"body":"he bone is not great for this"},{"speaker":"Chris Dy","startTime":2194.73,"endTime":2199.77,"body":"or this fracture. So even if I"},{"speaker":"Chris Dy","startTime":2194.73,"endTime":2199.77,"body":"think I have reasonable bite w"},{"speaker":"Chris Dy","startTime":2199.77,"endTime":2202.86,"body":"th that screw, I will, as you al"},{"speaker":"Chris Dy","startTime":2199.77,"endTime":2202.86,"body":"uded to earlier, I'll have my"},{"speaker":"Chris Dy","startTime":2202.86,"endTime":2206.04,"body":"humb on the volar cortex someti"},{"speaker":"Chris Dy","startTime":2202.86,"endTime":2206.04,"body":"es. And then while that screw"},{"speaker":"Chris Dy","startTime":2206.04,"endTime":2211.86,"body":"s going in, I will then take"},{"speaker":"Chris Dy","startTime":2206.04,"endTime":2211.86,"body":"finger and push dorsally. To"},{"speaker":"Chris Dy","startTime":2211.86,"endTime":2214.26,"body":"ry just kind of bring that bone"},{"speaker":"Chris Dy","startTime":2211.86,"endTime":2214.26,"body":"little bit closer, obviously t"},{"speaker":"Chris Dy","startTime":2214.26,"endTime":2217.05,"body":"e wrist is flexed too, and he"},{"speaker":"Chris Dy","startTime":2214.26,"endTime":2217.05,"body":"ping to engage that because I do"},{"speaker":"Chris Dy","startTime":2217.05,"endTime":2220.26,"body":"'t want to rely on the screw to"},{"speaker":"Chris Dy","startTime":2217.05,"endTime":2220.26,"body":"do much because you know you'"},{"speaker":"Chris Dy","startTime":2220.26,"endTime":2223.53,"body":"e in an area where the bone qua"},{"speaker":"Chris Dy","startTime":2220.26,"endTime":2223.53,"body":"ity may be suspect and you don't"},{"speaker":"Chris Dy","startTime":2223.53,"endTime":2227.16,"body":"want to get burned. And I ag"},{"speaker":"Chris Dy","startTime":2223.53,"endTime":2227.16,"body":"ee with swapping out that scre"},{"speaker":"Chris Dy","startTime":2227.16,"endTime":2227.49,"body":"at"},{"speaker":"Charles Goldfarb","startTime":2228.2,"endTime":2230.81,"body":"So we have I"},{"speaker":"Charles Goldfarb","startTime":2228.2,"endTime":2230.81,"body":"think you said all that very"},{"speaker":"Charles Goldfarb","startTime":2230.81,"endTime":2232.76,"body":"well, we have excellent"},{"speaker":"Charles Goldfarb","startTime":2230.81,"endTime":2232.76,"body":"residents and fellows, we're"},{"speaker":"Charles Goldfarb","startTime":2232.76,"endTime":2235.37,"body":"very fortunate in that regard."},{"speaker":"Charles Goldfarb","startTime":2232.76,"endTime":2235.37,"body":"And when we have residents on"},{"speaker":"Charles Goldfarb","startTime":2235.37,"endTime":2239.69,"body":"our service, you know, they've"},{"speaker":"Charles Goldfarb","startTime":2235.37,"endTime":2239.69,"body":"been doing bigger things they've"},{"speaker":"Charles Goldfarb","startTime":2239.69,"endTime":2242.75,"body":"been doing femur fractures and"},{"speaker":"Charles Goldfarb","startTime":2239.69,"endTime":2242.75,"body":"the like. And, you know, feeling"},{"speaker":"Charles Goldfarb","startTime":2242.75,"endTime":2246.26,"body":"that second cortex is so easy in"},{"speaker":"Charles Goldfarb","startTime":2242.75,"endTime":2246.26,"body":"those situations. But when you"},{"speaker":"Charles Goldfarb","startTime":2246.26,"endTime":2250.97,"body":"have a old patient like me, or"},{"speaker":"Charles Goldfarb","startTime":2246.26,"endTime":2250.97,"body":"maybe even slightly older, and"},{"speaker":"Charles Goldfarb","startTime":2250.97,"endTime":2255.44,"body":"that dorsal cortex is thin, and"},{"speaker":"Charles Goldfarb","startTime":2250.97,"endTime":2255.44,"body":"you don't get the feedback, and"},{"speaker":"Charles Goldfarb","startTime":2255.44,"endTime":2259.52,"body":"you haven't put screws in a lot"},{"speaker":"Charles Goldfarb","startTime":2255.44,"endTime":2259.52,"body":"of distal radius fractures, it"},{"speaker":"Charles Goldfarb","startTime":2259.52,"endTime":2263.69,"body":"can be really tough to feel that"},{"speaker":"Charles Goldfarb","startTime":2259.52,"endTime":2263.69,"body":"second cortex. Plus, you know,"},{"speaker":"Charles Goldfarb","startTime":2263.72,"endTime":2268.19,"body":"it can be displaced. And so I"},{"speaker":"Charles Goldfarb","startTime":2263.72,"endTime":2268.19,"body":"have no problem using a manual"},{"speaker":"Charles Goldfarb","startTime":2268.25,"endTime":2272.06,"body":"support dorsally both to help"},{"speaker":"Charles Goldfarb","startTime":2268.25,"endTime":2272.06,"body":"the reduction, but also to help"},{"speaker":"Charles Goldfarb","startTime":2272.06,"endTime":2275.15,"body":"feel that drill. And I don't"},{"speaker":"Charles Goldfarb","startTime":2272.06,"endTime":2275.15,"body":"think you need to go through"},{"speaker":"Charles Goldfarb","startTime":2275.15,"endTime":2277.85,"body":"that cortex. And you shouldn't"},{"speaker":"Charles Goldfarb","startTime":2275.15,"endTime":2277.85,"body":"go through that cortex when at"},{"speaker":"Charles Goldfarb","startTime":2277.85,"endTime":2282.56,"body":"all possible. But I think it's"},{"speaker":"Charles Goldfarb","startTime":2277.85,"endTime":2282.56,"body":"okay, it's okay to have your"},{"speaker":"Charles Goldfarb","startTime":2282.56,"endTime":2286.64,"body":"hand dorsally, finger dorsally"},{"speaker":"Charles Goldfarb","startTime":2282.56,"endTime":2286.64,"body":"to feel the drill that really"},{"speaker":"Charles Goldfarb","startTime":2286.64,"endTime":2287.33,"body":"can be helpful."},{"speaker":"Chris Dy","startTime":2287.81,"endTime":2291.26,"body":"Yeah, one of our you"},{"speaker":"Chris Dy","startTime":2287.81,"endTime":2291.26,"body":"know, the, the importance of the"},{"speaker":"Chris Dy","startTime":2291.26,"endTime":2295.64,"body":"dorsal ulnar corner fragment is,"},{"speaker":"Chris Dy","startTime":2291.26,"endTime":2295.64,"body":"is different, I think in"},{"speaker":"Chris Dy","startTime":2295.64,"endTime":2298.88,"body":"different patient populations,"},{"speaker":"Chris Dy","startTime":2295.64,"endTime":2298.88,"body":"perhaps less important in an"},{"speaker":"Chris Dy","startTime":2298.88,"endTime":2302.36,"body":"older patient population. But"},{"speaker":"Chris Dy","startTime":2298.88,"endTime":2302.36,"body":"there are, you know, a number of"},{"speaker":"Chris Dy","startTime":2302.36,"endTime":2304.55,"body":"publications about that"},{"speaker":"Chris Dy","startTime":2302.36,"endTime":2304.55,"body":"particular fragment, one of"},{"speaker":"Chris Dy","startTime":2304.55,"endTime":2308.42,"body":"which came from one of our"},{"speaker":"Chris Dy","startTime":2304.55,"endTime":2308.42,"body":"partners, David Brogan. And he"},{"speaker":"Chris Dy","startTime":2308.42,"endTime":2312.2,"body":"mentioned in that, you know, in"},{"speaker":"Chris Dy","startTime":2308.42,"endTime":2312.2,"body":"the postmenopausal female"},{"speaker":"Chris Dy","startTime":2312.2,"endTime":2315.65,"body":"population, which they studied,"},{"speaker":"Chris Dy","startTime":2312.2,"endTime":2315.65,"body":"that the size of that fragment"},{"speaker":"Chris Dy","startTime":2315.65,"endTime":2318.38,"body":"in terms of the width from"},{"speaker":"Chris Dy","startTime":2315.65,"endTime":2318.38,"body":"volar, to dorsal, it's about"},{"speaker":"Chris Dy","startTime":2318.38,"endTime":2322.88,"body":"24%. So if you want to get"},{"speaker":"Chris Dy","startTime":2318.38,"endTime":2322.88,"body":"fixation in there, you