{"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":21.48,"body":"surgery from technical to"},{"speaker":"Chris Dy","startTime":19.65,"endTime":21.48,"body":"personal."},{"speaker":"Charles Goldfarb","startTime":22.05,"endTime":24.33,"body":"Thank you for"},{"speaker":"Charles Goldfarb","startTime":22.05,"endTime":24.33,"body":"subscribing. Wherever you get"},{"speaker":"Charles Goldfarb","startTime":24.33,"endTime":25.23,"body":"your podcasts."},{"speaker":"Chris Dy","startTime":25.44,"endTime":27.66,"body":"And be sure to leave a"},{"speaker":"Chris Dy","startTime":25.44,"endTime":27.66,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":27.66,"endTime":28.17,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":28.35,"endTime":29.28,"body":"Oh, hey,"},{"speaker":"Charles Goldfarb","startTime":28.35,"endTime":29.28,"body":"Chris."},{"speaker":"Chris Dy","startTime":29.37,"endTime":30.6,"body":"Hey, Chuck, how are"},{"speaker":"Chris Dy","startTime":29.37,"endTime":30.6,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":31.02,"endTime":32.82,"body":"I'm doing"},{"speaker":"Charles Goldfarb","startTime":31.02,"endTime":32.82,"body":"pretty well. We're getting a"},{"speaker":"Charles Goldfarb","startTime":32.82,"endTime":34.02,"body":"little fancier."},{"speaker":"Chris Dy","startTime":34.35,"endTime":37.26,"body":"Yes, I hear that we're"},{"speaker":"Chris Dy","startTime":34.35,"endTime":37.26,"body":"now using a program that has all"},{"speaker":"Chris Dy","startTime":37.26,"endTime":41.34,"body":"sorts of fancy audio sound"},{"speaker":"Chris Dy","startTime":37.26,"endTime":41.34,"body":"clips, I think you're probably"},{"speaker":"Chris Dy","startTime":41.34,"endTime":44.58,"body":"going to start to work some of"},{"speaker":"Chris Dy","startTime":41.34,"endTime":44.58,"body":"those into the to the podcast."},{"speaker":"Chris Dy","startTime":44.58,"endTime":45.33,"body":"Pretty exciting."},{"speaker":"Charles Goldfarb","startTime":45.63,"endTime":49.17,"body":"Oh, for sure."},{"speaker":"Charles Goldfarb","startTime":45.63,"endTime":49.17,"body":"We are we have outgrown zoom."},{"speaker":"Charles Goldfarb","startTime":49.17,"endTime":51.96,"body":"And I say that totally tongue in"},{"speaker":"Charles Goldfarb","startTime":49.17,"endTime":51.96,"body":"cheek because A, I don't know if"},{"speaker":"Charles Goldfarb","startTime":51.96,"endTime":54.51,"body":"that's really true. And B, we"},{"speaker":"Charles Goldfarb","startTime":51.96,"endTime":54.51,"body":"may be back on zoom tomorrow."},{"speaker":"Chris Dy","startTime":54.87,"endTime":57.18,"body":"Exactly. I will say,"},{"speaker":"Chris Dy","startTime":54.87,"endTime":57.18,"body":"you know, now that you're"},{"speaker":"Chris Dy","startTime":57.18,"endTime":60.57,"body":"officially a funded podcast, I"},{"speaker":"Chris Dy","startTime":57.18,"endTime":60.57,"body":"mean, you know, I think we're"},{"speaker":"Chris Dy","startTime":60.57,"endTime":63.87,"body":"probably funded in a way that"},{"speaker":"Chris Dy","startTime":60.57,"endTime":63.87,"body":"very little other podcasts are"},{"speaker":"Chris Dy","startTime":63.87,"endTime":65.04,"body":"by an actual grant."},{"speaker":"Charles Goldfarb","startTime":66.0,"endTime":68.88,"body":"This is true."},{"speaker":"Charles Goldfarb","startTime":66.0,"endTime":68.88,"body":"This is true. Our funding"},{"speaker":"Charles Goldfarb","startTime":68.88,"endTime":72.69,"body":"mechanisms are limited. But we"},{"speaker":"Charles Goldfarb","startTime":68.88,"endTime":72.69,"body":"have access some funds, which"},{"speaker":"Charles Goldfarb","startTime":72.69,"endTime":73.95,"body":"makes it feel good."},{"speaker":"Chris Dy","startTime":73.4,"endTime":77.15,"body":"Excellent. Excellent."},{"speaker":"Chris Dy","startTime":73.4,"endTime":77.15,"body":"So I wanted to get to a reader"},{"speaker":"Chris Dy","startTime":77.15,"endTime":81.11,"body":"question, which was sent in to"},{"speaker":"Chris Dy","startTime":77.15,"endTime":81.11,"body":"us and I think you'll like this"},{"speaker":"Chris Dy","startTime":81.11,"endTime":84.83,"body":"one. And the subject line is"},{"speaker":"Chris Dy","startTime":81.11,"endTime":84.83,"body":"sports wrist question for Dr"},{"speaker":"Chris Dy","startTime":84.83,"endTime":88.82,"body":"Goldfarb. All right. So this i"},{"speaker":"Chris Dy","startTime":84.83,"endTime":88.82,"body":"from Paul Hovis. Thank you fo"},{"speaker":"Chris Dy","startTime":88.82,"endTime":91.76,"body":"sending in the question, Paul"},{"speaker":"Chris Dy","startTime":88.82,"endTime":91.76,"body":"Paul is an orthopedic hand an"},{"speaker":"Chris Dy","startTime":91.76,"endTime":95.93,"body":"upper extremity surgeon in Texa"},{"speaker":"Chris Dy","startTime":91.76,"endTime":95.93,"body":"and he is a consultant for on"},{"speaker":"Chris Dy","startTime":95.93,"endTime":99.05,"body":"of the major league teams an"},{"speaker":"Chris Dy","startTime":95.93,"endTime":99.05,"body":"their farm teams, which i"},{"speaker":"Chris Dy","startTime":99.05,"endTime":103.67,"body":"fantastic. So congrats on that"},{"speaker":"Chris Dy","startTime":99.05,"endTime":103.67,"body":"His question is stated, ther"},{"speaker":"Chris Dy","startTime":103.67,"endTime":106.31,"body":"has been a rash of comebac"},{"speaker":"Chris Dy","startTime":103.67,"endTime":106.31,"body":"balls hitting our pitchers i"},{"speaker":"Chris Dy","startTime":106.31,"endTime":110.12,"body":"there throwing wrists, causi"},{"speaker":"Chris Dy","startTime":106.31,"endTime":110.12,"body":"g distal ulnar shaft fractures"},{"speaker":"Chris Dy","startTime":110.12,"endTime":114.11,"body":"r ulnar styloid fractures. In t"},{"speaker":"Chris Dy","startTime":110.12,"endTime":114.11,"body":"e non high level athlete l"},{"speaker":"Chris Dy","startTime":114.11,"endTime":117.35,"body":"y person and for all ulnar styl"},{"speaker":"Chris Dy","startTime":114.11,"endTime":117.35,"body":"id fractures I adhere to"},{"speaker":"Chris Dy","startTime":117.35,"endTime":120.11,"body":"he typical literat"},{"speaker":"Chris Dy","startTime":117.35,"endTime":120.11,"body":"re recommendations consisting"},{"speaker":"Chris Dy","startTime":120.11,"endTime":124.52,"body":"of predominantly immobilizati"},{"speaker":"Chris Dy","startTime":120.11,"endTime":124.52,"body":"n. However, I was mostly wonder"},{"speaker":"Chris Dy","startTime":124.52,"endTime":127.43,"body":"ng what your opinion is on surgi"},{"speaker":"Chris Dy","startTime":124.52,"endTime":127.43,"body":"al intervention for pitchers w"},{"speaker":"Chris Dy","startTime":127.43,"endTime":130.73,"body":"th distal ulnar shaft fractures"},{"speaker":"Chris Dy","startTime":127.43,"endTime":130.73,"body":"on her throwing arm that wish"},{"speaker":"Chris Dy","startTime":130.73,"endTime":134.84,"body":"to pursue pursue surgery whet"},{"speaker":"Chris Dy","startTime":130.73,"endTime":134.84,"body":"er displaced or not, do you f"},{"speaker":"Chris Dy","startTime":134.84,"endTime":137.42,"body":"el this gets them back to p"},{"speaker":"Chris Dy","startTime":134.84,"endTime":137.42,"body":"ay faster, or at least back t"},{"speaker":"Chris Dy","startTime":137.42,"endTime":140.87,"body":"a throwing program more quickly"},{"speaker":"Chris Dy","startTime":137.42,"endTime":140.87,"body":"I know there are complex wr"},{"speaker":"Chris Dy","startTime":140.87,"endTime":143.66,"body":"st mechanics that are overloo"},{"speaker":"Chris Dy","startTime":140.87,"endTime":143.66,"body":"ed predominantly with curveballs"},{"speaker":"Chris Dy","startTime":143.66,"endTime":146.75,"body":"or sliders. And I can't say I"},{"speaker":"Chris Dy","startTime":143.66,"endTime":146.75,"body":"ve found much literature"},{"speaker":"Chris Dy","startTime":146.75,"endTime":149.48,"body":"or direction on this speci"},{"speaker":"Chris Dy","startTime":146.75,"endTime":149.48,"body":"ic patient populati"},{"speaker":"Charles Goldfarb","startTime":152.73,"endTime":155.52,"body":"It is a great"},{"speaker":"Charles Goldfarb","startTime":152.73,"endTime":155.52,"body":"question. I can talk, it's"},{"speaker":"Charles Goldfarb","startTime":155.52,"endTime":158.7,"body":"interesting. I take care of the"},{"speaker":"Charles Goldfarb","startTime":155.52,"endTime":158.7,"body":"Cardinals here in St. Louis and"},{"speaker":"Charles Goldfarb","startTime":158.73,"endTime":161.79,"body":"some of their farm players, some"},{"speaker":"Charles Goldfarb","startTime":158.73,"endTime":161.79,"body":"of them get cared for down near"},{"speaker":"Charles Goldfarb","startTime":161.79,"endTime":166.14,"body":"Jupiter, Florida. But this is an"},{"speaker":"Charles Goldfarb","startTime":161.79,"endTime":166.14,"body":"injury I haven't seen in the"},{"speaker":"Charles Goldfarb","startTime":166.14,"endTime":169.62,"body":"last five or six years in a"},{"speaker":"Charles Goldfarb","startTime":166.14,"endTime":169.62,"body":"baseball player. So you know,"},{"speaker":"Charles Goldfarb","startTime":169.65,"endTime":173.25,"body":"maybe it's coming because those"},{"speaker":"Charles Goldfarb","startTime":169.65,"endTime":173.25,"body":"balls come off the bat very"},{"speaker":"Charles Goldfarb","startTime":173.28,"endTime":175.92,"body":"quickly, especially with the"},{"speaker":"Charles Goldfarb","startTime":173.28,"endTime":175.92,"body":"speed pitchers are throwing"},{"speaker":"Charles Goldfarb","startTime":175.92,"endTime":178.98,"body":"today. So in my mind, I'm"},{"speaker":"Charles Goldfarb","startTime":175.92,"endTime":178.98,"body":"envisioning what I would call a"},{"speaker":"Charles Goldfarb","startTime":178.98,"endTime":183.36,"body":"nightstick fracture. And, you"},{"speaker":"Charles Goldfarb","startTime":178.98,"endTime":183.36,"body":"know, classically we are taught"},{"speaker":"Charles Goldfarb","startTime":183.39,"endTime":187.14,"body":"not to treat those surgically"},{"speaker":"Charles Goldfarb","startTime":183.39,"endTime":187.14,"body":"because they do heal nicely. I"},{"speaker":"Charles Goldfarb","startTime":187.14,"endTime":191.31,"body":"will go back to the basics of"},{"speaker":"Charles Goldfarb","startTime":187.14,"endTime":191.31,"body":"the care of the athlete. And"},{"speaker":"Charles Goldfarb","startTime":191.31,"endTime":194.76,"body":"answer this in the sense that,"},{"speaker":"Charles Goldfarb","startTime":191.31,"endTime":194.76,"body":"you know, the paradigm has"},{"speaker":"Charles Goldfarb","startTime":194.76,"endTime":198.42,"body":"changed. And we've talked about"},{"speaker":"Charles Goldfarb","startTime":194.76,"endTime":198.42,"body":"this a bit. 20 years ago, the"},{"speaker":"Charles Goldfarb","startTime":198.42,"endTime":201.57,"body":"paradigm of taking care of an"},{"speaker":"Charles Goldfarb","startTime":198.42,"endTime":201.57,"body":"athlete revolved around"},{"speaker":"Charles Goldfarb","startTime":201.81,"endTime":205.74,"body":"minimally invasive care, with"},{"speaker":"Charles Goldfarb","startTime":201.81,"endTime":205.74,"body":"attempts to go non operative."},{"speaker":"Charles Goldfarb","startTime":206.01,"endTime":209.7,"body":"Today, the care is more"},{"speaker":"Charles Goldfarb","startTime":206.01,"endTime":209.7,"body":"invasive, with attempts to"},{"speaker":"Charles Goldfarb","startTime":209.7,"endTime":214.47,"body":"minimize time away from sport,"},{"speaker":"Charles Goldfarb","startTime":209.7,"endTime":214.47,"body":"and maximize function upon"},{"speaker":"Charles Goldfarb","startTime":214.47,"endTime":218.52,"body":"return. And so that means more"},{"speaker":"Charles Goldfarb","startTime":214.47,"endTime":218.52,"body":"surgery. Let's be blunt. And so"},{"speaker":"Charles Goldfarb","startTime":218.58,"endTime":222.51,"body":"I think the question is really a"},{"speaker":"Charles Goldfarb","startTime":218.58,"endTime":222.51,"body":"good one. And I think Paul has a"},{"speaker":"Charles Goldfarb","startTime":222.51,"endTime":226.2,"body":"very valid point, that if you"},{"speaker":"Charles Goldfarb","startTime":222.51,"endTime":226.2,"body":"think you can get the athlete"},{"speaker":"Charles Goldfarb","startTime":226.2,"endTime":230.34,"body":"back playing faster, with"},{"speaker":"Charles Goldfarb","startTime":226.2,"endTime":230.34,"body":"minimal morbidity, then it makes"},{"speaker":"Charles Goldfarb","startTime":230.34,"endTime":235.26,"body":"some sense. And you know, a"},{"speaker":"Charles Goldfarb","startTime":230.34,"endTime":235.26,"body":"distal 1/3 on a shaft fracture"},{"speaker":"Charles Goldfarb","startTime":235.26,"endTime":239.16,"body":"is different than a very distal"},{"speaker":"Charles Goldfarb","startTime":235.26,"endTime":239.16,"body":"ulnar shaft fracture, which I"},{"speaker":"Charles Goldfarb","startTime":239.16,"endTime":243.06,"body":"think can be really tough to fix"},{"speaker":"Charles Goldfarb","startTime":239.16,"endTime":243.06,"body":"effectively. And obviously,"},{"speaker":"Charles Goldfarb","startTime":243.06,"endTime":245.79,"body":"that's different than an ulnar"},{"speaker":"Charles Goldfarb","startTime":243.06,"endTime":245.79,"body":"shaft- ulnar styloid fracture."},{"speaker":"Charles Goldfarb","startTime":245.79,"endTime":250.11,"body":"So my answer is if it's"},{"speaker":"Charles Goldfarb","startTime":245.79,"endTime":250.11,"body":"displaced, or if it even if it's"},{"speaker":"Charles Goldfarb","startTime":250.11,"endTime":253.77,"body":"not dramatically displaced, if"},{"speaker":"Charles Goldfarb","startTime":250.11,"endTime":253.77,"body":"we think we can get the athlete"},{"speaker":"Charles Goldfarb","startTime":253.77,"endTime":256.02,"body":"back to play faster then it's"},{"speaker":"Charles Goldfarb","startTime":253.77,"endTime":256.02,"body":"something I would consider."},{"speaker":"Chris Dy","startTime":257.069,"endTime":262.259,"body":"Do you think that the"},{"speaker":"Chris Dy","startTime":257.069,"endTime":262.259,"body":"fractures that are minimally"},{"speaker":"Chris Dy","startTime":262.259,"endTime":265.019,"body":"very minimally displaced like"},{"speaker":"Chris Dy","startTime":262.259,"endTime":265.019,"body":"you almost can barely make it"},{"speaker":"Chris Dy","startTime":265.019,"endTime":268.439,"body":"out in an X ray is just kind of"},{"speaker":"Chris Dy","startTime":265.019,"endTime":268.439,"body":"like scaphoids where for a while"},{"speaker":"Chris Dy","startTime":268.439,"endTime":269.939,"body":"people were fixing everything?"},{"speaker":"Charles Goldfarb","startTime":270.65,"endTime":273.02,"body":"Yeah, this I"},{"speaker":"Charles Goldfarb","startTime":270.65,"endTime":273.02,"body":"think it would be tough for me"},{"speaker":"Charles Goldfarb","startTime":273.02,"endTime":277.13,"body":"if it was a hairline fracture,"},{"speaker":"Charles Goldfarb","startTime":273.02,"endTime":277.13,"body":"or very subtle, I don't think I"},{"speaker":"Charles Goldfarb","startTime":277.13,"endTime":280.61,"body":"would treat that surgically. I"},{"speaker":"Charles Goldfarb","startTime":277.13,"endTime":280.61,"body":"would put the put the the"},{"speaker":"Charles Goldfarb","startTime":280.76,"endTime":285.71,"body":"pitcher in the cast and follow"},{"speaker":"Charles Goldfarb","startTime":280.76,"endTime":285.71,"body":"it closely with the expectation"},{"speaker":"Charles Goldfarb","startTime":285.71,"endTime":288.56,"body":"that it would heal rapidly and"},{"speaker":"Charles Goldfarb","startTime":285.71,"endTime":288.56,"body":"well and we wouldn't miss that"},{"speaker":"Charles Goldfarb","startTime":288.56,"endTime":291.35,"body":"much time. I think once it"},{"speaker":"Charles Goldfarb","startTime":288.56,"endTime":291.35,"body":"becomes displaced that obvious"},{"speaker":"Charles Goldfarb","startTime":291.35,"endTime":294.62,"body":"The next question is how"},{"speaker":"Charles Goldfarb","startTime":291.35,"endTime":294.62,"body":"displaced is too much, but I"},{"speaker":"Charles Goldfarb","startTime":294.62,"endTime":298.82,"body":"wouldn't be opposed to more"},{"speaker":"Charles Goldfarb","startTime":294.62,"endTime":298.82,"body":"aggressive care with at least"},{"speaker":"Charles Goldfarb","startTime":298.82,"endTime":299.57,"body":"some displacement."