{"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":27.63,"body":"And be sure to leave a"},{"speaker":"Chris Dy","startTime":25.44,"endTime":27.63,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":27.63,"endTime":28.14,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":28.21,"endTime":28.99,"body":"Oh hey, Chris."},{"speaker":"Chris Dy","startTime":29.38,"endTime":30.43,"body":"Hey, Chuck, how are"},{"speaker":"Chris Dy","startTime":29.38,"endTime":30.43,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":30.73,"endTime":33.04,"body":"I'm doing"},{"speaker":"Charles Goldfarb","startTime":30.73,"endTime":33.04,"body":"fantastic. What about you?"},{"speaker":"Chris Dy","startTime":33.46,"endTime":39.31,"body":"You know, I'm okay."},{"speaker":"Chris Dy","startTime":33.46,"endTime":39.31,"body":"Some pandemic, pandemic related"},{"speaker":"Chris Dy","startTime":39.31,"endTime":41.95,"body":"fatigue, I guess, but doing"},{"speaker":"Chris Dy","startTime":39.31,"endTime":41.95,"body":"okay, I had a couple of nice"},{"speaker":"Chris Dy","startTime":41.95,"endTime":46.42,"body":"cases this morning and have some"},{"speaker":"Chris Dy","startTime":41.95,"endTime":46.42,"body":"found time, because I had a"},{"speaker":"Chris Dy","startTime":46.42,"endTime":49.33,"body":"cancellation. So I'm happy to"},{"speaker":"Chris Dy","startTime":46.42,"endTime":49.33,"body":"hop on and record an episode"},{"speaker":"Chris Dy","startTime":49.33,"endTime":49.66,"body":"with you."},{"speaker":"Charles Goldfarb","startTime":49.9,"endTime":51.97,"body":"Yeah, I'm glad"},{"speaker":"Charles Goldfarb","startTime":49.9,"endTime":51.97,"body":"it worked. I'll be honest with"},{"speaker":"Charles Goldfarb","startTime":51.97,"endTime":56.47,"body":"you, my fantastic was probably a"},{"speaker":"Charles Goldfarb","startTime":51.97,"endTime":56.47,"body":"little overstated. But you know,"},{"speaker":"Charles Goldfarb","startTime":56.47,"endTime":60.85,"body":"it is entering the confluence of"},{"speaker":"Charles Goldfarb","startTime":56.47,"endTime":60.85,"body":"the pandemic, which doesn't feel"},{"speaker":"Charles Goldfarb","startTime":60.85,"endTime":63.16,"body":"like we're, you know, we're"},{"speaker":"Charles Goldfarb","startTime":60.85,"endTime":63.16,"body":"clearly all of us feel a little"},{"speaker":"Charles Goldfarb","startTime":63.16,"endTime":65.26,"body":"optimism that we're heading in"},{"speaker":"Charles Goldfarb","startTime":63.16,"endTime":65.26,"body":"the right direction now, but,"},{"speaker":"Charles Goldfarb","startTime":65.53,"endTime":70.51,"body":"and then St. Louis has been"},{"speaker":"Charles Goldfarb","startTime":65.53,"endTime":70.51,"body":"brutally cold. And so I'll"},{"speaker":"Charles Goldfarb","startTime":70.51,"endTime":73.21,"body":"admit, I think I have seasonal"},{"speaker":"Charles Goldfarb","startTime":70.51,"endTime":73.21,"body":"affective disorder or something"},{"speaker":"Charles Goldfarb","startTime":73.24,"endTime":76.21,"body":"like it. And so the shorter"},{"speaker":"Charles Goldfarb","startTime":73.24,"endTime":76.21,"body":"days, which are getting better,"},{"speaker":"Charles Goldfarb","startTime":76.45,"endTime":79.33,"body":"and the cold weather, both are"},{"speaker":"Charles Goldfarb","startTime":76.45,"endTime":79.33,"body":"just tough, just tough."},{"speaker":"Chris Dy","startTime":79.33,"endTime":81.67,"body":"I mean, we tried,"},{"speaker":"Chris Dy","startTime":79.33,"endTime":81.67,"body":"we've tried as much as we can to"},{"speaker":"Chris Dy","startTime":81.7,"endTime":84.97,"body":"counteract the colder weather by"},{"speaker":"Chris Dy","startTime":81.7,"endTime":84.97,"body":"at least layering and bundling"},{"speaker":"Chris Dy","startTime":84.97,"endTime":88.66,"body":"and going outside and doing"},{"speaker":"Chris Dy","startTime":84.97,"endTime":88.66,"body":"hikes and stuff. But a couple"},{"speaker":"Chris Dy","startTime":88.66,"endTime":93.91,"body":"things have come up, it's become"},{"speaker":"Chris Dy","startTime":88.66,"endTime":93.91,"body":"very apparent that my wife who"},{"speaker":"Chris Dy","startTime":93.91,"endTime":98.02,"body":"is from Texas, and I, hailing"},{"speaker":"Chris Dy","startTime":93.91,"endTime":98.02,"body":"from the Sunshine State of"},{"speaker":"Chris Dy","startTime":98.02,"endTime":101.92,"body":"Florida, are woefully prepared"},{"speaker":"Chris Dy","startTime":98.02,"endTime":101.92,"body":"for this kind of weather for"},{"speaker":"Chris Dy","startTime":101.92,"endTime":106.42,"body":"ourselves, which is one thing,"},{"speaker":"Chris Dy","startTime":101.92,"endTime":106.42,"body":"but specifically our kids. They"},{"speaker":"Chris Dy","startTime":106.42,"endTime":108.64,"body":"don't have the right gear. And I"},{"speaker":"Chris Dy","startTime":106.42,"endTime":108.64,"body":"think I don't remember what the"},{"speaker":"Chris Dy","startTime":108.64,"endTime":111.55,"body":"saying exactly is that there,"},{"speaker":"Chris Dy","startTime":108.64,"endTime":111.55,"body":"you know, there's no such thing"},{"speaker":"Chris Dy","startTime":111.55,"endTime":115.03,"body":"as bad weather, just bad gear,"},{"speaker":"Chris Dy","startTime":111.55,"endTime":115.03,"body":"bad planning or something. And"},{"speaker":"Chris Dy","startTime":115.03,"endTime":118.06,"body":"we definitely fall in that camp."},{"speaker":"Chris Dy","startTime":115.03,"endTime":118.06,"body":"Then the second thing that's"},{"speaker":"Chris Dy","startTime":118.06,"endTime":120.82,"body":"holding us back from going out,"},{"speaker":"Chris Dy","startTime":118.06,"endTime":120.82,"body":"you know, aside from the bone"},{"speaker":"Chris Dy","startTime":120.82,"endTime":124.09,"body":"chilling cold is the fact that"},{"speaker":"Chris Dy","startTime":120.82,"endTime":124.09,"body":"my son told me, I don't like"},{"speaker":"Chris Dy","startTime":124.09,"endTime":128.08,"body":"cold hikes. He automatically"},{"speaker":"Chris Dy","startTime":124.09,"endTime":128.08,"body":"puts a stop on that now."},{"speaker":"Charles Goldfarb","startTime":129.14,"endTime":131.27,"body":"Fair enough?"},{"speaker":"Charles Goldfarb","startTime":129.14,"endTime":131.27,"body":"Well, it's funny, because, you"},{"speaker":"Charles Goldfarb","startTime":131.27,"endTime":135.26,"body":"know, I grew up in Alabama, so"},{"speaker":"Charles Goldfarb","startTime":131.27,"endTime":135.26,"body":"I'm right there with you. And I"},{"speaker":"Charles Goldfarb","startTime":135.26,"endTime":138.14,"body":"tend to leave for work early, I"},{"speaker":"Charles Goldfarb","startTime":135.26,"endTime":138.14,"body":"get some work done at work"},{"speaker":"Charles Goldfarb","startTime":138.14,"endTime":140.72,"body":"before the zoom meetings start"},{"speaker":"Charles Goldfarb","startTime":138.14,"endTime":140.72,"body":"in the morning before the"},{"speaker":"Charles Goldfarb","startTime":140.72,"endTime":144.23,"body":"clinical care starts in the"},{"speaker":"Charles Goldfarb","startTime":140.72,"endTime":144.23,"body":"morning. And, you know, we had a"},{"speaker":"Charles Goldfarb","startTime":144.23,"endTime":148.43,"body":"dusting of snow on Tuesday and"},{"speaker":"Charles Goldfarb","startTime":144.23,"endTime":148.43,"body":"Wednesday. And I feel lame even"},{"speaker":"Charles Goldfarb","startTime":148.43,"endTime":151.79,"body":"saying this, but I'm just I'm an"},{"speaker":"Charles Goldfarb","startTime":148.43,"endTime":151.79,"body":"Alabama driver. And it stresses"},{"speaker":"Charles Goldfarb","startTime":151.79,"endTime":155.66,"body":"me out to drive even in a small"},{"speaker":"Charles Goldfarb","startTime":151.79,"endTime":155.66,"body":"amount of snow. And so I'm like,"},{"speaker":"Charles Goldfarb","startTime":155.69,"endTime":158.72,"body":"gripping the steering wheel with"},{"speaker":"Charles Goldfarb","startTime":155.69,"endTime":158.72,"body":"all my might, and it's like it"},{"speaker":"Charles Goldfarb","startTime":158.72,"endTime":159.62,"body":"exhausted me."},{"speaker":"Chris Dy","startTime":160.25,"endTime":163.43,"body":"You know, it was no"},{"speaker":"Chris Dy","startTime":160.25,"endTime":163.43,"body":"accident that as soon as I we"},{"speaker":"Chris Dy","startTime":163.43,"endTime":168.02,"body":"moved here I got, I got a four"},{"speaker":"Chris Dy","startTime":163.43,"endTime":168.02,"body":"wheel drive SUV with traction"},{"speaker":"Chris Dy","startTime":168.02,"endTime":170.72,"body":"control. There was no messing"},{"speaker":"Chris Dy","startTime":168.02,"endTime":170.72,"body":"around Florida boy does not know"},{"speaker":"Chris Dy","startTime":170.72,"endTime":173.27,"body":"how to drive in this stuff. Nor"},{"speaker":"Chris Dy","startTime":170.72,"endTime":173.27,"body":"do I want to learn the hard way."},{"speaker":"Charles Goldfarb","startTime":173.54,"endTime":176.24,"body":"Yes, that's"},{"speaker":"Charles Goldfarb","startTime":173.54,"endTime":176.24,"body":"exactly right. That is exactly"},{"speaker":"Charles Goldfarb","startTime":176.24,"endTime":181.4,"body":"right. Good. Well, let's jump"},{"speaker":"Charles Goldfarb","startTime":176.24,"endTime":181.4,"body":"in. Um, can I share a review?"},{"speaker":"Chris Dy","startTime":181.64,"endTime":182.78,"body":"Yeah, I think that'd"},{"speaker":"Chris Dy","startTime":181.64,"endTime":182.78,"body":"be great."},{"speaker":"Charles Goldfarb","startTime":183.29,"endTime":189.56,"body":"Perfect. So"},{"speaker":"Charles Goldfarb","startTime":183.29,"endTime":189.56,"body":"this one is from capsular 1243."},{"speaker":"Charles Goldfarb","startTime":190.19,"endTime":194.84,"body":"from Great Britain. Awesome."},{"speaker":"Charles Goldfarb","startTime":190.19,"endTime":194.84,"body":"This was in response to a nerve"},{"speaker":"Charles Goldfarb","startTime":194.84,"endTime":197.93,"body":"repair episode it said, great"},{"speaker":"Charles Goldfarb","startTime":194.84,"endTime":197.93,"body":"podcast, fun, informative,"},{"speaker":"Charles Goldfarb","startTime":197.93,"endTime":201.56,"body":"honest, a great online resource"},{"speaker":"Charles Goldfarb","startTime":197.93,"endTime":201.56,"body":"for hand, plastic and peripheral"},{"speaker":"Charles Goldfarb","startTime":201.56,"endTime":205.4,"body":"nerve surgeons, physios and"},{"speaker":"Charles Goldfarb","startTime":201.56,"endTime":205.4,"body":"tissue engineers, thumbs up, and"},{"speaker":"Charles Goldfarb","startTime":205.4,"endTime":210.05,"body":"five stars. Thank you, again,"},{"speaker":"Charles Goldfarb","startTime":205.4,"endTime":210.05,"body":"that that kind of review really,"},{"speaker":"Charles Goldfarb","startTime":210.59,"endTime":214.52,"body":"really is appreciated. And, you"},{"speaker":"Charles Goldfarb","startTime":210.59,"endTime":214.52,"body":"know, thank you very much."},{"speaker":"Chris Dy","startTime":215.23,"endTime":217.72,"body":"Fantastic. Well, thank"},{"speaker":"Chris Dy","startTime":215.23,"endTime":217.72,"body":"you for that. And you know, it's"},{"speaker":"Chris Dy","startTime":217.72,"endTime":220.54,"body":"that time of the month where"},{"speaker":"Chris Dy","startTime":217.72,"endTime":220.54,"body":"we're at that time on the"},{"speaker":"Chris Dy","startTime":220.54,"endTime":222.46,"body":"podcast where we should probably"},{"speaker":"Chris Dy","startTime":220.54,"endTime":222.46,"body":"do a drawing."},{"speaker":"Charles Goldfarb","startTime":222.91,"endTime":223.42,"body":"Let's do it."},{"speaker":"Chris Dy","startTime":223.42,"endTime":227.98,"body":"So, pick a number. And"},{"speaker":"Chris Dy","startTime":223.42,"endTime":227.98,"body":"I'll see which who's getting a"},{"speaker":"Chris Dy","startTime":227.98,"endTime":228.4,"body":"mug?"},{"speaker":"Charles Goldfarb","startTime":228.61,"endTime":232.51,"body":"I think I went"},{"speaker":"Charles Goldfarb","startTime":228.61,"endTime":232.51,"body":"low last time. Let's go number"},{"speaker":"Charles Goldfarb","startTime":232.51,"endTime":236.14,"body":"50, 5-0."},{"speaker":"Chris Dy","startTime":237.28,"endTime":242.95,"body":"All right. Okay, if"},{"speaker":"Chris Dy","startTime":237.28,"endTime":242.95,"body":"your email address starts with"},{"speaker":"Chris Dy","startTime":243.37,"endTime":245.47,"body":"San Jueswaran,"},{"speaker":"Charles Goldfarb","startTime":247.48,"endTime":248.98,"body":"That was"},{"speaker":"Charles Goldfarb","startTime":247.48,"endTime":248.98,"body":"really helpful."},{"speaker":"Chris Dy","startTime":249.4,"endTime":252.31,"body":"50, but you are you"},{"speaker":"Chris Dy","startTime":249.4,"endTime":252.31,"body":"are the winner of a mug, and"},{"speaker":"Chris Dy","startTime":252.31,"endTime":256.45,"body":"we're gonna get that one out to"},{"speaker":"Chris Dy","startTime":252.31,"endTime":256.45,"body":"you soon. Thank you for doing"},{"speaker":"Chris Dy","startTime":256.45,"endTime":259.99,"body":"the survey and then anybody that"},{"speaker":"Chris Dy","startTime":256.45,"endTime":259.99,"body":"wants to be entered in the"},{"speaker":"Chris Dy","startTime":259.99,"endTime":263.35,"body":"chance to win a mug Chuck is"},{"speaker":"Chris Dy","startTime":259.99,"endTime":263.35,"body":"going to promise to go very high"},{"speaker":"Chris Dy","startTime":263.35,"endTime":269.05,"body":"next time. As we pick our our"},{"speaker":"Chris Dy","startTime":263.35,"endTime":269.05,"body":"next mug. So please do the"},{"speaker":"Chris Dy","startTime":269.05,"endTime":272.53,"body":"survey. The survey is listed in"},{"speaker":"Chris Dy","startTime":269.05,"endTime":272.53,"body":"the show notes, I believe. And"},{"speaker":"Chris Dy","startTime":272.53,"endTime":277.75,"body":"also on our website at the upper"},{"speaker":"Chris Dy","startTime":272.53,"endTime":277.75,"body":"hand podcast, Wu stl.edu. We"},{"speaker":"Chris Dy","startTime":277.75,"endTime":280.15,"body":"love getting the feedback. We"},{"speaker":"Chris Dy","startTime":277.75,"endTime":280.15,"body":"also love hearing from anybody"},{"speaker":"Chris Dy","startTime":280.15,"endTime":283.93,"body":"that wants to email us at"},{"speaker":"Chris Dy","startTime":280.15,"endTime":283.93,"body":"handpodcast@gmail.com. And"},{"speaker":"Chris Dy","startTime":283.93,"endTime":287.47,"body":"remember, Chuck and I will"},{"speaker":"Chris Dy","startTime":283.93,"endTime":287.47,"body":"answer any question if you leave"},{"speaker":"Chris Dy","startTime":287.47,"endTime":290.08,"body":"it on a five star review on"},{"speaker":"Chris Dy","startTime":287.47,"endTime":290.08,"body":"iTunes."},{"speaker":"Charles Goldfarb","startTime":290.56,"endTime":293.05,"body":"Absolutely."},{"speaker":"Charles Goldfarb","startTime":290.56,"endTime":293.05,"body":"And yeah, for the name that"},{"speaker":"Charles Goldfarb","startTime":293.05,"endTime":296.2,"body":"Chris just read out. Just you"},{"speaker":"Charles Goldfarb","startTime":293.05,"endTime":296.2,"body":"know, email us please. And I"},{"speaker":"Charles Goldfarb","startTime":296.2,"endTime":299.32,"body":"will say Chris, that I did shout"},{"speaker":"Charles Goldfarb","startTime":296.2,"endTime":299.32,"body":"you out on Twitter recently"},{"speaker":"Charles Goldfarb","startTime":299.32,"endTime":304.12,"body":"because I was reviewing the poll"},{"speaker":"Charles Goldfarb","startTime":299.32,"endTime":304.12,"body":"results. And I think You"},{"speaker":"Charles Goldfarb","startTime":304.12,"endTime":307.24,"body":"deceived me at one point where"},{"speaker":"Charles Goldfarb","startTime":304.12,"endTime":307.24,"body":"you had me believing that the"},{"speaker":"Charles Goldfarb","startTime":307.45,"endTime":310.66,"body":"audience was begging for more"},{"speaker":"Charles Goldfarb","startTime":307.45,"endTime":310.66,"body":"nerve. And what what I learned"},{"speaker":"Charles Goldfarb","startTime":310.72,"endTime":313.57,"body":"instead was the audience was"},{"speaker":"Charles Goldfarb","startTime":310.72,"endTime":313.57,"body":"begging for more sports."},{"speaker":"Chris Dy","startTime":314.25,"endTime":316.74,"body":"You know, I think the"},{"speaker":"Chris Dy","startTime":314.25,"endTime":316.74,"body":"results are in the eye of the"},{"speaker":"Chris Dy","startTime":316.74,"endTime":321.6,"body":"beholder. Clearly the system,"},{"speaker":"Chris Dy","startTime":316.74,"endTime":321.6,"body":"the system was rigged. You know,"},{"speaker":"Chris Dy","startTime":321.6,"endTime":324.24,"body":"I think those are our two most"},{"speaker":"Chris Dy","startTime":321.6,"endTime":324.24,"body":"popular topics, for obvious"},{"speaker":"Chris Dy","startTime":324.24,"endTime":328.47,"body":"reasons. But we will sneak in a"},{"speaker":"Chris Dy","startTime":324.24,"endTime":328.47,"body":"little nerve today, don't worry,"},{"speaker":"Charles Goldfarb","startTime":328.63,"endTime":331.36,"body":"I've no doubt"},{"speaker":"Charles Goldfarb","startTime":328.63,"endTime":331.36,"body":"I'm guessing when I next ask you"},{"speaker":"Charles Goldfarb","startTime":331.36,"endTime":334.42,"body":"to talk about a case, it's not"},{"speaker":"Charles Goldfarb","startTime":331.36,"endTime":334.42,"body":"going to be a sports case."},{"speaker":"Chris Dy","startTime":335.05,"endTime":338.11,"body":"It is not going to be"},{"speaker":"Chris Dy","startTime":335.05,"endTime":338.11,"body":"a sports case. You know, one"},{"speaker":"Chris Dy","startTime":338.11,"endTime":340.72,"body":"thing that I think is really"},{"speaker":"Chris Dy","startTime":338.11,"endTime":340.72,"body":"interesting how sometimes things"},{"speaker":"Chris Dy","startTime":340.72,"endTime":345.04,"body":"come in spurts in practice. And"},{"speaker":"Chris Dy","startTime":340.72,"endTime":345.04,"body":"I'd say that, you know, a thing"},{"speaker":"Chris Dy","startTime":345.04,"endTime":349.09,"body":"that's come up for me a few"},{"speaker":"Chris Dy","startTime":345.04,"endTime":349.09,"body":"times in the last month or so is"},{"speaker":"Chris Dy","startTime":349.42,"endTime":354.31,"body":"doing superficial radial nerve"},{"speaker":"Chris Dy","startTime":349.42,"endTime":354.31,"body":"decompressions at the Wartenberg"},{"speaker":"Chris Dy","startTime":354.31,"endTime":356.44,"body":"point, essentially at the"},{"speaker":"Chris Dy","startTime":354.31,"endTime":356.44,"body":"fascial exit near the"},{"speaker":"Chris Dy","startTime":356.44,"endTime":360.49,"body":"brachioradialis. I don't do that"},{"speaker":"Chris Dy","startTime":356.44,"endTime":360.49,"body":"many, because it honestly, it"},{"speaker":"Chris Dy","startTime":360.49,"endTime":364.03,"body":"doesn't come up that often. You"},{"speaker":"Chris Dy","startTime":360.49,"endTime":364.03,"body":"know, and I had a couple of them"},{"speaker":"Chris Dy","startTime":364.03,"endTime":366.58,"body":"recently, and I thought they"},{"speaker":"Chris Dy","startTime":364.03,"endTime":366.58,"body":"were really interesting cases."