can't"},{"speaker":"Chris Dy","startTime":2322.88,"endTime":2327.89,"body":"typically use kind of the 75%"},{"speaker":"Chris Dy","startTime":2322.88,"endTime":2327.89,"body":"or, you know, that length of"},{"speaker":"Chris Dy","startTime":2327.89,"endTime":2330.08,"body":"screws. So it's a question of"},{"speaker":"Chris Dy","startTime":2327.89,"endTime":2330.08,"body":"whether you, as a surgeon feel"},{"speaker":"Chris Dy","startTime":2330.08,"endTime":2332.93,"body":"that that's an important"},{"speaker":"Chris Dy","startTime":2330.08,"endTime":2332.93,"body":"fragment to fix. Because"},{"speaker":"Chris Dy","startTime":2332.93,"endTime":2336.23,"body":"obviously, going bicortical with"},{"speaker":"Chris Dy","startTime":2332.93,"endTime":2336.23,"body":"your screw fixation there can"},{"speaker":"Chris Dy","startTime":2336.23,"endTime":2339.56,"body":"have some potential risk. Now,"},{"speaker":"Chris Dy","startTime":2336.23,"endTime":2339.56,"body":"if you're truly more on the"},{"speaker":"Chris Dy","startTime":2339.56,"endTime":2342.08,"body":"dorsal ulnar corner, you're a"},{"speaker":"Chris Dy","startTime":2339.56,"endTime":2342.08,"body":"little bit further away from the"},{"speaker":"Chris Dy","startTime":2342.08,"endTime":2345.95,"body":"EPL. But you know, still, I"},{"speaker":"Chris Dy","startTime":2342.08,"endTime":2345.95,"body":"would argue that you if you're"},{"speaker":"Chris Dy","startTime":2345.95,"endTime":2348.56,"body":"trying to really secure that"},{"speaker":"Chris Dy","startTime":2345.95,"endTime":2348.56,"body":"fragment, there are other"},{"speaker":"Chris Dy","startTime":2348.59,"endTime":2350.84,"body":"structures at risk, including"},{"speaker":"Chris Dy","startTime":2348.59,"endTime":2350.84,"body":"the sigmoid notch."},{"speaker":"Charles Goldfarb","startTime":2352.01,"endTime":2353.66,"body":"I think that's"},{"speaker":"Charles Goldfarb","startTime":2352.01,"endTime":2353.66,"body":"right. And that's well said and"},{"speaker":"Charles Goldfarb","startTime":2353.66,"endTime":2356.9,"body":"I appreciate David Brogan's work"},{"speaker":"Charles Goldfarb","startTime":2353.66,"endTime":2356.9,"body":"in that area. I'm not a huge"},{"speaker":"Charles Goldfarb","startTime":2356.9,"endTime":2360.11,"body":"believer in the importance of"},{"speaker":"Charles Goldfarb","startTime":2356.9,"endTime":2360.11,"body":"that fragment. It's not as if I"},{"speaker":"Charles Goldfarb","startTime":2360.23,"endTime":2363.02,"body":"don't believe it can be"},{"speaker":"Charles Goldfarb","startTime":2360.23,"endTime":2363.02,"body":"important, but I don't think for"},{"speaker":"Charles Goldfarb","startTime":2363.02,"endTime":2367.61,"body":"me it's a major factor for most"},{"speaker":"Charles Goldfarb","startTime":2363.02,"endTime":2367.61,"body":"patients. We owe a debt of"},{"speaker":"Charles Goldfarb","startTime":2367.61,"endTime":2370.73,"body":"gratitude to Lindley Wall, one"},{"speaker":"Charles Goldfarb","startTime":2367.61,"endTime":2370.73,"body":"of our other partners who helped"},{"speaker":"Charles Goldfarb","startTime":2370.73,"endTime":2377.03,"body":"to emphasize the sufficiency of"},{"speaker":"Charles Goldfarb","startTime":2370.73,"endTime":2377.03,"body":"screws at what 75% of volar to"},{"speaker":"Charles Goldfarb","startTime":2377.03,"endTime":2381.08,"body":"dorsal link. And so basically,"},{"speaker":"Charles Goldfarb","startTime":2377.03,"endTime":2381.08,"body":"we can expect a limited risk of"},{"speaker":"Charles Goldfarb","startTime":2381.26,"endTime":2384.47,"body":"displacement and fracture as"},{"speaker":"Charles Goldfarb","startTime":2381.26,"endTime":2384.47,"body":"long as you get up to that 75%"},{"speaker":"Charles Goldfarb","startTime":2384.47,"endTime":2387.83,"body":"point. And again, avoiding going"},{"speaker":"Charles Goldfarb","startTime":2384.47,"endTime":2387.83,"body":"through that dorsal cortex"},{"speaker":"Charles Goldfarb","startTime":2388.01,"endTime":2390.08,"body":"minimizes the risk of this"},{"speaker":"Charles Goldfarb","startTime":2388.01,"endTime":2390.08,"body":"surgery."},{"speaker":"Chris Dy","startTime":2391.59,"endTime":2393.48,"body":"So one thing that I"},{"speaker":"Chris Dy","startTime":2391.59,"endTime":2393.48,"body":"like to talk about with the"},{"speaker":"Chris Dy","startTime":2393.48,"endTime":2397.77,"body":"trainees is that I tend to fix"},{"speaker":"Chris Dy","startTime":2393.48,"endTime":2397.77,"body":"the volar ulnar, you know the"},{"speaker":"Chris Dy","startTime":2397.77,"endTime":2402.39,"body":"distal row first because going"},{"speaker":"Chris Dy","startTime":2397.77,"endTime":2402.39,"body":"to the radial side first makes"},{"speaker":"Chris Dy","startTime":2402.39,"endTime":2407.07,"body":"it harder to image things. In"},{"speaker":"Chris Dy","startTime":2402.39,"endTime":2407.07,"body":"terms of whether your screws are"},{"speaker":"Chris Dy","startTime":2407.4,"endTime":2410.73,"body":"interarticular or not. And the"},{"speaker":"Chris Dy","startTime":2407.4,"endTime":2410.73,"body":"group from Brown, I think it was"},{"speaker":"Chris Dy","startTime":2410.73,"endTime":2414.42,"body":"Max Soong who did this when he w"},{"speaker":"Chris Dy","startTime":2410.73,"endTime":2414.42,"body":"s a resident, he wrote a paper t"},{"speaker":"Chris Dy","startTime":2414.42,"endTime":2416.97,"body":"at looked at when you can see w"},{"speaker":"Chris Dy","startTime":2414.42,"endTime":2416.97,"body":"ether your screws are intra a"},{"speaker":"Chris Dy","startTime":2416.97,"endTime":2419.85,"body":"ticular or not. And that l"},{"speaker":"Chris Dy","startTime":2416.97,"endTime":2419.85,"body":"teral tilt view that you talk a"},{"speaker":"Chris Dy","startTime":2419.85,"endTime":2423.33,"body":"out, is truly the view that y"},{"speaker":"Chris Dy","startTime":2419.85,"endTime":2423.33,"body":"u want. And once you start p"},{"speaker":"Chris Dy","startTime":2423.33,"endTime":2425.49,"body":"tting things on the radial s"},{"speaker":"Chris Dy","startTime":2423.33,"endTime":2425.49,"body":"de, like shooting up the s"},{"speaker":"Chris Dy","startTime":2425.49,"endTime":2429.51,"body":"yloid, for example, it's just h"},{"speaker":"Chris Dy","startTime":2425.49,"endTime":2429.51,"body":"rder to see your ulnar sided s"},{"speaker":"Chris Dy","startTime":2429.51,"endTime":2432.03,"body":"rews. So I start with that. A"},{"speaker":"Chris Dy","startTime":2429.51,"endTime":2432.03,"body":"d then also, because a lot of p"},{"speaker":"Chris Dy","startTime":2432.03,"endTime":2434.37,"body":"ople think that the i"},{"speaker":"Chris Dy","startTime":2432.03,"endTime":2434.37,"body":"termediate column is the most i"},{"speaker":"Chris Dy","startTime":2434.37,"endTime":2436.59,"body":"portant portion of fixation."