},{"speaker":"Chris Dy","startTime":300.84,"endTime":302.49,"body":"Now when you're"},{"speaker":"Chris Dy","startTime":300.84,"endTime":302.49,"body":"talking about returning to a"},{"speaker":"Chris Dy","startTime":302.49,"endTime":305.37,"body":"throwing program, what do I"},{"speaker":"Chris Dy","startTime":302.49,"endTime":305.37,"body":"think what what I loved about"},{"speaker":"Chris Dy","startTime":305.37,"endTime":309.24,"body":"Paul's question was the thought"},{"speaker":"Chris Dy","startTime":305.37,"endTime":309.24,"body":"that there are some mechanics,"},{"speaker":"Chris Dy","startTime":309.24,"endTime":312.36,"body":"nuances to things like"},{"speaker":"Chris Dy","startTime":309.24,"endTime":312.36,"body":"curveballs and sliders. Now, I'm"},{"speaker":"Chris Dy","startTime":312.36,"endTime":314.73,"body":"not familiar enough with"},{"speaker":"Chris Dy","startTime":312.36,"endTime":314.73,"body":"throwing mechanics or taking"},{"speaker":"Chris Dy","startTime":314.73,"endTime":317.4,"body":"care of these high level"},{"speaker":"Chris Dy","startTime":314.73,"endTime":317.4,"body":"athletes know, perhaps what some"},{"speaker":"Chris Dy","startTime":317.4,"endTime":318.39,"body":"of those differences are?"},{"speaker":"Charles Goldfarb","startTime":318.66,"endTime":321.18,"body":"Well, I think"},{"speaker":"Charles Goldfarb","startTime":318.66,"endTime":321.18,"body":"it gets to the point that we"},{"speaker":"Charles Goldfarb","startTime":321.18,"endTime":325.62,"body":"could, you know, with a plate"},{"speaker":"Charles Goldfarb","startTime":321.18,"endTime":325.62,"body":"fixation, we could get the"},{"speaker":"Charles Goldfarb","startTime":325.62,"endTime":331.11,"body":"athlete back working on motion"},{"speaker":"Charles Goldfarb","startTime":325.62,"endTime":331.11,"body":"of the forearm, motion of the"},{"speaker":"Charles Goldfarb","startTime":331.11,"endTime":336.0,"body":"wrist, and potentially start"},{"speaker":"Charles Goldfarb","startTime":331.11,"endTime":336.0,"body":"strengthening really quickly. As"},{"speaker":"Charles Goldfarb","startTime":336.0,"endTime":339.39,"body":"far as the throwing mechanics,"},{"speaker":"Charles Goldfarb","startTime":336.0,"endTime":339.39,"body":"though, I don't think you get"},{"speaker":"Charles Goldfarb","startTime":339.39,"endTime":342.63,"body":"them back until they're really"},{"speaker":"Charles Goldfarb","startTime":339.39,"endTime":342.63,"body":"ready to go. Because I think you"},{"speaker":"Charles Goldfarb","startTime":342.63,"endTime":345.75,"body":"risk throwing off those"},{"speaker":"Charles Goldfarb","startTime":342.63,"endTime":345.75,"body":"mechanics, if you return them"},{"speaker":"Charles Goldfarb","startTime":345.75,"endTime":349.83,"body":"prematurely. And I do, you know,"},{"speaker":"Charles Goldfarb","startTime":345.75,"endTime":349.83,"body":"I, it's very fortunate that we,"},{"speaker":"Charles Goldfarb","startTime":350.07,"endTime":354.0,"body":"you know, every sport, baseball,"},{"speaker":"Charles Goldfarb","startTime":350.07,"endTime":354.0,"body":"as well as all the other"},{"speaker":"Charles Goldfarb","startTime":354.0,"endTime":358.53,"body":"professional sports have really"},{"speaker":"Charles Goldfarb","startTime":354.0,"endTime":358.53,"body":"high level training staff that"},{"speaker":"Charles Goldfarb","startTime":358.53,"endTime":362.91,"body":"get this at a super high level."},{"speaker":"Charles Goldfarb","startTime":358.53,"endTime":362.91,"body":"And so I think our job as"},{"speaker":"Charles Goldfarb","startTime":362.91,"endTime":366.42,"body":"physicians and surgeons, when"},{"speaker":"Charles Goldfarb","startTime":362.91,"endTime":366.42,"body":"it's called for, is to kind of"},{"speaker":"Charles Goldfarb","startTime":366.42,"endTime":370.44,"body":"give the green light. And their"},{"speaker":"Charles Goldfarb","startTime":366.42,"endTime":370.44,"body":"job is to work through the rehab"},{"speaker":"Charles Goldfarb","startTime":370.44,"endTime":374.52,"body":"and maximize full return to"},{"speaker":"Charles Goldfarb","startTime":370.44,"endTime":374.52,"body":"play. And so I don't know that"},{"speaker":"Charles Goldfarb","startTime":374.52,"endTime":377.52,"body":"the mechanics, I think the"},{"speaker":"Charles Goldfarb","startTime":374.52,"endTime":377.52,"body":"mechanics are a real concern."},{"speaker":"Charles Goldfarb","startTime":377.73,"endTime":382.05,"body":"And my philosophy would just be"},{"speaker":"Charles Goldfarb","startTime":377.73,"endTime":382.05,"body":"no throwing program, unless it's"},{"speaker":"Charles Goldfarb","startTime":382.05,"endTime":385.11,"body":"light toss kind of stuff, until"},{"speaker":"Charles Goldfarb","startTime":382.05,"endTime":385.11,"body":"they're really ready to go."},{"speaker":"Chris Dy","startTime":386.94,"endTime":389.16,"body":"Yeah, I mean, this is"},{"speaker":"Chris Dy","startTime":386.94,"endTime":389.16,"body":"like total level eight evidence"},{"speaker":"Chris Dy","startTime":389.16,"endTime":392.04,"body":"right now. But for me, I feel"},{"speaker":"Chris Dy","startTime":389.16,"endTime":392.04,"body":"like probably there is some,"},{"speaker":"Chris Dy","startTime":392.46,"endTime":395.61,"body":"some torque that is different in"},{"speaker":"Chris Dy","startTime":392.46,"endTime":395.61,"body":"slowing and throwing a curveball"},{"speaker":"Chris Dy","startTime":395.61,"endTime":398.82,"body":"or slider versus a fastball. And"},{"speaker":"Chris Dy","startTime":395.61,"endTime":398.82,"body":"I would imagine that comes"},{"speaker":"Chris Dy","startTime":398.82,"endTime":401.37,"body":"through the form and through the"},{"speaker":"Chris Dy","startTime":398.82,"endTime":401.37,"body":"carpus, in terms of, you know,"},{"speaker":"Chris Dy","startTime":401.4,"endTime":404.22,"body":"pronation, supination, probably"},{"speaker":"Chris Dy","startTime":401.4,"endTime":404.22,"body":"more supination than anything"},{"speaker":"Chris Dy","startTime":404.22,"endTime":409.11,"body":"else. So I would imagine that"},{"speaker":"Chris Dy","startTime":404.22,"endTime":409.11,"body":"the threshold to operate upon"},{"speaker":"Chris Dy","startTime":409.11,"endTime":411.93,"body":"these patients who use that"},{"speaker":"Chris Dy","startTime":409.11,"endTime":411.93,"body":"particular kind of pitch is"},{"speaker":"Chris Dy","startTime":411.93,"endTime":412.98,"body":"probably much lower."},{"speaker":"Charles Goldfarb","startTime":413.25,"endTime":415.98,"body":"Yeah, yes. And"},{"speaker":"Charles Goldfarb","startTime":413.25,"endTime":415.98,"body":"no, I mean, I think if you"},{"speaker":"Charles Goldfarb","startTime":415.98,"endTime":418.83,"body":"choose non operative care, you"},{"speaker":"Charles Goldfarb","startTime":415.98,"endTime":418.83,"body":"just have to be patient, and"},{"speaker":"Charles Goldfarb","startTime":418.83,"endTime":420.9,"body":"make sure that you have"},{"speaker":"Charles Goldfarb","startTime":418.83,"endTime":420.9,"body":"sufficient healing before you"},{"speaker":"Charles Goldfarb","startTime":420.9,"endTime":423.72,"body":"start the process. There is no"},{"speaker":"Charles Goldfarb","startTime":420.9,"endTime":423.72,"body":"doubt there's more torque,"},{"speaker":"Charles Goldfarb","startTime":423.75,"endTime":427.32,"body":"totally agree. And so it either"},{"speaker":"Charles Goldfarb","startTime":423.75,"endTime":427.32,"body":"it's going to slow you down on"},{"speaker":"Charles Goldfarb","startTime":427.32,"endTime":430.29,"body":"one end or the other, whether"},{"speaker":"Charles Goldfarb","startTime":427.32,"endTime":430.29,"body":"you're slowed down by initial"},{"speaker":"Charles Goldfarb","startTime":430.29,"endTime":432.69,"body":"mobilization, or slowed down"},{"speaker":"Charles Goldfarb","startTime":430.29,"endTime":432.69,"body":"before you can really go"},{"speaker":"Charles Goldfarb","startTime":432.69,"endTime":435.66,"body":"hardcore, you're still gonna"},{"speaker":"Charles Goldfarb","startTime":432.69,"endTime":435.66,"body":"have to be patient till you have"},{"speaker":"Charles Goldfarb","startTime":435.66,"endTime":436.32,"body":"clear healing."},{"speaker":"Chris Dy","startTime":437.68,"endTime":439.39,"body":"You're gonna love this"},{"speaker":"Chris Dy","startTime":437.68,"endTime":439.39,"body":"because I actually had this"},{"speaker":"Chris Dy","startTime":439.39,"endTime":441.16,"body":"patient within the last few"},{"speaker":"Chris Dy","startTime":439.39,"endTime":441.16,"body":"weeks."},{"speaker":"Charles Goldfarb","startTime":441.16,"endTime":441.61,"body":"Oh, wow."},{"speaker":"Chris Dy","startTime":442.96,"endTime":446.26,"body":"Not a pro athlete. Of"},{"speaker":"Chris Dy","startTime":442.96,"endTime":446.26,"body":"course, not in my practice, but"},{"speaker":"Chris Dy","startTime":446.29,"endTime":449.89,"body":"an actual collegiate bound"},{"speaker":"Chris Dy","startTime":446.29,"endTime":449.89,"body":"scholarship softball pitcher,"},{"speaker":"Chris Dy","startTime":450.61,"endTime":454.87,"body":"hit by a pitch coming back at"},{"speaker":"Chris Dy","startTime":450.61,"endTime":454.87,"body":"her right on the shaft fracture"},{"speaker":"Chris Dy","startTime":454.87,"endTime":457.78,"body":"actually tried to non op it,"},{"speaker":"Chris Dy","startTime":454.87,"endTime":457.78,"body":"because it was minimally"},{"speaker":"Chris Dy","startTime":457.78,"endTime":460.96,"body":"displaced. But then I watched it"},{"speaker":"Chris Dy","startTime":457.78,"endTime":460.96,"body":"displace, the next week, he came"},{"speaker":"Chris Dy","startTime":460.96,"endTime":464.26,"body":"back. And basically dad looked"},{"speaker":"Chris Dy","startTime":460.96,"endTime":464.26,"body":"at me and said, I was wondering"},{"speaker":"Chris Dy","startTime":464.26,"endTime":465.94,"body":"why you weren't operating on"},{"speaker":"Chris Dy","startTime":464.26,"endTime":465.94,"body":"her. Here we go."},{"speaker":"Charles Goldfarb","startTime":466.589,"endTime":470.279,"body":"Wow. So you,"},{"speaker":"Charles Goldfarb","startTime":466.589,"endTime":470.279,"body":"you put a standard plate on?"},{"speaker":"Chris Dy","startTime":471.56,"endTime":474.29,"body":"Yeah, standard plate."},{"speaker":"Chris Dy","startTime":471.56,"endTime":474.29,"body":"You know, what I have found"},{"speaker":"Chris Dy","startTime":474.29,"endTime":478.52,"body":"with, you know, I was trained by"},{"speaker":"Chris Dy","startTime":474.29,"endTime":478.52,"body":"one of the orthopedic trauma"},{"speaker":"Chris Dy","startTime":478.52,"endTime":483.59,"body":"surgeons that I worked with in"},{"speaker":"Chris Dy","startTime":478.52,"endTime":483.59,"body":"my residency, very much to dual"},{"speaker":"Chris Dy","startTime":483.59,"endTime":486.65,"body":"plating and orthogonal plating"},{"speaker":"Chris Dy","startTime":483.59,"endTime":486.65,"body":"was big. I think sometimes for"},{"speaker":"Chris Dy","startTime":486.65,"endTime":489.26,"body":"these, you might make them too"},{"speaker":"Chris Dy","startTime":486.65,"endTime":489.26,"body":"stiff, which would be my"},{"speaker":"Chris Dy","startTime":489.26,"endTime":489.86,"body":"concern."},{"speaker":"Charles Goldfarb","startTime":490.49,"endTime":493.76,"body":"Yeah, for me"},{"speaker":"Charles Goldfarb","startTime":490.49,"endTime":493.76,"body":"that ulna bone is not the one to"},{"speaker":"Charles Goldfarb","startTime":493.82,"endTime":497.15,"body":"be too aggressive like that, I"},{"speaker":"Charles Goldfarb","startTime":493.82,"endTime":497.15,"body":"completely agree with you. And"},{"speaker":"Charles Goldfarb","startTime":497.15,"endTime":500.78,"body":"this is the bone where I really"},{"speaker":"Charles Goldfarb","startTime":497.15,"endTime":500.78,"body":"am careful about minimizing,"},{"speaker":"Charles Goldfarb","startTime":500.78,"endTime":504.8,"body":"stripping. And really just"},{"speaker":"Charles Goldfarb","startTime":500.78,"endTime":504.8,"body":"expose wherever I'm going to put"},{"speaker":"Charles Goldfarb","startTime":504.8,"endTime":507.74,"body":"the plate and try to leave"},{"speaker":"Charles Goldfarb","startTime":504.8,"endTime":507.74,"body":"everything else intact,"},{"speaker":"Charles Goldfarb","startTime":507.74,"endTime":511.13,"body":"periosteum especially because,"},{"speaker":"Charles Goldfarb","startTime":507.74,"endTime":511.13,"body":"you know, even if you're a"},{"speaker":"Charles Goldfarb","startTime":511.13,"endTime":514.13,"body":"listener, and you don't do a lot"},{"speaker":"Charles Goldfarb","startTime":511.13,"endTime":514.13,"body":"of ulnar fracture surgery,"},{"speaker":"Charles Goldfarb","startTime":514.13,"endTime":517.31,"body":"that's probably all of our"},{"speaker":"Charles Goldfarb","startTime":514.13,"endTime":517.31,"body":"approaches. We all do ulnar"},{"speaker":"Charles Goldfarb","startTime":517.31,"endTime":521.42,"body":"shortening osteotomies. And that"},{"speaker":"Charles Goldfarb","startTime":517.31,"endTime":521.42,"body":"is one where I lay a lot of"},{"speaker":"Charles Goldfarb","startTime":521.42,"endTime":524.93,"body":"crepe about time to healing and"},{"speaker":"Charles Goldfarb","startTime":521.42,"endTime":524.93,"body":"my typical responses eight to 10"},{"speaker":"Charles Goldfarb","startTime":524.93,"endTime":525.47,"body":"weeks."},{"speaker":"Chris Dy","startTime":525.5,"endTime":527.27,"body":"Why do you think that"},{"speaker":"Chris Dy","startTime":525.5,"endTime":527.27,"body":"ulna bone takes so long?"},{"speaker":"Charles Goldfarb","startTime":527.33,"endTime":529.82,"body":"You know, I"},{"speaker":"Charles Goldfarb","startTime":527.33,"endTime":529.82,"body":"don't know the vascularity well."},{"speaker":"Charles Goldfarb","startTime":530.42,"endTime":533.84,"body":"Certainly, some of it comes from"},{"speaker":"Charles Goldfarb","startTime":530.42,"endTime":533.84,"body":"the interosseous membrane. But"},{"speaker":"Charles Goldfarb","startTime":533.84,"endTime":536.6,"body":"it's it I mean, it goes it's got"},{"speaker":"Charles Goldfarb","startTime":533.84,"endTime":536.6,"body":"to go back to the basics of the"},{"speaker":"Charles Goldfarb","startTime":536.6,"endTime":540.26,"body":"blood supply must be lousy. You"},{"speaker":"Charles Goldfarb","startTime":536.6,"endTime":540.26,"body":"know, I've I've investigated"},{"speaker":"Charles Goldfarb","startTime":540.26,"endTime":546.5,"body":"this in a very, very specialized"},{"speaker":"Charles Goldfarb","startTime":540.26,"endTime":546.5,"body":"population that is in in the"},{"speaker":"Charles Goldfarb","startTime":546.53,"endTime":550.91,"body":"osteoclasis patient. So,"},{"speaker":"Charles Goldfarb","startTime":546.53,"endTime":550.91,"body":"osteoclasis for me, is in"},{"speaker":"Charles Goldfarb","startTime":550.91,"endTime":555.26,"body":"regards to children born with"},{"speaker":"Charles Goldfarb","startTime":550.91,"endTime":555.26,"body":"proximal radioulnar synostosis."