{"version":"1.0.0","segments":[{"speaker":"Charles Goldfarb","startTime":10.8,"endTime":13.62,"body":"Welcome to the"},{"speaker":"Charles Goldfarb","startTime":10.8,"endTime":13.62,"body":"upper hand where Chuck and Chris"},{"speaker":"Charles Goldfarb","startTime":13.62,"endTime":14.46,"body":"talk hand surgery."},{"speaker":"Chris Dy","startTime":14.7,"endTime":16.56,"body":"We are two hand"},{"speaker":"Chris Dy","startTime":14.7,"endTime":16.56,"body":"surgeons at Washington"},{"speaker":"Chris Dy","startTime":16.56,"endTime":19.65,"body":"University in St. Louis here to"},{"speaker":"Chris Dy","startTime":16.56,"endTime":19.65,"body":"talk about all aspects of hand"},{"speaker":"Chris Dy","startTime":19.65,"endTime":21.45,"body":"surgery from technical to"},{"speaker":"Chris Dy","startTime":19.65,"endTime":21.45,"body":"personal."},{"speaker":"Charles Goldfarb","startTime":22.05,"endTime":24.33,"body":"Thank you for"},{"speaker":"Charles Goldfarb","startTime":22.05,"endTime":24.33,"body":"subscribing. Wherever you get"},{"speaker":"Charles Goldfarb","startTime":24.33,"endTime":25.23,"body":"your podcasts."},{"speaker":"Chris Dy","startTime":25.44,"endTime":27.66,"body":"And be sure to leave a"},{"speaker":"Chris Dy","startTime":25.44,"endTime":27.66,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":27.66,"endTime":28.14,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":28.2,"endTime":29.04,"body":"Oh, Hi, Chris."},{"speaker":"Chris Dy","startTime":29.19,"endTime":30.33,"body":"Hey, Chuck, how are"},{"speaker":"Chris Dy","startTime":29.19,"endTime":30.33,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":30.57,"endTime":31.77,"body":"Doing great."},{"speaker":"Charles Goldfarb","startTime":30.57,"endTime":31.77,"body":"How are you?"},{"speaker":"Chris Dy","startTime":32.28,"endTime":34.8,"body":"Great. It's a"},{"speaker":"Chris Dy","startTime":32.28,"endTime":34.8,"body":"beautiful weekend in St. Louis."},{"speaker":"Chris Dy","startTime":36.24,"endTime":39.12,"body":"I've been enjoying the weather."},{"speaker":"Chris Dy","startTime":36.24,"endTime":39.12,"body":"It's been fantastic. How about"},{"speaker":"Chris Dy","startTime":39.12,"endTime":39.42,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":39.72,"endTime":41.94,"body":"Oh, it's been"},{"speaker":"Charles Goldfarb","startTime":39.72,"endTime":41.94,"body":"great. And as we have discussed"},{"speaker":"Charles Goldfarb","startTime":41.94,"endTime":45.18,"body":"the nice weather. And I feel for"},{"speaker":"Charles Goldfarb","startTime":41.94,"endTime":45.18,"body":"those out there who may not yet"},{"speaker":"Charles Goldfarb","startTime":45.18,"endTime":47.58,"body":"have enjoyed nice weather,"},{"speaker":"Charles Goldfarb","startTime":45.18,"endTime":47.58,"body":"although I think much of the of"},{"speaker":"Charles Goldfarb","startTime":47.58,"endTime":51.45,"body":"the US at least is getting"},{"speaker":"Charles Goldfarb","startTime":47.58,"endTime":51.45,"body":"there. It really is. You know,"},{"speaker":"Charles Goldfarb","startTime":51.45,"endTime":56.85,"body":"spirits are, are doing well. And"},{"speaker":"Charles Goldfarb","startTime":51.45,"endTime":56.85,"body":"I just think it is remarkably"},{"speaker":"Charles Goldfarb","startTime":56.85,"endTime":57.45,"body":"positive."},{"speaker":"Chris Dy","startTime":58.2,"endTime":61.29,"body":"So yesterday, I did"},{"speaker":"Chris Dy","startTime":58.2,"endTime":61.29,"body":"something that I have not done"},{"speaker":"Chris Dy","startTime":61.29,"endTime":66.12,"body":"in at least three or four years."},{"speaker":"Chris Dy","startTime":61.29,"endTime":66.12,"body":"A shot I shot around, play"},{"speaker":"Chris Dy","startTime":66.12,"endTime":68.04,"body":"played basketball for an"},{"speaker":"Chris Dy","startTime":66.12,"endTime":68.04,"body":"extended period of time."},{"speaker":"Charles Goldfarb","startTime":68.46,"endTime":70.44,"body":"Wow, what"},{"speaker":"Charles Goldfarb","startTime":68.46,"endTime":70.44,"body":"prompted that?"},{"speaker":"Chris Dy","startTime":70.69,"endTime":73.42,"body":"Well, we were you"},{"speaker":"Chris Dy","startTime":70.69,"endTime":73.42,"body":"remember, you used to live near"},{"speaker":"Chris Dy","startTime":73.45,"endTime":77.86,"body":"Flynn park here in St. Louis. So"},{"speaker":"Chris Dy","startTime":73.45,"endTime":77.86,"body":"the kids were there. And they"},{"speaker":"Chris Dy","startTime":77.86,"endTime":80.38,"body":"were having a good time and"},{"speaker":"Chris Dy","startTime":77.86,"endTime":80.38,"body":"there was nobody on the blacktop"},{"speaker":"Chris Dy","startTime":80.47,"endTime":83.2,"body":"and they needed to go home to"},{"speaker":"Chris Dy","startTime":80.47,"endTime":83.2,"body":"get a snack. So I said, we're"},{"speaker":"Chris Dy","startTime":83.2,"endTime":85.45,"body":"gonna go home to get a snack"},{"speaker":"Chris Dy","startTime":83.2,"endTime":85.45,"body":"because it's only a five minute"},{"speaker":"Chris Dy","startTime":85.45,"endTime":88.12,"body":"walk. I'm gonna get my"},{"speaker":"Chris Dy","startTime":85.45,"endTime":88.12,"body":"basketball and I'm going to see"},{"speaker":"Chris Dy","startTime":88.12,"endTime":91.15,"body":"if they will let me shoot around"},{"speaker":"Chris Dy","startTime":88.12,"endTime":91.15,"body":"while they eat their snack at"},{"speaker":"Chris Dy","startTime":91.15,"endTime":97.99,"body":"the park and do their nature"},{"speaker":"Chris Dy","startTime":91.15,"endTime":97.99,"body":"hunts as they call it. So we got"},{"speaker":"Chris Dy","startTime":97.99,"endTime":100.63,"body":"the snacks packed up, got"},{"speaker":"Chris Dy","startTime":97.99,"endTime":100.63,"body":"everybody back in their little"},{"speaker":"Chris Dy","startTime":100.63,"endTime":106.33,"body":"radio flyer wagon. And my son my"},{"speaker":"Chris Dy","startTime":100.63,"endTime":106.33,"body":"five year old wanted to pull his"},{"speaker":"Chris Dy","startTime":106.33,"endTime":108.7,"body":"two year old sister along so"},{"speaker":"Chris Dy","startTime":106.33,"endTime":108.7,"body":"then I got to dribble all the"},{"speaker":"Chris Dy","startTime":108.7,"endTime":112.27,"body":"way to the park. I realized my"},{"speaker":"Chris Dy","startTime":108.7,"endTime":112.27,"body":"handle is sorry, compared to"},{"speaker":"Chris Dy","startTime":112.27,"endTime":114.73,"body":"what it used to be. It wasn't"},{"speaker":"Chris Dy","startTime":112.27,"endTime":114.73,"body":"that good before, let's be"},{"speaker":"Chris Dy","startTime":114.73,"endTime":120.43,"body":"honest. But the the action of"},{"speaker":"Chris Dy","startTime":114.73,"endTime":120.43,"body":"dribbling a basketball. It's"},{"speaker":"Chris Dy","startTime":120.43,"endTime":123.64,"body":"been a long, long time since"},{"speaker":"Chris Dy","startTime":120.43,"endTime":123.64,"body":"I've dribbled a basketball. You"},{"speaker":"Chris Dy","startTime":123.64,"endTime":127.6,"body":"know, just in general. Yeah, so"},{"speaker":"Chris Dy","startTime":123.64,"endTime":127.6,"body":"I got to play for a little bit"},{"speaker":"Chris Dy","startTime":127.6,"endTime":130.48,"body":"tonight. I got to shoot around."},{"speaker":"Chris Dy","startTime":127.6,"endTime":130.48,"body":"Still got the shot. It took a"},{"speaker":"Chris Dy","startTime":130.48,"endTime":131.35,"body":"while to get it back."},{"speaker":"Charles Goldfarb","startTime":132.86,"endTime":136.25,"body":"I miss playing"},{"speaker":"Charles Goldfarb","startTime":132.86,"endTime":136.25,"body":"basketball but I am enjoying"},{"speaker":"Charles Goldfarb","startTime":136.25,"endTime":139.55,"body":"watching basketball. A couple"},{"speaker":"Charles Goldfarb","startTime":136.25,"endTime":139.55,"body":"interesting things. I think."},{"speaker":"Charles Goldfarb","startTime":140.06,"endTime":147.14,"body":"First of all, I watched the vast"},{"speaker":"Charles Goldfarb","startTime":140.06,"endTime":147.14,"body":"majority of UConn versus Iowa in"},{"speaker":"Charles Goldfarb","startTime":147.14,"endTime":151.46,"body":"the women's sweet 16 game"},{"speaker":"Charles Goldfarb","startTime":147.14,"endTime":151.46,"body":"yesterday. And it's interesting"},{"speaker":"Charles Goldfarb","startTime":151.46,"endTime":153.41,"body":"essentially for a couple"},{"speaker":"Charles Goldfarb","startTime":151.46,"endTime":153.41,"body":"reasons. One I just love"},{"speaker":"Charles Goldfarb","startTime":153.41,"endTime":155.45,"body":"basketball, any and all"},{"speaker":"Charles Goldfarb","startTime":153.41,"endTime":155.45,"body":"basketball and the women's game"},{"speaker":"Charles Goldfarb","startTime":155.45,"endTime":158.81,"body":"in some ways is so much more"},{"speaker":"Charles Goldfarb","startTime":155.45,"endTime":158.81,"body":"fundamentally sound and fun to"},{"speaker":"Charles Goldfarb","startTime":158.81,"endTime":162.71,"body":"watch. If you enjoy a passing"},{"speaker":"Charles Goldfarb","startTime":158.81,"endTime":162.71,"body":"game, not just a one on one"},{"speaker":"Charles Goldfarb","startTime":162.71,"endTime":165.86,"body":"game, and it's really was great"},{"speaker":"Charles Goldfarb","startTime":162.71,"endTime":165.86,"body":"and UConn you know, is the"},{"speaker":"Charles Goldfarb","startTime":165.86,"endTime":170.78,"body":"pinnacle. And they have a great"},{"speaker":"Charles Goldfarb","startTime":165.86,"endTime":170.78,"body":"team top to bottom. And they"},{"speaker":"Charles Goldfarb","startTime":170.78,"endTime":174.53,"body":"have a freshman who's a"},{"speaker":"Charles Goldfarb","startTime":170.78,"endTime":174.53,"body":"superstar. This guy, this guy"},{"speaker":"Charles Goldfarb","startTime":174.53,"endTime":180.8,"body":"this this girl Bueckers and they"},{"speaker":"Charles Goldfarb","startTime":174.53,"endTime":180.8,"body":"played Iowa who has a superstar"},{"speaker":"Charles Goldfarb","startTime":180.8,"endTime":184.22,"body":"freshmen of their own, who"},{"speaker":"Charles Goldfarb","startTime":180.8,"endTime":184.22,"body":"actually is the leading scorer"},{"speaker":"Charles Goldfarb","startTime":184.22,"endTime":187.31,"body":"in the nation. And so there's a"},{"speaker":"Charles Goldfarb","startTime":184.22,"endTime":187.31,"body":"lot of promotion around, you"},{"speaker":"Charles Goldfarb","startTime":187.31,"endTime":190.85,"body":"know, the freshmen at UConn and"},{"speaker":"Charles Goldfarb","startTime":187.31,"endTime":190.85,"body":"the freshmen at at Iowa. This is"},{"speaker":"Charles Goldfarb","startTime":190.85,"endTime":194.06,"body":"super interesting. It was a"},{"speaker":"Charles Goldfarb","startTime":190.85,"endTime":194.06,"body":"great game, and UConn won and"},{"speaker":"Charles Goldfarb","startTime":194.06,"endTime":197.03,"body":"you know, neither freshmen had"},{"speaker":"Charles Goldfarb","startTime":194.06,"endTime":197.03,"body":"the game they hoped they would"},{"speaker":"Charles Goldfarb","startTime":197.03,"endTime":200.27,"body":"have, but they were both really"},{"speaker":"Charles Goldfarb","startTime":197.03,"endTime":200.27,"body":"still good. Draymond Green, who"},{"speaker":"Charles Goldfarb","startTime":200.27,"endTime":202.49,"body":"I really liked for the Golden"},{"speaker":"Charles Goldfarb","startTime":200.27,"endTime":202.49,"body":"State Warriors, who was"},{"speaker":"Charles Goldfarb","startTime":202.49,"endTime":209.36,"body":"outspoken, commented on, you"},{"speaker":"Charles Goldfarb","startTime":202.49,"endTime":209.36,"body":"know, equity in sports, and his"},{"speaker":"Charles Goldfarb","startTime":209.36,"endTime":212.75,"body":"comments on Twitter generate a"},{"speaker":"Charles Goldfarb","startTime":209.36,"endTime":212.75,"body":"little bit of a buzz. Because"},{"speaker":"Charles Goldfarb","startTime":212.75,"endTime":216.2,"body":"basically, he said, and I'm"},{"speaker":"Charles Goldfarb","startTime":212.75,"endTime":216.2,"body":"gonna oversimplify it that, that"},{"speaker":"Charles Goldfarb","startTime":216.2,"endTime":219.35,"body":"the women's sports in the"},{"speaker":"Charles Goldfarb","startTime":216.2,"endTime":219.35,"body":"women's game need to do more to"},{"speaker":"Charles Goldfarb","startTime":219.35,"endTime":223.1,"body":"promote their own to generate"},{"speaker":"Charles Goldfarb","startTime":219.35,"endTime":223.1,"body":"the buzz. And he got a little"},{"speaker":"Charles Goldfarb","startTime":223.1,"endTime":227.12,"body":"bit of pushback in a very"},{"speaker":"Charles Goldfarb","startTime":223.1,"endTime":227.12,"body":"positive way, not a not a pylon"},{"speaker":"Charles Goldfarb","startTime":227.12,"endTime":230.87,"body":"way from prominent women,"},{"speaker":"Charles Goldfarb","startTime":227.12,"endTime":230.87,"body":"saying, look, we've tried that,"},{"speaker":"Charles Goldfarb","startTime":230.9,"endTime":234.35,"body":"we need help. But what's"},{"speaker":"Charles Goldfarb","startTime":230.9,"endTime":234.35,"body":"interesting for me Sorry, and"},{"speaker":"Charles Goldfarb","startTime":234.35,"endTime":237.35,"body":"I'll stop jabbering on. What's"},{"speaker":"Charles Goldfarb","startTime":234.35,"endTime":237.35,"body":"interesting for me is the reason"},{"speaker":"Charles Goldfarb","startTime":237.35,"endTime":241.1,"body":"I watched that game, because"},{"speaker":"Charles Goldfarb","startTime":237.35,"endTime":241.1,"body":"there was that human element of"},{"speaker":"Charles Goldfarb","startTime":241.1,"endTime":243.17,"body":"this freshmen versus freshmen,"},{"speaker":"Charles Goldfarb","startTime":241.1,"endTime":243.17,"body":"which is a way"},{"speaker":"Charles Goldfarb","startTime":243.17,"endTime":245.99,"body":"oversimplification of a lot of"},{"speaker":"Charles Goldfarb","startTime":243.17,"endTime":245.99,"body":"great women on the court. But it"},{"speaker":"Charles Goldfarb","startTime":245.99,"endTime":248.99,"body":"was really fun to watch. And"},{"speaker":"Charles Goldfarb","startTime":245.99,"endTime":248.99,"body":"it's just a really interesting"},{"speaker":"Charles Goldfarb","startTime":248.99,"endTime":249.8,"body":"conversation."},{"speaker":"Chris Dy","startTime":250.13,"endTime":251.96,"body":"I think it's human"},{"speaker":"Chris Dy","startTime":250.13,"endTime":251.96,"body":"nature, though, for people to"},{"speaker":"Chris Dy","startTime":251.96,"endTime":255.26,"body":"like stories and people to like"},{"speaker":"Chris Dy","startTime":251.96,"endTime":255.26,"body":"narratives. I mean, Last Dance,"},{"speaker":"Chris Dy","startTime":255.26,"endTime":258.89,"body":"was a huge hit, you know, 10"},{"speaker":"Chris Dy","startTime":255.26,"endTime":258.89,"body":"months ago, because people"},{"speaker":"Chris Dy","startTime":258.89,"endTime":263.24,"body":"wanted to hear the story. Jordan"},{"speaker":"Chris Dy","startTime":258.89,"endTime":263.24,"body":"was a huge, you know, draw the"},{"speaker":"Chris Dy","startTime":263.24,"endTime":267.29,"body":"entire time because he was the"},{"speaker":"Chris Dy","startTime":263.24,"endTime":267.29,"body":"story. And just like everything"},{"speaker":"Chris Dy","startTime":267.29,"endTime":270.5,"body":"that we do, including our"},{"speaker":"Chris Dy","startTime":267.29,"endTime":270.5,"body":"research, you know, when we're"},{"speaker":"Chris Dy","startTime":270.77,"endTime":273.02,"body":"trying to pitch for grants, etc."},{"speaker":"Chris Dy","startTime":270.77,"endTime":273.02,"body":"Like it's all about"},{"speaker":"Chris Dy","startTime":273.02,"endTime":276.26,"body":"storytelling. It you know,"},{"speaker":"Chris Dy","startTime":273.02,"endTime":276.26,"body":"writing a good paper is, you"},{"speaker":"Chris Dy","startTime":276.26,"endTime":280.76,"body":"know, storytelling, because you"},{"speaker":"Chris Dy","startTime":276.26,"endTime":280.76,"body":"want to be, you need to capture"},{"speaker":"Chris Dy","startTime":280.76,"endTime":284.45,"body":"people. And you know, no matter"},{"speaker":"Chris Dy","startTime":280.76,"endTime":284.45,"body":"how many times you talk about"},{"speaker":"Chris Dy","startTime":284.54,"endTime":287.84,"body":"your data in a highly technical"},{"speaker":"Chris Dy","startTime":284.54,"endTime":287.84,"body":"way, unless you tell a"},{"speaker":"Chris Dy","startTime":287.84,"endTime":289.46,"body":"compelling story. It's not going"},{"speaker":"Chris Dy","startTime":287.84,"endTime":289.46,"body":"to sink."},{"speaker":"Charles Goldfarb","startTime":289.94,"endTime":291.86,"body":"I like I like"},{"speaker":"Charles Goldfarb","startTime":289.94,"endTime":291.86,"body":"how you frame that and that's"},{"speaker":"Charles Goldfarb","startTime":291.86,"endTime":296.33,"body":"exactly right. And with today's"},{"speaker":"Charles Goldfarb","startTime":291.86,"endTime":296.33,"body":"media world with so much"},{"speaker":"Charles Goldfarb","startTime":296.33,"endTime":300.8,"body":"segmentation in the world,"},{"speaker":"Charles Goldfarb","startTime":296.33,"endTime":300.8,"body":"grabbing someone's attention and"},{"speaker":"Charles Goldfarb","startTime":300.8,"endTime":303.86,"body":"then having it translate to"},{"speaker":"Charles Goldfarb","startTime":300.8,"endTime":303.86,"body":"watch a full basketball game"},{"speaker":"Charles Goldfarb","startTime":303.86,"endTime":306.71,"body":"just doesn't happen that much"},{"speaker":"Charles Goldfarb","startTime":303.86,"endTime":306.71,"body":"anymore and sports have a leg up"},{"speaker":"Charles Goldfarb","startTime":306.71,"endTime":309.92,"body":"over everything else but but it"},{"speaker":"Charles Goldfarb","startTime":306.71,"endTime":309.92,"body":"was really effective and i can"},{"speaker":"Charles Goldfarb","startTime":309.92,"endTime":313.19,"body":"tell you I will continue to"},{"speaker":"Charles Goldfarb","startTime":309.92,"endTime":313.19,"body":"watch UConn all the way through"},{"speaker":"Charles Goldfarb","startTime":313.4,"endTime":316.49,"body":"and pull for them when i really"},{"speaker":"Charles Goldfarb","startTime":313.4,"endTime":316.49,"body":"hadn't watched them all season"},{"speaker":"Charles Goldfarb","startTime":316.49,"endTime":321.26,"body":"and the women's game in some"},{"speaker":"Charles Goldfarb","startTime":316.49,"endTime":321.26,"body":"ways has become at least equally"},{"speaker":"Charles Goldfarb","startTime":321.26,"endTime":323.45,"body":"if not more compelling than the"},{"speaker":"Charles Goldfarb","startTime":321.26,"endTime":323.45,"body":"men's game because there's so"},{"speaker":"Charles Goldfarb","startTime":323.45,"endTime":325.7,"body":"many teams I don't know anything"},{"speaker":"Charles Goldfarb","startTime":323.45,"endTime":325.7,"body":"about in the men's tournament"},{"speaker":"Charles Goldfarb","startTime":325.7,"endTime":327.53,"body":"this year which is exciting but."},{"speaker":"Chris Dy","startTime":329.3,"endTime":331.73,"body":"Different game though"},{"speaker":"Chris Dy","startTime":329.3,"endTime":331.73,"body":"right you know it's especially"},{"speaker":"Chris Dy","startTime":331.73,"endTime":336.05,"body":"if you compare you know women's"},{"speaker":"Chris Dy","startTime":331.73,"endTime":336.05,"body":"hoops to the nba and watching"},{"speaker":"Chris Dy","startTime":336.05,"endTime":338.81,"body":"somebody like james harden play"},{"speaker":"Chris Dy","startTime":336.05,"endTime":338.81,"body":"it's completely different."},{"speaker":"Charles Goldfarb","startTime":339.2,"endTime":340.94,"body":"Yeah and i"},{"speaker":"Charles Goldfarb","startTime":339.2,"endTime":340.94,"body":"think that hits the nail on the"},{"speaker":"Charles Goldfarb","startTime":340.94,"endTime":344.48,"body":"head for me personally I don't"},{"speaker":"Charles Goldfarb","startTime":340.94,"endTime":344.48,"body":"enjoy watching james harden I"},{"speaker":"Charles Goldfarb","startTime":344.48,"endTime":347.66,"body":"don't enjoy the one on one game"},{"speaker":"Charles Goldfarb","startTime":344.48,"endTime":347.66,"body":"now james harden is an amazing"},{"speaker":"Charles Goldfarb","startTime":347.66,"endTime":351.68,"body":"passer when he wants to be but"},{"speaker":"Charles Goldfarb","startTime":347.66,"endTime":351.68,"body":"watching the women's game all"},{"speaker":"Charles Goldfarb","startTime":351.68,"endTime":354.74,"body":"the women look for the pass"},{"speaker":"Charles Goldfarb","startTime":351.68,"endTime":354.74,"body":"first, it's just a very cohesive"},{"speaker":"Charles Goldfarb","startTime":354.74,"endTime":355.19,"body":"sport."