},{"speaker":"Charles Goldfarb","startTime":2437.38,"endTime":2438.7,"body":"Yeah, I love"},{"speaker":"Charles Goldfarb","startTime":2437.38,"endTime":2438.7,"body":"what you said a couple of"},{"speaker":"Charles Goldfarb","startTime":2438.7,"endTime":2442.18,"body":"comments in regard to those to"},{"speaker":"Charles Goldfarb","startTime":2438.7,"endTime":2442.18,"body":"your thoughts. Number one, the"},{"speaker":"Charles Goldfarb","startTime":2442.18,"endTime":2444.61,"body":"concept of the radial column,"},{"speaker":"Charles Goldfarb","startTime":2442.18,"endTime":2444.61,"body":"the intermediate column, and"},{"speaker":"Charles Goldfarb","startTime":2444.64,"endTime":2447.4,"body":"ulnar column, love that. Really"},{"speaker":"Charles Goldfarb","startTime":2444.64,"endTime":2447.4,"body":"important and I agree that"},{"speaker":"Charles Goldfarb","startTime":2447.4,"endTime":2450.58,"body":"intermediate column is where"},{"speaker":"Charles Goldfarb","startTime":2447.4,"endTime":2450.58,"body":"it's at. If you choose to fix a"},{"speaker":"Charles Goldfarb","startTime":2450.58,"endTime":2453.55,"body":"distal radius like I do, where"},{"speaker":"Charles Goldfarb","startTime":2450.58,"endTime":2453.55,"body":"you're not using k wires"},{"speaker":"Charles Goldfarb","startTime":2453.55,"endTime":2456.07,"body":"routinely, and you're depending"},{"speaker":"Charles Goldfarb","startTime":2453.55,"endTime":2456.07,"body":"on a manual reduction, and"},{"speaker":"Charles Goldfarb","startTime":2456.07,"endTime":2459.04,"body":"you're depending on a flexed"},{"speaker":"Charles Goldfarb","startTime":2456.07,"endTime":2459.04,"body":"wrist, that makes it hard to put"},{"speaker":"Charles Goldfarb","startTime":2459.04,"endTime":2463.6,"body":"the ulnar distal row screws in"},{"speaker":"Charles Goldfarb","startTime":2459.04,"endTime":2463.6,"body":"first. And so if you do it, like"},{"speaker":"Charles Goldfarb","startTime":2463.6,"endTime":2468.82,"body":"I do it, and again, every"},{"speaker":"Charles Goldfarb","startTime":2463.6,"endTime":2468.82,"body":"fracture affects our approach, I"},{"speaker":"Charles Goldfarb","startTime":2468.82,"endTime":2471.52,"body":"tend to put the radial screw in"},{"speaker":"Charles Goldfarb","startTime":2468.82,"endTime":2471.52,"body":"first. But I think your point"},{"speaker":"Charles Goldfarb","startTime":2471.52,"endTime":2474.46,"body":"about visualization of the intra"},{"speaker":"Charles Goldfarb","startTime":2471.52,"endTime":2474.46,"body":"articular nature is really"},{"speaker":"Charles Goldfarb","startTime":2474.46,"endTime":2480.82,"body":"important. So I like that. And"},{"speaker":"Charles Goldfarb","startTime":2474.46,"endTime":2480.82,"body":"you know, the number of screws"},{"speaker":"Charles Goldfarb","startTime":2480.82,"endTime":2485.56,"body":"we need, I think there's no hard"},{"speaker":"Charles Goldfarb","startTime":2480.82,"endTime":2485.56,"body":"and fast rule. three screws,"},{"speaker":"Charles Goldfarb","startTime":2485.56,"endTime":2487.99,"body":"four screws depends on the"},{"speaker":"Charles Goldfarb","startTime":2485.56,"endTime":2487.99,"body":"fracture. So I typically use"},{"speaker":"Charles Goldfarb","startTime":2487.99,"endTime":2491.35,"body":"three or four distally, three"},{"speaker":"Charles Goldfarb","startTime":2487.99,"endTime":2491.35,"body":"proximately is that kind of your"},{"speaker":"Chris Dy","startTime":2491.0,"endTime":2494.99,"body":"Yeah, I think you"},{"speaker":"Chris Dy","startTime":2491.0,"endTime":2494.99,"body":"know, there there are some"},{"speaker":"Chris Dy","startTime":2491.35,"endTime":2491.98,"body":"standard?"},{"speaker":"Chris Dy","startTime":2494.99,"endTime":2497.51,"body":"mechanical studies demonstrating"},{"speaker":"Chris Dy","startTime":2494.99,"endTime":2497.51,"body":"they need at least three in the"},{"speaker":"Chris Dy","startTime":2497.51,"endTime":2501.53,"body":"most distal row, distal to the"},{"speaker":"Chris Dy","startTime":2497.51,"endTime":2501.53,"body":"main fracture and then maybe one"},{"speaker":"Chris Dy","startTime":2501.53,"endTime":2505.34,"body":"within that, that next to most"},{"speaker":"Chris Dy","startTime":2501.53,"endTime":2505.34,"body":"distal row. But again, I think"},{"speaker":"Chris Dy","startTime":2505.34,"endTime":2508.13,"body":"it's predicated on the fracture"},{"speaker":"Chris Dy","startTime":2505.34,"endTime":2508.13,"body":"itself and honestly, the the"},{"speaker":"Chris Dy","startTime":2508.13,"endTime":2510.86,"body":"implant, because some of these"},{"speaker":"Chris Dy","startTime":2508.13,"endTime":2510.86,"body":"implants have different widths,"},{"speaker":"Chris Dy","startTime":2511.13,"endTime":2514.01,"body":"and some patients align better"},{"speaker":"Chris Dy","startTime":2511.13,"endTime":2514.01,"body":"with the quote standard plate"},{"speaker":"Chris Dy","startTime":2514.01,"endTime":2517.64,"body":"versus the wider plates. You"},{"speaker":"Chris Dy","startTime":2514.01,"endTime":2517.64,"body":"know, I was never, and I'd love"},{"speaker":"Chris Dy","startTime":2517.64,"endTime":2520.79,"body":"your thoughts on this, I was"},{"speaker":"Chris Dy","startTime":2517.64,"endTime":2520.79,"body":"never huge on some surgeons love"},{"speaker":"Chris Dy","startTime":2520.79,"endTime":2523.58,"body":"kind of getting the longest"},{"speaker":"Chris Dy","startTime":2520.79,"endTime":2523.58,"body":"possible radial styloid screw."},{"speaker":"Chris Dy","startTime":2523.88,"endTime":2526.67,"body":"And some plates are designed to"},{"speaker":"Chris Dy","startTime":2523.88,"endTime":2526.67,"body":"do that. I don't think that"},{"speaker":"Chris Dy","startTime":2526.67,"endTime":2530.03,"body":"that's where the construct is"},{"speaker":"Chris Dy","startTime":2526.67,"endTime":2530.03,"body":"going to fail. So I don't make a"},{"speaker":"Chris Dy","startTime":2530.03,"endTime":2533.24,"body":"huge deal out of that. And, you"},{"speaker":"Chris Dy","startTime":2530.03,"endTime":2533.24,"body":"know, given the type of plate"},{"speaker":"Chris Dy","startTime":2533.24,"endTime":2536.75,"body":"that I use, it's not built for"},{"speaker":"Chris Dy","startTime":2533.24,"endTime":2536.75,"body":"that. If your screw head ends up"},{"speaker":"Chris Dy","startTime":2536.75,"endTime":2539.81,"body":"being prominent, because you"},{"speaker":"Chris Dy","startTime":2536.75,"endTime":2539.81,"body":"tried to get too acute, with"},{"speaker":"Chris Dy","startTime":2539.81,"endTime":2541.16,"body":"that that will be a problem."},{"speaker":"Charles Goldfarb","startTime":2542.41,"endTime":2544.75,"body":"Yeah,"},{"speaker":"Charles Goldfarb","startTime":2542.41,"endTime":2544.75,"body":"completely and totally agree."},{"speaker":"Charles Goldfarb","startTime":2546.55,"endTime":2549.22,"body":"You know, the only time I use"},{"speaker":"Charles Goldfarb","startTime":2546.55,"endTime":2549.22,"body":"less than three screws, and I"},{"speaker":"Charles Goldfarb","startTime":2549.22,"endTime":2552.52,"body":"might only use one or two, but I"},{"speaker":"Charles Goldfarb","startTime":2549.22,"endTime":2552.52,"body":"always put distal row screws in"},{"speaker":"Charles Goldfarb","startTime":2552.55,"endTime":2554.95,"body":"would be a classic volar"},{"speaker":"Charles Goldfarb","startTime":2552.55,"endTime":2554.95,"body":"Barton's, with an anatomical"},{"speaker":"Charles Goldfarb","startTime":2554.95,"endTime":2557.02,"body":"reduction where you're using a"},{"speaker":"Charles Goldfarb","startTime":2554.95,"endTime":2557.02,"body":"buttress plate, and then maybe"},{"speaker":"Charles Goldfarb","startTime":2557.02,"endTime":2559.66,"body":"one or two would be all I'd use."