},{"speaker":"Chris Dy","startTime":367.0,"endTime":370.03,"body":"At the conclusion of the case, I"},{"speaker":"Chris Dy","startTime":367.0,"endTime":370.03,"body":"said, You know, I should just do"},{"speaker":"Chris Dy","startTime":370.03,"endTime":373.03,"body":"this under local, because I'll"},{"speaker":"Chris Dy","startTime":370.03,"endTime":373.03,"body":"be honest, it's such a"},{"speaker":"Chris Dy","startTime":373.03,"endTime":376.75,"body":"superficial dissection, that,"},{"speaker":"Chris Dy","startTime":373.03,"endTime":376.75,"body":"you know, patients probably"},{"speaker":"Chris Dy","startTime":376.75,"endTime":378.94,"body":"better served with an under"},{"speaker":"Chris Dy","startTime":376.75,"endTime":378.94,"body":"local, what do you think?"},{"speaker":"Charles Goldfarb","startTime":379.5,"endTime":381.54,"body":"Wow, well,"},{"speaker":"Charles Goldfarb","startTime":379.5,"endTime":381.54,"body":"yeah, I agree with you, in my"},{"speaker":"Charles Goldfarb","startTime":381.54,"endTime":387.06,"body":"years of practice. I would say"},{"speaker":"Charles Goldfarb","startTime":381.54,"endTime":387.06,"body":"if I've done five, that would be"},{"speaker":"Charles Goldfarb","startTime":387.09,"endTime":390.21,"body":"a generous number. And it is"},{"speaker":"Charles Goldfarb","startTime":387.09,"endTime":390.21,"body":"interesting. So while we're on"},{"speaker":"Charles Goldfarb","startTime":390.21,"endTime":395.43,"body":"the topic, so I presumed these"},{"speaker":"Charles Goldfarb","startTime":390.21,"endTime":395.43,"body":"are non traumatic irritations"},{"speaker":"Charles Goldfarb","startTime":395.43,"endTime":397.68,"body":"may- you know, maybe bracelet"},{"speaker":"Charles Goldfarb","startTime":395.43,"endTime":397.68,"body":"wearing or tight watch or"},{"speaker":"Charles Goldfarb","startTime":397.68,"endTime":400.59,"body":"something, but not a blunt"},{"speaker":"Charles Goldfarb","startTime":397.68,"endTime":400.59,"body":"trauma, injury to that"},{"speaker":"Charles Goldfarb","startTime":400.59,"endTime":403.59,"body":"superficial branch of the radial"},{"speaker":"Charles Goldfarb","startTime":400.59,"endTime":403.59,"body":"nerve, truly a compression"},{"speaker":"Charles Goldfarb","startTime":403.59,"endTime":403.95,"body":"point."},{"speaker":"Chris Dy","startTime":404.59,"endTime":407.2,"body":"Yeah, so one, one"},{"speaker":"Chris Dy","startTime":404.59,"endTime":407.2,"body":"compression point, I literally"},{"speaker":"Chris Dy","startTime":407.2,"endTime":410.56,"body":"tried everything that I had not"},{"speaker":"Chris Dy","startTime":407.2,"endTime":410.56,"body":"to operate on him in terms of"},{"speaker":"Chris Dy","startTime":410.68,"endTime":412.78,"body":"non operative modalities. And"},{"speaker":"Chris Dy","startTime":410.68,"endTime":412.78,"body":"then the other one was"},{"speaker":"Chris Dy","startTime":412.78,"endTime":415.81,"body":"interesting, it was a radial"},{"speaker":"Chris Dy","startTime":412.78,"endTime":415.81,"body":"tunnel release that had been"},{"speaker":"Chris Dy","startTime":415.81,"endTime":420.49,"body":"done elsewhere, had continued"},{"speaker":"Chris Dy","startTime":415.81,"endTime":420.49,"body":"numbness in the SRN"},{"speaker":"Chris Dy","startTime":420.49,"endTime":423.79,"body":"distribution, and we waited a"},{"speaker":"Chris Dy","startTime":420.49,"endTime":423.79,"body":"long time and, you know, kind of"},{"speaker":"Chris Dy","startTime":423.79,"endTime":426.25,"body":"had an honest discussion with"},{"speaker":"Chris Dy","startTime":423.79,"endTime":426.25,"body":"the patient gave gave them"},{"speaker":"Chris Dy","startTime":426.25,"endTime":430.12,"body":"options, and they wanted me to"},{"speaker":"Chris Dy","startTime":426.25,"endTime":430.12,"body":"do it, which I think, you know,"},{"speaker":"Chris Dy","startTime":430.9,"endTime":433.75,"body":"is a reasonable thing. We talked"},{"speaker":"Chris Dy","startTime":430.9,"endTime":433.75,"body":"a little bit about shared"},{"speaker":"Chris Dy","startTime":433.75,"endTime":436.84,"body":"decision making in a prior"},{"speaker":"Chris Dy","startTime":433.75,"endTime":436.84,"body":"episode. And also, we talk about"},{"speaker":"Chris Dy","startTime":436.84,"endTime":439.09,"body":"it in journal club and stuff."},{"speaker":"Chris Dy","startTime":436.84,"endTime":439.09,"body":"And, you know, it wasn't a"},{"speaker":"Chris Dy","startTime":439.09,"endTime":444.04,"body":"formal process. But you know, I"},{"speaker":"Chris Dy","startTime":439.09,"endTime":444.04,"body":"like to give patients options. I"},{"speaker":"Chris Dy","startTime":444.04,"endTime":447.52,"body":"like to and they inevitably will"},{"speaker":"Chris Dy","startTime":444.04,"endTime":447.52,"body":"ask me what I would do. And then"},{"speaker":"Chris Dy","startTime":447.52,"endTime":449.44,"body":"I tell them that that's an"},{"speaker":"Chris Dy","startTime":447.52,"endTime":449.44,"body":"unfair question, because I don't"},{"speaker":"Chris Dy","startTime":449.44,"endTime":451.66,"body":"live with this, you know, I"},{"speaker":"Chris Dy","startTime":449.44,"endTime":451.66,"body":"don't live with the condition"},{"speaker":"Chris Dy","startTime":451.66,"endTime":454.84,"body":"they've been living with, I"},{"speaker":"Chris Dy","startTime":451.66,"endTime":454.84,"body":"don't know their decision making"},{"speaker":"Chris Dy","startTime":454.84,"endTime":457.36,"body":"calculus as well as they do. But"},{"speaker":"Chris Dy","startTime":454.84,"endTime":457.36,"body":"I try to spend a little extra"},{"speaker":"Chris Dy","startTime":457.39,"endTime":459.76,"body":"time and try to be empathetic"},{"speaker":"Chris Dy","startTime":457.39,"endTime":459.76,"body":"about it. And, you know, just"},{"speaker":"Chris Dy","startTime":459.76,"endTime":461.44,"body":"say, here are your options. And"},{"speaker":"Chris Dy","startTime":459.76,"endTime":461.44,"body":"then leave the room."},{"speaker":"Charles Goldfarb","startTime":461.53,"endTime":463.27,"body":"Totally agree,"},{"speaker":"Charles Goldfarb","startTime":461.53,"endTime":463.27,"body":"especially in something like"},{"speaker":"Charles Goldfarb","startTime":463.27,"endTime":467.5,"body":"this. And I will say when I have"},{"speaker":"Charles Goldfarb","startTime":463.27,"endTime":467.5,"body":"proceeded down this pathway, it"},{"speaker":"Charles Goldfarb","startTime":467.5,"endTime":470.74,"body":"has been successful. And I agree"},{"speaker":"Charles Goldfarb","startTime":467.5,"endTime":470.74,"body":"with you, it could be just fine"},{"speaker":"Charles Goldfarb","startTime":470.74,"endTime":473.89,"body":"under local only because you"},{"speaker":"Charles Goldfarb","startTime":470.74,"endTime":473.89,"body":"have a defined segment where"},{"speaker":"Charles Goldfarb","startTime":473.89,"endTime":478.87,"body":"you're working, and I think"},{"speaker":"Charles Goldfarb","startTime":473.89,"endTime":478.87,"body":"getting appropriate. analgesia"},{"speaker":"Charles Goldfarb","startTime":478.9,"endTime":482.05,"body":"should be, you know, something"},{"speaker":"Charles Goldfarb","startTime":478.9,"endTime":482.05,"body":"we could accomplish under local."},{"speaker":"Chris Dy","startTime":482.45,"endTime":484.85,"body":"There were a couple of"},{"speaker":"Chris Dy","startTime":482.45,"endTime":484.85,"body":"interesting points, teaching"},{"speaker":"Chris Dy","startTime":484.85,"endTime":487.85,"body":"points about the case that I was"},{"speaker":"Chris Dy","startTime":484.85,"endTime":487.85,"body":"pointing out to our trainees,"},{"speaker":"Chris Dy","startTime":488.27,"endTime":491.6,"body":"you know, the two things I think"},{"speaker":"Chris Dy","startTime":488.27,"endTime":491.6,"body":"both of them were described by"},{"speaker":"Chris Dy","startTime":491.6,"endTime":495.77,"body":"Delon and MacKinnon in the 90s."},{"speaker":"Chris Dy","startTime":491.6,"endTime":495.77,"body":"But, you know, the overlap"},{"speaker":"Chris Dy","startTime":495.77,"endTime":499.49,"body":"between the lateral and brachial"},{"speaker":"Chris Dy","startTime":495.77,"endTime":499.49,"body":"distribution and the superficial"},{"speaker":"Chris Dy","startTime":499.49,"endTime":502.91,"body":"radial distribution is very"},{"speaker":"Chris Dy","startTime":499.49,"endTime":502.91,"body":"real. But also the physical"},{"speaker":"Chris Dy","startTime":502.91,"endTime":507.59,"body":"proximity of those two nerves is"},{"speaker":"Chris Dy","startTime":502.91,"endTime":507.59,"body":"very real. And, you know, unless"},{"speaker":"Chris Dy","startTime":507.59,"endTime":511.16,"body":"you see the nerve emerging from"},{"speaker":"Chris Dy","startTime":507.59,"endTime":511.16,"body":"underneath the brachioradialis,"},{"speaker":"Chris Dy","startTime":511.19,"endTime":514.07,"body":"you could potentially confuse"},{"speaker":"Chris Dy","startTime":511.19,"endTime":514.07,"body":"the LABC for the superficial"},{"speaker":"Chris Dy","startTime":514.07,"endTime":516.53,"body":"radial nerve, because in one of"},{"speaker":"Chris Dy","startTime":514.07,"endTime":516.53,"body":"the cases, they were literally"},{"speaker":"Chris Dy","startTime":516.53,"endTime":520.25,"body":"on top of each other, you know,"},{"speaker":"Chris Dy","startTime":516.53,"endTime":520.25,"body":"in, you know, we were pretty"},{"speaker":"Chris Dy","startTime":520.25,"endTime":522.86,"body":"proximally. And we weren't, we"},{"speaker":"Chris Dy","startTime":520.25,"endTime":522.86,"body":"weren't down by the wrist level,"},{"speaker":"Chris Dy","startTime":522.86,"endTime":526.16,"body":"where it could be the volar and"},{"speaker":"Chris Dy","startTime":522.86,"endTime":526.16,"body":"dorsal branch of the SRN. So I"},{"speaker":"Chris Dy","startTime":526.16,"endTime":528.44,"body":"thought that was one interesting"},{"speaker":"Chris Dy","startTime":526.16,"endTime":528.44,"body":"point. And then the other"},{"speaker":"Chris Dy","startTime":528.8,"endTime":532.25,"body":"interesting point was whether or"},{"speaker":"Chris Dy","startTime":528.8,"endTime":532.25,"body":"not to add a brachial radialis"},{"speaker":"Chris Dy","startTime":532.25,"endTime":536.63,"body":"tenotomy, to the procedure, in"},{"speaker":"Chris Dy","startTime":532.25,"endTime":536.63,"body":"the efforts of trying to"},{"speaker":"Chris Dy","startTime":536.63,"endTime":539.72,"body":"minimize any chance of the"},{"speaker":"Chris Dy","startTime":536.63,"endTime":539.72,"body":"symptoms recurring. Do you ever"},{"speaker":"Chris Dy","startTime":539.75,"endTime":542.3,"body":"did you? And you said, you don't"},{"speaker":"Chris Dy","startTime":539.75,"endTime":542.3,"body":"do a ton of these, but did you?"},{"speaker":"Chris Dy","startTime":542.33,"endTime":543.8,"body":"Do you add that typically, or?"},{"speaker":"Charles Goldfarb","startTime":544.08,"endTime":546.81,"body":"I have not,"},{"speaker":"Charles Goldfarb","startTime":544.08,"endTime":546.81,"body":"but I certainly would not be"},{"speaker":"Charles Goldfarb","startTime":546.81,"endTime":552.09,"body":"against it. I have traditionally"},{"speaker":"Charles Goldfarb","startTime":546.81,"endTime":552.09,"body":"marked out the area of maximum"},{"speaker":"Charles Goldfarb","startTime":552.09,"endTime":557.04,"body":"discomfort and made a relatively"},{"speaker":"Charles Goldfarb","startTime":552.09,"endTime":557.04,"body":"small I'm not talking one"},{"speaker":"Charles Goldfarb","startTime":557.04,"endTime":560.49,"body":"centimeter but relatively small"},{"speaker":"Charles Goldfarb","startTime":557.04,"endTime":560.49,"body":"incision, maybe three"},{"speaker":"Charles Goldfarb","startTime":560.49,"endTime":565.11,"body":"centimeters. But maybe I'm not"},{"speaker":"Charles Goldfarb","startTime":560.49,"endTime":565.11,"body":"being robust enough with that."},{"speaker":"Chris Dy","startTime":567.01,"endTime":569.95,"body":"Yeah, I think that you"},{"speaker":"Chris Dy","startTime":567.01,"endTime":569.95,"body":"can certainly, I mean, you could"},{"speaker":"Chris Dy","startTime":569.95,"endTime":572.41,"body":"do this inci- you can do this"},{"speaker":"Chris Dy","startTime":569.95,"endTime":572.41,"body":"surgery through a transverse"},{"speaker":"Chris Dy","startTime":572.41,"endTime":575.92,"body":"incision, if you you know, look"},{"speaker":"Chris Dy","startTime":572.41,"endTime":575.92,"body":"at that maximum tinels and if it"},{"speaker":"Chris Dy","startTime":575.92,"endTime":580.03,"body":"matches anatomically, where you"},{"speaker":"Chris Dy","startTime":575.92,"endTime":580.03,"body":"know, it typically would be but"},{"speaker":"Chris Dy","startTime":580.03,"endTime":582.85,"body":"I enjoyed the dissection I keep"},{"speaker":"Chris Dy","startTime":580.03,"endTime":582.85,"body":"it as small as I can, but you"},{"speaker":"Chris Dy","startTime":582.85,"endTime":585.34,"body":"know, I think it ends up being a"},{"speaker":"Chris Dy","startTime":582.85,"endTime":585.34,"body":"four or five, you know, curved,"},{"speaker":"Chris Dy","startTime":585.73,"endTime":590.38,"body":"s shaped incision. And then I"},{"speaker":"Chris Dy","startTime":585.73,"endTime":590.38,"body":"find the brachial radialis"},{"speaker":"Chris Dy","startTime":590.89,"endTime":593.95,"body":"tendon essentially right after"},{"speaker":"Chris Dy","startTime":590.89,"endTime":593.95,"body":"the musculotendinous Junction,"},{"speaker":"Chris Dy","startTime":594.28,"endTime":597.49,"body":"and then I divide it under"},{"speaker":"Chris Dy","startTime":594.28,"endTime":597.49,"body":"direct visualization of course,"},{"speaker":"Chris Dy","startTime":598.57,"endTime":602.95,"body":"and I remember I did Did one of"},{"speaker":"Chris Dy","startTime":598.57,"endTime":602.95,"body":"these SRN decompressions, a few"},{"speaker":"Chris Dy","startTime":602.95,"endTime":606.34,"body":"years ago, and I was making"},{"speaker":"Chris Dy","startTime":602.95,"endTime":606.34,"body":"small talk with Dr. McKinnon in"},{"speaker":"Chris Dy","startTime":606.34,"endTime":609.31,"body":"the surgeons lounge, and she"},{"speaker":"Chris Dy","startTime":606.34,"endTime":609.31,"body":"said, What well did you do the"},{"speaker":"Chris Dy","startTime":609.31,"endTime":612.73,"body":"tenotomy? I was like, What? No,"},{"speaker":"Chris Dy","startTime":609.31,"endTime":612.73,"body":"no, why? Why would I do? And"},{"speaker":"Chris Dy","startTime":612.73,"endTime":615.34,"body":"then she looked at me like you"},{"speaker":"Chris Dy","startTime":612.73,"endTime":615.34,"body":"missed the boat, you should have"},{"speaker":"Chris Dy","startTime":615.34,"endTime":618.13,"body":"been doing a tenotomy the whole"},{"speaker":"Chris Dy","startTime":615.34,"endTime":618.13,"body":"time. And the patient was"},{"speaker":"Chris Dy","startTime":618.13,"endTime":621.55,"body":"totally fine. It did totally did"},{"speaker":"Chris Dy","startTime":618.13,"endTime":621.55,"body":"well. But you know, that was a"},{"speaker":"Chris Dy","startTime":621.55,"endTime":624.97,"body":"point that I was like, You know"},{"speaker":"Chris Dy","startTime":621.55,"endTime":624.97,"body":"what, I'm there. It doesn't add"},{"speaker":"Chris Dy","startTime":624.97,"endTime":629.02,"body":"anything to the surgery. And if"},{"speaker":"Chris Dy","startTime":624.97,"endTime":629.02,"body":"it has some benefit, I think"},{"speaker":"Chris Dy","startTime":629.02,"endTime":629.65,"body":"it's worth doing."},{"speaker":"Charles Goldfarb","startTime":630.43,"endTime":634.69,"body":"Yeah. Agreed."},{"speaker":"Charles Goldfarb","startTime":630.43,"endTime":634.69,"body":"Agreed. All right. Oh,"},{"speaker":"Charles Goldfarb","startTime":634.69,"endTime":636.67,"body":"interesting. So how many of"},{"speaker":"Charles Goldfarb","startTime":634.69,"endTime":636.67,"body":"those have you do you think"},{"speaker":"Charles Goldfarb","startTime":636.67,"endTime":639.67,"body":"you've done in the last, you"},{"speaker":"Charles Goldfarb","startTime":636.67,"endTime":639.67,"body":"know, in your, say, five years?"},{"speaker":"Chris Dy","startTime":640.3,"endTime":643.0,"body":"Probably less than 10."},{"speaker":"Chris Dy","startTime":640.3,"endTime":643.0,"body":"You know, there's some cases in"},{"speaker":"Chris Dy","startTime":643.0,"endTime":645.28,"body":"which I'll decompress the nerve"},{"speaker":"Chris Dy","startTime":643.0,"endTime":645.28,"body":"in the setting of trauma, as you"},{"speaker":"Chris Dy","startTime":645.28,"endTime":648.88,"body":"mentioned earlier, you know,"},{"speaker":"Chris Dy","startTime":645.28,"endTime":648.88,"body":"there's that belief that a nerve"},{"speaker":"Chris Dy","startTime":648.88,"endTime":651.58,"body":"that's been traumatized, whether"},{"speaker":"Chris Dy","startTime":648.88,"endTime":651.58,"body":"it's, you know, an injury or a"},{"speaker":"Chris Dy","startTime":651.58,"endTime":654.55,"body":"nerve that's recovering from a"},{"speaker":"Chris Dy","startTime":651.58,"endTime":654.55,"body":"nerve graft, or some kind of"},{"speaker":"Chris Dy","startTime":654.58,"endTime":660.46,"body":"surgery on the nerve is going to"},{"speaker":"Chris Dy","startTime":654.58,"endTime":660.46,"body":"swell distal to the site of, you"},{"speaker":"Chris Dy","startTime":660.46,"endTime":662.26,"body":"know, it's going to swell as"},{"speaker":"Chris Dy","startTime":660.46,"endTime":662.26,"body":"it's recovering and"},{"speaker":"Chris Dy","startTime":662.26,"endTime":666.01,"body":"regenerating. You know, that's,"},{"speaker":"Chris Dy","startTime":662.26,"endTime":666.01,"body":"I think that's still falls into"},{"speaker":"Chris Dy","startTime":666.01,"endTime":670.36,"body":"dogma camp, you know, it's based"},{"speaker":"Chris Dy","startTime":666.01,"endTime":670.36,"body":"on some laboratory research, you"},{"speaker":"Chris Dy","startTime":670.36,"endTime":674.35,"body":"know, that. And then it's kind"},{"speaker":"Chris Dy","startTime":670.36,"endTime":674.35,"body":"of spread on the podiums. And"},{"speaker":"Chris Dy","startTime":674.35,"endTime":677.5,"body":"there are a couple of case"},{"speaker":"Chris Dy","startTime":674.35,"endTime":677.5,"body":"series that have tangentially"},{"speaker":"Chris Dy","startTime":677.5,"endTime":681.7,"body":"I'll say, supported it. But I"},{"speaker":"Chris Dy","startTime":677.5,"endTime":681.7,"body":"think that most peripheral nerve"},{"speaker":"Chris Dy","startTime":681.7,"endTime":684.52,"body":"surgeons do subscribe to that"},{"speaker":"Chris Dy","startTime":681.7,"endTime":684.52,"body":"belief that if you have a"},{"speaker":"Chris Dy","startTime":684.52,"endTime":687.94,"body":"recovering nerve, there's little"},{"speaker":"Chris Dy","startTime":684.52,"endTime":687.94,"body":"harm in decompressing it. And I"},{"speaker":"Chris Dy","startTime":687.94,"endTime":691.57,"body":"think that's probably related to"},{"speaker":"Chris Dy","startTime":687.94,"endTime":691.57,"body":"our comfort with doing those"},{"speaker":"Chris Dy","startTime":691.57,"endTime":694.63,"body":"surgeries. And some of it and"},{"speaker":"Chris Dy","startTime":691.57,"endTime":694.63,"body":"this might be a little"},{"speaker":"Chris Dy","startTime":694.63,"endTime":697.99,"body":"controversial, is keeping the"},{"speaker":"Chris Dy","startTime":694.63,"endTime":697.99,"body":"patient in the game and giving"},{"speaker":"Chris Dy","startTime":697.99,"endTime":700.54,"body":"them continued hope, you know,"},{"speaker":"Chris Dy","startTime":697.99,"endTime":700.54,"body":"down the line that you know,"},{"speaker":"Chris Dy","startTime":700.54,"endTime":702.88,"body":"okay, we do this. And we do"},{"speaker":"Chris Dy","startTime":700.54,"endTime":702.88,"body":"that, and you'll continue to get"},{"speaker":"Chris Dy","startTime":702.88,"endTime":703.57,"body":"better and better."