{"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":28.14,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":28.2,"endTime":29.01,"body":"Oh, hey,"},{"speaker":"Charles Goldfarb","startTime":28.2,"endTime":29.01,"body":"Chris."},{"speaker":"Chris Dy","startTime":29.07,"endTime":30.27,"body":"Hey, Chuck, how are"},{"speaker":"Chris Dy","startTime":29.07,"endTime":30.27,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":30.42,"endTime":31.68,"body":"I'm well, how"},{"speaker":"Charles Goldfarb","startTime":30.42,"endTime":31.68,"body":"are you?"},{"speaker":"Chris Dy","startTime":31.77,"endTime":35.76,"body":"I am fantastic. Nice"},{"speaker":"Chris Dy","startTime":31.77,"endTime":35.76,"body":"to see you on another nice day"},{"speaker":"Chris Dy","startTime":35.76,"endTime":36.45,"body":"in St. Louis."},{"speaker":"Charles Goldfarb","startTime":36.54,"endTime":38.31,"body":"A little"},{"speaker":"Charles Goldfarb","startTime":36.54,"endTime":38.31,"body":"breezy, a little breezy."},{"speaker":"Chris Dy","startTime":38.54,"endTime":40.25,"body":"Yeah, there are some"},{"speaker":"Chris Dy","startTime":38.54,"endTime":40.25,"body":"things knocked over in my yard,"},{"speaker":"Chris Dy","startTime":40.25,"endTime":40.49,"body":"so."},{"speaker":"Charles Goldfarb","startTime":40.79,"endTime":41.69,"body":"So you're well"},{"speaker":"Charles Goldfarb","startTime":40.79,"endTime":41.69,"body":"aware."},{"speaker":"Chris Dy","startTime":41.96,"endTime":44.78,"body":"Oh, yeah. Fully aware"},{"speaker":"Chris Dy","startTime":41.96,"endTime":44.78,"body":"and a rainy day yesterday, so"},{"speaker":"Chris Dy","startTime":44.78,"endTime":46.01,"body":"it's nice to not have some rain."},{"speaker":"Charles Goldfarb","startTime":46.229,"endTime":48.119,"body":"Yeah, we are"},{"speaker":"Charles Goldfarb","startTime":46.229,"endTime":48.119,"body":"actually sitting in relative"},{"speaker":"Charles Goldfarb","startTime":48.209,"endTime":51.269,"body":"close proximity, I would give us"},{"speaker":"Charles Goldfarb","startTime":48.209,"endTime":51.269,"body":"six feet apart. But we're not"},{"speaker":"Charles Goldfarb","startTime":51.269,"endTime":54.059,"body":"doing this by zoom. It's a whole"},{"speaker":"Charles Goldfarb","startTime":51.269,"endTime":54.059,"body":"nother thing."},{"speaker":"Chris Dy","startTime":54.27,"endTime":56.7,"body":"Well, you know, our"},{"speaker":"Chris Dy","startTime":54.27,"endTime":56.7,"body":"tech director really got on my,"},{"speaker":"Chris Dy","startTime":56.73,"endTime":60.24,"body":"got on my case about the zoom"},{"speaker":"Chris Dy","startTime":56.73,"endTime":60.24,"body":"thing. So, you know, whoever"},{"speaker":"Chris Dy","startTime":60.24,"endTime":63.12,"body":"that guy is, is, uh, you know,"},{"speaker":"Chris Dy","startTime":60.24,"endTime":63.12,"body":"kind of kind of tough."},{"speaker":"Charles Goldfarb","startTime":63.18,"endTime":63.99,"body":"Sounds like a"},{"speaker":"Charles Goldfarb","startTime":63.18,"endTime":63.99,"body":"jerk."},{"speaker":"Chris Dy","startTime":64.02,"endTime":65.7,"body":"Yeah. Well, yeah at"},{"speaker":"Chris Dy","startTime":64.02,"endTime":65.7,"body":"times."},{"speaker":"Charles Goldfarb","startTime":68.07,"endTime":72.21,"body":"Well, it's"},{"speaker":"Charles Goldfarb","startTime":68.07,"endTime":72.21,"body":"good to be back. And we have I"},{"speaker":"Charles Goldfarb","startTime":72.21,"endTime":74.58,"body":"think what we're doing today is"},{"speaker":"Charles Goldfarb","startTime":72.21,"endTime":74.58,"body":"we're hitting up part three of"},{"speaker":"Charles Goldfarb","startTime":74.58,"endTime":76.02,"body":"distal radius fractures. Is that"},{"speaker":"Charles Goldfarb","startTime":74.58,"endTime":76.02,"body":"right?"},{"speaker":"Chris Dy","startTime":76.05,"endTime":78.21,"body":"Yeah. And I know"},{"speaker":"Chris Dy","startTime":76.05,"endTime":78.21,"body":"everybody loves to talk about"},{"speaker":"Chris Dy","startTime":78.21,"endTime":81.0,"body":"distal radius fractures, there"},{"speaker":"Chris Dy","startTime":78.21,"endTime":81.0,"body":"will eventually be a part four"},{"speaker":"Chris Dy","startTime":81.0,"endTime":84.0,"body":"in which we have one of our"},{"speaker":"Chris Dy","startTime":81.0,"endTime":84.0,"body":"therapy colleagues come on and"},{"speaker":"Chris Dy","startTime":84.0,"endTime":88.29,"body":"join us. But let's talk today, a"},{"speaker":"Chris Dy","startTime":84.0,"endTime":88.29,"body":"little later on about when we"},{"speaker":"Chris Dy","startTime":88.29,"endTime":90.99,"body":"don't use volar plates. But"},{"speaker":"Chris Dy","startTime":88.29,"endTime":90.99,"body":"before we launch into that, why"},{"speaker":"Chris Dy","startTime":90.99,"endTime":93.15,"body":"don't you share some feedback"},{"speaker":"Chris Dy","startTime":90.99,"endTime":93.15,"body":"from the listener survey?"},{"speaker":"Charles Goldfarb","startTime":93.93,"endTime":95.79,"body":"Yeah, once"},{"speaker":"Charles Goldfarb","startTime":93.93,"endTime":95.79,"body":"again, we're grateful for all"},{"speaker":"Charles Goldfarb","startTime":95.79,"endTime":100.29,"body":"reviews. And this one is"},{"speaker":"Charles Goldfarb","startTime":95.79,"endTime":100.29,"body":"unnamed. And it says, Thanks for"},{"speaker":"Charles Goldfarb","startTime":100.29,"endTime":103.08,"body":"the great podcast. I've been"},{"speaker":"Charles Goldfarb","startTime":100.29,"endTime":103.08,"body":"listening for a few months now."},{"speaker":"Charles Goldfarb","startTime":103.32,"endTime":106.05,"body":"And I like to hear about the"},{"speaker":"Charles Goldfarb","startTime":103.32,"endTime":106.05,"body":"technical and decision making"},{"speaker":"Charles Goldfarb","startTime":106.05,"endTime":109.53,"body":"steps as well as the great"},{"speaker":"Charles Goldfarb","startTime":106.05,"endTime":109.53,"body":"banter. I even got my PA to"},{"speaker":"Charles Goldfarb","startTime":109.53,"endTime":113.67,"body":"listen, and the show has really"},{"speaker":"Charles Goldfarb","startTime":109.53,"endTime":113.67,"body":"gotten him interested in and"},{"speaker":"Charles Goldfarb","startTime":113.67,"endTime":117.0,"body":"motivated in becoming more"},{"speaker":"Charles Goldfarb","startTime":113.67,"endTime":117.0,"body":"knowledgeable about taking care"},{"speaker":"Charles Goldfarb","startTime":117.0,"endTime":120.99,"body":"of hand patients. Thanks. And"},{"speaker":"Charles Goldfarb","startTime":117.0,"endTime":120.99,"body":"yeah, thank you, we appreciate"},{"speaker":"Charles Goldfarb","startTime":120.99,"endTime":124.41,"body":"the review. And I think this"},{"speaker":"Charles Goldfarb","startTime":120.99,"endTime":124.41,"body":"episode should hit the spot as"},{"speaker":"Charles Goldfarb","startTime":124.41,"endTime":126.39,"body":"far as the technical and the"},{"speaker":"Charles Goldfarb","startTime":124.41,"endTime":126.39,"body":"decision making."},{"speaker":"Chris Dy","startTime":126.57,"endTime":128.91,"body":"Absolutely. And the"},{"speaker":"Chris Dy","startTime":126.57,"endTime":128.91,"body":"listener survey is still open."},{"speaker":"Chris Dy","startTime":129.3,"endTime":132.21,"body":"If you want a chance to win one"},{"speaker":"Chris Dy","startTime":129.3,"endTime":132.21,"body":"of those fantastic upper hand"},{"speaker":"Chris Dy","startTime":132.21,"endTime":136.8,"body":"coffee mugs. Our first winner is"},{"speaker":"Chris Dy","startTime":132.21,"endTime":136.8,"body":"from Brazil. So congratulations"},{"speaker":"Chris Dy","startTime":136.8,"endTime":140.85,"body":"to him. And he'll be getting his"},{"speaker":"Chris Dy","startTime":136.8,"endTime":140.85,"body":"mug shortly. But if you want to"},{"speaker":"Chris Dy","startTime":140.85,"endTime":145.32,"body":"find the links, you can find us"},{"speaker":"Chris Dy","startTime":140.85,"endTime":145.32,"body":"on social @handpodcast. Then"},{"speaker":"Chris Dy","startTime":145.32,"endTime":147.09,"body":"we'll also have a link on our"},{"speaker":"Chris Dy","startTime":145.32,"endTime":147.09,"body":"website,"},{"speaker":"Chris Dy","startTime":147.12,"endTime":150.54,"body":"theupperhandpodcast.wustl.edu."},{"speaker":"Charles Goldfarb","startTime":151.02,"endTime":153.48,"body":"Perfect. Yeah,"},{"speaker":"Charles Goldfarb","startTime":151.02,"endTime":153.48,"body":"the we weren't expecting an"},{"speaker":"Charles Goldfarb","startTime":153.48,"endTime":156.72,"body":"international mailing, to be"},{"speaker":"Charles Goldfarb","startTime":153.48,"endTime":156.72,"body":"honest. And so we're not sure if"},{"speaker":"Charles Goldfarb","startTime":156.72,"endTime":159.39,"body":"this is gonna go out by the slow"},{"speaker":"Charles Goldfarb","startTime":156.72,"endTime":159.39,"body":"ship. So it might not be there"},{"speaker":"Charles Goldfarb","startTime":159.39,"endTime":161.43,"body":"tomorrow. But we'll get it to"},{"speaker":"Charles Goldfarb","startTime":159.39,"endTime":161.43,"body":"you."},{"speaker":"Chris Dy","startTime":162.2,"endTime":164.39,"body":"You'll get it"},{"speaker":"Chris Dy","startTime":162.2,"endTime":164.39,"body":"eventually. It'll be a wonderful"},{"speaker":"Chris Dy","startTime":164.39,"endTime":165.65,"body":"Christmas present, I guess."},{"speaker":"Charles Goldfarb","startTime":166.73,"endTime":170.51,"body":"So any"},{"speaker":"Charles Goldfarb","startTime":166.73,"endTime":170.51,"body":"interesting cases you want to"},{"speaker":"Charles Goldfarb","startTime":170.51,"endTime":170.78,"body":"share?"},{"speaker":"Chris Dy","startTime":170.81,"endTime":172.58,"body":"You're gonna roll your"},{"speaker":"Chris Dy","startTime":170.81,"endTime":172.58,"body":"eyes, but I'm gonna talk about"},{"speaker":"Chris Dy","startTime":172.58,"endTime":173.39,"body":"another WALANT case."},{"speaker":"Charles Goldfarb","startTime":173.39,"endTime":175.37,"body":"Oh my god, I'm"},{"speaker":"Charles Goldfarb","startTime":173.39,"endTime":175.37,"body":"rolling my eyes. I hope the"},{"speaker":"Charles Goldfarb","startTime":175.37,"endTime":176.75,"body":"audience can see that clearly."},{"speaker":"Chris Dy","startTime":176.81,"endTime":179.99,"body":"But the this patient"},{"speaker":"Chris Dy","startTime":176.81,"endTime":179.99,"body":"was so cool about everything. I"},{"speaker":"Chris Dy","startTime":179.99,"endTime":184.19,"body":"mean, you know, she I walked"},{"speaker":"Chris Dy","startTime":179.99,"endTime":184.19,"body":"into holding and First off, I"},{"speaker":"Chris Dy","startTime":184.19,"endTime":186.29,"body":"did discuss with her that I was"},{"speaker":"Chris Dy","startTime":184.19,"endTime":186.29,"body":"going to be sharing our"},{"speaker":"Chris Dy","startTime":186.29,"endTime":190.1,"body":"experience about her case on"},{"speaker":"Chris Dy","startTime":186.29,"endTime":190.1,"body":"social and on the podcast, and"},{"speaker":"Chris Dy","startTime":190.1,"endTime":193.7,"body":"she was cool with that. But she"},{"speaker":"Chris Dy","startTime":190.1,"endTime":193.7,"body":"I walked into the holding area"},{"speaker":"Chris Dy","startTime":193.7,"endTime":196.43,"body":"and I swear she is one of the"},{"speaker":"Chris Dy","startTime":193.7,"endTime":196.43,"body":"only patients I've ever seen"},{"speaker":"Chris Dy","startTime":196.43,"endTime":200.72,"body":"meditating. And it was a totally"},{"speaker":"Chris Dy","startTime":196.43,"endTime":200.72,"body":"cool vibe. Did the block, went"},{"speaker":"Chris Dy","startTime":200.72,"endTime":203.12,"body":"well. And then we went back in"},{"speaker":"Chris Dy","startTime":200.72,"endTime":203.12,"body":"the operating room and she"},{"speaker":"Chris Dy","startTime":203.12,"endTime":206.63,"body":"wanted to watch her surgery. So"},{"speaker":"Chris Dy","startTime":203.12,"endTime":206.63,"body":"our fellow, hello, Dr. Lauren"},{"speaker":"Chris Dy","startTime":206.63,"endTime":209.66,"body":"Wessel, and I did the case"},{"speaker":"Chris Dy","startTime":206.63,"endTime":209.66,"body":"together. And you know, we're"},{"speaker":"Chris Dy","startTime":209.66,"endTime":212.6,"body":"switching sides back and forth"},{"speaker":"Chris Dy","startTime":209.66,"endTime":212.6,"body":"and putting in core sutures and"},{"speaker":"Chris Dy","startTime":212.78,"endTime":216.23,"body":"epitendenis sutures and the"},{"speaker":"Chris Dy","startTime":212.78,"endTime":216.23,"body":"patient was a great participant"},{"speaker":"Chris Dy","startTime":216.23,"endTime":219.35,"body":"in the whole case, it was a"},{"speaker":"Chris Dy","startTime":216.23,"endTime":219.35,"body":"really honestly very enjoyable"},{"speaker":"Chris Dy","startTime":219.35,"endTime":219.95,"body":"experience."},{"speaker":"Charles Goldfarb","startTime":220.47,"endTime":223.44,"body":"Did that"},{"speaker":"Charles Goldfarb","startTime":220.47,"endTime":223.44,"body":"patient request certain ambience"},{"speaker":"Charles Goldfarb","startTime":223.44,"endTime":227.88,"body":"music in the room? Whether like,"},{"speaker":"Charles Goldfarb","startTime":223.44,"endTime":227.88,"body":"were there? I don't know what"},{"speaker":"Charles Goldfarb","startTime":227.88,"endTime":230.55,"body":"what holistic music even is."},{"speaker":"Chris Dy","startTime":230.57,"endTime":233.03,"body":"No, she would. You"},{"speaker":"Chris Dy","startTime":230.57,"endTime":233.03,"body":"know, it's funny. There was a"},{"speaker":"Chris Dy","startTime":233.03,"endTime":236.48,"body":"post about this on Twitter, I"},{"speaker":"Chris Dy","startTime":233.03,"endTime":236.48,"body":"did post about the playlists"},{"speaker":"Chris Dy","startTime":236.48,"endTime":240.08,"body":"that came on. I tend to play"},{"speaker":"Chris Dy","startTime":236.48,"endTime":240.08,"body":"pretty safe with the music in"},{"speaker":"Chris Dy","startTime":240.08,"endTime":241.97,"body":"the operating room. I think we"},{"speaker":"Chris Dy","startTime":240.08,"endTime":241.97,"body":"talked about this in one of the"},{"speaker":"Chris Dy","startTime":241.97,"endTime":246.2,"body":"other episodes, but I did have"},{"speaker":"Chris Dy","startTime":241.97,"endTime":246.2,"body":"Pandora on and I love my Hall"},{"speaker":"Chris Dy","startTime":246.2,"endTime":248.45,"body":"and Oates radio station because"},{"speaker":"Chris Dy","startTime":246.2,"endTime":248.45,"body":"it's got a little bit of"},{"speaker":"Chris Dy","startTime":248.45,"endTime":253.04,"body":"something for everybody. But no,"},{"speaker":"Chris Dy","startTime":248.45,"endTime":253.04,"body":"like, honestly, the playlist was"},{"speaker":"Chris Dy","startTime":253.55,"endTime":257.96,"body":"perfectly spot on. During the"},{"speaker":"Chris Dy","startTime":253.55,"endTime":257.96,"body":"part where we were exposing the"},{"speaker":"Chris Dy","startTime":257.96,"endTime":263.09,"body":"flexor tendon in zone two. It"},{"speaker":"Chris Dy","startTime":257.96,"endTime":263.09,"body":"was Air Tonight by Phil Collins."},{"speaker":"Chris Dy","startTime":264.23,"endTime":267.62,"body":"When we were putting in the core"},{"speaker":"Chris Dy","startTime":264.23,"endTime":267.62,"body":"sutures, it was Under Pressure"},{"speaker":"Chris Dy","startTime":267.62,"endTime":271.58,"body":"by Queen and David Bowie. And as"},{"speaker":"Chris Dy","startTime":267.62,"endTime":271.58,"body":"we were finishing the repair and"},{"speaker":"Chris Dy","startTime":271.58,"endTime":274.94,"body":"doing the wide awake active"},{"speaker":"Chris Dy","startTime":271.58,"endTime":274.94,"body":"motion check it was Signed,"},{"speaker":"Chris Dy","startTime":274.94,"endTime":276.65,"body":"Sealed and Delivered by Stevie"},{"speaker":"Chris Dy","startTime":274.94,"endTime":276.65,"body":"Wonder."