},{"speaker":"Charles Goldfarb","startTime":2557.02,"endTime":2559.66,"body":"I agree with you, I don't"},{"speaker":"Charles Goldfarb","startTime":2559.66,"endTime":2562.09,"body":"believe in the importance of the"},{"speaker":"Charles Goldfarb","startTime":2559.66,"endTime":2562.09,"body":"radial styloid. I think what's"},{"speaker":"Charles Goldfarb","startTime":2562.09,"endTime":2564.31,"body":"really interesting to me is when"},{"speaker":"Charles Goldfarb","startTime":2562.09,"endTime":2564.31,"body":"these plates first came out,"},{"speaker":"Charles Goldfarb","startTime":2564.31,"endTime":2568.45,"body":"there's a lot of emphasis on"},{"speaker":"Charles Goldfarb","startTime":2564.31,"endTime":2568.45,"body":"getting that distal row screw"},{"speaker":"Charles Goldfarb","startTime":2568.84,"endTime":2573.82,"body":"set up, right subchondral so"},{"speaker":"Charles Goldfarb","startTime":2568.84,"endTime":2573.82,"body":"that it would help decrease the"},{"speaker":"Charles Goldfarb","startTime":2573.82,"endTime":2577.18,"body":"risk of dorsal collapse of the"},{"speaker":"Charles Goldfarb","startTime":2573.82,"endTime":2577.18,"body":"fracture. I don't hear that"},{"speaker":"Charles Goldfarb","startTime":2577.18,"endTime":2580.15,"body":"mentioned quite as much anymore."},{"speaker":"Charles Goldfarb","startTime":2577.18,"endTime":2580.15,"body":"I think the recognition that you"},{"speaker":"Charles Goldfarb","startTime":2580.15,"endTime":2582.07,"body":"need to be a little more"},{"speaker":"Charles Goldfarb","startTime":2580.15,"endTime":2582.07,"body":"proximal with the plate,"},{"speaker":"Charles Goldfarb","startTime":2582.31,"endTime":2585.43,"body":"proximal to the watershed line"},{"speaker":"Charles Goldfarb","startTime":2582.31,"endTime":2585.43,"body":"can make that more challenging,"},{"speaker":"Charles Goldfarb","startTime":2585.43,"endTime":2589.3,"body":"especially if you're using the"},{"speaker":"Charles Goldfarb","startTime":2585.43,"endTime":2589.3,"body":"pre you know, design plates to"},{"speaker":"Charles Goldfarb","startTime":2589.42,"endTime":2592.18,"body":"affect which direction your"},{"speaker":"Charles Goldfarb","startTime":2589.42,"endTime":2592.18,"body":"screws go in. And your ability"},{"speaker":"Charles Goldfarb","startTime":2592.18,"endTime":2598.09,"body":"to correct that is, is limited."},{"speaker":"Charles Goldfarb","startTime":2592.18,"endTime":2598.09,"body":"So I think plate choice matters"},{"speaker":"Charles Goldfarb","startTime":2598.09,"endTime":2601.63,"body":"for that. And you know, you have"},{"speaker":"Charles Goldfarb","startTime":2598.09,"endTime":2601.63,"body":"to understand your fracture, to"},{"speaker":"Charles Goldfarb","startTime":2601.63,"endTime":2604.51,"body":"understand sometimes what the"},{"speaker":"Charles Goldfarb","startTime":2601.63,"endTime":2604.51,"body":"best plate is for that"},{"speaker":"Charles Goldfarb","startTime":2604.51,"endTime":2605.44,"body":"particular fracture."},{"speaker":"Chris Dy","startTime":2606.76,"endTime":2610.24,"body":"Yeah, and I think your"},{"speaker":"Chris Dy","startTime":2606.76,"endTime":2610.24,"body":"point about you know, where"},{"speaker":"Chris Dy","startTime":2610.24,"endTime":2613.33,"body":"those screws are in the bone"},{"speaker":"Chris Dy","startTime":2610.24,"endTime":2613.33,"body":"distally is an important one, it"},{"speaker":"Chris Dy","startTime":2613.33,"endTime":2616.66,"body":"isn't talked about a lot. But"},{"speaker":"Chris Dy","startTime":2613.33,"endTime":2616.66,"body":"you know, the original, fixed"},{"speaker":"Chris Dy","startTime":2616.66,"endTime":2620.95,"body":"angle type implants relied on"},{"speaker":"Chris Dy","startTime":2616.66,"endTime":2620.95,"body":"good subchondral bone, and"},{"speaker":"Chris Dy","startTime":2620.95,"endTime":2625.3,"body":"particularly in a potentially"},{"speaker":"Chris Dy","startTime":2620.95,"endTime":2625.3,"body":"geriatric and osteoporotic"},{"speaker":"Chris Dy","startTime":2625.3,"endTime":2628.9,"body":"population. If you are not in"},{"speaker":"Chris Dy","startTime":2625.3,"endTime":2628.9,"body":"subchondral bone, you know,"},{"speaker":"Chris Dy","startTime":2628.9,"endTime":2631.3,"body":"there is a chance that that"},{"speaker":"Chris Dy","startTime":2628.9,"endTime":2631.3,"body":"construct is going to fail if"},{"speaker":"Chris Dy","startTime":2631.3,"endTime":2634.75,"body":"you are purely relying on less"},{"speaker":"Chris Dy","startTime":2631.3,"endTime":2634.75,"body":"than ideal metaphyseal bone. So,"},{"speaker":"Chris Dy","startTime":2635.08,"endTime":2637.75,"body":"you know, I know that we're all"},{"speaker":"Chris Dy","startTime":2635.08,"endTime":2637.75,"body":"getting gun shy about putting"},{"speaker":"Chris Dy","startTime":2637.75,"endTime":2641.08,"body":"plates too distal etc. But you"},{"speaker":"Chris Dy","startTime":2637.75,"endTime":2641.08,"body":"know, take advantage of the"},{"speaker":"Chris Dy","startTime":2641.08,"endTime":2644.14,"body":"variable angle components of"},{"speaker":"Chris Dy","startTime":2641.08,"endTime":2644.14,"body":"your plate and make sure that if"},{"speaker":"Chris Dy","startTime":2644.14,"endTime":2647.68,"body":"you need to that you get into"},{"speaker":"Chris Dy","startTime":2644.14,"endTime":2647.68,"body":"that good subchondral bone,"},{"speaker":"Chris Dy","startTime":2648.13,"endTime":2650.38,"body":"again, without cheating your"},{"speaker":"Chris Dy","startTime":2648.13,"endTime":2650.38,"body":"plate too distally."},{"speaker":"Charles Goldfarb","startTime":2650.98,"endTime":2654.28,"body":"I think that's"},{"speaker":"Charles Goldfarb","startTime":2650.98,"endTime":2654.28,"body":"well said and let's be real. I"},{"speaker":"Charles Goldfarb","startTime":2654.28,"endTime":2660.01,"body":"don't know that I've ever truly"},{"speaker":"Charles Goldfarb","startTime":2654.28,"endTime":2660.01,"body":"blamed a plate on a construct"},{"speaker":"Charles Goldfarb","startTime":2660.01,"endTime":2663.13,"body":"failure. You know, we don't see"},{"speaker":"Charles Goldfarb","startTime":2660.01,"endTime":2663.13,"body":"broken distal radius plates or"},{"speaker":"Charles Goldfarb","startTime":2663.13,"endTime":2667.93,"body":"broken screws, these things"},{"speaker":"Charles Goldfarb","startTime":2663.13,"endTime":2667.93,"body":"heal. And so really, we as the"},{"speaker":"Charles Goldfarb","startTime":2667.93,"endTime":2673.39,"body":"surgeon, are the critical factor"},{"speaker":"Charles Goldfarb","startTime":2667.93,"endTime":2673.39,"body":"to determining the success of"},{"speaker":"Charles Goldfarb","startTime":2673.39,"endTime":2676.9,"body":"this treatment. We're lucky we"},{"speaker":"Charles Goldfarb","startTime":2673.39,"endTime":2676.9,"body":"have great hardware, the"},{"speaker":"Charles Goldfarb","startTime":2676.9,"endTime":2679.99,"body":"hardware does differ and"},{"speaker":"Charles Goldfarb","startTime":2676.9,"endTime":2679.99,"body":"manufacturers might matter more"},{"speaker":"Charles Goldfarb","startTime":2679.99,"endTime":2683.56,"body":"than we think. But this is not a"},{"speaker":"Charles Goldfarb","startTime":2679.99,"endTime":2683.56,"body":"hardware failure situation. This"},{"speaker":"Charles Goldfarb","startTime":2683.56,"endTime":2686.08,"body":"is really I think what it gets"},{"speaker":"Charles Goldfarb","startTime":2683.56,"endTime":2686.08,"body":"down to is probably not even"},{"speaker":"Charles Goldfarb","startTime":2686.08,"endTime":2689.8,"body":"technical. It's really about how"},{"speaker":"Charles Goldfarb","startTime":2686.08,"endTime":2689.8,"body":"well we understand the fracture."