},{"speaker":"Chris Dy","startTime":356.8,"endTime":359.62,"body":"Well I look forward to"},{"speaker":"Chris Dy","startTime":356.8,"endTime":359.62,"body":"seeing who takes home the"},{"speaker":"Chris Dy","startTime":359.65,"endTime":362.92,"body":"championship so we're recording"},{"speaker":"Chris Dy","startTime":359.65,"endTime":362.92,"body":"this on March 28 and this is"},{"speaker":"Chris Dy","startTime":362.92,"endTime":365.8,"body":"going to come out i think a week"},{"speaker":"Chris Dy","startTime":362.92,"endTime":365.8,"body":"later so we'll have some, we'll"},{"speaker":"Chris Dy","startTime":365.8,"endTime":366.73,"body":"have some updates."},{"speaker":"Charles Goldfarb","startTime":372.87,"endTime":381.9,"body":"our listeners"},{"speaker":"Charles Goldfarb","startTime":372.87,"endTime":381.9,"body":"have followed this story and you"},{"speaker":"Charles Goldfarb","startTime":381.9,"endTime":386.34,"body":"know Goldman is a well known"},{"speaker":"Charles Goldfarb","startTime":381.9,"endTime":386.34,"body":"financial institution and i"},{"speaker":"Charles Goldfarb","startTime":386.34,"endTime":388.95,"body":"don't know about your college"},{"speaker":"Charles Goldfarb","startTime":386.34,"endTime":388.95,"body":"but a lot of my friends from"},{"speaker":"Charles Goldfarb","startTime":388.95,"endTime":393.63,"body":"college went from undergrad to"},{"speaker":"Charles Goldfarb","startTime":388.95,"endTime":393.63,"body":"Goldman and firms like Goldman"},{"speaker":"Charles Goldfarb","startTime":393.87,"endTime":397.41,"body":"understanding that they would be"},{"speaker":"Charles Goldfarb","startTime":393.87,"endTime":397.41,"body":"really well compensated and they"},{"speaker":"Charles Goldfarb","startTime":397.41,"endTime":401.43,"body":"would work incredibly hard and"},{"speaker":"Charles Goldfarb","startTime":397.41,"endTime":401.43,"body":"it would launch their careers"},{"speaker":"Charles Goldfarb","startTime":401.43,"endTime":406.32,"body":"and so the the news was 13"},{"speaker":"Charles 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Goldfarb","startTime":433.8,"endTime":436.98,"body":"you had any quick takes on the"},{"speaker":"Charles Goldfarb","startTime":436.98,"endTime":437.43,"body":"story."},{"speaker":"Chris Dy","startTime":437.82,"endTime":439.8,"body":"Well I mean the way"},{"speaker":"Chris Dy","startTime":437.82,"endTime":439.8,"body":"you describe the Goldman"},{"speaker":"Chris Dy","startTime":439.8,"endTime":443.7,"body":"experience you know you're going"},{"speaker":"Chris Dy","startTime":439.8,"endTime":443.7,"body":"to right out of you know school"},{"speaker":"Chris Dy","startTime":443.73,"endTime":446.64,"body":"you're going to work incredibly"},{"speaker":"Chris Dy","startTime":443.73,"endTime":446.64,"body":"hard for very long hours for"},{"speaker":"Chris Dy","startTime":446.64,"endTime":450.15,"body":"little pay knowing that it would"},{"speaker":"Chris Dy","startTime":446.64,"endTime":450.15,"body":"set you up for the rest of your"},{"speaker":"Chris Dy","startTime":450.15,"endTime":452.85,"body":"career I mean you could have"},{"speaker":"Chris Dy","startTime":450.15,"endTime":452.85,"body":"just described residency in a"},{"speaker":"Chris Dy","startTime":452.85,"endTime":456.27,"body":"nutshell there right. You know I"},{"speaker":"Chris Dy","startTime":452.85,"endTime":456.27,"body":"did find it really interesting"},{"speaker":"Chris Dy","startTime":456.27,"endTime":458.28,"body":"you know the number of hours"},{"speaker":"Chris Dy","startTime":456.27,"endTime":458.28,"body":"they were working you know that"},{"speaker":"Chris Dy","startTime":458.31,"endTime":461.94,"body":"the slide that was in the"},{"speaker":"Chris Dy","startTime":458.31,"endTime":461.94,"body":"article you sent me said the you"},{"speaker":"Chris Dy","startTime":461.94,"endTime":464.82,"body":"know this past week this person"},{"speaker":"Chris Dy","startTime":461.94,"endTime":464.82,"body":"worked 105 hours and their"},{"speaker":"Chris Dy","startTime":464.82,"endTime":469.14,"body":"average was 95 hours they go to"},{"speaker":"Chris Dy","startTime":464.82,"endTime":469.14,"body":"sleep at 3am they have five"},{"speaker":"Chris Dy","startTime":469.14,"endTime":472.17,"body":"hours of sleep on average and"},{"speaker":"Chris Dy","startTime":469.14,"endTime":472.17,"body":"that means that they're getting"},{"speaker":"Chris Dy","startTime":472.17,"endTime":477.69,"body":"less sometimes I mean you know"},{"speaker":"Chris Dy","startTime":472.17,"endTime":477.69,"body":"it's it's how residency used to"},{"speaker":"Chris Dy","startTime":477.69,"endTime":482.1,"body":"be right and I only know the"},{"speaker":"Chris Dy","startTime":477.69,"endTime":482.1,"body":"residency that I went through"},{"speaker":"Chris Dy","startTime":482.1,"endTime":485.01,"body":"and i've heard the tales from"},{"speaker":"Chris Dy","startTime":482.1,"endTime":485.01,"body":"others and i've heard the tales"},{"speaker":"Chris Dy","startTime":485.01,"endTime":487.92,"body":"from my father and I know that"},{"speaker":"Chris Dy","startTime":485.01,"endTime":487.92,"body":"it was much more of a grind and"},{"speaker":"Chris Dy","startTime":487.92,"endTime":490.71,"body":"was a much more difficult"},{"speaker":"Chris Dy","startTime":487.92,"endTime":490.71,"body":"process than even when I went"},{"speaker":"Chris Dy","startTime":490.71,"endTime":494.4,"body":"through it and now it's even"},{"speaker":"Chris Dy","startTime":490.71,"endTime":494.4,"body":"more different but yeah the"},{"speaker":"Chris Dy","startTime":494.4,"endTime":497.37,"body":"story resonates for the obvious"},{"speaker":"Chris Dy","startTime":494.4,"endTime":497.37,"body":"reasons with regards to surgical"},{"speaker":"Chris Dy","startTime":497.37,"endTime":498.42,"body":"training in particular."},{"speaker":"Charles Goldfarb","startTime":499.2,"endTime":501.63,"body":"Yeah the"},{"speaker":"Charles Goldfarb","startTime":499.2,"endTime":501.63,"body":"difference of course there's"},{"speaker":"Charles Goldfarb","startTime":501.63,"endTime":506.22,"body":"several differences but the one"},{"speaker":"Charles Goldfarb","startTime":501.63,"endTime":506.22,"body":"difference is most people are"},{"speaker":"Charles Goldfarb","startTime":506.43,"endTime":510.09,"body":"going to somewhere like Goldman"},{"speaker":"Charles Goldfarb","startTime":506.43,"endTime":510.09,"body":"to learn a skill set, establish"},{"speaker":"Charles Goldfarb","startTime":510.09,"endTime":513.72,"body":"their name, make better money"},{"speaker":"Charles Goldfarb","startTime":510.09,"endTime":513.72,"body":"than we make as residents let's"},{"speaker":"Charles Goldfarb","startTime":513.72,"endTime":516.63,"body":"be clear for those first few"},{"speaker":"Charles Goldfarb","startTime":513.72,"endTime":516.63,"body":"years, and then make better"},{"speaker":"Charles Goldfarb","startTime":516.63,"endTime":519.69,"body":"money than most doctors could"},{"speaker":"Charles Goldfarb","startTime":516.63,"endTime":519.69,"body":"ever you know dream of that may"},{"speaker":"Charles Goldfarb","startTime":519.69,"endTime":522.51,"body":"be a little bit of an"},{"speaker":"Charles 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approach"},{"speaker":"Chris Dy","startTime":556.55,"endTime":562.25,"body":"life and work life balance or"},{"speaker":"Chris Dy","startTime":556.55,"endTime":562.25,"body":"integration or whatever you want"},{"speaker":"Chris Dy","startTime":562.25,"endTime":565.16,"body":"to call it is different than"},{"speaker":"Chris Dy","startTime":562.25,"endTime":565.16,"body":"even your generation and even"},{"speaker":"Chris Dy","startTime":565.16,"endTime":568.31,"body":"gen z will approach things"},{"speaker":"Chris Dy","startTime":565.16,"endTime":568.31,"body":"differently than millennials do"},{"speaker":"Chris Dy","startTime":569.66,"endTime":574.16,"body":"and I think that while the older"},{"speaker":"Chris Dy","startTime":569.66,"endTime":574.16,"body":"generations can tend to gripe"},{"speaker":"Chris Dy","startTime":574.16,"endTime":579.2,"body":"about the newer generations if"},{"speaker":"Chris Dy","startTime":574.16,"endTime":579.2,"body":"you don't recognize that you"},{"speaker":"Chris Dy","startTime":579.2,"endTime":582.65,"body":"can't change that generation you"},{"speaker":"Chris Dy","startTime":579.2,"endTime":582.65,"body":"honestly have to go with it and"},{"speaker":"Chris Dy","startTime":582.65,"endTime":584.54,"body":"if you don't change you're going"},{"speaker":"Chris Dy","startTime":582.65,"endTime":584.54,"body":"to be left behind"},{"speaker":"Charles Goldfarb","startTime":585.26,"endTime":586.91,"body":"that's exactly"},{"speaker":"Charles Goldfarb","startTime":585.26,"endTime":586.91,"body":"right it actually sounds like a"},{"speaker":"Charles Goldfarb","startTime":587.21,"endTime":589.97,"body":"good topic for a podcast i don't"},{"speaker":"Charles Goldfarb","startTime":587.21,"endTime":589.97,"body":"know that our listeners would"},{"speaker":"Charles Goldfarb","startTime":589.97,"endTime":594.86,"body":"appreciate it but I will never"},{"speaker":"Charles Goldfarb","startTime":589.97,"endTime":594.86,"body":"forget Peter Stern's ASSH"},{"speaker":"Charles Goldfarb","startTime":595.28,"endTime":600.14,"body":"presidential address was on"},{"speaker":"Charles Goldfarb","startTime":595.28,"endTime":600.14,"body":"generational differences. He"},{"speaker":"Charles Goldfarb","startTime":600.14,"endTime":602.84,"body":"talked about this is way back"},{"speaker":"Charles Goldfarb","startTime":600.14,"endTime":602.84,"body":"when he talked about the"},{"speaker":"Charles Goldfarb","startTime":602.84,"endTime":606.38,"body":"mailbox, what it meant to him,"},{"speaker":"Charles Goldfarb","startTime":602.84,"endTime":606.38,"body":"you know, the physical mailbox"},{"speaker":"Charles Goldfarb","startTime":606.41,"endTime":610.61,"body":"when he used the AOL example for"},{"speaker":"Charles Goldfarb","startTime":606.41,"endTime":610.61,"body":"his daughter, they AOL mailbox"},{"speaker":"Charles Goldfarb","startTime":610.61,"endTime":613.85,"body":"and how you know, just so"},{"speaker":"Charles Goldfarb","startTime":610.61,"endTime":613.85,"body":"different that was, but I love"},{"speaker":"Charles Goldfarb","startTime":613.85,"endTime":616.31,"body":"the topic and it could be it"},{"speaker":"Charles Goldfarb","startTime":613.85,"endTime":616.31,"body":"could be fun to explore."},{"speaker":"Chris Dy","startTime":616.69,"endTime":619.27,"body":"Shout out, shout out"},{"speaker":"Chris Dy","startTime":616.69,"endTime":619.27,"body":"to Peter Stern, I got something"},{"speaker":"Chris Dy","startTime":619.27,"endTime":622.03,"body":"really nice in the mail from"},{"speaker":"Chris Dy","startTime":619.27,"endTime":622.03,"body":"him, like the actual physical"},{"speaker":"Chris Dy","startTime":622.03,"endTime":626.32,"body":"mailbox, he sent me the most"},{"speaker":"Chris Dy","startTime":622.03,"endTime":626.32,"body":"updated version of selected"},{"speaker":"Chris Dy","startTime":626.32,"endTime":630.37,"body":"readings, which I love the fact"},{"speaker":"Chris Dy","startTime":626.32,"endTime":630.37,"body":"that it's on a flash drive, it's"},{"speaker":"Chris Dy","startTime":630.37,"endTime":633.73,"body":"got its own little imprinted,"},{"speaker":"Chris Dy","startTime":630.37,"endTime":633.73,"body":"you know, label on the flash"},{"speaker":"Chris Dy","startTime":633.73,"endTime":636.34,"body":"drive. And I'm sure I know, the"},{"speaker":"Chris Dy","startTime":633.73,"endTime":636.34,"body":"reason why he just doesn't"},{"speaker":"Chris Dy","startTime":636.34,"endTime":638.62,"body":"distributed electronically,"},{"speaker":"Chris Dy","startTime":636.34,"endTime":638.62,"body":"because there are obvious"},{"speaker":"Chris Dy","startTime":638.62,"endTime":642.46,"body":"copyright considerations there."},{"speaker":"Chris Dy","startTime":638.62,"endTime":642.46,"body":"But it's such a great collection"},{"speaker":"Chris Dy","startTime":642.46,"endTime":645.49,"body":"of articles. I remember"},{"speaker":"Chris Dy","startTime":642.46,"endTime":645.49,"body":"interviewing for fellowship and"},{"speaker":"Chris Dy","startTime":645.49,"endTime":651.79,"body":"getting a version on a CD ROM."},{"speaker":"Chris Dy","startTime":645.49,"endTime":651.79,"body":"And I kept, I still have it, to"},{"speaker":"Chris Dy","startTime":651.79,"endTime":655.06,"body":"be honest. Now I've got the USB,"},{"speaker":"Chris Dy","startTime":651.79,"endTime":655.06,"body":"which is great. So but it came"},{"speaker":"Chris Dy","startTime":655.06,"endTime":657.82,"body":"with a really nice note. He had"},{"speaker":"Chris Dy","startTime":655.06,"endTime":657.82,"body":"read the What's New in hand"},{"speaker":"Chris Dy","startTime":657.82,"endTime":660.85,"body":"surgery and commented on that."},{"speaker":"Chris Dy","startTime":657.82,"endTime":660.85,"body":"And, you know, what an"},{"speaker":"Chris Dy","startTime":660.85,"endTime":665.53,"body":"incredible, incredible gesture."},{"speaker":"Chris Dy","startTime":660.85,"endTime":665.53,"body":"And such a great person, a"},{"speaker":"Chris Dy","startTime":665.53,"endTime":666.76,"body":"little time capsule there."},{"speaker":"Charles Goldfarb","startTime":667.09,"endTime":669.7,"body":"For sure. You"},{"speaker":"Charles Goldfarb","startTime":667.09,"endTime":669.7,"body":"know, when I was at his fellow"},{"speaker":"Charles Goldfarb","startTime":669.73,"endTime":673.63,"body":"back in 2001, thankfully, still"},{"speaker":"Charles Goldfarb","startTime":669.73,"endTime":673.63,"body":"in the 21st century, or else"},{"speaker":"Charles Goldfarb","startTime":673.63,"endTime":674.02,"body":"you'd give me-"},{"speaker":"Chris Dy","startTime":674.02,"endTime":675.67,"body":"Was it on a floppy"},{"speaker":"Chris Dy","startTime":674.02,"endTime":675.67,"body":"disk, then?"},{"speaker":"Charles Goldfarb","startTime":675.91,"endTime":679.6,"body":"It was"},{"speaker":"Charles Goldfarb","startTime":675.91,"endTime":679.6,"body":"handwritten, typed manuscripts."},{"speaker":"Charles Goldfarb","startTime":681.16,"endTime":684.22,"body":"No, but it was I don't know when"},{"speaker":"Charles Goldfarb","startTime":681.16,"endTime":684.22,"body":"he started that process, but it"},{"speaker":"Charles Goldfarb","startTime":684.22,"endTime":689.08,"body":"felt early in the process. And"},{"speaker":"Charles Goldfarb","startTime":684.22,"endTime":689.08,"body":"it has evolved and become widely"},{"speaker":"Charles Goldfarb","startTime":689.08,"endTime":691.81,"body":"recognized. I don't know how"},{"speaker":"Charles Goldfarb","startTime":689.08,"endTime":691.81,"body":"widely it was recognized 20"},{"speaker":"Charles Goldfarb","startTime":691.81,"endTime":694.69,"body":"years ago, literally 20 years"},{"speaker":"Charles Goldfarb","startTime":691.81,"endTime":694.69,"body":"ago, I can tell you, I think you"},{"speaker":"Charles Goldfarb","startTime":694.69,"endTime":697.0,"body":"are aware of this. And I would"},{"speaker":"Charles Goldfarb","startTime":694.69,"endTime":697.0,"body":"say this honestly, to the"},{"speaker":"Charles Goldfarb","startTime":697.0,"endTime":700.21,"body":"listeners that Lindley Wall and"},{"speaker":"Charles Goldfarb","startTime":697.0,"endTime":700.21,"body":"I have put together a congenital"},{"speaker":"Charles Goldfarb","startTime":700.24,"endTime":704.53,"body":"selected readings which we"},{"speaker":"Charles Goldfarb","startTime":700.24,"endTime":704.53,"body":"update as we go. And it is for"},{"speaker":"Charles Goldfarb","startTime":704.83,"endTime":708.07,"body":"the basis of our congenital"},{"speaker":"Charles Goldfarb","startTime":704.83,"endTime":708.07,"body":"journal club once a month. And"},{"speaker":"Charles Goldfarb","startTime":708.43,"endTime":711.22,"body":"it's a great review process. And"},{"speaker":"Charles Goldfarb","startTime":708.43,"endTime":711.22,"body":"there may be a little selection"},{"speaker":"Charles Goldfarb","startTime":711.22,"endTime":714.94,"body":"bias favoring some of the work"},{"speaker":"Charles Goldfarb","startTime":711.22,"endTime":714.94,"body":"we've done here. But anyone who"},{"speaker":"Charles Goldfarb","startTime":714.94,"endTime":717.79,"body":"wants that just drop an email,"},{"speaker":"Charles Goldfarb","startTime":714.94,"endTime":717.79,"body":"and I'd be happy to share the"},{"speaker":"Charles Goldfarb","startTime":717.79,"endTime":719.74,"body":"list with you not the articles,"},{"speaker":"Charles Goldfarb","startTime":717.79,"endTime":719.74,"body":"but I'll share the list."},{"speaker":"Chris Dy","startTime":720.25,"endTime":723.58,"body":"Yeah, no, I think"},{"speaker":"Chris Dy","startTime":720.25,"endTime":723.58,"body":"that's a, a, what we so many"},{"speaker":"Chris Dy","startTime":723.58,"endTime":726.61,"body":"programs have done over the"},{"speaker":"Chris Dy","startTime":723.58,"endTime":726.61,"body":"years is adopted the, quote,"},{"speaker":"Chris Dy","startTime":726.61,"endTime":729.73,"body":"Stern articles into their"},{"speaker":"Chris Dy","startTime":726.61,"endTime":729.73,"body":"curriculum, because it's already"},{"speaker":"Chris Dy","startTime":729.73,"endTime":733.15,"body":"a curated list of articles. It's"},{"speaker":"Chris Dy","startTime":729.73,"endTime":733.15,"body":"great, and I think that if"},{"speaker":"Chris Dy","startTime":733.15,"endTime":736.84,"body":"anybody wants to incorporate the"},{"speaker":"Chris Dy","startTime":733.15,"endTime":736.84,"body":"congenital readings, I think"},{"speaker":"Chris Dy","startTime":736.84,"endTime":739.48,"body":"that why recreate, reinvent the"},{"speaker":"Chris Dy","startTime":736.84,"endTime":739.48,"body":"wheel?"},{"speaker":"Charles Goldfarb","startTime":740.53,"endTime":742.6,"body":"Yeah, I'm"},{"speaker":"Charles Goldfarb","startTime":740.53,"endTime":742.6,"body":"often you know, I love our"},{"speaker":"Charles Goldfarb","startTime":742.6,"endTime":744.94,"body":"congenital journal club. And we"},{"speaker":"Charles Goldfarb","startTime":742.6,"endTime":744.94,"body":"are getting way off topic, but I"},{"speaker":"Charles Goldfarb","startTime":744.94,"endTime":747.79,"body":"love the congenital journal"},{"speaker":"Charles Goldfarb","startTime":744.94,"endTime":747.79,"body":"club. And it ends up being the"},{"speaker":"Charles Goldfarb","startTime":747.79,"endTime":752.02,"body":"Socratic teaching method of"},{"speaker":"Charles Goldfarb","startTime":747.79,"endTime":752.02,"body":"myself and Dr. Wall and a few"},{"speaker":"Charles Goldfarb","startTime":752.02,"endTime":756.1,"body":"fellows and often a few"},{"speaker":"Charles Goldfarb","startTime":752.02,"endTime":756.1,"body":"residents. And I often say"},{"speaker":"Charles Goldfarb","startTime":756.1,"endTime":759.22,"body":"Should we just open that out and"},{"speaker":"Charles Goldfarb","startTime":756.1,"endTime":759.22,"body":"have whoever wants to join it? I"},{"speaker":"Charles Goldfarb","startTime":759.22,"endTime":761.5,"body":"think it would lose something. I"},{"speaker":"Charles Goldfarb","startTime":759.22,"endTime":761.5,"body":"think the small group really"},{"speaker":"Charles Goldfarb","startTime":761.5,"endTime":764.35,"body":"matters, but the readings are"},{"speaker":"Charles Goldfarb","startTime":761.5,"endTime":764.35,"body":"the basis of it. And the"},{"speaker":"Charles Goldfarb","startTime":764.35,"endTime":765.67,"body":"readings are easy to share."