},{"speaker":"Charles Goldfarb","startTime":703.71,"endTime":705.51,"body":"I'm not"},{"speaker":"Charles Goldfarb","startTime":703.71,"endTime":705.51,"body":"completely sold on that probably"},{"speaker":"Charles Goldfarb","startTime":705.51,"endTime":707.43,"body":"for the reasons you say, I would"},{"speaker":"Charles Goldfarb","startTime":705.51,"endTime":707.43,"body":"probably need to be more"},{"speaker":"Charles Goldfarb","startTime":707.43,"endTime":710.52,"body":"convinced with some literature"},{"speaker":"Charles Goldfarb","startTime":707.43,"endTime":710.52,"body":"about the benefits."},{"speaker":"Chris Dy","startTime":710.75,"endTime":713.66,"body":"We're trying to, you"},{"speaker":"Chris Dy","startTime":710.75,"endTime":713.66,"body":"know, we're trying to do a study"},{"speaker":"Chris Dy","startTime":713.66,"endTime":717.38,"body":"where we ultrasound, nerves"},{"speaker":"Chris Dy","startTime":713.66,"endTime":717.38,"body":"after injury before a"},{"speaker":"Chris Dy","startTime":717.38,"endTime":721.16,"body":"decompression distally at known"},{"speaker":"Chris Dy","startTime":717.38,"endTime":721.16,"body":"points of entrapment. So"},{"speaker":"Chris Dy","startTime":721.16,"endTime":723.62,"body":"hopefully, we'll be able to get"},{"speaker":"Chris Dy","startTime":721.16,"endTime":723.62,"body":"an answer within the next couple"},{"speaker":"Chris Dy","startTime":723.62,"endTime":726.83,"body":"of years enrollment's been a"},{"speaker":"Chris Dy","startTime":723.62,"endTime":726.83,"body":"little slow. But the literature"},{"speaker":"Chris Dy","startTime":726.83,"endTime":729.44,"body":"that that assertion is based on"},{"speaker":"Chris Dy","startTime":726.83,"endTime":729.44,"body":"is that, you know, there were a"},{"speaker":"Chris Dy","startTime":729.44,"endTime":732.74,"body":"series of radial nerve injuries,"},{"speaker":"Chris Dy","startTime":729.44,"endTime":732.74,"body":"for example, and a few didn't"},{"speaker":"Chris Dy","startTime":732.74,"endTime":735.44,"body":"get better. So then they went"},{"speaker":"Chris Dy","startTime":732.74,"endTime":735.44,"body":"and decompressed them, and"},{"speaker":"Chris Dy","startTime":735.44,"endTime":738.89,"body":"magically, they got better. You"},{"speaker":"Chris Dy","startTime":735.44,"endTime":738.89,"body":"know, so it's, it's a case, it's"},{"speaker":"Chris Dy","startTime":738.89,"endTime":743.69,"body":"almost a, a subgroup within a"},{"speaker":"Chris Dy","startTime":738.89,"endTime":743.69,"body":"case series. And that's at least"},{"speaker":"Chris Dy","startTime":743.69,"endTime":746.18,"body":"the best literature I could find"},{"speaker":"Chris Dy","startTime":743.69,"endTime":746.18,"body":"on that. And then there's one"},{"speaker":"Chris Dy","startTime":746.18,"endTime":748.43,"body":"more case series that came out."},{"speaker":"Chris Dy","startTime":746.18,"endTime":748.43,"body":"So it's kind of low level"},{"speaker":"Chris Dy","startTime":748.43,"endTime":752.06,"body":"evidence. But again, most people"},{"speaker":"Chris Dy","startTime":748.43,"endTime":752.06,"body":"subscribe to that. And if, if"},{"speaker":"Chris Dy","startTime":752.06,"endTime":755.3,"body":"you're a listener, and you feel"},{"speaker":"Chris Dy","startTime":752.06,"endTime":755.3,"body":"strongly about it, please let us"},{"speaker":"Chris Dy","startTime":755.3,"endTime":756.98,"body":"know. Because I'd love to be"},{"speaker":"Chris Dy","startTime":755.3,"endTime":756.98,"body":"educated more."},{"speaker":"Charles Goldfarb","startTime":757.26,"endTime":760.56,"body":"Absolutely."},{"speaker":"Charles Goldfarb","startTime":757.26,"endTime":760.56,"body":"Before we jump into our main"},{"speaker":"Charles Goldfarb","startTime":760.56,"endTime":765.42,"body":"topic of the day, I did want to"},{"speaker":"Charles Goldfarb","startTime":760.56,"endTime":765.42,"body":"shout out Jim Chang, who was our"},{"speaker":"Charles Goldfarb","startTime":765.42,"endTime":770.79,"body":"guest, or visiting professor"},{"speaker":"Charles Goldfarb","startTime":765.42,"endTime":770.79,"body":"really, last couple of days, it"},{"speaker":"Charles Goldfarb","startTime":770.79,"endTime":773.79,"body":"was virtual. And you know, Jim,"},{"speaker":"Charles Goldfarb","startTime":770.79,"endTime":773.79,"body":"for those of you who don't know"},{"speaker":"Charles Goldfarb","startTime":773.79,"endTime":777.81,"body":"him is the chief of plastic"},{"speaker":"Charles Goldfarb","startTime":773.79,"endTime":777.81,"body":"surgery at Stanford University."},{"speaker":"Charles Goldfarb","startTime":777.81,"endTime":782.04,"body":"And he is a renaissance man in"},{"speaker":"Charles Goldfarb","startTime":777.81,"endTime":782.04,"body":"every respect, really has done a"},{"speaker":"Charles Goldfarb","startTime":782.04,"endTime":785.28,"body":"lot in every domain from"},{"speaker":"Charles Goldfarb","startTime":782.04,"endTime":785.28,"body":"President of the hand society to"},{"speaker":"Charles Goldfarb","startTime":785.7,"endTime":788.88,"body":"Chief Medical Officer of"},{"speaker":"Charles Goldfarb","startTime":785.7,"endTime":788.88,"body":"research, which does"},{"speaker":"Charles Goldfarb","startTime":788.88,"endTime":792.66,"body":"international work to being a"},{"speaker":"Charles Goldfarb","startTime":788.88,"endTime":792.66,"body":"well published, well funded,"},{"speaker":"Charles Goldfarb","startTime":793.32,"endTime":795.9,"body":"basic science researcher to"},{"speaker":"Charles Goldfarb","startTime":793.32,"endTime":795.9,"body":"being an outstanding clinician."},{"speaker":"Charles Goldfarb","startTime":795.9,"endTime":798.36,"body":"So it was great to have Jim and"},{"speaker":"Charles Goldfarb","startTime":795.9,"endTime":798.36,"body":"we asked him to talk about"},{"speaker":"Charles Goldfarb","startTime":798.36,"endTime":800.73,"body":"leadership. So he's invited as"},{"speaker":"Charles Goldfarb","startTime":798.36,"endTime":800.73,"body":"part of the Washington"},{"speaker":"Charles Goldfarb","startTime":800.73,"endTime":804.39,"body":"University Department orthopedic"},{"speaker":"Charles Goldfarb","startTime":800.73,"endTime":804.39,"body":"surgery leadership series, and"},{"speaker":"Charles Goldfarb","startTime":804.39,"endTime":806.94,"body":"he really did a great job. And I"},{"speaker":"Charles Goldfarb","startTime":804.39,"endTime":806.94,"body":"don't want to belabor this"},{"speaker":"Charles Goldfarb","startTime":806.94,"endTime":811.65,"body":"point, but I did order. Not"},{"speaker":"Charles Goldfarb","startTime":806.94,"endTime":811.65,"body":"exactly the book he recommended,"},{"speaker":"Charles Goldfarb","startTime":811.65,"endTime":813.45,"body":"but he made a book"},{"speaker":"Charles Goldfarb","startTime":811.65,"endTime":813.45,"body":"recommendation, which I had not"},{"speaker":"Charles Goldfarb","startTime":813.45,"endTime":817.98,"body":"heard of, by Bill Burnett and"},{"speaker":"Charles Goldfarb","startTime":813.45,"endTime":817.98,"body":"Dave Evans called designing your"},{"speaker":"Charles Goldfarb","startTime":817.98,"endTime":822.87,"body":"life how to build a well lived"},{"speaker":"Charles Goldfarb","startTime":817.98,"endTime":822.87,"body":"joyful life, actually ordered"},{"speaker":"Charles Goldfarb","startTime":822.87,"endTime":827.04,"body":"the subsequent book in that"},{"speaker":"Charles Goldfarb","startTime":822.87,"endTime":827.04,"body":"series, which is, I believe,"},{"speaker":"Charles Goldfarb","startTime":827.04,"endTime":830.91,"body":"called designing your work life."},{"speaker":"Charles Goldfarb","startTime":827.04,"endTime":830.91,"body":"And it's a little more"},{"speaker":"Charles Goldfarb","startTime":830.94,"endTime":836.28,"body":"instructional, apparently,"},{"speaker":"Charles Goldfarb","startTime":830.94,"endTime":836.28,"body":"versus aspirational. But it"},{"speaker":"Charles Goldfarb","startTime":836.28,"endTime":839.31,"body":"reminds me My daughter is going"},{"speaker":"Charles Goldfarb","startTime":836.28,"endTime":839.31,"body":"to Yale next year, and I guess"},{"speaker":"Charles Goldfarb","startTime":839.46,"endTime":843.48,"body":"one of the most popular courses"},{"speaker":"Charles Goldfarb","startTime":839.46,"endTime":843.48,"body":"if not the most popular courses"},{"speaker":"Charles Goldfarb","startTime":843.48,"endTime":847.29,"body":"on the Yale campus is about"},{"speaker":"Charles Goldfarb","startTime":843.48,"endTime":847.29,"body":"happiness. And so I think the"},{"speaker":"Charles Goldfarb","startTime":847.29,"endTime":849.93,"body":"you know, this is all these"},{"speaker":"Charles Goldfarb","startTime":847.29,"endTime":849.93,"body":"topics have to resonate with"},{"speaker":"Charles Goldfarb","startTime":849.96,"endTime":852.48,"body":"each of us especially in the"},{"speaker":"Charles Goldfarb","startTime":849.96,"endTime":852.48,"body":"middle of a pandemic, but I look"},{"speaker":"Charles Goldfarb","startTime":852.48,"endTime":853.53,"body":"forward to reading this book."},{"speaker":"Chris Dy","startTime":854.29,"endTime":857.17,"body":"In classic Chuck"},{"speaker":"Chris Dy","startTime":854.29,"endTime":857.17,"body":"fashion, I'm gonna answer with"},{"speaker":"Chris Dy","startTime":857.17,"endTime":859.69,"body":"your the way you typically"},{"speaker":"Chris Dy","startTime":857.17,"endTime":859.69,"body":"answer everything, two things."},{"speaker":"Charles Goldfarb","startTime":861.97,"endTime":862.63,"body":"Just two?"},{"speaker":"Chris Dy","startTime":864.7,"endTime":867.01,"body":"The number of emails I"},{"speaker":"Chris Dy","startTime":864.7,"endTime":867.01,"body":"have from you with the subject"},{"speaker":"Chris Dy","startTime":867.01,"endTime":870.88,"body":"two things. You didn't know that"},{"speaker":"Chris Dy","startTime":867.01,"endTime":870.88,"body":"did you?"},{"speaker":"Charles Goldfarb","startTime":871.24,"endTime":872.05,"body":"Did not."},{"speaker":"Chris Dy","startTime":872.74,"endTime":876.52,"body":"So two things. First"},{"speaker":"Chris Dy","startTime":872.74,"endTime":876.52,"body":"one is that I almost got as far"},{"speaker":"Chris Dy","startTime":876.52,"endTime":879.04,"body":"as you did. I actually had it"},{"speaker":"Chris Dy","startTime":876.52,"endTime":879.04,"body":"pulled up on Amazon and did not"},{"speaker":"Chris Dy","startTime":879.04,"endTime":882.52,"body":"get to add to cart yet, but I"},{"speaker":"Chris Dy","startTime":879.04,"endTime":882.52,"body":"will add to cart maybe we'll do"},{"speaker":"Chris Dy","startTime":882.52,"endTime":886.09,"body":"a little book club kind of"},{"speaker":"Chris Dy","startTime":882.52,"endTime":886.09,"body":"situation, either on the podcast"},{"speaker":"Chris Dy","startTime":886.09,"endTime":888.31,"body":"or off air. I think that'd be"},{"speaker":"Chris Dy","startTime":886.09,"endTime":888.31,"body":"good. And I didn't realize"},{"speaker":"Chris Dy","startTime":888.31,"endTime":892.27,"body":"there. There is actually a"},{"speaker":"Chris Dy","startTime":888.31,"endTime":892.27,"body":"second installment. So I look"},{"speaker":"Chris Dy","startTime":892.27,"endTime":896.08,"body":"forward to that. And the second"},{"speaker":"Chris Dy","startTime":892.27,"endTime":896.08,"body":"thing is that I think I've heard"},{"speaker":"Chris Dy","startTime":896.08,"endTime":900.67,"body":"about the happiness class course"},{"speaker":"Chris Dy","startTime":896.08,"endTime":900.67,"body":"at Yale, and I I think some of"},{"speaker":"Chris Dy","startTime":900.67,"endTime":903.52,"body":"those lectures are available as"},{"speaker":"Chris Dy","startTime":900.67,"endTime":903.52,"body":"TED talks or online somewhere. I"},{"speaker":"Chris Dy","startTime":903.52,"endTime":908.11,"body":"remember during the beginning"},{"speaker":"Chris Dy","startTime":903.52,"endTime":908.11,"body":"part of the pandemic, there,"},{"speaker":"Chris Dy","startTime":908.14,"endTime":911.53,"body":"they were actually offering I"},{"speaker":"Chris Dy","startTime":908.14,"endTime":911.53,"body":"think that same Yale course as"},{"speaker":"Chris Dy","startTime":911.53,"endTime":914.77,"body":"an open access kind of deal. I"},{"speaker":"Chris Dy","startTime":911.53,"endTime":914.77,"body":"may have to do a little digging"},{"speaker":"Chris Dy","startTime":914.77,"endTime":916.66,"body":"on that one, but I think it was"},{"speaker":"Chris Dy","startTime":914.77,"endTime":916.66,"body":"available."},{"speaker":"Charles Goldfarb","startTime":916.9,"endTime":918.64,"body":"I think"},{"speaker":"Charles Goldfarb","startTime":916.9,"endTime":918.64,"body":"you're, I think you're correct."},{"speaker":"Charles Goldfarb","startTime":919.99,"endTime":923.26,"body":"I'm gonna what I'm going to say"},{"speaker":"Charles Goldfarb","startTime":919.99,"endTime":923.26,"body":"next is going to make half of"},{"speaker":"Charles Goldfarb","startTime":923.26,"endTime":926.08,"body":"the audience roll their eyes and"},{"speaker":"Charles Goldfarb","startTime":923.26,"endTime":926.08,"body":"the other half is going to fist"},{"speaker":"Charles Goldfarb","startTime":926.08,"endTime":930.58,"body":"bump. Alright, so and this is"},{"speaker":"Charles Goldfarb","startTime":926.08,"endTime":930.58,"body":"all Talia, this is all my wife."},{"speaker":"Charles Goldfarb","startTime":930.85,"endTime":934.66,"body":"So I went to Amazon first and I"},{"speaker":"Charles Goldfarb","startTime":930.85,"endTime":934.66,"body":"looked at the book and I don't"},{"speaker":"Charles Goldfarb","startTime":934.66,"endTime":938.86,"body":"remember what it was 15 bucks or"},{"speaker":"Charles Goldfarb","startTime":934.66,"endTime":938.86,"body":"something. And I almost put it"},{"speaker":"Charles Goldfarb","startTime":938.86,"endTime":944.29,"body":"in my basket. And then I'm like,"},{"speaker":"Charles Goldfarb","startTime":938.86,"endTime":944.29,"body":"I should really order locally"},{"speaker":"Charles Goldfarb","startTime":944.29,"endTime":947.74,"body":"from from a local St. Louis"},{"speaker":"Charles Goldfarb","startTime":944.29,"endTime":947.74,"body":"bookstore. Because my wife has"},{"speaker":"Charles Goldfarb","startTime":947.74,"endTime":949.69,"body":"been pounding that in my head so"},{"speaker":"Charles Goldfarb","startTime":947.74,"endTime":949.69,"body":"I go-"},{"speaker":"Chris Dy","startTime":949.41,"endTime":951.69,"body":"Did you drive down the"},{"speaker":"Chris Dy","startTime":949.41,"endTime":951.69,"body":"left bank books or did you just"},{"speaker":"Chris Dy","startTime":951.69,"endTime":952.35,"body":"order online"},{"speaker":"Charles Goldfarb","startTime":953.29,"endTime":955.99,"body":"I ordered"},{"speaker":"Charles Goldfarb","startTime":953.29,"endTime":955.99,"body":"online from left bank books, and"},{"speaker":"Charles Goldfarb","startTime":955.99,"endTime":958.87,"body":"you know, it cost me 10 bucks"},{"speaker":"Charles Goldfarb","startTime":955.99,"endTime":958.87,"body":"more. It's not gonna be here for"},{"speaker":"Charles Goldfarb","startTime":958.87,"endTime":962.65,"body":"a week, which is fine, but I do"},{"speaker":"Charles Goldfarb","startTime":958.87,"endTime":962.65,"body":"feel better doing that. I really"},{"speaker":"Charles Goldfarb","startTime":962.65,"endTime":962.92,"body":"do."},{"speaker":"Chris Dy","startTime":963.4,"endTime":966.07,"body":"You know, if they do"},{"speaker":"Chris Dy","startTime":963.4,"endTime":966.07,"body":"curbside, I may go to Left Bank"},{"speaker":"Chris Dy","startTime":966.07,"endTime":969.07,"body":"books and then pick up some"},{"speaker":"Chris Dy","startTime":966.07,"endTime":969.07,"body":"Jenny's ice cream is just a"},{"speaker":"Chris Dy","startTime":969.07,"endTime":972.01,"body":"dangerous thing. Some some"},{"speaker":"Chris Dy","startTime":969.07,"endTime":972.01,"body":"listeners may be familiar with"},{"speaker":"Chris Dy","startTime":972.01,"endTime":974.26,"body":"Jenny's. I think it's from"},{"speaker":"Chris Dy","startTime":972.01,"endTime":974.26,"body":"Columbus, Ohio. And they have"},{"speaker":"Chris Dy","startTime":974.26,"endTime":977.92,"body":"multiple outposts. But man"},{"speaker":"Chris Dy","startTime":974.26,"endTime":977.92,"body":"that's the dangerous part about"},{"speaker":"Chris Dy","startTime":977.92,"endTime":980.47,"body":"being at left bank books for me."},{"speaker":"Chris Dy","startTime":977.92,"endTime":980.47,"body":"And then you've got you know,"},{"speaker":"Chris Dy","startTime":980.47,"endTime":983.05,"body":"that wonderful pie pizzeria"},{"speaker":"Chris Dy","startTime":980.47,"endTime":983.05,"body":"caddy corner. So that's a"},{"speaker":"Chris Dy","startTime":983.05,"endTime":984.85,"body":"dangerous corner down in the"},{"speaker":"Chris Dy","startTime":983.05,"endTime":984.85,"body":"Central West end."},{"speaker":"Charles Goldfarb","startTime":985.18,"endTime":987.28,"body":"It is and they"},{"speaker":"Charles Goldfarb","startTime":985.18,"endTime":987.28,"body":"actually have the book in stock."},{"speaker":"Charles Goldfarb","startTime":987.28,"endTime":990.73,"body":"And they do curbside so no"},{"speaker":"Charles Goldfarb","startTime":987.28,"endTime":990.73,"body":"reason to follow through on your"},{"speaker":"Charles Goldfarb","startTime":990.76,"endTime":991.39,"body":"Amazon order."},{"speaker":"Chris Dy","startTime":991.39,"endTime":996.43,"body":"Okay. So one question"},{"speaker":"Chris Dy","startTime":991.39,"endTime":996.43,"body":"for you after Jim Chang's"},{"speaker":"Chris Dy","startTime":996.43,"endTime":1000.69,"body":"lecture. He had some wonderful"},{"speaker":"Chris Dy","startTime":996.43,"endTime":1000.69,"body":"leadership pearls, a lot of"},{"speaker":"Chris Dy","startTime":1000.72,"endTime":1004.56,"body":"practical advice too about how"},{"speaker":"Chris Dy","startTime":1000.72,"endTime":1004.56,"body":"to integrate, I think it's"},{"speaker":"Chris Dy","startTime":1004.56,"endTime":1007.89,"body":"probably the way to say it, some"},{"speaker":"Chris Dy","startTime":1004.56,"endTime":1007.89,"body":"of your work and family"},{"speaker":"Chris Dy","startTime":1007.89,"endTime":1012.54,"body":"considerations. He mentioned"},{"speaker":"Chris Dy","startTime":1007.89,"endTime":1012.54,"body":"bringing his bringing one child"},{"speaker":"Chris Dy","startTime":1012.6,"endTime":1017.88,"body":"to to an academic meeting once"},{"speaker":"Chris Dy","startTime":1012.6,"endTime":1017.88,"body":"they've turned 10. Have you ever"},{"speaker":"Chris Dy","startTime":1017.88,"endTime":1020.46,"body":"done that? Obviously, it depends"},{"speaker":"Chris Dy","startTime":1017.88,"endTime":1020.46,"body":"on the meeting. And he did say"},{"speaker":"Chris Dy","startTime":1020.46,"endTime":1023.58,"body":"that and you know, or would you"},{"speaker":"Chris Dy","startTime":1020.46,"endTime":1023.58,"body":"ever do that? In retrospect,"},{"speaker":"Chris Dy","startTime":1023.64,"endTime":1024.84,"body":"would you wish you'd done it?"