},{"speaker":"Charles Goldfarb","startTime":2690.16,"endTime":2693.91,"body":"And that understanding doesn't"},{"speaker":"Charles Goldfarb","startTime":2690.16,"endTime":2693.91,"body":"have to be so sophisticated for"},{"speaker":"Charles Goldfarb","startTime":2693.94,"endTime":2696.01,"body":"80 or 90% of the fracture"},{"speaker":"Charles Goldfarb","startTime":2693.94,"endTime":2696.01,"body":"because most of these are"},{"speaker":"Charles Goldfarb","startTime":2696.01,"endTime":2698.14,"body":"straightforward even if we're"},{"speaker":"Charles Goldfarb","startTime":2696.01,"endTime":2698.14,"body":"going to the operating room. But"},{"speaker":"Charles Goldfarb","startTime":2698.14,"endTime":2702.19,"body":"there's a couple of times where"},{"speaker":"Charles Goldfarb","startTime":2698.14,"endTime":2702.19,"body":"we'll get really difficult or"},{"speaker":"Charles Goldfarb","startTime":2702.22,"endTime":2706.27,"body":"deceiving fractures that make"},{"speaker":"Charles Goldfarb","startTime":2702.22,"endTime":2706.27,"body":"our life difficult. And I think"},{"speaker":"Charles Goldfarb","startTime":2706.27,"endTime":2708.73,"body":"you've got to get it right. At"},{"speaker":"Charles Goldfarb","startTime":2706.27,"endTime":2708.73,"body":"that point, technically,"},{"speaker":"Chris Dy","startTime":2710.19,"endTime":2712.8,"body":"Do you have a"},{"speaker":"Chris Dy","startTime":2710.19,"endTime":2712.8,"body":"preference for the metal of your"},{"speaker":"Chris Dy","startTime":2712.8,"endTime":2715.98,"body":"implants? You know, I, I know"},{"speaker":"Chris Dy","startTime":2712.8,"endTime":2715.98,"body":"that there are a lot of implants"},{"speaker":"Chris Dy","startTime":2715.98,"endTime":2719.37,"body":"now that are made out of"},{"speaker":"Chris Dy","startTime":2715.98,"endTime":2719.37,"body":"titanium for distal radius sets."},{"speaker":"Chris Dy","startTime":2719.37,"endTime":2721.86,"body":"And you know I was totally fine"},{"speaker":"Chris Dy","startTime":2719.37,"endTime":2721.86,"body":"with using them most of the"},{"speaker":"Chris Dy","startTime":2721.86,"endTime":2724.5,"body":"time. But you know, I have a"},{"speaker":"Chris Dy","startTime":2721.86,"endTime":2724.5,"body":"preference for stainless steel,"},{"speaker":"Chris Dy","startTime":2724.5,"endTime":2728.94,"body":"because I tend to just know how"},{"speaker":"Chris Dy","startTime":2724.5,"endTime":2728.94,"body":"that material feels. And I also"},{"speaker":"Chris Dy","startTime":2728.97,"endTime":2731.85,"body":"have gone away from certain"},{"speaker":"Chris Dy","startTime":2728.97,"endTime":2731.85,"body":"manufacturers because I don't"},{"speaker":"Chris Dy","startTime":2731.85,"endTime":2735.18,"body":"like their locking mechanism,"},{"speaker":"Chris Dy","startTime":2731.85,"endTime":2735.18,"body":"and having true confidence that"},{"speaker":"Chris Dy","startTime":2735.18,"endTime":2737.55,"body":"that locking mechanism is"},{"speaker":"Chris Dy","startTime":2735.18,"endTime":2737.55,"body":"engaged, because I've seen"},{"speaker":"Chris Dy","startTime":2737.55,"endTime":2741.3,"body":"several different manufacturers"},{"speaker":"Chris Dy","startTime":2737.55,"endTime":2741.3,"body":"plates that the locking"},{"speaker":"Chris Dy","startTime":2741.3,"endTime":2744.39,"body":"mechanism I thought was engaged,"},{"speaker":"Chris Dy","startTime":2741.3,"endTime":2744.39,"body":"and it wasn't, and that screw"},{"speaker":"Chris Dy","startTime":2744.39,"endTime":2748.02,"body":"was backed out really early. And"},{"speaker":"Chris Dy","startTime":2744.39,"endTime":2748.02,"body":"it only takes a couple of times"},{"speaker":"Chris Dy","startTime":2748.02,"endTime":2750.84,"body":"to where you get burned, where"},{"speaker":"Chris Dy","startTime":2748.02,"endTime":2750.84,"body":"you are going to switch plates."},{"speaker":"Charles Goldfarb","startTime":2751.32,"endTime":2753.3,"body":"Yeah, I don't"},{"speaker":"Charles Goldfarb","startTime":2751.32,"endTime":2753.3,"body":"have a huge preference. But I"},{"speaker":"Charles Goldfarb","startTime":2753.3,"endTime":2756.36,"body":"agree that stainless is"},{"speaker":"Charles Goldfarb","startTime":2753.3,"endTime":2756.36,"body":"preferable if all other things"},{"speaker":"Charles Goldfarb","startTime":2756.36,"endTime":2759.18,"body":"being equal, especially if you"},{"speaker":"Charles Goldfarb","startTime":2756.36,"endTime":2759.18,"body":"may have to take the plate out."},{"speaker":"Charles Goldfarb","startTime":2759.21,"endTime":2762.03,"body":"It's just so much easier."},{"speaker":"Charles Goldfarb","startTime":2759.21,"endTime":2762.03,"body":"Totally agree with that."},{"speaker":"Chris Dy","startTime":2763.23,"endTime":2765.93,"body":"Yeah, you don't love"},{"speaker":"Chris Dy","startTime":2763.23,"endTime":2765.93,"body":"those easy to strip screw heads"},{"speaker":"Chris Dy","startTime":2765.93,"endTime":2770.04,"body":"on the titanium screws. You"},{"speaker":"Chris Dy","startTime":2765.93,"endTime":2770.04,"body":"know, so I have pretty much"},{"speaker":"Chris Dy","startTime":2770.04,"endTime":2772.26,"body":"routinely gone to stainless,"},{"speaker":"Chris Dy","startTime":2770.04,"endTime":2772.26,"body":"although there are some patients"},{"speaker":"Chris Dy","startTime":2772.26,"endTime":2776.22,"body":"who have, you know, pre known or"},{"speaker":"Chris Dy","startTime":2772.26,"endTime":2776.22,"body":"stated nickel allergies, kind of"},{"speaker":"Chris Dy","startTime":2776.22,"endTime":2777.96,"body":"dictate that you go towards"},{"speaker":"Chris Dy","startTime":2776.22,"endTime":2777.96,"body":"titanium."},{"speaker":"Charles Goldfarb","startTime":2778.59,"endTime":2782.37,"body":"So why don't"},{"speaker":"Charles Goldfarb","startTime":2778.59,"endTime":2782.37,"body":"we finish up talking about when"},{"speaker":"Charles Goldfarb","startTime":2782.37,"endTime":2787.08,"body":"you consider fragment specific"},{"speaker":"Charles Goldfarb","startTime":2782.37,"endTime":2787.08,"body":"fixation with a volar approach?"},{"speaker":"Charles Goldfarb","startTime":2787.11,"endTime":2790.38,"body":"So what are your thoughts aside"},{"speaker":"Charles Goldfarb","startTime":2787.11,"endTime":2790.38,"body":"from the volar ulnar corner,"},{"speaker":"Charles Goldfarb","startTime":2790.38,"endTime":2792.72,"body":"because we know that when you"},{"speaker":"Charles Goldfarb","startTime":2790.38,"endTime":2792.72,"body":"have a volar ulnar corner, you"},{"speaker":"Charles Goldfarb","startTime":2792.72,"endTime":2795.3,"body":"need a very distal plate, and"},{"speaker":"Charles Goldfarb","startTime":2792.72,"endTime":2795.3,"body":"you need a fragment specific"},{"speaker":"Charles Goldfarb","startTime":2795.3,"endTime":2797.34,"body":"approach and threr are different"},{"speaker":"Charles Goldfarb","startTime":2795.3,"endTime":2797.34,"body":"ways to tackle that. Are there"},{"speaker":"Charles Goldfarb","startTime":2797.37,"endTime":2800.4,"body":"any other fracture patterns that"},{"speaker":"Charles Goldfarb","startTime":2797.37,"endTime":2800.4,"body":"make you immediately think about"},{"speaker":"Charles Goldfarb","startTime":2800.4,"endTime":2800.76,"body":"that?"