},{"speaker":"Chris Dy","startTime":765.93,"endTime":769.83,"body":"I will say now that I"},{"speaker":"Chris Dy","startTime":765.93,"endTime":769.83,"body":"enjoyed it, but I did not enjoy"},{"speaker":"Chris Dy","startTime":769.83,"endTime":773.82,"body":"it all the time. When I was"},{"speaker":"Chris Dy","startTime":769.83,"endTime":773.82,"body":"prepping for it. It was it felt"},{"speaker":"Chris Dy","startTime":773.82,"endTime":777.63,"body":"like you know, you know"},{"speaker":"Chris Dy","startTime":773.82,"endTime":777.63,"body":"preparing and you know, it was"},{"speaker":"Chris Dy","startTime":777.66,"endTime":781.38,"body":"like you said Socratic, so it"},{"speaker":"Chris Dy","startTime":777.66,"endTime":781.38,"body":"was a little bit stressful. But"},{"speaker":"Chris Dy","startTime":781.41,"endTime":783.81,"body":"you know, it is a great session,"},{"speaker":"Chris Dy","startTime":781.41,"endTime":783.81,"body":"I still have my notes. And I"},{"speaker":"Chris Dy","startTime":783.81,"endTime":786.6,"body":"know that some of our former"},{"speaker":"Chris Dy","startTime":783.81,"endTime":786.6,"body":"fellows, I remember when I was"},{"speaker":"Chris Dy","startTime":786.6,"endTime":790.71,"body":"interviewing our former fellows"},{"speaker":"Chris Dy","startTime":786.6,"endTime":790.71,"body":"for some fellowship promotion"},{"speaker":"Chris Dy","startTime":790.71,"endTime":794.61,"body":"stuff. Brinkley Sandvall talking"},{"speaker":"Chris Dy","startTime":790.71,"endTime":794.61,"body":"about opening up her notes from"},{"speaker":"Chris Dy","startTime":794.61,"endTime":797.82,"body":"congenital journal club and"},{"speaker":"Chris Dy","startTime":794.61,"endTime":797.82,"body":"still talking to you about cases"},{"speaker":"Chris Dy","startTime":797.82,"endTime":802.53,"body":"and everything. So clearly it"},{"speaker":"Chris Dy","startTime":797.82,"endTime":802.53,"body":"it's an effective educational"},{"speaker":"Chris Dy","startTime":802.53,"endTime":807.33,"body":"conference, and especially with"},{"speaker":"Chris Dy","startTime":802.53,"endTime":807.33,"body":"those inclined to go into that"},{"speaker":"Chris Dy","startTime":807.33,"endTime":811.71,"body":"area, it really resonates. So we"},{"speaker":"Chris Dy","startTime":807.33,"endTime":811.71,"body":"have a great review, I wanted to"},{"speaker":"Chris Dy","startTime":811.98,"endTime":816.39,"body":"read a review from Clayton"},{"speaker":"Chris Dy","startTime":811.98,"endTime":816.39,"body":"Nelson, that he kindly left this"},{"speaker":"Chris Dy","startTime":816.39,"endTime":820.68,"body":"for us on iTunes about a week"},{"speaker":"Chris Dy","startTime":816.39,"endTime":820.68,"body":"ago. So he gave us five stars,"},{"speaker":"Chris Dy","startTime":820.68,"endTime":823.77,"body":"which is pretty much the only"},{"speaker":"Chris Dy","startTime":820.68,"endTime":823.77,"body":"option right? Incredible"},{"speaker":"Chris Dy","startTime":823.77,"endTime":826.41,"body":"resource for surgeons,"},{"speaker":"Chris Dy","startTime":823.77,"endTime":826.41,"body":"therapists and patients. As a"},{"speaker":"Chris Dy","startTime":826.41,"endTime":829.14,"body":"young hand surgeon, I have found"},{"speaker":"Chris Dy","startTime":826.41,"endTime":829.14,"body":"these to be a valuable tool in"},{"speaker":"Chris Dy","startTime":829.14,"endTime":832.83,"body":"my continuing education. I truly"},{"speaker":"Chris Dy","startTime":829.14,"endTime":832.83,"body":"look forward to my commute so I"},{"speaker":"Chris Dy","startTime":832.83,"endTime":835.83,"body":"can catch another episode. And"},{"speaker":"Chris Dy","startTime":832.83,"endTime":835.83,"body":"that's from Dr. Clayton Nelson"},{"speaker":"Chris Dy","startTime":835.83,"endTime":838.11,"body":"Clayton, thank you for"},{"speaker":"Chris Dy","startTime":835.83,"endTime":838.11,"body":"listening. Thank you for leaving"},{"speaker":"Chris Dy","startTime":838.11,"endTime":842.04,"body":"the review and we are glad that"},{"speaker":"Chris Dy","startTime":838.11,"endTime":842.04,"body":"you have found it so enjoyable"},{"speaker":"Chris Dy","startTime":842.04,"endTime":842.43,"body":"and useful."},{"speaker":"Charles Goldfarb","startTime":843.06,"endTime":844.86,"body":"Absolutely."},{"speaker":"Charles Goldfarb","startTime":843.06,"endTime":844.86,"body":"Thank you so much. Thank you so"},{"speaker":"Charles Goldfarb","startTime":844.86,"endTime":849.63,"body":"much. Do you have a case? I have"},{"speaker":"Charles Goldfarb","startTime":844.86,"endTime":849.63,"body":"been on vacation this week? It's"},{"speaker":"Charles Goldfarb","startTime":849.63,"endTime":854.88,"body":"weird. I've had a great week."},{"speaker":"Charles Goldfarb","startTime":849.63,"endTime":854.88,"body":"And you know, I don't know if"},{"speaker":"Charles Goldfarb","startTime":854.88,"endTime":857.52,"body":"everyone experiences life I"},{"speaker":"Charles Goldfarb","startTime":854.88,"endTime":857.52,"body":"think I'm probably a little bit"},{"speaker":"Charles Goldfarb","startTime":857.52,"endTime":860.19,"body":"of an outlier. But first few"},{"speaker":"Charles Goldfarb","startTime":857.52,"endTime":860.19,"body":"days of vacation. You know, I"},{"speaker":"Charles Goldfarb","startTime":860.19,"endTime":865.08,"body":"kept up with email. And then a"},{"speaker":"Charles Goldfarb","startTime":860.19,"endTime":865.08,"body":"couple days later, I didn't and"},{"speaker":"Charles Goldfarb","startTime":865.11,"endTime":867.66,"body":"you know I check once or twice a"},{"speaker":"Charles Goldfarb","startTime":865.11,"endTime":867.66,"body":"day that's me not keeping up"},{"speaker":"Charles Goldfarb","startTime":867.66,"endTime":870.45,"body":"with email is checking once or"},{"speaker":"Charles Goldfarb","startTime":867.66,"endTime":870.45,"body":"twice a day and then the last"},{"speaker":"Charles Goldfarb","startTime":870.45,"endTime":873.66,"body":"couple of days I've been working"},{"speaker":"Charles Goldfarb","startTime":870.45,"endTime":873.66,"body":"to be honest with you. But it"},{"speaker":"Charles Goldfarb","startTime":873.66,"endTime":876.63,"body":"has been a very nice week. So I"},{"speaker":"Charles Goldfarb","startTime":873.66,"endTime":876.63,"body":"did not operate this week. Did"},{"speaker":"Charles Goldfarb","startTime":876.63,"endTime":878.55,"body":"you do anything especially"},{"speaker":"Charles Goldfarb","startTime":876.63,"endTime":878.55,"body":"exciting?"},{"speaker":"Chris Dy","startTime":879.08,"endTime":882.11,"body":"Um, you know, I had a"},{"speaker":"Chris Dy","startTime":879.08,"endTime":882.11,"body":"an interesting follow up that"},{"speaker":"Chris Dy","startTime":882.11,"endTime":885.11,"body":"came into the office. And he"},{"speaker":"Chris Dy","startTime":882.11,"endTime":885.11,"body":"actually has signed a bunch of"},{"speaker":"Chris Dy","startTime":885.11,"endTime":890.39,"body":"consents for marketing, social"},{"speaker":"Chris Dy","startTime":885.11,"endTime":890.39,"body":"media, etc. But there was a case"},{"speaker":"Chris Dy","startTime":890.39,"endTime":894.41,"body":"that I did back I think in the"},{"speaker":"Chris Dy","startTime":890.39,"endTime":894.41,"body":"fall and actually I talked about"},{"speaker":"Chris Dy","startTime":894.41,"endTime":899.72,"body":"it on the podcast earlier doing"},{"speaker":"Chris Dy","startTime":894.41,"endTime":899.72,"body":"a wide awake you know, first"},{"speaker":"Chris Dy","startTime":899.72,"endTime":903.5,"body":"compartment tendon repair from a"},{"speaker":"Chris Dy","startTime":899.72,"endTime":903.5,"body":"traumatic laceration and then"},{"speaker":"Chris Dy","startTime":903.86,"endTime":908.24,"body":"doing a superficial radial nerve"},{"speaker":"Chris Dy","startTime":903.86,"endTime":908.24,"body":"repair and he was my first wide"},{"speaker":"Chris Dy","startTime":908.24,"endTime":914.63,"body":"awake nerve repair the guy's"},{"speaker":"Chris Dy","startTime":908.24,"endTime":914.63,"body":"done fantastically well you know"},{"speaker":"Chris Dy","startTime":914.63,"endTime":919.85,"body":"it's so uncommon to get you know"},{"speaker":"Chris Dy","startTime":914.63,"endTime":919.85,"body":"excellent motion from some types"},{"speaker":"Chris Dy","startTime":919.85,"endTime":923.27,"body":"of traumatic lacerations, got"},{"speaker":"Chris Dy","startTime":919.85,"endTime":923.27,"body":"great motion of his thumb and"},{"speaker":"Chris Dy","startTime":923.27,"endTime":928.94,"body":"his SRN is completely grown back"},{"speaker":"Chris Dy","startTime":923.27,"endTime":928.94,"body":"it's fantastic he loves it and"},{"speaker":"Chris Dy","startTime":928.94,"endTime":932.69,"body":"it was great watching a distal"},{"speaker":"Chris Dy","startTime":928.94,"endTime":932.69,"body":"Tinel sign he loved being part"},{"speaker":"Chris Dy","startTime":932.69,"endTime":936.92,"body":"of the surgery and I am more and"},{"speaker":"Chris Dy","startTime":932.69,"endTime":936.92,"body":"more convinced that you know"},{"speaker":"Chris Dy","startTime":937.58,"endTime":940.31,"body":"patients know what we do is hard"},{"speaker":"Chris Dy","startTime":937.58,"endTime":940.31,"body":"but they don't really know how"},{"speaker":"Chris Dy","startTime":940.31,"endTime":943.28,"body":"hard what some of what we do is"},{"speaker":"Chris Dy","startTime":940.31,"endTime":943.28,"body":"and the different you know, on"},{"speaker":"Chris Dy","startTime":943.28,"endTime":945.89,"body":"the fly decisions that you're"},{"speaker":"Chris Dy","startTime":943.28,"endTime":945.89,"body":"making. I mean we make so many"},{"speaker":"Chris Dy","startTime":945.89,"endTime":949.25,"body":"consequential decisions on the"},{"speaker":"Chris Dy","startTime":945.89,"endTime":949.25,"body":"fly kind of like what we talked"},{"speaker":"Chris Dy","startTime":949.25,"endTime":951.89,"body":"about last week with you know"},{"speaker":"Chris Dy","startTime":949.25,"endTime":951.89,"body":"when you're thinking fast"},{"speaker":"Chris Dy","startTime":951.89,"endTime":957.11,"body":"thinking slow and you know not"},{"speaker":"Chris Dy","startTime":951.89,"endTime":957.11,"body":"overthinking things but what I"},{"speaker":"Chris Dy","startTime":957.11,"endTime":959.54,"body":"love about teaching residents"},{"speaker":"Chris Dy","startTime":957.11,"endTime":959.54,"body":"and fellows and students is that"},{"speaker":"Chris Dy","startTime":959.54,"endTime":962.09,"body":"you're talking through these"},{"speaker":"Chris Dy","startTime":959.54,"endTime":962.09,"body":"decisions and honestly i'm"},{"speaker":"Chris Dy","startTime":962.09,"endTime":965.18,"body":"talking through it i'm become"},{"speaker":"Chris Dy","startTime":962.09,"endTime":965.18,"body":"more confident as a surgeon now"},{"speaker":"Chris Dy","startTime":965.18,"endTime":967.82,"body":"that i've been practicing longer"},{"speaker":"Chris Dy","startTime":965.18,"endTime":967.82,"body":"to incorporate the patient into"},{"speaker":"Chris Dy","startTime":967.82,"endTime":970.91,"body":"these discussions and even a"},{"speaker":"Chris Dy","startTime":967.82,"endTime":970.91,"body":"wide awake case that i did this"},{"speaker":"Chris Dy","startTime":970.91,"endTime":973.76,"body":"week where we're doing a you"},{"speaker":"Chris Dy","startTime":970.91,"endTime":973.76,"body":"know some, a reconstruction of"},{"speaker":"Chris Dy","startTime":973.76,"endTime":978.68,"body":"some sort, I won't say what kind"},{"speaker":"Chris Dy","startTime":973.76,"endTime":978.68,"body":"but for hipaa reasons but the"},{"speaker":"Chris Dy","startTime":979.4,"endTime":982.91,"body":"engaging the patient having to"},{"speaker":"Chris Dy","startTime":979.4,"endTime":982.91,"body":"be part of it whether or not"},{"speaker":"Chris Dy","startTime":982.91,"endTime":986.03,"body":"they want to see the bloody"},{"speaker":"Chris Dy","startTime":982.91,"endTime":986.03,"body":"stuff or not it's never it's"},{"speaker":"Chris Dy","startTime":986.03,"endTime":991.1,"body":"bloodless but it's it's been"},{"speaker":"Chris Dy","startTime":986.03,"endTime":991.1,"body":"fantastic so yes a great update"},{"speaker":"Chris Dy","startTime":991.1,"endTime":993.17,"body":"on that case it's incredibly"},{"speaker":"Chris Dy","startTime":991.1,"endTime":993.17,"body":"rewarding."},{"speaker":"Charles Goldfarb","startTime":993.66,"endTime":995.94,"body":"Love that"},{"speaker":"Charles Goldfarb","startTime":993.66,"endTime":995.94,"body":"thank you thank you maybe maybe"},{"speaker":"Charles Goldfarb","startTime":995.94,"endTime":998.94,"body":"one last thing to do put you on"},{"speaker":"Charles Goldfarb","startTime":995.94,"endTime":998.94,"body":"the spot and perhaps embarrass"},{"speaker":"Charles Goldfarb","startTime":998.94,"endTime":1002.3,"body":"you a little bit I just want to"},{"speaker":"Charles Goldfarb","startTime":998.94,"endTime":1002.3,"body":"say in this forum"},{"speaker":"Charles Goldfarb","startTime":1002.3,"endTime":1006.59,"body":"congratulations it so Chris for"},{"speaker":"Charles Goldfarb","startTime":1002.3,"endTime":1006.59,"body":"those of you who aren't"},{"speaker":"Charles Goldfarb","startTime":1006.59,"endTime":1012.89,"body":"following us on twitter recently"},{"speaker":"Charles Goldfarb","startTime":1006.59,"endTime":1012.89,"body":"had a award finalized by NYAM"},{"speaker":"Charles Goldfarb","startTime":1012.89,"endTime":1016.91,"body":"switches his brachial plexus"},{"speaker":"Charles 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Goldfarb","startTime":1030.92,"endTime":1033.47,"body":"congratulations and B, you got"},{"speaker":"Charles Goldfarb","startTime":1030.92,"endTime":1033.47,"body":"to feel great."},{"speaker":"Chris Dy","startTime":1034.14,"endTime":1036.03,"body":"Well thanks I"},{"speaker":"Chris Dy","startTime":1034.14,"endTime":1036.03,"body":"appreciate it, thanks for saying"},{"speaker":"Chris Dy","startTime":1036.03,"endTime":1039.9,"body":"that, little embarrassing but"},{"speaker":"Chris Dy","startTime":1036.03,"endTime":1039.9,"body":"you know it's been a lot of hard"},{"speaker":"Chris Dy","startTime":1039.9,"endTime":1044.04,"body":"work and you know a lot of steps"},{"speaker":"Chris Dy","startTime":1039.9,"endTime":1044.04,"body":"I actually wrote an email to the"},{"speaker":"Chris Dy","startTime":1044.04,"endTime":1048.57,"body":"hand society leadership kind of"},{"speaker":"Chris Dy","startTime":1044.04,"endTime":1048.57,"body":"thanking them for the investing"},{"speaker":"Chris 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So, I"},{"speaker":"Chris Dy","startTime":1048.57,"endTime":1053.1,"body":"went to the clinician scientist"},{"speaker":"Chris Dy","startTime":1053.1,"endTime":1056.22,"body":"development program that the"},{"speaker":"Chris Dy","startTime":1053.1,"endTime":1056.22,"body":"academy in the ORS and the ORAF"},{"speaker":"Chris Dy","startTime":1056.22,"endTime":1059.76,"body":"run in 2011 sponsored by the"},{"speaker":"Chris Dy","startTime":1056.22,"endTime":1059.76,"body":"Hand Society when I was a"},{"speaker":"Chris Dy","startTime":1059.76,"endTime":1064.53,"body":"resident and that kind of showed"},{"speaker":"Chris Dy","startTime":1059.76,"endTime":1064.53,"body":"me the pathway to getting where"},{"speaker":"Chris Dy","startTime":1064.53,"endTime":1068.82,"body":"I am now in terms of whether I"},{"speaker":"Chris Dy","startTime":1064.53,"endTime":1068.82,"body":"wanted to dedicate time to"},{"speaker":"Chris Dy","startTime":1068.82,"endTime":1071.79,"body":"research whether I wanted to do"},{"speaker":"Chris Dy","startTime":1068.82,"endTime":1071.79,"body":"a career development award, a K"},{"speaker":"Chris Dy","startTime":1071.79,"endTime":1076.02,"body":"award. How to do that and then"},{"speaker":"Chris Dy","startTime":1071.79,"endTime":1076.02,"body":"what you need to you know apply"},{"speaker":"Chris Dy","startTime":1076.02,"endTime":1079.14,"body":"for an RO1 eventually you know"},{"speaker":"Chris Dy","startTime":1076.02,"endTime":1079.14,"body":"why why would you apply for an"},{"speaker":"Chris Dy","startTime":1079.14,"endTime":1083.1,"body":"RO1 all that kind of stuff and"},{"speaker":"Chris Dy","startTime":1079.14,"endTime":1083.1,"body":"it's, you know the process has"},{"speaker":"Chris Dy","startTime":1083.1,"endTime":1086.64,"body":"been long but you know the hand"},{"speaker":"Chris Dy","startTime":1083.1,"endTime":1086.64,"body":"society has kind of stood by me"},{"speaker":"Chris Dy","startTime":1086.64,"endTime":1090.3,"body":"the whole way multiple grant"},{"speaker":"Chris Dy","startTime":1086.64,"endTime":1090.3,"body":"writing workshops you know from"},{"speaker":"Chris Dy","startTime":1090.66,"endTime":1095.61,"body":"the US bone and joint initiative"},{"speaker":"Chris Dy","startTime":1090.66,"endTime":1095.61,"body":"to the ORS and it's led to this"},{"speaker":"Chris Dy","startTime":1095.61,"endTime":1100.17,"body":"and i'm really proud and really"},{"speaker":"Chris Dy","startTime":1095.61,"endTime":1100.17,"body":"happy, but it does take a"},{"speaker":"Chris Dy","startTime":1100.17,"endTime":1103.89,"body":"village so you know a lot of"},{"speaker":"Chris Dy","startTime":1100.17,"endTime":1103.89,"body":"collaborators and mentors along"},{"speaker":"Chris Dy","startTime":1103.89,"endTime":1108.48,"body":"the way. What we're going to be"},{"speaker":"Chris Dy","startTime":1103.89,"endTime":1108.48,"body":"doing is studying, sounds simple"},{"speaker":"Chris Dy","startTime":1108.48,"endTime":1111.81,"body":"but studying brachial plexus,"},{"speaker":"Chris Dy","startTime":1108.48,"endTime":1111.81,"body":"adult traumatic brachial plexus"},{"speaker":"Chris Dy","startTime":1111.81,"endTime":1115.23,"body":"patients using the same outcome"},{"speaker":"Chris Dy","startTime":1111.81,"endTime":1115.23,"body":"measures at the same time"},{"speaker":"Chris Dy","startTime":1115.23,"endTime":1118.53,"body":"intervals prospectively and"},{"speaker":"Chris Dy","startTime":1115.23,"endTime":1118.53,"body":"those outcome measures are going"},{"speaker":"Chris Dy","startTime":1118.53,"endTime":1123.9,"body":"to be patient centered so using"},{"speaker":"Chris Dy","startTime":1118.53,"endTime":1123.9,"body":"you know plexus specific"},{"speaker":"Chris Dy","startTime":1123.9,"endTime":1126.78,"body":"instrument that was developed at"},{"speaker":"Chris Dy","startTime":1123.9,"endTime":1126.78,"body":"HSS when I was a resident I"},{"speaker":"Chris Dy","startTime":1126.78,"endTime":1130.05,"body":"helped out Scott Wolfe and Steve"},{"speaker":"Chris Dy","startTime":1126.78,"endTime":1130.05,"body":"Lee with that and now we're"},{"speaker":"Chris Dy","startTime":1130.05,"endTime":1133.68,"body":"taking it broader to five"},{"speaker":"Chris Dy","startTime":1130.05,"endTime":1133.68,"body":"different centers across the us"},{"speaker":"Chris Dy","startTime":1133.68,"endTime":1137.52,"body":"and hopefully continuing to"},{"speaker":"Chris Dy","startTime":1133.68,"endTime":1137.52,"body":"expand beyond that. It's it's"},{"speaker":"Chris Dy","startTime":1137.52,"endTime":1141.48,"body":"been a great process it's been a"},{"speaker":"Chris Dy","startTime":1137.52,"endTime":1141.48,"body":"lot of fun a lot of stress. I've"},{"speaker":"Chris Dy","startTime":1141.48,"endTime":1144.6,"body":"wrote the grant back this time"},{"speaker":"Chris Dy","startTime":1141.48,"endTime":1144.6,"body":"last year actually is when I"},{"speaker":"Chris Dy","startTime":1144.6,"endTime":1148.26,"body":"started. Submitted it in July,"},{"speaker":"Chris Dy","startTime":1144.6,"endTime":1148.26,"body":"got scored in the fall and then"},{"speaker":"Chris Dy","startTime":1148.26,"endTime":1151.5,"body":"they make you wait really really"},{"speaker":"Chris Dy","startTime":1148.26,"endTime":1151.5,"body":"long to find out whether you're"},{"speaker":"Chris Dy","startTime":1151.5,"endTime":1153.45,"body":"actually going to get funded we"},{"speaker":"Chris Dy","startTime":1151.5,"endTime":1153.45,"body":"found out this week."},{"speaker":"Charles Goldfarb","startTime":1154.62,"endTime":1156.6,"body":"Well it's"},{"speaker":"Charles Goldfarb","startTime":1154.62,"endTime":1156.6,"body":"incredible and we are all"},{"speaker":"Charles Goldfarb","startTime":1156.6,"endTime":1160.05,"body":"certainly proud and looking"},{"speaker":"Charles Goldfarb","startTime":1156.6,"endTime":1160.05,"body":"forward to you know your"},{"speaker":"Charles Goldfarb","startTime":1160.05,"endTime":1162.12,"body":"findings as we move forward and"},{"speaker":"Charles Goldfarb","startTime":1160.05,"endTime":1162.12,"body":"I know it's gonna be a lot of"},{"speaker":"Charles Goldfarb","startTime":1162.12,"endTime":1165.45,"body":"years before we really know the"},{"speaker":"Charles Goldfarb","startTime":1162.12,"endTime":1165.45,"body":"outcome in the way that you want"},{"speaker":"Charles Goldfarb","startTime":1165.45,"endTime":1167.37,"body":"to share but amazing really"},{"speaker":"Charles Goldfarb","startTime":1165.45,"endTime":1167.37,"body":"amazing."