},{"speaker":"Charles Goldfarb","startTime":276.81,"endTime":279.27,"body":"That is"},{"speaker":"Charles Goldfarb","startTime":276.81,"endTime":279.27,"body":"excellent. I did see that on"},{"speaker":"Charles Goldfarb","startTime":279.27,"endTime":282.3,"body":"social media. And we should talk"},{"speaker":"Charles Goldfarb","startTime":279.27,"endTime":282.3,"body":"about that for a second. But I"},{"speaker":"Charles Goldfarb","startTime":282.3,"endTime":288.15,"body":"will say that one of my friends"},{"speaker":"Charles Goldfarb","startTime":282.3,"endTime":288.15,"body":"and congenital hand surgery"},{"speaker":"Charles Goldfarb","startTime":288.15,"endTime":292.38,"body":"lovers is Michelle James out in"},{"speaker":"Charles Goldfarb","startTime":288.15,"endTime":292.38,"body":"California in Sacramento and she"},{"speaker":"Charles Goldfarb","startTime":292.38,"endTime":297.51,"body":"has a playlist for pollicization"},{"speaker":"Charles Goldfarb","startTime":292.38,"endTime":297.51,"body":"procedures and she knows that"},{"speaker":"Charles Goldfarb","startTime":297.51,"endTime":300.21,"body":"for each particular part of the"},{"speaker":"Charles Goldfarb","startTime":297.51,"endTime":300.21,"body":"case and there are well you'd"},{"speaker":"Charles Goldfarb","startTime":300.21,"endTime":303.12,"body":"say that there are 10 steps."},{"speaker":"Charles Goldfarb","startTime":300.21,"endTime":303.12,"body":"Now, it's not perfectly aligned"},{"speaker":"Charles Goldfarb","startTime":303.12,"endTime":305.94,"body":"that every 10 steps are the same"},{"speaker":"Charles Goldfarb","startTime":303.12,"endTime":305.94,"body":"for every patient. But she has"},{"speaker":"Charles Goldfarb","startTime":305.94,"endTime":311.13,"body":"exactly where she should be for"},{"speaker":"Charles Goldfarb","startTime":305.94,"endTime":311.13,"body":"each case by the song that's on"},{"speaker":"Charles Goldfarb","startTime":311.16,"endTime":313.53,"body":"on the radio, which is super"},{"speaker":"Charles Goldfarb","startTime":311.16,"endTime":313.53,"body":"interesting for a case like"},{"speaker":"Chris Dy","startTime":313.0,"endTime":316.45,"body":"That that is"},{"speaker":"Chris Dy","startTime":313.0,"endTime":316.45,"body":"interesting. I think the only"},{"speaker":"Chris Dy","startTime":313.53,"endTime":313.8,"body":"that."},{"speaker":"Chris Dy","startTime":316.99,"endTime":322.66,"body":"variation I have on that is when"},{"speaker":"Chris Dy","startTime":316.99,"endTime":322.66,"body":"I'm doing a long Plexus case, I"},{"speaker":"Chris Dy","startTime":322.66,"endTime":325.72,"body":"know which radio stations I need"},{"speaker":"Chris Dy","startTime":322.66,"endTime":325.72,"body":"to listen to during different"},{"speaker":"Chris Dy","startTime":325.72,"endTime":328.42,"body":"parts of the case. And part of"},{"speaker":"Chris Dy","startTime":325.72,"endTime":328.42,"body":"that is, you know, as one of our"},{"speaker":"Chris Dy","startTime":328.42,"endTime":330.94,"body":"partners, Marty Boyer has"},{"speaker":"Chris Dy","startTime":328.42,"endTime":330.94,"body":"pointed out, he's like, if you"},{"speaker":"Chris Dy","startTime":330.94,"endTime":333.61,"body":"have these all day cases, and"},{"speaker":"Chris Dy","startTime":330.94,"endTime":333.61,"body":"you let them take all day, and"},{"speaker":"Chris Dy","startTime":333.61,"endTime":336.55,"body":"you don't intentionally push the"},{"speaker":"Chris Dy","startTime":333.61,"endTime":336.55,"body":"pace on things, you will be"},{"speaker":"Chris Dy","startTime":336.55,"endTime":340.0,"body":"there far longer than you need"},{"speaker":"Chris Dy","startTime":336.55,"endTime":340.0,"body":"to. So I know when the energy"},{"speaker":"Chris Dy","startTime":340.0,"endTime":343.12,"body":"needs to come up, when the hip"},{"speaker":"Chris Dy","startTime":340.0,"endTime":343.12,"body":"hop barbecue needs to come on,"},{"speaker":"Chris Dy","startTime":343.33,"endTime":345.64,"body":"you know, right at the middle of"},{"speaker":"Chris Dy","startTime":343.33,"endTime":345.64,"body":"the day when we need to really"},{"speaker":"Chris Dy","startTime":345.64,"endTime":346.48,"body":"get to an end."},{"speaker":"Charles Goldfarb","startTime":346.96,"endTime":348.52,"body":"That's a great"},{"speaker":"Charles Goldfarb","startTime":346.96,"endTime":348.52,"body":"point. That's a great point."},{"speaker":"Charles Goldfarb","startTime":348.52,"endTime":353.02,"body":"Speaking of social, I think we"},{"speaker":"Charles Goldfarb","startTime":348.52,"endTime":353.02,"body":"both done a little more"},{"speaker":"Charles Goldfarb","startTime":353.02,"endTime":357.22,"body":"recently, on Instagram, because"},{"speaker":"Charles Goldfarb","startTime":353.02,"endTime":357.22,"body":"we're both really young, you"},{"speaker":"Charles Goldfarb","startTime":357.22,"endTime":360.64,"body":"claim that you're a lot younger"},{"speaker":"Charles Goldfarb","startTime":357.22,"endTime":360.64,"body":"than me which by, by dog years"},{"speaker":"Charles Goldfarb","startTime":360.64,"endTime":364.33,"body":"you are, but we've opened a few"},{"speaker":"Charles Goldfarb","startTime":360.64,"endTime":364.33,"body":"new Instagram accounts."},{"speaker":"Chris Dy","startTime":364.42,"endTime":366.82,"body":"Yeah, you know, for"},{"speaker":"Chris Dy","startTime":364.42,"endTime":366.82,"body":"me, it was more reactivating an"},{"speaker":"Chris Dy","startTime":366.82,"endTime":370.15,"body":"account that had been dormant"},{"speaker":"Chris Dy","startTime":366.82,"endTime":370.15,"body":"for four years and actually"},{"speaker":"Chris Dy","startTime":370.33,"endTime":373.03,"body":"spent some time and looked back"},{"speaker":"Chris Dy","startTime":370.33,"endTime":373.03,"body":"at the last things I posted and"},{"speaker":"Chris Dy","startTime":373.03,"endTime":375.64,"body":"realized I was at a very"},{"speaker":"Chris Dy","startTime":373.03,"endTime":375.64,"body":"different point in my life. When"},{"speaker":"Chris Dy","startTime":375.64,"endTime":379.48,"body":"I was active on Instagram. Last"},{"speaker":"Chris Dy","startTime":375.64,"endTime":379.48,"body":"I had just rounded the corner"},{"speaker":"Chris Dy","startTime":379.48,"endTime":382.99,"body":"from residency into fellowship,"},{"speaker":"Chris Dy","startTime":379.48,"endTime":382.99,"body":"and had just started my first"},{"speaker":"Chris Dy","startTime":382.99,"endTime":385.27,"body":"years in attending so life is"},{"speaker":"Chris Dy","startTime":382.99,"endTime":385.27,"body":"quite different now."},{"speaker":"Charles Goldfarb","startTime":385.69,"endTime":388.69,"body":"For sure it"},{"speaker":"Charles Goldfarb","startTime":385.69,"endTime":388.69,"body":"is. It'll be fun to see what"},{"speaker":"Charles Goldfarb","startTime":388.69,"endTime":392.68,"body":"happens. It's definitely there's"},{"speaker":"Charles Goldfarb","startTime":388.69,"endTime":392.68,"body":"some similar faces and names and"},{"speaker":"Charles Goldfarb","startTime":392.68,"endTime":395.83,"body":"I'm using it I'm using Instagram"},{"speaker":"Charles Goldfarb","startTime":392.68,"endTime":395.83,"body":"a little bit differently than I"},{"speaker":"Charles Goldfarb","startTime":395.83,"endTime":400.0,"body":"am using Twitter. But I'll have"},{"speaker":"Charles Goldfarb","startTime":395.83,"endTime":400.0,"body":"a couple of accounts, one for"},{"speaker":"Charles Goldfarb","startTime":400.0,"endTime":404.17,"body":"sports, one for congenital, and"},{"speaker":"Charles Goldfarb","startTime":400.0,"endTime":404.17,"body":"one where I don't post but I"},{"speaker":"Charles Goldfarb","startTime":404.17,"endTime":406.0,"body":"just get feedback on different"},{"speaker":"Charles Goldfarb","startTime":404.17,"endTime":406.0,"body":"things."},{"speaker":"Chris Dy","startTime":406.03,"endTime":408.43,"body":"I think that there're"},{"speaker":"Chris Dy","startTime":406.03,"endTime":408.43,"body":"definitely different target"},{"speaker":"Chris Dy","startTime":408.43,"endTime":412.84,"body":"audiences. In terms of you know,"},{"speaker":"Chris Dy","startTime":408.43,"endTime":412.84,"body":"you know, what kind of content"},{"speaker":"Chris Dy","startTime":412.84,"endTime":415.66,"body":"goes out there what the vibe is."},{"speaker":"Chris Dy","startTime":412.84,"endTime":415.66,"body":"And I honestly, I'm still trying"},{"speaker":"Chris Dy","startTime":415.66,"endTime":418.78,"body":"to figure out the Instagram app"},{"speaker":"Chris Dy","startTime":415.66,"endTime":418.78,"body":"after four years of taking off."},{"speaker":"Chris Dy","startTime":418.78,"endTime":420.67,"body":"It's very different. Now there"},{"speaker":"Chris Dy","startTime":418.78,"endTime":420.67,"body":"are a lot of new features that"},{"speaker":"Chris Dy","startTime":420.67,"endTime":421.54,"body":"were not there before."},{"speaker":"Charles Goldfarb","startTime":421.0,"endTime":423.97,"body":"I t is and"},{"speaker":"Charles Goldfarb","startTime":421.0,"endTime":423.97,"body":"it's so tied into Facebook, and"},{"speaker":"Charles Goldfarb","startTime":423.97,"endTime":426.49,"body":"I have a business account on"},{"speaker":"Charles Goldfarb","startTime":423.97,"endTime":426.49,"body":"Facebook again from my"},{"speaker":"Charles Goldfarb","startTime":426.49,"endTime":429.67,"body":"congenital work. But I don't"},{"speaker":"Charles Goldfarb","startTime":426.49,"endTime":429.67,"body":"personally use Facebook, but"},{"speaker":"Charles Goldfarb","startTime":429.67,"endTime":431.62,"body":"they are intricately linked."},{"speaker":"Chris Dy","startTime":431.77,"endTime":432.76,"body":"That's not by"},{"speaker":"Chris Dy","startTime":431.77,"endTime":432.76,"body":"accident."},{"speaker":"Charles Goldfarb","startTime":433.12,"endTime":434.26,"body":"That is not by"},{"speaker":"Charles Goldfarb","startTime":433.12,"endTime":434.26,"body":"accident."},{"speaker":"Chris Dy","startTime":434.26,"endTime":435.79,"body":"The algorithms are"},{"speaker":"Chris Dy","startTime":434.26,"endTime":435.79,"body":"strong, Chuck."},{"speaker":"Charles Goldfarb","startTime":437.35,"endTime":440.2,"body":"Yes, they know"},{"speaker":"Charles Goldfarb","startTime":437.35,"endTime":440.2,"body":"us better than we know us most"},{"speaker":"Charles Goldfarb","startTime":440.2,"endTime":442.51,"body":"likely. All right, what do you"},{"speaker":"Charles Goldfarb","startTime":440.2,"endTime":442.51,"body":"say? Should we jump in?"},{"speaker":"Chris Dy","startTime":442.54,"endTime":445.75,"body":"Yeah, so we spent the"},{"speaker":"Chris Dy","startTime":442.54,"endTime":445.75,"body":"last episode talking about volar"},{"speaker":"Chris Dy","startTime":445.75,"endTime":449.29,"body":"plating, which is I think, for"},{"speaker":"Chris Dy","startTime":445.75,"endTime":449.29,"body":"most surgeons now the default"},{"speaker":"Chris Dy","startTime":449.29,"endTime":453.25,"body":"option. And I think there's been"},{"speaker":"Chris Dy","startTime":449.29,"endTime":453.25,"body":"a bit of a backlash against"},{"speaker":"Chris Dy","startTime":453.31,"endTime":457.33,"body":"using other types of fixation."},{"speaker":"Chris Dy","startTime":453.31,"endTime":457.33,"body":"Although there are certainly"},{"speaker":"Chris Dy","startTime":457.33,"endTime":460.42,"body":"cases in which, you know, maybe"},{"speaker":"Chris Dy","startTime":457.33,"endTime":460.42,"body":"a volar plate isn't the best. So"},{"speaker":"Chris Dy","startTime":460.45,"endTime":461.77,"body":"how do you think about that?"},{"speaker":"Charles Goldfarb","startTime":462.35,"endTime":465.98,"body":"I guess I"},{"speaker":"Charles Goldfarb","startTime":462.35,"endTime":465.98,"body":"would first say that, for me,"},{"speaker":"Charles Goldfarb","startTime":465.98,"endTime":468.53,"body":"there's always been two broad"},{"speaker":"Charles Goldfarb","startTime":465.98,"endTime":468.53,"body":"categories. When do you always"},{"speaker":"Charles Goldfarb","startTime":468.53,"endTime":472.01,"body":"go volar? Or when do you"},{"speaker":"Charles Goldfarb","startTime":468.53,"endTime":472.01,"body":"consider going dorsal and we're"},{"speaker":"Charles Goldfarb","startTime":472.01,"endTime":475.16,"body":"going to hit on that difference,"},{"speaker":"Charles Goldfarb","startTime":472.01,"endTime":475.16,"body":"we're also going to consider"},{"speaker":"Charles Goldfarb","startTime":475.4,"endTime":479.0,"body":"really fragment specific"},{"speaker":"Charles Goldfarb","startTime":475.4,"endTime":479.0,"body":"approaches. And some of the"},{"speaker":"Charles Goldfarb","startTime":479.0,"endTime":483.53,"body":"volar versus dorsal is purely"},{"speaker":"Charles Goldfarb","startTime":479.0,"endTime":483.53,"body":"dealer's choice. And you can"},{"speaker":"Charles Goldfarb","startTime":483.53,"endTime":485.81,"body":"show the same X ray to a couple"},{"speaker":"Charles Goldfarb","startTime":483.53,"endTime":485.81,"body":"different people. And I think"},{"speaker":"Charles Goldfarb","startTime":485.81,"endTime":489.59,"body":"the technology of the hardware"},{"speaker":"Charles Goldfarb","startTime":485.81,"endTime":489.59,"body":"is pretty similar. And so you"},{"speaker":"Charles Goldfarb","startTime":489.59,"endTime":492.11,"body":"can really make a choice, what"},{"speaker":"Charles Goldfarb","startTime":489.59,"endTime":492.11,"body":"we're going to hit on today are"},{"speaker":"Charles Goldfarb","startTime":492.11,"endTime":496.52,"body":"the cases that, you know, aren't"},{"speaker":"Charles Goldfarb","startTime":492.11,"endTime":496.52,"body":"so simple as just volar, or just"},{"speaker":"Charles Goldfarb","startTime":496.52,"endTime":499.13,"body":"dorsal, we're going to get on"},{"speaker":"Charles Goldfarb","startTime":496.52,"endTime":499.13,"body":"the, we're gonna hit on those"},{"speaker":"Charles Goldfarb","startTime":499.13,"endTime":502.28,"body":"cases that require a little"},{"speaker":"Charles Goldfarb","startTime":499.13,"endTime":502.28,"body":"different thought, rather than"},{"speaker":"Charles Goldfarb","startTime":502.28,"endTime":504.23,"body":"your standard volar locking"},{"speaker":"Charles Goldfarb","startTime":502.28,"endTime":504.23,"body":"plate."},{"speaker":"Chris Dy","startTime":504.839,"endTime":507.599,"body":"Yeah, so what are the"},{"speaker":"Chris Dy","startTime":504.839,"endTime":507.599,"body":"you know, what's the first type"},{"speaker":"Chris Dy","startTime":507.599,"endTime":511.739,"body":"of case that comes to mind? When"},{"speaker":"Chris Dy","startTime":507.599,"endTime":511.739,"body":"you know, perhaps your standard"},{"speaker":"Chris Dy","startTime":511.739,"endTime":516.449,"body":"volar locking plate would not be"},{"speaker":"Chris Dy","startTime":511.739,"endTime":516.449,"body":"would not be enough?"},{"speaker":"Charles Goldfarb","startTime":517.32,"endTime":520.47,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":517.32,"endTime":520.47,"body":"well, in many of these you can"},{"speaker":"Charles Goldfarb","startTime":520.47,"endTime":523.32,"body":"prob- you might be able to get"},{"speaker":"Charles Goldfarb","startTime":520.47,"endTime":523.32,"body":"away with a volar locking plate."