},{"speaker":"Chris Dy","startTime":2802.16,"endTime":2806.9,"body":"I think a fracture"},{"speaker":"Chris Dy","startTime":2802.16,"endTime":2806.9,"body":"that has a split, multiple"},{"speaker":"Chris Dy","startTime":2806.9,"endTime":2812.21,"body":"splits in this the radial"},{"speaker":"Chris Dy","startTime":2806.9,"endTime":2812.21,"body":"column, where I truly do think"},{"speaker":"Chris Dy","startTime":2812.21,"endTime":2814.97,"body":"that I need support along the"},{"speaker":"Chris Dy","startTime":2812.21,"endTime":2814.97,"body":"radial column, I will use a"},{"speaker":"Chris Dy","startTime":2814.97,"endTime":2818.57,"body":"fragment specific type approach."},{"speaker":"Chris Dy","startTime":2814.97,"endTime":2818.57,"body":"And I think I what you're saying"},{"speaker":"Chris Dy","startTime":2818.57,"endTime":2822.17,"body":"here is not the proprietary term"},{"speaker":"Chris Dy","startTime":2818.57,"endTime":2822.17,"body":"fragment specific fixation, but"},{"speaker":"Chris Dy","startTime":2822.17,"endTime":2825.41,"body":"you know, using multiple plates,"},{"speaker":"Chris Dy","startTime":2822.17,"endTime":2825.41,"body":"perhaps orthogonal plates,"},{"speaker":"Chris Dy","startTime":2825.56,"endTime":2827.96,"body":"sometimes with the volar plate,"},{"speaker":"Chris Dy","startTime":2825.56,"endTime":2827.96,"body":"and sometimes with the radial"},{"speaker":"Chris Dy","startTime":2827.96,"endTime":2832.52,"body":"column plate or both, to secure"},{"speaker":"Chris Dy","startTime":2827.96,"endTime":2832.52,"body":"a fragment. You know, if there,"},{"speaker":"Chris Dy","startTime":2832.55,"endTime":2836.54,"body":"if there's a lot of comminution"},{"speaker":"Chris Dy","startTime":2832.55,"endTime":2836.54,"body":"in that area or multiple fragmen"},{"speaker":"Chris Dy","startTime":2836.57,"endTime":2841.37,"body":"s, I will take a small kind of 2"},{"speaker":"Chris Dy","startTime":2836.57,"endTime":2841.37,"body":"0, or 2-4 recon plate, and con"},{"speaker":"Chris Dy","startTime":2841.37,"endTime":2844.28,"body":"our it to sit along the radial"},{"speaker":"Chris Dy","startTime":2841.37,"endTime":2844.28,"body":"column. I know that there are,"},{"speaker":"Chris Dy","startTime":2844.31,"endTime":2847.73,"body":"you know, radial styloid plates"},{"speaker":"Chris Dy","startTime":2844.31,"endTime":2847.73,"body":"ut there, I don't typically love"},{"speaker":"Chris Dy","startTime":2847.73,"endTime":2851.51,"body":"them. And you know, honestly,"},{"speaker":"Chris Dy","startTime":2847.73,"endTime":2851.51,"body":"I trained with kind of contourin"},{"speaker":"Chris Dy","startTime":2851.51,"endTime":2855.95,"body":"your own and I've become"},{"speaker":"Chris Dy","startTime":2851.51,"endTime":2855.95,"body":"elatively facile with that. And"},{"speaker":"Chris Dy","startTime":2855.95,"endTime":2856.58,"body":"I kind of ma"},{"speaker":"Charles Goldfarb","startTime":2857.65,"endTime":2859.96,"body":"Yeah, I like I"},{"speaker":"Charles Goldfarb","startTime":2857.65,"endTime":2859.96,"body":"like what you said, I think you"},{"speaker":"Charles Goldfarb","startTime":2859.96,"endTime":2862.9,"body":"know, go either way control your"},{"speaker":"Charles Goldfarb","startTime":2859.96,"endTime":2862.9,"body":"own or use the pre manufactured"},{"speaker":"Charles Goldfarb","startTime":2862.9,"endTime":2866.83,"body":"if your manufacturer of choice"},{"speaker":"Charles Goldfarb","startTime":2862.9,"endTime":2866.83,"body":"has them, you know, we don't do"},{"speaker":"Charles Goldfarb","startTime":2866.83,"endTime":2869.71,"body":"them every day. And if you're"},{"speaker":"Charles Goldfarb","startTime":2866.83,"endTime":2869.71,"body":"not used to using that radial"},{"speaker":"Charles Goldfarb","startTime":2869.71,"endTime":2872.92,"body":"column plate, it can seem"},{"speaker":"Charles Goldfarb","startTime":2869.71,"endTime":2872.92,"body":"daunting, it shouldn't be, it's"},{"speaker":"Charles Goldfarb","startTime":2872.92,"endTime":2877.33,"body":"not daunting, you have to have"},{"speaker":"Charles Goldfarb","startTime":2872.92,"endTime":2877.33,"body":"the right exposure. And you have"},{"speaker":"Charles Goldfarb","startTime":2877.33,"endTime":2880.54,"body":"to get that plate down on the"},{"speaker":"Charles Goldfarb","startTime":2877.33,"endTime":2880.54,"body":"metaphyseal portion of the"},{"speaker":"Charles Goldfarb","startTime":2880.54,"endTime":2884.17,"body":"distal radius first and secure"},{"speaker":"Charles Goldfarb","startTime":2880.54,"endTime":2884.17,"body":"it there. But it can be a game"},{"speaker":"Charles Goldfarb","startTime":2884.17,"endTime":2887.86,"body":"changer as far as fixation, it"},{"speaker":"Charles Goldfarb","startTime":2884.17,"endTime":2887.86,"body":"really can make a big"},{"speaker":"Charles Goldfarb","startTime":2887.86,"endTime":2889.66,"body":"difference. So when it's"},{"speaker":"Charles Goldfarb","startTime":2887.86,"endTime":2889.66,"body":"necessary, I would just"},{"speaker":"Charles Goldfarb","startTime":2889.66,"endTime":2892.45,"body":"encourage all those listening to"},{"speaker":"Charles Goldfarb","startTime":2889.66,"endTime":2892.45,"body":"think about that option."},{"speaker":"Chris Dy","startTime":2893.5,"endTime":2896.32,"body":"And sometimes, you"},{"speaker":"Chris Dy","startTime":2893.5,"endTime":2896.32,"body":"know, to be honest with you, it"},{"speaker":"Chris Dy","startTime":2896.32,"endTime":2900.13,"body":"is a good thing to show trainees"},{"speaker":"Chris Dy","startTime":2896.32,"endTime":2900.13,"body":"how to do because they're going"},{"speaker":"Chris Dy","startTime":2900.13,"endTime":2903.1,"body":"to need to do it. And if it's a"},{"speaker":"Chris Dy","startTime":2900.13,"endTime":2903.1,"body":"reasonable indication, I may"},{"speaker":"Chris Dy","startTime":2903.1,"endTime":2907.57,"body":"sometimes will use a small kind"},{"speaker":"Chris Dy","startTime":2903.1,"endTime":2907.57,"body":"of 2-0 plate along the radial"},{"speaker":"Chris Dy","startTime":2907.57,"endTime":2911.38,"body":"side just as provisional"},{"speaker":"Chris Dy","startTime":2907.57,"endTime":2911.38,"body":"stabilization and then opt to"},{"speaker":"Chris Dy","startTime":2911.38,"endTime":2916.24,"body":"take it out. Because it's it you"},{"speaker":"Chris Dy","startTime":2911.38,"endTime":2916.24,"body":"know, it is no longer necessary."},{"speaker":"Chris Dy","startTime":2916.24,"endTime":2919.63,"body":"But if I'm going to do that, I"},{"speaker":"Chris Dy","startTime":2916.24,"endTime":2919.63,"body":"typically will use, design a"},{"speaker":"Chris Dy","startTime":2919.63,"endTime":2922.81,"body":"plate or contour a plate in a"},{"speaker":"Chris Dy","startTime":2919.63,"endTime":2922.81,"body":"way that I can leave it in if I"},{"speaker":"Chris Dy","startTime":2922.81,"endTime":2925.87,"body":"wanted to. And I think it is"},{"speaker":"Chris Dy","startTime":2922.81,"endTime":2925.87,"body":"important you know with if"},{"speaker":"Chris Dy","startTime":2925.87,"endTime":2930.4,"body":"you're using that radial column"},{"speaker":"Chris Dy","startTime":2925.87,"endTime":2930.4,"body":"plate that you don't have"},{"speaker":"Chris Dy","startTime":2930.58,"endTime":2933.52,"body":"prominent distal screws because"},{"speaker":"Chris Dy","startTime":2930.58,"endTime":2933.52,"body":"that styloid is you know,"},{"speaker":"Chris Dy","startTime":2933.52,"endTime":2938.17,"body":"subcutaneous and the first one"},{"speaker":"Chris Dy","startTime":2933.52,"endTime":2938.17,"body":"here. And if you are too"},{"speaker":"Chris Dy","startTime":2938.17,"endTime":2942.04,"body":"prominent with any part of the"},{"speaker":"Chris Dy","startTime":2938.17,"endTime":2942.04,"body":"plate or the screws, it can be"},{"speaker":"Chris Dy","startTime":2942.04,"endTime":2943.27,"body":"bothersome to patients."