},{"speaker":"Chris Dy","startTime":1167.64,"endTime":1169.92,"body":"Thank you and shout"},{"speaker":"Chris Dy","startTime":1167.64,"endTime":1169.92,"body":"out to all you US taxpayers"},{"speaker":"Chris Dy","startTime":1169.92,"endTime":1172.08,"body":"thank you for the for your hard"},{"speaker":"Chris Dy","startTime":1169.92,"endTime":1172.08,"body":"earned money."},{"speaker":"Charles Goldfarb","startTime":1172.74,"endTime":1174.09,"body":"Absolutely."},{"speaker":"Chris Dy","startTime":1174.36,"endTime":1176.73,"body":"You never, you never"},{"speaker":"Chris Dy","startTime":1174.36,"endTime":1176.73,"body":"watched congressional budget"},{"speaker":"Chris Dy","startTime":1176.73,"endTime":1179.73,"body":"stuff as closely as when you are"},{"speaker":"Chris Dy","startTime":1176.73,"endTime":1179.73,"body":"waiting for a grant to come"},{"speaker":"Chris Dy","startTime":1179.73,"endTime":1181.56,"body":"through and you're hoping that"},{"speaker":"Chris Dy","startTime":1179.73,"endTime":1181.56,"body":"the government doesn't shut down"},{"speaker":"Chris Dy","startTime":1181.56,"endTime":1181.74,"body":"so."},{"speaker":"Charles Goldfarb","startTime":1182.43,"endTime":1184.92,"body":"That has got"},{"speaker":"Charles Goldfarb","startTime":1182.43,"endTime":1184.92,"body":"to be the case. All right, let's"},{"speaker":"Charles Goldfarb","startTime":1184.92,"endTime":1188.7,"body":"jump into our topic so we've had"},{"speaker":"Charles Goldfarb","startTime":1184.92,"endTime":1188.7,"body":"some requests to talk more"},{"speaker":"Charles Goldfarb","startTime":1188.7,"endTime":1192.72,"body":"pediatric and more congenital"},{"speaker":"Charles Goldfarb","startTime":1188.7,"endTime":1192.72,"body":"that certainly is one of my"},{"speaker":"Charles Goldfarb","startTime":1192.75,"endTime":1197.1,"body":"strong areas of interest we do a"},{"speaker":"Charles Goldfarb","startTime":1192.75,"endTime":1197.1,"body":"lot of nerve here we've talked a"},{"speaker":"Charles Goldfarb","startTime":1197.1,"endTime":1200.28,"body":"fair amount of sports but we"},{"speaker":"Charles Goldfarb","startTime":1197.1,"endTime":1200.28,"body":"haven't done a lot of kids talk,"},{"speaker":"Charles Goldfarb","startTime":1200.67,"endTime":1203.07,"body":"and perhaps starting with"},{"speaker":"Charles Goldfarb","startTime":1200.67,"endTime":1203.07,"body":"something pretty straightforward"},{"speaker":"Charles Goldfarb","startTime":1203.07,"endTime":1206.34,"body":"with a hopefully a broad"},{"speaker":"Charles Goldfarb","startTime":1203.07,"endTime":1206.34,"body":"interest will work. So we"},{"speaker":"Charles Goldfarb","startTime":1206.34,"endTime":1210.66,"body":"decided to talk today about"},{"speaker":"Charles Goldfarb","startTime":1206.34,"endTime":1210.66,"body":"pediatric phalanx fractures. And"},{"speaker":"Charles Goldfarb","startTime":1210.66,"endTime":1213.72,"body":"we're keeping it pretty specific"},{"speaker":"Charles Goldfarb","startTime":1210.66,"endTime":1213.72,"body":"because this is a, you know,"},{"speaker":"Charles Goldfarb","startTime":1213.72,"endTime":1218.19,"body":"hand fractures are it's a big"},{"speaker":"Charles Goldfarb","startTime":1213.72,"endTime":1218.19,"body":"topic and we want to be direct"},{"speaker":"Charles Goldfarb","startTime":1218.22,"endTime":1221.07,"body":"and just have the conversations"},{"speaker":"Charles Goldfarb","startTime":1218.22,"endTime":1221.07,"body":"need to have does that. Does"},{"speaker":"Charles Goldfarb","startTime":1221.07,"endTime":1223.02,"body":"that sound like a reasonable"},{"speaker":"Charles Goldfarb","startTime":1221.07,"endTime":1223.02,"body":"plan?"},{"speaker":"Chris Dy","startTime":1223.3,"endTime":1226.42,"body":"Absolutely. I mean,"},{"speaker":"Chris Dy","startTime":1223.3,"endTime":1226.42,"body":"there's so much to cover with"},{"speaker":"Chris Dy","startTime":1226.45,"endTime":1229.9,"body":"even just phalanx fractures and"},{"speaker":"Chris Dy","startTime":1226.45,"endTime":1229.9,"body":"kids. And these are things that"},{"speaker":"Chris Dy","startTime":1229.9,"endTime":1233.14,"body":"you know, people see commonly"},{"speaker":"Chris Dy","startTime":1229.9,"endTime":1233.14,"body":"They come in all the time any"},{"speaker":"Chris Dy","startTime":1233.47,"endTime":1235.9,"body":"orthopedic surgeon, plastic"},{"speaker":"Chris Dy","startTime":1233.47,"endTime":1235.9,"body":"surgeon, hand surgeon, hand"},{"speaker":"Chris Dy","startTime":1235.9,"endTime":1239.98,"body":"therapist is going to see these."},{"speaker":"Chris Dy","startTime":1235.9,"endTime":1239.98,"body":"And I think having a great"},{"speaker":"Chris Dy","startTime":1239.98,"endTime":1243.22,"body":"understanding of what you know,"},{"speaker":"Chris Dy","startTime":1239.98,"endTime":1243.22,"body":"an expert like you, who has"},{"speaker":"Chris Dy","startTime":1243.25,"endTime":1246.07,"body":"treated lots of these and"},{"speaker":"Chris Dy","startTime":1243.25,"endTime":1246.07,"body":"written a lot about them, you"},{"speaker":"Chris Dy","startTime":1246.07,"endTime":1248.71,"body":"know, went to what's routine,"},{"speaker":"Chris Dy","startTime":1246.07,"endTime":1248.71,"body":"what's not routine, what are the"},{"speaker":"Chris Dy","startTime":1248.71,"endTime":1251.26,"body":"bad actors, that kind of stuff"},{"speaker":"Chris Dy","startTime":1248.71,"endTime":1251.26,"body":"would be great. So I think we"},{"speaker":"Chris Dy","startTime":1251.26,"endTime":1254.56,"body":"get into it, and why don't you"},{"speaker":"Chris Dy","startTime":1251.26,"endTime":1254.56,"body":"start with, let's start"},{"speaker":"Chris Dy","startTime":1254.65,"endTime":1258.13,"body":"anatomically, from proximal,"},{"speaker":"Chris Dy","startTime":1254.65,"endTime":1258.13,"body":"distal, let's go to the proximal"},{"speaker":"Chris Dy","startTime":1258.13,"endTime":1261.52,"body":"phalanx and start at the base."},{"speaker":"Chris Dy","startTime":1258.13,"endTime":1261.52,"body":"So what are the common fractures"},{"speaker":"Chris Dy","startTime":1261.52,"endTime":1264.73,"body":"that you see? That can be"},{"speaker":"Chris Dy","startTime":1261.52,"endTime":1264.73,"body":"problematic? Here? We know"},{"speaker":"Chris Dy","startTime":1264.73,"endTime":1267.34,"body":"classically, the extra octave is"},{"speaker":"Chris Dy","startTime":1264.73,"endTime":1267.34,"body":"one that gets talked about a"},{"speaker":"Chris Dy","startTime":1267.34,"endTime":1267.67,"body":"lot."},{"speaker":"Charles Goldfarb","startTime":1268.23,"endTime":1270.48,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":1268.23,"endTime":1270.48,"body":"the extra octave is is is the"},{"speaker":"Charles Goldfarb","startTime":1270.48,"endTime":1274.86,"body":"place to start, just to define"},{"speaker":"Charles Goldfarb","startTime":1270.48,"endTime":1274.86,"body":"that term. Typically, the extra"},{"speaker":"Charles Goldfarb","startTime":1274.86,"endTime":1278.64,"body":"octave fracture is a"},{"speaker":"Charles Goldfarb","startTime":1274.86,"endTime":1278.64,"body":"Salter-Harris two, or it can be"},{"speaker":"Charles Goldfarb","startTime":1278.64,"endTime":1281.7,"body":"a periphyseal, and I'll discuss"},{"speaker":"Charles Goldfarb","startTime":1278.64,"endTime":1281.7,"body":"the difference, fracture at the"},{"speaker":"Charles Goldfarb","startTime":1281.7,"endTime":1284.91,"body":"base of the little finger"},{"speaker":"Charles Goldfarb","startTime":1281.7,"endTime":1284.91,"body":"proximal phalanx. The finger"},{"speaker":"Charles Goldfarb","startTime":1284.94,"endTime":1288.63,"body":"becomes abducted or ulnarly"},{"speaker":"Charles Goldfarb","startTime":1284.94,"endTime":1288.63,"body":"deviated. And the name comes"},{"speaker":"Charles Goldfarb","startTime":1288.63,"endTime":1290.7,"body":"from the ability to"},{"speaker":"Charles Goldfarb","startTime":1288.63,"endTime":1290.7,"body":"theoretically reach an extra"},{"speaker":"Charles Goldfarb","startTime":1290.7,"endTime":1295.62,"body":"octave on the piano. And it's a"},{"speaker":"Charles Goldfarb","startTime":1290.7,"endTime":1295.62,"body":"common fracture. And of course,"},{"speaker":"Charles Goldfarb","startTime":1295.62,"endTime":1298.14,"body":"it can happen in other digits,"},{"speaker":"Charles Goldfarb","startTime":1295.62,"endTime":1298.14,"body":"it can happen in multiple"},{"speaker":"Charles Goldfarb","startTime":1298.14,"endTime":1302.25,"body":"digits, but that is very common."},{"speaker":"Charles Goldfarb","startTime":1298.14,"endTime":1302.25,"body":"And so those kids thankfully,"},{"speaker":"Charles Goldfarb","startTime":1302.52,"endTime":1306.84,"body":"respond almost always to a close"},{"speaker":"Charles Goldfarb","startTime":1302.52,"endTime":1306.84,"body":"reduction. I don't know how many"},{"speaker":"Charles Goldfarb","startTime":1306.84,"endTime":1310.47,"body":"of these you see in your clinic,"},{"speaker":"Charles Goldfarb","startTime":1306.84,"endTime":1310.47,"body":"but I think I see them back from"},{"speaker":"Charles Goldfarb","startTime":1310.47,"endTime":1313.5,"body":"the ER, typically if they come"},{"speaker":"Charles Goldfarb","startTime":1310.47,"endTime":1313.5,"body":"to our ER they've been reduced,"},{"speaker":"Charles Goldfarb","startTime":1313.5,"endTime":1316.23,"body":"and then I have to follow them."},{"speaker":"Charles Goldfarb","startTime":1313.5,"endTime":1316.23,"body":"Do you I assume that would be"},{"speaker":"Charles Goldfarb","startTime":1316.29,"endTime":1317.07,"body":"similar for you?"},{"speaker":"Chris Dy","startTime":1317.79,"endTime":1320.4,"body":"Yeah. So I actually,"},{"speaker":"Chris Dy","startTime":1317.79,"endTime":1320.4,"body":"you know, I don't see a ton of"},{"speaker":"Chris Dy","startTime":1320.4,"endTime":1322.5,"body":"these in follow up. Because you"},{"speaker":"Chris Dy","startTime":1320.4,"endTime":1322.5,"body":"know, we have such great"},{"speaker":"Chris Dy","startTime":1322.5,"endTime":1326.88,"body":"partners, you and Dr. Wall have"},{"speaker":"Chris Dy","startTime":1322.5,"endTime":1326.88,"body":"been great about, you know,"},{"speaker":"Chris Dy","startTime":1327.51,"endTime":1330.9,"body":"wanting to see kids with"},{"speaker":"Chris Dy","startTime":1327.51,"endTime":1330.9,"body":"fractures, particularly Lindley."},{"speaker":"Chris Dy","startTime":1331.41,"endTime":1334.26,"body":"And I think that that's"},{"speaker":"Chris Dy","startTime":1331.41,"endTime":1334.26,"body":"something that she enjoys, and"},{"speaker":"Chris Dy","startTime":1334.26,"endTime":1338.01,"body":"is part of her practice that she"},{"speaker":"Chris Dy","startTime":1334.26,"endTime":1338.01,"body":"wants to continue to grow. But I"},{"speaker":"Chris Dy","startTime":1338.01,"endTime":1340.35,"body":"do remember treating these a lot"},{"speaker":"Chris Dy","startTime":1338.01,"endTime":1340.35,"body":"as a resident and as a fellow."},{"speaker":"Chris Dy","startTime":1341.01,"endTime":1343.44,"body":"So there are a couple of"},{"speaker":"Chris Dy","startTime":1341.01,"endTime":1343.44,"body":"textbook maneuvers that are"},{"speaker":"Chris Dy","startTime":1343.44,"endTime":1346.98,"body":"talked about. And I want to get"},{"speaker":"Chris Dy","startTime":1343.44,"endTime":1346.98,"body":"your sense of, you know, if I'm"},{"speaker":"Chris Dy","startTime":1346.98,"endTime":1351.66,"body":"an orthopedic or plastic surgery"},{"speaker":"Chris Dy","startTime":1346.98,"endTime":1351.66,"body":"trainee that is listening right"},{"speaker":"Chris Dy","startTime":1351.66,"endTime":1354.99,"body":"now, how do you reduce these"},{"speaker":"Chris Dy","startTime":1351.66,"endTime":1354.99,"body":"fractures and do it well? Is it"},{"speaker":"Chris Dy","startTime":1354.99,"endTime":1357.57,"body":"like the textbook said, so you"},{"speaker":"Chris Dy","startTime":1354.99,"endTime":1357.57,"body":"put a little pencil or something"},{"speaker":"Chris Dy","startTime":1357.57,"endTime":1361.29,"body":"in between in that web space and"},{"speaker":"Chris Dy","startTime":1357.57,"endTime":1361.29,"body":"use it as a lever? Or what's the"},{"speaker":"Chris Dy","startTime":1361.29,"endTime":1363.39,"body":"chuckle for preferred reduction"},{"speaker":"Chris Dy","startTime":1361.29,"endTime":1363.39,"body":"maneuver?"},{"speaker":"Charles Goldfarb","startTime":1363.93,"endTime":1365.97,"body":"Yeah, so first"},{"speaker":"Charles Goldfarb","startTime":1363.93,"endTime":1365.97,"body":"of all, I would say is in the"},{"speaker":"Charles Goldfarb","startTime":1366.0,"endTime":1368.73,"body":"ER, and sometimes in clinic, if"},{"speaker":"Charles Goldfarb","startTime":1366.0,"endTime":1368.73,"body":"you have the right kid, if you"},{"speaker":"Charles Goldfarb","startTime":1368.73,"endTime":1371.94,"body":"have a mature seven or eight"},{"speaker":"Charles Goldfarb","startTime":1368.73,"endTime":1371.94,"body":"year old with this fracture, and"},{"speaker":"Charles Goldfarb","startTime":1371.94,"endTime":1376.68,"body":"let's be clear this fracture"},{"speaker":"Charles Goldfarb","startTime":1371.94,"endTime":1376.68,"body":"happens, can happen from a major"},{"speaker":"Charles Goldfarb","startTime":1376.68,"endTime":1380.64,"body":"trauma or a less severe trauma,"},{"speaker":"Charles Goldfarb","startTime":1376.68,"endTime":1380.64,"body":"as the growth plate weakens as"},{"speaker":"Charles Goldfarb","startTime":1380.64,"endTime":1384.39,"body":"it nears closure. And so you"},{"speaker":"Charles Goldfarb","startTime":1380.64,"endTime":1384.39,"body":"know, it can happen in a 9, 10,"},{"speaker":"Charles Goldfarb","startTime":1384.39,"endTime":1387.99,"body":"11 year old as the child's"},{"speaker":"Charles Goldfarb","startTime":1384.39,"endTime":1387.99,"body":"physes mature. But if you have"},{"speaker":"Charles Goldfarb","startTime":1387.99,"endTime":1391.47,"body":"the right kid, you can numb them"},{"speaker":"Charles Goldfarb","startTime":1387.99,"endTime":1391.47,"body":"up in clinic and take care of"},{"speaker":"Charles Goldfarb","startTime":1391.47,"endTime":1393.51,"body":"this, although it's a little"},{"speaker":"Charles Goldfarb","startTime":1391.47,"endTime":1393.51,"body":"trickier, it's easier to do in"},{"speaker":"Charles Goldfarb","startTime":1393.51,"endTime":1397.44,"body":"the ER, and the ER can truly be"},{"speaker":"Charles Goldfarb","startTime":1393.51,"endTime":1397.44,"body":"a block or could be some"},{"speaker":"Charles Goldfarb","startTime":1397.44,"endTime":1401.55,"body":"sedation and a block. The pencil"},{"speaker":"Charles Goldfarb","startTime":1397.44,"endTime":1401.55,"body":"technique where you put a pencil"},{"speaker":"Charles Goldfarb","startTime":1401.55,"endTime":1404.85,"body":"between the fourth and fifth"},{"speaker":"Charles Goldfarb","startTime":1401.55,"endTime":1404.85,"body":"fingers, sounds good. But the"},{"speaker":"Charles Goldfarb","startTime":1404.85,"endTime":1408.27,"body":"reality is, if you look at your"},{"speaker":"Charles Goldfarb","startTime":1404.85,"endTime":1408.27,"body":"own hand, to get the pencil far"},{"speaker":"Charles Goldfarb","startTime":1408.27,"endTime":1411.72,"body":"enough proximally, it has to be"},{"speaker":"Charles Goldfarb","startTime":1408.27,"endTime":1411.72,"body":"a really small pencil. And I"},{"speaker":"Charles Goldfarb","startTime":1411.72,"endTime":1415.14,"body":"don't really use that technique."},{"speaker":"Charles Goldfarb","startTime":1411.72,"endTime":1415.14,"body":"And so what I do in those"},{"speaker":"Charles Goldfarb","startTime":1415.14,"endTime":1420.24,"body":"fractures is I grabb the finger,"},{"speaker":"Charles Goldfarb","startTime":1415.14,"endTime":1420.24,"body":"and I, I tend to flex it beneath"},{"speaker":"Charles Goldfarb","startTime":1420.24,"endTime":1424.71,"body":"the other fingers, and really"},{"speaker":"Charles Goldfarb","startTime":1420.24,"endTime":1424.71,"body":"just radially deviate it firmly"},{"speaker":"Charles Goldfarb","startTime":1424.71,"endTime":1427.26,"body":"and it tends to come back in"},{"speaker":"Charles Goldfarb","startTime":1424.71,"endTime":1427.26,"body":"place pretty easily. And then"},{"speaker":"Charles Goldfarb","startTime":1427.26,"endTime":1432.51,"body":"you have to check the cascade."},{"speaker":"Charles Goldfarb","startTime":1427.26,"endTime":1432.51,"body":"And so for me that's checking"},{"speaker":"Charles Goldfarb","startTime":1432.54,"endTime":1435.36,"body":"the child's hand, you know, with"},{"speaker":"Charles Goldfarb","startTime":1432.54,"endTime":1435.36,"body":"the fingers extended with the"},{"speaker":"Charles Goldfarb","startTime":1435.36,"endTime":1438.81,"body":"fingers in a resting posture."},{"speaker":"Charles Goldfarb","startTime":1435.36,"endTime":1438.81,"body":"And then I simulate flexion with"},{"speaker":"Charles Goldfarb","startTime":1438.81,"endTime":1442.77,"body":"tenodesis, that is extending the"},{"speaker":"Charles Goldfarb","startTime":1438.81,"endTime":1442.77,"body":"wrist. And then I add to that by"},{"speaker":"Charles Goldfarb","startTime":1442.77,"endTime":1446.1,"body":"squeezing the forearm, which"},{"speaker":"Charles Goldfarb","startTime":1442.77,"endTime":1446.1,"body":"causes the fingers to flex. And"},{"speaker":"Charles Goldfarb","startTime":1446.1,"endTime":1448.92,"body":"so it's really understanding as"},{"speaker":"Charles Goldfarb","startTime":1446.1,"endTime":1448.92,"body":"much as you can about all those"},{"speaker":"Charles Goldfarb","startTime":1448.92,"endTime":1451.35,"body":"positions. And if the child is"},{"speaker":"Charles Goldfarb","startTime":1448.92,"endTime":1451.35,"body":"wide awake, you can ask them to"},{"speaker":"Charles Goldfarb","startTime":1451.35,"endTime":1455.19,"body":"bend doesn't always work very"},{"speaker":"Charles Goldfarb","startTime":1451.35,"endTime":1455.19,"body":"well. But reduction itself is"},{"speaker":"Charles Goldfarb","startTime":1455.19,"endTime":1458.76,"body":"not that hard. assuring your"},{"speaker":"Charles Goldfarb","startTime":1455.19,"endTime":1458.76,"body":"reduction is good is really"},{"speaker":"Charles Goldfarb","startTime":1458.76,"endTime":1461.13,"body":"important. And then the"},{"speaker":"Charles Goldfarb","startTime":1458.76,"endTime":1461.13,"body":"immobilization piece."},{"speaker":"Chris Dy","startTime":1461.46,"endTime":1464.07,"body":"So a couple of things"},{"speaker":"Chris Dy","startTime":1461.46,"endTime":1464.07,"body":"before you get into those last"},{"speaker":"Chris Dy","startTime":1464.07,"endTime":1467.19,"body":"two areas about immobilization"},{"speaker":"Chris Dy","startTime":1464.07,"endTime":1467.19,"body":"or checking your reduction and"},{"speaker":"Chris Dy","startTime":1467.19,"endTime":1471.9,"body":"immobilization. So if anybody's"},{"speaker":"Chris Dy","startTime":1467.19,"endTime":1471.9,"body":"listening and wants to actually"},{"speaker":"Chris Dy","startTime":1471.9,"endTime":1474.93,"body":"see the reduction maneuver,"},{"speaker":"Chris Dy","startTime":1471.9,"endTime":1474.93,"body":"we're putting more video content"},{"speaker":"Chris Dy","startTime":1474.93,"endTime":1479.04,"body":"up on YouTube. So Chuck just"},{"speaker":"Chris Dy","startTime":1474.93,"endTime":1479.04,"body":"demonstrated exactly how to do"},{"speaker":"Chris Dy","startTime":1479.04,"endTime":1482.82,"body":"the reduction and exactly how to"},{"speaker":"Chris Dy","startTime":1479.04,"endTime":1482.82,"body":"do the tenodesis maneuver to"},{"speaker":"Chris Dy","startTime":1482.82,"endTime":1487.74,"body":"check it. Are there any things"},{"speaker":"Chris Dy","startTime":1482.82,"endTime":1487.74,"body":"that you mean? Do you ever use a"},{"speaker":"Chris Dy","startTime":1487.74,"endTime":1491.28,"body":"fulcrum? Are you just using your"},{"speaker":"Chris Dy","startTime":1487.74,"endTime":1491.28,"body":"jedi kind of you know, I"},{"speaker":"Chris Dy","startTime":1491.28,"endTime":1493.29,"body":"remember as a resident you're"},{"speaker":"Chris Dy","startTime":1491.28,"endTime":1493.29,"body":"always like, Oh, yeah, I read"},{"speaker":"Chris Dy","startTime":1493.29,"endTime":1495.72,"body":"about this. It's exciting. Let's"},{"speaker":"Chris Dy","startTime":1493.29,"endTime":1495.72,"body":"go put something down in the web"},{"speaker":"Chris Dy","startTime":1495.72,"endTime":1498.75,"body":"space. But I guess skinny"},{"speaker":"Chris Dy","startTime":1495.72,"endTime":1498.75,"body":"pencils aren't really that"},{"speaker":"Chris Dy","startTime":1498.75,"endTime":1499.53,"body":"common anymore."