},{"speaker":"Charles Goldfarb","startTime":555.26,"endTime":559.82,"body":"So congenital anomaly, and we"},{"speaker":"Charles Goldfarb","startTime":555.26,"endTime":559.82,"body":"rotate the forearm in those kids"},{"speaker":"Charles Goldfarb","startTime":559.97,"endTime":563.87,"body":"by creating osteotomies. And one"},{"speaker":"Charles Goldfarb","startTime":559.97,"endTime":563.87,"body":"of our excellent previous"},{"speaker":"Charles Goldfarb","startTime":563.87,"endTime":566.66,"body":"fellows many years ago,"},{"speaker":"Charles Goldfarb","startTime":563.87,"endTime":566.66,"body":"basically came to the conclusion"},{"speaker":"Charles Goldfarb","startTime":566.66,"endTime":572.48,"body":"that once a child is over age"},{"speaker":"Charles Goldfarb","startTime":566.66,"endTime":572.48,"body":"six, healing is so unpredictable"},{"speaker":"Charles Goldfarb","startTime":572.69,"endTime":577.76,"body":"that doing that surgery and not"},{"speaker":"Charles Goldfarb","startTime":572.69,"endTime":577.76,"body":"putting hardware in really risk"},{"speaker":"Charles Goldfarb","startTime":577.76,"endTime":580.49,"body":"the non union and so it's just"},{"speaker":"Charles Goldfarb","startTime":577.76,"endTime":580.49,"body":"got to be a vascularity issue."},{"speaker":"Charles Goldfarb","startTime":580.85,"endTime":585.83,"body":"And, and there's so much the"},{"speaker":"Charles Goldfarb","startTime":580.85,"endTime":585.83,"body":"cortical bone is such a great"},{"speaker":"Charles Goldfarb","startTime":585.83,"endTime":589.22,"body":"percentage of the ulna right? So"},{"speaker":"Charles Goldfarb","startTime":585.83,"endTime":589.22,"body":"there's just not a lot of"},{"speaker":"Charles Goldfarb","startTime":589.22,"endTime":590.81,"body":"cancellous bone to promote"},{"speaker":"Charles Goldfarb","startTime":589.22,"endTime":590.81,"body":"healing."},{"speaker":"Chris Dy","startTime":592.91,"endTime":595.88,"body":"Do you change your"},{"speaker":"Chris Dy","startTime":592.91,"endTime":595.88,"body":"immobilization based on the fact"},{"speaker":"Chris Dy","startTime":595.88,"endTime":597.98,"body":"that it takes so long to heal?"},{"speaker":"Chris Dy","startTime":595.88,"endTime":597.98,"body":"Is there any thought to"},{"speaker":"Chris Dy","startTime":597.98,"endTime":600.83,"body":"mobilizing people with you"},{"speaker":"Chris Dy","startTime":597.98,"endTime":600.83,"body":"including their forearm, at"},{"speaker":"Chris Dy","startTime":600.83,"endTime":601.28,"body":"least?"},{"speaker":"Charles Goldfarb","startTime":601.37,"endTime":603.59,"body":"In a fracture?"},{"speaker":"Chris Dy","startTime":604.61,"endTime":605.93,"body":"Yes, in a fracture"},{"speaker":"Chris Dy","startTime":604.61,"endTime":605.93,"body":"setting,"},{"speaker":"Charles Goldfarb","startTime":605.96,"endTime":609.71,"body":"Yeah, I don't"},{"speaker":"Charles Goldfarb","startTime":605.96,"endTime":609.71,"body":"go above the elbow. But I tend"},{"speaker":"Charles Goldfarb","startTime":609.71,"endTime":613.04,"body":"to do it with like a nightstick"},{"speaker":"Charles Goldfarb","startTime":609.71,"endTime":613.04,"body":"fracture non athlete. I just put"},{"speaker":"Charles Goldfarb","startTime":613.04,"endTime":615.26,"body":"them in a cast for six weeks as"},{"speaker":"Charles Goldfarb","startTime":613.04,"endTime":615.26,"body":"a starting point and then"},{"speaker":"Charles Goldfarb","startTime":615.26,"endTime":618.83,"body":"reassess. Hopefully then getting"},{"speaker":"Charles Goldfarb","startTime":615.26,"endTime":618.83,"body":"them into something different."},{"speaker":"Chris Dy","startTime":619.56,"endTime":621.96,"body":"Below elbow, so not a"},{"speaker":"Chris Dy","startTime":619.56,"endTime":621.96,"body":"Munster or anything like that."},{"speaker":"Charles Goldfarb","startTime":622.02,"endTime":624.24,"body":"Yeah, I mean,"},{"speaker":"Charles Goldfarb","startTime":622.02,"endTime":624.24,"body":"as I think about it, not totally"},{"speaker":"Charles Goldfarb","startTime":624.24,"endTime":627.42,"body":"fair, but it's the radius"},{"speaker":"Charles Goldfarb","startTime":624.24,"endTime":627.42,"body":"rotating around the ulna. But"},{"speaker":"Charles Goldfarb","startTime":627.42,"endTime":630.18,"body":"certainly, there's torque on the"},{"speaker":"Charles Goldfarb","startTime":627.42,"endTime":630.18,"body":"ulna during that rotation, no"},{"speaker":"Charles Goldfarb","startTime":630.18,"endTime":630.84,"body":"doubt about it."},{"speaker":"Chris Dy","startTime":631.95,"endTime":634.8,"body":"Yeah, I've been known"},{"speaker":"Chris Dy","startTime":631.95,"endTime":634.8,"body":"to use the Munster. But yeah,"},{"speaker":"Chris Dy","startTime":634.8,"endTime":638.58,"body":"this patient this patient got"},{"speaker":"Chris Dy","startTime":634.8,"endTime":638.58,"body":"single plate has done incredibly"},{"speaker":"Chris Dy","startTime":638.58,"endTime":642.24,"body":"well so far. And we're hoping to"},{"speaker":"Chris Dy","startTime":638.58,"endTime":642.24,"body":"get get them back ASAP. So Paul,"},{"speaker":"Chris Dy","startTime":642.24,"endTime":644.52,"body":"probably not the person you"},{"speaker":"Chris Dy","startTime":642.24,"endTime":644.52,"body":"wanted answering the question in"},{"speaker":"Chris Dy","startTime":644.52,"endTime":647.1,"body":"terms of a recent case, but you"},{"speaker":"Chris Dy","startTime":644.52,"endTime":647.1,"body":"definitely got Chuck's thoughts."},{"speaker":"Chris Dy","startTime":647.1,"endTime":648.51,"body":"Thank you for that. Great"},{"speaker":"Chris Dy","startTime":647.1,"endTime":648.51,"body":"question."},{"speaker":"Charles Goldfarb","startTime":648.66,"endTime":651.63,"body":"So Chris, keep"},{"speaker":"Charles Goldfarb","startTime":648.66,"endTime":651.63,"body":"working hard. And one day, you"},{"speaker":"Charles Goldfarb","startTime":651.63,"endTime":654.6,"body":"might graduate from nerve"},{"speaker":"Charles Goldfarb","startTime":651.63,"endTime":654.6,"body":"surgery, and you can move into"},{"speaker":"Charles Goldfarb","startTime":654.6,"endTime":657.21,"body":"sports, I don't want to promise"},{"speaker":"Charles Goldfarb","startTime":654.6,"endTime":657.21,"body":"you anything. But there's hope"},{"speaker":"Charles Goldfarb","startTime":657.21,"endTime":657.63,"body":"for you."},{"speaker":"Chris Dy","startTime":657.93,"endTime":659.76,"body":"I'm hoping to stay"},{"speaker":"Chris Dy","startTime":657.93,"endTime":659.76,"body":"where I am right now. I'm good."},{"speaker":"Chris Dy","startTime":660.54,"endTime":661.41,"body":"I'm good on that."},{"speaker":"Charles Goldfarb","startTime":661.59,"endTime":664.44,"body":"Alright, so I"},{"speaker":"Charles Goldfarb","startTime":661.59,"endTime":664.44,"body":"know you have the topic that we"},{"speaker":"Charles Goldfarb","startTime":664.44,"endTime":666.93,"body":"are going to discuss tonight."},{"speaker":"Charles Goldfarb","startTime":664.44,"endTime":666.93,"body":"And it's a good one. So I'm"},{"speaker":"Charles Goldfarb","startTime":666.93,"endTime":668.91,"body":"going to give you a little"},{"speaker":"Charles Goldfarb","startTime":666.93,"endTime":668.91,"body":"special intro."},{"speaker":"Charles Goldfarb","startTime":675.41,"endTime":676.19,"body":"I love it."},{"speaker":"Chris Dy","startTime":677.12,"endTime":682.34,"body":"That is so awful. So I"},{"speaker":"Chris Dy","startTime":677.12,"endTime":682.34,"body":"was actually listening to the"},{"speaker":"Chris Dy","startTime":682.46,"endTime":687.71,"body":"ortho hub podcast. I think they"},{"speaker":"Chris Dy","startTime":682.46,"endTime":687.71,"body":"called see one do one now. And"},{"speaker":"Chris Dy","startTime":687.74,"endTime":690.56,"body":"actually, in one of their recent"},{"speaker":"Chris Dy","startTime":687.74,"endTime":690.56,"body":"episodes, I guess they got a"},{"speaker":"Chris Dy","startTime":690.56,"endTime":694.07,"body":"hold on one of these little"},{"speaker":"Chris Dy","startTime":690.56,"endTime":694.07,"body":"sound machine things too. So it"},{"speaker":"Chris Dy","startTime":694.07,"endTime":697.34,"body":"was used excessively in that"},{"speaker":"Chris Dy","startTime":694.07,"endTime":697.34,"body":"episode, and I'm sure you're"},{"speaker":"Chris Dy","startTime":697.34,"endTime":698.39,"body":"going to be using it more."},{"speaker":"Charles Goldfarb","startTime":698.52,"endTime":700.83,"body":"We're done."},{"speaker":"Charles Goldfarb","startTime":698.52,"endTime":700.83,"body":"We're done, I think unless"},{"speaker":"Charles Goldfarb","startTime":700.83,"endTime":702.24,"body":"something special happens."},{"speaker":"Chris Dy","startTime":702.63,"endTime":706.23,"body":"So today's case,"},{"speaker":"Chris Dy","startTime":702.63,"endTime":706.23,"body":"actually is what actually will"},{"speaker":"Chris Dy","startTime":706.23,"endTime":709.62,"body":"lead us into our topic for"},{"speaker":"Chris Dy","startTime":706.23,"endTime":709.62,"body":"today. So I was treating a"},{"speaker":"Chris Dy","startTime":709.62,"endTime":712.17,"body":"patient who had a couple of"},{"speaker":"Chris Dy","startTime":709.62,"endTime":712.17,"body":"fractures, one of them being"},{"speaker":"Chris Dy","startTime":712.32,"endTime":715.02,"body":"displaced distal radius"},{"speaker":"Chris Dy","startTime":712.32,"endTime":715.02,"body":"fracture, pretty run of the mill"},{"speaker":"Chris Dy","startTime":715.02,"endTime":719.22,"body":"volar plate kind of thing. But"},{"speaker":"Chris Dy","startTime":715.02,"endTime":719.22,"body":"then also had a Pilon type"},{"speaker":"Chris Dy","startTime":719.22,"endTime":725.97,"body":"fracture of the base of P two of"},{"speaker":"Chris Dy","startTime":719.22,"endTime":725.97,"body":"the small finger. So a fracture"},{"speaker":"Chris Dy","startTime":725.97,"endTime":730.17,"body":"that I groan every time I see."},{"speaker":"Chris Dy","startTime":725.97,"endTime":730.17,"body":"Absolutely, that's a tough one."},{"speaker":"Chris Dy","startTime":731.34,"endTime":733.47,"body":"So it got me thinking,"},{"speaker":"Chris Dy","startTime":731.34,"endTime":733.47,"body":"obviously, we're thinking about"},{"speaker":"Chris Dy","startTime":733.47,"endTime":737.1,"body":"our options. So maybe we can"},{"speaker":"Chris Dy","startTime":733.47,"endTime":737.1,"body":"talk through some of those. So"},{"speaker":"Chris Dy","startTime":738.45,"endTime":741.78,"body":"how what's your threshold to"},{"speaker":"Chris Dy","startTime":738.45,"endTime":741.78,"body":"operate on patients with a, you"},{"speaker":"Chris Dy","startTime":741.78,"endTime":744.6,"body":"know, smash, P2, fracture, and"},{"speaker":"Chris Dy","startTime":741.78,"endTime":744.6,"body":"then possibly some volar or"},{"speaker":"Chris Dy","startTime":744.6,"endTime":747.27,"body":"dorsal? More often dorsal"},{"speaker":"Chris Dy","startTime":744.6,"endTime":747.27,"body":"subluxation of the PIJ?"},{"speaker":"Charles Goldfarb","startTime":748.86,"endTime":751.59,"body":"Well, it's a"},{"speaker":"Charles Goldfarb","startTime":748.86,"endTime":751.59,"body":"really interesting question,"},{"speaker":"Charles Goldfarb","startTime":751.59,"endTime":754.77,"body":"because I think as we think"},{"speaker":"Charles Goldfarb","startTime":751.59,"endTime":754.77,"body":"about fractures, and we're"},{"speaker":"Charles Goldfarb","startTime":754.77,"endTime":758.04,"body":"really talking about fractures"},{"speaker":"Charles Goldfarb","startTime":754.77,"endTime":758.04,"body":"at the base of the middle"},{"speaker":"Charles Goldfarb","startTime":758.04,"endTime":762.12,"body":"phalanx, I think about them in"},{"speaker":"Charles Goldfarb","startTime":758.04,"endTime":762.12,"body":"really, I guess I would say,"},{"speaker":"Charles Goldfarb","startTime":762.12,"endTime":764.52,"body":"three different groups, I think"},{"speaker":"Charles Goldfarb","startTime":762.12,"endTime":764.52,"body":"we have what I would call the"},{"speaker":"Charles Goldfarb","startTime":764.52,"endTime":768.15,"body":"classic fracture dislocation,"},{"speaker":"Charles Goldfarb","startTime":764.52,"endTime":768.15,"body":"which is a volar lip fracture,"},{"speaker":"Charles Goldfarb","startTime":768.42,"endTime":773.31,"body":"of varying size. We have the"},{"speaker":"Charles Goldfarb","startTime":768.42,"endTime":773.31,"body":"Pilon fracture, or really kind"},{"speaker":"Charles Goldfarb","startTime":773.31,"endTime":777.93,"body":"of a severe fracture involving"},{"speaker":"Charles Goldfarb","startTime":773.31,"endTime":777.93,"body":"the entirety of the Joint"},{"speaker":"Charles Goldfarb","startTime":777.93,"endTime":781.23,"body":"Service. And then we have what I"},{"speaker":"Charles Goldfarb","startTime":777.93,"endTime":781.23,"body":"call the central slip fracture,"},{"speaker":"Charles Goldfarb","startTime":781.23,"endTime":784.74,"body":"which you and I discussed in"},{"speaker":"Charles Goldfarb","startTime":781.23,"endTime":784.74,"body":"within the last month or two,"},{"speaker":"Charles Goldfarb","startTime":785.25,"endTime":788.22,"body":"with a case example. So we"},{"speaker":"Charles Goldfarb","startTime":785.25,"endTime":788.22,"body":"probably don't need to rehash"},{"speaker":"Charles Goldfarb","startTime":788.22,"endTime":792.24,"body":"that one. But if we talk about"},{"speaker":"Charles Goldfarb","startTime":788.22,"endTime":792.24,"body":"the Pilon fracture, and the"},{"speaker":"Charles Goldfarb","startTime":792.24,"endTime":796.2,"body":"volar lip fracture, I think"},{"speaker":"Charles Goldfarb","startTime":792.24,"endTime":796.2,"body":"there's just so much to discuss."},{"speaker":"Charles Goldfarb","startTime":796.2,"endTime":799.11,"body":"And so I would start by saying,"},{"speaker":"Charles Goldfarb","startTime":796.2,"endTime":799.11,"body":"and I'd be interested to hear"},{"speaker":"Charles Goldfarb","startTime":799.11,"endTime":803.46,"body":"how you think about this, my"},{"speaker":"Charles Goldfarb","startTime":799.11,"endTime":803.46,"body":"first goal is understanding if"},{"speaker":"Charles Goldfarb","startTime":803.46,"endTime":808.29,"body":"there is a concentric joint"},{"speaker":"Charles Goldfarb","startTime":803.46,"endTime":808.29,"body":"reduction. And so I don't you"},{"speaker":"Charles Goldfarb","startTime":808.29,"endTime":811.11,"body":"know, I love standard x rays,"},{"speaker":"Charles Goldfarb","startTime":808.29,"endTime":811.11,"body":"because they give us great"},{"speaker":"Charles Goldfarb","startTime":811.11,"endTime":814.44,"body":"definition. But for me, that is"},{"speaker":"Charles Goldfarb","startTime":811.11,"endTime":814.44,"body":"a C-arm, I'm lucky to have a"},{"speaker":"Charles Goldfarb","startTime":814.44,"endTime":817.89,"body":"C-arm in my office, so I can"},{"speaker":"Charles Goldfarb","startTime":814.44,"endTime":817.89,"body":"really profile the joint and"},{"speaker":"Charles Goldfarb","startTime":817.89,"endTime":819.33,"body":"really understand reduction."