},{"speaker":"Charles Goldfarb","startTime":523.32,"endTime":526.53,"body":"And that's what's so tricky,"},{"speaker":"Charles Goldfarb","startTime":523.32,"endTime":526.53,"body":"because you can be lulled into"},{"speaker":"Charles Goldfarb","startTime":526.53,"endTime":528.69,"body":"that sense of Oh, yeah, I'll"},{"speaker":"Charles Goldfarb","startTime":526.53,"endTime":528.69,"body":"just put a volar plate I'll,"},{"speaker":"Charles Goldfarb","startTime":528.75,"endTime":531.27,"body":"I'll quote unquote, throw a"},{"speaker":"Charles Goldfarb","startTime":528.75,"endTime":531.27,"body":"volar plate on that, and it'll"},{"speaker":"Charles Goldfarb","startTime":531.27,"endTime":534.42,"body":"be fine and I think that's"},{"speaker":"Charles Goldfarb","startTime":531.27,"endTime":534.42,"body":"risky. And the fracture types"},{"speaker":"Charles Goldfarb","startTime":534.42,"endTime":536.37,"body":"that we're going to point out"},{"speaker":"Charles Goldfarb","startTime":534.42,"endTime":536.37,"body":"today make it especially risky."},{"speaker":"Charles Goldfarb","startTime":536.37,"endTime":539.52,"body":"So let's start with a radial"},{"speaker":"Charles Goldfarb","startTime":536.37,"endTime":539.52,"body":"styloid fragment. So that quote,"},{"speaker":"Charles Goldfarb","startTime":539.52,"endTime":544.08,"body":"unquote, chauffeur's fracture,"},{"speaker":"Charles Goldfarb","startTime":539.52,"endTime":544.08,"body":"which can be, it's typically a"},{"speaker":"Charles Goldfarb","startTime":544.08,"endTime":548.67,"body":"relatively sizable fragment, it"},{"speaker":"Charles Goldfarb","startTime":544.08,"endTime":548.67,"body":"typically exits in the joint"},{"speaker":"Charles Goldfarb","startTime":548.67,"endTime":553.17,"body":"right at the SL ligament, which"},{"speaker":"Charles Goldfarb","startTime":548.67,"endTime":553.17,"body":"also for me, is of concern, for"},{"speaker":"Charles Goldfarb","startTime":553.17,"endTime":556.68,"body":"all of us it should be of a"},{"speaker":"Charles Goldfarb","startTime":553.17,"endTime":556.68,"body":"concern. And yeah, you might be"},{"speaker":"Charles Goldfarb","startTime":556.68,"endTime":559.41,"body":"able to put a standard volar"},{"speaker":"Charles Goldfarb","startTime":556.68,"endTime":559.41,"body":"locking plate on there, but it's"},{"speaker":"Charles Goldfarb","startTime":559.41,"endTime":561.24,"body":"probably not the best approach."},{"speaker":"Chris Dy","startTime":561.6,"endTime":563.34,"body":"Yeah, I think that,"},{"speaker":"Chris Dy","startTime":561.6,"endTime":563.34,"body":"you know, one of the things"},{"speaker":"Chris Dy","startTime":563.34,"endTime":565.74,"body":"about the volar locking plate is"},{"speaker":"Chris Dy","startTime":563.34,"endTime":565.74,"body":"that it is such an exceptional"},{"speaker":"Chris Dy","startTime":565.74,"endTime":570.06,"body":"piece of technology that we can"},{"speaker":"Chris Dy","startTime":565.74,"endTime":570.06,"body":"rely on it to do a lot of the"},{"speaker":"Chris Dy","startTime":570.06,"endTime":572.82,"body":"things that almost violate some"},{"speaker":"Chris Dy","startTime":570.06,"endTime":572.82,"body":"of the standard AO"},{"speaker":"Chris Dy","startTime":572.82,"endTime":576.57,"body":"osteosynthesis principles. So,"},{"speaker":"Chris Dy","startTime":572.82,"endTime":576.57,"body":"you know, for example, for a,"},{"speaker":"Chris Dy","startTime":576.66,"endTime":579.0,"body":"you know, one of the standard"},{"speaker":"Chris Dy","startTime":576.66,"endTime":579.0,"body":"indications I think most of us"},{"speaker":"Chris Dy","startTime":579.0,"endTime":581.76,"body":"have for a volar locking plate"},{"speaker":"Chris Dy","startTime":579.0,"endTime":581.76,"body":"is for a dorsally displaced"},{"speaker":"Chris Dy","startTime":581.76,"endTime":585.15,"body":"fracture. And that violates"},{"speaker":"Chris Dy","startTime":581.76,"endTime":585.15,"body":"Principle number one of AO of,"},{"speaker":"Chris Dy","startTime":585.18,"endTime":588.87,"body":"you know, going on preventing"},{"speaker":"Chris Dy","startTime":585.18,"endTime":588.87,"body":"the side, going against the"},{"speaker":"Chris Dy","startTime":588.87,"endTime":593.13,"body":"deforming force and force"},{"speaker":"Chris Dy","startTime":588.87,"endTime":593.13,"body":"displacement. So, there are a"},{"speaker":"Chris Dy","startTime":593.13,"endTime":595.59,"body":"lot of ways in which we can get"},{"speaker":"Chris Dy","startTime":593.13,"endTime":595.59,"body":"away with volar plates. And I"},{"speaker":"Chris Dy","startTime":595.59,"endTime":598.17,"body":"think that for that particular"},{"speaker":"Chris Dy","startTime":595.59,"endTime":598.17,"body":"fracture for the chauffeur's"},{"speaker":"Chris Dy","startTime":598.17,"endTime":601.89,"body":"fragment, you can maybe rely on,"},{"speaker":"Chris Dy","startTime":598.17,"endTime":601.89,"body":"you know, one or two, maybe"},{"speaker":"Chris Dy","startTime":601.89,"endTime":605.37,"body":"three of those radial sided"},{"speaker":"Chris Dy","startTime":601.89,"endTime":605.37,"body":"distal locking screws and get"},{"speaker":"Chris Dy","startTime":605.37,"endTime":609.06,"body":"away with it, particularly if"},{"speaker":"Chris Dy","startTime":605.37,"endTime":609.06,"body":"you have a plate that is, you"},{"speaker":"Chris Dy","startTime":609.06,"endTime":612.72,"body":"know, allows you a longer screw"},{"speaker":"Chris Dy","startTime":609.06,"endTime":612.72,"body":"length through that radial sided"},{"speaker":"Chris Dy","startTime":613.2,"endTime":618.75,"body":"distal row. But you know, if it"},{"speaker":"Chris Dy","startTime":613.2,"endTime":618.75,"body":"fails, you know, you have a good"},{"speaker":"Chris Dy","startTime":618.75,"endTime":619.47,"body":"reason why."},{"speaker":"Charles Goldfarb","startTime":620.08,"endTime":621.91,"body":"I think that's"},{"speaker":"Charles Goldfarb","startTime":620.08,"endTime":621.91,"body":"right. And I think there are a"},{"speaker":"Charles Goldfarb","startTime":621.91,"endTime":625.12,"body":"couple of, so so I'll accept and"},{"speaker":"Charles Goldfarb","startTime":621.91,"endTime":625.12,"body":"I think you'll accept that a"},{"speaker":"Charles Goldfarb","startTime":625.12,"endTime":629.02,"body":"volar locking plate is"},{"speaker":"Charles Goldfarb","startTime":625.12,"endTime":629.02,"body":"absolutely okay for for most"},{"speaker":"Charles Goldfarb","startTime":629.05,"endTime":632.17,"body":"chauffeur fractures, but I don't"},{"speaker":"Charles Goldfarb","startTime":629.05,"endTime":632.17,"body":"know that it's my first choice."},{"speaker":"Charles Goldfarb","startTime":633.19,"endTime":636.16,"body":"I guess it depends exactly on"},{"speaker":"Charles Goldfarb","startTime":633.19,"endTime":636.16,"body":"how big the fragment is, etc."},{"speaker":"Charles Goldfarb","startTime":636.16,"endTime":640.87,"body":"But the other options I consider"},{"speaker":"Charles Goldfarb","startTime":636.16,"endTime":640.87,"body":"or one would be simply a limited"},{"speaker":"Charles Goldfarb","startTime":640.9,"endTime":643.54,"body":"approach from the radial"},{"speaker":"Charles Goldfarb","startTime":640.9,"endTime":643.54,"body":"styloid. And so I'm not a big"},{"speaker":"Charles Goldfarb","startTime":643.54,"endTime":647.29,"body":"believer in one or two headless"},{"speaker":"Charles Goldfarb","startTime":643.54,"endTime":647.29,"body":"screws, but that's an option,"},{"speaker":"Charles Goldfarb","startTime":647.44,"endTime":651.58,"body":"certainly, or a radial column"},{"speaker":"Charles Goldfarb","startTime":647.44,"endTime":651.58,"body":"plate is an option, or perhaps,"},{"speaker":"Charles Goldfarb","startTime":651.79,"endTime":656.38,"body":"ideally, is simply a more"},{"speaker":"Charles Goldfarb","startTime":651.79,"endTime":656.38,"body":"fragment specific type plate on"},{"speaker":"Charles Goldfarb","startTime":656.38,"endTime":660.22,"body":"the volar radial aspect of the"},{"speaker":"Charles Goldfarb","startTime":656.38,"endTime":660.22,"body":"distal radius."},{"speaker":"Chris Dy","startTime":660.28,"endTime":662.2,"body":"Yeah, and I think that"},{"speaker":"Chris Dy","startTime":660.28,"endTime":662.2,"body":"will when we say the words"},{"speaker":"Chris Dy","startTime":662.2,"endTime":665.08,"body":"fragment specific, it's"},{"speaker":"Chris Dy","startTime":662.2,"endTime":665.08,"body":"important to acknowledge that we"},{"speaker":"Chris Dy","startTime":665.08,"endTime":667.66,"body":"are not talking about the"},{"speaker":"Chris Dy","startTime":665.08,"endTime":667.66,"body":"proprietary technology that you"},{"speaker":"Chris Dy","startTime":667.66,"endTime":670.09,"body":"know a manufacturer has, but"},{"speaker":"Chris Dy","startTime":667.66,"endTime":670.09,"body":"really more of approach than"},{"speaker":"Chris Dy","startTime":670.09,"endTime":674.95,"body":"anything else. And you can do"},{"speaker":"Chris Dy","startTime":670.09,"endTime":674.95,"body":"fragment specific type surgery"},{"speaker":"Chris Dy","startTime":674.95,"endTime":678.1,"body":"without, with any type of"},{"speaker":"Chris Dy","startTime":674.95,"endTime":678.1,"body":"implant. It doesn't need to be"},{"speaker":"Chris Dy","startTime":678.1,"endTime":684.82,"body":"specifically designed for that."},{"speaker":"Chris Dy","startTime":678.1,"endTime":684.82,"body":"You know it, for me, the radial"},{"speaker":"Chris Dy","startTime":684.82,"endTime":687.37,"body":"styloid fractures that are"},{"speaker":"Chris Dy","startTime":684.82,"endTime":687.37,"body":"worrisome are the ones with"},{"speaker":"Chris Dy","startTime":687.4,"endTime":691.21,"body":"either a lot of comminution on"},{"speaker":"Chris Dy","startTime":687.4,"endTime":691.21,"body":"that side suggesting a higher"},{"speaker":"Chris Dy","startTime":691.21,"endTime":693.61,"body":"energy or the ones associated"},{"speaker":"Chris Dy","startTime":691.21,"endTime":693.61,"body":"with the radiocarpal"},{"speaker":"Chris Dy","startTime":693.61,"endTime":697.69,"body":"dislocation, again, associate,"},{"speaker":"Chris Dy","startTime":693.61,"endTime":697.69,"body":"you know, making you think of a"},{"speaker":"Chris Dy","startTime":697.69,"endTime":701.02,"body":"higher energy type injury that"},{"speaker":"Chris Dy","startTime":697.69,"endTime":701.02,"body":"probably deserves a little more"},{"speaker":"Chris Dy","startTime":701.02,"endTime":703.06,"body":"respect than a couple of locking"},{"speaker":"Chris Dy","startTime":701.02,"endTime":703.06,"body":"screws."},{"speaker":"Charles Goldfarb","startTime":703.66,"endTime":706.21,"body":"So what is"},{"speaker":"Charles Goldfarb","startTime":703.66,"endTime":706.21,"body":"your approach regarding the SL"},{"speaker":"Charles Goldfarb","startTime":706.21,"endTime":710.23,"body":"ligament? Are we as surgeons"},{"speaker":"Charles Goldfarb","startTime":706.21,"endTime":710.23,"body":"under any specific obligation to"},{"speaker":"Charles Goldfarb","startTime":710.23,"endTime":714.73,"body":"explore the possibility of an SL"},{"speaker":"Charles Goldfarb","startTime":710.23,"endTime":714.73,"body":"ligament disruption? Let's say"},{"speaker":"Charles Goldfarb","startTime":714.73,"endTime":719.05,"body":"the X rays look normal? Do you"},{"speaker":"Charles Goldfarb","startTime":714.73,"endTime":719.05,"body":"automatically throw a scope in"},{"speaker":"Charles Goldfarb","startTime":719.05,"endTime":721.81,"body":"or make a small incision?"},{"speaker":"Charles Goldfarb","startTime":719.05,"endTime":721.81,"body":"dorsally? Do you stress the"},{"speaker":"Charles Goldfarb","startTime":721.81,"endTime":724.72,"body":"patient when they're asleep?"},{"speaker":"Charles Goldfarb","startTime":721.81,"endTime":724.72,"body":"either before or after fixation"},{"speaker":"Charles Goldfarb","startTime":724.72,"endTime":726.04,"body":"of the fracture, how do you"},{"speaker":"Charles Goldfarb","startTime":724.72,"endTime":726.04,"body":"approach it?"},{"speaker":"Chris Dy","startTime":726.0,"endTime":729.24,"body":"I think that that's"},{"speaker":"Chris Dy","startTime":726.0,"endTime":729.24,"body":"probably my response to that is"},{"speaker":"Chris Dy","startTime":729.24,"endTime":733.74,"body":"going to be a function of my, my"},{"speaker":"Chris Dy","startTime":729.24,"endTime":733.74,"body":"limited use of arthroscopy, so I"},{"speaker":"Chris Dy","startTime":733.74,"endTime":736.14,"body":"don't go to arthroscopy."},{"speaker":"Chris Dy","startTime":733.74,"endTime":736.14,"body":"Although I certainly understand"},{"speaker":"Chris Dy","startTime":736.14,"endTime":738.3,"body":"how that could be useful,"},{"speaker":"Chris Dy","startTime":736.14,"endTime":738.3,"body":"because I just, you know, it's"},{"speaker":"Chris Dy","startTime":738.3,"endTime":741.69,"body":"not the first thing I think"},{"speaker":"Chris Dy","startTime":738.3,"endTime":741.69,"body":"about, you know, you could"},{"speaker":"Chris Dy","startTime":741.69,"endTime":744.93,"body":"approach this radial styloid"},{"speaker":"Chris Dy","startTime":741.69,"endTime":744.93,"body":"type fracture either through a"},{"speaker":"Chris Dy","startTime":744.93,"endTime":747.21,"body":"straight radial approach, like"},{"speaker":"Chris Dy","startTime":744.93,"endTime":747.21,"body":"you described, or a dorsal"},{"speaker":"Chris Dy","startTime":747.21,"endTime":750.0,"body":"approach, which I think the"},{"speaker":"Chris Dy","startTime":747.21,"endTime":750.0,"body":"dorsal approach gives you the"},{"speaker":"Chris Dy","startTime":750.0,"endTime":753.06,"body":"advantage of being able to"},{"speaker":"Chris Dy","startTime":750.0,"endTime":753.06,"body":"inspect the joint which may or"},{"speaker":"Chris Dy","startTime":753.06,"endTime":756.9,"body":"may not matter based on honestly"},{"speaker":"Chris Dy","startTime":753.06,"endTime":756.9,"body":"your own work. But then also"},{"speaker":"Chris Dy","startTime":756.9,"endTime":760.02,"body":"look at that SL ligament and"},{"speaker":"Chris Dy","startTime":756.9,"endTime":760.02,"body":"directly inspect it, because"},{"speaker":"Chris Dy","startTime":760.02,"endTime":761.91,"body":"you're there, you have to open"},{"speaker":"Chris Dy","startTime":760.02,"endTime":761.91,"body":"you know, if you're going to"},{"speaker":"Chris Dy","startTime":761.91,"endTime":763.68,"body":"look in the joint, you have to"},{"speaker":"Chris Dy","startTime":761.91,"endTime":763.68,"body":"open the capsule anyway. And"},{"speaker":"Chris Dy","startTime":763.68,"endTime":767.61,"body":"then you can also go over and"},{"speaker":"Chris Dy","startTime":763.68,"endTime":767.61,"body":"fix your radial styloid fracture"},{"speaker":"Chris Dy","startTime":767.82,"endTime":770.52,"body":"through however, wherever you"},{"speaker":"Chris Dy","startTime":767.82,"endTime":770.52,"body":"put the plate, whether it's"},{"speaker":"Chris Dy","startTime":770.52,"endTime":774.18,"body":"dorsal radial, or straight"},{"speaker":"Chris Dy","startTime":770.52,"endTime":774.18,"body":"radial, and I do like a radial"},{"speaker":"Chris Dy","startTime":774.18,"endTime":777.33,"body":"column buttress plate, and I, I"},{"speaker":"Chris Dy","startTime":774.18,"endTime":777.33,"body":"personally tend to design that"},{"speaker":"Chris Dy","startTime":777.33,"endTime":781.2,"body":"myself, I don't use a pre"},{"speaker":"Chris Dy","startTime":777.33,"endTime":781.2,"body":"manufactured or pre contoured"},{"speaker":"Chris Dy","startTime":781.2,"endTime":781.5,"body":"plate."},{"speaker":"Charles Goldfarb","startTime":782.14,"endTime":784.48,"body":"And some would"},{"speaker":"Charles Goldfarb","startTime":782.14,"endTime":784.48,"body":"say the only negative to a"},{"speaker":"Charles Goldfarb","startTime":784.48,"endTime":787.93,"body":"dorsal approach for this"},{"speaker":"Charles Goldfarb","startTime":784.48,"endTime":787.93,"body":"fracture is the forced pronated"},{"speaker":"Charles Goldfarb","startTime":787.93,"endTime":791.2,"body":"position. Obviously, when we're"},{"speaker":"Charles Goldfarb","startTime":787.93,"endTime":791.2,"body":"treating things volarly, we're"},{"speaker":"Charles Goldfarb","startTime":791.2,"endTime":794.74,"body":"in a forced supinated position."