},{"speaker":"Charles Goldfarb","startTime":1499.95,"endTime":1501.66,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":1499.95,"endTime":1501.66,"body":"it's hard to create the fulcrum"},{"speaker":"Charles Goldfarb","startTime":1501.69,"endTime":1504.84,"body":"I really do, I think you're more"},{"speaker":"Charles Goldfarb","startTime":1501.69,"endTime":1504.84,"body":"likely to succeed grabbing,"},{"speaker":"Charles Goldfarb","startTime":1505.08,"endTime":1507.27,"body":"because you can grab more"},{"speaker":"Charles Goldfarb","startTime":1505.08,"endTime":1507.27,"body":"proximally than you can get that"},{"speaker":"Charles Goldfarb","startTime":1507.27,"endTime":1509.82,"body":"fulcrum in. And that's a whole"},{"speaker":"Charles Goldfarb","startTime":1507.27,"endTime":1509.82,"body":"nother topic on my syndactyly"},{"speaker":"Charles Goldfarb","startTime":1509.82,"endTime":1512.37,"body":"reconstructions. But I think"},{"speaker":"Charles Goldfarb","startTime":1509.82,"endTime":1512.37,"body":"it's grabbing and it's not a"},{"speaker":"Charles Goldfarb","startTime":1512.37,"endTime":1514.68,"body":"hard reduction, you just have to"},{"speaker":"Charles Goldfarb","startTime":1512.37,"endTime":1514.68,"body":"get it right."},{"speaker":"Chris Dy","startTime":1515.04,"endTime":1517.62,"body":"Okay, do you put your"},{"speaker":"Chris Dy","startTime":1515.04,"endTime":1517.62,"body":"thumb kind of in that space"},{"speaker":"Chris Dy","startTime":1517.62,"endTime":1520.11,"body":"there and use that to lever over"},{"speaker":"Chris Dy","startTime":1517.62,"endTime":1520.11,"body":"instead?"},{"speaker":"Charles Goldfarb","startTime":1520.48,"endTime":1522.61,"body":"Either i'd"},{"speaker":"Charles Goldfarb","startTime":1520.48,"endTime":1522.61,"body":"just radially deviate the"},{"speaker":"Charles Goldfarb","startTime":1522.61,"endTime":1526.3,"body":"inflection. Or I do try to"},{"speaker":"Charles Goldfarb","startTime":1522.61,"endTime":1526.3,"body":"actually grab the finger and"},{"speaker":"Charles Goldfarb","startTime":1526.3,"endTime":1529.06,"body":"deviate it that way. And you can"},{"speaker":"Charles Goldfarb","startTime":1526.3,"endTime":1529.06,"body":"try both. And you got to be"},{"speaker":"Charles Goldfarb","startTime":1529.06,"endTime":1531.79,"body":"careful not to over reduce some"},{"speaker":"Charles Goldfarb","startTime":1529.06,"endTime":1531.79,"body":"of these because the periosteum"},{"speaker":"Charles Goldfarb","startTime":1531.82,"endTime":1534.04,"body":"provides a supportive"},{"speaker":"Charles Goldfarb","startTime":1531.82,"endTime":1534.04,"body":"environment. And so you don't"},{"speaker":"Charles Goldfarb","startTime":1534.04,"endTime":1537.97,"body":"want to overdo it. And, you"},{"speaker":"Charles Goldfarb","startTime":1534.04,"endTime":1537.97,"body":"know, I think it's an acquired"},{"speaker":"Charles Goldfarb","startTime":1537.97,"endTime":1542.14,"body":"skill. And I think by the time"},{"speaker":"Charles Goldfarb","startTime":1537.97,"endTime":1542.14,"body":"most of our residents are"},{"speaker":"Charles Goldfarb","startTime":1542.14,"endTime":1545.17,"body":"halfway through their PGY 2 year"},{"speaker":"Charles Goldfarb","startTime":1542.14,"endTime":1545.17,"body":"they have this fracture down"},{"speaker":"Charles Goldfarb","startTime":1545.17,"endTime":1546.16,"body":"because it's so common."},{"speaker":"Chris Dy","startTime":1546.64,"endTime":1550.21,"body":"How long do you think"},{"speaker":"Chris Dy","startTime":1546.64,"endTime":1550.21,"body":"you have to do a close reduction"},{"speaker":"Chris Dy","startTime":1550.21,"endTime":1553.33,"body":"before you know, it starts to"},{"speaker":"Chris Dy","startTime":1550.21,"endTime":1553.33,"body":"get sticky in that angulated"},{"speaker":"Chris Dy","startTime":1553.33,"endTime":1553.9,"body":"position?"},{"speaker":"Charles Goldfarb","startTime":1554.32,"endTime":1556.78,"body":"Yeah, probably"},{"speaker":"Charles Goldfarb","startTime":1554.32,"endTime":1556.78,"body":"a week to 10 days, I think by a"},{"speaker":"Charles Goldfarb","startTime":1556.78,"endTime":1561.37,"body":"week to 10 days, it can be"},{"speaker":"Charles Goldfarb","startTime":1556.78,"endTime":1561.37,"body":"harder. And sometimes those"},{"speaker":"Charles Goldfarb","startTime":1561.37,"endTime":1563.95,"body":"patients are better served in"},{"speaker":"Charles Goldfarb","startTime":1561.37,"endTime":1563.95,"body":"the ER, I'm sorry, in the"},{"speaker":"Charles Goldfarb","startTime":1563.98,"endTime":1566.89,"body":"operating room, even if it's"},{"speaker":"Charles Goldfarb","startTime":1563.98,"endTime":1566.89,"body":"just for closed reduction."},{"speaker":"Charles Goldfarb","startTime":1567.13,"endTime":1571.27,"body":"Although my typical protocol is"},{"speaker":"Charles Goldfarb","startTime":1567.13,"endTime":1571.27,"body":"if I go to the OR, I typically"},{"speaker":"Charles Goldfarb","startTime":1571.27,"endTime":1575.2,"body":"add a pen, unless it's just an"},{"speaker":"Charles Goldfarb","startTime":1571.27,"endTime":1575.2,"body":"incredibly stable reduction. To"},{"speaker":"Charles Goldfarb","startTime":1575.26,"endTime":1578.65,"body":"finish the ER conversation, my"},{"speaker":"Charles Goldfarb","startTime":1575.26,"endTime":1578.65,"body":"personal protocol is I put a two"},{"speaker":"Charles Goldfarb","startTime":1578.65,"endTime":1581.59,"body":"by two after the reduction, I"},{"speaker":"Charles Goldfarb","startTime":1578.65,"endTime":1581.59,"body":"put a two by two between the"},{"speaker":"Charles Goldfarb","startTime":1581.59,"endTime":1585.07,"body":"fingers, I buddy tape the ring"},{"speaker":"Charles Goldfarb","startTime":1581.59,"endTime":1585.07,"body":"and small finger and I put an"},{"speaker":"Charles Goldfarb","startTime":1585.1,"endTime":1588.73,"body":"ulnar gutter splint or cast on,"},{"speaker":"Charles Goldfarb","startTime":1585.1,"endTime":1588.73,"body":"and then I give it three weeks."},{"speaker":"Charles Goldfarb","startTime":1589.12,"endTime":1592.42,"body":"Because at three weeks, we know"},{"speaker":"Charles Goldfarb","startTime":1589.12,"endTime":1592.42,"body":"that the fracture is sticky, if"},{"speaker":"Charles Goldfarb","startTime":1592.42,"endTime":1595.09,"body":"not well on its way to being"},{"speaker":"Charles Goldfarb","startTime":1592.42,"endTime":1595.09,"body":"healed. And depending on the"},{"speaker":"Charles Goldfarb","startTime":1595.09,"endTime":1597.94,"body":"kid, I'll bring him back to the"},{"speaker":"Charles Goldfarb","startTime":1595.09,"endTime":1597.94,"body":"office may offer a therapy"},{"speaker":"Charles Goldfarb","startTime":1597.94,"endTime":1601.27,"body":"fabricated splint, although that"},{"speaker":"Charles Goldfarb","startTime":1597.94,"endTime":1601.27,"body":"adds cost and some would"},{"speaker":"Charles Goldfarb","startTime":1601.27,"endTime":1604.51,"body":"question the value of that"},{"speaker":"Charles Goldfarb","startTime":1601.27,"endTime":1604.51,"body":"process. I may get him a"},{"speaker":"Charles Goldfarb","startTime":1604.51,"endTime":1607.39,"body":"removable brace in the clinic,"},{"speaker":"Charles Goldfarb","startTime":1604.51,"endTime":1607.39,"body":"or depending on the amount of"},{"speaker":"Charles Goldfarb","startTime":1607.39,"endTime":1609.19,"body":"healing, I may just let them go"},{"speaker":"Charles Goldfarb","startTime":1607.39,"endTime":1609.19,"body":"with buddy tapes."},{"speaker":"Chris Dy","startTime":1609.52,"endTime":1613.09,"body":"Now are you checking"},{"speaker":"Chris Dy","startTime":1609.52,"endTime":1613.09,"body":"your reduction radiographically"},{"speaker":"Chris Dy","startTime":1613.09,"endTime":1616.81,"body":"at all, with like a fluoroscan"},{"speaker":"Chris Dy","startTime":1613.09,"endTime":1616.81,"body":"or something in the ER because I"},{"speaker":"Chris Dy","startTime":1616.81,"endTime":1619.48,"body":"know a lot of our residents"},{"speaker":"Chris Dy","startTime":1616.81,"endTime":1619.48,"body":"because now that's more broadly"},{"speaker":"Chris Dy","startTime":1619.48,"endTime":1622.72,"body":"available. Will do a fluoroscan"},{"speaker":"Chris Dy","startTime":1619.48,"endTime":1622.72,"body":"as opposed to a formal X ray,"},{"speaker":"Chris Dy","startTime":1622.75,"endTime":1626.11,"body":"are you getting a formal X ray"},{"speaker":"Chris Dy","startTime":1622.75,"endTime":1626.11,"body":"visit before after the splint is"},{"speaker":"Chris Dy","startTime":1626.11,"endTime":1628.39,"body":"on? How do you do that?"},{"speaker":"Charles Goldfarb","startTime":1628.51,"endTime":1630.43,"body":"Yeah, it's"},{"speaker":"Charles Goldfarb","startTime":1628.51,"endTime":1630.43,"body":"tricky. So our residents I think"},{"speaker":"Charles Goldfarb","startTime":1630.43,"endTime":1633.61,"body":"would be lost without the mini C"},{"speaker":"Charles Goldfarb","startTime":1630.43,"endTime":1633.61,"body":"arm in the ER, I mean, it's"},{"speaker":"Charles Goldfarb","startTime":1633.61,"endTime":1636.49,"body":"really remarkable how much they"},{"speaker":"Charles Goldfarb","startTime":1633.61,"endTime":1636.49,"body":"depend on it now. And it does"},{"speaker":"Charles Goldfarb","startTime":1636.49,"endTime":1639.67,"body":"allow a greater degree of"},{"speaker":"Charles Goldfarb","startTime":1636.49,"endTime":1639.67,"body":"confidence in one's reduction."},{"speaker":"Charles Goldfarb","startTime":1639.97,"endTime":1642.91,"body":"It is tricky when I see them"},{"speaker":"Charles Goldfarb","startTime":1639.97,"endTime":1642.91,"body":"back in the office, which may be"},{"speaker":"Charles Goldfarb","startTime":1642.91,"endTime":1645.52,"body":"in one week, what do you do with"},{"speaker":"Charles Goldfarb","startTime":1642.91,"endTime":1645.52,"body":"them, then, you know, if their"},{"speaker":"Charles Goldfarb","startTime":1645.52,"endTime":1649.09,"body":"buddy taped, then that does"},{"speaker":"Charles Goldfarb","startTime":1645.52,"endTime":1649.09,"body":"allow you to remove a splint and"},{"speaker":"Charles Goldfarb","startTime":1649.09,"endTime":1652.63,"body":"transition to a cast pretty"},{"speaker":"Charles Goldfarb","startTime":1649.09,"endTime":1652.63,"body":"safely. Or you can try to image"},{"speaker":"Charles Goldfarb","startTime":1652.66,"endTime":1655.54,"body":"through the cast. Now, if I try"},{"speaker":"Charles Goldfarb","startTime":1652.66,"endTime":1655.54,"body":"to image through the cast, it is"},{"speaker":"Charles Goldfarb","startTime":1655.54,"endTime":1657.73,"body":"done with the mini C arm because"},{"speaker":"Charles Goldfarb","startTime":1655.54,"endTime":1657.73,"body":"I don't think you can send a"},{"speaker":"Charles Goldfarb","startTime":1657.73,"endTime":1660.64,"body":"patient to radiology and expect"},{"speaker":"Charles Goldfarb","startTime":1657.73,"endTime":1660.64,"body":"them to have much luck with a"},{"speaker":"Charles Goldfarb","startTime":1660.64,"endTime":1665.62,"body":"static radiograph. But I think"},{"speaker":"Charles Goldfarb","startTime":1660.64,"endTime":1665.62,"body":"the mini C arm is really"},{"speaker":"Charles Goldfarb","startTime":1665.62,"endTime":1666.04,"body":"helpful."},{"speaker":"Chris Dy","startTime":1667.0,"endTime":1671.08,"body":"So are there any extra"},{"speaker":"Chris Dy","startTime":1667.0,"endTime":1671.08,"body":"octave fractures that are bad"},{"speaker":"Chris Dy","startTime":1671.08,"endTime":1676.42,"body":"actors? Is there any concern for"},{"speaker":"Chris Dy","startTime":1671.08,"endTime":1676.42,"body":"you know, when is it not"},{"speaker":"Chris Dy","startTime":1676.42,"endTime":1677.08,"body":"straightforward."},{"speaker":"Charles Goldfarb","startTime":1677.87,"endTime":1679.64,"body":"Yeah, I have"},{"speaker":"Charles Goldfarb","startTime":1677.87,"endTime":1679.64,"body":"to I have three comments that"},{"speaker":"Charles Goldfarb","startTime":1679.64,"endTime":1684.56,"body":"for first comment is that most"},{"speaker":"Charles Goldfarb","startTime":1679.64,"endTime":1684.56,"body":"are not bad actors at all. And"},{"speaker":"Charles Goldfarb","startTime":1684.56,"endTime":1688.37,"body":"they just need a good reduction."},{"speaker":"Charles Goldfarb","startTime":1684.56,"endTime":1688.37,"body":"And they do great. Second is"},{"speaker":"Charles Goldfarb","startTime":1688.37,"endTime":1692.27,"body":"that, you know, adult orthopedic"},{"speaker":"Charles Goldfarb","startTime":1688.37,"endTime":1692.27,"body":"surgeons, plastic surgeons,"},{"speaker":"Charles Goldfarb","startTime":1692.93,"endTime":1697.19,"body":"generalist in any form or"},{"speaker":"Charles Goldfarb","startTime":1692.93,"endTime":1697.19,"body":"fashion get scared off by the"},{"speaker":"Charles Goldfarb","startTime":1697.19,"endTime":1701.06,"body":"fact that the physis is involved"},{"speaker":"Charles Goldfarb","startTime":1697.19,"endTime":1701.06,"body":"with this fracture. And"},{"speaker":"Charles Goldfarb","startTime":1701.06,"endTime":1704.54,"body":"thankfully, knock on wood, I"},{"speaker":"Charles Goldfarb","startTime":1701.06,"endTime":1704.54,"body":"don't think I've ever seen a"},{"speaker":"Charles Goldfarb","startTime":1704.54,"endTime":1710.12,"body":"growth plate arrest after base"},{"speaker":"Charles Goldfarb","startTime":1704.54,"endTime":1710.12,"body":"of P one or P two fracture ever."},{"speaker":"Charles Goldfarb","startTime":1711.08,"endTime":1715.73,"body":"And so yes, the physis may be"},{"speaker":"Charles Goldfarb","startTime":1711.08,"endTime":1715.73,"body":"involved, but it's rarely a"},{"speaker":"Charles Goldfarb","startTime":1715.73,"endTime":1719.93,"body":"problem. And then the third"},{"speaker":"Charles Goldfarb","startTime":1715.73,"endTime":1719.93,"body":"thing is that this can be a"},{"speaker":"Charles Goldfarb","startTime":1719.93,"endTime":1723.35,"body":"periphyseal injury, they don't"},{"speaker":"Charles Goldfarb","startTime":1719.93,"endTime":1723.35,"body":"all involve the growth plate."},{"speaker":"Charles Goldfarb","startTime":1723.53,"endTime":1725.75,"body":"And I don't think that changes"},{"speaker":"Charles Goldfarb","startTime":1723.53,"endTime":1725.75,"body":"anything practically about how"},{"speaker":"Charles Goldfarb","startTime":1725.75,"endTime":1729.32,"body":"we handle it. But they're not"},{"speaker":"Charles Goldfarb","startTime":1725.75,"endTime":1729.32,"body":"all truly a Salter-Harris type"},{"speaker":"Charles Goldfarb","startTime":1729.32,"endTime":1734.21,"body":"fracture. So again, the key is"},{"speaker":"Charles Goldfarb","startTime":1729.32,"endTime":1734.21,"body":"get the sagittal alignment"},{"speaker":"Charles Goldfarb","startTime":1734.21,"endTime":1738.35,"body":"correct. So bring it back"},{"speaker":"Charles Goldfarb","startTime":1734.21,"endTime":1738.35,"body":"towards the middle and ring"},{"speaker":"Charles Goldfarb","startTime":1738.35,"endTime":1742.76,"body":"fingers. And two get the"},{"speaker":"Charles Goldfarb","startTime":1738.35,"endTime":1742.76,"body":"rotation correct. Dorsal volar"},{"speaker":"Charles Goldfarb","startTime":1742.76,"endTime":1746.99,"body":"is rarely an issue. It's really"},{"speaker":"Charles Goldfarb","startTime":1742.76,"endTime":1746.99,"body":"about rotation and deviation. If"},{"speaker":"Charles Goldfarb","startTime":1746.99,"endTime":1750.26,"body":"you get those right, then you're"},{"speaker":"Charles Goldfarb","startTime":1746.99,"endTime":1750.26,"body":"good. The last thing I'll say is"},{"speaker":"Charles Goldfarb","startTime":1750.26,"endTime":1754.49,"body":"to me the worry about bad actors"},{"speaker":"Charles Goldfarb","startTime":1750.26,"endTime":1754.49,"body":"is when you have multiple"},{"speaker":"Charles Goldfarb","startTime":1754.52,"endTime":1758.48,"body":"fingers affected because it"},{"speaker":"Charles Goldfarb","startTime":1754.52,"endTime":1758.48,"body":"indicates a higher level of"},{"speaker":"Charles Goldfarb","startTime":1758.48,"endTime":1762.32,"body":"energy and typically a less"},{"speaker":"Charles Goldfarb","startTime":1758.48,"endTime":1762.32,"body":"stable pattern. And so those"},{"speaker":"Charles Goldfarb","startTime":1762.53,"endTime":1765.41,"body":"often but not always, often"},{"speaker":"Charles Goldfarb","startTime":1762.53,"endTime":1765.41,"body":"require surgery."},{"speaker":"Chris Dy","startTime":1765.95,"endTime":1767.75,"body":"And is that almost"},{"speaker":"Chris Dy","startTime":1765.95,"endTime":1767.75,"body":"like have like a windswept"},{"speaker":"Chris Dy","startTime":1767.75,"endTime":1770.69,"body":"appearance of the hand where"},{"speaker":"Chris Dy","startTime":1767.75,"endTime":1770.69,"body":"they've kind of come all across."},{"speaker":"Charles Goldfarb","startTime":1770.93,"endTime":1773.09,"body":"Yeah, exactly."},{"speaker":"Charles Goldfarb","startTime":1770.93,"endTime":1773.09,"body":"That's exactly right. And then"},{"speaker":"Charles Goldfarb","startTime":1773.12,"endTime":1775.64,"body":"you know, the the final point"},{"speaker":"Charles Goldfarb","startTime":1773.12,"endTime":1775.64,"body":"maybe on these before we bore"},{"speaker":"Charles Goldfarb","startTime":1775.64,"endTime":1779.15,"body":"our audience to death is that"},{"speaker":"Charles Goldfarb","startTime":1775.64,"endTime":1779.15,"body":"when you go the OR. Well you go"},{"speaker":"Charles Goldfarb","startTime":1779.15,"endTime":1782.45,"body":"to the OR if A it's a delay in"},{"speaker":"Charles Goldfarb","startTime":1779.15,"endTime":1782.45,"body":"you're seeing them but you do"},{"speaker":"Charles Goldfarb","startTime":1782.45,"endTime":1785.06,"body":"have to be careful because you"},{"speaker":"Charles Goldfarb","startTime":1782.45,"endTime":1785.06,"body":"don't want to traumatize the"},{"speaker":"Charles Goldfarb","startTime":1785.06,"endTime":1788.81,"body":"growth plate too much. But more"},{"speaker":"Charles Goldfarb","startTime":1785.06,"endTime":1788.81,"body":"commonly, you see them acutely"},{"speaker":"Charles Goldfarb","startTime":1788.81,"endTime":1793.04,"body":"or subacutely and they're just"},{"speaker":"Charles Goldfarb","startTime":1788.81,"endTime":1793.04,"body":"not acceptably aligned. And then"},{"speaker":"Charles Goldfarb","startTime":1793.04,"endTime":1797.42,"body":"you have to go to the OR and as"},{"speaker":"Charles Goldfarb","startTime":1793.04,"endTime":1797.42,"body":"I mentioned, I often put pins in"},{"speaker":"Charles Goldfarb","startTime":1797.42,"endTime":1802.07,"body":"almost always put pins and just"},{"speaker":"Charles Goldfarb","startTime":1797.42,"endTime":1802.07,"body":"because my, The scenario of go"},{"speaker":"Charles Goldfarb","startTime":1802.07,"endTime":1804.83,"body":"in the OR getting a close"},{"speaker":"Charles Goldfarb","startTime":1802.07,"endTime":1804.83,"body":"reduction, having the patient"},{"speaker":"Charles Goldfarb","startTime":1804.83,"endTime":1808.49,"body":"come back and have the deviation"},{"speaker":"Charles Goldfarb","startTime":1804.83,"endTime":1808.49,"body":"recur is really not palatable."},{"speaker":"Charles Goldfarb","startTime":1808.67,"endTime":1811.94,"body":"So unless it's super stable, I"},{"speaker":"Charles Goldfarb","startTime":1808.67,"endTime":1811.94,"body":"will put one or 2 K wires and"},{"speaker":"Charles Goldfarb","startTime":1811.94,"endTime":1815.81,"body":"from proximal to distal, I think"},{"speaker":"Charles Goldfarb","startTime":1811.94,"endTime":1815.81,"body":"it's safe, well tolerated and"},{"speaker":"Charles Goldfarb","startTime":1815.81,"endTime":1816.95,"body":"the pins don't stay in long."},{"speaker":"Chris Dy","startTime":1818.09,"endTime":1821.0,"body":"Now, one question that"},{"speaker":"Chris Dy","startTime":1818.09,"endTime":1821.0,"body":"probably applies to the rest of"},{"speaker":"Chris Dy","startTime":1821.0,"endTime":1824.87,"body":"the fractures that we'll talk"},{"speaker":"Chris Dy","startTime":1821.0,"endTime":1824.87,"body":"about today, but when do you do"},{"speaker":"Chris Dy","startTime":1824.87,"endTime":1828.77,"body":"you have the conversation about"},{"speaker":"Chris Dy","startTime":1824.87,"endTime":1828.77,"body":"physeal involvement potential"},{"speaker":"Chris Dy","startTime":1828.77,"endTime":1832.01,"body":"for arrest with all of these"},{"speaker":"Chris Dy","startTime":1828.77,"endTime":1832.01,"body":"factors? Or maybe not so much"},{"speaker":"Chris Dy","startTime":1832.01,"endTime":1833.66,"body":"with this fracture and more with"},{"speaker":"Chris Dy","startTime":1832.01,"endTime":1833.66,"body":"others?"