},{"speaker":"Chris Dy","startTime":820.68,"endTime":822.6,"body":"Yeah, I think that's"},{"speaker":"Chris Dy","startTime":820.68,"endTime":822.6,"body":"that's critical, because"},{"speaker":"Chris Dy","startTime":822.6,"endTime":826.44,"body":"oftentimes, your the X rays you"},{"speaker":"Chris Dy","startTime":822.6,"endTime":826.44,"body":"get are suboptimal. And it's"},{"speaker":"Chris Dy","startTime":826.44,"endTime":828.99,"body":"really hard to I think this is"},{"speaker":"Chris Dy","startTime":826.44,"endTime":828.99,"body":"when we're truly understanding"},{"speaker":"Chris Dy","startTime":828.99,"endTime":833.52,"body":"the, quote, personality of the"},{"speaker":"Chris Dy","startTime":828.99,"endTime":833.52,"body":"fracture is useful. Because you"},{"speaker":"Chris Dy","startTime":833.52,"endTime":836.64,"body":"understand the deforming forces,"},{"speaker":"Chris Dy","startTime":833.52,"endTime":836.64,"body":"you understand your end goal in"},{"speaker":"Chris Dy","startTime":836.64,"endTime":840.54,"body":"terms of what you're trying to"},{"speaker":"Chris Dy","startTime":836.64,"endTime":840.54,"body":"achieve with any sort of"},{"speaker":"Chris Dy","startTime":840.54,"endTime":843.78,"body":"stabilization. And then keeping"},{"speaker":"Chris Dy","startTime":840.54,"endTime":843.78,"body":"in mind the fact that you're"},{"speaker":"Chris Dy","startTime":843.78,"endTime":845.76,"body":"just trying to get this joint"},{"speaker":"Chris Dy","startTime":843.78,"endTime":845.76,"body":"lined up and moving."},{"speaker":"Charles Goldfarb","startTime":846.18,"endTime":848.61,"body":"Now that's"},{"speaker":"Charles Goldfarb","startTime":846.18,"endTime":848.61,"body":"exactly right. And so, you know,"},{"speaker":"Charles Goldfarb","startTime":848.64,"endTime":853.83,"body":"most fractures can be thoroughly"},{"speaker":"Charles Goldfarb","startTime":848.64,"endTime":853.83,"body":"assessed with a good C-arm"},{"speaker":"Charles Goldfarb","startTime":853.83,"endTime":858.42,"body":"radiograph I'm not really one to"},{"speaker":"Charles Goldfarb","startTime":853.83,"endTime":858.42,"body":"order CT scans, or certainly not"},{"speaker":"Charles Goldfarb","startTime":858.45,"endTime":863.07,"body":"MRIs and these cases, the only"},{"speaker":"Charles Goldfarb","startTime":858.45,"endTime":863.07,"body":"other thing I would throw out is"},{"speaker":"Charles Goldfarb","startTime":863.07,"endTime":867.24,"body":"if it's a really bad fracture,"},{"speaker":"Charles Goldfarb","startTime":863.07,"endTime":867.24,"body":"and if the joint is is clearly"},{"speaker":"Charles Goldfarb","startTime":867.24,"endTime":869.46,"body":"not aligned and you know, you"},{"speaker":"Charles Goldfarb","startTime":867.24,"endTime":869.46,"body":"have to take the patient to the"},{"speaker":"Charles Goldfarb","startTime":869.46,"endTime":873.06,"body":"operating room, then a traction"},{"speaker":"Charles Goldfarb","startTime":869.46,"endTime":873.06,"body":"radiograph is gold in these"},{"speaker":"Charles Goldfarb","startTime":873.06,"endTime":875.43,"body":"patients and so but for me,"},{"speaker":"Charles Goldfarb","startTime":873.06,"endTime":875.43,"body":"that's not done in clinic"},{"speaker":"Charles Goldfarb","startTime":875.43,"endTime":877.56,"body":"because then you have to"},{"speaker":"Charles Goldfarb","startTime":875.43,"endTime":877.56,"body":"anesthetize the patient. It"},{"speaker":"Charles Goldfarb","startTime":877.56,"endTime":879.36,"body":"would I mean, you have to you"},{"speaker":"Charles Goldfarb","startTime":877.56,"endTime":879.36,"body":"know, give them an injection of"},{"speaker":"Charles Goldfarb","startTime":879.36,"endTime":882.78,"body":"lidocaine, but but in the OR a"},{"speaker":"Charles Goldfarb","startTime":879.36,"endTime":882.78,"body":"traction radiograph can be gold."},{"speaker":"Chris Dy","startTime":883.89,"endTime":886.83,"body":"So how would the"},{"speaker":"Chris Dy","startTime":883.89,"endTime":886.83,"body":"traction radiograph influence"},{"speaker":"Chris Dy","startTime":886.83,"endTime":887.49,"body":"your management?"},{"speaker":"Charles Goldfarb","startTime":887.85,"endTime":890.1,"body":"Yeah, so I'm"},{"speaker":"Charles Goldfarb","startTime":887.85,"endTime":890.1,"body":"us and I'd be interested see"},{"speaker":"Charles Goldfarb","startTime":890.1,"endTime":892.41,"body":"philosophically how you think"},{"speaker":"Charles Goldfarb","startTime":890.1,"endTime":892.41,"body":"about this. When I go to the"},{"speaker":"Charles Goldfarb","startTime":892.41,"endTime":896.28,"body":"operating room, it is always my"},{"speaker":"Charles Goldfarb","startTime":892.41,"endTime":896.28,"body":"goal, to know exactly what I'm"},{"speaker":"Charles Goldfarb","startTime":896.28,"endTime":899.46,"body":"going to do. I don't you know,"},{"speaker":"Charles Goldfarb","startTime":896.28,"endTime":899.46,"body":"and which is interesting for"},{"speaker":"Charles Goldfarb","startTime":899.46,"endTime":902.79,"body":"someone like me To say, because"},{"speaker":"Charles Goldfarb","startTime":899.46,"endTime":902.79,"body":"one of the things that appealed"},{"speaker":"Charles Goldfarb","startTime":902.79,"endTime":906.12,"body":"to me about congenital hand"},{"speaker":"Charles Goldfarb","startTime":902.79,"endTime":906.12,"body":"surgery is some of the general"},{"speaker":"Charles Goldfarb","startTime":906.12,"endTime":910.08,"body":"hand surgery is figuring things"},{"speaker":"Charles Goldfarb","startTime":906.12,"endTime":910.08,"body":"out on the fly. And that's fine."},{"speaker":"Charles Goldfarb","startTime":910.08,"endTime":913.35,"body":"I think in that world, I'm okay"},{"speaker":"Charles Goldfarb","startTime":910.08,"endTime":913.35,"body":"with it in the adult world, I"},{"speaker":"Charles Goldfarb","startTime":913.35,"endTime":916.8,"body":"really like to have a plan. Some"},{"speaker":"Charles Goldfarb","startTime":913.35,"endTime":916.8,"body":"of that's practical, because I"},{"speaker":"Charles Goldfarb","startTime":916.8,"endTime":920.28,"body":"run to rooms, and I really like"},{"speaker":"Charles Goldfarb","startTime":916.8,"endTime":920.28,"body":"to be on time, and I like to"},{"speaker":"Charles Goldfarb","startTime":920.28,"endTime":925.71,"body":"have the day run smoothly. But"},{"speaker":"Charles Goldfarb","startTime":920.28,"endTime":925.71,"body":"this is a case where I typically"},{"speaker":"Charles Goldfarb","startTime":925.71,"endTime":930.45,"body":"go to the operating room with a"},{"speaker":"Charles Goldfarb","startTime":925.71,"endTime":930.45,"body":"plan A, B, and C. And that and"},{"speaker":"Charles Goldfarb","startTime":930.48,"endTime":934.98,"body":"the ultimate choice is based on"},{"speaker":"Charles Goldfarb","startTime":930.48,"endTime":934.98,"body":"kind of what we see."},{"speaker":"Chris Dy","startTime":936.73,"endTime":939.76,"body":"So the traction"},{"speaker":"Chris Dy","startTime":936.73,"endTime":939.76,"body":"radiograph helps you in, helps,"},{"speaker":"Chris Dy","startTime":940.24,"endTime":944.23,"body":"maybe has you shift A, B, and C"},{"speaker":"Chris Dy","startTime":940.24,"endTime":944.23,"body":"up and down in terms of what you"},{"speaker":"Chris Dy","startTime":944.23,"endTime":945.55,"body":"know which one you're gonna try"},{"speaker":"Chris Dy","startTime":944.23,"endTime":945.55,"body":"first."},{"speaker":"Charles Goldfarb","startTime":945.63,"endTime":948.78,"body":"Yeah, I'm a"},{"speaker":"Charles Goldfarb","startTime":945.63,"endTime":948.78,"body":"fan of, and I think especially"},{"speaker":"Charles Goldfarb","startTime":948.81,"endTime":951.84,"body":"keep it you know, trying to keep"},{"speaker":"Charles Goldfarb","startTime":948.81,"endTime":951.84,"body":"this minimally invasive is"},{"speaker":"Charles Goldfarb","startTime":951.84,"endTime":957.12,"body":"always the goal. And, you know,"},{"speaker":"Charles Goldfarb","startTime":951.84,"endTime":957.12,"body":"this is a forgiving joint in the"},{"speaker":"Charles Goldfarb","startTime":957.12,"endTime":962.91,"body":"sense that if you have a"},{"speaker":"Charles Goldfarb","startTime":957.12,"endTime":962.91,"body":"reduction, and the head of the"},{"speaker":"Charles Goldfarb","startTime":962.91,"endTime":966.57,"body":"proximal phalanx is generally"},{"speaker":"Charles Goldfarb","startTime":962.91,"endTime":966.57,"body":"well aligned with the base, the"},{"speaker":"Charles Goldfarb","startTime":966.57,"endTime":969.57,"body":"middle phalanx, that base of the"},{"speaker":"Charles Goldfarb","startTime":966.57,"endTime":969.57,"body":"middle phalanx can remodel, and"},{"speaker":"Charles Goldfarb","startTime":969.57,"endTime":971.94,"body":"even if the radiographs don't"},{"speaker":"Charles Goldfarb","startTime":969.57,"endTime":971.94,"body":"look good, if you restore your"},{"speaker":"Charles Goldfarb","startTime":971.94,"endTime":974.97,"body":"natural curve, then I think you"},{"speaker":"Charles Goldfarb","startTime":971.94,"endTime":974.97,"body":"can get a really good result,"},{"speaker":"Charles Goldfarb","startTime":975.0,"endTime":977.49,"body":"even if the radiographs don't"},{"speaker":"Charles Goldfarb","startTime":975.0,"endTime":977.49,"body":"look perfectly, don't look"},{"speaker":"Charles Goldfarb","startTime":977.49,"endTime":981.09,"body":"perfect, but so I go for"},{"speaker":"Charles Goldfarb","startTime":977.49,"endTime":981.09,"body":"minimally invasive, but really,"},{"speaker":"Charles Goldfarb","startTime":981.09,"endTime":984.03,"body":"I'm thinking about can I do a"},{"speaker":"Charles Goldfarb","startTime":981.09,"endTime":984.03,"body":"closed reduction alone? And the"},{"speaker":"Charles Goldfarb","startTime":984.03,"endTime":988.14,"body":"answer that is almost never. A"},{"speaker":"Charles Goldfarb","startTime":984.03,"endTime":988.14,"body":"closed reduction with pinning of"},{"speaker":"Charles Goldfarb","startTime":988.14,"endTime":994.65,"body":"some sort, an open reduction in"},{"speaker":"Charles Goldfarb","startTime":988.14,"endTime":994.65,"body":"either pinning or fixation. And"},{"speaker":"Charles Goldfarb","startTime":994.65,"endTime":1000.56,"body":"then finally, a traction device,"},{"speaker":"Charles Goldfarb","startTime":994.65,"endTime":1000.56,"body":"which is can be gold, you know,"},{"speaker":"Charles Goldfarb","startTime":1000.56,"endTime":1003.26,"body":"and Joe Slade taught us so much"},{"speaker":"Charles Goldfarb","startTime":1000.56,"endTime":1003.26,"body":"about the traction device and"},{"speaker":"Charles Goldfarb","startTime":1003.26,"endTime":1006.38,"body":"others have added to that basic"},{"speaker":"Charles Goldfarb","startTime":1003.26,"endTime":1006.38,"body":"knowledge of how do you create"},{"speaker":"Charles Goldfarb","startTime":1006.38,"endTime":1009.47,"body":"an effective traction device"},{"speaker":"Charles Goldfarb","startTime":1006.38,"endTime":1009.47,"body":"that's tolerated, and there's so"},{"speaker":"Charles Goldfarb","startTime":1009.47,"endTime":1013.79,"body":"much to it. But those are the"},{"speaker":"Charles Goldfarb","startTime":1009.47,"endTime":1013.79,"body":"kind of how I'm thinking about"},{"speaker":"Charles Goldfarb","startTime":1013.79,"endTime":1015.23,"body":"these when I go to the operating"},{"speaker":"Charles Goldfarb","startTime":1013.79,"endTime":1015.23,"body":"room."},{"speaker":"Chris Dy","startTime":1016.19,"endTime":1018.32,"body":"So let's let's for"},{"speaker":"Chris Dy","startTime":1016.19,"endTime":1018.32,"body":"completeness sake, let's cover"},{"speaker":"Chris Dy","startTime":1018.32,"endTime":1020.03,"body":"the whole spectrum. So you"},{"speaker":"Chris Dy","startTime":1018.32,"endTime":1020.03,"body":"mentioned doing closed"},{"speaker":"Chris Dy","startTime":1020.03,"endTime":1022.79,"body":"reduction, and when that would"},{"speaker":"Chris Dy","startTime":1020.03,"endTime":1022.79,"body":"work. Now, typically, you know,"},{"speaker":"Chris Dy","startTime":1022.79,"endTime":1025.13,"body":"you're not seeing that in the"},{"speaker":"Chris Dy","startTime":1022.79,"endTime":1025.13,"body":"office, that's something that"},{"speaker":"Chris Dy","startTime":1025.13,"endTime":1027.83,"body":"you know, makes its way to the"},{"speaker":"Chris Dy","startTime":1025.13,"endTime":1027.83,"body":"ED or the urgent care, that kind"},{"speaker":"Chris Dy","startTime":1027.83,"endTime":1031.04,"body":"of thing. And it's quote,"},{"speaker":"Chris Dy","startTime":1027.83,"endTime":1031.04,"body":"simple, meaning there's no"},{"speaker":"Chris Dy","startTime":1031.04,"endTime":1034.07,"body":"fracture associated with with"},{"speaker":"Chris Dy","startTime":1031.04,"endTime":1034.07,"body":"it, or there's a very small"},{"speaker":"Chris Dy","startTime":1034.07,"endTime":1037.46,"body":"fragment. I actually had one of"},{"speaker":"Chris Dy","startTime":1034.07,"endTime":1037.46,"body":"these walk into the office"},{"speaker":"Chris Dy","startTime":1037.46,"endTime":1040.07,"body":"because they came to our injury"},{"speaker":"Chris Dy","startTime":1037.46,"endTime":1040.07,"body":"clinic. And I happen to be"},{"speaker":"Chris Dy","startTime":1040.07,"endTime":1042.86,"body":"dictating at the time. So I saw"},{"speaker":"Chris Dy","startTime":1040.07,"endTime":1042.86,"body":"the patient and did a closed"},{"speaker":"Chris Dy","startTime":1042.86,"endTime":1045.89,"body":"reduction in the in the fluoro"},{"speaker":"Chris Dy","startTime":1042.86,"endTime":1045.89,"body":"suite. And everybody was"},{"speaker":"Chris Dy","startTime":1046.01,"endTime":1049.49,"body":"obviously happy with that. After"},{"speaker":"Chris Dy","startTime":1046.01,"endTime":1049.49,"body":"you do a closed reduction, and"},{"speaker":"Chris Dy","startTime":1049.49,"endTime":1052.16,"body":"it feels really good. Do you do"},{"speaker":"Chris Dy","startTime":1049.49,"endTime":1052.16,"body":"a dorsal blocking splint? Do you"},{"speaker":"Chris Dy","startTime":1052.16,"endTime":1054.17,"body":"just buddy tape? What do you how"},{"speaker":"Chris Dy","startTime":1052.16,"endTime":1054.17,"body":"do you manage that?"},{"speaker":"Charles Goldfarb","startTime":1054.65,"endTime":1056.84,"body":"For me, it's"},{"speaker":"Charles Goldfarb","startTime":1054.65,"endTime":1056.84,"body":"always a dorsal blocking splint."},{"speaker":"Charles Goldfarb","startTime":1057.08,"endTime":1061.61,"body":"And let's say your reduction of"},{"speaker":"Charles Goldfarb","startTime":1057.08,"endTime":1061.61,"body":"that dislocated joint was good."},{"speaker":"Charles Goldfarb","startTime":1061.7,"endTime":1064.52,"body":"But as you extended the finger,"},{"speaker":"Charles Goldfarb","startTime":1061.7,"endTime":1064.52,"body":"you know you started to get that"},{"speaker":"Charles Goldfarb","startTime":1064.52,"endTime":1070.34,"body":"V sign where the dorsal joint is"},{"speaker":"Charles Goldfarb","startTime":1064.52,"endTime":1070.34,"body":"not parallel, but as V, then I"},{"speaker":"Charles Goldfarb","startTime":1070.34,"endTime":1074.9,"body":"flex the finger down. I mean 60"},{"speaker":"Charles Goldfarb","startTime":1070.34,"endTime":1074.9,"body":"degrees is fine. And then I"},{"speaker":"Charles Goldfarb","startTime":1074.9,"endTime":1077.72,"body":"create a dorsal blocking splint"},{"speaker":"Charles Goldfarb","startTime":1074.9,"endTime":1077.72,"body":"either in the office or ideally"},{"speaker":"Charles Goldfarb","startTime":1077.72,"endTime":1081.38,"body":"with a therapist. With the goal"},{"speaker":"Charles Goldfarb","startTime":1077.72,"endTime":1081.38,"body":"being extended 10 degrees every"},{"speaker":"Charles Goldfarb","startTime":1081.38,"endTime":1085.01,"body":"week, during the healing"},{"speaker":"Charles Goldfarb","startTime":1081.38,"endTime":1085.01,"body":"process. I you know that that is"},{"speaker":"Charles Goldfarb","startTime":1085.01,"endTime":1087.11,"body":"a really important part of my"},{"speaker":"Charles Goldfarb","startTime":1085.01,"endTime":1087.11,"body":"practice."