},{"speaker":"Charles Goldfarb","startTime":1025.62,"endTime":1028.23,"body":"Yeah, you"},{"speaker":"Charles Goldfarb","startTime":1025.62,"endTime":1028.23,"body":"know, I, others have recommended"},{"speaker":"Charles Goldfarb","startTime":1028.23,"endTime":1031.62,"body":"the same. And it really does"},{"speaker":"Charles Goldfarb","startTime":1028.23,"endTime":1031.62,"body":"depend on the meeting. So for"},{"speaker":"Charles Goldfarb","startTime":1031.62,"endTime":1035.07,"body":"example, the hands society,"},{"speaker":"Charles Goldfarb","startTime":1031.62,"endTime":1035.07,"body":"definitely for me, and I assume"},{"speaker":"Charles Goldfarb","startTime":1035.07,"endTime":1038.07,"body":"for you would be not a great"},{"speaker":"Charles Goldfarb","startTime":1035.07,"endTime":1038.07,"body":"idea, because we're so busy all"},{"speaker":"Charles Goldfarb","startTime":1038.07,"endTime":1042.0,"body":"day and all evening. For me, the"},{"speaker":"Charles Goldfarb","startTime":1038.07,"endTime":1042.0,"body":"Academy, the Orthopedic Academy"},{"speaker":"Charles Goldfarb","startTime":1042.0,"endTime":1044.76,"body":"would be fine, because I'm not"},{"speaker":"Charles Goldfarb","startTime":1042.0,"endTime":1044.76,"body":"that busy at The Academy, I've"},{"speaker":"Charles Goldfarb","startTime":1044.76,"endTime":1048.45,"body":"talked about it. For me, it's"},{"speaker":"Charles Goldfarb","startTime":1044.76,"endTime":1048.45,"body":"always been my kids are in"},{"speaker":"Charles Goldfarb","startTime":1048.45,"endTime":1051.33,"body":"sports, and they don't want to"},{"speaker":"Charles Goldfarb","startTime":1048.45,"endTime":1051.33,"body":"miss sports, and it's just never"},{"speaker":"Charles Goldfarb","startTime":1051.33,"endTime":1054.81,"body":"worked out. I love the idea. I"},{"speaker":"Charles Goldfarb","startTime":1051.33,"endTime":1054.81,"body":"think it's a great bonding"},{"speaker":"Charles Goldfarb","startTime":1054.81,"endTime":1058.53,"body":"opportunity. And I can"},{"speaker":"Charles Goldfarb","startTime":1054.81,"endTime":1058.53,"body":"definitely see you doing it. And"},{"speaker":"Charles Goldfarb","startTime":1058.53,"endTime":1061.05,"body":"I can see me babysitting when"},{"speaker":"Charles Goldfarb","startTime":1058.53,"endTime":1061.05,"body":"you're busier than I am at the"},{"speaker":"Charles Goldfarb","startTime":1061.05,"endTime":1061.41,"body":"meeting."},{"speaker":"Chris Dy","startTime":1062.44,"endTime":1065.83,"body":"The funny thing is, is"},{"speaker":"Chris Dy","startTime":1062.44,"endTime":1065.83,"body":"that before the the AAOS the"},{"speaker":"Chris Dy","startTime":1065.83,"endTime":1070.93,"body":"academy meeting was canceled for"},{"speaker":"Chris Dy","startTime":1065.83,"endTime":1070.93,"body":"March 2020. I was actually"},{"speaker":"Chris Dy","startTime":1070.93,"endTime":1074.14,"body":"planning on bringing my five"},{"speaker":"Chris Dy","startTime":1070.93,"endTime":1074.14,"body":"year old to the meeting, he's"},{"speaker":"Chris Dy","startTime":1074.14,"endTime":1077.08,"body":"was four at the time. And we"},{"speaker":"Chris Dy","startTime":1074.14,"endTime":1077.08,"body":"were going to we were going to"},{"speaker":"Chris Dy","startTime":1077.08,"endTime":1080.41,"body":"stay at one of the Universal"},{"speaker":"Chris Dy","startTime":1077.08,"endTime":1080.41,"body":"Orlando hotels, you know, with"},{"speaker":"Chris Dy","startTime":1080.41,"endTime":1083.17,"body":"all like the pool and all that"},{"speaker":"Chris Dy","startTime":1080.41,"endTime":1083.17,"body":"stuff. And I had a light"},{"speaker":"Chris Dy","startTime":1083.17,"endTime":1088.15,"body":"schedule relative to every other"},{"speaker":"Chris Dy","startTime":1083.17,"endTime":1088.15,"body":"meeting. And I was, actually the"},{"speaker":"Chris Dy","startTime":1088.15,"endTime":1090.7,"body":"Brogans one of our partners they"},{"speaker":"Chris Dy","startTime":1088.15,"endTime":1090.7,"body":"were going to watch over my son"},{"speaker":"Chris Dy","startTime":1090.7,"endTime":1094.12,"body":"for a little bit I had arranged"},{"speaker":"Chris Dy","startTime":1090.7,"endTime":1094.12,"body":"a cadre of babysitters from"},{"speaker":"Chris Dy","startTime":1094.27,"endTime":1099.13,"body":"former co residents and co"},{"speaker":"Chris Dy","startTime":1094.27,"endTime":1099.13,"body":"partners to to watch Rafi while"},{"speaker":"Chris Dy","startTime":1099.43,"endTime":1101.74,"body":"while I was at doing the minimal"},{"speaker":"Chris Dy","startTime":1099.43,"endTime":1101.74,"body":"amount of meeting stuff that I"},{"speaker":"Chris Dy","startTime":1101.74,"endTime":1104.5,"body":"needed to in terms of either I"},{"speaker":"Chris Dy","startTime":1101.74,"endTime":1104.5,"body":"was actually giving a lecture or"},{"speaker":"Chris Dy","startTime":1104.5,"endTime":1107.08,"body":"I was in a committee meeting."},{"speaker":"Chris Dy","startTime":1104.5,"endTime":1107.08,"body":"That all you know, obviously"},{"speaker":"Chris Dy","startTime":1107.08,"endTime":1109.9,"body":"those plans changed. I'm not"},{"speaker":"Chris Dy","startTime":1107.08,"endTime":1109.9,"body":"ruling it out for the future. I"},{"speaker":"Chris Dy","startTime":1109.9,"endTime":1112.66,"body":"don't know if I'm gonna wait"},{"speaker":"Chris Dy","startTime":1109.9,"endTime":1112.66,"body":"until 10 years old, I probably"},{"speaker":"Chris Dy","startTime":1112.66,"endTime":1117.01,"body":"will try to take advantage of it"},{"speaker":"Chris Dy","startTime":1112.66,"endTime":1117.01,"body":"sooner. But I will say one. One"},{"speaker":"Chris Dy","startTime":1117.01,"endTime":1122.11,"body":"remix that I did on that was"},{"speaker":"Chris Dy","startTime":1117.01,"endTime":1122.11,"body":"when we though I think one of"},{"speaker":"Chris Dy","startTime":1122.11,"endTime":1125.26,"body":"the last international trips I"},{"speaker":"Chris Dy","startTime":1122.11,"endTime":1125.26,"body":"took before the pandemic was"},{"speaker":"Chris Dy","startTime":1125.26,"endTime":1132.4,"body":"going to Korea going to Seoul in"},{"speaker":"Chris Dy","startTime":1125.26,"endTime":1132.4,"body":"November of 19. And, you know,"},{"speaker":"Chris Dy","startTime":1132.46,"endTime":1136.3,"body":"Marty Boyer kindly invited me"},{"speaker":"Chris Dy","startTime":1132.46,"endTime":1136.3,"body":"and David Brogan to join him as"},{"speaker":"Chris Dy","startTime":1136.3,"endTime":1139.48,"body":"part of the ASSH delegation to"},{"speaker":"Chris Dy","startTime":1136.3,"endTime":1139.48,"body":"the Korean society for surgery"},{"speaker":"Chris Dy","startTime":1139.48,"endTime":1144.07,"body":"of the Hands annual meeting. And"},{"speaker":"Chris Dy","startTime":1139.48,"endTime":1144.07,"body":"I never been to Seoul. I asked"},{"speaker":"Chris Dy","startTime":1144.07,"endTime":1146.68,"body":"my wife if she wanted to come"},{"speaker":"Chris Dy","startTime":1144.07,"endTime":1146.68,"body":"and she was couldn't make it"},{"speaker":"Chris Dy","startTime":1146.68,"endTime":1151.12,"body":"work in terms of work. But I"},{"speaker":"Chris Dy","startTime":1146.68,"endTime":1151.12,"body":"then asked my dad to come and"},{"speaker":"Chris Dy","startTime":1151.12,"endTime":1155.02,"body":"that was awesome. You know, I"},{"speaker":"Chris Dy","startTime":1151.12,"endTime":1155.02,"body":"had a different workshop I was"},{"speaker":"Chris Dy","startTime":1155.02,"endTime":1159.28,"body":"going to in Toronto right before"},{"speaker":"Chris Dy","startTime":1155.02,"endTime":1159.28,"body":"going to Seoul. And he joined he"},{"speaker":"Chris Dy","startTime":1159.28,"endTime":1164.02,"body":"met me in Toronto, and we hung"},{"speaker":"Chris Dy","startTime":1159.28,"endTime":1164.02,"body":"out there for a night or two and"},{"speaker":"Chris Dy","startTime":1164.02,"endTime":1168.1,"body":"then flew to Seoul and had a ton"},{"speaker":"Chris Dy","startTime":1164.02,"endTime":1168.1,"body":"of fun and the meeting, there"},{"speaker":"Chris Dy","startTime":1168.1,"endTime":1171.13,"body":"were meeting obligations of"},{"speaker":"Chris Dy","startTime":1168.1,"endTime":1171.13,"body":"course, and he explored Seoul in"},{"speaker":"Chris Dy","startTime":1171.13,"endTime":1174.28,"body":"part on his own but we had a lot"},{"speaker":"Chris Dy","startTime":1171.13,"endTime":1174.28,"body":"of time together and like you're"},{"speaker":"Chris Dy","startTime":1174.28,"endTime":1177.67,"body":"saying it's not just the you"},{"speaker":"Chris Dy","startTime":1174.28,"endTime":1177.67,"body":"know, the highlight sightseeing"},{"speaker":"Chris Dy","startTime":1177.67,"endTime":1181.75,"body":"stuff. It's the mundane, that"},{"speaker":"Chris Dy","startTime":1177.67,"endTime":1181.75,"body":"becomes very memorable."},{"speaker":"Charles Goldfarb","startTime":1182.5,"endTime":1186.28,"body":"Love that."},{"speaker":"Charles Goldfarb","startTime":1182.5,"endTime":1186.28,"body":"Love that. And I don't you know,"},{"speaker":"Charles Goldfarb","startTime":1186.28,"endTime":1189.88,"body":"I think our wives are busy and"},{"speaker":"Charles Goldfarb","startTime":1186.28,"endTime":1189.88,"body":"and I haven't had an opportunity"},{"speaker":"Charles Goldfarb","startTime":1189.94,"endTime":1192.13,"body":"to, Talia just chooses"},{"speaker":"Charles Goldfarb","startTime":1189.94,"endTime":1192.13,"body":"essentially not to come to"},{"speaker":"Charles Goldfarb","startTime":1192.13,"endTime":1194.47,"body":"medical meetings and I don't"},{"speaker":"Charles Goldfarb","startTime":1192.13,"endTime":1194.47,"body":"know that that'll change. Maybe"},{"speaker":"Charles Goldfarb","startTime":1194.47,"endTime":1196.72,"body":"it will when the kids kids are"},{"speaker":"Charles Goldfarb","startTime":1194.47,"endTime":1196.72,"body":"out of the house which is not"},{"speaker":"Charles Goldfarb","startTime":1196.72,"endTime":1201.88,"body":"that far distant but even that"},{"speaker":"Charles Goldfarb","startTime":1196.72,"endTime":1201.88,"body":"would be fun for me. But the"},{"speaker":"Charles Goldfarb","startTime":1201.88,"endTime":1204.7,"body":"kids is a whole nother level, I"},{"speaker":"Charles Goldfarb","startTime":1201.88,"endTime":1204.7,"body":"can see that working well for"},{"speaker":"Charles Goldfarb","startTime":1204.7,"endTime":1205.57,"body":"you, for sure."},{"speaker":"Chris Dy","startTime":1206.89,"endTime":1208.99,"body":"You're like, you're"},{"speaker":"Chris Dy","startTime":1206.89,"endTime":1208.99,"body":"not very busy at these meetings."},{"speaker":"Chris Dy","startTime":1209.8,"endTime":1212.68,"body":"You're not actually working"},{"speaker":"Chris Dy","startTime":1209.8,"endTime":1212.68,"body":"while our department pays for"},{"speaker":"Chris Dy","startTime":1212.68,"endTime":1216.1,"body":"you to be away. Well anyway, we"},{"speaker":"Chris Dy","startTime":1212.68,"endTime":1216.1,"body":"probably should talk about a"},{"speaker":"Chris Dy","startTime":1216.1,"endTime":1220.9,"body":"clinical topic, we've spent now"},{"speaker":"Chris Dy","startTime":1216.1,"endTime":1220.9,"body":"two episodes were rambling. 20"},{"speaker":"Chris Dy","startTime":1220.9,"endTime":1224.47,"body":"minutes before actually getting"},{"speaker":"Chris Dy","startTime":1220.9,"endTime":1224.47,"body":"to the topic. So a topic that's"},{"speaker":"Chris Dy","startTime":1224.47,"endTime":1227.95,"body":"closer to the sports world,"},{"speaker":"Chris Dy","startTime":1224.47,"endTime":1227.95,"body":"certainly, any general hand"},{"speaker":"Chris Dy","startTime":1227.98,"endTime":1231.22,"body":"surgeon or orthopedic surgeon,"},{"speaker":"Chris Dy","startTime":1227.98,"endTime":1231.22,"body":"plastic surgeon, and therapists"},{"speaker":"Chris Dy","startTime":1231.22,"endTime":1234.46,"body":"will see these issues. We want"},{"speaker":"Chris Dy","startTime":1231.22,"endTime":1234.46,"body":"to wanted to talk about, you"},{"speaker":"Chris Dy","startTime":1234.46,"endTime":1237.7,"body":"know, Bennett Rolando fractures"},{"speaker":"Chris Dy","startTime":1234.46,"endTime":1237.7,"body":"and also the corollary the"},{"speaker":"Chris Dy","startTime":1237.7,"endTime":1242.53,"body":"reverse or baby Bennett, you"},{"speaker":"Chris Dy","startTime":1237.7,"endTime":1242.53,"body":"know, ulnar sided CMC issues. So"},{"speaker":"Chris Dy","startTime":1243.01,"endTime":1246.07,"body":"should we start with the, with"},{"speaker":"Chris Dy","startTime":1243.01,"endTime":1246.07,"body":"the Bennett fracture?"},{"speaker":"Charles Goldfarb","startTime":1246.48,"endTime":1249.24,"body":"Yeah, let's"},{"speaker":"Charles Goldfarb","startTime":1246.48,"endTime":1249.24,"body":"talk about Bennetts. I I'm not"},{"speaker":"Charles Goldfarb","startTime":1249.24,"endTime":1251.97,"body":"an eponym person. I don't know"},{"speaker":"Charles Goldfarb","startTime":1249.24,"endTime":1251.97,"body":"about you, but I think most of"},{"speaker":"Charles Goldfarb","startTime":1251.97,"endTime":1254.52,"body":"us that's all you have to say"},{"speaker":"Charles Goldfarb","startTime":1251.97,"endTime":1254.52,"body":"you say Bennett and you know"},{"speaker":"Charles Goldfarb","startTime":1254.52,"endTime":1257.43,"body":"that there's a single fragment,"},{"speaker":"Charles Goldfarb","startTime":1254.52,"endTime":1257.43,"body":"you say Rolando, you know,"},{"speaker":"Charles Goldfarb","startTime":1257.43,"endTime":1261.0,"body":"multiple fragments? And and, you"},{"speaker":"Charles Goldfarb","startTime":1257.43,"endTime":1261.0,"body":"know, we think about the"},{"speaker":"Charles Goldfarb","startTime":1261.0,"endTime":1264.36,"body":"deforming force being primarily"},{"speaker":"Charles Goldfarb","startTime":1261.0,"endTime":1264.36,"body":"the abductor pollicis longus,"},{"speaker":"Charles Goldfarb","startTime":1265.29,"endTime":1267.75,"body":"but these are sports injuries,"},{"speaker":"Charles Goldfarb","startTime":1265.29,"endTime":1267.75,"body":"certainly they happen in car"},{"speaker":"Charles Goldfarb","startTime":1267.75,"endTime":1270.69,"body":"accidents, and they happen in"},{"speaker":"Charles Goldfarb","startTime":1267.75,"endTime":1270.69,"body":"random situations, but we see"},{"speaker":"Charles Goldfarb","startTime":1270.69,"endTime":1272.52,"body":"them commonly in sports."},{"speaker":"Chris Dy","startTime":1273.45,"endTime":1277.14,"body":"Yeah, I mean, I think"},{"speaker":"Chris Dy","startTime":1273.45,"endTime":1277.14,"body":"that this is a good fracture, to"},{"speaker":"Chris Dy","startTime":1277.14,"endTime":1280.02,"body":"think about for a number of"},{"speaker":"Chris Dy","startTime":1277.14,"endTime":1280.02,"body":"reasons. You know, from a"},{"speaker":"Chris Dy","startTime":1280.02,"endTime":1282.9,"body":"trainee perspective,"},{"speaker":"Chris Dy","startTime":1280.02,"endTime":1282.9,"body":"anatomically, it's a fracture"},{"speaker":"Chris Dy","startTime":1282.9,"endTime":1287.34,"body":"that makes a lot of sense. Like,"},{"speaker":"Chris Dy","startTime":1282.9,"endTime":1287.34,"body":"once you get in your mind that"},{"speaker":"Chris Dy","startTime":1287.43,"endTime":1292.05,"body":"the volar beak ligament is going"},{"speaker":"Chris Dy","startTime":1287.43,"endTime":1292.05,"body":"to keep a small portion, but"},{"speaker":"Chris Dy","startTime":1292.05,"endTime":1295.29,"body":"important portion of that thumb"},{"speaker":"Chris Dy","startTime":1292.05,"endTime":1295.29,"body":"metacarpal in place, and the"},{"speaker":"Chris Dy","startTime":1295.29,"endTime":1299.22,"body":"rest of the thumb is going to"},{"speaker":"Chris Dy","startTime":1295.29,"endTime":1299.22,"body":"displace based on the deforming"},{"speaker":"Chris Dy","startTime":1299.22,"endTime":1302.64,"body":"forces that you described, then"},{"speaker":"Chris Dy","startTime":1299.22,"endTime":1302.64,"body":"it all kind of makes sense."},{"speaker":"Chris Dy","startTime":1302.64,"endTime":1306.54,"body":"Right? You know, and I think"},{"speaker":"Chris Dy","startTime":1302.64,"endTime":1306.54,"body":"that it's, it's, it's very"},{"speaker":"Chris Dy","startTime":1306.54,"endTime":1311.04,"body":"testable, it comes up on a lot"},{"speaker":"Chris Dy","startTime":1306.54,"endTime":1311.04,"body":"of in training exams. And I know"},{"speaker":"Chris Dy","startTime":1311.04,"endTime":1313.77,"body":"that when you gave your most"},{"speaker":"Chris Dy","startTime":1311.04,"endTime":1313.77,"body":"recent interactive lecture for"},{"speaker":"Chris Dy","startTime":1313.77,"endTime":1315.93,"body":"our residents, I think that you"},{"speaker":"Chris Dy","startTime":1313.77,"endTime":1315.93,"body":"spent a little bit of time on"},{"speaker":"Chris Dy","startTime":1315.93,"endTime":1316.71,"body":"this fracture too."