},{"speaker":"Charles Goldfarb","startTime":2943.84,"endTime":2946.78,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":2943.84,"endTime":2946.78,"body":"that's well said three concepts"},{"speaker":"Charles Goldfarb","startTime":2946.78,"endTime":2951.16,"body":"to close on. And I'll give my"},{"speaker":"Charles Goldfarb","startTime":2946.78,"endTime":2951.16,"body":"opinion on all three and then"},{"speaker":"Charles Goldfarb","startTime":2951.55,"endTime":2954.25,"body":"really want your honest opinion"},{"speaker":"Charles Goldfarb","startTime":2951.55,"endTime":2954.25,"body":"on them as well. Number one,"},{"speaker":"Charles Goldfarb","startTime":2955.03,"endTime":2958.06,"body":"there is no shame in"},{"speaker":"Charles Goldfarb","startTime":2955.03,"endTime":2958.06,"body":"supplementing a distal radius"},{"speaker":"Charles Goldfarb","startTime":2958.06,"endTime":2961.87,"body":"fracture with K wires and I"},{"speaker":"Charles Goldfarb","startTime":2958.06,"endTime":2961.87,"body":"don't do that often but I don't"},{"speaker":"Charles Goldfarb","startTime":2961.87,"endTime":2964.54,"body":"have a problem doing that so"},{"speaker":"Charles Goldfarb","startTime":2961.87,"endTime":2964.54,"body":"leaving k wires typically"},{"speaker":"Charles Goldfarb","startTime":2964.54,"endTime":2967.66,"body":"through the radial styloid as a"},{"speaker":"Charles Goldfarb","startTime":2964.54,"endTime":2967.66,"body":"supplemental fixation point and"},{"speaker":"Charles Goldfarb","startTime":2967.66,"endTime":2969.7,"body":"that would be for a more"},{"speaker":"Charles Goldfarb","startTime":2967.66,"endTime":2969.7,"body":"comminuted fracture where you"},{"speaker":"Charles Goldfarb","startTime":2969.7,"endTime":2972.13,"body":"need a little more support. I"},{"speaker":"Charles Goldfarb","startTime":2969.7,"endTime":2972.13,"body":"typically leave those in for"},{"speaker":"Charles Goldfarb","startTime":2972.13,"endTime":2975.61,"body":"four weeks and just slows down"},{"speaker":"Charles Goldfarb","startTime":2972.13,"endTime":2975.61,"body":"my rehab a touch but I have no"},{"speaker":"Charles Goldfarb","startTime":2975.61,"endTime":2979.15,"body":"problem doing that. So that's"},{"speaker":"Charles Goldfarb","startTime":2975.61,"endTime":2979.15,"body":"number one. Number two, no shame"},{"speaker":"Charles Goldfarb","startTime":2979.15,"endTime":2982.84,"body":"in going dorsal as a secondary"},{"speaker":"Charles Goldfarb","startTime":2979.15,"endTime":2982.84,"body":"exposure, whether to look in the"},{"speaker":"Charles Goldfarb","startTime":2982.84,"endTime":2985.57,"body":"joint if you're not sure or"},{"speaker":"Charles Goldfarb","startTime":2982.84,"endTime":2985.57,"body":"whether to add a supplemental"},{"speaker":"Charles Goldfarb","startTime":2985.57,"endTime":2989.44,"body":"plate if you think it's"},{"speaker":"Charles Goldfarb","startTime":2985.57,"endTime":2989.44,"body":"necessary. And number three, no"},{"speaker":"Charles Goldfarb","startTime":2989.44,"endTime":2994.15,"body":"shame in using a spanning dorsal"},{"speaker":"Charles Goldfarb","startTime":2989.44,"endTime":2994.15,"body":"plate. Although I will say I"},{"speaker":"Charles Goldfarb","startTime":2994.15,"endTime":2998.32,"body":"think that is over subscribed. I"},{"speaker":"Charles Goldfarb","startTime":2994.15,"endTime":2998.32,"body":"think the pendulum has really"},{"speaker":"Charles Goldfarb","startTime":2998.32,"endTime":3001.68,"body":"tilted towards using those type"},{"speaker":"Charles Goldfarb","startTime":2998.32,"endTime":3001.68,"body":"of plates more frequently than"},{"speaker":"Charles Goldfarb","startTime":3001.68,"endTime":3005.91,"body":"necessary. But it's a great"},{"speaker":"Charles Goldfarb","startTime":3001.68,"endTime":3005.91,"body":"option especially for the"},{"speaker":"Charles Goldfarb","startTime":3005.91,"endTime":3009.33,"body":"support of the volar ulnar"},{"speaker":"Charles Goldfarb","startTime":3005.91,"endTime":3009.33,"body":"corner fracture, and just really"},{"speaker":"Charles Goldfarb","startTime":3009.36,"endTime":3012.39,"body":"difficult comminuted fractures."},{"speaker":"Charles Goldfarb","startTime":3009.36,"endTime":3012.39,"body":"So I'd love your opinion all"},{"speaker":"Charles Goldfarb","startTime":3012.39,"endTime":3017.04,"body":"three, k wires, dorsal"},{"speaker":"Charles Goldfarb","startTime":3012.39,"endTime":3017.04,"body":"supplementary approach and the"},{"speaker":"Charles Goldfarb","startTime":3017.04,"endTime":3017.97,"body":"dorsal spanning plate."},{"speaker":"Chris Dy","startTime":3018.92,"endTime":3021.53,"body":"On the first one, I"},{"speaker":"Chris Dy","startTime":3018.92,"endTime":3021.53,"body":"agree. If I'm at that point"},{"speaker":"Chris Dy","startTime":3021.53,"endTime":3023.75,"body":"where it's that unstable, I'm"},{"speaker":"Chris Dy","startTime":3021.53,"endTime":3023.75,"body":"usually putting a radial column"},{"speaker":"Chris Dy","startTime":3023.75,"endTime":3026.93,"body":"played in any way to accomplish"},{"speaker":"Chris Dy","startTime":3023.75,"endTime":3026.93,"body":"the same thing. But 100% agree"},{"speaker":"Chris Dy","startTime":3026.93,"endTime":3032.24,"body":"with the thought. The second one"},{"speaker":"Chris Dy","startTime":3026.93,"endTime":3032.24,"body":"actually did this recently, in"},{"speaker":"Chris Dy","startTime":3032.24,"endTime":3034.97,"body":"which I made a separate"},{"speaker":"Chris Dy","startTime":3032.24,"endTime":3034.97,"body":"accessory dorsal approach, not"},{"speaker":"Chris Dy","startTime":3034.97,"endTime":3038.96,"body":"the full on dorsal approach to"},{"speaker":"Chris Dy","startTime":3034.97,"endTime":3038.96,"body":"to secure a dorsal ulnar corner"},{"speaker":"Chris Dy","startTime":3038.96,"endTime":3041.96,"body":"fragment that I thought had"},{"speaker":"Chris Dy","startTime":3038.96,"endTime":3041.96,"body":"implications for the sigmoid"},{"speaker":"Chris Dy","startTime":3041.96,"endTime":3045.56,"body":"notch. And because I wanted to"},{"speaker":"Chris Dy","startTime":3041.96,"endTime":3045.56,"body":"rotate the patient's forearm"},{"speaker":"Chris Dy","startTime":3045.59,"endTime":3049.16,"body":"right away, I secured it with a"},{"speaker":"Chris Dy","startTime":3045.59,"endTime":3049.16,"body":"separate inter fragmentary screw"},{"speaker":"Chris Dy","startTime":3049.16,"endTime":3053.51,"body":"through that kind of accessory"},{"speaker":"Chris Dy","startTime":3049.16,"endTime":3053.51,"body":"approach. So yes, 100% agree, if"},{"speaker":"Chris Dy","startTime":3053.51,"endTime":3056.09,"body":"you think there's an important"},{"speaker":"Chris Dy","startTime":3053.51,"endTime":3056.09,"body":"fragment or some other reason to"},{"speaker":"Chris Dy","startTime":3056.09,"endTime":3059.3,"body":"get over there. Sometimes that"},{"speaker":"Chris Dy","startTime":3056.09,"endTime":3059.3,"body":"can be in a malunion setting"},{"speaker":"Chris Dy","startTime":3059.3,"endTime":3063.98,"body":"more than anything else. Yes,"},{"speaker":"Chris Dy","startTime":3059.3,"endTime":3063.98,"body":"dorsal approach is successful."