},{"speaker":"Chris Dy","startTime":1087.0,"endTime":1090.36,"body":"That's textbook right"},{"speaker":"Chris Dy","startTime":1087.0,"endTime":1090.36,"body":"10 degrees every week. So I got"},{"speaker":"Chris Dy","startTime":1090.36,"endTime":1093.33,"body":"the reduction, I put a little"},{"speaker":"Chris Dy","startTime":1090.36,"endTime":1093.33,"body":"alumafoam splint in the fluoro"},{"speaker":"Chris Dy","startTime":1093.33,"endTime":1096.18,"body":"and then actually took her right"},{"speaker":"Chris Dy","startTime":1093.33,"endTime":1096.18,"body":"to the to the therapy office"},{"speaker":"Chris Dy","startTime":1096.18,"endTime":1099.15,"body":"that was co-located an"},{"speaker":"Chris Dy","startTime":1096.18,"endTime":1099.15,"body":"orthopedic suite, so that worked"},{"speaker":"Chris Dy","startTime":1099.15,"endTime":1102.24,"body":"out really well in terms of"},{"speaker":"Chris Dy","startTime":1099.15,"endTime":1102.24,"body":"getting a splint made for that"},{"speaker":"Chris Dy","startTime":1102.24,"endTime":1102.66,"body":"patient."},{"speaker":"Charles Goldfarb","startTime":1103.65,"endTime":1105.78,"body":"Yeah, that's"},{"speaker":"Charles Goldfarb","startTime":1103.65,"endTime":1105.78,"body":"that's magic. And we are"},{"speaker":"Charles Goldfarb","startTime":1105.78,"endTime":1108.09,"body":"fortunate we've said this"},{"speaker":"Charles Goldfarb","startTime":1105.78,"endTime":1108.09,"body":"before, we'll say it again to"},{"speaker":"Charles Goldfarb","startTime":1108.09,"endTime":1111.99,"body":"have the, you know, close"},{"speaker":"Charles Goldfarb","startTime":1108.09,"endTime":1111.99,"body":"proximity as well as expertise"},{"speaker":"Charles Goldfarb","startTime":1111.99,"endTime":1115.56,"body":"of our therapy colleagues. And,"},{"speaker":"Charles Goldfarb","startTime":1111.99,"endTime":1115.56,"body":"and you know, once you have"},{"speaker":"Charles Goldfarb","startTime":1115.56,"endTime":1118.26,"body":"obtained the reduction, their"},{"speaker":"Charles Goldfarb","startTime":1115.56,"endTime":1118.26,"body":"role in this is really"},{"speaker":"Charles Goldfarb","startTime":1118.26,"endTime":1118.71,"body":"everything."},{"speaker":"Chris Dy","startTime":1119.46,"endTime":1121.71,"body":"So then let's go to"},{"speaker":"Chris Dy","startTime":1119.46,"endTime":1121.71,"body":"the next scenario. Let's say you"},{"speaker":"Chris Dy","startTime":1121.71,"endTime":1125.43,"body":"have a dorsal dislocation,"},{"speaker":"Chris Dy","startTime":1121.71,"endTime":1125.43,"body":"meaning that the prox-the middle"},{"speaker":"Chris Dy","startTime":1125.43,"endTime":1128.43,"body":"phalanx is drifting dorsally."},{"speaker":"Chris Dy","startTime":1125.43,"endTime":1128.43,"body":"And so you've got a volar lip"},{"speaker":"Chris Dy","startTime":1128.43,"endTime":1131.49,"body":"fragment, say it looks to be"},{"speaker":"Chris Dy","startTime":1128.43,"endTime":1131.49,"body":"about 20% of the joint."},{"speaker":"Charles Goldfarb","startTime":1132.78,"endTime":1135.96,"body":"Yeah, I don't"},{"speaker":"Charles Goldfarb","startTime":1132.78,"endTime":1135.96,"body":"focus so much anymore on the"},{"speaker":"Charles Goldfarb","startTime":1136.86,"endTime":1141.15,"body":"percent involvement of the joint"},{"speaker":"Charles Goldfarb","startTime":1136.86,"endTime":1141.15,"body":"I would do with you know, I"},{"speaker":"Charles Goldfarb","startTime":1141.15,"endTime":1143.07,"body":"would try to close production in"},{"speaker":"Charles Goldfarb","startTime":1141.15,"endTime":1143.07,"body":"the clinic, hopefully,"},{"speaker":"Charles Goldfarb","startTime":1143.07,"endTime":1145.26,"body":"depending, you know, on the"},{"speaker":"Charles Goldfarb","startTime":1143.07,"endTime":1145.26,"body":"situation, or else I would"},{"speaker":"Charles Goldfarb","startTime":1145.44,"endTime":1147.57,"body":"proceed to the operate, if it's"},{"speaker":"Charles Goldfarb","startTime":1145.44,"endTime":1147.57,"body":"a week out or whatever, I would"},{"speaker":"Charles Goldfarb","startTime":1147.57,"endTime":1151.29,"body":"proceed to the operating room,"},{"speaker":"Charles Goldfarb","startTime":1147.57,"endTime":1151.29,"body":"assess it with traction, assess"},{"speaker":"Charles Goldfarb","startTime":1151.29,"endTime":1154.89,"body":"whether a closed reduction in"},{"speaker":"Charles Goldfarb","startTime":1151.29,"endTime":1154.89,"body":"flexion will reduce the joint."},{"speaker":"Charles Goldfarb","startTime":1155.28,"endTime":1158.55,"body":"And again, this is when you have"},{"speaker":"Charles Goldfarb","startTime":1155.28,"endTime":1158.55,"body":"to be very critical of yourself"},{"speaker":"Charles Goldfarb","startTime":1158.55,"endTime":1162.15,"body":"and your x rays. And if you're"},{"speaker":"Charles Goldfarb","startTime":1158.55,"endTime":1162.15,"body":"not convinced that you really"},{"speaker":"Charles Goldfarb","startTime":1162.15,"endTime":1167.01,"body":"have that anatomical alignment,"},{"speaker":"Charles Goldfarb","startTime":1162.15,"endTime":1167.01,"body":"and that parallel alignment with"},{"speaker":"Charles Goldfarb","startTime":1167.01,"endTime":1171.24,"body":"the head and the base of P two,"},{"speaker":"Charles Goldfarb","startTime":1167.01,"endTime":1171.24,"body":"then I think you have to, you"},{"speaker":"Charles Goldfarb","startTime":1171.24,"endTime":1176.1,"body":"know, move on to the next stage."},{"speaker":"Charles Goldfarb","startTime":1171.24,"endTime":1176.1,"body":"And depending on that volar"},{"speaker":"Charles Goldfarb","startTime":1176.1,"endTime":1180.36,"body":"fragment and in some ways for me"},{"speaker":"Charles Goldfarb","startTime":1176.1,"endTime":1180.36,"body":"a large volar fragment and we"},{"speaker":"Charles Goldfarb","startTime":1180.36,"endTime":1184.32,"body":"can quibble on what large means"},{"speaker":"Charles Goldfarb","startTime":1180.36,"endTime":1184.32,"body":"is fantastic because you go on"},{"speaker":"Charles Goldfarb","startTime":1184.32,"endTime":1187.44,"body":"you fix it, and I think those"},{"speaker":"Charles Goldfarb","startTime":1184.32,"endTime":1187.44,"body":"patients can do really well and"},{"speaker":"Charles Goldfarb","startTime":1187.44,"endTime":1188.88,"body":"they get moving really quickly."},{"speaker":"Chris Dy","startTime":1189.679,"endTime":1192.259,"body":"So is it is large"},{"speaker":"Chris Dy","startTime":1189.679,"endTime":1192.259,"body":"enough meaning large enough for"},{"speaker":"Chris Dy","startTime":1192.259,"endTime":1193.189,"body":"you put a screw in."},{"speaker":"Charles Goldfarb","startTime":1193.87,"endTime":1196.54,"body":"That is"},{"speaker":"Charles Goldfarb","startTime":1193.87,"endTime":1196.54,"body":"exactly right of screw or two"},{"speaker":"Charles Goldfarb","startTime":1197.74,"endTime":1201.4,"body":"and I can't think of too many"},{"speaker":"Charles Goldfarb","startTime":1197.74,"endTime":1201.4,"body":"more satisfying cases and I"},{"speaker":"Charles Goldfarb","startTime":1201.4,"endTime":1205.24,"body":"think they're uncommon that you"},{"speaker":"Charles Goldfarb","startTime":1201.4,"endTime":1205.24,"body":"have that one non comminuted"},{"speaker":"Charles Goldfarb","startTime":1205.24,"endTime":1209.8,"body":"volar fragment, that clearly"},{"speaker":"Charles Goldfarb","startTime":1205.24,"endTime":1209.8,"body":"that buttress is required to"},{"speaker":"Charles Goldfarb","startTime":1209.8,"endTime":1214.24,"body":"restore stability. And flexions"},{"speaker":"Charles Goldfarb","startTime":1209.8,"endTime":1214.24,"body":"not enough. So you go in, you"},{"speaker":"Charles Goldfarb","startTime":1214.24,"endTime":1217.93,"body":"get the reduction, you put two"},{"speaker":"Charles Goldfarb","startTime":1214.24,"endTime":1217.93,"body":"screws in that in that fragment."},{"speaker":"Charles Goldfarb","startTime":1217.96,"endTime":1222.16,"body":"And again, to me, that is such a"},{"speaker":"Charles Goldfarb","startTime":1217.96,"endTime":1222.16,"body":"satisfying case."},{"speaker":"Chris Dy","startTime":1222.55,"endTime":1224.62,"body":"So walk me through"},{"speaker":"Chris Dy","startTime":1222.55,"endTime":1224.62,"body":"some of the technical details."},{"speaker":"Chris Dy","startTime":1224.65,"endTime":1227.71,"body":"So what size screws you're"},{"speaker":"Chris Dy","startTime":1224.65,"endTime":1227.71,"body":"using? How do you approach it?"},{"speaker":"Chris Dy","startTime":1228.01,"endTime":1231.25,"body":"And then do you do anything to"},{"speaker":"Chris Dy","startTime":1228.01,"endTime":1231.25,"body":"keep the joint blocked after"},{"speaker":"Chris Dy","startTime":1231.25,"endTime":1231.58,"body":"that?"},{"speaker":"Charles Goldfarb","startTime":1232.24,"endTime":1235.51,"body":"Yeah, so happy"},{"speaker":"Charles Goldfarb","startTime":1232.24,"endTime":1235.51,"body":"to and certainly what your"},{"speaker":"Charles Goldfarb","startTime":1235.51,"endTime":1238.66,"body":"opinion on some of these things."},{"speaker":"Charles Goldfarb","startTime":1235.51,"endTime":1238.66,"body":"So for me, it would be I when I"},{"speaker":"Charles Goldfarb","startTime":1238.66,"endTime":1241.75,"body":"approached the volar PIP joint"},{"speaker":"Charles Goldfarb","startTime":1238.66,"endTime":1241.75,"body":"more commonly for a joint"},{"speaker":"Charles Goldfarb","startTime":1241.75,"endTime":1245.62,"body":"release than for this fracture"},{"speaker":"Charles Goldfarb","startTime":1241.75,"endTime":1245.62,"body":"pattern. Specifically, I create"},{"speaker":"Charles Goldfarb","startTime":1245.62,"endTime":1250.93,"body":"a V incision. So oblique"},{"speaker":"Charles Goldfarb","startTime":1245.62,"endTime":1250.93,"body":"incision across the skin volarly"},{"speaker":"Charles Goldfarb","startTime":1250.96,"endTime":1255.37,"body":"over the proximal phalanx, and"},{"speaker":"Charles Goldfarb","startTime":1250.96,"endTime":1255.37,"body":"then oblique incision over the"},{"speaker":"Charles Goldfarb","startTime":1255.37,"endTime":1259.33,"body":"middle phalanx elevator, full"},{"speaker":"Charles Goldfarb","startTime":1255.37,"endTime":1259.33,"body":"thickness flap, protect the"},{"speaker":"Charles Goldfarb","startTime":1259.33,"endTime":1263.83,"body":"neurovascular bundles, and"},{"speaker":"Charles Goldfarb","startTime":1259.33,"endTime":1263.83,"body":"expose the sheath. And then I"},{"speaker":"Charles Goldfarb","startTime":1263.83,"endTime":1269.5,"body":"simply work between a two and a"},{"speaker":"Charles Goldfarb","startTime":1263.83,"endTime":1269.5,"body":"four. I retract the tendons, and"},{"speaker":"Charles Goldfarb","startTime":1269.5,"endTime":1271.84,"body":"you know, you're working more"},{"speaker":"Charles Goldfarb","startTime":1269.5,"endTime":1271.84,"body":"distally. You know, obviously, I"},{"speaker":"Charles Goldfarb","startTime":1271.84,"endTime":1275.62,"body":"stated that often you're doing"},{"speaker":"Charles Goldfarb","startTime":1271.84,"endTime":1275.62,"body":"this to expose and treat a volar"},{"speaker":"Charles Goldfarb","startTime":1275.62,"endTime":1278.53,"body":"plate contracture. So in those"},{"speaker":"Charles Goldfarb","startTime":1275.62,"endTime":1278.53,"body":"patients, I'm working proximally"},{"speaker":"Charles Goldfarb","startTime":1278.53,"endTime":1281.2,"body":"at the checkering ligaments,"},{"speaker":"Charles Goldfarb","startTime":1278.53,"endTime":1281.2,"body":"etc. In these cases, you're"},{"speaker":"Charles Goldfarb","startTime":1281.2,"endTime":1285.49,"body":"working distally. And so you"},{"speaker":"Charles Goldfarb","startTime":1281.2,"endTime":1285.49,"body":"have to really assess, you know,"},{"speaker":"Charles Goldfarb","startTime":1285.49,"endTime":1288.97,"body":"where the insertion of the FDS"},{"speaker":"Charles Goldfarb","startTime":1285.49,"endTime":1288.97,"body":"is more distal than we think."},{"speaker":"Charles Goldfarb","startTime":1289.36,"endTime":1293.53,"body":"And so it's more broad than we"},{"speaker":"Charles Goldfarb","startTime":1289.36,"endTime":1293.53,"body":"think. And so dealing with the"},{"speaker":"Charles Goldfarb","startTime":1293.53,"endTime":1297.85,"body":"FDS are working through FDS,"},{"speaker":"Charles Goldfarb","startTime":1293.53,"endTime":1297.85,"body":"using a dental pick, hopefully"},{"speaker":"Charles Goldfarb","startTime":1297.85,"endTime":1303.94,"body":"to obtain the reduction using"},{"speaker":"Charles Goldfarb","startTime":1297.85,"endTime":1303.94,"body":"temporary k wires to maintain a"},{"speaker":"Charles Goldfarb","startTime":1303.94,"endTime":1307.48,"body":"reduction while you check C-arm."},{"speaker":"Charles Goldfarb","startTime":1303.94,"endTime":1307.48,"body":"And then I would say typically,"},{"speaker":"Charles Goldfarb","startTime":1307.48,"endTime":1311.59,"body":"it's a 1.5 millimeter screws, so"},{"speaker":"Charles Goldfarb","startTime":1307.48,"endTime":1311.59,"body":"1.1 drill bit, 1.5 millimeter"},{"speaker":"Charles Goldfarb","startTime":1311.59,"endTime":1314.65,"body":"screws and two of them, do you"},{"speaker":"Charles Goldfarb","startTime":1311.59,"endTime":1314.65,"body":"think about it differently? Or"},{"speaker":"Charles Goldfarb","startTime":1314.65,"endTime":1315.49,"body":"does that resonate?"},{"speaker":"Chris Dy","startTime":1316.21,"endTime":1319.45,"body":"No, I, I've done it a"},{"speaker":"Chris Dy","startTime":1316.21,"endTime":1319.45,"body":"handful of times. And I think"},{"speaker":"Chris Dy","startTime":1319.45,"endTime":1322.45,"body":"about it the same way this this"},{"speaker":"Chris Dy","startTime":1319.45,"endTime":1322.45,"body":"just honestly doesn't come up as"},{"speaker":"Chris Dy","startTime":1322.45,"endTime":1325.66,"body":"much as as much maybe as it"},{"speaker":"Chris Dy","startTime":1322.45,"endTime":1325.66,"body":"comes up for you. Maybe it's"},{"speaker":"Chris Dy","startTime":1325.66,"endTime":1328.39,"body":"some of its patient population,"},{"speaker":"Chris Dy","startTime":1325.66,"endTime":1328.39,"body":"that kind of thing. But you"},{"speaker":"Chris Dy","startTime":1328.39,"endTime":1331.12,"body":"know, you and and Lindley Wall"},{"speaker":"Chris Dy","startTime":1328.39,"endTime":1331.12,"body":"actually does a fair bit of"},{"speaker":"Chris Dy","startTime":1331.6,"endTime":1335.74,"body":"fixing these, at least from what"},{"speaker":"Chris Dy","startTime":1331.6,"endTime":1335.74,"body":"she said. And you know, at it,"},{"speaker":"Chris Dy","startTime":1336.07,"endTime":1339.37,"body":"it looks like a great, very"},{"speaker":"Chris Dy","startTime":1336.07,"endTime":1339.37,"body":"satisfying procedure."},{"speaker":"Charles Goldfarb","startTime":1339.81,"endTime":1343.11,"body":"Oh, it is. And"},{"speaker":"Charles Goldfarb","startTime":1339.81,"endTime":1343.11,"body":"I think that led to an"},{"speaker":"Charles Goldfarb","startTime":1343.11,"endTime":1348.39,"body":"evolution. So what really makes"},{"speaker":"Charles Goldfarb","startTime":1343.11,"endTime":1348.39,"body":"me happy is when you watch"},{"speaker":"Charles Goldfarb","startTime":1348.39,"endTime":1354.45,"body":"really smart people process, how"},{"speaker":"Charles Goldfarb","startTime":1348.39,"endTime":1354.45,"body":"can we do something differently?"