},{"speaker":"Charles Goldfarb","startTime":1317.76,"endTime":1321.24,"body":"Yeah, for the"},{"speaker":"Charles Goldfarb","startTime":1317.76,"endTime":1321.24,"body":"reasons you say it is, when we,"},{"speaker":"Charles Goldfarb","startTime":1321.27,"endTime":1326.22,"body":"you know, every we should try as"},{"speaker":"Charles Goldfarb","startTime":1321.27,"endTime":1326.22,"body":"surgeons, and certainly, all"},{"speaker":"Charles Goldfarb","startTime":1326.22,"endTime":1328.8,"body":"listeners should try to"},{"speaker":"Charles Goldfarb","startTime":1326.22,"endTime":1328.8,"body":"understand the personality of"},{"speaker":"Charles Goldfarb","startTime":1328.8,"endTime":1331.53,"body":"fractures. And I think when I"},{"speaker":"Charles Goldfarb","startTime":1328.8,"endTime":1331.53,"body":"first started out, I kind of"},{"speaker":"Charles Goldfarb","startTime":1331.62,"endTime":1334.59,"body":"rolled my eyes when people said"},{"speaker":"Charles Goldfarb","startTime":1331.62,"endTime":1334.59,"body":"that, but the more we work to"},{"speaker":"Charles Goldfarb","startTime":1334.59,"endTime":1337.8,"body":"understand the fractures,"},{"speaker":"Charles Goldfarb","startTime":1334.59,"endTime":1337.8,"body":"whether they are of the thumb,"},{"speaker":"Charles Goldfarb","startTime":1337.8,"endTime":1341.4,"body":"metacarpal, or of the distal"},{"speaker":"Charles Goldfarb","startTime":1337.8,"endTime":1341.4,"body":"radius, I think the better we"},{"speaker":"Charles Goldfarb","startTime":1341.4,"endTime":1344.94,"body":"can be at treating those"},{"speaker":"Charles Goldfarb","startTime":1341.4,"endTime":1344.94,"body":"fractures successfully. And the"},{"speaker":"Charles Goldfarb","startTime":1345.15,"endTime":1348.87,"body":"Bennett fracture is just it's"},{"speaker":"Charles Goldfarb","startTime":1345.15,"endTime":1348.87,"body":"not that hard to understand. I"},{"speaker":"Charles Goldfarb","startTime":1348.87,"endTime":1352.89,"body":"will say, when we talk about the"},{"speaker":"Charles Goldfarb","startTime":1348.87,"endTime":1352.89,"body":"reduction maneuver, we talk"},{"speaker":"Charles Goldfarb","startTime":1352.89,"endTime":1355.89,"body":"about traction, we talk about"},{"speaker":"Charles Goldfarb","startTime":1352.89,"endTime":1355.89,"body":"direct pressure on the"},{"speaker":"Charles Goldfarb","startTime":1355.89,"endTime":1360.96,"body":"metacarpal. And then we tend to"},{"speaker":"Charles Goldfarb","startTime":1355.89,"endTime":1360.96,"body":"talk about rotation. And the"},{"speaker":"Charles Goldfarb","startTime":1360.96,"endTime":1364.32,"body":"rotation part is the part that I"},{"speaker":"Charles Goldfarb","startTime":1360.96,"endTime":1364.32,"body":"sometimes I will supinate it, I"},{"speaker":"Charles Goldfarb","startTime":1364.32,"endTime":1366.99,"body":"will pronate it I will do"},{"speaker":"Charles Goldfarb","startTime":1364.32,"endTime":1366.99,"body":"whatever I can to get the"},{"speaker":"Charles Goldfarb","startTime":1366.99,"endTime":1369.33,"body":"reduction, but I think the"},{"speaker":"Charles Goldfarb","startTime":1366.99,"endTime":1369.33,"body":"traction and the direct"},{"speaker":"Charles Goldfarb","startTime":1369.33,"endTime":1372.3,"body":"pressure, downward pressure on"},{"speaker":"Charles Goldfarb","startTime":1369.33,"endTime":1372.3,"body":"the metacarpal are the two most"},{"speaker":"Charles Goldfarb","startTime":1372.3,"endTime":1375.33,"body":"important parts. And I just try"},{"speaker":"Charles Goldfarb","startTime":1372.3,"endTime":1375.33,"body":"to get to key and with rotation."},{"speaker":"Chris Dy","startTime":1375.83,"endTime":1378.29,"body":"Yeah, I agree with"},{"speaker":"Chris Dy","startTime":1375.83,"endTime":1378.29,"body":"you. 100%. That's where I think"},{"speaker":"Chris Dy","startTime":1378.29,"endTime":1380.42,"body":"that you know, there's certainly"},{"speaker":"Chris Dy","startTime":1378.29,"endTime":1380.42,"body":"a book answer. And then there's"},{"speaker":"Chris Dy","startTime":1380.42,"endTime":1384.41,"body":"the real world, you know, how"},{"speaker":"Chris Dy","startTime":1380.42,"endTime":1384.41,"body":"you actually take care of it."},{"speaker":"Chris Dy","startTime":1385.37,"endTime":1389.06,"body":"You know, so what is an"},{"speaker":"Chris Dy","startTime":1385.37,"endTime":1389.06,"body":"acceptable amount of"},{"speaker":"Chris Dy","startTime":1389.06,"endTime":1392.39,"body":"displacement for this fracture?"},{"speaker":"Chris Dy","startTime":1389.06,"endTime":1392.39,"body":"Is there an acceptable amount of"},{"speaker":"Chris Dy","startTime":1392.39,"endTime":1395.99,"body":"displacement for this fracture,"},{"speaker":"Chris Dy","startTime":1392.39,"endTime":1395.99,"body":"and I'll say, not necessarily"},{"speaker":"Chris Dy","startTime":1395.99,"endTime":1398.48,"body":"for the articular surface,"},{"speaker":"Chris Dy","startTime":1395.99,"endTime":1398.48,"body":"because that's an entire little"},{"speaker":"Chris Dy","startTime":1398.54,"endTime":1401.33,"body":"subtopic, we could talk about,"},{"speaker":"Chris Dy","startTime":1398.54,"endTime":1401.33,"body":"but just for the thumb in"},{"speaker":"Chris Dy","startTime":1401.33,"endTime":1401.84,"body":"general."},{"speaker":"Charles Goldfarb","startTime":1402.65,"endTime":1408.26,"body":"So when I was"},{"speaker":"Charles Goldfarb","startTime":1402.65,"endTime":1408.26,"body":"17, heading off to college, I"},{"speaker":"Charles Goldfarb","startTime":1408.26,"endTime":1413.27,"body":"played soccer goalkeeper in"},{"speaker":"Charles Goldfarb","startTime":1408.26,"endTime":1413.27,"body":"college, and I was training and"},{"speaker":"Charles Goldfarb","startTime":1413.27,"endTime":1415.82,"body":"I sustained a Bennett fracture"},{"speaker":"Charles Goldfarb","startTime":1413.27,"endTime":1415.82,"body":"about two weeks before I was to"},{"speaker":"Charles Goldfarb","startTime":1415.82,"endTime":1417.14,"body":"report to my first camp."},{"speaker":"Chris Dy","startTime":1418.43,"endTime":1419.51,"body":"Is that your first"},{"speaker":"Chris Dy","startTime":1418.43,"endTime":1419.51,"body":"fracture?"},{"speaker":"Charles Goldfarb","startTime":1420.56,"endTime":1422.96,"body":"I had an ankle"},{"speaker":"Charles Goldfarb","startTime":1420.56,"endTime":1422.96,"body":"fracture prior to that, but that"},{"speaker":"Charles Goldfarb","startTime":1423.02,"endTime":1425.57,"body":"this one was impactful in a"},{"speaker":"Charles Goldfarb","startTime":1423.02,"endTime":1425.57,"body":"different way, just because I"},{"speaker":"Charles Goldfarb","startTime":1425.57,"endTime":1429.26,"body":"was, you know, going to college"},{"speaker":"Charles Goldfarb","startTime":1425.57,"endTime":1429.26,"body":"and you know, expected to play"},{"speaker":"Charles Goldfarb","startTime":1429.26,"endTime":1432.41,"body":"soccer. And this was"},{"speaker":"Charles Goldfarb","startTime":1429.26,"endTime":1432.41,"body":"challenging. I remember the"},{"speaker":"Charles Goldfarb","startTime":1432.41,"endTime":1435.59,"body":"sports surgeon i saw i didn't"},{"speaker":"Charles Goldfarb","startTime":1432.41,"endTime":1435.59,"body":"see a hand surgeon Go figure."},{"speaker":"Charles Goldfarb","startTime":1435.89,"endTime":1439.01,"body":"And he said, Oh, you'll be fine."},{"speaker":"Charles Goldfarb","startTime":1435.89,"endTime":1439.01,"body":"You could have problems later."},{"speaker":"Charles Goldfarb","startTime":1439.01,"endTime":1445.88,"body":"Well, laters now because I'm"},{"speaker":"Charles Goldfarb","startTime":1439.01,"endTime":1445.88,"body":"hurt. And I'm too scared to x"},{"speaker":"Charles Goldfarb","startTime":1445.88,"endTime":1447.2,"body":"ray it. So I haven't looked at"},{"speaker":"Charles Goldfarb","startTime":1445.88,"endTime":1447.2,"body":"it lately."},{"speaker":"Chris Dy","startTime":1447.56,"endTime":1449.6,"body":"Come on, you have"},{"speaker":"Chris Dy","startTime":1447.56,"endTime":1449.6,"body":"never you've never run in under"},{"speaker":"Chris Dy","startTime":1449.6,"endTime":1450.29,"body":"the C arm?"},{"speaker":"Charles Goldfarb","startTime":1450.38,"endTime":1453.17,"body":"I have not. I"},{"speaker":"Charles Goldfarb","startTime":1450.38,"endTime":1453.17,"body":"have not, maybe I will but I"},{"speaker":"Charles Goldfarb","startTime":1453.17,"endTime":1453.56,"body":"have not."},{"speaker":"Chris Dy","startTime":1453.59,"endTime":1456.08,"body":"Your disability"},{"speaker":"Chris Dy","startTime":1453.59,"endTime":1456.08,"body":"insurance agent is probably not"},{"speaker":"Chris Dy","startTime":1456.08,"endTime":1456.5,"body":"listening."},{"speaker":"Charles Goldfarb","startTime":1458.03,"endTime":1461.72,"body":"True. But you"},{"speaker":"Charles Goldfarb","startTime":1458.03,"endTime":1461.72,"body":"know, I went through a phase"},{"speaker":"Charles Goldfarb","startTime":1461.72,"endTime":1464.69,"body":"where I would scope these to get"},{"speaker":"Charles Goldfarb","startTime":1461.72,"endTime":1464.69,"body":"to the actual the articular"},{"speaker":"Charles Goldfarb","startTime":1464.69,"endTime":1467.93,"body":"part. I just don't think that's"},{"speaker":"Charles Goldfarb","startTime":1464.69,"endTime":1467.93,"body":"an efficient use of resources or"},{"speaker":"Charles Goldfarb","startTime":1467.93,"endTime":1471.56,"body":"typically necessary. And it is"},{"speaker":"Charles Goldfarb","startTime":1467.93,"endTime":1471.56,"body":"for me all about the articular"},{"speaker":"Charles Goldfarb","startTime":1471.56,"endTime":1474.56,"body":"surface. And I think that it"},{"speaker":"Charles Goldfarb","startTime":1471.56,"endTime":1474.56,"body":"needs to be a millimeter or"},{"speaker":"Charles Goldfarb","startTime":1474.56,"endTime":1478.04,"body":"less. I think it really does."},{"speaker":"Charles Goldfarb","startTime":1474.56,"endTime":1478.04,"body":"And I don't think that's"},{"speaker":"Charles Goldfarb","startTime":1478.04,"endTime":1481.88,"body":"typically very hard to get"},{"speaker":"Charles Goldfarb","startTime":1478.04,"endTime":1481.88,"body":"closed. But there are"},{"speaker":"Charles Goldfarb","startTime":1481.88,"endTime":1483.53,"body":"opportunities when we open it."},{"speaker":"Chris Dy","startTime":1485.06,"endTime":1488.36,"body":"So we this is probably"},{"speaker":"Chris Dy","startTime":1485.06,"endTime":1488.36,"body":"one of the fractures where I"},{"speaker":"Chris Dy","startTime":1488.36,"endTime":1492.68,"body":"think there's some controversy"},{"speaker":"Chris Dy","startTime":1488.36,"endTime":1492.68,"body":"as to how much step off in gap"},{"speaker":"Chris Dy","startTime":1492.71,"endTime":1496.16,"body":"you could potentially accept at"},{"speaker":"Chris Dy","startTime":1492.71,"endTime":1496.16,"body":"the articular surface. So you"},{"speaker":"Chris Dy","startTime":1496.16,"endTime":1499.04,"body":"seem to think it's a millimeter"},{"speaker":"Chris Dy","startTime":1496.16,"endTime":1499.04,"body":"Do you fault anybody that says"},{"speaker":"Chris Dy","startTime":1499.04,"endTime":1501.59,"body":"you know, you can just get in"},{"speaker":"Chris Dy","startTime":1499.04,"endTime":1501.59,"body":"the ballpark, it'll be okay."},{"speaker":"Charles Goldfarb","startTime":1502.71,"endTime":1506.73,"body":"Like many"},{"speaker":"Charles Goldfarb","startTime":1502.71,"endTime":1506.73,"body":"things, I focus more on step and"},{"speaker":"Charles Goldfarb","startTime":1506.73,"endTime":1511.11,"body":"less on gap. And so a step off"},{"speaker":"Charles Goldfarb","startTime":1506.73,"endTime":1511.11,"body":"deformity to me is definitely"},{"speaker":"Charles Goldfarb","startTime":1511.11,"endTime":1512.88,"body":"more concerning if someone's-"},{"speaker":"Chris Dy","startTime":1512.91,"endTime":1514.71,"body":"So then for somebody"},{"speaker":"Chris Dy","startTime":1512.91,"endTime":1514.71,"body":"who's not familiar with that"},{"speaker":"Chris Dy","startTime":1514.71,"endTime":1517.5,"body":"concept. So why is a step worse"},{"speaker":"Chris Dy","startTime":1514.71,"endTime":1517.5,"body":"than a gap?"},{"speaker":"Charles Goldfarb","startTime":1518.34,"endTime":1520.8,"body":"I think with a"},{"speaker":"Charles Goldfarb","startTime":1518.34,"endTime":1520.8,"body":"gap deformity So literally, the"},{"speaker":"Charles Goldfarb","startTime":1520.8,"endTime":1524.43,"body":"articular surfaces is well"},{"speaker":"Charles Goldfarb","startTime":1520.8,"endTime":1524.43,"body":"aligned, but it's just"},{"speaker":"Charles Goldfarb","startTime":1524.43,"endTime":1532.05,"body":"separated. I think that the"},{"speaker":"Charles Goldfarb","startTime":1524.43,"endTime":1532.05,"body":"forces traveling across the"},{"speaker":"Charles Goldfarb","startTime":1532.05,"endTime":1536.1,"body":"thumb down to the trapezium are"},{"speaker":"Charles Goldfarb","startTime":1532.05,"endTime":1536.1,"body":"still evenly dispersed. When"},{"speaker":"Charles Goldfarb","startTime":1536.1,"endTime":1538.83,"body":"there is a literal step off"},{"speaker":"Charles Goldfarb","startTime":1536.1,"endTime":1538.83,"body":"where part of the articular"},{"speaker":"Charles Goldfarb","startTime":1538.83,"endTime":1541.32,"body":"surface is closer to the"},{"speaker":"Charles Goldfarb","startTime":1538.83,"endTime":1541.32,"body":"trapezium than the rest of the"},{"speaker":"Charles Goldfarb","startTime":1541.32,"endTime":1545.82,"body":"articular surface, the forces"},{"speaker":"Charles Goldfarb","startTime":1541.32,"endTime":1545.82,"body":"are magnified on a certain part"},{"speaker":"Charles Goldfarb","startTime":1545.82,"endTime":1548.4,"body":"of the joint, which is not"},{"speaker":"Charles Goldfarb","startTime":1545.82,"endTime":1548.4,"body":"tolerated well."},{"speaker":"Chris Dy","startTime":1548.7,"endTime":1549.93,"body":"Pressure divided by"},{"speaker":"Chris Dy","startTime":1548.7,"endTime":1549.93,"body":"area."},{"speaker":"Charles Goldfarb","startTime":1550.17,"endTime":1554.16,"body":"Thank you."},{"speaker":"Charles Goldfarb","startTime":1550.17,"endTime":1554.16,"body":"Well said. So yeah, so I think"},{"speaker":"Charles Goldfarb","startTime":1554.16,"endTime":1557.25,"body":"if you had a two millimeter gap,"},{"speaker":"Charles Goldfarb","startTime":1554.16,"endTime":1557.25,"body":"I wouldn't think it's crazy. If"},{"speaker":"Charles Goldfarb","startTime":1557.25,"endTime":1559.29,"body":"it's a three, four or five"},{"speaker":"Charles Goldfarb","startTime":1557.25,"endTime":1559.29,"body":"millimeter gap, very different"},{"speaker":"Charles Goldfarb","startTime":1559.29,"endTime":1561.96,"body":"story. I don't know how much"},{"speaker":"Charles Goldfarb","startTime":1559.29,"endTime":1561.96,"body":"depth is okay. But I would hope"},{"speaker":"Charles Goldfarb","startTime":1561.96,"endTime":1563.73,"body":"it would be less than two"},{"speaker":"Charles Goldfarb","startTime":1561.96,"endTime":1563.73,"body":"millimeters for sure."},{"speaker":"Chris Dy","startTime":1564.09,"endTime":1567.72,"body":"Well, so you mentioned"},{"speaker":"Chris Dy","startTime":1564.09,"endTime":1567.72,"body":"that it's a lot easier to to"},{"speaker":"Chris Dy","startTime":1567.72,"endTime":1570.21,"body":"make the articular surface as"},{"speaker":"Chris Dy","startTime":1567.72,"endTime":1570.21,"body":"perfect as you would like to"},{"speaker":"Chris Dy","startTime":1570.21,"endTime":1574.68,"body":"make it if you open when do you"},{"speaker":"Chris Dy","startTime":1570.21,"endTime":1574.68,"body":"treat these closed versus when"},{"speaker":"Chris Dy","startTime":1574.68,"endTime":1578.58,"body":"do you treat them open? And you"},{"speaker":"Chris Dy","startTime":1574.68,"endTime":1578.58,"body":"know, say you've got a good and"},{"speaker":"Chris Dy","startTime":1578.58,"endTime":1582.81,"body":"acceptable, but not perfect"},{"speaker":"Chris Dy","startTime":1578.58,"endTime":1582.81,"body":"articular reduction with with"},{"speaker":"Chris Dy","startTime":1582.81,"endTime":1584.88,"body":"closed means when do you decide"},{"speaker":"Chris Dy","startTime":1582.81,"endTime":1584.88,"body":"to open?"},{"speaker":"Charles Goldfarb","startTime":1585.56,"endTime":1587.78,"body":"Well, I think"},{"speaker":"Charles Goldfarb","startTime":1585.56,"endTime":1587.78,"body":"there's there's variable"},{"speaker":"Charles Goldfarb","startTime":1587.78,"endTime":1592.73,"body":"factors, as we might expect, age"},{"speaker":"Charles Goldfarb","startTime":1587.78,"endTime":1592.73,"body":"related for sure, I have, you"},{"speaker":"Charles Goldfarb","startTime":1592.73,"endTime":1595.4,"body":"know, in my age group, I would"},{"speaker":"Charles Goldfarb","startTime":1592.73,"endTime":1595.4,"body":"have more of a tolerance for"},{"speaker":"Charles Goldfarb","startTime":1595.4,"endTime":1602.18,"body":"displacement. But when you think"},{"speaker":"Charles Goldfarb","startTime":1595.4,"endTime":1602.18,"body":"about the sports population, I"},{"speaker":"Charles Goldfarb","startTime":1602.18,"endTime":1606.14,"body":"think there's another reason to"},{"speaker":"Charles Goldfarb","startTime":1602.18,"endTime":1606.14,"body":"open if your fragment is big"},{"speaker":"Charles Goldfarb","startTime":1606.14,"endTime":1610.82,"body":"enough, I would prefer to put a"},{"speaker":"Charles Goldfarb","startTime":1606.14,"endTime":1610.82,"body":"couple of screws or a small"},{"speaker":"Charles Goldfarb","startTime":1610.82,"endTime":1614.72,"body":"plate and screws and create a"},{"speaker":"Charles Goldfarb","startTime":1610.82,"endTime":1614.72,"body":"construct that's stable without"},{"speaker":"Charles Goldfarb","startTime":1614.72,"endTime":1617.54,"body":"pins external to the skin,"},{"speaker":"Charles Goldfarb","startTime":1614.72,"endTime":1617.54,"body":"because it totally changes"},{"speaker":"Charles Goldfarb","startTime":1617.54,"endTime":1624.95,"body":"return to play. So pins have"},{"speaker":"Charles Goldfarb","startTime":1617.54,"endTime":1624.95,"body":"increasingly become well that"},{"speaker":"Charles Goldfarb","startTime":1624.95,"endTime":1626.75,"body":"won't make sense, but"},{"speaker":"Charles Goldfarb","startTime":1624.95,"endTime":1626.75,"body":"increasingly become less"},{"speaker":"Charles Goldfarb","startTime":1626.75,"endTime":1630.2,"body":"desirable in taking care of the"},{"speaker":"Charles Goldfarb","startTime":1626.75,"endTime":1630.2,"body":"athlete, the high level athlete,"},{"speaker":"Charles Goldfarb","startTime":1630.2,"endTime":1632.42,"body":"whether it's professional, or"},{"speaker":"Charles Goldfarb","startTime":1630.2,"endTime":1632.42,"body":"college, or high level, high"},{"speaker":"Charles Goldfarb","startTime":1632.42,"endTime":1634.79,"body":"school, whatever you want to"},{"speaker":"Charles Goldfarb","startTime":1632.42,"endTime":1634.79,"body":"call it. Because when someone"},{"speaker":"Charles Goldfarb","startTime":1634.79,"endTime":1637.37,"body":"has pins in, you have to be"},{"speaker":"Charles Goldfarb","startTime":1634.79,"endTime":1637.37,"body":"careful about even sweating, and"},{"speaker":"Charles Goldfarb","startTime":1637.37,"endTime":1640.4,"body":"you certainly have to avoid"},{"speaker":"Charles Goldfarb","startTime":1637.37,"endTime":1640.4,"body":"contact and the risks go up if"},{"speaker":"Charles Goldfarb","startTime":1640.4,"endTime":1644.03,"body":"someone has a plate or good"},{"speaker":"Charles Goldfarb","startTime":1640.4,"endTime":1644.03,"body":"screws, and the wound is close,"},{"speaker":"Charles Goldfarb","startTime":1644.21,"endTime":1647.51,"body":"you know, within a few days,"},{"speaker":"Charles Goldfarb","startTime":1644.21,"endTime":1647.51,"body":"usually three to five days Max,"},{"speaker":"Charles Goldfarb","startTime":1647.51,"endTime":1650.63,"body":"I'll let them sweat and do"},{"speaker":"Charles Goldfarb","startTime":1647.51,"endTime":1650.63,"body":"cardiovascular. And so staying"},{"speaker":"Charles Goldfarb","startTime":1650.63,"endTime":1653.21,"body":"in shape is easier, and then"},{"speaker":"Charles Goldfarb","startTime":1650.63,"endTime":1653.21,"body":"potentially get back to play"},{"speaker":"Charles Goldfarb","startTime":1653.21,"endTime":1657.74,"body":"with a little external"},{"speaker":"Charles Goldfarb","startTime":1653.21,"endTime":1657.74,"body":"protection much faster. And so I"},{"speaker":"Charles Goldfarb","startTime":1658.58,"endTime":1662.69,"body":"am giving a long winded answer."