},{"speaker":"Charles Goldfarb","startTime":1834.26,"endTime":1837.26,"body":"Yeah, I"},{"speaker":"Charles Goldfarb","startTime":1834.26,"endTime":1837.26,"body":"really, most families come in"},{"speaker":"Charles Goldfarb","startTime":1837.26,"endTime":1841.07,"body":"and understand the growth plates"},{"speaker":"Charles Goldfarb","startTime":1837.26,"endTime":1841.07,"body":"involved, I actually tell them"},{"speaker":"Charles Goldfarb","startTime":1841.1,"endTime":1843.8,"body":"and I feel pretty comfortable"},{"speaker":"Charles Goldfarb","startTime":1841.1,"endTime":1843.8,"body":"saying this that, like I shared"},{"speaker":"Charles Goldfarb","startTime":1843.8,"endTime":1846.08,"body":"earlier, it's just almost never"},{"speaker":"Charles Goldfarb","startTime":1843.8,"endTime":1846.08,"body":"a problem. So I usually don't"},{"speaker":"Charles Goldfarb","startTime":1846.08,"endTime":1849.14,"body":"bring it up, if they don't bring"},{"speaker":"Charles Goldfarb","startTime":1846.08,"endTime":1849.14,"body":"it up. Because I just like I"},{"speaker":"Charles Goldfarb","startTime":1849.14,"endTime":1851.6,"body":"said, I've never seen it. And so"},{"speaker":"Charles Goldfarb","startTime":1849.14,"endTime":1851.6,"body":"anything's possible, but I've"},{"speaker":"Charles Goldfarb","startTime":1851.6,"endTime":1852.23,"body":"never seen it."},{"speaker":"Chris Dy","startTime":1853.41,"endTime":1855.0,"body":"It's interesting,"},{"speaker":"Chris Dy","startTime":1853.41,"endTime":1855.0,"body":"because I bring it up for even"},{"speaker":"Chris Dy","startTime":1855.0,"endTime":1857.55,"body":"things like buckle fractures,"},{"speaker":"Chris Dy","startTime":1855.0,"endTime":1857.55,"body":"you know, that was like, it's"},{"speaker":"Chris Dy","startTime":1857.55,"endTime":1860.58,"body":"close. It's close to the growth"},{"speaker":"Chris Dy","startTime":1857.55,"endTime":1860.58,"body":"plate. I don't think the growth"},{"speaker":"Chris Dy","startTime":1860.58,"endTime":1862.77,"body":"plate's involved. But you know,"},{"speaker":"Chris Dy","startTime":1860.58,"endTime":1862.77,"body":"and I think that's, that's"},{"speaker":"Chris Dy","startTime":1862.77,"endTime":1866.19,"body":"because I just don't have the"},{"speaker":"Chris Dy","startTime":1862.77,"endTime":1866.19,"body":"same level of comfort, you know,"},{"speaker":"Chris Dy","startTime":1866.19,"endTime":1870.21,"body":"in reps and volume in treating,"},{"speaker":"Chris Dy","startTime":1866.19,"endTime":1870.21,"body":"you know, pediatric fractures."},{"speaker":"Charles Goldfarb","startTime":1870.69,"endTime":1872.22,"body":"Well, the"},{"speaker":"Charles Goldfarb","startTime":1870.69,"endTime":1872.22,"body":"distal radius is a different"},{"speaker":"Charles Goldfarb","startTime":1872.22,"endTime":1876.66,"body":"thing, because it doesn't even"},{"speaker":"Charles Goldfarb","startTime":1872.22,"endTime":1876.66,"body":"have to involve the physis till"},{"speaker":"Charles Goldfarb","startTime":1876.66,"endTime":1879.3,"body":"we do a subsequent growth plate"},{"speaker":"Charles Goldfarb","startTime":1876.66,"endTime":1879.3,"body":"at least radiographically. So"},{"speaker":"Charles Goldfarb","startTime":1879.48,"endTime":1881.79,"body":"the distal radius is a little"},{"speaker":"Charles Goldfarb","startTime":1879.48,"endTime":1881.79,"body":"bit trickier, you're certainly"},{"speaker":"Charles Goldfarb","startTime":1881.79,"endTime":1884.67,"body":"not wrong to bring it up, never"},{"speaker":"Charles Goldfarb","startTime":1881.79,"endTime":1884.67,"body":"could be faulted for bringing it"},{"speaker":"Charles Goldfarb","startTime":1884.67,"endTime":1888.54,"body":"up and have parents aware of it."},{"speaker":"Charles Goldfarb","startTime":1884.67,"endTime":1888.54,"body":"And maybe I have seen it and"},{"speaker":"Charles Goldfarb","startTime":1888.54,"endTime":1891.51,"body":"just hadn't recognized it. But I"},{"speaker":"Charles Goldfarb","startTime":1888.54,"endTime":1891.51,"body":"just think it's super uncommon,"},{"speaker":"Charles Goldfarb","startTime":1891.51,"endTime":1895.14,"body":"whether that be base of P one,"},{"speaker":"Charles Goldfarb","startTime":1891.51,"endTime":1895.14,"body":"or base of P two now with"},{"speaker":"Charles Goldfarb","startTime":1895.32,"endTime":1897.51,"body":"Seymour fractures, and we're"},{"speaker":"Charles Goldfarb","startTime":1895.32,"endTime":1897.51,"body":"probably not going to talk too"},{"speaker":"Charles Goldfarb","startTime":1897.51,"endTime":1901.14,"body":"much about Seymour fractures."},{"speaker":"Charles Goldfarb","startTime":1897.51,"endTime":1901.14,"body":"That's the open, you know, nail"},{"speaker":"Charles Goldfarb","startTime":1901.14,"endTime":1906.72,"body":"plate injury. And distal phalanx"},{"speaker":"Charles Goldfarb","startTime":1901.14,"endTime":1906.72,"body":"fracture, it ends up looking a"},{"speaker":"Charles Goldfarb","startTime":1906.72,"endTime":1911.46,"body":"little like a mallet finger."},{"speaker":"Charles Goldfarb","startTime":1906.72,"endTime":1911.46,"body":"Those I have seen growth arrest"},{"speaker":"Charles Goldfarb","startTime":1911.46,"endTime":1914.04,"body":"with I've also seen infections"},{"speaker":"Charles Goldfarb","startTime":1911.46,"endTime":1914.04,"body":"with and so we treat those"},{"speaker":"Charles Goldfarb","startTime":1914.04,"endTime":1916.92,"body":"aggressively with irrigation,"},{"speaker":"Charles Goldfarb","startTime":1914.04,"endTime":1916.92,"body":"often pinning and nail plate"},{"speaker":"Charles Goldfarb","startTime":1916.92,"endTime":1919.86,"body":"repair. But I just haven't seen"},{"speaker":"Charles Goldfarb","startTime":1916.92,"endTime":1919.86,"body":"it really, for P one and P two."},{"speaker":"Chris Dy","startTime":1920.38,"endTime":1921.97,"body":"Well, we should get"},{"speaker":"Chris Dy","startTime":1920.38,"endTime":1921.97,"body":"back to Seymours though because"},{"speaker":"Chris Dy","startTime":1921.97,"endTime":1924.43,"body":"I think that's something that"},{"speaker":"Chris Dy","startTime":1921.97,"endTime":1924.43,"body":"there is some controversy, some"},{"speaker":"Chris Dy","startTime":1924.43,"endTime":1927.46,"body":"new literature out there. But"},{"speaker":"Chris Dy","startTime":1924.43,"endTime":1927.46,"body":"let's stick in the proximal"},{"speaker":"Chris Dy","startTime":1927.46,"endTime":1930.97,"body":"phalanx for now. Go a little"},{"speaker":"Chris Dy","startTime":1927.46,"endTime":1930.97,"body":"more distal. So let's talk about"},{"speaker":"Chris Dy","startTime":1930.97,"endTime":1933.37,"body":"some of those subcondylar"},{"speaker":"Chris Dy","startTime":1930.97,"endTime":1933.37,"body":"fractures. And I think this is a"},{"speaker":"Chris Dy","startTime":1933.37,"endTime":1937.15,"body":"topic that you have published on"},{"speaker":"Chris Dy","startTime":1933.37,"endTime":1937.15,"body":"recently, was in the last 10"},{"speaker":"Chris Dy","startTime":1937.15,"endTime":1942.34,"body":"years or so. Can you tell me a"},{"speaker":"Chris Dy","startTime":1937.15,"endTime":1942.34,"body":"little bit about these"},{"speaker":"Chris Dy","startTime":1942.34,"endTime":1945.64,"body":"subcondylar fractures, you know,"},{"speaker":"Chris Dy","startTime":1942.34,"endTime":1945.64,"body":"are they, you know, what makes"},{"speaker":"Chris Dy","startTime":1945.64,"endTime":1947.95,"body":"them a little more challenging"},{"speaker":"Chris Dy","startTime":1945.64,"endTime":1947.95,"body":"to deal with? And what can be"},{"speaker":"Chris Dy","startTime":1947.95,"endTime":1948.64,"body":"the issues?"},{"speaker":"Charles Goldfarb","startTime":1949.17,"endTime":1951.12,"body":"Yeah, so the"},{"speaker":"Charles Goldfarb","startTime":1949.17,"endTime":1951.12,"body":"subcondylar just to define them"},{"speaker":"Charles Goldfarb","startTime":1951.12,"endTime":1954.87,"body":"carefully. Those are the"},{"speaker":"Charles Goldfarb","startTime":1951.12,"endTime":1954.87,"body":"fractures that can be either the"},{"speaker":"Charles Goldfarb","startTime":1954.87,"endTime":1958.71,"body":"proximal phalanx and I use the"},{"speaker":"Charles Goldfarb","startTime":1954.87,"endTime":1958.71,"body":"abbreviation p one, but not"},{"speaker":"Charles Goldfarb","startTime":1958.71,"endTime":1961.56,"body":"everyone likes that abbreviation"},{"speaker":"Charles Goldfarb","startTime":1958.71,"endTime":1961.56,"body":"but can be of the proximal"},{"speaker":"Charles Goldfarb","startTime":1961.56,"endTime":1966.09,"body":"phalanx or middle phalanx p one"},{"speaker":"Charles Goldfarb","startTime":1961.56,"endTime":1966.09,"body":"or P two, that's just below the"},{"speaker":"Charles Goldfarb","startTime":1966.09,"endTime":1971.55,"body":"head, or the condyles of that"},{"speaker":"Charles Goldfarb","startTime":1966.09,"endTime":1971.55,"body":"particular bone. And it's often"},{"speaker":"Charles Goldfarb","startTime":1971.97,"endTime":1976.41,"body":"almost always a transverse"},{"speaker":"Charles Goldfarb","startTime":1971.97,"endTime":1976.41,"body":"fracture. By definition, it"},{"speaker":"Charles Goldfarb","startTime":1976.41,"endTime":1979.83,"body":"doesn't split into the joint. So"},{"speaker":"Charles Goldfarb","startTime":1976.41,"endTime":1979.83,"body":"it's not a unicondylar fracture."},{"speaker":"Charles Goldfarb","startTime":1980.34,"endTime":1984.18,"body":"It doesn't involve a joint. But"},{"speaker":"Charles Goldfarb","startTime":1980.34,"endTime":1984.18,"body":"the danger with these fractures"},{"speaker":"Charles Goldfarb","startTime":1984.21,"endTime":1988.26,"body":"is that the blood supply is"},{"speaker":"Charles Goldfarb","startTime":1984.21,"endTime":1988.26,"body":"precarious. And because a lot of"},{"speaker":"Charles Goldfarb","startTime":1988.26,"endTime":1991.29,"body":"the fracture fragment distally"},{"speaker":"Charles Goldfarb","startTime":1988.26,"endTime":1991.29,"body":"is covered with cartilage,"},{"speaker":"Charles Goldfarb","startTime":1991.32,"endTime":1994.32,"body":"there's no blood supply coming"},{"speaker":"Charles Goldfarb","startTime":1991.32,"endTime":1994.32,"body":"in there. The blood supply"},{"speaker":"Charles Goldfarb","startTime":1994.32,"endTime":1997.56,"body":"largely comes from the"},{"speaker":"Charles Goldfarb","startTime":1994.32,"endTime":1997.56,"body":"collateral ligaments. And we"},{"speaker":"Charles Goldfarb","startTime":1997.56,"endTime":2003.08,"body":"know that a trauma alone or a"},{"speaker":"Charles Goldfarb","startTime":1997.56,"endTime":2003.08,"body":"trauma plus surgery can lead to"},{"speaker":"Charles Goldfarb","startTime":2003.14,"endTime":2005.78,"body":"avascular necrosis of these"},{"speaker":"Charles Goldfarb","startTime":2003.14,"endTime":2005.78,"body":"fractures. And so we tread"},{"speaker":"Charles Goldfarb","startTime":2005.78,"endTime":2010.31,"body":"really carefully. And so we have"},{"speaker":"Charles Goldfarb","startTime":2005.78,"endTime":2010.31,"body":"to think about that as we"},{"speaker":"Charles Goldfarb","startTime":2010.31,"endTime":2015.14,"body":"consider treatment for these."},{"speaker":"Charles Goldfarb","startTime":2010.31,"endTime":2015.14,"body":"I'll keep babbling. So the"},{"speaker":"Charles Goldfarb","startTime":2015.14,"endTime":2018.71,"body":"classic presentation is again,"},{"speaker":"Charles Goldfarb","startTime":2015.14,"endTime":2018.71,"body":"little finger quite commonly,"},{"speaker":"Charles Goldfarb","startTime":2018.95,"endTime":2024.35,"body":"and the distal fragment"},{"speaker":"Charles Goldfarb","startTime":2018.95,"endTime":2024.35,"body":"translates and angles dorsally"},{"speaker":"Charles Goldfarb","startTime":2025.04,"endTime":2030.26,"body":"and may angle A little bit"},{"speaker":"Charles Goldfarb","startTime":2025.04,"endTime":2030.26,"body":"ulnarly as well. And so those"},{"speaker":"Charles Goldfarb","startTime":2030.26,"endTime":2033.95,"body":"fractures have the potential to"},{"speaker":"Charles Goldfarb","startTime":2030.26,"endTime":2033.95,"body":"do fine, but we try to treat"},{"speaker":"Charles Goldfarb","startTime":2033.95,"endTime":2038.66,"body":"them carefully. We try to reduce"},{"speaker":"Charles Goldfarb","startTime":2033.95,"endTime":2038.66,"body":"them anatomically, and often pin"},{"speaker":"Charles Goldfarb","startTime":2038.66,"endTime":2043.43,"body":"them to hold them in place. And"},{"speaker":"Charles Goldfarb","startTime":2038.66,"endTime":2043.43,"body":"we really, really try not to do"},{"speaker":"Charles Goldfarb","startTime":2043.43,"endTime":2044.21,"body":"an open reduction."},{"speaker":"Chris Dy","startTime":2044.87,"endTime":2047.39,"body":"So when you say it"},{"speaker":"Chris Dy","startTime":2044.87,"endTime":2047.39,"body":"translates dorsally, and"},{"speaker":"Chris Dy","startTime":2047.69,"endTime":2052.4,"body":"angulates dorsally, is that an"},{"speaker":"Chris Dy","startTime":2047.69,"endTime":2052.4,"body":"apex volar type of angulation?"},{"speaker":"Chris Dy","startTime":2053.33,"endTime":2055.37,"body":"Just to make sure that"},{"speaker":"Chris Dy","startTime":2053.33,"endTime":2055.37,"body":"everybody's on the same page,"},{"speaker":"Chris Dy","startTime":2055.37,"endTime":2056.9,"body":"because I know there are"},{"speaker":"Chris Dy","startTime":2055.37,"endTime":2056.9,"body":"different ways of describing"},{"speaker":"Chris Dy","startTime":2056.9,"endTime":2060.53,"body":"fractures and you're using the"},{"speaker":"Chris Dy","startTime":2056.9,"endTime":2060.53,"body":"classic orthopedic terminology."},{"speaker":"Chris Dy","startTime":2060.53,"endTime":2060.89,"body":"But."},{"speaker":"Charles Goldfarb","startTime":2061.34,"endTime":2064.43,"body":"Yeah, so I'll"},{"speaker":"Charles Goldfarb","startTime":2061.34,"endTime":2064.43,"body":"try to say it as clearly as this"},{"speaker":"Charles Goldfarb","startTime":2064.43,"endTime":2067.7,"body":"how I think about so the actual"},{"speaker":"Charles Goldfarb","startTime":2064.43,"endTime":2067.7,"body":"distal fragment shifts dorsally"},{"speaker":"Charles Goldfarb","startTime":2068.9,"endTime":2074.18,"body":"and also the joint surface"},{"speaker":"Charles Goldfarb","startTime":2068.9,"endTime":2074.18,"body":"angles dorsally. So that, to me"},{"speaker":"Charles Goldfarb","startTime":2074.18,"endTime":2076.28,"body":"is the most straightforward way"},{"speaker":"Charles Goldfarb","startTime":2074.18,"endTime":2076.28,"body":"to describe it. I guess that is"},{"speaker":"Charles Goldfarb","startTime":2076.28,"endTime":2081.44,"body":"Apex volar. Because there's more"},{"speaker":"Charles Goldfarb","startTime":2076.28,"endTime":2081.44,"body":"of a prominence volarly and the"},{"speaker":"Charles Goldfarb","startTime":2081.44,"endTime":2084.26,"body":"prominence volarly is the"},{"speaker":"Charles Goldfarb","startTime":2081.44,"endTime":2084.26,"body":"problem. So if this is"},{"speaker":"Charles Goldfarb","startTime":2084.26,"endTime":2088.07,"body":"untreated, number one, it'll"},{"speaker":"Charles Goldfarb","startTime":2084.26,"endTime":2088.07,"body":"heal. For sure. Like almost"},{"speaker":"Charles Goldfarb","startTime":2088.07,"endTime":2091.49,"body":"everything else in a kid's hand,"},{"speaker":"Charles Goldfarb","startTime":2088.07,"endTime":2091.49,"body":"it will heal the problem"},{"speaker":"Charles Goldfarb","startTime":2091.49,"endTime":2091.85,"body":"becomes-"},{"speaker":"Chris Dy","startTime":2091.85,"endTime":2093.05,"body":"But not not in a good"},{"speaker":"Chris Dy","startTime":2091.85,"endTime":2093.05,"body":"way."},{"speaker":"Charles Goldfarb","startTime":2093.56,"endTime":2095.09,"body":"Not"},{"speaker":"Charles Goldfarb","startTime":2093.56,"endTime":2095.09,"body":"necessarily in a good way. And"},{"speaker":"Charles Goldfarb","startTime":2095.09,"endTime":2098.54,"body":"the problem becomes Yes, there"},{"speaker":"Charles Goldfarb","startTime":2095.09,"endTime":2098.54,"body":"can be some angulation of the"},{"speaker":"Charles Goldfarb","startTime":2098.54,"endTime":2100.73,"body":"finger like I mentioned in the"},{"speaker":"Charles Goldfarb","startTime":2098.54,"endTime":2100.73,"body":"ulnar direction, but the other"},{"speaker":"Charles Goldfarb","startTime":2100.73,"endTime":2103.76,"body":"problem is you can lose finger"},{"speaker":"Charles Goldfarb","startTime":2100.73,"endTime":2103.76,"body":"flexion at that PIP joint"},{"speaker":"Charles Goldfarb","startTime":2103.76,"endTime":2108.38,"body":"because you know the shape of"},{"speaker":"Charles Goldfarb","startTime":2103.76,"endTime":2108.38,"body":"the head and the morphology"},{"speaker":"Charles Goldfarb","startTime":2108.41,"endTime":2112.82,"body":"allows for that middle phalanx"},{"speaker":"Charles Goldfarb","startTime":2108.41,"endTime":2112.82,"body":"with PIP flexion to really"},{"speaker":"Charles Goldfarb","startTime":2112.82,"endTime":2117.95,"body":"engage at the neck level of the"},{"speaker":"Charles Goldfarb","startTime":2112.82,"endTime":2117.95,"body":"proximal phalanx and if you have"},{"speaker":"Charles Goldfarb","startTime":2117.95,"endTime":2121.82,"body":"a malunion you will lose flexion"},{"speaker":"Charles Goldfarb","startTime":2117.95,"endTime":2121.82,"body":"of the PIP joint, not the end of"},{"speaker":"Charles Goldfarb","startTime":2121.82,"endTime":2125.45,"body":"the world but in a kid you know"},{"speaker":"Charles Goldfarb","startTime":2121.82,"endTime":2125.45,"body":"you want to restore normal"},{"speaker":"Charles Goldfarb","startTime":2125.45,"endTime":2126.98,"body":"anatomy and maximize function."},{"speaker":"Chris Dy","startTime":2127.55,"endTime":2131.78,"body":"So your goal is a"},{"speaker":"Chris Dy","startTime":2127.55,"endTime":2131.78,"body":"closed reduction and pinning is"},{"speaker":"Chris Dy","startTime":2131.78,"endTime":2134.99,"body":"that what kind of pin"},{"speaker":"Chris Dy","startTime":2131.78,"endTime":2134.99,"body":"configuration is that like"},{"speaker":"Chris Dy","startTime":2134.99,"endTime":2139.37,"body":"retrograde cross pins you know"},{"speaker":"Chris Dy","startTime":2134.99,"endTime":2139.37,"body":"do you go or do you go the other"},{"speaker":"Chris Dy","startTime":2139.37,"endTime":2142.85,"body":"way antegrade and what kind of"},{"speaker":"Chris Dy","startTime":2139.37,"endTime":2142.85,"body":"size of pins are you using?"},{"speaker":"Charles Goldfarb","startTime":2142.9,"endTime":2145.03,"body":"Theoretically"},{"speaker":"Charles Goldfarb","startTime":2142.9,"endTime":2145.03,"body":"these can be closed reduced"},{"speaker":"Charles Goldfarb","startTime":2145.03,"endTime":2149.59,"body":"alone but again as you said we"},{"speaker":"Charles Goldfarb","startTime":2145.03,"endTime":2149.59,"body":"typically pin these for security"},{"speaker":"Charles Goldfarb","startTime":2149.59,"endTime":2154.69,"body":"to make sure it doesn't have a"},{"speaker":"Charles Goldfarb","startTime":2149.59,"endTime":2154.69,"body":"problem the goal is a closed"},{"speaker":"Charles Goldfarb","startTime":2154.69,"endTime":2157.33,"body":"reduction often flexion of the"},{"speaker":"Charles Goldfarb","startTime":2154.69,"endTime":2157.33,"body":"finger can accomplish a lot of"},{"speaker":"Charles Goldfarb","startTime":2157.33,"endTime":2162.37,"body":"your reduction but sometimes"},{"speaker":"Charles Goldfarb","startTime":2157.33,"endTime":2162.37,"body":"that's not enough we typically"},{"speaker":"Charles Goldfarb","startTime":2162.37,"endTime":2167.65,"body":"use 35, 0.035 Kirschner wires"},{"speaker":"Charles Goldfarb","startTime":2162.37,"endTime":2167.65,"body":"sometimes two eight Kirschner"},{"speaker":"Charles Goldfarb","startTime":2167.65,"endTime":2172.27,"body":"wires typically retrograde from"},{"speaker":"Charles Goldfarb","startTime":2167.65,"endTime":2172.27,"body":"the condyles so crossed k wires"},{"speaker":"Charles Goldfarb","startTime":2173.47,"endTime":2178.24,"body":"and that's that's the typical"},{"speaker":"Charles Goldfarb","startTime":2173.47,"endTime":2178.24,"body":"format proximal to distal wires"},{"speaker":"Charles Goldfarb","startTime":2178.24,"endTime":2182.68,"body":"are easier to place but it's"},{"speaker":"Charles Goldfarb","startTime":2178.24,"endTime":2182.68,"body":"very difficult to get a proximal"},{"speaker":"Charles Goldfarb","startTime":2182.68,"endTime":2186.94,"body":"wire all the way into the"},{"speaker":"Charles Goldfarb","startTime":2182.68,"endTime":2186.94,"body":"condyle and to have it grab"},{"speaker":"Charles Goldfarb","startTime":2186.94,"endTime":2188.71,"body":"enough bone to secure it and"},{"speaker":"Charles Goldfarb","startTime":2186.94,"endTime":2188.71,"body":"that's the beauty of the"},{"speaker":"Charles Goldfarb","startTime":2188.71,"endTime":2191.29,"body":"retrograde wire because the pins"},{"speaker":"Charles Goldfarb","startTime":2188.71,"endTime":2191.29,"body":"that are left outside the skin"},{"speaker":"Charles Goldfarb","startTime":2191.47,"endTime":2195.07,"body":"can be capped outside the skin"},{"speaker":"Charles Goldfarb","startTime":2191.47,"endTime":2195.07,"body":"and you have more security for"},{"speaker":"Charles Goldfarb","startTime":2195.07,"endTime":2196.69,"body":"the small distal fragment."