},{"speaker":"Charles Goldfarb","startTime":791.2,"endTime":794.74,"body":"But I agree, I think this is"},{"speaker":"Charles Goldfarb","startTime":794.74,"endTime":797.98,"body":"dealer's choice, whether you go"},{"speaker":"Charles Goldfarb","startTime":794.74,"endTime":797.98,"body":"volar, or dorsal, I would tend"},{"speaker":"Charles Goldfarb","startTime":797.98,"endTime":802.18,"body":"to go volar, or a little mini"},{"speaker":"Charles Goldfarb","startTime":797.98,"endTime":802.18,"body":"incision and something from the"},{"speaker":"Charles Goldfarb","startTime":802.18,"endTime":805.21,"body":"styloid area. But I think it's"},{"speaker":"Charles Goldfarb","startTime":802.18,"endTime":805.21,"body":"your comfort and your with the"},{"speaker":"Charles Goldfarb","startTime":805.21,"endTime":810.43,"body":"approach. And if I did go volar"},{"speaker":"Charles Goldfarb","startTime":805.21,"endTime":810.43,"body":"and had any concerns whatsoever"},{"speaker":"Charles Goldfarb","startTime":810.43,"endTime":813.85,"body":"about the SL, then either I"},{"speaker":"Charles Goldfarb","startTime":810.43,"endTime":813.85,"body":"would look inside with the with"},{"speaker":"Charles Goldfarb","startTime":813.85,"endTime":816.58,"body":"the scope or make a small and"},{"speaker":"Charles Goldfarb","startTime":813.85,"endTime":816.58,"body":"you can get away with a really"},{"speaker":"Charles Goldfarb","startTime":816.58,"endTime":819.07,"body":"small incision to look inside"},{"speaker":"Charles Goldfarb","startTime":816.58,"endTime":819.07,"body":"the joint to make sure the SL is"},{"speaker":"Charles Goldfarb","startTime":819.07,"endTime":822.61,"body":"okay, but I don't certainly"},{"speaker":"Charles Goldfarb","startTime":819.07,"endTime":822.61,"body":"don't always do that. But it's"},{"speaker":"Charles Goldfarb","startTime":822.64,"endTime":824.23,"body":"always at the top of mind."},{"speaker":"Chris Dy","startTime":824.3,"endTime":826.97,"body":"I think the fracture,"},{"speaker":"Chris Dy","startTime":824.3,"endTime":826.97,"body":"the injury characteristics and"},{"speaker":"Chris Dy","startTime":826.97,"endTime":831.08,"body":"the fracture personality are,"},{"speaker":"Chris Dy","startTime":826.97,"endTime":831.08,"body":"you know, will drive me towards"},{"speaker":"Chris Dy","startTime":831.14,"endTime":834.44,"body":"looking into the joint if it is"},{"speaker":"Chris Dy","startTime":831.14,"endTime":834.44,"body":"truly a higher energy injury, I"},{"speaker":"Chris Dy","startTime":834.44,"endTime":838.73,"body":"will I will look. But if it's a"},{"speaker":"Chris Dy","startTime":834.44,"endTime":838.73,"body":"lower energy injury, and I'm not"},{"speaker":"Chris Dy","startTime":838.73,"endTime":841.37,"body":"as concerned it doesn't drive"},{"speaker":"Chris Dy","startTime":838.73,"endTime":841.37,"body":"me. And I think one of the"},{"speaker":"Chris Dy","startTime":841.37,"endTime":843.71,"body":"points you made is, you know,"},{"speaker":"Chris Dy","startTime":841.37,"endTime":843.71,"body":"trying to avoid multiple large"},{"speaker":"Chris Dy","startTime":843.71,"endTime":848.09,"body":"approaches. In the heat of a"},{"speaker":"Chris Dy","startTime":843.71,"endTime":848.09,"body":"tough case, it is tempting to"},{"speaker":"Chris Dy","startTime":848.09,"endTime":850.46,"body":"say, all right, well, let's just"},{"speaker":"Chris Dy","startTime":848.09,"endTime":850.46,"body":"open on the other side. And, you"},{"speaker":"Chris Dy","startTime":850.46,"endTime":854.93,"body":"know, take a look. Now that, it"},{"speaker":"Chris Dy","startTime":850.46,"endTime":854.93,"body":"may end up making your X ray"},{"speaker":"Chris Dy","startTime":854.93,"endTime":858.35,"body":"look better in the end, but it's"},{"speaker":"Chris Dy","startTime":854.93,"endTime":858.35,"body":"there's a price to pay for"},{"speaker":"Chris Dy","startTime":858.35,"endTime":861.59,"body":"multiple large approaches. Now I"},{"speaker":"Chris Dy","startTime":858.35,"endTime":861.59,"body":"think there's a difference for"},{"speaker":"Chris Dy","startTime":861.59,"endTime":864.44,"body":"the smaller kinds of, you know,"},{"speaker":"Chris Dy","startTime":861.59,"endTime":864.44,"body":"look in the joints or even you"},{"speaker":"Chris Dy","startTime":864.44,"endTime":868.07,"body":"know, for outside of today's"},{"speaker":"Chris Dy","startTime":864.44,"endTime":868.07,"body":"talk, but you know, when I do a"},{"speaker":"Chris Dy","startTime":868.07,"endTime":870.8,"body":"mal union correction with an"},{"speaker":"Chris Dy","startTime":868.07,"endTime":870.8,"body":"osteotomy I put a volar plate, I"},{"speaker":"Chris Dy","startTime":870.8,"endTime":873.95,"body":"do make a little small incision,"},{"speaker":"Chris Dy","startTime":870.8,"endTime":873.95,"body":"get the EPL out of the way and"},{"speaker":"Chris Dy","startTime":873.95,"endTime":876.14,"body":"free up the dorsal cortex that"},{"speaker":"Chris Dy","startTime":873.95,"endTime":876.14,"body":"way."},{"speaker":"Charles Goldfarb","startTime":876.72,"endTime":879.51,"body":"Yeah, that's"},{"speaker":"Charles Goldfarb","startTime":876.72,"endTime":879.51,"body":"that's great stuff for sure. All"},{"speaker":"Charles Goldfarb","startTime":879.51,"endTime":886.89,"body":"right. Let's we briefly hit on"},{"speaker":"Charles Goldfarb","startTime":879.51,"endTime":886.89,"body":"the topic of the basically volar"},{"speaker":"Charles Goldfarb","startTime":886.89,"endTime":889.68,"body":"ulnar facet fracture, but we"},{"speaker":"Charles Goldfarb","startTime":886.89,"endTime":889.68,"body":"should probably talk about that"},{"speaker":"Charles Goldfarb","startTime":889.68,"endTime":892.68,"body":"a little more. In my mind. These"},{"speaker":"Charles Goldfarb","startTime":889.68,"endTime":892.68,"body":"come in a couple different"},{"speaker":"Charles Goldfarb","startTime":892.68,"endTime":896.91,"body":"varieties. One is the one that's"},{"speaker":"Charles Goldfarb","startTime":892.68,"endTime":896.91,"body":"obvious from from the time of"},{"speaker":"Charles Goldfarb","startTime":896.91,"endTime":899.46,"body":"the original surgery and the"},{"speaker":"Charles Goldfarb","startTime":896.91,"endTime":899.46,"body":"other is the one that may"},{"speaker":"Charles Goldfarb","startTime":899.46,"endTime":902.58,"body":"surprise us because it's not"},{"speaker":"Charles Goldfarb","startTime":899.46,"endTime":902.58,"body":"quite so obvious. So the first"},{"speaker":"Charles Goldfarb","startTime":902.58,"endTime":907.41,"body":"question is, when do you think"},{"speaker":"Charles Goldfarb","startTime":902.58,"endTime":907.41,"body":"about a CT scan? And does it"},{"speaker":"Charles Goldfarb","startTime":907.41,"endTime":911.4,"body":"have a role? If you're just not"},{"speaker":"Charles Goldfarb","startTime":907.41,"endTime":911.4,"body":"quite certain about fracture"},{"speaker":"Charles Goldfarb","startTime":911.4,"endTime":913.92,"body":"personality? So how often do you"},{"speaker":"Charles Goldfarb","startTime":911.4,"endTime":913.92,"body":"order a CT scan for distal"},{"speaker":"Charles Goldfarb","startTime":913.92,"endTime":916.08,"body":"radius fractures? And when do"},{"speaker":"Charles Goldfarb","startTime":913.92,"endTime":916.08,"body":"you use it?"},{"speaker":"Chris Dy","startTime":916.8,"endTime":921.33,"body":"If it's, um, if I'm"},{"speaker":"Chris Dy","startTime":916.8,"endTime":921.33,"body":"concerned about a subtle volar"},{"speaker":"Chris Dy","startTime":921.33,"endTime":926.25,"body":"displacement from a volar lunate"},{"speaker":"Chris Dy","startTime":921.33,"endTime":926.25,"body":"facet fragment, and when I say"},{"speaker":"Chris Dy","startTime":926.25,"endTime":928.11,"body":"volar displacement, I mean,"},{"speaker":"Chris Dy","startTime":926.25,"endTime":928.11,"body":"volar, displacement of the"},{"speaker":"Chris Dy","startTime":928.11,"endTime":931.59,"body":"carpus. And it's not a large"},{"speaker":"Chris Dy","startTime":928.11,"endTime":931.59,"body":"enough fragment for me to"},{"speaker":"Chris Dy","startTime":931.59,"endTime":934.86,"body":"identify and feel confident that"},{"speaker":"Chris Dy","startTime":931.59,"endTime":934.86,"body":"I can get it with a volar plate."},{"speaker":"Chris Dy","startTime":935.4,"endTime":939.33,"body":"Or, you know, I need to honestly"},{"speaker":"Chris Dy","startTime":935.4,"endTime":939.33,"body":"measure it based on some of the"},{"speaker":"Chris Dy","startTime":939.33,"endTime":942.45,"body":"work that Jupiter and harness"},{"speaker":"Chris Dy","startTime":939.33,"endTime":942.45,"body":"have done, I will get a CT scan,"},{"speaker":"Chris Dy","startTime":942.45,"endTime":946.47,"body":"but it is less common. I think I"},{"speaker":"Chris Dy","startTime":942.45,"endTime":946.47,"body":"have a lower threshold to"},{"speaker":"Chris Dy","startTime":946.68,"endTime":951.72,"body":"perform a volar ulnar approach"},{"speaker":"Chris Dy","startTime":946.68,"endTime":951.72,"body":"between the long flexors and the"},{"speaker":"Chris Dy","startTime":951.75,"endTime":955.5,"body":"ulnar bundle, and honestly"},{"speaker":"Chris Dy","startTime":951.75,"endTime":955.5,"body":"directly inspect it that way. I"},{"speaker":"Chris Dy","startTime":955.5,"endTime":958.56,"body":"have a lower threshold to switch"},{"speaker":"Chris Dy","startTime":955.5,"endTime":958.56,"body":"away from volar plate for any"},{"speaker":"Chris Dy","startTime":958.95,"endTime":960.33,"body":"concerning fragments."},{"speaker":"Charles Goldfarb","startTime":960.9,"endTime":963.45,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":960.9,"endTime":963.45,"body":"I think that's well said, we"},{"speaker":"Charles Goldfarb","startTime":963.45,"endTime":965.85,"body":"were joking earlier about"},{"speaker":"Charles Goldfarb","startTime":963.45,"endTime":965.85,"body":"Facebook and Instagram, knowing"},{"speaker":"Charles Goldfarb","startTime":965.85,"endTime":967.98,"body":"us better than we know"},{"speaker":"Charles Goldfarb","startTime":965.85,"endTime":967.98,"body":"ourselves, the other group of"},{"speaker":"Charles Goldfarb","startTime":968.1,"endTime":970.8,"body":"people who know us better than"},{"speaker":"Charles Goldfarb","startTime":968.1,"endTime":970.8,"body":"we know ourselves, are the"},{"speaker":"Charles Goldfarb","startTime":970.8,"endTime":975.9,"body":"insurance companies. And they"},{"speaker":"Charles Goldfarb","startTime":970.8,"endTime":975.9,"body":"absolutely know what Chuck"},{"speaker":"Charles Goldfarb","startTime":975.9,"endTime":981.0,"body":"Goldfarb costs to fix a distal"},{"speaker":"Charles Goldfarb","startTime":975.9,"endTime":981.0,"body":"radius fracture. And I don't"},{"speaker":"Charles Goldfarb","startTime":981.0,"endTime":984.99,"body":"think I worry overly about that."},{"speaker":"Charles Goldfarb","startTime":981.0,"endTime":984.99,"body":"But I do worry about cost just"},{"speaker":"Charles Goldfarb","startTime":984.99,"endTime":988.35,"body":"because I think it's my"},{"speaker":"Charles Goldfarb","startTime":984.99,"endTime":988.35,"body":"obligation. So I don't order as"},{"speaker":"Charles Goldfarb","startTime":988.35,"endTime":992.34,"body":"many CT scans, perhaps as"},{"speaker":"Charles Goldfarb","startTime":988.35,"endTime":992.34,"body":"others, and maybe I underorder"},{"speaker":"Charles Goldfarb","startTime":992.37,"endTime":995.7,"body":"CT scan sometimes. And I think"},{"speaker":"Charles Goldfarb","startTime":992.37,"endTime":995.7,"body":"this fracture is just so"},{"speaker":"Charles Goldfarb","startTime":995.7,"endTime":999.42,"body":"dangerous. And the benefit of"},{"speaker":"Charles Goldfarb","startTime":995.7,"endTime":999.42,"body":"avoiding a second or third"},{"speaker":"Charles Goldfarb","startTime":999.42,"endTime":1002.54,"body":"surgery because of this fragment"},{"speaker":"Charles Goldfarb","startTime":999.42,"endTime":1002.54,"body":"is just so incredibly important."},{"speaker":"Charles Goldfarb","startTime":1002.93,"endTime":1005.75,"body":"I would throw back to you that"},{"speaker":"Charles Goldfarb","startTime":1002.93,"endTime":1005.75,"body":"sometimes if you know that"},{"speaker":"Charles Goldfarb","startTime":1005.75,"endTime":1009.02,"body":"fracture is there with or"},{"speaker":"Charles Goldfarb","startTime":1005.75,"endTime":1009.02,"body":"without a CT scan, and it's"},{"speaker":"Charles Goldfarb","startTime":1009.05,"endTime":1012.32,"body":"isolated, then you definitely"},{"speaker":"Charles Goldfarb","startTime":1009.05,"endTime":1012.32,"body":"you know, you use that volar"},{"speaker":"Charles Goldfarb","startTime":1012.32,"endTime":1015.92,"body":"ulnar approach. For me, it gets"},{"speaker":"Charles Goldfarb","startTime":1012.32,"endTime":1015.92,"body":"trickier when it's just part of"},{"speaker":"Charles Goldfarb","startTime":1015.92,"endTime":1019.16,"body":"the fracture personality. And so"},{"speaker":"Charles Goldfarb","startTime":1015.92,"endTime":1019.16,"body":"then maybe a standard volar"},{"speaker":"Charles Goldfarb","startTime":1019.16,"endTime":1021.41,"body":"approach works and you have to"},{"speaker":"Charles Goldfarb","startTime":1019.16,"endTime":1021.41,"body":"sneak over."},{"speaker":"Chris Dy","startTime":1021.69,"endTime":1024.54,"body":"Do you think it's hard"},{"speaker":"Chris Dy","startTime":1021.69,"endTime":1024.54,"body":"to sneak over and get to that"},{"speaker":"Chris Dy","startTime":1024.54,"endTime":1029.37,"body":"fragment and truly assess it and"},{"speaker":"Chris Dy","startTime":1024.54,"endTime":1029.37,"body":"capture it through a standard"},{"speaker":"Chris Dy","startTime":1029.37,"endTime":1030.06,"body":"volar approach."},{"speaker":"Charles Goldfarb","startTime":1031.02,"endTime":1033.57,"body":"I think it's"},{"speaker":"Charles Goldfarb","startTime":1031.02,"endTime":1033.57,"body":"doable in most patients, some of"},{"speaker":"Charles Goldfarb","startTime":1033.57,"endTime":1037.95,"body":"it depends on their bulk and it"},{"speaker":"Charles Goldfarb","startTime":1033.57,"endTime":1037.95,"body":"may require a longer incision,"},{"speaker":"Charles Goldfarb","startTime":1037.95,"endTime":1040.47,"body":"both proximally and distally."},{"speaker":"Charles Goldfarb","startTime":1037.95,"endTime":1040.47,"body":"Distally, you know, crossing the"},{"speaker":"Charles Goldfarb","startTime":1040.47,"endTime":1043.47,"body":"wrist crease and we both said we"},{"speaker":"Charles Goldfarb","startTime":1040.47,"endTime":1043.47,"body":"don't like that, but I do think"},{"speaker":"Charles Goldfarb","startTime":1043.47,"endTime":1046.41,"body":"it may require more extensive"},{"speaker":"Charles Goldfarb","startTime":1043.47,"endTime":1046.41,"body":"incision, but in the right"},{"speaker":"Charles Goldfarb","startTime":1046.41,"endTime":1048.66,"body":"patient, you can get there"},{"speaker":"Charles Goldfarb","startTime":1046.41,"endTime":1048.66,"body":"pretty easily. In the wrong"},{"speaker":"Charles Goldfarb","startTime":1048.66,"endTime":1049.98,"body":"patient, it can be a struggle."