},{"speaker":"Charles Goldfarb","startTime":1354.66,"endTime":1358.47,"body":"And how can we advance our"},{"speaker":"Charles Goldfarb","startTime":1354.66,"endTime":1358.47,"body":"field. And so we've talked about"},{"speaker":"Charles Goldfarb","startTime":1358.47,"endTime":1361.05,"body":"that with other episodes, and"},{"speaker":"Charles Goldfarb","startTime":1358.47,"endTime":1361.05,"body":"we've had guests that have done"},{"speaker":"Charles Goldfarb","startTime":1361.05,"endTime":1365.25,"body":"just that. But Hill Hastings,"},{"speaker":"Charles Goldfarb","startTime":1361.05,"endTime":1365.25,"body":"who was at the Indiana Hand"},{"speaker":"Charles Goldfarb","startTime":1365.25,"endTime":1369.36,"body":"Center, did that for these"},{"speaker":"Charles Goldfarb","startTime":1365.25,"endTime":1369.36,"body":"fractures. And so I'm sure all"},{"speaker":"Charles Goldfarb","startTime":1369.36,"endTime":1372.93,"body":"the hand surgeons out there, and"},{"speaker":"Charles Goldfarb","startTime":1369.36,"endTime":1372.93,"body":"many of the residents know the"},{"speaker":"Charles Goldfarb","startTime":1372.93,"endTime":1379.68,"body":"Hemi hamate arthroplasty. And it"},{"speaker":"Charles Goldfarb","startTime":1372.93,"endTime":1379.68,"body":"is a really smart way to deal"},{"speaker":"Charles Goldfarb","startTime":1379.68,"endTime":1385.02,"body":"with chronic vo-you know, volar"},{"speaker":"Charles Goldfarb","startTime":1379.68,"endTime":1385.02,"body":"lip fractures are ones that are"},{"speaker":"Charles Goldfarb","startTime":1385.02,"endTime":1390.09,"body":"not re constructible. And man,"},{"speaker":"Charles Goldfarb","startTime":1385.02,"endTime":1390.09,"body":"it is really a smart procedure."},{"speaker":"Chris Dy","startTime":1391.05,"endTime":1392.91,"body":"Now, how many of those"},{"speaker":"Chris Dy","startTime":1391.05,"endTime":1392.91,"body":"Do you think you do a year?"},{"speaker":"Charles Goldfarb","startTime":1393.99,"endTime":1397.59,"body":"Not many, I"},{"speaker":"Charles Goldfarb","startTime":1393.99,"endTime":1397.59,"body":"would say to a year would be a"},{"speaker":"Charles Goldfarb","startTime":1397.59,"endTime":1401.97,"body":"good guess. Obviously everything"},{"speaker":"Charles Goldfarb","startTime":1397.59,"endTime":1401.97,"body":"comes in waves but to a year do"},{"speaker":"Charles Goldfarb","startTime":1401.97,"endTime":1405.06,"body":"you do or have you? Is that a"},{"speaker":"Charles Goldfarb","startTime":1401.97,"endTime":1405.06,"body":"part of your arsenal? Or is that"},{"speaker":"Charles Goldfarb","startTime":1405.06,"endTime":1406.11,"body":"one you might send on?"},{"speaker":"Chris Dy","startTime":1407.22,"endTime":1409.23,"body":"It's a part of the"},{"speaker":"Chris Dy","startTime":1407.22,"endTime":1409.23,"body":"arsenal The last time I did it"},{"speaker":"Chris Dy","startTime":1409.23,"endTime":1412.17,"body":"was actually on somebody who had"},{"speaker":"Chris Dy","startTime":1409.23,"endTime":1412.17,"body":"not succeeded with other"},{"speaker":"Chris Dy","startTime":1412.17,"endTime":1415.98,"body":"attempts at pinning and"},{"speaker":"Chris Dy","startTime":1412.17,"endTime":1415.98,"body":"everything else. And honestly,"},{"speaker":"Chris Dy","startTime":1415.98,"endTime":1419.25,"body":"that's what did the trick and it"},{"speaker":"Chris Dy","startTime":1415.98,"endTime":1419.25,"body":"was wonderful. It was very,"},{"speaker":"Chris Dy","startTime":1419.25,"endTime":1423.87,"body":"very, very satisfying. Maybe"},{"speaker":"Chris Dy","startTime":1419.25,"endTime":1423.87,"body":"think I should do this more. And"},{"speaker":"Chris Dy","startTime":1423.87,"endTime":1426.69,"body":"maybe the patient has other"},{"speaker":"Chris Dy","startTime":1423.87,"endTime":1426.69,"body":"patients with this issue. have"},{"speaker":"Chris Dy","startTime":1426.69,"endTime":1430.11,"body":"seen me more. But I haven't"},{"speaker":"Chris Dy","startTime":1426.69,"endTime":1430.11,"body":"pulled the trigger on it."},{"speaker":"Charles Goldfarb","startTime":1430.14,"endTime":1432.72,"body":"Yeah. Is this"},{"speaker":"Charles Goldfarb","startTime":1430.14,"endTime":1432.72,"body":"an example? And I think you're"},{"speaker":"Charles Goldfarb","startTime":1432.75,"endTime":1436.95,"body":"what you just said is exactly"},{"speaker":"Charles Goldfarb","startTime":1432.75,"endTime":1436.95,"body":"right. You it can be such a home"},{"speaker":"Charles Goldfarb","startTime":1436.95,"endTime":1441.33,"body":"run, that you look to broaden"},{"speaker":"Charles Goldfarb","startTime":1436.95,"endTime":1441.33,"body":"your indications. And I have to"},{"speaker":"Charles Goldfarb","startTime":1441.33,"endTime":1444.81,"body":"say it's not always a home run."},{"speaker":"Charles Goldfarb","startTime":1441.33,"endTime":1444.81,"body":"And you know, our partner Marty"},{"speaker":"Charles Goldfarb","startTime":1444.81,"endTime":1447.66,"body":"Boyer has, as he would say,"},{"speaker":"Charles Goldfarb","startTime":1444.81,"endTime":1447.66,"body":"can't can't regularly make it"},{"speaker":"Charles Goldfarb","startTime":1447.66,"endTime":1450.93,"body":"work. And so you have to be"},{"speaker":"Charles Goldfarb","startTime":1447.66,"endTime":1450.93,"body":"careful about the indications."},{"speaker":"Charles Goldfarb","startTime":1451.11,"endTime":1455.1,"body":"And really you have to be"},{"speaker":"Charles Goldfarb","startTime":1451.11,"endTime":1455.1,"body":"careful about the carpentry. And"},{"speaker":"Charles Goldfarb","startTime":1455.1,"endTime":1457.29,"body":"that's what's fun about this"},{"speaker":"Charles Goldfarb","startTime":1455.1,"endTime":1457.29,"body":"case, but that's also what's"},{"speaker":"Charles Goldfarb","startTime":1457.29,"endTime":1458.67,"body":"challenging about this case."},{"speaker":"Chris Dy","startTime":1459.9,"endTime":1462.24,"body":"Yes, definitely high"},{"speaker":"Chris Dy","startTime":1459.9,"endTime":1462.24,"body":"risk, high reward. I remember"},{"speaker":"Chris Dy","startTime":1462.24,"endTime":1465.21,"body":"the first one of these that I"},{"speaker":"Chris Dy","startTime":1462.24,"endTime":1465.21,"body":"booked out of training, I had"},{"speaker":"Chris Dy","startTime":1465.21,"endTime":1469.26,"body":"one of our partners scrub with"},{"speaker":"Chris Dy","startTime":1465.21,"endTime":1469.26,"body":"me on it. And I felt much better"},{"speaker":"Chris Dy","startTime":1469.26,"endTime":1471.54,"body":"because that partner said, You"},{"speaker":"Chris Dy","startTime":1469.26,"endTime":1471.54,"body":"know what, let's just do the"},{"speaker":"Chris Dy","startTime":1471.54,"endTime":1475.17,"body":"volar plate arthroplasty he"},{"speaker":"Chris Dy","startTime":1471.54,"endTime":1475.17,"body":"couldn't make it work. So it"},{"speaker":"Chris Dy","startTime":1475.17,"endTime":1478.02,"body":"made me feel a little better to"},{"speaker":"Chris Dy","startTime":1475.17,"endTime":1478.02,"body":"know that somebody who I"},{"speaker":"Chris Dy","startTime":1478.02,"endTime":1480.51,"body":"consider a very good technical"},{"speaker":"Chris Dy","startTime":1478.02,"endTime":1480.51,"body":"surgeon was also quite humbled"},{"speaker":"Chris Dy","startTime":1480.51,"endTime":1481.14,"body":"by this."},{"speaker":"Charles Goldfarb","startTime":1481.35,"endTime":1484.38,"body":"Yes. And that"},{"speaker":"Charles Goldfarb","startTime":1481.35,"endTime":1484.38,"body":"can absolutely happen. The volar"},{"speaker":"Charles Goldfarb","startTime":1484.38,"endTime":1487.02,"body":"plate arthroplasty is"},{"speaker":"Charles Goldfarb","startTime":1484.38,"endTime":1487.02,"body":"interesting. And I would say"},{"speaker":"Charles Goldfarb","startTime":1487.02,"endTime":1490.47,"body":"largely that's one for the"},{"speaker":"Charles Goldfarb","startTime":1487.02,"endTime":1490.47,"body":"history books and I'm guessing"},{"speaker":"Charles Goldfarb","startTime":1490.71,"endTime":1493.5,"body":"that most of the younger folks"},{"speaker":"Charles Goldfarb","startTime":1490.71,"endTime":1493.5,"body":"out there haven't done that"},{"speaker":"Charles Goldfarb","startTime":1493.5,"endTime":1497.25,"body":"procedure is not part of"},{"speaker":"Charles Goldfarb","startTime":1493.5,"endTime":1497.25,"body":"residency training for most of"},{"speaker":"Charles Goldfarb","startTime":1497.25,"endTime":1501.51,"body":"us or fellowship training in"},{"speaker":"Charles Goldfarb","startTime":1497.25,"endTime":1501.51,"body":"That's another procedure. It's"},{"speaker":"Charles Goldfarb","startTime":1501.51,"endTime":1503.91,"body":"just so interesting. When"},{"speaker":"Charles Goldfarb","startTime":1501.51,"endTime":1503.91,"body":"procedures aren't done"},{"speaker":"Charles Goldfarb","startTime":1503.91,"endTime":1507.69,"body":"regularly, you don't learn the"},{"speaker":"Charles Goldfarb","startTime":1503.91,"endTime":1507.69,"body":"nuances. And so it becomes"},{"speaker":"Charles Goldfarb","startTime":1507.69,"endTime":1511.53,"body":"harder to use it as a bailout"},{"speaker":"Charles Goldfarb","startTime":1507.69,"endTime":1511.53,"body":"down the road. And so, you know,"},{"speaker":"Charles Goldfarb","startTime":1511.86,"endTime":1515.28,"body":"I haven't done that many of that"},{"speaker":"Charles Goldfarb","startTime":1511.86,"endTime":1515.28,"body":"procedure, and it's really not"},{"speaker":"Charles Goldfarb","startTime":1515.28,"endTime":1516.0,"body":"in my arsenal."},{"speaker":"Chris Dy","startTime":1517.08,"endTime":1519.75,"body":"Well, it's a procedure"},{"speaker":"Chris Dy","startTime":1517.08,"endTime":1519.75,"body":"you don't do until you have to"},{"speaker":"Chris Dy","startTime":1519.75,"endTime":1522.81,"body":"do it. Like you're saying it's a"},{"speaker":"Chris Dy","startTime":1519.75,"endTime":1522.81,"body":"bailout. And, you know, it's"},{"speaker":"Chris Dy","startTime":1522.81,"endTime":1526.35,"body":"certainly, like you I call I go"},{"speaker":"Chris Dy","startTime":1522.81,"endTime":1526.35,"body":"into the OR with, you know, Plan"},{"speaker":"Chris Dy","startTime":1526.38,"endTime":1529.65,"body":"A through F for some of these"},{"speaker":"Chris Dy","startTime":1526.38,"endTime":1529.65,"body":"cases, and it's certainly not"},{"speaker":"Chris Dy","startTime":1529.65,"endTime":1531.87,"body":"the one at the top, but"},{"speaker":"Chris Dy","startTime":1529.65,"endTime":1531.87,"body":"sometimes it gets pulled out."},{"speaker":"Charles Goldfarb","startTime":1532.47,"endTime":1535.89,"body":"But if you"},{"speaker":"Charles Goldfarb","startTime":1532.47,"endTime":1535.89,"body":"were considering it, would you"},{"speaker":"Charles Goldfarb","startTime":1535.89,"endTime":1540.63,"body":"be more likely to consider"},{"speaker":"Charles Goldfarb","startTime":1535.89,"endTime":1540.63,"body":"traction device as opposed to a"},{"speaker":"Charles Goldfarb","startTime":1540.63,"endTime":1541.8,"body":"volar plate arthroplasty?"},{"speaker":"Chris Dy","startTime":1542.58,"endTime":1546.39,"body":"I think so. But I, you"},{"speaker":"Chris Dy","startTime":1542.58,"endTime":1546.39,"body":"know, I, so a traction devices."},{"speaker":"Chris Dy","startTime":1546.39,"endTime":1551.88,"body":"Another thing that I think we as"},{"speaker":"Chris Dy","startTime":1546.39,"endTime":1551.88,"body":"surgeons find is very cool. But"},{"speaker":"Chris Dy","startTime":1551.88,"endTime":1554.25,"body":"I'm not convinced that patients"},{"speaker":"Chris Dy","startTime":1551.88,"endTime":1554.25,"body":"love it as much as we think they"},{"speaker":"Chris Dy","startTime":1554.25,"endTime":1554.55,"body":"do."},{"speaker":"Charles Goldfarb","startTime":1555.41,"endTime":1557.93,"body":"I think that's"},{"speaker":"Charles Goldfarb","startTime":1555.41,"endTime":1557.93,"body":"an understatement. I think"},{"speaker":"Charles Goldfarb","startTime":1557.93,"endTime":1561.65,"body":"you've got to be held to wear"},{"speaker":"Charles Goldfarb","startTime":1557.93,"endTime":1561.65,"body":"that thing for six weeks. But it"},{"speaker":"Charles Goldfarb","startTime":1561.65,"endTime":1562.37,"body":"is cool."},{"speaker":"Chris Dy","startTime":1563.12,"endTime":1565.55,"body":"I mean, it's it's a"},{"speaker":"Chris Dy","startTime":1563.12,"endTime":1565.55,"body":"technical triumph. And it's"},{"speaker":"Chris Dy","startTime":1565.55,"endTime":1570.86,"body":"incredible that the whole thing"},{"speaker":"Chris Dy","startTime":1565.55,"endTime":1570.86,"body":"costs like 30 cents. And it"},{"speaker":"Chris Dy","startTime":1570.86,"endTime":1574.37,"body":"works. If you purely Think of it"},{"speaker":"Chris Dy","startTime":1570.86,"endTime":1574.37,"body":"as stabilizing the joint"},{"speaker":"Chris Dy","startTime":1574.4,"endTime":1577.64,"body":"maintaining some element of"},{"speaker":"Chris Dy","startTime":1574.4,"endTime":1577.64,"body":"motion, I guess you could argue"},{"speaker":"Chris Dy","startTime":1577.64,"endTime":1581.03,"body":"as to how much people actually"},{"speaker":"Chris Dy","startTime":1577.64,"endTime":1581.03,"body":"move with that thing on. I think"},{"speaker":"Chris Dy","startTime":1581.03,"endTime":1583.88,"body":"this comes down to patient"},{"speaker":"Chris Dy","startTime":1581.03,"endTime":1583.88,"body":"selection. It's fracture"},{"speaker":"Chris Dy","startTime":1583.88,"endTime":1586.76,"body":"selection, but then also the the"},{"speaker":"Chris Dy","startTime":1583.88,"endTime":1586.76,"body":"has to be the right patient."},{"speaker":"Charles Goldfarb","startTime":1587.3,"endTime":1589.34,"body":"Totally agree."},{"speaker":"Charles Goldfarb","startTime":1587.3,"endTime":1589.34,"body":"That's Well said. And that's"},{"speaker":"Charles Goldfarb","startTime":1589.34,"endTime":1592.97,"body":"really important. That has to be"},{"speaker":"Charles Goldfarb","startTime":1589.34,"endTime":1592.97,"body":"a patient who understands what"},{"speaker":"Charles Goldfarb","startTime":1592.97,"endTime":1595.82,"body":"they're signing up for."},{"speaker":"Charles Goldfarb","startTime":1592.97,"endTime":1595.82,"body":"understands that, hey, this is"},{"speaker":"Charles Goldfarb","startTime":1595.82,"endTime":1598.58,"body":"probably not our first choice."},{"speaker":"Charles Goldfarb","startTime":1595.82,"endTime":1598.58,"body":"But we're picking this because"},{"speaker":"Charles Goldfarb","startTime":1598.76,"endTime":1602.0,"body":"we we need to do something"},{"speaker":"Charles Goldfarb","startTime":1598.76,"endTime":1602.0,"body":"unusual to stabilize this"},{"speaker":"Charles Goldfarb","startTime":1602.0,"endTime":1603.95,"body":"fracture is definitely never my"},{"speaker":"Charles Goldfarb","startTime":1602.0,"endTime":1603.95,"body":"first choice."},{"speaker":"Chris Dy","startTime":1604.82,"endTime":1607.13,"body":"Yeah, it's kind of a"},{"speaker":"Chris Dy","startTime":1604.82,"endTime":1607.13,"body":"weird thing to try to explain to"},{"speaker":"Chris Dy","startTime":1607.13,"endTime":1612.56,"body":"somebody during the preoperative"},{"speaker":"Chris Dy","startTime":1607.13,"endTime":1612.56,"body":"discussion. I always make the"},{"speaker":"Chris Dy","startTime":1612.56,"endTime":1614.72,"body":"joke that they're going to have"},{"speaker":"Chris Dy","startTime":1612.56,"endTime":1614.72,"body":"great TV reception. But I think"},{"speaker":"Chris Dy","startTime":1614.72,"endTime":1618.2,"body":"that's getting lost on my"},{"speaker":"Chris Dy","startTime":1614.72,"endTime":1618.2,"body":"generation and younger."