},{"speaker":"Chris Dy","startTime":2197.17,"endTime":2200.83,"body":"I apologize to our"},{"speaker":"Chris Dy","startTime":2197.17,"endTime":2200.83,"body":"overseas listeners we are still"},{"speaker":"Chris Dy","startTime":2200.83,"endTime":2205.72,"body":"stuck in the British system I"},{"speaker":"Chris Dy","startTime":2200.83,"endTime":2205.72,"body":"will blame our British friends."},{"speaker":"Chris Dy","startTime":2206.38,"endTime":2211.24,"body":"So that's 0.028 inches which i"},{"speaker":"Chris Dy","startTime":2206.38,"endTime":2211.24,"body":"don't know what the millimeters"},{"speaker":"Chris Dy","startTime":2211.24,"endTime":2213.79,"body":"are i'm sure we can find a"},{"speaker":"Chris Dy","startTime":2211.24,"endTime":2213.79,"body":"translation or conversion."},{"speaker":"Charles Goldfarb","startTime":2213.94,"endTime":2217.36,"body":"Yeah isn't"},{"speaker":"Charles Goldfarb","startTime":2213.94,"endTime":2217.36,"body":"like a 0.062 inch K wire, I"},{"speaker":"Charles Goldfarb","startTime":2217.36,"endTime":2221.89,"body":"think it's 1.1 millimeters but i"},{"speaker":"Charles Goldfarb","startTime":2217.36,"endTime":2221.89,"body":"have no idea what the others are"},{"speaker":"Charles Goldfarb","startTime":2221.89,"endTime":2228.25,"body":"i'm embarrassed to say. Oh lord."},{"speaker":"Charles Goldfarb","startTime":2221.89,"endTime":2228.25,"body":"Yeah and so the the other caveat"},{"speaker":"Charles Goldfarb","startTime":2228.25,"endTime":2232.63,"body":"which Peter Waters taught us and"},{"speaker":"Charles Goldfarb","startTime":2228.25,"endTime":2232.63,"body":"Roger Cornwall from Cincinnati"},{"speaker":"Charles Goldfarb","startTime":2232.63,"endTime":2237.25,"body":"expanded upon is if there is"},{"speaker":"Charles Goldfarb","startTime":2232.63,"endTime":2237.25,"body":"early healing and it's not a"},{"speaker":"Charles Goldfarb","startTime":2237.25,"endTime":2240.67,"body":"minimal to a true closed"},{"speaker":"Charles Goldfarb","startTime":2237.25,"endTime":2240.67,"body":"reduction than an osteoclasis"},{"speaker":"Charles Goldfarb","startTime":2240.7,"endTime":2243.91,"body":"procedure which i think i"},{"speaker":"Charles Goldfarb","startTime":2240.7,"endTime":2243.91,"body":"mentioned on our last podcast"},{"speaker":"Charles Goldfarb","startTime":2243.91,"endTime":2246.1,"body":"can be really helpful we're"},{"speaker":"Charles Goldfarb","startTime":2243.91,"endTime":2246.1,"body":"using a wire to break up the"},{"speaker":"Charles Goldfarb","startTime":2246.1,"endTime":2249.34,"body":"healing and that can be great"},{"speaker":"Charles Goldfarb","startTime":2246.1,"endTime":2249.34,"body":"and again the key is really try"},{"speaker":"Charles Goldfarb","startTime":2249.34,"endTime":2251.77,"body":"to avoid an open reduction"},{"speaker":"Charles Goldfarb","startTime":2249.34,"endTime":2251.77,"body":"because you don't want to do"},{"speaker":"Charles Goldfarb","startTime":2251.77,"endTime":2254.59,"body":"anything as a surgeon which"},{"speaker":"Charles Goldfarb","startTime":2251.77,"endTime":2254.59,"body":"would further risk the blood"},{"speaker":"Charles Goldfarb","startTime":2254.59,"endTime":2254.95,"body":"supply."},{"speaker":"Chris Dy","startTime":2255.47,"endTime":2257.51,"body":"Sure and that"},{"speaker":"Chris Dy","startTime":2255.47,"endTime":2257.51,"body":"osteoclasis is that something"},{"speaker":"Chris Dy","startTime":2257.51,"endTime":2260.87,"body":"that you would typically do with"},{"speaker":"Chris Dy","startTime":2257.51,"endTime":2260.87,"body":"fluoro guidance making sure"},{"speaker":"Chris Dy","startTime":2260.87,"endTime":2264.8,"body":"obviously not to compromise that"},{"speaker":"Chris Dy","startTime":2260.87,"endTime":2264.8,"body":"fragment that very tenuous"},{"speaker":"Chris Dy","startTime":2264.8,"endTime":2266.0,"body":"fragment too much right?"},{"speaker":"Charles Goldfarb","startTime":2266.0,"endTime":2268.79,"body":"Absolutely,"},{"speaker":"Charles Goldfarb","startTime":2266.0,"endTime":2268.79,"body":"absolutely. Yeah and then this"},{"speaker":"Charles Goldfarb","startTime":2268.79,"endTime":2271.58,"body":"can be a proximal phalanx this"},{"speaker":"Charles Goldfarb","startTime":2268.79,"endTime":2271.58,"body":"which is far more common it"},{"speaker":"Charles Goldfarb","startTime":2271.58,"endTime":2274.13,"body":"absolutely can be middle"},{"speaker":"Charles Goldfarb","startTime":2271.58,"endTime":2274.13,"body":"phalanx. The middle phalanx"},{"speaker":"Charles Goldfarb","startTime":2274.13,"endTime":2278.03,"body":"probably gets underestimated for"},{"speaker":"Charles Goldfarb","startTime":2274.13,"endTime":2278.03,"body":"this severity just because it's"},{"speaker":"Charles Goldfarb","startTime":2278.03,"endTime":2280.4,"body":"the middle phalanx and we tend"},{"speaker":"Charles Goldfarb","startTime":2278.03,"endTime":2280.4,"body":"to you know think it's less"},{"speaker":"Charles Goldfarb","startTime":2280.4,"endTime":2284.42,"body":"severe and you know for those"},{"speaker":"Charles Goldfarb","startTime":2280.4,"endTime":2284.42,"body":"who are in training you know"},{"speaker":"Charles Goldfarb","startTime":2284.57,"endTime":2288.44,"body":"what a couple of major points."},{"speaker":"Charles Goldfarb","startTime":2284.57,"endTime":2288.44,"body":"This fracture while it's not"},{"speaker":"Charles Goldfarb","startTime":2288.44,"endTime":2291.44,"body":"physically that distant from the"},{"speaker":"Charles Goldfarb","startTime":2288.44,"endTime":2291.44,"body":"growth plate because the"},{"speaker":"Charles Goldfarb","startTime":2291.44,"endTime":2295.94,"body":"phalanges are small bones is"},{"speaker":"Charles Goldfarb","startTime":2291.44,"endTime":2295.94,"body":"about as far from the growth"},{"speaker":"Charles Goldfarb","startTime":2295.94,"endTime":2298.19,"body":"plate as you can be because all"},{"speaker":"Charles Goldfarb","startTime":2295.94,"endTime":2298.19,"body":"the growth plates are proximal"},{"speaker":"Charles Goldfarb","startTime":2298.19,"endTime":2301.85,"body":"in the in the phalanx and so"},{"speaker":"Charles Goldfarb","startTime":2298.19,"endTime":2301.85,"body":"it's distant from the growth"},{"speaker":"Charles Goldfarb","startTime":2301.85,"endTime":2305.69,"body":"plate so remodelling potential"},{"speaker":"Charles Goldfarb","startTime":2301.85,"endTime":2305.69,"body":"is less although in a really"},{"speaker":"Charles Goldfarb","startTime":2305.69,"endTime":2310.43,"body":"young child it might remodel"},{"speaker":"Charles Goldfarb","startTime":2305.69,"endTime":2310.43,"body":"from a sagittal and coronal"},{"speaker":"Charles Goldfarb","startTime":2310.43,"endTime":2315.32,"body":"perspective but there is zero"},{"speaker":"Charles Goldfarb","startTime":2310.43,"endTime":2315.32,"body":"expectation from any rotational"},{"speaker":"Charles Goldfarb","startTime":2315.35,"endTime":2320.9,"body":"malalignment and so we don't"},{"speaker":"Charles Goldfarb","startTime":2315.35,"endTime":2320.9,"body":"assume remodeling in these kids"},{"speaker":"Charles Goldfarb","startTime":2321.32,"endTime":2324.56,"body":"we might hope for it if we see a"},{"speaker":"Charles Goldfarb","startTime":2321.32,"endTime":2324.56,"body":"kid late that has a lot of"},{"speaker":"Charles Goldfarb","startTime":2324.56,"endTime":2328.19,"body":"healing but we don't assume"},{"speaker":"Charles Goldfarb","startTime":2324.56,"endTime":2328.19,"body":"remodeling we tend to intervene"},{"speaker":"Charles Goldfarb","startTime":2328.34,"endTime":2330.92,"body":"to try to decrease the chance of"},{"speaker":"Charles Goldfarb","startTime":2328.34,"endTime":2330.92,"body":"future problems."},{"speaker":"Chris Dy","startTime":2331.73,"endTime":2336.11,"body":"So why don't we close"},{"speaker":"Chris Dy","startTime":2331.73,"endTime":2336.11,"body":"this episode with with condylar"},{"speaker":"Chris Dy","startTime":2336.11,"endTime":2339.98,"body":"fractures of the proximal"},{"speaker":"Chris Dy","startTime":2336.11,"endTime":2339.98,"body":"phalanx for example and how you"},{"speaker":"Chris Dy","startTime":2339.98,"endTime":2343.55,"body":"approach those because these are"},{"speaker":"Chris Dy","startTime":2339.98,"endTime":2343.55,"body":"ones that involve the joints you"},{"speaker":"Chris Dy","startTime":2343.55,"endTime":2347.54,"body":"know what's your what's your"},{"speaker":"Chris Dy","startTime":2343.55,"endTime":2347.54,"body":"what are the considerations you"},{"speaker":"Chris Dy","startTime":2347.54,"endTime":2350.6,"body":"have in your algorithm for for"},{"speaker":"Chris Dy","startTime":2347.54,"endTime":2350.6,"body":"decision making?"},{"speaker":"Charles Goldfarb","startTime":2351.35,"endTime":2354.05,"body":"So the"},{"speaker":"Charles Goldfarb","startTime":2351.35,"endTime":2354.05,"body":"condylar fracture and a kid is"},{"speaker":"Charles Goldfarb","startTime":2354.05,"endTime":2358.13,"body":"typically an older kid because"},{"speaker":"Charles Goldfarb","startTime":2354.05,"endTime":2358.13,"body":"it's just not the typical growth"},{"speaker":"Charles Goldfarb","startTime":2358.13,"endTime":2361.55,"body":"plate centered or subcondylar"},{"speaker":"Charles Goldfarb","startTime":2358.13,"endTime":2361.55,"body":"fracture pattern so i think"},{"speaker":"Charles Goldfarb","startTime":2361.55,"endTime":2365.33,"body":"about them honestly like i think"},{"speaker":"Charles Goldfarb","startTime":2361.55,"endTime":2365.33,"body":"about condylar fractures in"},{"speaker":"Charles Goldfarb","startTime":2365.33,"endTime":2369.68,"body":"adults i think the need to"},{"speaker":"Charles Goldfarb","startTime":2365.33,"endTime":2369.68,"body":"assure anatomical reduction in"},{"speaker":"Charles Goldfarb","startTime":2369.68,"endTime":2373.13,"body":"my mind is a little higher"},{"speaker":"Charles Goldfarb","startTime":2369.68,"endTime":2373.13,"body":"because it's a kid and what i"},{"speaker":"Charles Goldfarb","startTime":2373.13,"endTime":2378.65,"body":"see in practice is malunions of"},{"speaker":"Charles Goldfarb","startTime":2373.13,"endTime":2378.65,"body":"these fractures when they are"},{"speaker":"Charles Goldfarb","startTime":2378.65,"endTime":2382.19,"body":"again underestimated. Oh it's a"},{"speaker":"Charles Goldfarb","startTime":2378.65,"endTime":2382.19,"body":"kid it'll be fine well that's"},{"speaker":"Charles Goldfarb","startTime":2382.19,"endTime":2386.03,"body":"totally false so a condylar"},{"speaker":"Charles Goldfarb","startTime":2382.19,"endTime":2386.03,"body":"fracture is not going to remodel"},{"speaker":"Charles Goldfarb","startTime":2386.03,"endTime":2389.63,"body":"if you have a joint step or gap"},{"speaker":"Charles Goldfarb","startTime":2386.03,"endTime":2389.63,"body":"deformity is not going to fix"},{"speaker":"Charles Goldfarb","startTime":2389.63,"endTime":2394.76,"body":"itself and so i end up treating"},{"speaker":"Charles Goldfarb","startTime":2389.63,"endTime":2394.76,"body":"those malunions not infrequently"},{"speaker":"Charles Goldfarb","startTime":2394.88,"endTime":2398.54,"body":"because they are underestimated"},{"speaker":"Charles Goldfarb","startTime":2394.88,"endTime":2398.54,"body":"and so these have to be treated"},{"speaker":"Charles Goldfarb","startTime":2398.72,"endTime":2403.52,"body":"like one would treat an adult"},{"speaker":"Charles Goldfarb","startTime":2398.72,"endTime":2403.52,"body":"with an articular malalignment."},{"speaker":"Charles Goldfarb","startTime":2403.52,"endTime":2407.93,"body":"And they have to be anatomically"},{"speaker":"Charles Goldfarb","startTime":2403.52,"endTime":2407.93,"body":"reduced. I think this is one of"},{"speaker":"Charles Goldfarb","startTime":2407.93,"endTime":2410.81,"body":"those situations that we've"},{"speaker":"Charles Goldfarb","startTime":2407.93,"endTime":2410.81,"body":"talked about where that your"},{"speaker":"Charles Goldfarb","startTime":2410.81,"endTime":2414.05,"body":"comfort level you the surgeon's"},{"speaker":"Charles Goldfarb","startTime":2410.81,"endTime":2414.05,"body":"comfort level has to come into"},{"speaker":"Charles Goldfarb","startTime":2414.05,"endTime":2418.64,"body":"play, I often make a small"},{"speaker":"Charles Goldfarb","startTime":2414.05,"endTime":2418.64,"body":"incision to examine the joint to"},{"speaker":"Charles Goldfarb","startTime":2418.64,"endTime":2422.09,"body":"assure that joint surface is"},{"speaker":"Charles Goldfarb","startTime":2418.64,"endTime":2422.09,"body":"anatomically aligned, others"},{"speaker":"Charles Goldfarb","startTime":2422.09,"endTime":2424.94,"body":"feel more comfortable with their"},{"speaker":"Charles Goldfarb","startTime":2422.09,"endTime":2424.94,"body":"ability to obtain and maintain a"},{"speaker":"Charles Goldfarb","startTime":2424.94,"endTime":2428.96,"body":"closed reduction. And we I"},{"speaker":"Charles Goldfarb","startTime":2424.94,"endTime":2428.96,"body":"typically use pens, rather than"},{"speaker":"Charles Goldfarb","startTime":2428.96,"endTime":2431.18,"body":"screws, although again, depends"},{"speaker":"Charles Goldfarb","startTime":2428.96,"endTime":2431.18,"body":"a little bit on the age of the"},{"speaker":"Charles Goldfarb","startTime":2431.18,"endTime":2435.65,"body":"child would consider screws like"},{"speaker":"Charles Goldfarb","startTime":2431.18,"endTime":2435.65,"body":"I would consider an adult. How"},{"speaker":"Charles Goldfarb","startTime":2435.65,"endTime":2438.14,"body":"do you think about unicondylar"},{"speaker":"Charles Goldfarb","startTime":2435.65,"endTime":2438.14,"body":"fractures, whether they be adult"},{"speaker":"Charles Goldfarb","startTime":2438.17,"endTime":2439.31,"body":"or pediatric?"},{"speaker":"Chris Dy","startTime":2440.21,"endTime":2442.76,"body":"I follow the same"},{"speaker":"Chris Dy","startTime":2440.21,"endTime":2442.76,"body":"principles, you know, I have a"},{"speaker":"Chris Dy","startTime":2442.76,"endTime":2445.88,"body":"lower threshold. And because I"},{"speaker":"Chris Dy","startTime":2442.76,"endTime":2445.88,"body":"treat more adults, I think in"},{"speaker":"Chris Dy","startTime":2445.88,"endTime":2450.11,"body":"these cases, I have a lower"},{"speaker":"Chris Dy","startTime":2445.88,"endTime":2450.11,"body":"threshold to use screws because"},{"speaker":"Chris Dy","startTime":2450.11,"endTime":2455.12,"body":"I want that that finger moving"},{"speaker":"Chris Dy","startTime":2450.11,"endTime":2455.12,"body":"in an adult. And you know, like"},{"speaker":"Chris Dy","startTime":2455.12,"endTime":2457.73,"body":"you said, it depends on your"},{"speaker":"Chris Dy","startTime":2455.12,"endTime":2457.73,"body":"comfort level as a surgeon, if"},{"speaker":"Chris Dy","startTime":2457.73,"endTime":2462.08,"body":"you feel like you can get stable"},{"speaker":"Chris Dy","startTime":2457.73,"endTime":2462.08,"body":"fixation through pinning with"},{"speaker":"Chris Dy","startTime":2462.11,"endTime":2466.31,"body":"obviously the benefit of not"},{"speaker":"Chris Dy","startTime":2462.11,"endTime":2466.31,"body":"having to, you know, add more"},{"speaker":"Chris Dy","startTime":2466.31,"endTime":2471.41,"body":"trauma. But oftentimes, I feel"},{"speaker":"Chris Dy","startTime":2466.31,"endTime":2471.41,"body":"like I can perform the reduction"},{"speaker":"Chris Dy","startTime":2471.44,"endTime":2474.29,"body":"and plate some screws to hold"},{"speaker":"Chris Dy","startTime":2471.44,"endTime":2474.29,"body":"everything together with"},{"speaker":"Chris Dy","startTime":2474.29,"endTime":2476.6,"body":"confidence so that we can get"},{"speaker":"Chris Dy","startTime":2474.29,"endTime":2476.6,"body":"the patient moving in therapy,"},{"speaker":"Chris Dy","startTime":2476.6,"endTime":2479.6,"body":"but a completely different"},{"speaker":"Chris Dy","startTime":2476.6,"endTime":2479.6,"body":"ballgame in terms of motion and"},{"speaker":"Chris Dy","startTime":2479.6,"endTime":2481.37,"body":"therapy and adults versus kids"},{"speaker":"Chris Dy","startTime":2479.6,"endTime":2481.37,"body":"though."},{"speaker":"Charles Goldfarb","startTime":2481.87,"endTime":2483.82,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":2481.87,"endTime":2483.82,"body":"a couple of comments. I think"},{"speaker":"Charles Goldfarb","startTime":2483.82,"endTime":2487.0,"body":"that's perfectly summarized."},{"speaker":"Charles Goldfarb","startTime":2483.82,"endTime":2487.0,"body":"Number one, where's two"},{"speaker":"Charles Goldfarb","startTime":2487.0,"endTime":2490.03,"body":"advantages in kids, the first"},{"speaker":"Charles Goldfarb","startTime":2487.0,"endTime":2490.03,"body":"advantage is they heal faster,"},{"speaker":"Charles Goldfarb","startTime":2490.09,"endTime":2492.7,"body":"no one would dispute that we"},{"speaker":"Charles Goldfarb","startTime":2490.09,"endTime":2492.7,"body":"believe that's periosteum"},{"speaker":"Charles Goldfarb","startTime":2492.7,"endTime":2496.0,"body":"related, but they will heal"},{"speaker":"Charles Goldfarb","startTime":2492.7,"endTime":2496.0,"body":"faster. And number two, they"},{"speaker":"Charles Goldfarb","startTime":2496.0,"endTime":2499.15,"body":"just don't tend to get as stiff"},{"speaker":"Charles Goldfarb","startTime":2496.0,"endTime":2499.15,"body":"as adults do. And so when a"},{"speaker":"Charles Goldfarb","startTime":2499.15,"endTime":2502.45,"body":"young kid, I may pin for three"},{"speaker":"Charles Goldfarb","startTime":2499.15,"endTime":2502.45,"body":"weeks. In an older kid and maybe"},{"speaker":"Charles Goldfarb","startTime":2502.45,"endTime":2505.51,"body":"four or five weeks. But in an"},{"speaker":"Charles Goldfarb","startTime":2502.45,"endTime":2505.51,"body":"adult, you may end up pending"},{"speaker":"Charles Goldfarb","startTime":2505.51,"endTime":2508.69,"body":"for six weeks. And then all of a"},{"speaker":"Charles Goldfarb","startTime":2505.51,"endTime":2508.69,"body":"sudden, they hate the pins, you"},{"speaker":"Charles Goldfarb","startTime":2508.69,"endTime":2512.2,"body":"hate the pins and they're going"},{"speaker":"Charles Goldfarb","startTime":2508.69,"endTime":2512.2,"body":"to be stiff. And that that's"},{"speaker":"Charles Goldfarb","startTime":2512.2,"endTime":2516.91,"body":"tough. I will say with an adult,"},{"speaker":"Charles Goldfarb","startTime":2512.2,"endTime":2516.91,"body":"the same caution goes for a"},{"speaker":"Charles Goldfarb","startTime":2516.91,"endTime":2520.57,"body":"small unicondylar fracture,"},{"speaker":"Charles Goldfarb","startTime":2516.91,"endTime":2520.57,"body":"about protecting the collateral"},{"speaker":"Charles Goldfarb","startTime":2520.57,"endTime":2524.14,"body":"ligament. Because exposure wise"},{"speaker":"Charles Goldfarb","startTime":2520.57,"endTime":2524.14,"body":"it can just seem so easy and so"},{"speaker":"Charles Goldfarb","startTime":2524.14,"endTime":2526.9,"body":"straightforward on that, you"},{"speaker":"Charles Goldfarb","startTime":2524.14,"endTime":2526.9,"body":"know collateral ligament, but"},{"speaker":"Charles Goldfarb","startTime":2526.93,"endTime":2529.42,"body":"don't take it down maintain that"},{"speaker":"Charles Goldfarb","startTime":2526.93,"endTime":2529.42,"body":"collateral ligament."