},{"speaker":"Chris Dy","startTime":3064.7,"endTime":3068.87,"body":"And then for the third one, I"},{"speaker":"Chris Dy","startTime":3064.7,"endTime":3068.87,"body":"agree, I think that the spanning"},{"speaker":"Chris Dy","startTime":3068.87,"endTime":3071.24,"body":"plate has a role and a purpose."},{"speaker":"Chris Dy","startTime":3068.87,"endTime":3071.24,"body":"And you should have it"},{"speaker":"Chris Dy","startTime":3071.24,"endTime":3074.15,"body":"available, you know, in terms of"},{"speaker":"Chris Dy","startTime":3071.24,"endTime":3074.15,"body":"what implants are in your"},{"speaker":"Chris Dy","startTime":3074.15,"endTime":3078.74,"body":"facility, for some of these more"},{"speaker":"Chris Dy","startTime":3074.15,"endTime":3078.74,"body":"challenging cases, but it's not"},{"speaker":"Chris Dy","startTime":3078.74,"endTime":3082.85,"body":"a panacea. And there are a lot"},{"speaker":"Chris Dy","startTime":3078.74,"endTime":3082.85,"body":"of influential papers or"},{"speaker":"Chris Dy","startTime":3082.88,"endTime":3085.76,"body":"influential speakers and papers"},{"speaker":"Chris Dy","startTime":3082.88,"endTime":3085.76,"body":"that are getting out there and"},{"speaker":"Chris Dy","startTime":3085.76,"endTime":3088.82,"body":"kind of using it very"},{"speaker":"Chris Dy","startTime":3085.76,"endTime":3088.82,"body":"frequently. And I think it's"},{"speaker":"Chris Dy","startTime":3088.82,"endTime":3093.2,"body":"probably overused. And I think"},{"speaker":"Chris Dy","startTime":3088.82,"endTime":3093.2,"body":"that if you're a trainee, and"},{"speaker":"Chris Dy","startTime":3093.2,"endTime":3096.65,"body":"your first thought is to go to a"},{"speaker":"Chris Dy","startTime":3093.2,"endTime":3096.65,"body":"spanning plate, that's okay. But"},{"speaker":"Chris Dy","startTime":3096.65,"endTime":3099.2,"body":"you should understand there are"},{"speaker":"Chris Dy","startTime":3096.65,"endTime":3099.2,"body":"some other ways to get out of"},{"speaker":"Chris Dy","startTime":3099.2,"endTime":3102.89,"body":"that, which will, you know,"},{"speaker":"Chris Dy","startTime":3099.2,"endTime":3102.89,"body":"potentially avoid a second"},{"speaker":"Chris Dy","startTime":3102.92,"endTime":3105.38,"body":"surgery, albeit a planned"},{"speaker":"Chris Dy","startTime":3102.92,"endTime":3105.38,"body":"surgery to remove the plate."},{"speaker":"Charles Goldfarb","startTime":3106.04,"endTime":3108.95,"body":"All right. I"},{"speaker":"Charles Goldfarb","startTime":3106.04,"endTime":3108.95,"body":"think on that note, we can talk"},{"speaker":"Charles Goldfarb","startTime":3108.95,"endTime":3111.89,"body":"about distal radius fractures"},{"speaker":"Charles Goldfarb","startTime":3108.95,"endTime":3111.89,"body":"for days, we probably should"},{"speaker":"Charles Goldfarb","startTime":3111.89,"endTime":3114.26,"body":"have another episode in the"},{"speaker":"Charles Goldfarb","startTime":3111.89,"endTime":3114.26,"body":"future about when and why we go"},{"speaker":"Charles Goldfarb","startTime":3114.26,"endTime":3116.78,"body":"dorsal and how we approach"},{"speaker":"Charles Goldfarb","startTime":3114.26,"endTime":3116.78,"body":"fractures from a dorsal"},{"speaker":"Charles Goldfarb","startTime":3116.78,"endTime":3120.11,"body":"approach. But I think we've hit"},{"speaker":"Charles Goldfarb","startTime":3116.78,"endTime":3120.11,"body":"the high points of the benefits"},{"speaker":"Charles Goldfarb","startTime":3120.11,"endTime":3123.71,"body":"of a volar approach and our"},{"speaker":"Charles Goldfarb","startTime":3120.11,"endTime":3123.71,"body":"personal approaches. Anything"},{"speaker":"Charles Goldfarb","startTime":3123.71,"endTime":3124.64,"body":"you'd like to close with?"},{"speaker":"Chris Dy","startTime":3125.6,"endTime":3127.43,"body":"No, except for the"},{"speaker":"Chris Dy","startTime":3125.6,"endTime":3127.43,"body":"fact that we should probably do"},{"speaker":"Chris Dy","startTime":3127.43,"endTime":3129.71,"body":"a rehab episode too after we've"},{"speaker":"Chris Dy","startTime":3127.43,"endTime":3129.71,"body":"covered all the different"},{"speaker":"Chris Dy","startTime":3129.71,"endTime":3130.28,"body":"approaches."},{"speaker":"Charles Goldfarb","startTime":3130.82,"endTime":3134.06,"body":"Yeah, so rehab"},{"speaker":"Charles Goldfarb","startTime":3130.82,"endTime":3134.06,"body":"episode on crps. Rehab episode"},{"speaker":"Charles Goldfarb","startTime":3134.09,"endTime":3138.23,"body":"on distal radius for sure. So,"},{"speaker":"Charles Goldfarb","startTime":3134.09,"endTime":3138.23,"body":"so critical that we get the"},{"speaker":"Charles Goldfarb","startTime":3138.23,"endTime":3140.81,"body":"right experienced hands on"},{"speaker":"Charles Goldfarb","startTime":3138.23,"endTime":3140.81,"body":"working with patients."},{"speaker":"Chris Dy","startTime":3140.84,"endTime":3142.07,"body":"Have a great"},{"speaker":"Chris Dy","startTime":3140.84,"endTime":3142.07,"body":"afternoon, Chuck."},{"speaker":"Charles Goldfarb","startTime":3142.13,"endTime":3142.94,"body":"All right."},{"speaker":"Charles Goldfarb","startTime":3142.13,"endTime":3142.94,"body":"Great to see you."},{"speaker":"Chris Dy","startTime":3143.33,"endTime":3144.29,"body":"Nice seeing you."},{"speaker":"Charles Goldfarb","startTime":3145.1,"endTime":3147.08,"body":"Hey, Chris."},{"speaker":"Charles Goldfarb","startTime":3145.1,"endTime":3147.08,"body":"That was fun. Let's do it again"},{"speaker":"Charles Goldfarb","startTime":3147.08,"endTime":3147.59,"body":"real soon."},{"speaker":"Chris Dy","startTime":3147.83,"endTime":3150.38,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":3147.83,"endTime":3150.38,"body":"sure to check us out on Twitter"},{"speaker":"Chris Dy","startTime":3150.62,"endTime":3152.78,"body":"@handpodcast. Hey, Chuck, what's"},{"speaker":"Chris Dy","startTime":3150.62,"endTime":3152.78,"body":"your Twitter handle?"},{"speaker":"Charles Goldfarb","startTime":3153.14,"endTime":3155.99,"body":"Mine is"},{"speaker":"Charles Goldfarb","startTime":3153.14,"endTime":3155.99,"body":"@congenitalhand. What about you?"},{"speaker":"Chris Dy","startTime":3156.14,"endTime":3159.5,"body":"Mine is @ChrisDyMD"},{"speaker":"Chris Dy","startTime":3156.14,"endTime":3159.5,"body":"spelled d y. And if you'd like"},{"speaker":"Chris Dy","startTime":3159.5,"endTime":3163.37,"body":"to email us, you can reach us at"},{"speaker":"Chris Dy","startTime":3159.5,"endTime":3163.37,"body":"handpodcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":3163.94,"endTime":3166.07,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":3163.94,"endTime":3166.07,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":3166.07,"endTime":3167.18,"body":"get your podcasts"},{"speaker":"Chris Dy","startTime":3167.21,"endTime":3169.4,"body":"and be sure to leave a"},{"speaker":"Chris Dy","startTime":3167.21,"endTime":3169.4,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":3169.4,"endTime":3169.82,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":3170.19,"endTime":3172.5,"body":"Special thanks"},{"speaker":"Charles Goldfarb","startTime":3170.19,"endTime":3172.5,"body":"to Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":3172.5,"endTime":3176.49,"body":"music. And remember, keep the"},{"speaker":"Charles Goldfarb","startTime":3172.5,"endTime":3176.49,"body":"upper hand. Come back next time."}]}