},{"speaker":"Charles Goldfarb","startTime":1618.3,"endTime":1620.58,"body":"Oh, it's so"},{"speaker":"Charles Goldfarb","startTime":1618.3,"endTime":1620.58,"body":"funny, because I did that. I"},{"speaker":"Charles Goldfarb","startTime":1620.58,"endTime":1622.65,"body":"don't think I told you the"},{"speaker":"Charles Goldfarb","startTime":1620.58,"endTime":1622.65,"body":"story. So I'm sitting at"},{"speaker":"Charles Goldfarb","startTime":1622.65,"endTime":1625.41,"body":"Children's Hospital and I'm"},{"speaker":"Charles Goldfarb","startTime":1622.65,"endTime":1625.41,"body":"talking to a six year old"},{"speaker":"Charles Goldfarb","startTime":1625.41,"endTime":1628.5,"body":"patient and I go, yeah, we're"},{"speaker":"Charles Goldfarb","startTime":1625.41,"endTime":1628.5,"body":"gonna get the fracture reduced"},{"speaker":"Charles Goldfarb","startTime":1628.5,"endTime":1630.93,"body":"and put a couple pins in, it'll"},{"speaker":"Charles Goldfarb","startTime":1628.5,"endTime":1630.93,"body":"look like you have an antenna."},{"speaker":"Charles Goldfarb","startTime":1631.35,"endTime":1634.77,"body":"And I go, Oh, my God, you don't"},{"speaker":"Charles Goldfarb","startTime":1631.35,"endTime":1634.77,"body":"know what an antenna is. And he"},{"speaker":"Charles Goldfarb","startTime":1634.77,"endTime":1638.1,"body":"goes, of course, I know what an"},{"speaker":"Charles Goldfarb","startTime":1634.77,"endTime":1638.1,"body":"antenna is. I'm like, how do you"},{"speaker":"Charles Goldfarb","startTime":1638.1,"endTime":1641.01,"body":"know what an antenna is? He's"},{"speaker":"Charles Goldfarb","startTime":1638.1,"endTime":1641.01,"body":"like, yeah, it's on a little"},{"speaker":"Charles Goldfarb","startTime":1641.01,"endTime":1644.01,"body":"bug. It's the little things"},{"speaker":"Charles Goldfarb","startTime":1641.01,"endTime":1644.01,"body":"coming out of his head. I'm"},{"speaker":"Charles Goldfarb","startTime":1644.01,"endTime":1647.16,"body":"like, Yes, it is. Of course it"},{"speaker":"Charles Goldfarb","startTime":1644.01,"endTime":1647.16,"body":"is."},{"speaker":"Chris Dy","startTime":1647.67,"endTime":1652.23,"body":"Wow, wow. Wow. That's"},{"speaker":"Chris Dy","startTime":1647.67,"endTime":1652.23,"body":"pretty awesome. Yeah, I've"},{"speaker":"Chris Dy","startTime":1652.23,"endTime":1656.43,"body":"noticed that the references I'm"},{"speaker":"Chris Dy","startTime":1652.23,"endTime":1656.43,"body":"making are getting lost upon the"},{"speaker":"Chris Dy","startTime":1656.46,"endTime":1659.01,"body":"the medical students already so"},{"speaker":"Chris Dy","startTime":1656.46,"endTime":1659.01,"body":"you can't you can't make"},{"speaker":"Chris Dy","startTime":1659.01,"endTime":1662.01,"body":"Seinfeld references anyways,"},{"speaker":"Chris Dy","startTime":1659.01,"endTime":1662.01,"body":"nobody gets those. It's got to"},{"speaker":"Chris Dy","startTime":1662.01,"endTime":1663.33,"body":"be Friends. Friends and newer."},{"speaker":"Charles Goldfarb","startTime":1663.48,"endTime":1665.52,"body":"And that's a"},{"speaker":"Charles Goldfarb","startTime":1663.48,"endTime":1665.52,"body":"loss. The other one I use, and I"},{"speaker":"Charles Goldfarb","startTime":1665.52,"endTime":1668.52,"body":"always kind of, kind of, you"},{"speaker":"Charles Goldfarb","startTime":1665.52,"endTime":1668.52,"body":"know, tilt my head to see if"},{"speaker":"Charles Goldfarb","startTime":1668.52,"endTime":1671.25,"body":"they get it is the give me a"},{"speaker":"Charles Goldfarb","startTime":1668.52,"endTime":1671.25,"body":"give me a hit. You know, show me"},{"speaker":"Charles Goldfarb","startTime":1671.25,"endTime":1673.32,"body":"what you do when you hitchhike,"},{"speaker":"Charles Goldfarb","startTime":1671.25,"endTime":1673.32,"body":"you know, like, give me a thumbs"},{"speaker":"Charles Goldfarb","startTime":1673.32,"endTime":1675.84,"body":"up like you're hitchhiking. And"},{"speaker":"Charles Goldfarb","startTime":1673.32,"endTime":1675.84,"body":"sometimes I get a what?"},{"speaker":"Chris Dy","startTime":1677.58,"endTime":1679.95,"body":"Yeah, why would you"},{"speaker":"Chris Dy","startTime":1677.58,"endTime":1679.95,"body":"hitchhike when there's Uber and"},{"speaker":"Chris Dy","startTime":1679.95,"endTime":1681.72,"body":"Lyft and every other ridesharing"},{"speaker":"Chris Dy","startTime":1679.95,"endTime":1681.72,"body":"platform."},{"speaker":"Charles Goldfarb","startTime":1681.78,"endTime":1684.84,"body":"Yeah that went"},{"speaker":"Charles Goldfarb","startTime":1681.78,"endTime":1684.84,"body":"away when the serial killer"},{"speaker":"Charles Goldfarb","startTime":1685.38,"endTime":1686.31,"body":"movies came out."},{"speaker":"Chris Dy","startTime":1688.13,"endTime":1692.54,"body":"Exactly. So dynamic ex"},{"speaker":"Chris Dy","startTime":1688.13,"endTime":1692.54,"body":"fix. You know I found these to"},{"speaker":"Chris Dy","startTime":1692.54,"endTime":1697.22,"body":"be a little challenging every"},{"speaker":"Chris Dy","startTime":1692.54,"endTime":1697.22,"body":"time that I plan on doing it, I"},{"speaker":"Chris Dy","startTime":1697.43,"endTime":1700.88,"body":"want to bring the paper myself"},{"speaker":"Chris Dy","startTime":1697.43,"endTime":1700.88,"body":"put it up in the OR I make the"},{"speaker":"Chris Dy","startTime":1700.88,"endTime":1704.84,"body":"resident be ready to put it up"},{"speaker":"Chris Dy","startTime":1700.88,"endTime":1704.84,"body":"in the OR draw it out, have all"},{"speaker":"Chris Dy","startTime":1704.84,"endTime":1708.08,"body":"the wires ready and know exactly"},{"speaker":"Chris Dy","startTime":1704.84,"endTime":1708.08,"body":"how to do it. Because this can"},{"speaker":"Chris Dy","startTime":1708.08,"endTime":1711.56,"body":"be relatively straightforward,"},{"speaker":"Chris Dy","startTime":1708.08,"endTime":1711.56,"body":"or can be very frustrating for"},{"speaker":"Chris Dy","startTime":1711.56,"endTime":1714.77,"body":"like, God, I got to put the band"},{"speaker":"Chris Dy","startTime":1711.56,"endTime":1714.77,"body":"here and put this little s band"},{"speaker":"Chris Dy","startTime":1714.77,"endTime":1716.54,"body":"and that's not that's not"},{"speaker":"Chris Dy","startTime":1714.77,"endTime":1716.54,"body":"exactly fun."},{"speaker":"Charles Goldfarb","startTime":1717.32,"endTime":1719.87,"body":"I think it is"},{"speaker":"Charles Goldfarb","startTime":1717.32,"endTime":1719.87,"body":"personality driven. Some people"},{"speaker":"Charles Goldfarb","startTime":1719.87,"endTime":1724.82,"body":"enjoy the fiddle factor. That's"},{"speaker":"Charles Goldfarb","startTime":1719.87,"endTime":1724.82,"body":"not really my strong suit. I not"},{"speaker":"Charles Goldfarb","startTime":1724.82,"endTime":1729.23,"body":"a big Fiddler. Again, it can be"},{"speaker":"Charles Goldfarb","startTime":1724.82,"endTime":1729.23,"body":"a really satisfying procedure if"},{"speaker":"Charles Goldfarb","startTime":1729.23,"endTime":1732.26,"body":"you're able to reduce the joint"},{"speaker":"Charles Goldfarb","startTime":1729.23,"endTime":1732.26,"body":"apply the traction, and you"},{"speaker":"Charles Goldfarb","startTime":1732.26,"endTime":1737.06,"body":"know, allow even motion. But I"},{"speaker":"Charles Goldfarb","startTime":1732.26,"endTime":1737.06,"body":"have to say it's not one of my"},{"speaker":"Charles Goldfarb","startTime":1737.06,"endTime":1738.56,"body":"top 10 favorite procedures."},{"speaker":"Chris Dy","startTime":1738.98,"endTime":1741.53,"body":"How much do people how"},{"speaker":"Chris Dy","startTime":1738.98,"endTime":1741.53,"body":"much do people move when they"},{"speaker":"Chris Dy","startTime":1741.53,"endTime":1743.54,"body":"actually and this will not be"},{"speaker":"Chris Dy","startTime":1741.53,"endTime":1743.54,"body":"good for one of our therapy"},{"speaker":"Chris Dy","startTime":1743.54,"endTime":1746.87,"body":"colleagues to let us know? Do"},{"speaker":"Chris Dy","startTime":1743.54,"endTime":1746.87,"body":"they actually move?"},{"speaker":"Charles Goldfarb","startTime":1747.95,"endTime":1749.84,"body":"I think this"},{"speaker":"Charles Goldfarb","startTime":1747.95,"endTime":1749.84,"body":"is a great guest episode or"},{"speaker":"Charles Goldfarb","startTime":1749.84,"endTime":1753.8,"body":"maybe guest and they're about"},{"speaker":"Charles Goldfarb","startTime":1749.84,"endTime":1753.8,"body":"both a surgeon and a therapist"},{"speaker":"Charles Goldfarb","startTime":1753.8,"endTime":1757.82,"body":"who loved this procedure to"},{"speaker":"Charles Goldfarb","startTime":1753.8,"endTime":1757.82,"body":"really talk through the nuances"},{"speaker":"Charles Goldfarb","startTime":1757.82,"endTime":1761.12,"body":"of applying that fixator"},{"speaker":"Charles Goldfarb","startTime":1757.82,"endTime":1761.12,"body":"correctly. I think they moved"},{"speaker":"Charles Goldfarb","startTime":1761.12,"endTime":1764.15,"body":"some but I think you're looking"},{"speaker":"Charles Goldfarb","startTime":1761.12,"endTime":1764.15,"body":"at a limited arc of 45 degrees"},{"speaker":"Charles Goldfarb","startTime":1764.15,"endTime":1765.86,"body":"or something. I don't think"},{"speaker":"Charles Goldfarb","startTime":1764.15,"endTime":1765.86,"body":"they're getting much more than"},{"speaker":"Charles Goldfarb","startTime":1765.86,"endTime":1767.54,"body":"that. But hey, it's a Head"},{"speaker":"Charles Goldfarb","startTime":1765.86,"endTime":1767.54,"body":"Start."},{"speaker":"Chris Dy","startTime":1768.05,"endTime":1770.42,"body":"So do you think that"},{"speaker":"Chris Dy","startTime":1768.05,"endTime":1770.42,"body":"they move more than if you do"},{"speaker":"Chris Dy","startTime":1770.42,"endTime":1774.05,"body":"just a dorsal blocking pin to"},{"speaker":"Chris Dy","startTime":1770.42,"endTime":1774.05,"body":"kind of stabilize things and"},{"speaker":"Chris Dy","startTime":1774.05,"endTime":1776.27,"body":"they just move within that arc"},{"speaker":"Chris Dy","startTime":1774.05,"endTime":1776.27,"body":"that the dorsal blocking pin"},{"speaker":"Chris Dy","startTime":1776.27,"endTime":1776.78,"body":"allows?"},{"speaker":"Charles Goldfarb","startTime":1777.44,"endTime":1779.57,"body":"So we haven't"},{"speaker":"Charles Goldfarb","startTime":1777.44,"endTime":1779.57,"body":"mentioned the dorsal block pin."},{"speaker":"Charles Goldfarb","startTime":1779.57,"endTime":1781.85,"body":"I'm glad you brought that up. I"},{"speaker":"Charles Goldfarb","startTime":1779.57,"endTime":1781.85,"body":"mean, most people think of that"},{"speaker":"Charles Goldfarb","startTime":1781.85,"endTime":1785.6,"body":"dorsal blocking pin into the"},{"speaker":"Charles Goldfarb","startTime":1781.85,"endTime":1785.6,"body":"head of the proximal phalanx to"},{"speaker":"Charles Goldfarb","startTime":1785.6,"endTime":1789.05,"body":"really create almost a dorsal"},{"speaker":"Charles Goldfarb","startTime":1785.6,"endTime":1789.05,"body":"block splint but a little more"},{"speaker":"Charles Goldfarb","startTime":1789.05,"endTime":1792.17,"body":"rigid. Most people think about"},{"speaker":"Charles Goldfarb","startTime":1789.05,"endTime":1792.17,"body":"that for a mallet fracture, but"},{"speaker":"Charles Goldfarb","startTime":1792.17,"endTime":1796.58,"body":"it can have a role here. And I"},{"speaker":"Charles Goldfarb","startTime":1792.17,"endTime":1796.58,"body":"do think it can be appropriate I"},{"speaker":"Charles Goldfarb","startTime":1796.58,"endTime":1800.21,"body":"think, you know, given the"},{"speaker":"Charles Goldfarb","startTime":1796.58,"endTime":1800.21,"body":"severity of the fracture sure"},{"speaker":"Charles Goldfarb","startTime":1800.21,"endTime":1804.08,"body":"that we would consider the"},{"speaker":"Charles Goldfarb","startTime":1800.21,"endTime":1804.08,"body":"dynamic ex fix for, I think they"},{"speaker":"Charles Goldfarb","startTime":1804.08,"endTime":1806.39,"body":"move pretty well, I'm not sure"},{"speaker":"Charles Goldfarb","startTime":1804.08,"endTime":1806.39,"body":"which ones more. But I think"},{"speaker":"Charles Goldfarb","startTime":1806.42,"endTime":1809.81,"body":"given again, the severity, I"},{"speaker":"Charles Goldfarb","startTime":1806.42,"endTime":1809.81,"body":"think they can they can move"},{"speaker":"Charles Goldfarb","startTime":1809.81,"endTime":1813.74,"body":"reasonably well in the traction."},{"speaker":"Charles Goldfarb","startTime":1809.81,"endTime":1813.74,"body":"And then once you get the fixer"},{"speaker":"Charles Goldfarb","startTime":1813.74,"endTime":1816.53,"body":"off, I think we can, it can"},{"speaker":"Charles Goldfarb","startTime":1813.74,"endTime":1816.53,"body":"really be a nice Head Start."},{"speaker":"Chris Dy","startTime":1817.49,"endTime":1819.95,"body":"So to bring things to"},{"speaker":"Chris Dy","startTime":1817.49,"endTime":1819.95,"body":"a close, how do you manage the"},{"speaker":"Chris Dy","startTime":1819.95,"endTime":1823.58,"body":"Pilon fracture differently than"},{"speaker":"Chris Dy","startTime":1819.95,"endTime":1823.58,"body":"you would say, the volar lip"},{"speaker":"Chris Dy","startTime":1823.64,"endTime":1825.71,"body":"fracture with the associated"},{"speaker":"Chris Dy","startTime":1823.64,"endTime":1825.71,"body":"dislocation?"},{"speaker":"Charles Goldfarb","startTime":1826.73,"endTime":1829.28,"body":"Well, I"},{"speaker":"Charles Goldfarb","startTime":1826.73,"endTime":1829.28,"body":"certainly Pilons come in all"},{"speaker":"Charles Goldfarb","startTime":1829.28,"endTime":1834.62,"body":"varieties, but I think it's"},{"speaker":"Charles Goldfarb","startTime":1829.28,"endTime":1834.62,"body":"becomes more difficult to think"},{"speaker":"Charles Goldfarb","startTime":1834.62,"endTime":1838.01,"body":"about fixation of the fragments."},{"speaker":"Charles Goldfarb","startTime":1834.62,"endTime":1838.01,"body":"So you know, if there's a dorsal"},{"speaker":"Charles Goldfarb","startTime":1838.01,"endTime":1841.34,"body":"fragment and a volar, fracture"},{"speaker":"Charles Goldfarb","startTime":1838.01,"endTime":1841.34,"body":"fragment, and then you have that"},{"speaker":"Charles Goldfarb","startTime":1841.34,"endTime":1846.14,"body":"kind of intact central area,"},{"speaker":"Charles Goldfarb","startTime":1841.34,"endTime":1846.14,"body":"traction makes a lot of sense."},{"speaker":"Charles Goldfarb","startTime":1846.35,"endTime":1848.75,"body":"And so sometimes you can get"},{"speaker":"Charles Goldfarb","startTime":1846.35,"endTime":1848.75,"body":"away with a percutaneous"},{"speaker":"Charles Goldfarb","startTime":1848.75,"endTime":1854.24,"body":"fixation. But I think the real"},{"speaker":"Charles Goldfarb","startTime":1848.75,"endTime":1854.24,"body":"Pilon is the one for me, at"},{"speaker":"Charles Goldfarb","startTime":1854.24,"endTime":1856.76,"body":"least, that makes the most sense"},{"speaker":"Charles Goldfarb","startTime":1854.24,"endTime":1856.76,"body":"for dynamic traction."