},{"speaker":"Charles Goldfarb","startTime":1658.58,"endTime":1662.69,"body":"But I for a standard non"},{"speaker":"Charles Goldfarb","startTime":1662.69,"endTime":1665.96,"body":"athlete, where I can get a good"},{"speaker":"Charles Goldfarb","startTime":1662.69,"endTime":1665.96,"body":"reduction closed, pinning is"},{"speaker":"Charles Goldfarb","startTime":1665.96,"endTime":1670.64,"body":"fantastic. But there are reasons"},{"speaker":"Charles Goldfarb","startTime":1665.96,"endTime":1670.64,"body":"even in that population to open"},{"speaker":"Charles Goldfarb","startTime":1670.64,"endTime":1673.01,"body":"if you just simply are not"},{"speaker":"Charles Goldfarb","startTime":1670.64,"endTime":1673.01,"body":"satisfied with your reduction."},{"speaker":"Chris Dy","startTime":1674.21,"endTime":1676.97,"body":"How often when you're"},{"speaker":"Chris Dy","startTime":1674.21,"endTime":1676.97,"body":"doing this closed, do you go"},{"speaker":"Chris Dy","startTime":1676.97,"endTime":1680.84,"body":"after the volar ulnar beak"},{"speaker":"Chris Dy","startTime":1676.97,"endTime":1680.84,"body":"ligament fragment? Do you try to"},{"speaker":"Chris Dy","startTime":1680.84,"endTime":1684.47,"body":"pin into that? Are you basically"},{"speaker":"Chris Dy","startTime":1680.84,"endTime":1684.47,"body":"pinning the joint around the"},{"speaker":"Chris Dy","startTime":1684.47,"endTime":1684.95,"body":"fragment?"},{"speaker":"Charles Goldfarb","startTime":1685.95,"endTime":1688.95,"body":"I think you"},{"speaker":"Charles Goldfarb","startTime":1685.95,"endTime":1688.95,"body":"one can do either. And in our"},{"speaker":"Charles Goldfarb","startTime":1688.98,"endTime":1692.31,"body":"you know, in our setting where"},{"speaker":"Charles Goldfarb","startTime":1688.98,"endTime":1692.31,"body":"we have assistants and and"},{"speaker":"Charles Goldfarb","startTime":1692.37,"endTime":1695.76,"body":"various factors about how a"},{"speaker":"Charles Goldfarb","startTime":1692.37,"endTime":1695.76,"body":"procedure may be done. It"},{"speaker":"Charles Goldfarb","startTime":1695.76,"endTime":1700.2,"body":"doesn't really matter does it? I"},{"speaker":"Charles Goldfarb","startTime":1695.76,"endTime":1700.2,"body":"think as long as we can secure"},{"speaker":"Charles Goldfarb","startTime":1700.5,"endTime":1704.61,"body":"the metacarpal to that beak"},{"speaker":"Charles Goldfarb","startTime":1700.5,"endTime":1704.61,"body":"ligament fragment, I think we've"},{"speaker":"Charles Goldfarb","startTime":1704.61,"endTime":1709.32,"body":"done our job. And if usually I"},{"speaker":"Charles Goldfarb","startTime":1704.61,"endTime":1709.32,"body":"put two pins in, I love it if"},{"speaker":"Charles Goldfarb","startTime":1709.32,"endTime":1713.61,"body":"what I'm just for aesthetics of"},{"speaker":"Charles Goldfarb","startTime":1709.32,"endTime":1713.61,"body":"the X ray, I love it if one of"},{"speaker":"Charles Goldfarb","startTime":1713.61,"endTime":1716.55,"body":"them crosses the fracture and"},{"speaker":"Charles Goldfarb","startTime":1713.61,"endTime":1716.55,"body":"secures the fracture, and the"},{"speaker":"Charles Goldfarb","startTime":1716.55,"endTime":1719.58,"body":"other one may actually go from"},{"speaker":"Charles Goldfarb","startTime":1716.55,"endTime":1719.58,"body":"the metacarpal to the trapezium."},{"speaker":"Charles Goldfarb","startTime":1720.42,"endTime":1725.64,"body":"I don't like pins going across"},{"speaker":"Charles Goldfarb","startTime":1720.42,"endTime":1725.64,"body":"the first webspace. So a pin mid"},{"speaker":"Charles Goldfarb","startTime":1725.64,"endTime":1729.3,"body":"metacarpal or distal going to"},{"speaker":"Charles Goldfarb","startTime":1725.64,"endTime":1729.3,"body":"the second metacarpal there's a"},{"speaker":"Charles Goldfarb","startTime":1729.3,"endTime":1732.87,"body":"role for that pin, but not here."},{"speaker":"Charles Goldfarb","startTime":1729.3,"endTime":1732.87,"body":"I don't want to scar the first"},{"speaker":"Charles Goldfarb","startTime":1732.87,"endTime":1735.69,"body":"dorsal interrosseus and scar the"},{"speaker":"Charles Goldfarb","startTime":1732.87,"endTime":1735.69,"body":"first webspace. So I don't put"},{"speaker":"Charles Goldfarb","startTime":1735.69,"endTime":1736.77,"body":"that in in this fraction."},{"speaker":"Chris Dy","startTime":1737.38,"endTime":1739.48,"body":"Yeah, I will say and"},{"speaker":"Chris Dy","startTime":1737.38,"endTime":1739.48,"body":"this is probably not the"},{"speaker":"Chris Dy","startTime":1739.48,"endTime":1742.42,"body":"appropriate thing to say. But I"},{"speaker":"Chris Dy","startTime":1739.48,"endTime":1742.42,"body":"do like the marksmanship aspect"},{"speaker":"Chris Dy","startTime":1742.42,"endTime":1745.66,"body":"of trying to get something into"},{"speaker":"Chris Dy","startTime":1742.42,"endTime":1745.66,"body":"that volar beak ligament and I"},{"speaker":"Chris Dy","startTime":1745.66,"endTime":1750.25,"body":"think it's an excellent training"},{"speaker":"Chris Dy","startTime":1745.66,"endTime":1750.25,"body":"exercise for our trainees. That"},{"speaker":"Chris Dy","startTime":1750.25,"endTime":1753.61,"body":"being said, another incorrect"},{"speaker":"Chris Dy","startTime":1750.25,"endTime":1753.61,"body":"politically incorrect thing to"},{"speaker":"Chris Dy","startTime":1753.61,"endTime":1757.78,"body":"say, I don't like excessive X"},{"speaker":"Chris Dy","startTime":1753.61,"endTime":1757.78,"body":"ray masturbation, I think that"},{"speaker":"Chris Dy","startTime":1757.78,"endTime":1762.49,"body":"you know, spending so much time"},{"speaker":"Chris Dy","startTime":1757.78,"endTime":1762.49,"body":"on that defeats the purpose and"},{"speaker":"Chris Dy","startTime":1762.49,"endTime":1765.52,"body":"potentially does some harm. And"},{"speaker":"Chris Dy","startTime":1762.49,"endTime":1765.52,"body":"I can say that word masturbation"},{"speaker":"Chris Dy","startTime":1765.52,"endTime":1768.82,"body":"because your friend is the one"},{"speaker":"Chris Dy","startTime":1765.52,"endTime":1768.82,"body":"who said it first on our podcast"},{"speaker":"Chris Dy","startTime":1768.82,"endTime":1771.52,"body":"last week. So I just want to"},{"speaker":"Chris Dy","startTime":1768.82,"endTime":1771.52,"body":"make that very clear that we"},{"speaker":"Chris Dy","startTime":1771.52,"endTime":1774.28,"body":"have expanded the lexicon of"},{"speaker":"Chris Dy","startTime":1771.52,"endTime":1774.28,"body":"upper hand words because of"},{"speaker":"Chris Dy","startTime":1774.82,"endTime":1776.29,"body":"Aaron Perlut last week."},{"speaker":"Charles Goldfarb","startTime":1776.3,"endTime":1779.39,"body":"So so that"},{"speaker":"Charles Goldfarb","startTime":1776.3,"endTime":1779.39,"body":"that podcast is gonna drop on"},{"speaker":"Charles Goldfarb","startTime":1779.42,"endTime":1782.87,"body":"this Sunday, and I was gonna cut"},{"speaker":"Charles Goldfarb","startTime":1779.42,"endTime":1782.87,"body":"it out but now I'm just gonna"},{"speaker":"Charles Goldfarb","startTime":1782.87,"endTime":1783.11,"body":"leave that in."},{"speaker":"Chris Dy","startTime":1783.56,"endTime":1785.84,"body":"You gotta own it man,"},{"speaker":"Chris Dy","startTime":1783.56,"endTime":1785.84,"body":"you gotta you gotta keep it."},{"speaker":"Charles Goldfarb","startTime":1786.26,"endTime":1788.69,"body":"Look where"},{"speaker":"Charles Goldfarb","startTime":1786.26,"endTime":1788.69,"body":"physicians, it's a medical term."},{"speaker":"Chris Dy","startTime":1788.72,"endTime":1791.48,"body":"Feels like that"},{"speaker":"Chris Dy","startTime":1788.72,"endTime":1791.48,"body":"whatever Dr. Drew's show was in"},{"speaker":"Chris Dy","startTime":1791.48,"endTime":1794.96,"body":"the 90s, the controversial one"},{"speaker":"Chris Dy","startTime":1791.48,"endTime":1794.96,"body":"on MTV about dating with Adam"},{"speaker":"Chris Dy","startTime":1794.96,"endTime":1797.75,"body":"Carolla. Okay, I think it was"},{"speaker":"Chris Dy","startTime":1794.96,"endTime":1797.75,"body":"loveline back in the day."},{"speaker":"Charles Goldfarb","startTime":1797.84,"endTime":1799.91,"body":"Yes, that is"},{"speaker":"Charles Goldfarb","startTime":1797.84,"endTime":1799.91,"body":"back in the day, for real."},{"speaker":"Chris Dy","startTime":1799.94,"endTime":1804.08,"body":"Back to our topic. So"},{"speaker":"Chris Dy","startTime":1799.94,"endTime":1804.08,"body":"if you if you are putting a"},{"speaker":"Chris Dy","startTime":1804.08,"endTime":1807.74,"body":"screw and you're trying to"},{"speaker":"Chris Dy","startTime":1804.08,"endTime":1807.74,"body":"secure a screw from the main,"},{"speaker":"Chris Dy","startTime":1807.77,"endTime":1812.15,"body":"you know, metacarpal portion"},{"speaker":"Chris Dy","startTime":1807.77,"endTime":1812.15,"body":"into the volar ulnar beak"},{"speaker":"Chris Dy","startTime":1812.15,"endTime":1815.3,"body":"ligament fragment, what size"},{"speaker":"Chris Dy","startTime":1812.15,"endTime":1815.3,"body":"screw is it usually obviously I"},{"speaker":"Chris Dy","startTime":1815.3,"endTime":1817.76,"body":"know it depends on the size of"},{"speaker":"Chris Dy","startTime":1815.3,"endTime":1817.76,"body":"the fragment. But what's your"},{"speaker":"Chris Dy","startTime":1817.76,"endTime":1818.57,"body":"typical go to?"},{"speaker":"Charles Goldfarb","startTime":1818.96,"endTime":1821.06,"body":"Yeah, if I"},{"speaker":"Charles Goldfarb","startTime":1818.96,"endTime":1821.06,"body":"really want security, I'll put a"},{"speaker":"Charles Goldfarb","startTime":1821.06,"endTime":1824.24,"body":"small plate, and ideally two"},{"speaker":"Charles Goldfarb","startTime":1821.06,"endTime":1824.24,"body":"screws in the fragment. And then"},{"speaker":"Charles Goldfarb","startTime":1824.27,"endTime":1828.74,"body":"typically a 2.0 plate and"},{"speaker":"Charles Goldfarb","startTime":1824.27,"endTime":1828.74,"body":"screws, I think feels right most"},{"speaker":"Charles Goldfarb","startTime":1828.74,"endTime":1832.73,"body":"of the time. And that's not for"},{"speaker":"Charles Goldfarb","startTime":1828.74,"endTime":1832.73,"body":"the tiny little fragments, it"},{"speaker":"Charles Goldfarb","startTime":1832.73,"endTime":1835.58,"body":"just isn't, if that's the"},{"speaker":"Charles Goldfarb","startTime":1832.73,"endTime":1835.58,"body":"professional athlete with that"},{"speaker":"Charles Goldfarb","startTime":1835.58,"endTime":1839.21,"body":"fracture, the tiny fragment, it"},{"speaker":"Charles Goldfarb","startTime":1835.58,"endTime":1839.21,"body":"is what it is, then you pin"},{"speaker":"Charles Goldfarb","startTime":1839.21,"endTime":1841.85,"body":"them, and you do what you can to"},{"speaker":"Charles Goldfarb","startTime":1839.21,"endTime":1841.85,"body":"get them back playing as soon as"},{"speaker":"Charles Goldfarb","startTime":1841.85,"endTime":1847.67,"body":"possible. So it is it is a"},{"speaker":"Charles Goldfarb","startTime":1841.85,"endTime":1847.67,"body":"little tricky. In the true, you"},{"speaker":"Charles Goldfarb","startTime":1847.67,"endTime":1850.91,"body":"know, you know I'm from Alabama,"},{"speaker":"Charles Goldfarb","startTime":1847.67,"endTime":1850.91,"body":"I don't pronounce anything"},{"speaker":"Charles Goldfarb","startTime":1850.91,"endTime":1858.26,"body":"correctly. But the Wagner"},{"speaker":"Charles Goldfarb","startTime":1850.91,"endTime":1858.26,"body":"approach or spelled Wagner it's"},{"speaker":"Charles Goldfarb","startTime":1858.26,"endTime":1861.44,"body":"not a small approach, because"},{"speaker":"Charles Goldfarb","startTime":1858.26,"endTime":1861.44,"body":"you have to take down the thenar"},{"speaker":"Charles Goldfarb","startTime":1861.44,"endTime":1865.37,"body":"musculature to really look"},{"speaker":"Charles Goldfarb","startTime":1861.44,"endTime":1865.37,"body":"around the metacarpal and at the"},{"speaker":"Charles Goldfarb","startTime":1865.37,"endTime":1869.33,"body":"fragment and so it is a much"},{"speaker":"Charles Goldfarb","startTime":1865.37,"endTime":1869.33,"body":"it's not only less invasive from"},{"speaker":"Charles Goldfarb","startTime":1869.33,"endTime":1872.66,"body":"a skin perspective to just pin"},{"speaker":"Charles Goldfarb","startTime":1869.33,"endTime":1872.66,"body":"these, but the muscle take down"},{"speaker":"Charles Goldfarb","startTime":1872.66,"endTime":1875.78,"body":"to truly work for an anatomical"},{"speaker":"Charles Goldfarb","startTime":1872.66,"endTime":1875.78,"body":"reduction is not insignificant."},{"speaker":"Chris Dy","startTime":1876.62,"endTime":1878.6,"body":"Well, let me ask you,"},{"speaker":"Chris Dy","startTime":1876.62,"endTime":1878.6,"body":"I'm thinking back to kind of the"},{"speaker":"Chris Dy","startTime":1878.66,"endTime":1882.68,"body":"AO fracture kind of principles."},{"speaker":"Chris Dy","startTime":1878.66,"endTime":1882.68,"body":"If you don't have if this isn't"},{"speaker":"Chris Dy","startTime":1882.68,"endTime":1886.31,"body":"a Rolando, meaning there's no Y"},{"speaker":"Chris Dy","startTime":1882.68,"endTime":1886.31,"body":"split? Why do you put the plate?"},{"speaker":"Chris Dy","startTime":1886.37,"endTime":1890.12,"body":"Is it not is essentially acting"},{"speaker":"Chris Dy","startTime":1886.37,"endTime":1890.12,"body":"as a big washer? Do you think it"},{"speaker":"Chris Dy","startTime":1890.12,"endTime":1892.01,"body":"strengthens your construct"},{"speaker":"Chris Dy","startTime":1890.12,"endTime":1892.01,"body":"compared to your inner"},{"speaker":"Chris Dy","startTime":1892.01,"endTime":1893.24,"body":"fragmentary screws?"},{"speaker":"Charles Goldfarb","startTime":1893.48,"endTime":1896.3,"body":"Yes,"},{"speaker":"Charles Goldfarb","startTime":1893.48,"endTime":1896.3,"body":"absolutely. Especially with the"},{"speaker":"Charles Goldfarb","startTime":1896.3,"endTime":1900.92,"body":"larger fragment a larger plate"},{"speaker":"Charles Goldfarb","startTime":1896.3,"endTime":1900.92,"body":"multiple screws, I think just"},{"speaker":"Charles Goldfarb","startTime":1900.92,"endTime":1904.61,"body":"gets the athlete back to doing"},{"speaker":"Charles Goldfarb","startTime":1900.92,"endTime":1904.61,"body":"their thing faster. As we you"},{"speaker":"Charles Goldfarb","startTime":1904.61,"endTime":1907.01,"body":"know, as you and I have, I think"},{"speaker":"Charles Goldfarb","startTime":1904.61,"endTime":1907.01,"body":"discussed on this podcast, we"},{"speaker":"Charles Goldfarb","startTime":1907.01,"endTime":1909.5,"body":"certainly stress I don't think"},{"speaker":"Charles Goldfarb","startTime":1907.01,"endTime":1909.5,"body":"it speeds healing necessarily,"},{"speaker":"Charles Goldfarb","startTime":1909.68,"endTime":1913.73,"body":"probably a little bit but not"},{"speaker":"Charles Goldfarb","startTime":1909.68,"endTime":1913.73,"body":"enough to make it the reason to"},{"speaker":"Charles Goldfarb","startTime":1913.73,"endTime":1916.31,"body":"do the surgery. But it speeds"},{"speaker":"Charles Goldfarb","startTime":1913.73,"endTime":1916.31,"body":"recovery."},{"speaker":"Chris Dy","startTime":1917.33,"endTime":1921.47,"body":"Yeah, absolutely. And"},{"speaker":"Chris Dy","startTime":1917.33,"endTime":1921.47,"body":"then when do you do you ever,"},{"speaker":"Chris Dy","startTime":1921.77,"endTime":1925.37,"body":"ever lag these fragments, either"},{"speaker":"Chris Dy","startTime":1921.77,"endTime":1925.37,"body":"by design or by a technique?"},{"speaker":"Charles Goldfarb","startTime":1925.93,"endTime":1930.01,"body":"I don't. I"},{"speaker":"Charles Goldfarb","startTime":1925.93,"endTime":1930.01,"body":"have, there was a study out of"},{"speaker":"Charles Goldfarb","startTime":1930.01,"endTime":1935.65,"body":"Indianapolis many years ago"},{"speaker":"Charles Goldfarb","startTime":1930.01,"endTime":1935.65,"body":"looking at Synthes modular hand"},{"speaker":"Charles Goldfarb","startTime":1935.65,"endTime":1938.62,"body":"screws or obviously it doesn't"},{"speaker":"Charles Goldfarb","startTime":1935.65,"endTime":1938.62,"body":"matter the company but but"},{"speaker":"Charles Goldfarb","startTime":1938.62,"endTime":1942.52,"body":"modular hand small screws 1.5"},{"speaker":"Charles Goldfarb","startTime":1938.62,"endTime":1942.52,"body":"2.0. And looking at lag"},{"speaker":"Charles Goldfarb","startTime":1942.52,"endTime":1946.39,"body":"technique versus simple fixation"},{"speaker":"Charles Goldfarb","startTime":1942.52,"endTime":1946.39,"body":"techniques, and there was no"},{"speaker":"Charles Goldfarb","startTime":1946.39,"endTime":1950.11,"body":"benefit demonstrated with lag"},{"speaker":"Charles Goldfarb","startTime":1946.39,"endTime":1950.11,"body":"techniques. And because of our"},{"speaker":"Charles Goldfarb","startTime":1950.11,"endTime":1953.11,"body":"setting, I don't see the"},{"speaker":"Charles Goldfarb","startTime":1950.11,"endTime":1953.11,"body":"advantage, it can be really"},{"speaker":"Charles Goldfarb","startTime":1953.11,"endTime":1959.35,"body":"tricky to lag with a 1.5"},{"speaker":"Charles Goldfarb","startTime":1953.11,"endTime":1959.35,"body":"millimeter screw 1.1 drill bit"},{"speaker":"Charles Goldfarb","startTime":1959.35,"endTime":1961.42,"body":"so you're drilling with the what"},{"speaker":"Charles Goldfarb","startTime":1959.35,"endTime":1961.42,"body":"for those who don't do this"},{"speaker":"Charles Goldfarb","startTime":1961.42,"endTime":1965.53,"body":"often, if you're going to place"},{"speaker":"Charles Goldfarb","startTime":1961.42,"endTime":1965.53,"body":"a 1.5 millimeter screw, you"},{"speaker":"Charles Goldfarb","startTime":1965.53,"endTime":1969.67,"body":"initially drill with a 1.5"},{"speaker":"Charles Goldfarb","startTime":1965.53,"endTime":1969.67,"body":"millimeter drill bit. And then"},{"speaker":"Charles Goldfarb","startTime":1969.67,"endTime":1974.56,"body":"you drill small, smaller hole"},{"speaker":"Charles Goldfarb","startTime":1969.67,"endTime":1974.56,"body":"1.1 millimeter drill bit such"},{"speaker":"Charles Goldfarb","startTime":1974.56,"endTime":1979.36,"body":"that you have to place your it"},{"speaker":"Charles Goldfarb","startTime":1974.56,"endTime":1979.36,"body":"has to be perfect drill, drill"},{"speaker":"Charles Goldfarb","startTime":1979.36,"endTime":1982.39,"body":"holes, and then you place your"},{"speaker":"Charles Goldfarb","startTime":1979.36,"endTime":1982.39,"body":"screw and you bring the fragment"},{"speaker":"Charles Goldfarb","startTime":1982.39,"endTime":1985.9,"body":"together with some compression."},{"speaker":"Charles Goldfarb","startTime":1982.39,"endTime":1985.9,"body":"I think you can obtain your"},{"speaker":"Charles Goldfarb","startTime":1985.9,"endTime":1989.65,"body":"compression with a clamp in most"},{"speaker":"Charles Goldfarb","startTime":1985.9,"endTime":1989.65,"body":"cases. And then you just hold"},{"speaker":"Charles Goldfarb","startTime":1989.65,"endTime":1993.16,"body":"that compressed reduction with"},{"speaker":"Charles Goldfarb","startTime":1989.65,"endTime":1993.16,"body":"screws or screws in place."