},{"speaker":"Chris Dy","startTime":1050.43,"endTime":1052.77,"body":"Yeah, and I think that"},{"speaker":"Chris Dy","startTime":1050.43,"endTime":1052.77,"body":"for me, there have been a"},{"speaker":"Chris Dy","startTime":1052.77,"endTime":1055.23,"body":"couple, I probably had one or"},{"speaker":"Chris Dy","startTime":1052.77,"endTime":1055.23,"body":"two cases, I remember where I"},{"speaker":"Chris Dy","startTime":1055.23,"endTime":1057.99,"body":"went and volar ulnar and then"},{"speaker":"Chris Dy","startTime":1055.23,"endTime":1057.99,"body":"kind of wished I had a better"},{"speaker":"Chris Dy","startTime":1057.99,"endTime":1060.72,"body":"radial sided exposure, and I had"},{"speaker":"Chris Dy","startTime":1057.99,"endTime":1060.72,"body":"a low threshold to make a small"},{"speaker":"Chris Dy","startTime":1060.72,"endTime":1065.76,"body":"radial accessory incision, you"},{"speaker":"Chris Dy","startTime":1060.72,"endTime":1065.76,"body":"know, I was able to get done"},{"speaker":"Chris Dy","startTime":1065.76,"endTime":1070.53,"body":"what I needed to do in terms of"},{"speaker":"Chris Dy","startTime":1065.76,"endTime":1070.53,"body":"the fracture reduction. But I, I"},{"speaker":"Chris Dy","startTime":1070.53,"endTime":1073.62,"body":"agree, I don't like crossing the"},{"speaker":"Chris Dy","startTime":1070.53,"endTime":1073.62,"body":"wrist crease. And I think that,"},{"speaker":"Chris Dy","startTime":1073.89,"endTime":1079.53,"body":"you know that that scar on the"},{"speaker":"Chris Dy","startTime":1073.89,"endTime":1079.53,"body":"skin is very tough for patients"},{"speaker":"Chris Dy","startTime":1079.53,"endTime":1082.74,"body":"to get over in a trauma setting."},{"speaker":"Chris Dy","startTime":1079.53,"endTime":1082.74,"body":"You know, they're they're"},{"speaker":"Chris Dy","startTime":1082.74,"endTime":1085.98,"body":"already prone to stiffness, and"},{"speaker":"Chris Dy","startTime":1082.74,"endTime":1085.98,"body":"that can be a problematic area."},{"speaker":"Charles Goldfarb","startTime":1086.56,"endTime":1089.11,"body":"Absolutely."},{"speaker":"Charles Goldfarb","startTime":1086.56,"endTime":1089.11,"body":"One thing that's not acceptable,"},{"speaker":"Charles Goldfarb","startTime":1089.11,"endTime":1092.32,"body":"though, is to try to do an"},{"speaker":"Charles Goldfarb","startTime":1089.11,"endTime":1092.32,"body":"incision halfway in between"},{"speaker":"Charles Goldfarb","startTime":1092.44,"endTime":1096.19,"body":"halfway in between a standard"},{"speaker":"Charles Goldfarb","startTime":1092.44,"endTime":1096.19,"body":"FCR or volar Henry, and then a"},{"speaker":"Charles Goldfarb","startTime":1096.19,"endTime":1098.47,"body":"volar ulnar, because that just"},{"speaker":"Charles Goldfarb","startTime":1096.19,"endTime":1098.47,"body":"gets you into a world of trouble"},{"speaker":"Charles Goldfarb","startTime":1098.47,"endTime":1101.8,"body":"with the median nerve proper and"},{"speaker":"Charles Goldfarb","startTime":1098.47,"endTime":1101.8,"body":"the palmar cutaneous. So you"},{"speaker":"Charles Goldfarb","startTime":1101.8,"endTime":1104.17,"body":"kind of have to make a choice."},{"speaker":"Charles Goldfarb","startTime":1101.8,"endTime":1104.17,"body":"Yeah. And you do that"},{"speaker":"Charles Goldfarb","startTime":1104.17,"endTime":1105.4,"body":"preoperatively obviously."},{"speaker":"Chris Dy","startTime":1105.48,"endTime":1108.51,"body":"Yeah, and these, you"},{"speaker":"Chris Dy","startTime":1105.48,"endTime":1108.51,"body":"know, that point is important"},{"speaker":"Chris Dy","startTime":1108.51,"endTime":1111.96,"body":"because I my hesitation about"},{"speaker":"Chris Dy","startTime":1108.51,"endTime":1111.96,"body":"using a standard FCR type"},{"speaker":"Chris Dy","startTime":1111.96,"endTime":1116.88,"body":"approach for for these volar"},{"speaker":"Chris Dy","startTime":1111.96,"endTime":1116.88,"body":"lunate facet fragments is the"},{"speaker":"Chris Dy","startTime":1116.88,"endTime":1120.75,"body":"amount of traction on the median"},{"speaker":"Chris Dy","startTime":1116.88,"endTime":1120.75,"body":"nerve that occurs to get all the"},{"speaker":"Chris Dy","startTime":1120.75,"endTime":1123.69,"body":"way to that volar ulnar piece,"},{"speaker":"Chris Dy","startTime":1120.75,"endTime":1123.69,"body":"you know, a it's a hard enough"},{"speaker":"Chris Dy","startTime":1123.69,"endTime":1126.69,"body":"exposure to make sure you can"},{"speaker":"Chris Dy","startTime":1123.69,"endTime":1126.69,"body":"identify the fragment,"},{"speaker":"Chris Dy","startTime":1126.69,"endTime":1130.98,"body":"appreciate it, not strip it and"},{"speaker":"Chris Dy","startTime":1126.69,"endTime":1130.98,"body":"fix it. And then you know,"},{"speaker":"Chris Dy","startTime":1130.98,"endTime":1133.77,"body":"having a retractor over in that"},{"speaker":"Chris Dy","startTime":1130.98,"endTime":1133.77,"body":"area on the median nerve can be"},{"speaker":"Chris Dy","startTime":1133.8,"endTime":1135.93,"body":"taxing on the nerve. And you"},{"speaker":"Chris Dy","startTime":1133.8,"endTime":1135.93,"body":"know, I'm always thinking about"},{"speaker":"Chris Dy","startTime":1135.93,"endTime":1138.27,"body":"the nerve. And these are cases"},{"speaker":"Chris Dy","startTime":1135.93,"endTime":1138.27,"body":"in which I have a lower"},{"speaker":"Chris Dy","startTime":1138.27,"endTime":1140.37,"body":"threshold to perform a carpal"},{"speaker":"Chris Dy","startTime":1138.27,"endTime":1140.37,"body":"tunnel release as well."},{"speaker":"Charles Goldfarb","startTime":1140.94,"endTime":1143.73,"body":"Yeah, I agree"},{"speaker":"Charles Goldfarb","startTime":1140.94,"endTime":1143.73,"body":"with everything you said. And I"},{"speaker":"Charles Goldfarb","startTime":1144.0,"endTime":1147.72,"body":"joke about being, showing"},{"speaker":"Charles Goldfarb","startTime":1144.0,"endTime":1147.72,"body":"disdain for nerves, but I really"},{"speaker":"Charles Goldfarb","startTime":1147.72,"endTime":1150.9,"body":"don't. And as I think I've"},{"speaker":"Charles Goldfarb","startTime":1147.72,"endTime":1150.9,"body":"mentioned early in my career, I"},{"speaker":"Charles Goldfarb","startTime":1150.9,"endTime":1155.4,"body":"was burned with over retraction"},{"speaker":"Charles Goldfarb","startTime":1150.9,"endTime":1155.4,"body":"with this case and an angry"},{"speaker":"Charles Goldfarb","startTime":1155.4,"endTime":1158.28,"body":"median nerve afterwards and I"},{"speaker":"Charles Goldfarb","startTime":1155.4,"endTime":1158.28,"body":"learned my lesson but don't"},{"speaker":"Charles Goldfarb","startTime":1158.28,"endTime":1160.26,"body":"don't if you haven't had that"},{"speaker":"Charles Goldfarb","startTime":1158.28,"endTime":1160.26,"body":"happen, please don't learn your"},{"speaker":"Charles Goldfarb","startTime":1160.26,"endTime":1163.23,"body":"lesson the hard way. Do you have"},{"speaker":"Charles Goldfarb","startTime":1160.26,"endTime":1163.23,"body":"a, I'm not asking for a"},{"speaker":"Charles Goldfarb","startTime":1163.23,"endTime":1167.67,"body":"manufacturer. But do you have a"},{"speaker":"Charles Goldfarb","startTime":1163.23,"endTime":1167.67,"body":"preferred construct plate wise?"},{"speaker":"Charles Goldfarb","startTime":1167.67,"endTime":1169.71,"body":"Like how do you think about that"},{"speaker":"Charles Goldfarb","startTime":1167.67,"endTime":1169.71,"body":"for if you if you have an"},{"speaker":"Charles Goldfarb","startTime":1169.71,"endTime":1171.36,"body":"isolated volar ulnar corner."},{"speaker":"Chris Dy","startTime":1171.63,"endTime":1174.57,"body":"I like to take either"},{"speaker":"Chris Dy","startTime":1171.63,"endTime":1174.57,"body":"depending on the size of the"},{"speaker":"Chris Dy","startTime":1174.57,"endTime":1180.36,"body":"patient, a 2-0 or 2-4 standard"},{"speaker":"Chris Dy","startTime":1174.57,"endTime":1180.36,"body":"recon type plate, usually an L"},{"speaker":"Chris Dy","startTime":1180.36,"endTime":1184.77,"body":"or a T shaped and I will custom"},{"speaker":"Chris Dy","startTime":1180.36,"endTime":1184.77,"body":"bend that to what I think will"},{"speaker":"Chris Dy","startTime":1184.77,"endTime":1189.72,"body":"sit appropriately in that in"},{"speaker":"Chris Dy","startTime":1184.77,"endTime":1189.72,"body":"that concavity it's a little"},{"speaker":"Chris Dy","startTime":1189.72,"endTime":1192.39,"body":"more distal, you have the leeway"},{"speaker":"Chris Dy","startTime":1189.72,"endTime":1192.39,"body":"to go a little more distal than"},{"speaker":"Chris Dy","startTime":1192.39,"endTime":1194.04,"body":"you will with the volar plate"},{"speaker":"Chris Dy","startTime":1192.39,"endTime":1194.04,"body":"because you're obviously trying"},{"speaker":"Chris Dy","startTime":1194.04,"endTime":1197.25,"body":"to capture this fragment and I"},{"speaker":"Chris Dy","startTime":1194.04,"endTime":1197.25,"body":"like having a lower profile"},{"speaker":"Chris Dy","startTime":1197.25,"endTime":1200.64,"body":"implant out there because you"},{"speaker":"Chris Dy","startTime":1197.25,"endTime":1200.64,"body":"know honestly it's not on the"},{"speaker":"Chris Dy","startTime":1200.64,"endTime":1203.43,"body":"radial side, and you're not"},{"speaker":"Chris Dy","startTime":1200.64,"endTime":1203.43,"body":"going to catch the FPL with it."},{"speaker":"Chris Dy","startTime":1203.46,"endTime":1207.42,"body":"It's a plate where you can put"},{"speaker":"Chris Dy","startTime":1203.46,"endTime":1207.42,"body":"it really distal, and not have"},{"speaker":"Chris Dy","startTime":1207.42,"endTime":1209.46,"body":"to worry as much about"},{"speaker":"Chris Dy","startTime":1207.42,"endTime":1209.46,"body":"irritating the tendons providing"},{"speaker":"Chris Dy","startTime":1209.46,"endTime":1213.36,"body":"that provided that you either"},{"speaker":"Chris Dy","startTime":1209.46,"endTime":1213.36,"body":"bend it appropriately to match"},{"speaker":"Chris Dy","startTime":1213.36,"endTime":1216.21,"body":"that fossa or you trust the"},{"speaker":"Chris Dy","startTime":1213.36,"endTime":1216.21,"body":"patient's bone to allow the"},{"speaker":"Chris Dy","startTime":1216.21,"endTime":1220.95,"body":"screws to make that to make the"},{"speaker":"Chris Dy","startTime":1216.21,"endTime":1220.95,"body":"plate sit nicely when you do"},{"speaker":"Chris Dy","startTime":1220.95,"endTime":1222.84,"body":"that apex screw for your"},{"speaker":"Chris Dy","startTime":1220.95,"endTime":1222.84,"body":"buttress plating."},{"speaker":"Charles Goldfarb","startTime":1223.41,"endTime":1225.12,"body":"Yeah, well"},{"speaker":"Charles Goldfarb","startTime":1223.41,"endTime":1225.12,"body":"said, I mean, there certainly"},{"speaker":"Charles Goldfarb","startTime":1225.12,"endTime":1228.33,"body":"are lots of plates out there"},{"speaker":"Charles Goldfarb","startTime":1225.12,"endTime":1228.33,"body":"that have even little hooks that"},{"speaker":"Charles Goldfarb","startTime":1228.33,"endTime":1230.76,"body":"you know, extend really far"},{"speaker":"Charles Goldfarb","startTime":1228.33,"endTime":1230.76,"body":"distal off the plate, or you can"},{"speaker":"Charles Goldfarb","startTime":1230.76,"endTime":1233.16,"body":"add them to the plate, there's"},{"speaker":"Charles Goldfarb","startTime":1230.76,"endTime":1233.16,"body":"all kinds of variability. The"},{"speaker":"Charles Goldfarb","startTime":1233.16,"endTime":1236.01,"body":"bottom line is put something"},{"speaker":"Charles Goldfarb","startTime":1233.16,"endTime":1236.01,"body":"pretty darn distal, and make"},{"speaker":"Charles Goldfarb","startTime":1236.01,"endTime":1240.69,"body":"sure you buttress or capture"},{"speaker":"Charles Goldfarb","startTime":1236.01,"endTime":1240.69,"body":"that fragment. Because again, to"},{"speaker":"Charles Goldfarb","startTime":1240.69,"endTime":1243.33,"body":"make it very clear, for those of"},{"speaker":"Charles Goldfarb","startTime":1240.69,"endTime":1243.33,"body":"you who haven't seen a lot of"},{"speaker":"Charles Goldfarb","startTime":1243.33,"endTime":1246.48,"body":"these fractures, the danger here"},{"speaker":"Charles Goldfarb","startTime":1243.33,"endTime":1246.48,"body":"is that if your plate is too"},{"speaker":"Charles Goldfarb","startTime":1246.48,"endTime":1249.72,"body":"proximal, or you don't"},{"speaker":"Charles Goldfarb","startTime":1246.48,"endTime":1249.72,"body":"understand the fracture fully,"},{"speaker":"Charles Goldfarb","startTime":1249.87,"endTime":1252.69,"body":"when you see the patient back,"},{"speaker":"Charles Goldfarb","startTime":1249.87,"endTime":1252.69,"body":"and honestly, this can happen,"},{"speaker":"Charles Goldfarb","startTime":1252.69,"endTime":1254.58,"body":"no matter how good you are, and"},{"speaker":"Charles Goldfarb","startTime":1252.69,"endTime":1254.58,"body":"how many of these you've"},{"speaker":"Charles Goldfarb","startTime":1254.58,"endTime":1258.9,"body":"treated, that if that fragment"},{"speaker":"Charles Goldfarb","startTime":1254.58,"endTime":1258.9,"body":"escapes volarly over your plate,"},{"speaker":"Charles Goldfarb","startTime":1259.23,"endTime":1263.85,"body":"then the carpus comes with it."},{"speaker":"Charles Goldfarb","startTime":1259.23,"endTime":1263.85,"body":"And that's that's difficult to"},{"speaker":"Charles Goldfarb","startTime":1263.85,"endTime":1266.19,"body":"deal with in a sub acute"},{"speaker":"Charles Goldfarb","startTime":1263.85,"endTime":1266.19,"body":"setting. So you want to get that"},{"speaker":"Charles Goldfarb","startTime":1266.19,"endTime":1270.36,"body":"right the first time. Now, do"},{"speaker":"Charles Goldfarb","startTime":1266.19,"endTime":1270.36,"body":"you consider a dorsal"},{"speaker":"Charles Goldfarb","startTime":1270.36,"endTime":1273.6,"body":"supplementation with a spanning"},{"speaker":"Charles Goldfarb","startTime":1270.36,"endTime":1273.6,"body":"plate? If you feel like you've"},{"speaker":"Charles Goldfarb","startTime":1273.6,"endTime":1277.77,"body":"captured this volar ulnar corner"},{"speaker":"Charles Goldfarb","startTime":1273.6,"endTime":1277.77,"body":"appropriately at surgery one?"