},{"speaker":"Chris Dy","startTime":1857.84,"endTime":1860.69,"body":"So when we talk about"},{"speaker":"Chris Dy","startTime":1857.84,"endTime":1860.69,"body":"Pilon fractures, you know, just"},{"speaker":"Chris Dy","startTime":1860.69,"endTime":1862.73,"body":"for those, you know, that may"},{"speaker":"Chris Dy","startTime":1860.69,"endTime":1862.73,"body":"not be as familiar, we're"},{"speaker":"Chris Dy","startTime":1862.73,"endTime":1865.07,"body":"talking about a fracture, that's"},{"speaker":"Chris Dy","startTime":1862.73,"endTime":1865.07,"body":"essentially an impaction"},{"speaker":"Chris Dy","startTime":1865.07,"endTime":1867.98,"body":"fracture to the cartilage"},{"speaker":"Chris Dy","startTime":1865.07,"endTime":1867.98,"body":"surface of the base of the"},{"speaker":"Chris Dy","startTime":1867.98,"endTime":1872.18,"body":"middle phalanx splitting that"},{"speaker":"Chris Dy","startTime":1867.98,"endTime":1872.18,"body":"middle phalanx space into two or"},{"speaker":"Chris Dy","startTime":1872.18,"endTime":1876.02,"body":"more pieces. So like Chuck said,"},{"speaker":"Chris Dy","startTime":1872.18,"endTime":1876.02,"body":"a large kind of dorsal piece,"},{"speaker":"Chris Dy","startTime":1876.02,"endTime":1878.3,"body":"and then a large kind of volar"},{"speaker":"Chris Dy","startTime":1876.02,"endTime":1878.3,"body":"piece, and maybe some"},{"speaker":"Chris Dy","startTime":1878.3,"endTime":1879.77,"body":"combination in between."},{"speaker":"Charles Goldfarb","startTime":1879.84,"endTime":1881.52,"body":"Yeah, and I"},{"speaker":"Charles Goldfarb","startTime":1879.84,"endTime":1881.52,"body":"think it's really important to"},{"speaker":"Charles Goldfarb","startTime":1881.52,"endTime":1884.91,"body":"emphasize as much as we try to"},{"speaker":"Charles Goldfarb","startTime":1881.52,"endTime":1884.91,"body":"treat these closed, because you"},{"speaker":"Charles Goldfarb","startTime":1884.91,"endTime":1889.29,"body":"know, with, with multiple"},{"speaker":"Charles Goldfarb","startTime":1884.91,"endTime":1889.29,"body":"fragments, you can get yourself"},{"speaker":"Charles Goldfarb","startTime":1889.29,"endTime":1891.84,"body":"in a world of hurt very quickly,"},{"speaker":"Charles Goldfarb","startTime":1889.29,"endTime":1891.84,"body":"if you try to go in and piece"},{"speaker":"Charles Goldfarb","startTime":1891.84,"endTime":1894.84,"body":"everything back together. Now,"},{"speaker":"Charles Goldfarb","startTime":1891.84,"endTime":1894.84,"body":"there's a role for piecing"},{"speaker":"Charles Goldfarb","startTime":1894.84,"endTime":1899.25,"body":"everything back together. But"},{"speaker":"Charles Goldfarb","startTime":1894.84,"endTime":1899.25,"body":"often, what we do, whether"},{"speaker":"Charles Goldfarb","startTime":1899.25,"endTime":1903.0,"body":"you're treating this with an"},{"speaker":"Charles Goldfarb","startTime":1899.25,"endTime":1903.0,"body":"traction or a couple of pins, is"},{"speaker":"Charles Goldfarb","startTime":1903.0,"endTime":1906.24,"body":"you can elevate the fracture"},{"speaker":"Charles Goldfarb","startTime":1903.0,"endTime":1906.24,"body":"fragment to try to create a"},{"speaker":"Charles Goldfarb","startTime":1906.24,"endTime":1910.29,"body":"concentric join again, and then"},{"speaker":"Charles Goldfarb","startTime":1906.24,"endTime":1910.29,"body":"support the you know, the"},{"speaker":"Charles Goldfarb","startTime":1910.29,"endTime":1912.96,"body":"fracture, however you do it"},{"speaker":"Charles Goldfarb","startTime":1910.29,"endTime":1912.96,"body":"again, with K wires or with a"},{"speaker":"Charles Goldfarb","startTime":1913.08,"endTime":1914.07,"body":"traction setup."},{"speaker":"Chris Dy","startTime":1915.11,"endTime":1917.63,"body":"Like you said that the"},{"speaker":"Chris Dy","startTime":1915.11,"endTime":1917.63,"body":"base of that middle phalanx is"},{"speaker":"Chris Dy","startTime":1917.63,"endTime":1920.72,"body":"somewhat forgiving in terms of"},{"speaker":"Chris Dy","startTime":1917.63,"endTime":1920.72,"body":"the remodeling. So that is"},{"speaker":"Chris Dy","startTime":1921.02,"endTime":1923.42,"body":"helpful. You don't have to have"},{"speaker":"Chris Dy","startTime":1921.02,"endTime":1923.42,"body":"it absolutely perfect. You just"},{"speaker":"Chris Dy","startTime":1923.42,"endTime":1927.41,"body":"need something that you can flex"},{"speaker":"Chris Dy","startTime":1923.42,"endTime":1927.41,"body":"around, obviously, I'd asked you"},{"speaker":"Chris Dy","startTime":1927.41,"endTime":1931.97,"body":"one question to close. When"},{"speaker":"Chris Dy","startTime":1927.41,"endTime":1931.97,"body":"you're deciding closed versus"},{"speaker":"Chris Dy","startTime":1932.0,"endTime":1935.72,"body":"open, obviously, the downside"},{"speaker":"Chris Dy","startTime":1932.0,"endTime":1935.72,"body":"potentially of opening this"},{"speaker":"Chris Dy","startTime":1936.05,"endTime":1938.63,"body":"finger is that you're going to"},{"speaker":"Chris Dy","startTime":1936.05,"endTime":1938.63,"body":"compound the swelling from the"},{"speaker":"Chris Dy","startTime":1938.63,"endTime":1941.63,"body":"trauma, the upside, obviously,"},{"speaker":"Chris Dy","startTime":1938.63,"endTime":1941.63,"body":"you can get more stable"},{"speaker":"Chris Dy","startTime":1941.63,"endTime":1947.18,"body":"fixation. So how do you navigate"},{"speaker":"Chris Dy","startTime":1941.63,"endTime":1947.18,"body":"that balance as you're thinking"},{"speaker":"Chris Dy","startTime":1947.18,"endTime":1949.79,"body":"about the patient and the"},{"speaker":"Chris Dy","startTime":1947.18,"endTime":1949.79,"body":"fracture? And that kind of"},{"speaker":"Chris Dy","startTime":1949.79,"endTime":1951.62,"body":"thing? Because do you look at"},{"speaker":"Chris Dy","startTime":1949.79,"endTime":1951.62,"body":"how swollen the finger is to"},{"speaker":"Chris Dy","startTime":1951.62,"endTime":1952.73,"body":"start that kind of thing?"},{"speaker":"Charles Goldfarb","startTime":1953.23,"endTime":1955.81,"body":"Well, I think"},{"speaker":"Charles Goldfarb","startTime":1953.23,"endTime":1955.81,"body":"timing is important for this"},{"speaker":"Charles Goldfarb","startTime":1955.81,"endTime":1958.18,"body":"fracture, you know, you don't"},{"speaker":"Charles Goldfarb","startTime":1955.81,"endTime":1958.18,"body":"want to leave a joint dislocated"},{"speaker":"Charles Goldfarb","startTime":1958.18,"endTime":1961.42,"body":"for too long. But you're right,"},{"speaker":"Charles Goldfarb","startTime":1958.18,"endTime":1961.42,"body":"I don't think this is the"},{"speaker":"Charles Goldfarb","startTime":1961.42,"endTime":1964.45,"body":"fracture that I want to go there"},{"speaker":"Charles Goldfarb","startTime":1961.42,"endTime":1964.45,"body":"are a day for when they're"},{"speaker":"Charles Goldfarb","startTime":1964.45,"endTime":1967.0,"body":"maximally swollen, or when you"},{"speaker":"Charles Goldfarb","startTime":1964.45,"endTime":1967.0,"body":"know, whenever they're massively"},{"speaker":"Charles Goldfarb","startTime":1967.0,"endTime":1969.97,"body":"swollen. So if I don't get this"},{"speaker":"Charles Goldfarb","startTime":1967.0,"endTime":1969.97,"body":"acutely, it may be one that I"},{"speaker":"Charles Goldfarb","startTime":1969.97,"endTime":1972.88,"body":"wait until day seven and have"},{"speaker":"Charles Goldfarb","startTime":1969.97,"endTime":1972.88,"body":"the patient home and elevating."},{"speaker":"Charles Goldfarb","startTime":1973.21,"endTime":1976.93,"body":"So that if I do need to go in"},{"speaker":"Charles Goldfarb","startTime":1973.21,"endTime":1976.93,"body":"that I'm not overly worried"},{"speaker":"Charles Goldfarb","startTime":1976.93,"endTime":1980.29,"body":"about compounding the swelling,"},{"speaker":"Charles Goldfarb","startTime":1976.93,"endTime":1980.29,"body":"you know, for me, this gets back"},{"speaker":"Charles Goldfarb","startTime":1980.29,"endTime":1984.01,"body":"to the basic principle of the"},{"speaker":"Charles Goldfarb","startTime":1980.29,"endTime":1984.01,"body":"first thing we have to do as"},{"speaker":"Charles Goldfarb","startTime":1984.01,"endTime":1987.79,"body":"surgeons is get the bone and get"},{"speaker":"Charles Goldfarb","startTime":1984.01,"endTime":1987.79,"body":"the joint right, we can deal"},{"speaker":"Charles Goldfarb","startTime":1987.79,"endTime":1991.27,"body":"with stiffness, no doubt about"},{"speaker":"Charles Goldfarb","startTime":1987.79,"endTime":1991.27,"body":"it, we can deal with the stiff"},{"speaker":"Charles Goldfarb","startTime":1991.27,"endTime":1997.33,"body":"tip joint, as long as we restore"},{"speaker":"Charles Goldfarb","startTime":1991.27,"endTime":1997.33,"body":"the bony anatomy. If we get that"},{"speaker":"Charles Goldfarb","startTime":1997.33,"endTime":2000.54,"body":"bone healed, and the PIP joint"},{"speaker":"Charles Goldfarb","startTime":1997.33,"endTime":2000.54,"body":"contracts, I'm not overly"},{"speaker":"Charles Goldfarb","startTime":2000.54,"endTime":2003.0,"body":"worried about that, because I"},{"speaker":"Charles Goldfarb","startTime":2000.54,"endTime":2003.0,"body":"can make that better. What you"},{"speaker":"Charles Goldfarb","startTime":2003.0,"endTime":2006.27,"body":"can't make better. Well, it's"},{"speaker":"Charles Goldfarb","startTime":2003.0,"endTime":2006.27,"body":"more difficult to make it better"},{"speaker":"Charles Goldfarb","startTime":2006.27,"endTime":2008.79,"body":"if you have a big step off and"},{"speaker":"Charles Goldfarb","startTime":2006.27,"endTime":2008.79,"body":"the joint or a joint that"},{"speaker":"Charles Goldfarb","startTime":2008.79,"endTime":2012.75,"body":"subluxated. And so I think the"},{"speaker":"Charles Goldfarb","startTime":2008.79,"endTime":2012.75,"body":"decision making really has to be"},{"speaker":"Charles Goldfarb","startTime":2012.75,"endTime":2017.85,"body":"about restoring that alignment,"},{"speaker":"Charles Goldfarb","startTime":2012.75,"endTime":2017.85,"body":"even if it's not perfect, but"},{"speaker":"Charles Goldfarb","startTime":2017.85,"endTime":2021.06,"body":"really the basic alignment of"},{"speaker":"Charles Goldfarb","startTime":2017.85,"endTime":2021.06,"body":"the base of P2."},{"speaker":"Chris Dy","startTime":2022.32,"endTime":2025.68,"body":"The fractures that I"},{"speaker":"Chris Dy","startTime":2022.32,"endTime":2025.68,"body":"dislike the most probably the"},{"speaker":"Chris Dy","startTime":2025.68,"endTime":2028.98,"body":"PIP fracture dislocation. So"},{"speaker":"Chris Dy","startTime":2025.68,"endTime":2028.98,"body":"thanks for thanks for talking me"},{"speaker":"Chris Dy","startTime":2028.98,"endTime":2029.64,"body":"through some of it."},{"speaker":"Charles Goldfarb","startTime":2029.97,"endTime":2031.83,"body":"No, I loved"},{"speaker":"Charles Goldfarb","startTime":2029.97,"endTime":2031.83,"body":"it. I think you bring good"},{"speaker":"Charles Goldfarb","startTime":2031.83,"endTime":2035.94,"body":"insights. And I hope that some"},{"speaker":"Charles Goldfarb","startTime":2031.83,"endTime":2035.94,"body":"of our listeners will, will"},{"speaker":"Charles Goldfarb","startTime":2035.94,"endTime":2039.54,"body":"raise some questions and"},{"speaker":"Charles Goldfarb","startTime":2035.94,"endTime":2039.54,"body":"hopefully we you know, I can"},{"speaker":"Charles Goldfarb","startTime":2039.54,"endTime":2041.94,"body":"give you another drumroll"},{"speaker":"Charles Goldfarb","startTime":2039.54,"endTime":2041.94,"body":"though, to take us home if you"},{"speaker":"Charles Goldfarb","startTime":2041.94,"endTime":2042.15,"body":"want."},{"speaker":"Chris Dy","startTime":2042.63,"endTime":2044.73,"body":"Please don't. But if"},{"speaker":"Chris Dy","startTime":2042.63,"endTime":2044.73,"body":"there's any if there are any"},{"speaker":"Chris Dy","startTime":2044.73,"endTime":2048.6,"body":"therapists or surgeons that are"},{"speaker":"Chris Dy","startTime":2044.73,"endTime":2048.6,"body":"dynamic ex fix aficionados,"},{"speaker":"Chris Dy","startTime":2048.93,"endTime":2051.87,"body":"either for surgery or therapy,"},{"speaker":"Chris Dy","startTime":2048.93,"endTime":2051.87,"body":"let us know we'd love to have"},{"speaker":"Chris Dy","startTime":2051.87,"endTime":2052.11,"body":"you on."},{"speaker":"Charles Goldfarb","startTime":2052.29,"endTime":2053.97,"body":"Absolutely."},{"speaker":"Charles Goldfarb","startTime":2052.29,"endTime":2053.97,"body":"And I'm going to throw a teaser"},{"speaker":"Charles Goldfarb","startTime":2053.97,"endTime":2056.64,"body":"out there to all of you guys. So"},{"speaker":"Charles Goldfarb","startTime":2053.97,"endTime":2056.64,"body":"Chris is going on a special"},{"speaker":"Charles Goldfarb","startTime":2056.64,"endTime":2059.82,"body":"adventure with his family and I"},{"speaker":"Charles Goldfarb","startTime":2056.64,"endTime":2059.82,"body":"if he survives it, then we're"},{"speaker":"Charles Goldfarb","startTime":2059.82,"endTime":2062.79,"body":"going to hear about it on our"},{"speaker":"Charles Goldfarb","startTime":2059.82,"endTime":2062.79,"body":"next episode. Fair enough."},{"speaker":"Chris Dy","startTime":2063.3,"endTime":2065.52,"body":"Yeah, the first-the"},{"speaker":"Chris Dy","startTime":2063.3,"endTime":2065.52,"body":"first time we're going camping,"},{"speaker":"Chris Dy","startTime":2065.52,"endTime":2070.62,"body":"so Filipino American guy from"},{"speaker":"Chris Dy","startTime":2065.52,"endTime":2070.62,"body":"Florida. This is not a common"},{"speaker":"Chris Dy","startTime":2070.62,"endTime":2072.6,"body":"thing. So let's see how it goes."},{"speaker":"Charles Goldfarb","startTime":2072.72,"endTime":2076.32,"body":"Good luck."},{"speaker":"Charles Goldfarb","startTime":2072.72,"endTime":2076.32,"body":"Alright, take care."},{"speaker":"Chris Dy","startTime":2076.44,"endTime":2077.01,"body":"Alright."},{"speaker":"Charles Goldfarb","startTime":2077.61,"endTime":2079.62,"body":"Hey, Chris."},{"speaker":"Charles Goldfarb","startTime":2077.61,"endTime":2079.62,"body":"That was fun. Let's do it again"},{"speaker":"Charles Goldfarb","startTime":2079.62,"endTime":2080.1,"body":"real soon."},{"speaker":"Chris Dy","startTime":2080.4,"endTime":2082.92,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":2080.4,"endTime":2082.92,"body":"sure to check us out on Twitter"},{"speaker":"Chris Dy","startTime":2083.13,"endTime":2085.32,"body":"@Handpodcast. Hey, Chuck, what's"},{"speaker":"Chris Dy","startTime":2083.13,"endTime":2085.32,"body":"your Twitter handle?"},{"speaker":"Charles Goldfarb","startTime":2085.65,"endTime":2088.53,"body":"Mine is"},{"speaker":"Charles Goldfarb","startTime":2085.65,"endTime":2088.53,"body":"@congenitalhand. What about you?"},{"speaker":"Chris Dy","startTime":2088.68,"endTime":2092.04,"body":"Mine is @ChrisDyMD"},{"speaker":"Chris Dy","startTime":2088.68,"endTime":2092.04,"body":"spelled d y. And if you'd like"},{"speaker":"Chris Dy","startTime":2092.04,"endTime":2095.34,"body":"to email us, you can reach us at"},{"speaker":"Chris Dy","startTime":2092.04,"endTime":2095.34,"body":"hand podcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":2096.48,"endTime":2098.61,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":2096.48,"endTime":2098.61,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2098.61,"endTime":2099.72,"body":"get your podcasts"},{"speaker":"Chris Dy","startTime":2099.75,"endTime":2101.97,"body":"and be to leave a"},{"speaker":"Chris Dy","startTime":2099.75,"endTime":2101.97,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2101.97,"endTime":2102.36,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":2102.76,"endTime":2105.04,"body":"Special thanks"},{"speaker":"Charles Goldfarb","startTime":2102.76,"endTime":2105.04,"body":"to Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":2105.04,"endTime":2109.0,"body":"music. And remember, keep the"},{"speaker":"Charles Goldfarb","startTime":2105.04,"endTime":2109.0,"body":"upper hand. Come back next time"}]}