},{"speaker":"Chris Dy","startTime":2529.6,"endTime":2532.27,"body":"Yeah, can't strip the"},{"speaker":"Chris Dy","startTime":2529.6,"endTime":2532.27,"body":"fragment you'll want, you don't"},{"speaker":"Chris Dy","startTime":2532.27,"endTime":2534.82,"body":"want to watch it disappear"},{"speaker":"Chris Dy","startTime":2532.27,"endTime":2534.82,"body":"either in real time or in six"},{"speaker":"Chris Dy","startTime":2534.82,"endTime":2536.35,"body":"weeks. That's not a fun thing."},{"speaker":"Charles Goldfarb","startTime":2536.59,"endTime":2539.26,"body":"No, alright,"},{"speaker":"Charles Goldfarb","startTime":2536.59,"endTime":2539.26,"body":"let's finish up with just"},{"speaker":"Charles Goldfarb","startTime":2539.26,"endTime":2541.69,"body":"hitting the highlights of the"},{"speaker":"Charles Goldfarb","startTime":2539.26,"endTime":2541.69,"body":"Seymour fracture again, because"},{"speaker":"Charles Goldfarb","startTime":2541.69,"endTime":2544.24,"body":"this of all these fractures,"},{"speaker":"Charles Goldfarb","startTime":2541.69,"endTime":2544.24,"body":"this is the one that in some"},{"speaker":"Charles Goldfarb","startTime":2544.24,"endTime":2545.32,"body":"ways has the most risk."},{"speaker":"Chris Dy","startTime":2545.8,"endTime":2548.98,"body":"So you describe what a"},{"speaker":"Chris Dy","startTime":2545.8,"endTime":2548.98,"body":"Seymour fracture is. But for"},{"speaker":"Chris Dy","startTime":2548.98,"endTime":2552.1,"body":"those who who aren't as familiar"},{"speaker":"Chris Dy","startTime":2548.98,"endTime":2552.1,"body":"with these, we know that these"},{"speaker":"Chris Dy","startTime":2552.1,"endTime":2556.15,"body":"are technically open fractures"},{"speaker":"Chris Dy","startTime":2552.1,"endTime":2556.15,"body":"because the there has been"},{"speaker":"Chris Dy","startTime":2556.15,"endTime":2559.66,"body":"compromise to the cuticle seal."},{"speaker":"Chris Dy","startTime":2556.15,"endTime":2559.66,"body":"So the you know, while there may"},{"speaker":"Chris Dy","startTime":2559.66,"endTime":2562.48,"body":"not be you know, exposed bone"},{"speaker":"Chris Dy","startTime":2559.66,"endTime":2562.48,"body":"when they come in, they did"},{"speaker":"Chris Dy","startTime":2562.51,"endTime":2566.11,"body":"probably have a nail bed"},{"speaker":"Chris Dy","startTime":2562.51,"endTime":2566.11,"body":"laceration. And, you know, it's"},{"speaker":"Chris Dy","startTime":2566.11,"endTime":2568.99,"body":"just, I guess, more pattern"},{"speaker":"Chris Dy","startTime":2566.11,"endTime":2568.99,"body":"recognition, looking at the X"},{"speaker":"Chris Dy","startTime":2568.99,"endTime":2571.12,"body":"ray saying that just looks like"},{"speaker":"Chris Dy","startTime":2568.99,"endTime":2571.12,"body":"you know, might have been a"},{"speaker":"Chris Dy","startTime":2571.12,"endTime":2574.69,"body":"Seymour fracture. And then"},{"speaker":"Chris Dy","startTime":2571.12,"endTime":2574.69,"body":"historically the concerns are,"},{"speaker":"Chris Dy","startTime":2574.69,"endTime":2578.65,"body":"you know, things like infection"},{"speaker":"Chris Dy","startTime":2574.69,"endTime":2578.65,"body":"and growth plate issues. So in"},{"speaker":"Chris Dy","startTime":2578.65,"endTime":2580.6,"body":"2021, what's your algorithm?"},{"speaker":"Charles Goldfarb","startTime":2581.38,"endTime":2584.2,"body":"So the classic"},{"speaker":"Charles Goldfarb","startTime":2581.38,"endTime":2584.2,"body":"clinical presentation and this"},{"speaker":"Charles Goldfarb","startTime":2584.2,"endTime":2589.84,"body":"is classic, but doesn't always"},{"speaker":"Charles Goldfarb","startTime":2584.2,"endTime":2589.84,"body":"happen is the nail plate is"},{"speaker":"Charles Goldfarb","startTime":2589.84,"endTime":2595.24,"body":"avulsed, and lays on top of the"},{"speaker":"Charles Goldfarb","startTime":2589.84,"endTime":2595.24,"body":"dorsal nail fold. And so when"},{"speaker":"Charles Goldfarb","startTime":2595.24,"endTime":2598.81,"body":"you see that together with a"},{"speaker":"Charles Goldfarb","startTime":2595.24,"endTime":2598.81,"body":"fracture that goes through the"},{"speaker":"Charles Goldfarb","startTime":2598.87,"endTime":2601.42,"body":"physis of the distal phalanx,"},{"speaker":"Charles Goldfarb","startTime":2598.87,"endTime":2601.42,"body":"that's a Seymour fracture."},{"speaker":"Charles Goldfarb","startTime":2602.29,"endTime":2605.95,"body":"Sometimes the nail is still"},{"speaker":"Charles Goldfarb","startTime":2602.29,"endTime":2605.95,"body":"sitting underneath that dorsal"},{"speaker":"Charles Goldfarb","startTime":2605.95,"endTime":2608.89,"body":"nail fold and then it becomes"},{"speaker":"Charles Goldfarb","startTime":2605.95,"endTime":2608.89,"body":"trickier. But I would say the"},{"speaker":"Charles Goldfarb","startTime":2608.89,"endTime":2611.71,"body":"vast majority of the time if you"},{"speaker":"Charles Goldfarb","startTime":2608.89,"endTime":2611.71,"body":"see a Salter Harris fracture,"},{"speaker":"Charles Goldfarb","startTime":2611.71,"endTime":2616.06,"body":"which is typically Salter Harris"},{"speaker":"Charles Goldfarb","startTime":2611.71,"endTime":2616.06,"body":"two. If that distal phalanx"},{"speaker":"Charles Goldfarb","startTime":2616.06,"endTime":2619.66,"body":"looks flexed like a mallet"},{"speaker":"Charles Goldfarb","startTime":2616.06,"endTime":2619.66,"body":"fracture, you have to assume"},{"speaker":"Charles Goldfarb","startTime":2619.66,"endTime":2622.69,"body":"it's a Seymour fracture. And"},{"speaker":"Charles Goldfarb","startTime":2619.66,"endTime":2622.69,"body":"there has been some good good"},{"speaker":"Charles Goldfarb","startTime":2622.69,"endTime":2626.56,"body":"work looking at the risk of"},{"speaker":"Charles Goldfarb","startTime":2622.69,"endTime":2626.56,"body":"infection and what you do. You"},{"speaker":"Charles Goldfarb","startTime":2626.56,"endTime":2631.15,"body":"know, Julie Samora from"},{"speaker":"Charles Goldfarb","startTime":2626.56,"endTime":2631.15,"body":"nationwide has published on this"},{"speaker":"Charles Goldfarb","startTime":2631.36,"endTime":2635.05,"body":"and it's helpful it's helpful to"},{"speaker":"Charles Goldfarb","startTime":2631.36,"endTime":2635.05,"body":"understand the role of washing"},{"speaker":"Charles Goldfarb","startTime":2635.05,"endTime":2639.1,"body":"out in the ER, the role of oral"},{"speaker":"Charles Goldfarb","startTime":2635.05,"endTime":2639.1,"body":"antibiotics. To me for most"},{"speaker":"Charles Goldfarb","startTime":2639.1,"endTime":2644.56,"body":"kids, this still is treated not"},{"speaker":"Charles Goldfarb","startTime":2639.1,"endTime":2644.56,"body":"universally in the OR, but"},{"speaker":"Charles Goldfarb","startTime":2644.77,"endTime":2647.26,"body":"certainly every kid gets"},{"speaker":"Charles Goldfarb","startTime":2644.77,"endTime":2647.26,"body":"antibiotics. Every kid gets a"},{"speaker":"Charles Goldfarb","startTime":2647.26,"endTime":2650.56,"body":"wash out and most kids do"},{"speaker":"Charles Goldfarb","startTime":2647.26,"endTime":2650.56,"body":"deserve a trip to the OR for,"},{"speaker":"Charles Goldfarb","startTime":2650.62,"endTime":2651.55,"body":"often for pinning."},{"speaker":"Chris Dy","startTime":2651.7,"endTime":2653.95,"body":"Do you think that"},{"speaker":"Chris Dy","startTime":2651.7,"endTime":2653.95,"body":"these kids need to go on"},{"speaker":"Chris Dy","startTime":2653.95,"endTime":2656.59,"body":"prolonged antibiotics or say"},{"speaker":"Chris Dy","startTime":2653.95,"endTime":2656.59,"body":"they're in the OR they get a"},{"speaker":"Chris Dy","startTime":2656.59,"endTime":2659.89,"body":"single dose of IV? Is that good?"},{"speaker":"Chris Dy","startTime":2656.59,"endTime":2659.89,"body":"Or in the ED they get single"},{"speaker":"Chris Dy","startTime":2659.89,"endTime":2661.06,"body":"dose of IV? Is that enough?"},{"speaker":"Charles Goldfarb","startTime":2661.63,"endTime":2663.64,"body":"Yeah so my"},{"speaker":"Charles Goldfarb","startTime":2661.63,"endTime":2663.64,"body":"protocol is if they're seen in"},{"speaker":"Charles Goldfarb","startTime":2663.64,"endTime":2667.39,"body":"the ED, they're washed out the"},{"speaker":"Charles Goldfarb","startTime":2663.64,"endTime":2667.39,"body":"finger is stable and able to be"},{"speaker":"Charles Goldfarb","startTime":2667.39,"endTime":2670.87,"body":"reduced. I put them on seven"},{"speaker":"Charles Goldfarb","startTime":2667.39,"endTime":2670.87,"body":"days of antibiotic. If they go"},{"speaker":"Charles Goldfarb","startTime":2670.87,"endTime":2676.24,"body":"to the OR for formal wash out"},{"speaker":"Charles Goldfarb","startTime":2670.87,"endTime":2676.24,"body":"for a K wire. A single shot of"},{"speaker":"Charles Goldfarb","startTime":2676.24,"endTime":2679.87,"body":"antibiotics in the OR is"},{"speaker":"Charles Goldfarb","startTime":2676.24,"endTime":2679.87,"body":"sufficient with that degree of"},{"speaker":"Charles Goldfarb","startTime":2679.87,"endTime":2682.39,"body":"washout and cleaning out the the"},{"speaker":"Charles Goldfarb","startTime":2679.87,"endTime":2682.39,"body":"open fracture."},{"speaker":"Chris Dy","startTime":2682.96,"endTime":2686.44,"body":"Do you have you"},{"speaker":"Chris Dy","startTime":2682.96,"endTime":2686.44,"body":"considered having anybody do"},{"speaker":"Chris Dy","startTime":2686.44,"endTime":2687.49,"body":"pins in the ED?"},{"speaker":"Charles Goldfarb","startTime":2688.72,"endTime":2691.36,"body":"We are not set"},{"speaker":"Charles Goldfarb","startTime":2688.72,"endTime":2691.36,"body":"up to do that. I absolutely have"},{"speaker":"Charles Goldfarb","startTime":2691.36,"endTime":2694.69,"body":"no problem with that in the"},{"speaker":"Charles Goldfarb","startTime":2691.36,"endTime":2694.69,"body":"right emergency department set"},{"speaker":"Charles Goldfarb","startTime":2694.69,"endTime":2698.11,"body":"up so it during my fellowship in"},{"speaker":"Charles Goldfarb","startTime":2694.69,"endTime":2698.11,"body":"Cincinnati, at least for adults,"},{"speaker":"Charles Goldfarb","startTime":2698.11,"endTime":2702.61,"body":"that was certainly possible and"},{"speaker":"Charles Goldfarb","startTime":2698.11,"endTime":2702.61,"body":"kids potentially but yes i think"},{"speaker":"Charles Goldfarb","startTime":2702.61,"endTime":2705.34,"body":"that's highly appropriate to"},{"speaker":"Charles Goldfarb","startTime":2702.61,"endTime":2705.34,"body":"take care of in the ed with the"},{"speaker":"Charles Goldfarb","startTime":2705.34,"endTime":2706.78,"body":"right setup with the right kid."},{"speaker":"Chris Dy","startTime":2707.38,"endTime":2709.12,"body":"And I think probably"},{"speaker":"Chris Dy","startTime":2707.38,"endTime":2709.12,"body":"the only point i would make"},{"speaker":"Chris Dy","startTime":2709.12,"endTime":2712.81,"body":"since i don't i'm not an expert"},{"speaker":"Chris Dy","startTime":2709.12,"endTime":2712.81,"body":"in this area by any means but"},{"speaker":"Chris Dy","startTime":2712.81,"endTime":2716.77,"body":"you know not all washouts are"},{"speaker":"Chris Dy","startTime":2712.81,"endTime":2716.77,"body":"created equal you know i think"},{"speaker":"Chris Dy","startTime":2716.77,"endTime":2719.65,"body":"that the sprinkling of holy"},{"speaker":"Chris Dy","startTime":2716.77,"endTime":2719.65,"body":"water in the ED is probably not"},{"speaker":"Chris Dy","startTime":2719.65,"endTime":2722.44,"body":"sufficient to call it a wash"},{"speaker":"Chris Dy","startTime":2719.65,"endTime":2722.44,"body":"out. You really want to make"},{"speaker":"Chris Dy","startTime":2722.44,"endTime":2724.81,"body":"sure that you got everything"},{"speaker":"Chris Dy","startTime":2722.44,"endTime":2724.81,"body":"nice and clean."},{"speaker":"Charles Goldfarb","startTime":2725.74,"endTime":2728.62,"body":"Yeah and I"},{"speaker":"Charles Goldfarb","startTime":2725.74,"endTime":2728.62,"body":"remove the nail plate in all of"},{"speaker":"Charles Goldfarb","startTime":2728.62,"endTime":2732.82,"body":"these kids I do a horizontal"},{"speaker":"Charles Goldfarb","startTime":2728.62,"endTime":2732.82,"body":"mattress repair of the very"},{"speaker":"Charles Goldfarb","startTime":2732.82,"endTime":2736.84,"body":"proximal aspect of the germinal"},{"speaker":"Charles Goldfarb","startTime":2732.82,"endTime":2736.84,"body":"matrix which is not your typical"},{"speaker":"Charles Goldfarb","startTime":2736.84,"endTime":2739.72,"body":"nail bed repair it's also not a"},{"speaker":"Charles Goldfarb","startTime":2736.84,"endTime":2739.72,"body":"nail bed repair to consider with"},{"speaker":"Charles Goldfarb","startTime":2739.75,"endTime":2743.59,"body":"glue and then i put adaptec"},{"speaker":"Charles Goldfarb","startTime":2739.75,"endTime":2743.59,"body":"under the dorsal nailfold, you"},{"speaker":"Charles Goldfarb","startTime":2743.59,"endTime":2746.35,"body":"could replace the nail plate"},{"speaker":"Charles Goldfarb","startTime":2743.59,"endTime":2746.35,"body":"under the dorsal nail fold and"},{"speaker":"Charles Goldfarb","startTime":2746.35,"endTime":2749.53,"body":"again the nail plate is helpful"},{"speaker":"Charles Goldfarb","startTime":2746.35,"endTime":2749.53,"body":"because it provides some"},{"speaker":"Charles Goldfarb","startTime":2749.53,"endTime":2753.01,"body":"stability but if you're adding a"},{"speaker":"Charles Goldfarb","startTime":2749.53,"endTime":2753.01,"body":"k wire in the operating room i"},{"speaker":"Charles Goldfarb","startTime":2753.01,"endTime":2756.37,"body":"don't think you need the nail"},{"speaker":"Charles Goldfarb","startTime":2753.01,"endTime":2756.37,"body":"plate and so i think that's"},{"speaker":"Charles Goldfarb","startTime":2756.37,"endTime":2759.46,"body":"generally accepted protocol but"},{"speaker":"Charles Goldfarb","startTime":2756.37,"endTime":2759.46,"body":"again not every kid has to be"},{"speaker":"Charles Goldfarb","startTime":2759.46,"endTime":2762.34,"body":"treated exactly the same way and"},{"speaker":"Charles Goldfarb","startTime":2759.46,"endTime":2762.34,"body":"i would also make the point you"},{"speaker":"Charles Goldfarb","startTime":2762.34,"endTime":2765.79,"body":"go to the OR you do all the"},{"speaker":"Charles Goldfarb","startTime":2762.34,"endTime":2765.79,"body":"above it doesn't remove the"},{"speaker":"Charles Goldfarb","startTime":2765.79,"endTime":2768.73,"body":"possibility of an infection and"},{"speaker":"Charles Goldfarb","startTime":2765.79,"endTime":2768.73,"body":"by infection we typically mean"},{"speaker":"Charles Goldfarb","startTime":2768.73,"endTime":2774.16,"body":"osteomyelitis it just decreases"},{"speaker":"Charles Goldfarb","startTime":2768.73,"endTime":2774.16,"body":"that chance which again is is a"},{"speaker":"Charles Goldfarb","startTime":2774.16,"endTime":2775.3,"body":"complication we don't want to"},{"speaker":"Charles Goldfarb","startTime":2774.16,"endTime":2775.3,"body":"see."},{"speaker":"Chris Dy","startTime":2776.32,"endTime":2778.24,"body":"Well let's come back"},{"speaker":"Chris Dy","startTime":2776.32,"endTime":2778.24,"body":"next week and well why don't we"},{"speaker":"Chris Dy","startTime":2778.24,"endTime":2782.59,"body":"talk about adult phalanx"},{"speaker":"Chris Dy","startTime":2778.24,"endTime":2782.59,"body":"fractures or we can continue on"},{"speaker":"Chris Dy","startTime":2782.59,"endTime":2785.86,"body":"any other pedes finger fracture"},{"speaker":"Chris Dy","startTime":2782.59,"endTime":2785.86,"body":"topic that that you'd like to"},{"speaker":"Chris Dy","startTime":2785.86,"endTime":2786.85,"body":"educate everybody about."},{"speaker":"Charles Goldfarb","startTime":2786.88,"endTime":2790.27,"body":"I hope this"},{"speaker":"Charles Goldfarb","startTime":2786.88,"endTime":2790.27,"body":"translates again maybe the video"},{"speaker":"Charles Goldfarb","startTime":2790.27,"endTime":2792.76,"body":"on youtube would be more helpful"},{"speaker":"Charles Goldfarb","startTime":2790.27,"endTime":2792.76,"body":"i hope it does translate for the"},{"speaker":"Charles Goldfarb","startTime":2792.76,"endTime":2797.35,"body":"listeners and also i think the"},{"speaker":"Charles Goldfarb","startTime":2792.76,"endTime":2797.35,"body":"therapy aspect of this these"},{"speaker":"Charles Goldfarb","startTime":2797.35,"endTime":2801.55,"body":"injuries will be helpful as well"},{"speaker":"Charles Goldfarb","startTime":2797.35,"endTime":2801.55,"body":"so maybe we can convince Macy to"},{"speaker":"Charles Goldfarb","startTime":2801.55,"endTime":2805.09,"body":"come on i know she's still out"},{"speaker":"Charles Goldfarb","startTime":2801.55,"endTime":2805.09,"body":"on maternity leave but maybe we"},{"speaker":"Charles Goldfarb","startTime":2805.09,"endTime":2808.24,"body":"can get her to join us either"},{"speaker":"Charles Goldfarb","startTime":2805.09,"endTime":2808.24,"body":"for the next podcast or the one"},{"speaker":"Charles Goldfarb","startTime":2808.24,"endTime":2808.84,"body":"subsequently."},{"speaker":"Chris Dy","startTime":2809.26,"endTime":2811.81,"body":"Well because we know"},{"speaker":"Chris Dy","startTime":2809.26,"endTime":2811.81,"body":"that podcast is not work, the"},{"speaker":"Chris Dy","startTime":2811.81,"endTime":2812.8,"body":"podcast is fun."},{"speaker":"Charles Goldfarb","startTime":2815.14,"endTime":2817.63,"body":"Amen and when"},{"speaker":"Charles Goldfarb","startTime":2815.14,"endTime":2817.63,"body":"it stops being fun you know what"},{"speaker":"Charles Goldfarb","startTime":2817.63,"endTime":2818.23,"body":"happens."},{"speaker":"Chris Dy","startTime":2818.38,"endTime":2821.68,"body":"Exactly exactly it'll"},{"speaker":"Chris Dy","startTime":2818.38,"endTime":2821.68,"body":"go into the time capsule well"},{"speaker":"Chris Dy","startTime":2821.68,"endTime":2823.81,"body":"all right go enjoy your day i'm"},{"speaker":"Chris Dy","startTime":2821.68,"endTime":2823.81,"body":"gonna go mow the lawn."},{"speaker":"Charles Goldfarb","startTime":2824.23,"endTime":2825.91,"body":"Awesome enjoy"},{"speaker":"Charles Goldfarb","startTime":2824.23,"endTime":2825.91,"body":"it, take care."},{"speaker":"Chris Dy","startTime":2825.94,"endTime":2827.29,"body":"All right, take care"},{"speaker":"Chris Dy","startTime":2825.94,"endTime":2827.29,"body":"bye."},{"speaker":"Charles Goldfarb","startTime":2828.13,"endTime":2830.32,"body":"Hey Chris that"},{"speaker":"Charles Goldfarb","startTime":2828.13,"endTime":2830.32,"body":"was fun let's do it again real"},{"speaker":"Charles Goldfarb","startTime":2830.32,"endTime":2830.65,"body":"soon."},{"speaker":"Chris Dy","startTime":2830.92,"endTime":2833.44,"body":"Sounds good well be"},{"speaker":"Chris Dy","startTime":2830.92,"endTime":2833.44,"body":"sure to check us out on twitter"},{"speaker":"Chris Dy","startTime":2833.68,"endTime":2835.87,"body":"@handpodcast. Hey Chuck what's"},{"speaker":"Chris Dy","startTime":2833.68,"endTime":2835.87,"body":"your twitter handle."},{"speaker":"Charles Goldfarb","startTime":2836.2,"endTime":2839.05,"body":"Mine is"},{"speaker":"Charles Goldfarb","startTime":2836.2,"endTime":2839.05,"body":"@congenitalhand what about you?"},{"speaker":"Chris Dy","startTime":2839.2,"endTime":2842.68,"body":"Mine is @ChrisDyMD"},{"speaker":"Chris Dy","startTime":2839.2,"endTime":2842.68,"body":"spelled d y and if you'd like to"},{"speaker":"Chris Dy","startTime":2842.68,"endTime":2845.86,"body":"email us you can reach us at"},{"speaker":"Chris Dy","startTime":2842.68,"endTime":2845.86,"body":"handpodcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":2847.0,"endTime":2849.16,"body":"And remember"},{"speaker":"Charles Goldfarb","startTime":2847.0,"endTime":2849.16,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2849.16,"endTime":2850.24,"body":"get your podcasts"},{"speaker":"Chris Dy","startTime":2850.27,"endTime":2852.49,"body":"and be sure to leave a"},{"speaker":"Chris Dy","startTime":2850.27,"endTime":2852.49,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2852.49,"endTime":2852.91,"body":"word out"},{"speaker":"Charles Goldfarb","startTime":2853.3,"endTime":2855.58,"body":"special thanks"},{"speaker":"Charles Goldfarb","startTime":2853.3,"endTime":2855.58,"body":"to Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":2855.58,"endTime":2859.57,"body":"music and remember keep the"},{"speaker":"Charles Goldfarb","startTime":2855.58,"endTime":2859.57,"body":"upper hand, come back next time."}]}