},{"speaker":"Chris Dy","startTime":1277.81,"endTime":1280.63,"body":"No, I don't. I know a"},{"speaker":"Chris Dy","startTime":1277.81,"endTime":1280.63,"body":"lot of people do. And we talked"},{"speaker":"Chris Dy","startTime":1280.63,"endTime":1283.48,"body":"a little bit about it last time,"},{"speaker":"Chris Dy","startTime":1280.63,"endTime":1283.48,"body":"I think the dorsal spanning"},{"speaker":"Chris Dy","startTime":1283.48,"endTime":1287.47,"body":"plate may be over utilized. You"},{"speaker":"Chris Dy","startTime":1283.48,"endTime":1287.47,"body":"know, and I think that certainly"},{"speaker":"Chris Dy","startTime":1287.47,"endTime":1290.35,"body":"it's one consideration, I always"},{"speaker":"Chris Dy","startTime":1287.47,"endTime":1290.35,"body":"have in the back pocket,"},{"speaker":"Chris Dy","startTime":1290.38,"endTime":1294.22,"body":"whenever I'm doing a radius, a"},{"speaker":"Chris Dy","startTime":1290.38,"endTime":1294.22,"body":"distal radius it is in the"},{"speaker":"Chris Dy","startTime":1294.31,"endTime":1298.21,"body":"surgical center. So it's there"},{"speaker":"Chris Dy","startTime":1294.31,"endTime":1298.21,"body":"in case I need it. But I"},{"speaker":"Chris Dy","startTime":1298.24,"endTime":1300.34,"body":"honestly will just tend to"},{"speaker":"Chris Dy","startTime":1298.24,"endTime":1300.34,"body":"immobilize these patients"},{"speaker":"Chris Dy","startTime":1300.34,"endTime":1303.73,"body":"longer, I do have the same"},{"speaker":"Chris Dy","startTime":1300.34,"endTime":1303.73,"body":"concern that you have, even if I"},{"speaker":"Chris Dy","startTime":1303.94,"endTime":1307.21,"body":"think I captured it, well, I"},{"speaker":"Chris Dy","startTime":1303.94,"endTime":1307.21,"body":"still am pretty paranoid about"},{"speaker":"Chris Dy","startTime":1307.21,"endTime":1309.79,"body":"getting x rays, you know, the"},{"speaker":"Chris Dy","startTime":1307.21,"endTime":1309.79,"body":"first few weeks just to make"},{"speaker":"Chris Dy","startTime":1309.79,"endTime":1315.13,"body":"sure it hasn't shifted. You"},{"speaker":"Chris Dy","startTime":1309.79,"endTime":1315.13,"body":"know, and I think that there are"},{"speaker":"Chris Dy","startTime":1315.13,"endTime":1317.23,"body":"a number of ways you can capture"},{"speaker":"Chris Dy","startTime":1315.13,"endTime":1317.23,"body":"that fragment, doesn't always"},{"speaker":"Chris Dy","startTime":1317.23,"endTime":1320.65,"body":"have to be through a buttress"},{"speaker":"Chris Dy","startTime":1317.23,"endTime":1320.65,"body":"fragment, or buttress plate. The"},{"speaker":"Chris Dy","startTime":1320.65,"endTime":1323.62,"body":"other ways that have been"},{"speaker":"Chris Dy","startTime":1320.65,"endTime":1323.62,"body":"described are to use a K wire"},{"speaker":"Chris Dy","startTime":1323.62,"endTime":1326.68,"body":"and, you know, bend it back and"},{"speaker":"Chris Dy","startTime":1323.62,"endTime":1326.68,"body":"tuck it underneath the volar"},{"speaker":"Chris Dy","startTime":1326.68,"endTime":1329.59,"body":"plate. So that's one way to do"},{"speaker":"Chris Dy","startTime":1326.68,"endTime":1329.59,"body":"it. You talked about adding"},{"speaker":"Chris Dy","startTime":1329.59,"endTime":1332.59,"body":"extensions onto a volar plate or"},{"speaker":"Chris Dy","startTime":1329.59,"endTime":1332.59,"body":"certain volar plates that have"},{"speaker":"Chris Dy","startTime":1332.59,"endTime":1336.01,"body":"extensions to get out there. I"},{"speaker":"Chris Dy","startTime":1332.59,"endTime":1336.01,"body":"don't love that, because then"},{"speaker":"Chris Dy","startTime":1336.01,"endTime":1338.26,"body":"you're still, the natural"},{"speaker":"Chris Dy","startTime":1336.01,"endTime":1338.26,"body":"tendency is to put the volar"},{"speaker":"Chris Dy","startTime":1338.26,"endTime":1341.02,"body":"plate a little more distal,"},{"speaker":"Chris Dy","startTime":1338.26,"endTime":1341.02,"body":"which can obviously get into"},{"speaker":"Chris Dy","startTime":1341.02,"endTime":1345.04,"body":"some issues with the FPL. And"},{"speaker":"Chris Dy","startTime":1341.02,"endTime":1345.04,"body":"the long flexors. And then the"},{"speaker":"Chris Dy","startTime":1345.04,"endTime":1348.37,"body":"other way that's been described"},{"speaker":"Chris Dy","startTime":1345.04,"endTime":1348.37,"body":"is to use, you know, a"},{"speaker":"Chris Dy","startTime":1348.37,"endTime":1352.24,"body":"cannulated screw, you know, so"},{"speaker":"Chris Dy","startTime":1348.37,"endTime":1352.24,"body":"using one of those old school"},{"speaker":"Chris Dy","startTime":1352.6,"endTime":1355.39,"body":"screws and putting a putting a"},{"speaker":"Chris Dy","startTime":1352.6,"endTime":1355.39,"body":"wire in first and getting it"},{"speaker":"Chris Dy","startTime":1355.39,"endTime":1358.42,"body":"secured that way, you just want"},{"speaker":"Chris Dy","startTime":1355.39,"endTime":1358.42,"body":"a couple of points of fixation."},{"speaker":"Chris Dy","startTime":1358.42,"endTime":1359.92,"body":"I think that's probably the"},{"speaker":"Chris Dy","startTime":1358.42,"endTime":1359.92,"body":"biggest thing."},{"speaker":"Charles Goldfarb","startTime":1360.59,"endTime":1363.53,"body":"I think that's"},{"speaker":"Charles Goldfarb","startTime":1360.59,"endTime":1363.53,"body":"great. I totally agree. Excuse"},{"speaker":"Charles Goldfarb","startTime":1363.53,"endTime":1369.38,"body":"me, the other issue can be if"},{"speaker":"Charles Goldfarb","startTime":1363.53,"endTime":1369.38,"body":"you are having to go back to the"},{"speaker":"Charles Goldfarb","startTime":1369.38,"endTime":1373.49,"body":"operating room, or this is a sub"},{"speaker":"Charles Goldfarb","startTime":1369.38,"endTime":1373.49,"body":"acute setting, I will absolutely"},{"speaker":"Charles Goldfarb","startTime":1373.49,"endTime":1377.06,"body":"use that dorsal spanning plate"},{"speaker":"Charles Goldfarb","startTime":1373.49,"endTime":1377.06,"body":"because it is a game changer in"},{"speaker":"Charles Goldfarb","startTime":1377.06,"endTime":1379.46,"body":"a sa- not salvage because you"},{"speaker":"Charles Goldfarb","startTime":1377.06,"endTime":1379.46,"body":"can still hopefully get the"},{"speaker":"Charles Goldfarb","startTime":1379.46,"endTime":1381.68,"body":"patient everything they would"},{"speaker":"Charles Goldfarb","startTime":1379.46,"endTime":1381.68,"body":"have had. But it really"},{"speaker":"Charles Goldfarb","startTime":1381.68,"endTime":1385.01,"body":"neutralizes those volar forces"},{"speaker":"Charles Goldfarb","startTime":1381.68,"endTime":1385.01,"body":"on the carpus. So that's a great"},{"speaker":"Charles Goldfarb","startTime":1385.01,"endTime":1388.04,"body":"option in a subacute setting."},{"speaker":"Charles Goldfarb","startTime":1385.01,"endTime":1388.04,"body":"But I agree with you, if you're"},{"speaker":"Charles Goldfarb","startTime":1388.19,"endTime":1391.13,"body":"if you A, identify the fracture"},{"speaker":"Charles Goldfarb","startTime":1388.19,"endTime":1391.13,"body":"at the time of the original"},{"speaker":"Charles Goldfarb","startTime":1391.13,"endTime":1395.24,"body":"surgery, and B, able to"},{"speaker":"Charles Goldfarb","startTime":1391.13,"endTime":1395.24,"body":"sufficiently isolate and"},{"speaker":"Charles Goldfarb","startTime":1395.3,"endTime":1398.21,"body":"stabilize that fragment, there's"},{"speaker":"Charles Goldfarb","startTime":1395.3,"endTime":1398.21,"body":"no need for a dorsal implant."},{"speaker":"Chris Dy","startTime":1398.24,"endTime":1402.44,"body":"So last question for"},{"speaker":"Chris Dy","startTime":1398.24,"endTime":1402.44,"body":"this particular fragment. What's"},{"speaker":"Chris Dy","startTime":1402.44,"endTime":1405.62,"body":"your post-op protocol? You know,"},{"speaker":"Chris Dy","startTime":1402.44,"endTime":1405.62,"body":"one of the we talked in the last"},{"speaker":"Chris Dy","startTime":1405.62,"endTime":1409.67,"body":"episode. You know, one of the"},{"speaker":"Chris Dy","startTime":1405.62,"endTime":1409.67,"body":"standard advantages of operating"},{"speaker":"Chris Dy","startTime":1409.97,"endTime":1412.4,"body":"for these fractures for just"},{"speaker":"Chris Dy","startTime":1409.97,"endTime":1412.4,"body":"distal radius fractures in"},{"speaker":"Chris Dy","startTime":1412.4,"endTime":1415.25,"body":"general is early mobilization."},{"speaker":"Chris Dy","startTime":1412.4,"endTime":1415.25,"body":"But I think this one may be a"},{"speaker":"Chris Dy","startTime":1415.25,"endTime":1415.82,"body":"little different."},{"speaker":"Charles Goldfarb","startTime":1416.11,"endTime":1418.12,"body":"Yeah, I go"},{"speaker":"Charles Goldfarb","startTime":1416.11,"endTime":1418.12,"body":"slower with this one for sure."},{"speaker":"Charles Goldfarb","startTime":1418.12,"endTime":1423.25,"body":"So my typical protocol is five"},{"speaker":"Charles Goldfarb","startTime":1418.12,"endTime":1423.25,"body":"to six days after surgery with a"},{"speaker":"Charles Goldfarb","startTime":1423.28,"endTime":1426.46,"body":"stabilized distal radius"},{"speaker":"Charles Goldfarb","startTime":1423.28,"endTime":1426.46,"body":"fracture with a volar locking"},{"speaker":"Charles Goldfarb","startTime":1426.46,"endTime":1430.36,"body":"plate or a dorsal locking plate."},{"speaker":"Charles Goldfarb","startTime":1426.46,"endTime":1430.36,"body":"They go to therapy have a"},{"speaker":"Charles Goldfarb","startTime":1430.36,"endTime":1434.02,"body":"removable brace and start active"},{"speaker":"Charles Goldfarb","startTime":1430.36,"endTime":1434.02,"body":"and general passive motion. With"},{"speaker":"Charles Goldfarb","startTime":1434.02,"endTime":1437.98,"body":"this fracture it's"},{"speaker":"Charles Goldfarb","startTime":1434.02,"endTime":1437.98,"body":"immobilization for four or five"},{"speaker":"Charles Goldfarb","startTime":1437.98,"endTime":1439.09,"body":"weeks for me."},{"speaker":"Chris Dy","startTime":1439.12,"endTime":1440.08,"body":"Yeah, same here."},{"speaker":"Charles Goldfarb","startTime":1440.53,"endTime":1442.57,"body":"Okay. All"},{"speaker":"Charles Goldfarb","startTime":1440.53,"endTime":1442.57,"body":"right, let's, let's jump. We"},{"speaker":"Charles Goldfarb","startTime":1442.57,"endTime":1445.72,"body":"have two more fracture"},{"speaker":"Charles Goldfarb","startTime":1442.57,"endTime":1445.72,"body":"fragments. We talked about the"},{"speaker":"Charles Goldfarb","startTime":1445.72,"endTime":1449.2,"body":"dorsal ulnar corner a bit, we"},{"speaker":"Charles Goldfarb","startTime":1445.72,"endTime":1449.2,"body":"probably don't need to rehash"},{"speaker":"Charles Goldfarb","startTime":1449.2,"endTime":1452.65,"body":"too much of that. But when do"},{"speaker":"Charles Goldfarb","startTime":1449.2,"endTime":1452.65,"body":"you worry about that dorsal"},{"speaker":"Charles Goldfarb","startTime":1452.71,"endTime":1453.67,"body":"ulnar corner?"},{"speaker":"Chris Dy","startTime":1453.99,"endTime":1456.54,"body":"This is the one where"},{"speaker":"Chris Dy","startTime":1453.99,"endTime":1456.54,"body":"you know if there's pretty"},{"speaker":"Chris Dy","startTime":1456.54,"endTime":1459.45,"body":"substantial dorsal subluxation"},{"speaker":"Chris Dy","startTime":1456.54,"endTime":1459.45,"body":"of the carpus more than the"},{"speaker":"Chris Dy","startTime":1459.45,"endTime":1462.06,"body":"standard, it looks a little bit"},{"speaker":"Chris Dy","startTime":1459.45,"endTime":1462.06,"body":"off because of the dorsal tilt."},{"speaker":"Chris Dy","startTime":1462.39,"endTime":1465.12,"body":"If I think that the carpus is"},{"speaker":"Chris Dy","startTime":1462.39,"endTime":1465.12,"body":"moving with that fragment, which"},{"speaker":"Chris Dy","startTime":1465.12,"endTime":1468.39,"body":"is not common, that's when I"},{"speaker":"Chris Dy","startTime":1465.12,"endTime":1468.39,"body":"would get concerned about it."},{"speaker":"Chris Dy","startTime":1468.39,"endTime":1470.73,"body":"And then the other situation"},{"speaker":"Chris Dy","startTime":1468.39,"endTime":1470.73,"body":"which I get concerned is the"},{"speaker":"Chris Dy","startTime":1470.73,"endTime":1474.0,"body":"sigmoid notch, and how you know"},{"speaker":"Chris Dy","startTime":1470.73,"endTime":1474.0,"body":"malunion there can obviously"},{"speaker":"Chris Dy","startTime":1474.0,"endTime":1476.28,"body":"have implications for forearm"},{"speaker":"Chris Dy","startTime":1474.0,"endTime":1476.28,"body":"motion. What about you?"},{"speaker":"Charles Goldfarb","startTime":1476.79,"endTime":1479.76,"body":"Yeah, I have"},{"speaker":"Charles Goldfarb","startTime":1476.79,"endTime":1479.76,"body":"to say it's not at the top of my"},{"speaker":"Charles Goldfarb","startTime":1479.76,"endTime":1484.2,"body":"list of worrisome fracture"},{"speaker":"Charles Goldfarb","startTime":1479.76,"endTime":1484.2,"body":"patterns, but I don't completely"},{"speaker":"Charles Goldfarb","startTime":1484.2,"endTime":1487.62,"body":"ignore it. And so the reasons"},{"speaker":"Charles Goldfarb","startTime":1484.2,"endTime":1487.62,"body":"you just said are exactly spot"},{"speaker":"Charles Goldfarb","startTime":1487.62,"endTime":1491.7,"body":"on. I worry a bit more about the"},{"speaker":"Charles Goldfarb","startTime":1487.62,"endTime":1491.7,"body":"DREJ and again, it's one of"},{"speaker":"Charles Goldfarb","startTime":1491.7,"endTime":1494.4,"body":"those fracture fragments where"},{"speaker":"Charles Goldfarb","startTime":1491.7,"endTime":1494.4,"body":"something just doesn't look"},{"speaker":"Charles Goldfarb","startTime":1494.4,"endTime":1497.52,"body":"right a CT scan can help"},{"speaker":"Charles Goldfarb","startTime":1494.4,"endTime":1497.52,"body":"clarify. And as we mentioned in"},{"speaker":"Charles Goldfarb","startTime":1497.52,"endTime":1499.98,"body":"the previous podcast, David"},{"speaker":"Charles Goldfarb","startTime":1497.52,"endTime":1499.98,"body":"Brogan has done good work with"},{"speaker":"Charles Goldfarb","startTime":1499.98,"endTime":1503.34,"body":"identifying that this can be a"},{"speaker":"Charles Goldfarb","startTime":1499.98,"endTime":1503.34,"body":"substantial fragment. And we"},{"speaker":"Charles Goldfarb","startTime":1503.34,"endTime":1506.46,"body":"shouldn't neglect it when there"},{"speaker":"Charles Goldfarb","startTime":1503.34,"endTime":1506.46,"body":"are signs of concern."},{"speaker":"Chris Dy","startTime":1506.64,"endTime":1508.41,"body":"Yeah. And I read, you"},{"speaker":"Chris Dy","startTime":1506.64,"endTime":1508.41,"body":"know, we talked about David's"},{"speaker":"Chris Dy","startTime":1508.41,"endTime":1510.81,"body":"paper, I think one of the issues"},{"speaker":"Chris Dy","startTime":1508.41,"endTime":1510.81,"body":"with his paper, you know love"},{"speaker":"Chris Dy","startTime":1510.81,"endTime":1514.02,"body":"the guy, but you know, this, the"},{"speaker":"Chris Dy","startTime":1510.81,"endTime":1514.02,"body":"paper was characterizing that"},{"speaker":"Chris Dy","startTime":1514.02,"endTime":1517.95,"body":"fragment in a population,"},{"speaker":"Chris Dy","startTime":1514.02,"endTime":1517.95,"body":"postmenopausal females in which"},{"speaker":"Chris Dy","startTime":1517.95,"endTime":1520.41,"body":"they had a lot of CT scans, in"},{"speaker":"Chris Dy","startTime":1517.95,"endTime":1520.41,"body":"which maybe it didn't matter as"},{"speaker":"Chris Dy","startTime":1520.41,"endTime":1524.19,"body":"much. I think the the the"},{"speaker":"Chris Dy","startTime":1520.41,"endTime":1524.19,"body":"characteristics or personality"},{"speaker":"Chris Dy","startTime":1524.19,"endTime":1527.58,"body":"of that fragment are going to be"},{"speaker":"Chris Dy","startTime":1524.19,"endTime":1527.58,"body":"different in the younger, higher"},{"speaker":"Chris Dy","startTime":1527.58,"endTime":1530.16,"body":"energy population, which that"},{"speaker":"Chris Dy","startTime":1527.58,"endTime":1530.16,"body":"probably matters more."},{"speaker":"Charles Goldfarb","startTime":1531.21,"endTime":1532.74,"body":"I think you"},{"speaker":"Charles Goldfarb","startTime":1531.21,"endTime":1532.74,"body":"said it, right. I think you said"},{"speaker":"Charles Goldfarb","startTime":1532.74,"endTime":1533.04,"body":"it, right."},{"speaker":"Chris Dy","startTime":1533.07,"endTime":1535.08,"body":"So what implant do you"},{"speaker":"Chris Dy","startTime":1533.07,"endTime":1535.08,"body":"like to put over there, if you"},{"speaker":"Chris Dy","startTime":1535.08,"endTime":1538.11,"body":"have to? Do you like using the"},{"speaker":"Chris Dy","startTime":1535.08,"endTime":1538.11,"body":"standard dorsal plates that come"},{"speaker":"Chris Dy","startTime":1538.11,"endTime":1539.64,"body":"from manufacturers or?"},{"speaker":"Charles Goldfarb","startTime":1539.91,"endTime":1542.85,"body":"I typically"},{"speaker":"Charles Goldfarb","startTime":1539.91,"endTime":1542.85,"body":"use a smaller more, again,"},{"speaker":"Charles Goldfarb","startTime":1542.88,"endTime":1545.28,"body":"fragment specific plate, and"},{"speaker":"Charles Goldfarb","startTime":1542.88,"endTime":1545.28,"body":"what I mean by that is just a"},{"speaker":"Charles Goldfarb","startTime":1545.28,"endTime":1548.7,"body":"narrower, often that L plate you"},{"speaker":"Charles Goldfarb","startTime":1545.28,"endTime":1548.7,"body":"talk about whether it's just a"},{"speaker":"Charles Goldfarb","startTime":1548.7,"endTime":1552.39,"body":"standard 2-0 or 2-4 plate, or is"},{"speaker":"Charles Goldfarb","startTime":1548.7,"endTime":1552.39,"body":"something out of a distal radius"},{"speaker":"Charles Goldfarb","startTime":1552.39,"endTime":1556.71,"body":"set. For me, this one's a little"},{"speaker":"Charles Goldfarb","startTime":1552.39,"endTime":1556.71,"body":"more personality driven by the"},{"speaker":"Charles Goldfarb","startTime":1556.71,"endTime":1560.4,"body":"size of the fragment and, and"},{"speaker":"Charles Goldfarb","startTime":1556.71,"endTime":1560.4,"body":"what else I might need to do. So"},{"speaker":"Charles Goldfarb","startTime":1560.4,"endTime":1562.8,"body":"I don't have a standard per se,"},{"speaker":"Charles Goldfarb","startTime":1560.4,"endTime":1562.8,"body":"for this fracture."