},{"speaker":"Chris Dy","startTime":1993.61,"endTime":1995.98,"body":"Yeah, I think one of"},{"speaker":"Chris Dy","startTime":1993.61,"endTime":1995.98,"body":"the things that you told me when"},{"speaker":"Chris Dy","startTime":1995.98,"endTime":1998.53,"body":"I was your fellow is that if"},{"speaker":"Chris Dy","startTime":1995.98,"endTime":1998.53,"body":"you're not ready as the"},{"speaker":"Chris Dy","startTime":1998.53,"endTime":2002.7,"body":"attending to hold the reduction"},{"speaker":"Chris Dy","startTime":1998.53,"endTime":2002.7,"body":"until that fixations in you're"},{"speaker":"Chris Dy","startTime":2002.7,"endTime":2005.28,"body":"not the you can't be an"},{"speaker":"Chris Dy","startTime":2002.7,"endTime":2005.28,"body":"attending. And that's probably"},{"speaker":"Chris Dy","startTime":2005.28,"endTime":2008.22,"body":"be the reason you said that is"},{"speaker":"Chris Dy","startTime":2005.28,"endTime":2008.22,"body":"because I was probably taking"},{"speaker":"Chris Dy","startTime":2008.22,"endTime":2011.58,"body":"too long and your thumb CMC"},{"speaker":"Chris Dy","startTime":2008.22,"endTime":2011.58,"body":"arthritis is starting to set in."},{"speaker":"Charles Goldfarb","startTime":2012.48,"endTime":2013.47,"body":"Sounds about"},{"speaker":"Charles Goldfarb","startTime":2012.48,"endTime":2013.47,"body":"right."},{"speaker":"Chris Dy","startTime":2014.13,"endTime":2015.9,"body":"But in all"},{"speaker":"Chris Dy","startTime":2014.13,"endTime":2015.9,"body":"seriousness, I mean, I think"},{"speaker":"Chris Dy","startTime":2015.9,"endTime":2020.88,"body":"that in hand because of what you"},{"speaker":"Chris Dy","startTime":2015.9,"endTime":2020.88,"body":"mentioned, with the, with the"},{"speaker":"Chris Dy","startTime":2020.88,"endTime":2023.31,"body":"small caliber of the drill and"},{"speaker":"Chris Dy","startTime":2020.88,"endTime":2023.31,"body":"the small caliber of the"},{"speaker":"Chris Dy","startTime":2023.31,"endTime":2028.53,"body":"implants, you know, if you if"},{"speaker":"Chris Dy","startTime":2023.31,"endTime":2028.53,"body":"you have any technical missteps,"},{"speaker":"Chris Dy","startTime":2028.56,"endTime":2032.37,"body":"either with the over drilling,"},{"speaker":"Chris Dy","startTime":2028.56,"endTime":2032.37,"body":"or with establishing the path"},{"speaker":"Chris Dy","startTime":2032.37,"endTime":2036.12,"body":"for the screw, you know, on the"},{"speaker":"Chris Dy","startTime":2032.37,"endTime":2036.12,"body":"far side, or with insertion of"},{"speaker":"Chris Dy","startTime":2036.12,"endTime":2039.42,"body":"the screw, that's it, your"},{"speaker":"Chris Dy","startTime":2036.12,"endTime":2039.42,"body":"chance is gone. Like it's not"},{"speaker":"Chris Dy","startTime":2039.42,"endTime":2042.3,"body":"like a femur, like he had a lot"},{"speaker":"Chris Dy","startTime":2039.42,"endTime":2042.3,"body":"of chances on a femur. And"},{"speaker":"Chris Dy","startTime":2042.3,"endTime":2044.19,"body":"that's nothing against trauma"},{"speaker":"Chris Dy","startTime":2042.3,"endTime":2044.19,"body":"colleagues or it's not like a"},{"speaker":"Chris Dy","startTime":2044.19,"endTime":2047.88,"body":"humerus like you know, or even"},{"speaker":"Chris Dy","startTime":2044.19,"endTime":2047.88,"body":"even metacarpals to be honest"},{"speaker":"Chris Dy","startTime":2047.88,"endTime":2051.12,"body":"with you. But anything outside"},{"speaker":"Chris Dy","startTime":2047.88,"endTime":2051.12,"body":"of a metacarpal I think is much"},{"speaker":"Chris Dy","startTime":2051.15,"endTime":2052.44,"body":"more unforgiving."},{"speaker":"Charles Goldfarb","startTime":2053.16,"endTime":2056.04,"body":"That's right,"},{"speaker":"Charles Goldfarb","startTime":2053.16,"endTime":2056.04,"body":"that's right and and, and"},{"speaker":"Charles Goldfarb","startTime":2056.07,"endTime":2059.94,"body":"unforgiving and I don't know"},{"speaker":"Charles Goldfarb","startTime":2056.07,"endTime":2059.94,"body":"that the benefit is is worth the"},{"speaker":"Charles Goldfarb","startTime":2059.97,"endTime":2063.36,"body":"the potential challenges of"},{"speaker":"Charles Goldfarb","startTime":2059.97,"endTime":2063.36,"body":"trying that technique is that is"},{"speaker":"Charles Goldfarb","startTime":2063.36,"endTime":2064.05,"body":"the bottom line."},{"speaker":"Chris Dy","startTime":2064.53,"endTime":2066.81,"body":"So and the only other"},{"speaker":"Chris Dy","startTime":2064.53,"endTime":2066.81,"body":"thing I'll add is that you know"},{"speaker":"Chris Dy","startTime":2066.81,"endTime":2069.69,"body":"I like getting a little dental"},{"speaker":"Chris Dy","startTime":2066.81,"endTime":2069.69,"body":"pick around that volar ulnar"},{"speaker":"Chris Dy","startTime":2069.69,"endTime":2072.42,"body":"beak fragment and using that to"},{"speaker":"Chris Dy","startTime":2069.69,"endTime":2072.42,"body":"hold I have not typically you"},{"speaker":"Chris Dy","startTime":2072.42,"endTime":2075.0,"body":"know, taking a point reduction"},{"speaker":"Chris Dy","startTime":2072.42,"endTime":2075.0,"body":"clamp and put it around there."},{"speaker":"Chris Dy","startTime":2075.51,"endTime":2077.58,"body":"But I think if you have the"},{"speaker":"Chris Dy","startTime":2075.51,"endTime":2077.58,"body":"exposure and dental picks a nice"},{"speaker":"Chris Dy","startTime":2077.58,"endTime":2081.96,"body":"way to secure that fragment"},{"speaker":"Chris Dy","startTime":2077.58,"endTime":2081.96,"body":"without any excessive stripping."},{"speaker":"Charles Goldfarb","startTime":2082.83,"endTime":2085.47,"body":"I think that's"},{"speaker":"Charles Goldfarb","startTime":2082.83,"endTime":2085.47,"body":"well said and so my first choice"},{"speaker":"Charles Goldfarb","startTime":2085.47,"endTime":2088.74,"body":"in general is close reduction"},{"speaker":"Charles Goldfarb","startTime":2085.47,"endTime":2088.74,"body":"and pinning but it with a bigger"},{"speaker":"Charles Goldfarb","startTime":2088.74,"endTime":2092.64,"body":"fragment with a higher demand"},{"speaker":"Charles Goldfarb","startTime":2088.74,"endTime":2092.64,"body":"athlete. I have no problem"},{"speaker":"Charles Goldfarb","startTime":2092.64,"endTime":2095.64,"body":"putting a plate and screws on"},{"speaker":"Charles Goldfarb","startTime":2092.64,"endTime":2095.64,"body":"there or two screws or whatever."},{"speaker":"Charles Goldfarb","startTime":2096.24,"endTime":2102.0,"body":"But these fractures do well and"},{"speaker":"Charles Goldfarb","startTime":2096.24,"endTime":2102.0,"body":"Patients, you know, very quickly"},{"speaker":"Charles Goldfarb","startTime":2102.0,"endTime":2104.88,"body":"typically heal because the"},{"speaker":"Charles Goldfarb","startTime":2102.0,"endTime":2104.88,"body":"robust blood supply, and I'm"},{"speaker":"Charles Goldfarb","startTime":2104.88,"endTime":2108.72,"body":"not, knock on wood, seeing many"},{"speaker":"Charles Goldfarb","startTime":2104.88,"endTime":2108.72,"body":"of any complications or, or"},{"speaker":"Charles Goldfarb","startTime":2108.75,"endTime":2111.54,"body":"delayed presentation"},{"speaker":"Charles Goldfarb","startTime":2108.75,"endTime":2111.54,"body":"complications. So I like"},{"speaker":"Charles Goldfarb","startTime":2111.54,"endTime":2114.39,"body":"treating these they do well."},{"speaker":"Charles Goldfarb","startTime":2111.54,"endTime":2114.39,"body":"It's just a question of how"},{"speaker":"Charles Goldfarb","startTime":2114.39,"endTime":2116.58,"body":"quickly can you get them back to"},{"speaker":"Charles Goldfarb","startTime":2114.39,"endTime":2116.58,"body":"the activities they want to go"},{"speaker":"Charles Goldfarb","startTime":2116.58,"endTime":2117.0,"body":"back to."},{"speaker":"Chris Dy","startTime":2117.96,"endTime":2121.23,"body":"Now what about the"},{"speaker":"Chris Dy","startTime":2117.96,"endTime":2121.23,"body":"ulnar side? So you know, CMC"},{"speaker":"Chris Dy","startTime":2121.23,"endTime":2124.56,"body":"issues for the ring and small"},{"speaker":"Chris Dy","startTime":2121.23,"endTime":2124.56,"body":"finger, the fourth and fifth"},{"speaker":"Chris Dy","startTime":2124.56,"endTime":2125.34,"body":"metacarpals?"},{"speaker":"Charles Goldfarb","startTime":2125.63,"endTime":2127.25,"body":"Yeah, I've had"},{"speaker":"Charles Goldfarb","startTime":2125.63,"endTime":2127.25,"body":"a couple of these recently"},{"speaker":"Charles Goldfarb","startTime":2127.25,"endTime":2131.33,"body":"interesting. So not truly the"},{"speaker":"Charles Goldfarb","startTime":2127.25,"endTime":2131.33,"body":"baby Bennett, which is a"},{"speaker":"Charles Goldfarb","startTime":2131.33,"endTime":2135.83,"body":"fracture of the base of the"},{"speaker":"Charles Goldfarb","startTime":2131.33,"endTime":2135.83,"body":"fifth metacarpal in which the"},{"speaker":"Charles Goldfarb","startTime":2135.86,"endTime":2139.37,"body":"ECU tendon is the deforming"},{"speaker":"Charles Goldfarb","startTime":2135.86,"endTime":2139.37,"body":"force, the ones I've had"},{"speaker":"Charles Goldfarb","startTime":2139.37,"endTime":2144.5,"body":"recently have been true fracture"},{"speaker":"Charles Goldfarb","startTime":2139.37,"endTime":2144.5,"body":"subluxations at the fourth fifth"},{"speaker":"Charles Goldfarb","startTime":2144.5,"endTime":2148.16,"body":"CMC joint where the dorsal"},{"speaker":"Charles Goldfarb","startTime":2144.5,"endTime":2148.16,"body":"handmade is sheared as well."},{"speaker":"Charles Goldfarb","startTime":2148.49,"endTime":2154.19,"body":"And, you know, those are those"},{"speaker":"Charles Goldfarb","startTime":2148.49,"endTime":2154.19,"body":"are high impact injuries, often"},{"speaker":"Charles Goldfarb","startTime":2154.19,"endTime":2157.13,"body":"punching and honestly, I don't"},{"speaker":"Charles Goldfarb","startTime":2154.19,"endTime":2157.13,"body":"know that I understand the"},{"speaker":"Charles Goldfarb","startTime":2157.13,"endTime":2159.89,"body":"biomechanics of when one may get"},{"speaker":"Charles Goldfarb","startTime":2157.13,"endTime":2159.89,"body":"a Bennett fracture, I'm sorry,"},{"speaker":"Charles Goldfarb","startTime":2160.01,"endTime":2164.33,"body":"when one may get a boxer's"},{"speaker":"Charles Goldfarb","startTime":2160.01,"endTime":2164.33,"body":"fracture, versus a base of the,"},{"speaker":"Charles Goldfarb","startTime":2164.48,"endTime":2169.73,"body":"you know, fourth and fifth CMC"},{"speaker":"Charles Goldfarb","startTime":2164.48,"endTime":2169.73,"body":"joint fracture injury. But it's"},{"speaker":"Charles Goldfarb","startTime":2169.73,"endTime":2172.43,"body":"a it's a high energy trauma, for"},{"speaker":"Charles Goldfarb","startTime":2169.73,"endTime":2172.43,"body":"sure."},{"speaker":"Chris Dy","startTime":2173.62,"endTime":2177.31,"body":"Now, one thing that I"},{"speaker":"Chris Dy","startTime":2173.62,"endTime":2177.31,"body":"think this comes up on tests,"},{"speaker":"Chris Dy","startTime":2177.31,"endTime":2180.1,"body":"but these can be a little"},{"speaker":"Chris Dy","startTime":2177.31,"endTime":2180.1,"body":"difficult to diagnose if you're"},{"speaker":"Chris Dy","startTime":2180.1,"endTime":2184.66,"body":"not looking for them. And you"},{"speaker":"Chris Dy","startTime":2180.1,"endTime":2184.66,"body":"know, using a straight hand PA,"},{"speaker":"Chris Dy","startTime":2184.72,"endTime":2188.17,"body":"and the straight lateral view,"},{"speaker":"Chris Dy","startTime":2184.72,"endTime":2188.17,"body":"can be deceptive. And I really"},{"speaker":"Chris Dy","startTime":2188.17,"endTime":2191.86,"body":"think that this is where having"},{"speaker":"Chris Dy","startTime":2188.17,"endTime":2191.86,"body":"that, you know, oblique or Semi"},{"speaker":"Chris Dy","startTime":2191.86,"endTime":2195.28,"body":"Pronative, you can be super"},{"speaker":"Chris Dy","startTime":2191.86,"endTime":2195.28,"body":"useful. And even you know,"},{"speaker":"Chris Dy","startTime":2195.28,"endTime":2198.31,"body":"having live mini C arm"},{"speaker":"Chris Dy","startTime":2195.28,"endTime":2198.31,"body":"fluoroscopy can be useful if"},{"speaker":"Chris Dy","startTime":2198.31,"endTime":2200.71,"body":"you're concerned if you have a"},{"speaker":"Chris Dy","startTime":2198.31,"endTime":2200.71,"body":"high index of suspicion for this"},{"speaker":"Chris Dy","startTime":2200.71,"endTime":2201.22,"body":"fracture."},{"speaker":"Charles Goldfarb","startTime":2202.08,"endTime":2204.72,"body":"Yes. So again,"},{"speaker":"Charles Goldfarb","startTime":2202.08,"endTime":2204.72,"body":"focusing on that four or five"},{"speaker":"Charles Goldfarb","startTime":2204.75,"endTime":2208.41,"body":"and handmade fracture, it can be"},{"speaker":"Charles Goldfarb","startTime":2204.75,"endTime":2208.41,"body":"difficult to confirm that"},{"speaker":"Charles Goldfarb","startTime":2208.41,"endTime":2211.74,"body":"radiographically a couple of"},{"speaker":"Charles Goldfarb","startTime":2208.41,"endTime":2211.74,"body":"thoughts, as you said this, the"},{"speaker":"Charles Goldfarb","startTime":2211.74,"endTime":2215.79,"body":"live fluoroscopy can be really"},{"speaker":"Charles Goldfarb","startTime":2211.74,"endTime":2215.79,"body":"helpful. A perfect lateral can"},{"speaker":"Charles Goldfarb","startTime":2215.79,"endTime":2219.72,"body":"be really helpful. And there was"},{"speaker":"Charles Goldfarb","startTime":2215.79,"endTime":2219.72,"body":"a there was an article out of"},{"speaker":"Charles Goldfarb","startTime":2219.72,"endTime":2224.79,"body":"the Mayo Clinic 10 or so years"},{"speaker":"Charles Goldfarb","startTime":2219.72,"endTime":2224.79,"body":"ago, which looked at flexion of"},{"speaker":"Charles Goldfarb","startTime":2224.79,"endTime":2228.57,"body":"the fourth and fifth"},{"speaker":"Charles Goldfarb","startTime":2224.79,"endTime":2228.57,"body":"metacarpals. And so if those"},{"speaker":"Charles Goldfarb","startTime":2228.57,"endTime":2232.62,"body":"metacarpals flex, that's a"},{"speaker":"Charles Goldfarb","startTime":2228.57,"endTime":2232.62,"body":"secondary indicator or problem"},{"speaker":"Charles Goldfarb","startTime":2232.62,"endTime":2236.07,"body":"proximately And that, to me has"},{"speaker":"Charles Goldfarb","startTime":2232.62,"endTime":2236.07,"body":"been really useful when I'm not"},{"speaker":"Charles Goldfarb","startTime":2236.07,"endTime":2240.12,"body":"when I know to look for that."},{"speaker":"Charles Goldfarb","startTime":2236.07,"endTime":2240.12,"body":"That's a great indicator, there"},{"speaker":"Charles Goldfarb","startTime":2240.12,"endTime":2245.19,"body":"could be a bigger problem. And a"},{"speaker":"Charles Goldfarb","startTime":2240.12,"endTime":2245.19,"body":"CT scan ultimately, is often I"},{"speaker":"Charles Goldfarb","startTime":2245.19,"endTime":2248.76,"body":"don't wanna say required, but"},{"speaker":"Charles Goldfarb","startTime":2245.19,"endTime":2248.76,"body":"it's often helpful. I don't know"},{"speaker":"Charles Goldfarb","startTime":2248.76,"endTime":2251.76,"body":"that I need it for preoperative"},{"speaker":"Charles Goldfarb","startTime":2248.76,"endTime":2251.76,"body":"planning, because the fracture"},{"speaker":"Charles Goldfarb","startTime":2251.76,"endTime":2255.24,"body":"pattern is predictable of that"},{"speaker":"Charles Goldfarb","startTime":2251.76,"endTime":2255.24,"body":"dorsal hamate. But if you're"},{"speaker":"Charles Goldfarb","startTime":2255.24,"endTime":2258.9,"body":"uncertain about whether it's"},{"speaker":"Charles Goldfarb","startTime":2255.24,"endTime":2258.9,"body":"needed based on alignment, a CT"},{"speaker":"Charles Goldfarb","startTime":2258.9,"endTime":2262.05,"body":"scan can be really helpful in"},{"speaker":"Charles Goldfarb","startTime":2258.9,"endTime":2262.05,"body":"making the decision about"},{"speaker":"Charles Goldfarb","startTime":2262.05,"endTime":2263.85,"body":"whether surgery is necessary or"},{"speaker":"Charles Goldfarb","startTime":2262.05,"endTime":2263.85,"body":"not."},{"speaker":"Chris Dy","startTime":2264.36,"endTime":2267.66,"body":"So if you're"},{"speaker":"Chris Dy","startTime":2264.36,"endTime":2267.66,"body":"operating, what's your preferred"},{"speaker":"Chris Dy","startTime":2267.66,"endTime":2271.5,"body":"tactic, do you just pin the CMC"},{"speaker":"Chris Dy","startTime":2267.66,"endTime":2271.5,"body":"joints after reducing them and"},{"speaker":"Chris Dy","startTime":2271.5,"endTime":2272.58,"body":"then call it a day?"},{"speaker":"Charles Goldfarb","startTime":2273.57,"endTime":2276.78,"body":"I think this"},{"speaker":"Charles Goldfarb","startTime":2273.57,"endTime":2276.78,"body":"is debatable but I do not know"},{"speaker":"Charles Goldfarb","startTime":2276.78,"endTime":2281.1,"body":"good literature to guide us if"},{"speaker":"Charles Goldfarb","startTime":2276.78,"endTime":2281.1,"body":"there is a real fracture a"},{"speaker":"Charles Goldfarb","startTime":2281.1,"endTime":2284.85,"body":"substantial fracture of the"},{"speaker":"Charles Goldfarb","startTime":2281.1,"endTime":2284.85,"body":"hamate I fix it and so I will"},{"speaker":"Charles Goldfarb","startTime":2284.85,"endTime":2288.87,"body":"make a small incision clean out"},{"speaker":"Charles Goldfarb","startTime":2284.85,"endTime":2288.87,"body":"the fracture site reduce the"},{"speaker":"Charles Goldfarb","startTime":2288.87,"endTime":2292.71,"body":"dorsal hamate to the rest of the"},{"speaker":"Charles Goldfarb","startTime":2288.87,"endTime":2292.71,"body":"hamate and put two screws in"},{"speaker":"Charles Goldfarb","startTime":2293.79,"endTime":2298.89,"body":"obviously careful with the volar"},{"speaker":"Charles Goldfarb","startTime":2293.79,"endTime":2298.89,"body":"position of the screws and they"},{"speaker":"Charles Goldfarb","startTime":2298.92,"endTime":2301.11,"body":"certainly the screws can go in"},{"speaker":"Charles Goldfarb","startTime":2298.92,"endTime":2301.11,"body":"the hook of the hamate you can"},{"speaker":"Charles Goldfarb","startTime":2301.11,"endTime":2303.87,"body":"feel really good if you get a 30"},{"speaker":"Charles Goldfarb","startTime":2301.11,"endTime":2303.87,"body":"millimeter screw and they don't"},{"speaker":"Charles Goldfarb","startTime":2303.9,"endTime":2306.96,"body":"they need not to go into the"},{"speaker":"Charles Goldfarb","startTime":2303.9,"endTime":2306.96,"body":"hook of the hamate they simply"},{"speaker":"Charles Goldfarb","startTime":2307.02,"endTime":2310.17,"body":"can't but you have to be careful"},{"speaker":"Charles Goldfarb","startTime":2307.02,"endTime":2310.17,"body":"with the drill because we all"},{"speaker":"Charles Goldfarb","startTime":2310.17,"endTime":2312.42,"body":"know the proximity of the ulnar"},{"speaker":"Charles Goldfarb","startTime":2310.17,"endTime":2312.42,"body":"nerve."},{"speaker":"Chris Dy","startTime":2312.72,"endTime":2313.92,"body":"See brought back to"},{"speaker":"Chris Dy","startTime":2312.72,"endTime":2313.92,"body":"nerve."},{"speaker":"Charles Goldfarb","startTime":2313.95,"endTime":2314.4,"body":"Dammit."},{"speaker":"Chris Dy","startTime":2315.849,"endTime":2319.239,"body":"Well so if you you"},{"speaker":"Chris Dy","startTime":2315.849,"endTime":2319.239,"body":"said substantial and then I was"},{"speaker":"Chris Dy","startTime":2319.239,"endTime":2321.909,"body":"going to ask you what the"},{"speaker":"Chris Dy","startTime":2319.239,"endTime":2321.909,"body":"substantial mean and then you"},{"speaker":"Chris Dy","startTime":2321.909,"endTime":2325.119,"body":"went on to say put two screws."},{"speaker":"Chris Dy","startTime":2321.909,"endTime":2325.119,"body":"So does it mean that it is a"},{"speaker":"Chris Dy","startTime":2325.119,"endTime":2328.569,"body":"fracture that is big enough for"},{"speaker":"Chris Dy","startTime":2325.119,"endTime":2328.569,"body":"two 1.5 or 2.0 screws?"},{"speaker":"Charles Goldfarb","startTime":2328.9,"endTime":2331.75,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":2328.9,"endTime":2331.75,"body":"two 2.0 screws is what I try to"},{"speaker":"Charles Goldfarb","startTime":2331.78,"endTime":2338.14,"body":"do and yes I do not have a"},{"speaker":"Charles Goldfarb","startTime":2331.78,"endTime":2338.14,"body":"specific size criteria for for"},{"speaker":"Charles Goldfarb","startTime":2338.14,"endTime":2342.01,"body":"making that decision. But when"},{"speaker":"Charles Goldfarb","startTime":2338.14,"endTime":2342.01,"body":"there is a fracture which looks"},{"speaker":"Charles Goldfarb","startTime":2342.01,"endTime":2346.96,"body":"robust enough to hold the"},{"speaker":"Charles Goldfarb","startTime":2342.01,"endTime":2346.96,"body":"screws, I then reduce the CMC"},{"speaker":"Charles Goldfarb","startTime":2346.96,"endTime":2353.35,"body":"joint hold it with a 6-2 K wire"},{"speaker":"Charles Goldfarb","startTime":2346.96,"endTime":2353.35,"body":"and fix the fracture as well I"},{"speaker":"Charles Goldfarb","startTime":2353.35,"endTime":2356.14,"body":"feel better about doing both of"},{"speaker":"Charles Goldfarb","startTime":2353.35,"endTime":2356.14,"body":"those one could argue if you're"},{"speaker":"Charles Goldfarb","startTime":2356.14,"endTime":2361.39,"body":"fixing the hamate Do you need to"},{"speaker":"Charles Goldfarb","startTime":2356.14,"endTime":2361.39,"body":"secure the CMC joints with a K"},{"speaker":"Charles Goldfarb","startTime":2361.39,"endTime":2364.51,"body":"wire and that's k wire for me"},{"speaker":"Charles Goldfarb","startTime":2361.39,"endTime":2364.51,"body":"typically goes from five to four"},{"speaker":"Charles Goldfarb","startTime":2364.9,"endTime":2368.92,"body":"to three or more commonly five"},{"speaker":"Charles Goldfarb","startTime":2364.9,"endTime":2368.92,"body":"to four to the capitate and it"},{"speaker":"Charles Goldfarb","startTime":2368.92,"endTime":2372.46,"body":"one or two k wires. I feel"},{"speaker":"Charles Goldfarb","startTime":2368.92,"endTime":2372.46,"body":"better with both I think the K"},{"speaker":"Charles Goldfarb","startTime":2372.46,"endTime":2377.2,"body":"wires unload the healing hamate"},{"speaker":"Charles Goldfarb","startTime":2372.46,"endTime":2377.2,"body":"and that makes me feel better."},{"speaker":"Chris Dy","startTime":2377.62,"endTime":2379.96,"body":"What about your"},{"speaker":"Chris Dy","startTime":2377.62,"endTime":2379.96,"body":"athlete though? So you mentioned"},{"speaker":"Chris Dy","startTime":2379.96,"endTime":2384.91,"body":"the fancy sports surgeons"},{"speaker":"Chris Dy","startTime":2379.96,"endTime":2384.91,"body":"disdain for external wires. So"},{"speaker":"Chris Dy","startTime":2384.91,"endTime":2388.63,"body":"say you have you know to 2.0"},{"speaker":"Chris Dy","startTime":2384.91,"endTime":2388.63,"body":"screws in there. You have your"},{"speaker":"Chris Dy","startTime":2388.63,"endTime":2392.62,"body":"provisional six two pin from"},{"speaker":"Chris Dy","startTime":2388.63,"endTime":2392.62,"body":"five to four into the capitate"},{"speaker":"Chris Dy","startTime":2392.65,"endTime":2395.11,"body":"does it remain provisional? Does"},{"speaker":"Chris Dy","startTime":2392.65,"endTime":2395.11,"body":"it get pulled out or mean does"},{"speaker":"Chris Dy","startTime":2395.11,"endTime":2398.53,"body":"it stay and do you leave it"},{"speaker":"Chris Dy","startTime":2395.11,"endTime":2398.53,"body":"exterior to the skin Do you cut"},{"speaker":"Chris Dy","startTime":2398.53,"endTime":2401.02,"body":"it deep with the plan on coming"},{"speaker":"Chris Dy","startTime":2398.53,"endTime":2401.02,"body":"back under local or in the"},{"speaker":"Chris Dy","startTime":2401.02,"endTime":2401.65,"body":"office?"},{"speaker":"Charles Goldfarb","startTime":2403.39,"endTime":2406.9,"body":"That pin stays"},{"speaker":"Charles Goldfarb","startTime":2403.39,"endTime":2406.9,"body":"in. But I'll get it out more"},{"speaker":"Charles Goldfarb","startTime":2406.9,"endTime":2409.78,"body":"quickly. So probably stays in"},{"speaker":"Charles Goldfarb","startTime":2406.9,"endTime":2409.78,"body":"for four weeks till we feel"},{"speaker":"Charles Goldfarb","startTime":2409.78,"endTime":2412.72,"body":"comfortable that the hamate is"},{"speaker":"Charles Goldfarb","startTime":2409.78,"endTime":2412.72,"body":"at least starting to heal. And"},{"speaker":"Charles Goldfarb","startTime":2412.72,"endTime":2415.3,"body":"then I start the rehab process"},{"speaker":"Charles Goldfarb","startTime":2412.72,"endTime":2415.3,"body":"without heavy gripping or"},{"speaker":"Charles Goldfarb","startTime":2415.3,"endTime":2418.66,"body":"pushing until probably six weeks"},{"speaker":"Charles Goldfarb","startTime":2415.3,"endTime":2418.66,"body":"in a non athlete or someone"},{"speaker":"Charles Goldfarb","startTime":2418.66,"endTime":2421.24,"body":"where we're not, we don't feel"},{"speaker":"Charles Goldfarb","startTime":2418.66,"endTime":2421.24,"body":"as rushed. I will leave the pin"},{"speaker":"Charles Goldfarb","startTime":2421.24,"endTime":2423.76,"body":"in for six weeks, and then I"},{"speaker":"Charles Goldfarb","startTime":2421.24,"endTime":2423.76,"body":"pull it without much concern"},{"speaker":"Charles Goldfarb","startTime":2423.76,"endTime":2424.42,"body":"about anything."},{"speaker":"Chris Dy","startTime":2424.6,"endTime":2426.37,"body":"Do you leave it"},{"speaker":"Chris Dy","startTime":2424.6,"endTime":2426.37,"body":"buried? Or do you leave it out"},{"speaker":"Chris Dy","startTime":2426.37,"endTime":2428.23,"body":"of the skin for in both"},{"speaker":"Chris Dy","startTime":2426.37,"endTime":2428.23,"body":"situations?"},{"speaker":"Charles Goldfarb","startTime":2428.26,"endTime":2429.82,"body":"In both"},{"speaker":"Charles Goldfarb","startTime":2428.26,"endTime":2429.82,"body":"situations I leave it out. What"},{"speaker":"Charles Goldfarb","startTime":2429.82,"endTime":2430.18,"body":"do you do?"},{"speaker":"Chris Dy","startTime":2430.24,"endTime":2432.61,"body":"You know, I'm not"},{"speaker":"Chris Dy","startTime":2430.24,"endTime":2432.61,"body":"fancy. I'm not a sports guy. So"},{"speaker":"Chris Dy","startTime":2432.64,"endTime":2437.26,"body":"I have no problem leaving"},{"speaker":"Chris Dy","startTime":2432.64,"endTime":2437.26,"body":"external pins on people. Just"},{"speaker":"Chris Dy","startTime":2437.26,"endTime":2440.44,"body":"for simplicity's sake, but I"},{"speaker":"Chris Dy","startTime":2437.26,"endTime":2440.44,"body":"guess with you know, WALANT,"},{"speaker":"Chris Dy","startTime":2440.44,"endTime":2443.83,"body":"etc, I've been doing some local"},{"speaker":"Chris Dy","startTime":2440.44,"endTime":2443.83,"body":"or even just taking it out in"},{"speaker":"Chris Dy","startTime":2443.83,"endTime":2447.16,"body":"the office, which I know some of"},{"speaker":"Chris Dy","startTime":2443.83,"endTime":2447.16,"body":"our partners do. Just burying"},{"speaker":"Chris Dy","startTime":2447.16,"endTime":2451.81,"body":"pins just deep to the skin. I"},{"speaker":"Chris Dy","startTime":2447.16,"endTime":2451.81,"body":"just, I don't like going halfway"},{"speaker":"Chris Dy","startTime":2451.81,"endTime":2455.26,"body":"on it. And then one thing I'll"},{"speaker":"Chris Dy","startTime":2451.81,"endTime":2455.26,"body":"say about that, you know,"},{"speaker":"Chris Dy","startTime":2455.35,"endTime":2459.58,"body":"capturing into the hook of the"},{"speaker":"Chris Dy","startTime":2455.35,"endTime":2459.58,"body":"hamate. It's dangerous, right?"},{"speaker":"Chris Dy","startTime":2459.58,"endTime":2462.64,"body":"So you know, when you're"},{"speaker":"Chris Dy","startTime":2459.58,"endTime":2462.64,"body":"drilling, you know, there, there"},{"speaker":"Chris Dy","startTime":2462.64,"endTime":2465.4,"body":"was I pulled some data when I"},{"speaker":"Chris Dy","startTime":2462.64,"endTime":2465.4,"body":"was giving a talk a few years"},{"speaker":"Chris Dy","startTime":2465.4,"endTime":2468.13,"body":"ago, and there was a really"},{"speaker":"Chris Dy","startTime":2465.4,"endTime":2468.13,"body":"interesting paper that came out"},{"speaker":"Chris Dy","startTime":2468.13,"endTime":2471.64,"body":"of one of David Ring's, many"},{"speaker":"Chris Dy","startTime":2468.13,"endTime":2471.64,"body":"labs, and they looked at they"},{"speaker":"Chris Dy","startTime":2471.64,"endTime":2474.64,"body":"took CTs and did 3D"},{"speaker":"Chris Dy","startTime":2471.64,"endTime":2474.64,"body":"reconstructions of the hamate."},{"speaker":"Chris Dy","startTime":2475.03,"endTime":2477.91,"body":"And then if you look at the"},{"speaker":"Chris Dy","startTime":2475.03,"endTime":2477.91,"body":"tightest part of the hamate, you"},{"speaker":"Chris Dy","startTime":2477.91,"endTime":2481.21,"body":"know, in the hook, you know, the"},{"speaker":"Chris Dy","startTime":2477.91,"endTime":2481.21,"body":"diameter of that, you know, is"},{"speaker":"Chris Dy","startTime":2481.21,"endTime":2484.72,"body":"about four or five millimeters."},{"speaker":"Chris Dy","startTime":2481.21,"endTime":2484.72,"body":"You can have quite a long length"},{"speaker":"Chris Dy","startTime":2484.72,"endTime":2487.99,"body":"on it if you want, but it's a"},{"speaker":"Chris Dy","startTime":2484.72,"endTime":2487.99,"body":"really narrow corridor. And I"},{"speaker":"Chris Dy","startTime":2487.99,"endTime":2490.81,"body":"think the last thing you want to"},{"speaker":"Chris Dy","startTime":2487.99,"endTime":2490.81,"body":"do here is be in out in with"},{"speaker":"Chris Dy","startTime":2490.81,"endTime":2493.9,"body":"your drill, and you know,"},{"speaker":"Chris Dy","startTime":2490.81,"endTime":2493.9,"body":"confuse yourself those of us"},{"speaker":"Chris Dy","startTime":2493.9,"endTime":2495.76,"body":"that have trained in"},{"speaker":"Chris Dy","startTime":2493.9,"endTime":2495.76,"body":"orthopedics. Remember that with"},{"speaker":"Chris Dy","startTime":2495.76,"endTime":2498.52,"body":"pedicle screws. Did they have"},{"speaker":"Chris Dy","startTime":2495.76,"endTime":2498.52,"body":"pedicle screws when you were"},{"speaker":"Chris Dy","startTime":2498.67,"endTime":2499.81,"body":"training? Chuck, I don't think"},{"speaker":"Chris Dy","startTime":2498.67,"endTime":2499.81,"body":"they."},{"speaker":"Charles Goldfarb","startTime":2499.329,"endTime":2501.399,"body":"No, just we"},{"speaker":"Charles Goldfarb","startTime":2499.329,"endTime":2501.399,"body":"just had plaster. Those athat"},{"speaker":"Charles Goldfarb","startTime":2501.609,"endTime":2503.259,"body":"saw us just got a big cast o"},{"speaker":"Charles Goldfarb","startTime":2501.609,"endTime":2503.259,"body":"their back"},{"speaker":"Chris Dy","startTime":2504.37,"endTime":2507.07,"body":"Scully cast. That's"},{"speaker":"Chris Dy","startTime":2504.37,"endTime":2507.07,"body":"right. But yeah, it's kind of"},{"speaker":"Chris Dy","startTime":2507.07,"endTime":2510.25,"body":"like doing a pedicle screw, you"},{"speaker":"Chris Dy","startTime":2507.07,"endTime":2510.25,"body":"gotta be perfect. You know, and"},{"speaker":"Chris Dy","startTime":2510.25,"endTime":2511.63,"body":"so the alternative is not good."},{"speaker":"Charles Goldfarb","startTime":2512.29,"endTime":2514.72,"body":"It is"},{"speaker":"Charles Goldfarb","startTime":2512.29,"endTime":2514.72,"body":"technical, right? If you if you"},{"speaker":"Charles Goldfarb","startTime":2514.72,"endTime":2517.21,"body":"are comfortable with your"},{"speaker":"Charles Goldfarb","startTime":2514.72,"endTime":2517.21,"body":"ability to palpate with a drill"},{"speaker":"Charles Goldfarb","startTime":2517.21,"endTime":2521.17,"body":"while you are drilling, I think"},{"speaker":"Charles Goldfarb","startTime":2517.21,"endTime":2521.17,"body":"it's safe. But you can't fool"},{"speaker":"Charles Goldfarb","startTime":2521.17,"endTime":2525.25,"body":"yourself and you can't feel"},{"speaker":"Charles Goldfarb","startTime":2521.17,"endTime":2525.25,"body":"cortical. You know, you just"},{"speaker":"Charles Goldfarb","startTime":2525.25,"endTime":2527.65,"body":"can't confuse yourself. And you"},{"speaker":"Charles Goldfarb","startTime":2525.25,"endTime":2527.65,"body":"have to be honest with yourself."},{"speaker":"Charles Goldfarb","startTime":2527.65,"endTime":2531.16,"body":"So you're right, it is not"},{"speaker":"Charles Goldfarb","startTime":2527.65,"endTime":2531.16,"body":"necessary. It does feel good if"},{"speaker":"Charles Goldfarb","startTime":2531.16,"endTime":2534.28,"body":"you make it happen, and it can"},{"speaker":"Charles Goldfarb","startTime":2531.16,"endTime":2534.28,"body":"be safe, but it you know, you"},{"speaker":"Charles Goldfarb","startTime":2534.28,"endTime":2535.57,"body":"just have to have to do it"},{"speaker":"Charles Goldfarb","startTime":2534.28,"endTime":2535.57,"body":"right."},{"speaker":"Chris Dy","startTime":2536.02,"endTime":2538.57,"body":"Last question. I'll"},{"speaker":"Chris Dy","startTime":2536.02,"endTime":2538.57,"body":"ask you on those dorsal hamate"},{"speaker":"Chris Dy","startTime":2538.57,"endTime":2542.47,"body":"fractures. I've seen some people"},{"speaker":"Chris Dy","startTime":2538.57,"endTime":2542.47,"body":"use plates here. Essentially,"},{"speaker":"Chris Dy","startTime":2542.5,"endTime":2546.76,"body":"the plate is a washer. Do you"},{"speaker":"Chris Dy","startTime":2542.5,"endTime":2546.76,"body":"like that concept doesn't add a"},{"speaker":"Chris Dy","startTime":2546.76,"endTime":2547.48,"body":"whole lot for you."},{"speaker":"Charles Goldfarb","startTime":2548.35,"endTime":2550.48,"body":"It depends on"},{"speaker":"Charles Goldfarb","startTime":2548.35,"endTime":2550.48,"body":"the quality of your screws. To"},{"speaker":"Charles Goldfarb","startTime":2550.48,"endTime":2553.24,"body":"be honest, I do not mind that"},{"speaker":"Charles Goldfarb","startTime":2550.48,"endTime":2553.24,"body":"concept at all. I think it's"},{"speaker":"Charles Goldfarb","startTime":2553.24,"endTime":2556.87,"body":"typically overkill. typically"},{"speaker":"Charles Goldfarb","startTime":2553.24,"endTime":2556.87,"body":"not necessary. Two good screws,"},{"speaker":"Charles Goldfarb","startTime":2556.87,"endTime":2560.44,"body":"I think are fine in that"},{"speaker":"Charles Goldfarb","startTime":2556.87,"endTime":2560.44,"body":"fracture. But there's no doubt"},{"speaker":"Charles Goldfarb","startTime":2560.47,"endTime":2564.85,"body":"that if you if you want a little"},{"speaker":"Charles Goldfarb","startTime":2560.47,"endTime":2564.85,"body":"more substance and just spread"},{"speaker":"Charles Goldfarb","startTime":2564.85,"endTime":2568.93,"body":"the compression forces out a"},{"speaker":"Charles Goldfarb","startTime":2564.85,"endTime":2568.93,"body":"small plate can be helpful, it's"},{"speaker":"Charles Goldfarb","startTime":2568.93,"endTime":2570.4,"body":"not typically in my routine."},{"speaker":"Chris Dy","startTime":2571.51,"endTime":2574.33,"body":"Okay, well, we snuck"},{"speaker":"Chris Dy","startTime":2571.51,"endTime":2574.33,"body":"in some sporty kind of stuff for"},{"speaker":"Chris Dy","startTime":2574.33,"endTime":2574.78,"body":"you there."},{"speaker":"Charles Goldfarb","startTime":2574.87,"endTime":2575.56,"body":"Thank you."},{"speaker":"Chris Dy","startTime":2576.85,"endTime":2579.37,"body":"We have sustained you"},{"speaker":"Chris Dy","startTime":2576.85,"endTime":2579.37,"body":"for another six nerve episodes,"},{"speaker":"Chris Dy","startTime":2579.37,"endTime":2580.99,"body":"which I know is what do people"},{"speaker":"Chris Dy","startTime":2579.37,"endTime":2580.99,"body":"really want."},{"speaker":"Charles Goldfarb","startTime":2581.71,"endTime":2584.17,"body":"Probably. All"},{"speaker":"Charles Goldfarb","startTime":2581.71,"endTime":2584.17,"body":"right. Have a good rest of your"},{"speaker":"Charles Goldfarb","startTime":2584.17,"endTime":2589.27,"body":"day. You too. Hey, Chris, that"},{"speaker":"Charles Goldfarb","startTime":2584.17,"endTime":2589.27,"body":"was fun. Let's do it again real"},{"speaker":"Charles Goldfarb","startTime":2589.27,"endTime":2589.63,"body":"soon."},{"speaker":"Chris Dy","startTime":2589.87,"endTime":2592.39,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":2589.87,"endTime":2592.39,"body":"sure to check us out on Twitter"},{"speaker":"Chris Dy","startTime":2592.6,"endTime":2594.82,"body":"@handpodcast. Hey, Chuck, what's"},{"speaker":"Chris Dy","startTime":2592.6,"endTime":2594.82,"body":"your Twitter handle?"},{"speaker":"Charles Goldfarb","startTime":2595.15,"endTime":2596.8,"body":"Mine is"},{"speaker":"Charles Goldfarb","startTime":2595.15,"endTime":2596.8,"body":"@congenitalhand."},{"speaker":"Chris Dy","startTime":2597.4,"endTime":2601.15,"body":"What about you? Mine"},{"speaker":"Chris Dy","startTime":2597.4,"endTime":2601.15,"body":"is @ChrisDyMD spelled d y. And"},{"speaker":"Chris Dy","startTime":2601.15,"endTime":2603.76,"body":"if you'd like to email us, you"},{"speaker":"Chris Dy","startTime":2601.15,"endTime":2603.76,"body":"can reach us at hand"},{"speaker":"Chris Dy","startTime":2603.76,"endTime":2604.81,"body":"podcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":2605.98,"endTime":2608.08,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":2605.98,"endTime":2608.08,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2608.08,"endTime":2609.19,"body":"get your podcasts"},{"speaker":"Chris Dy","startTime":2609.25,"endTime":2611.44,"body":"and be sure to leave a"},{"speaker":"Chris Dy","startTime":2609.25,"endTime":2611.44,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2611.44,"endTime":2611.83,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":2612.22,"endTime":2614.53,"body":"Special thanks"},{"speaker":"Charles Goldfarb","startTime":2612.22,"endTime":2614.53,"body":"to Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":2614.53,"endTime":2618.43,"body":"music. And remember, keep the"},{"speaker":"Charles Goldfarb","startTime":2614.53,"endTime":2618.43,"body":"upper hand come back next"}]}