},{"speaker":"Chris Dy","startTime":1562.0,"endTime":1564.91,"body":"And I'm with you on"},{"speaker":"Chris Dy","startTime":1562.0,"endTime":1564.91,"body":"that, I mean, know what part of"},{"speaker":"Chris Dy","startTime":1564.91,"endTime":1568.54,"body":"the way I was trained in"},{"speaker":"Chris Dy","startTime":1564.91,"endTime":1568.54,"body":"residency, you know, did a lot"},{"speaker":"Chris Dy","startTime":1568.54,"endTime":1573.22,"body":"of distal radius fractures with"},{"speaker":"Chris Dy","startTime":1568.54,"endTime":1573.22,"body":"the trauma service there. And it"},{"speaker":"Chris Dy","startTime":1573.22,"endTime":1576.07,"body":"was, you know, using 2-0 and 2-4"},{"speaker":"Chris Dy","startTime":1573.22,"endTime":1576.07,"body":"plates, and, you know, designing"},{"speaker":"Chris Dy","startTime":1576.07,"endTime":1577.87,"body":"your own and contouring and all"},{"speaker":"Chris Dy","startTime":1576.07,"endTime":1577.87,"body":"that kind of stuff. So I"},{"speaker":"Chris Dy","startTime":1577.87,"endTime":1580.87,"body":"honestly, I enjoy that process."},{"speaker":"Chris Dy","startTime":1577.87,"endTime":1580.87,"body":"In all, in all honesty, though,"},{"speaker":"Chris Dy","startTime":1580.87,"endTime":1583.72,"body":"the dorsal sets that I had"},{"speaker":"Chris Dy","startTime":1580.87,"endTime":1583.72,"body":"looked at when I started in"},{"speaker":"Chris Dy","startTime":1583.72,"endTime":1587.29,"body":"practice, those plates are"},{"speaker":"Chris Dy","startTime":1583.72,"endTime":1587.29,"body":"relatively thick. So you know, I"},{"speaker":"Chris Dy","startTime":1587.29,"endTime":1590.59,"body":"think, you know, if you look"},{"speaker":"Chris Dy","startTime":1587.29,"endTime":1590.59,"body":"back at why we started using"},{"speaker":"Chris Dy","startTime":1590.59,"endTime":1593.71,"body":"volar plates, you know, the"},{"speaker":"Chris Dy","startTime":1590.59,"endTime":1593.71,"body":"concern for irritation of the"},{"speaker":"Chris Dy","startTime":1593.71,"endTime":1596.8,"body":"extensor tendons with a"},{"speaker":"Chris Dy","startTime":1593.71,"endTime":1596.8,"body":"prominent dorsal plate was a"},{"speaker":"Chris Dy","startTime":1596.8,"endTime":1600.37,"body":"very real one. One thing that's"},{"speaker":"Chris Dy","startTime":1596.8,"endTime":1600.37,"body":"important, I think, when you're"},{"speaker":"Chris Dy","startTime":1600.4,"endTime":1602.56,"body":"when you are cutting and"},{"speaker":"Chris Dy","startTime":1600.4,"endTime":1602.56,"body":"contouring plates and stuff"},{"speaker":"Chris Dy","startTime":1602.56,"endTime":1605.17,"body":"yourself Is that just make,"},{"speaker":"Chris Dy","startTime":1602.56,"endTime":1605.17,"body":"watch the edges, if you do"},{"speaker":"Chris Dy","startTime":1605.17,"endTime":1608.47,"body":"happen to cut a hole off of say,"},{"speaker":"Chris Dy","startTime":1605.17,"endTime":1608.47,"body":"you have like a T plate, and"},{"speaker":"Chris Dy","startTime":1608.47,"endTime":1611.62,"body":"you're cutting one hole off on"},{"speaker":"Chris Dy","startTime":1608.47,"endTime":1611.62,"body":"the distal part. So it fits"},{"speaker":"Chris Dy","startTime":1611.62,"endTime":1614.65,"body":"well, just make sure that you,"},{"speaker":"Chris Dy","startTime":1611.62,"endTime":1614.65,"body":"you know, smooth down those"},{"speaker":"Chris Dy","startTime":1614.65,"endTime":1617.59,"body":"edges with the side of a drill"},{"speaker":"Chris Dy","startTime":1614.65,"endTime":1617.59,"body":"or a freer or something like"},{"speaker":"Chris Dy","startTime":1617.59,"endTime":1617.86,"body":"that."},{"speaker":"Charles Goldfarb","startTime":1618.31,"endTime":1620.29,"body":"I agree with"},{"speaker":"Charles Goldfarb","startTime":1618.31,"endTime":1620.29,"body":"you completely, the benefit of"},{"speaker":"Charles Goldfarb","startTime":1620.29,"endTime":1623.02,"body":"using a more standard plate"},{"speaker":"Charles Goldfarb","startTime":1620.29,"endTime":1623.02,"body":"rather than one of the smaller"},{"speaker":"Charles Goldfarb","startTime":1623.02,"endTime":1629.35,"body":"plates out of any any company's"},{"speaker":"Charles Goldfarb","startTime":1623.02,"endTime":1629.35,"body":"distal radius set is that those"},{"speaker":"Charles Goldfarb","startTime":1629.35,"endTime":1632.92,"body":"plates are expensive in the"},{"speaker":"Charles Goldfarb","startTime":1629.35,"endTime":1632.92,"body":"sets. I think that competition"},{"speaker":"Charles Goldfarb","startTime":1633.4,"endTime":1637.63,"body":"for cost control is around the"},{"speaker":"Charles Goldfarb","startTime":1633.4,"endTime":1637.63,"body":"standard volar and the standard"},{"speaker":"Charles Goldfarb","startTime":1637.63,"endTime":1642.13,"body":"dorsal plate. And the other"},{"speaker":"Charles Goldfarb","startTime":1637.63,"endTime":1642.13,"body":"plates are less, we're less"},{"speaker":"Charles Goldfarb","startTime":1642.13,"endTime":1645.64,"body":"concerned typically about cost."},{"speaker":"Charles Goldfarb","startTime":1642.13,"endTime":1645.64,"body":"And so those are not the"},{"speaker":"Charles Goldfarb","startTime":1645.64,"endTime":1647.83,"body":"cheapest plates in the set. In"},{"speaker":"Charles Goldfarb","startTime":1645.64,"endTime":1647.83,"body":"fact, they're often the most"},{"speaker":"Charles Goldfarb","startTime":1647.83,"endTime":1651.73,"body":"expensive set, plates in a set."},{"speaker":"Charles Goldfarb","startTime":1647.83,"endTime":1651.73,"body":"And that's why sometimes using a"},{"speaker":"Charles Goldfarb","startTime":1651.73,"endTime":1654.85,"body":"more standard plate and"},{"speaker":"Charles Goldfarb","startTime":1651.73,"endTime":1654.85,"body":"contouring it will be more cost"},{"speaker":"Charles Goldfarb","startTime":1654.85,"endTime":1655.3,"body":"effective."},{"speaker":"Chris Dy","startTime":1655.33,"endTime":1658.75,"body":"Yeah, fair points. So"},{"speaker":"Chris Dy","startTime":1655.33,"endTime":1658.75,"body":"you like to, you're an"},{"speaker":"Chris Dy","startTime":1658.75,"endTime":1662.41,"body":"arthroscopy guy, a wizard, some"},{"speaker":"Chris Dy","startTime":1658.75,"endTime":1662.41,"body":"would say. Do you worry about"},{"speaker":"Chris Dy","startTime":1662.44,"endTime":1665.47,"body":"you know, those, the other types"},{"speaker":"Chris Dy","startTime":1662.44,"endTime":1665.47,"body":"of fragments that involve the"},{"speaker":"Chris Dy","startTime":1665.47,"endTime":1668.05,"body":"joint that are impacted and kind"},{"speaker":"Chris Dy","startTime":1665.47,"endTime":1668.05,"body":"of really pushed down?"},{"speaker":"Charles Goldfarb","startTime":1668.69,"endTime":1670.73,"body":"Yeah, so I"},{"speaker":"Charles Goldfarb","startTime":1668.69,"endTime":1670.73,"body":"mean, some people would I mean a"},{"speaker":"Charles Goldfarb","startTime":1670.73,"endTime":1676.01,"body":"die punch fragment is one type"},{"speaker":"Charles Goldfarb","startTime":1670.73,"endTime":1676.01,"body":"of intra articular displaced"},{"speaker":"Charles Goldfarb","startTime":1676.01,"endTime":1678.95,"body":"fracture, and that one, the die"},{"speaker":"Charles Goldfarb","startTime":1676.01,"endTime":1678.95,"body":"punch implies lunate"},{"speaker":"Charles Goldfarb","startTime":1678.98,"endTime":1684.17,"body":"compression. So Central, central"},{"speaker":"Charles Goldfarb","startTime":1678.98,"endTime":1684.17,"body":"central often. And those are"},{"speaker":"Charles Goldfarb","startTime":1684.17,"endTime":1687.17,"body":"ones where I do think a CT scan"},{"speaker":"Charles Goldfarb","startTime":1684.17,"endTime":1687.17,"body":"can be beneficial. But really"},{"speaker":"Charles Goldfarb","startTime":1687.2,"endTime":1692.81,"body":"any combination of the articular"},{"speaker":"Charles Goldfarb","startTime":1687.2,"endTime":1692.81,"body":"surface, I would say, requires a"},{"speaker":"Charles Goldfarb","startTime":1692.81,"endTime":1696.68,"body":"direct look, in most cases. And"},{"speaker":"Charles Goldfarb","startTime":1692.81,"endTime":1696.68,"body":"whether you do that with an open"},{"speaker":"Charles Goldfarb","startTime":1696.68,"endTime":1701.57,"body":"incision, or you do that, with a"},{"speaker":"Charles Goldfarb","startTime":1696.68,"endTime":1701.57,"body":"scope is completely dealer's"},{"speaker":"Charles Goldfarb","startTime":1701.57,"endTime":1704.69,"body":"choice. I think it is an"},{"speaker":"Charles Goldfarb","startTime":1701.57,"endTime":1704.69,"body":"acquired skill if you choose to"},{"speaker":"Charles Goldfarb","startTime":1704.69,"endTime":1709.13,"body":"do this arthroscopically. And so"},{"speaker":"Charles Goldfarb","startTime":1704.69,"endTime":1709.13,"body":"trying to, again, hopefully use"},{"speaker":"Charles Goldfarb","startTime":1709.13,"endTime":1712.4,"body":"one of the columns, ideally, the"},{"speaker":"Charles Goldfarb","startTime":1709.13,"endTime":1712.4,"body":"the intermediate column, the"},{"speaker":"Charles Goldfarb","startTime":1712.46,"endTime":1716.21,"body":"more ulnar aspect of the radius,"},{"speaker":"Charles Goldfarb","startTime":1712.46,"endTime":1716.21,"body":"or wherever you can stabilize to"},{"speaker":"Charles Goldfarb","startTime":1716.39,"endTime":1720.05,"body":"is helpful in elevation of that"},{"speaker":"Charles Goldfarb","startTime":1716.39,"endTime":1720.05,"body":"central depressed fragment,"},{"speaker":"Charles Goldfarb","startTime":1720.26,"endTime":1722.84,"body":"sometimes with bone graft"},{"speaker":"Charles Goldfarb","startTime":1720.26,"endTime":1722.84,"body":"beneath it. But if you have good"},{"speaker":"Charles Goldfarb","startTime":1722.84,"endTime":1726.14,"body":"quality hardware, you don't, I"},{"speaker":"Charles Goldfarb","startTime":1722.84,"endTime":1726.14,"body":"don't feel you always need that,"},{"speaker":"Charles Goldfarb","startTime":1726.83,"endTime":1729.65,"body":"it's totally dealer's choice."},{"speaker":"Charles Goldfarb","startTime":1726.83,"endTime":1729.65,"body":"And I will say that sometimes I"},{"speaker":"Charles Goldfarb","startTime":1729.65,"endTime":1731.63,"body":"use a scope. And other times I"},{"speaker":"Charles Goldfarb","startTime":1729.65,"endTime":1731.63,"body":"do not."},{"speaker":"Chris Dy","startTime":1731.78,"endTime":1734.09,"body":"Yeah, you know, when"},{"speaker":"Chris Dy","startTime":1731.78,"endTime":1734.09,"body":"I've had to deal with these"},{"speaker":"Chris Dy","startTime":1734.09,"endTime":1737.21,"body":"fragments, I do like using bone"},{"speaker":"Chris Dy","startTime":1734.09,"endTime":1737.21,"body":"graft, not because I think it's"},{"speaker":"Chris Dy","startTime":1737.24,"endTime":1739.73,"body":"gonna make a difference down the"},{"speaker":"Chris Dy","startTime":1737.24,"endTime":1739.73,"body":"line. It's mainly because it"},{"speaker":"Chris Dy","startTime":1739.73,"endTime":1742.04,"body":"frees up you know, can help tamp"},{"speaker":"Chris Dy","startTime":1739.73,"endTime":1742.04,"body":"things up, hold it there"},{"speaker":"Chris Dy","startTime":1742.04,"endTime":1745.04,"body":"provisionally, while I get my"},{"speaker":"Chris Dy","startTime":1742.04,"endTime":1745.04,"body":"plate on, and I don't it's one"},{"speaker":"Chris Dy","startTime":1745.04,"endTime":1746.3,"body":"less thing I have to worry"},{"speaker":"Chris Dy","startTime":1745.04,"endTime":1746.3,"body":"about."},{"speaker":"Charles Goldfarb","startTime":1746.84,"endTime":1750.17,"body":"I think that's"},{"speaker":"Charles Goldfarb","startTime":1746.84,"endTime":1750.17,"body":"exactly right. One of the I've"},{"speaker":"Charles Goldfarb","startTime":1750.17,"endTime":1753.38,"body":"seen you know, when we go"},{"speaker":"Charles Goldfarb","startTime":1750.17,"endTime":1753.38,"body":"dorsally consider a dorsal"},{"speaker":"Charles Goldfarb","startTime":1753.38,"endTime":1756.14,"body":"plate. And I would say that's"},{"speaker":"Charles Goldfarb","startTime":1753.38,"endTime":1756.14,"body":"the tried and true and accepted"},{"speaker":"Charles Goldfarb","startTime":1756.14,"endTime":1759.14,"body":"way of dealing with these"},{"speaker":"Charles Goldfarb","startTime":1756.14,"endTime":1759.14,"body":"fractures is sometimes you can"},{"speaker":"Charles Goldfarb","startTime":1759.14,"endTime":1764.39,"body":"lift up the dorsal distal"},{"speaker":"Charles Goldfarb","startTime":1759.14,"endTime":1764.39,"body":"portion of the distal radius and"},{"speaker":"Charles Goldfarb","startTime":1764.39,"endTime":1768.08,"body":"bring the capsule with it. And"},{"speaker":"Charles Goldfarb","startTime":1764.39,"endTime":1768.08,"body":"so you're not making a separate"},{"speaker":"Charles Goldfarb","startTime":1768.08,"endTime":1771.11,"body":"capsular incision. And then you"},{"speaker":"Charles Goldfarb","startTime":1768.08,"endTime":1771.11,"body":"have exposure into the joint."},{"speaker":"Charles Goldfarb","startTime":1771.41,"endTime":1774.02,"body":"You can elevate the fragment,"},{"speaker":"Charles Goldfarb","startTime":1771.41,"endTime":1774.02,"body":"you can add some bone graft,"},{"speaker":"Charles Goldfarb","startTime":1774.02,"endTime":1777.11,"body":"which I completely agree makes"},{"speaker":"Charles Goldfarb","startTime":1774.02,"endTime":1777.11,"body":"this a little easier. And then"},{"speaker":"Charles Goldfarb","startTime":1777.11,"endTime":1780.02,"body":"you can close the the fracture"},{"speaker":"Charles Goldfarb","startTime":1777.11,"endTime":1780.02,"body":"back down at the end and put"},{"speaker":"Charles Goldfarb","startTime":1780.02,"endTime":1782.09,"body":"your plate on. So there's"},{"speaker":"Charles Goldfarb","startTime":1780.02,"endTime":1782.09,"body":"different ways to get there."},{"speaker":"Charles Goldfarb","startTime":1782.21,"endTime":1784.97,"body":"Sometimes you need a capsular"},{"speaker":"Charles Goldfarb","startTime":1782.21,"endTime":1784.97,"body":"incision. Sometimes you can work"},{"speaker":"Charles Goldfarb","startTime":1784.97,"endTime":1788.6,"body":"without it. But anything you can"},{"speaker":"Charles Goldfarb","startTime":1784.97,"endTime":1788.6,"body":"do to just to support the"},{"speaker":"Charles Goldfarb","startTime":1788.6,"endTime":1790.79,"body":"elevated fragments is really the"},{"speaker":"Charles Goldfarb","startTime":1788.6,"endTime":1790.79,"body":"key."},{"speaker":"Chris Dy","startTime":1790.9,"endTime":1793.54,"body":"So when you're going"},{"speaker":"Chris Dy","startTime":1790.9,"endTime":1793.54,"body":"dorsal to sort of close out this"},{"speaker":"Chris Dy","startTime":1793.54,"endTime":1797.47,"body":"discussion, do you have any"},{"speaker":"Chris Dy","startTime":1793.54,"endTime":1797.47,"body":"pearls in terms of the approach"},{"speaker":"Chris Dy","startTime":1797.5,"endTime":1801.04,"body":"to help cover a dorsal plate and"},{"speaker":"Chris Dy","startTime":1797.5,"endTime":1801.04,"body":"protect the extensor tendons"},{"speaker":"Chris Dy","startTime":1801.04,"endTime":1802.39,"body":"from that dorsal plate down the"},{"speaker":"Chris Dy","startTime":1801.04,"endTime":1802.39,"body":"line."},{"speaker":"Charles Goldfarb","startTime":1802.99,"endTime":1805.63,"body":"So I use a"},{"speaker":"Charles Goldfarb","startTime":1802.99,"endTime":1805.63,"body":"third compartment approach for"},{"speaker":"Charles Goldfarb","startTime":1805.63,"endTime":1807.79,"body":"all of these. And whether that's"},{"speaker":"Charles Goldfarb","startTime":1805.63,"endTime":1807.79,"body":"approaching the carpus, or the"},{"speaker":"Charles Goldfarb","startTime":1807.79,"endTime":1811.6,"body":"distal radius, I carefully"},{"speaker":"Charles Goldfarb","startTime":1807.79,"endTime":1811.6,"body":"incise the third compartment"},{"speaker":"Charles Goldfarb","startTime":1811.6,"endTime":1814.21,"body":"distally to protect the"},{"speaker":"Charles Goldfarb","startTime":1811.6,"endTime":1814.21,"body":"superficial branch of the radial"},{"speaker":"Charles Goldfarb","startTime":1814.21,"endTime":1817.57,"body":"nerve, and I incise, the"},{"speaker":"Charles Goldfarb","startTime":1814.21,"endTime":1817.57,"body":"compartment proximally I"},{"speaker":"Charles Goldfarb","startTime":1817.57,"endTime":1821.71,"body":"transpose the EPL radially. And"},{"speaker":"Charles Goldfarb","startTime":1817.57,"endTime":1821.71,"body":"I leave it transposed and I"},{"speaker":"Charles Goldfarb","startTime":1821.71,"endTime":1824.05,"body":"close the retinaculum at the end"},{"speaker":"Charles Goldfarb","startTime":1821.71,"endTime":1824.05,"body":"of the case with the EPL"},{"speaker":"Charles Goldfarb","startTime":1824.05,"endTime":1829.18,"body":"transposed. And then I elevate,"},{"speaker":"Charles Goldfarb","startTime":1824.05,"endTime":1829.18,"body":"excuse me, I elevate the fourth"},{"speaker":"Charles Goldfarb","startTime":1829.18,"endTime":1833.53,"body":"compartment in the ulnar"},{"speaker":"Charles Goldfarb","startTime":1829.18,"endTime":1833.53,"body":"direction, I try to leave it"},{"speaker":"Charles Goldfarb","startTime":1833.53,"endTime":1836.92,"body":"closed, that'll expose your post"},{"speaker":"Charles Goldfarb","startTime":1833.53,"endTime":1836.92,"body":"interosseous nerve and artery."},{"speaker":"Charles Goldfarb","startTime":1836.92,"endTime":1839.47,"body":"And we can talk about how we"},{"speaker":"Charles Goldfarb","startTime":1836.92,"endTime":1839.47,"body":"handle those and elevate as"},{"speaker":"Charles Goldfarb","startTime":1839.47,"endTime":1842.41,"body":"necessary the second compartment"},{"speaker":"Charles Goldfarb","startTime":1839.47,"endTime":1842.41,"body":"as well, with a really"},{"speaker":"Charles Goldfarb","startTime":1842.41,"endTime":1847.51,"body":"comminuted dorsal fragment. You"},{"speaker":"Charles Goldfarb","startTime":1842.41,"endTime":1847.51,"body":"know, that dorsal rim is"},{"speaker":"Charles Goldfarb","startTime":1847.51,"endTime":1850.18,"body":"difficult, and it can be really"},{"speaker":"Charles Goldfarb","startTime":1847.51,"endTime":1850.18,"body":"thin. And that's why I say"},{"speaker":"Charles Goldfarb","startTime":1850.18,"endTime":1852.22,"body":"sometimes you can take it with"},{"speaker":"Charles Goldfarb","startTime":1850.18,"endTime":1852.22,"body":"the capsule, sometimes you just"},{"speaker":"Charles Goldfarb","startTime":1852.22,"endTime":1855.28,"body":"have free floating fragments"},{"speaker":"Charles Goldfarb","startTime":1852.22,"endTime":1855.28,"body":"there. And it just is, you have"},{"speaker":"Charles Goldfarb","startTime":1855.28,"endTime":1858.28,"body":"to figure out what you can do."},{"speaker":"Charles Goldfarb","startTime":1855.28,"endTime":1858.28,"body":"So I think the exposure, a good"},{"speaker":"Charles Goldfarb","startTime":1858.28,"endTime":1862.27,"body":"exposure is key, and then you"},{"speaker":"Charles Goldfarb","startTime":1858.28,"endTime":1862.27,"body":"can close back over that. What"},{"speaker":"Charles Goldfarb","startTime":1862.27,"endTime":1862.72,"body":"about you?"},{"speaker":"Chris Dy","startTime":1863.11,"endTime":1864.76,"body":"Yeah, I think it's,"},{"speaker":"Chris Dy","startTime":1863.11,"endTime":1864.76,"body":"it's included in what you"},{"speaker":"Chris Dy","startTime":1864.76,"endTime":1868.66,"body":"described. But you know, one of"},{"speaker":"Chris Dy","startTime":1864.76,"endTime":1868.66,"body":"our former partners and mentors,"},{"speaker":"Chris Dy","startTime":1868.75,"endTime":1871.42,"body":"Richard Gelberman would always"},{"speaker":"Chris Dy","startTime":1868.75,"endTime":1871.42,"body":"talk about this infraretinacular"},{"speaker":"Chris Dy","startTime":1871.42,"endTime":1874.9,"body":"type approach, and there is a"},{"speaker":"Chris Dy","startTime":1871.42,"endTime":1874.9,"body":"layer of tissue deep to the"},{"speaker":"Chris Dy","startTime":1875.23,"endTime":1878.44,"body":"second and fourth compartment"},{"speaker":"Chris Dy","startTime":1875.23,"endTime":1878.44,"body":"tendons that you can lift off"},{"speaker":"Chris Dy","startTime":1878.44,"endTime":1883.87,"body":"and save as a layer to close"},{"speaker":"Chris Dy","startTime":1878.44,"endTime":1883.87,"body":"over the over the plate as"},{"speaker":"Chris Dy","startTime":1883.87,"endTime":1886.66,"body":"something that will buffer the"},{"speaker":"Chris Dy","startTime":1883.87,"endTime":1886.66,"body":"extensor. buffer it from the"},{"speaker":"Chris Dy","startTime":1886.66,"endTime":1887.71,"body":"extensor tendons."},{"speaker":"Charles Goldfarb","startTime":1888.11,"endTime":1890.51,"body":"Yeah,"},{"speaker":"Charles Goldfarb","startTime":1888.11,"endTime":1890.51,"body":"absolutely. So you are a lover"},{"speaker":"Charles Goldfarb","startTime":1890.51,"endTime":1893.75,"body":"of nerves. Do you sacrifice the"},{"speaker":"Charles Goldfarb","startTime":1890.51,"endTime":1893.75,"body":"post interosseous nerve on these"},{"speaker":"Charles Goldfarb","startTime":1893.75,"endTime":1894.23,"body":"cases?"},{"speaker":"Chris Dy","startTime":1894.3,"endTime":1897.78,"body":"I don't, you know, I"},{"speaker":"Chris Dy","startTime":1894.3,"endTime":1897.78,"body":"don't go out of my way to do it"},{"speaker":"Chris Dy","startTime":1897.78,"endTime":1902.64,"body":"and I've seen a lot of people do"},{"speaker":"Chris Dy","startTime":1897.78,"endTime":1902.64,"body":"that. I think that there's a lot"},{"speaker":"Chris Dy","startTime":1902.64,"endTime":1906.84,"body":"we could have a long debate"},{"speaker":"Chris Dy","startTime":1902.64,"endTime":1906.84,"body":"about the merits of denervation."},{"speaker":"Chris Dy","startTime":1907.56,"endTime":1910.56,"body":"This is not a case where I think"},{"speaker":"Chris Dy","startTime":1907.56,"endTime":1910.56,"body":"you need it. And perhaps that"},{"speaker":"Chris Dy","startTime":1910.56,"endTime":1913.14,"body":"nerve could be helpful in terms"},{"speaker":"Chris Dy","startTime":1910.56,"endTime":1913.14,"body":"of proprioception, I know that"},{"speaker":"Chris Dy","startTime":1913.14,"endTime":1915.15,"body":"there are strong feelings on"},{"speaker":"Chris Dy","startTime":1913.14,"endTime":1915.15,"body":"both sides of the fence for"},{"speaker":"Chris Dy","startTime":1915.15,"endTime":1915.84,"body":"that, how about you?"},{"speaker":"Charles Goldfarb","startTime":1916.2,"endTime":1918.51,"body":"I don't"},{"speaker":"Charles Goldfarb","startTime":1916.2,"endTime":1918.51,"body":"routinely take it for anything."},{"speaker":"Charles Goldfarb","startTime":1918.72,"endTime":1922.8,"body":"I do believe that nerve serves a"},{"speaker":"Charles Goldfarb","startTime":1918.72,"endTime":1922.8,"body":"purpose. But I don't I'm not"},{"speaker":"Charles Goldfarb","startTime":1922.8,"endTime":1925.95,"body":"critical of those who do. So I"},{"speaker":"Charles Goldfarb","startTime":1922.8,"endTime":1925.95,"body":"don't have super strong"},{"speaker":"Charles Goldfarb","startTime":1925.95,"endTime":1928.59,"body":"feelings, but I don't I don't"},{"speaker":"Charles Goldfarb","startTime":1925.95,"endTime":1928.59,"body":"routinely take it. So to"},{"speaker":"Charles Goldfarb","startTime":1928.59,"endTime":1932.37,"body":"summarize this last group, open"},{"speaker":"Charles Goldfarb","startTime":1928.59,"endTime":1932.37,"body":"or arthroscopic approach, but"},{"speaker":"Charles Goldfarb","startTime":1932.37,"endTime":1936.72,"body":"directly visualizing the"},{"speaker":"Charles Goldfarb","startTime":1932.37,"endTime":1936.72,"body":"reduction is key. And, you know,"},{"speaker":"Charles Goldfarb","startTime":1936.72,"endTime":1940.02,"body":"elevation and support of the"},{"speaker":"Charles Goldfarb","startTime":1936.72,"endTime":1940.02,"body":"fracture fragments. And then"},{"speaker":"Charles Goldfarb","startTime":1940.02,"endTime":1942.33,"body":"protection of the plate as"},{"speaker":"Charles Goldfarb","startTime":1940.02,"endTime":1942.33,"body":"possible. On the way out,"},{"speaker":"Chris Dy","startTime":1942.36,"endTime":1945.57,"body":"How much do you worry"},{"speaker":"Chris Dy","startTime":1942.36,"endTime":1945.57,"body":"about step off? I mean, so you"},{"speaker":"Chris Dy","startTime":1945.57,"endTime":1948.48,"body":"wrote the paper on this. But"},{"speaker":"Chris Dy","startTime":1945.57,"endTime":1948.48,"body":"you're obviously an"},{"speaker":"Chris Dy","startTime":1948.54,"endTime":1951.09,"body":"arthroscopist. So you have, you"},{"speaker":"Chris Dy","startTime":1948.54,"endTime":1951.09,"body":"know obviously a concern for"},{"speaker":"Chris Dy","startTime":1951.09,"endTime":1953.7,"body":"cartilage, I mean, what's the"},{"speaker":"Chris Dy","startTime":1951.09,"endTime":1953.7,"body":"acceptable amount of step off,"},{"speaker":"Chris Dy","startTime":1953.76,"endTime":1956.22,"body":"you know, that you can you think"},{"speaker":"Chris Dy","startTime":1953.76,"endTime":1956.22,"body":"patients can tolerate or that"},{"speaker":"Chris Dy","startTime":1956.22,"endTime":1957.18,"body":"you leave the OR with."},{"speaker":"Charles Goldfarb","startTime":1957.42,"endTime":1960.75,"body":"Yah so just to"},{"speaker":"Charles Goldfarb","startTime":1957.42,"endTime":1960.75,"body":"be clear, a gap in the articular"},{"speaker":"Charles Goldfarb","startTime":1960.75,"endTime":1964.47,"body":"surface is less than ideal. And"},{"speaker":"Charles Goldfarb","startTime":1960.75,"endTime":1964.47,"body":"we can go way back to Jesse"},{"speaker":"Charles Goldfarb","startTime":1964.47,"endTime":1967.35,"body":"Jupiter's paper 30 years ago,"},{"speaker":"Charles Goldfarb","startTime":1964.47,"endTime":1967.35,"body":"and we talked about two"},{"speaker":"Charles Goldfarb","startTime":1967.35,"endTime":1972.12,"body":"millimeters. I'm not sure what"},{"speaker":"Charles Goldfarb","startTime":1967.35,"endTime":1972.12,"body":"the right number is, honestly."},{"speaker":"Charles Goldfarb","startTime":1972.51,"endTime":1976.47,"body":"But the smaller the gap, the"},{"speaker":"Charles Goldfarb","startTime":1972.51,"endTime":1976.47,"body":"better. But a gap is much better"},{"speaker":"Charles Goldfarb","startTime":1976.5,"endTime":1980.19,"body":"tolerated, especially in the"},{"speaker":"Charles Goldfarb","startTime":1976.5,"endTime":1980.19,"body":"weight bearing joints, compared"},{"speaker":"Charles Goldfarb","startTime":1980.19,"endTime":1984.9,"body":"to a step off. And I think you"},{"speaker":"Charles Goldfarb","startTime":1980.19,"endTime":1984.9,"body":"really want almost no step off."},{"speaker":"Charles Goldfarb","startTime":1984.93,"endTime":1987.75,"body":"I think a step off in the wrong"},{"speaker":"Charles Goldfarb","startTime":1984.93,"endTime":1987.75,"body":"place is going to lead to rapid"},{"speaker":"Charles Goldfarb","startTime":1987.75,"endTime":1991.23,"body":"degeneration. And what's too"},{"speaker":"Charles Goldfarb","startTime":1987.75,"endTime":1991.23,"body":"much, I would say any"},{"speaker":"Charles Goldfarb","startTime":1991.26,"endTime":1993.96,"body":"significant step off is too"},{"speaker":"Charles Goldfarb","startTime":1991.26,"endTime":1993.96,"body":"much. Certainly more than a"},{"speaker":"Charles Goldfarb","startTime":1993.96,"endTime":1995.22,"body":"millimeter is too much."},{"speaker":"Chris Dy","startTime":1996.0,"endTime":1996.87,"body":"There you have it."},{"speaker":"Charles Goldfarb","startTime":1997.89,"endTime":1999.81,"body":"All right."},{"speaker":"Charles Goldfarb","startTime":1997.89,"endTime":1999.81,"body":"Well, this was great. And this"},{"speaker":"Charles Goldfarb","startTime":1999.81,"endTime":2002.21,"body":"time I guess we'll for now"},{"speaker":"Charles Goldfarb","startTime":1999.81,"endTime":2002.21,"body":"conclude our discussion of"},{"speaker":"Charles Goldfarb","startTime":2002.21,"endTime":2004.88,"body":"distal radius because I think in"},{"speaker":"Charles Goldfarb","startTime":2002.21,"endTime":2004.88,"body":"the near future, we'll circle"},{"speaker":"Charles Goldfarb","startTime":2004.88,"endTime":2007.64,"body":"back and get one of our therapy"},{"speaker":"Charles Goldfarb","startTime":2004.88,"endTime":2007.64,"body":"colleagues to to weigh in."},{"speaker":"Chris Dy","startTime":2007.66,"endTime":2009.19,"body":"Yeah, I think it'd be"},{"speaker":"Chris Dy","startTime":2007.66,"endTime":2009.19,"body":"good to go behind the curtain"},{"speaker":"Chris Dy","startTime":2009.19,"endTime":2011.05,"body":"and see what happens with"},{"speaker":"Chris Dy","startTime":2009.19,"endTime":2011.05,"body":"therapy for for radius"},{"speaker":"Chris Dy","startTime":2011.05,"endTime":2011.38,"body":"fractures."},{"speaker":"Charles Goldfarb","startTime":2011.38,"endTime":2013.03,"body":"Yeah, I need"},{"speaker":"Charles Goldfarb","startTime":2011.38,"endTime":2013.03,"body":"to learn so it'll it'll be good"},{"speaker":"Charles Goldfarb","startTime":2013.03,"endTime":2015.22,"body":"for me. All right. Have a great"},{"speaker":"Charles Goldfarb","startTime":2013.03,"endTime":2015.22,"body":"day."},{"speaker":"Chris Dy","startTime":2015.28,"endTime":2016.09,"body":"All right. Take care."},{"speaker":"Charles Goldfarb","startTime":2016.75,"endTime":2018.76,"body":"Hey, Chris."},{"speaker":"Charles Goldfarb","startTime":2016.75,"endTime":2018.76,"body":"That was fun. Let's do it again,"},{"speaker":"Charles Goldfarb","startTime":2018.76,"endTime":2019.27,"body":"real soon."},{"speaker":"Chris Dy","startTime":2019.51,"endTime":2022.03,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":2019.51,"endTime":2022.03,"body":"sure to check us out on Twitter"},{"speaker":"Chris Dy","startTime":2022.27,"endTime":2024.43,"body":"@handpodcast. Hey, Chuck, what's"},{"speaker":"Chris Dy","startTime":2022.27,"endTime":2024.43,"body":"your Twitter handle?"},{"speaker":"Charles Goldfarb","startTime":2024.79,"endTime":2027.67,"body":"Mine is"},{"speaker":"Charles Goldfarb","startTime":2024.79,"endTime":2027.67,"body":"@congenitalhand. What about you?"},{"speaker":"Chris Dy","startTime":2027.79,"endTime":2031.18,"body":"Mine is @ChrisDyMD"},{"speaker":"Chris Dy","startTime":2027.79,"endTime":2031.18,"body":"spelled d y. And if you'd like"},{"speaker":"Chris Dy","startTime":2031.18,"endTime":2035.05,"body":"to email us, you can reach us at"},{"speaker":"Chris Dy","startTime":2031.18,"endTime":2035.05,"body":"handpodcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":2035.62,"endTime":2037.75,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":2035.62,"endTime":2037.75,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2037.75,"endTime":2038.77,"body":"get your podcasts"},{"speaker":"Chris Dy","startTime":2038.89,"endTime":2041.08,"body":"and be sure to leave a"},{"speaker":"Chris Dy","startTime":2038.89,"endTime":2041.08,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2041.08,"endTime":2041.5,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":2041.86,"endTime":2044.17,"body":"Special thanks"},{"speaker":"Charles Goldfarb","startTime":2041.86,"endTime":2044.17,"body":"to Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":2044.17,"endTime":2048.16,"body":"music. And remember, keep the"},{"speaker":"Charles Goldfarb","startTime":2044.17,"endTime":2048.16,"body":"upper hand. Come back next time."}]}