{"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":14.49,"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":28.14,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":28.17,"endTime":29.13,"body":"Oh, hey,"},{"speaker":"Charles Goldfarb","startTime":28.17,"endTime":29.13,"body":"Chris."},{"speaker":"Chris Dy","startTime":29.55,"endTime":30.57,"body":"Hey, Chuck, how are"},{"speaker":"Chris Dy","startTime":29.55,"endTime":30.57,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":30.99,"endTime":33.21,"body":"It's been a"},{"speaker":"Charles Goldfarb","startTime":30.99,"endTime":33.21,"body":"pretty good day. How you been?"},{"speaker":"Chris Dy","startTime":33.66,"endTime":36.12,"body":"Doing well. I'm"},{"speaker":"Chris Dy","startTime":33.66,"endTime":36.12,"body":"excited about the new segment"},{"speaker":"Chris Dy","startTime":36.12,"endTime":38.58,"body":"we've got planned. I love the"},{"speaker":"Chris Dy","startTime":36.12,"endTime":38.58,"body":"fact that you have no idea"},{"speaker":"Chris Dy","startTime":38.58,"endTime":39.3,"body":"what's coming your way."},{"speaker":"Charles Goldfarb","startTime":39.57,"endTime":41.61,"body":"I'm a little"},{"speaker":"Charles Goldfarb","startTime":39.57,"endTime":41.61,"body":"frightened. You scare me a"},{"speaker":"Charles Goldfarb","startTime":41.61,"endTime":44.46,"body":"little bit with I'm giving up"},{"speaker":"Charles Goldfarb","startTime":41.61,"endTime":44.46,"body":"control here. I don't know if"},{"speaker":"Charles Goldfarb","startTime":44.46,"endTime":45.48,"body":"I'm comfortable with that."},{"speaker":"Chris Dy","startTime":45.51,"endTime":48.66,"body":"Yeah, I know. And this"},{"speaker":"Chris Dy","startTime":45.51,"endTime":48.66,"body":"is why it's even better. Before"},{"speaker":"Chris Dy","startTime":48.66,"endTime":51.81,"body":"we before we jump in, do you"},{"speaker":"Chris Dy","startTime":48.66,"endTime":51.81,"body":"have any interesting reader or"},{"speaker":"Chris Dy","startTime":51.81,"endTime":54.09,"body":"excuse me listener feedback to"},{"speaker":"Chris Dy","startTime":51.81,"endTime":54.09,"body":"share with us?"},{"speaker":"Charles Goldfarb","startTime":54.33,"endTime":56.67,"body":"I do see, you"},{"speaker":"Charles Goldfarb","startTime":54.33,"endTime":56.67,"body":"know, I was at a fellowship"},{"speaker":"Charles Goldfarb","startTime":56.67,"endTime":59.91,"body":"reunion a few weeks back, and it"},{"speaker":"Charles Goldfarb","startTime":56.67,"endTime":59.91,"body":"was fantastic. And I was asked"},{"speaker":"Charles Goldfarb","startTime":59.91,"endTime":63.6,"body":"to speak on social media. So I"},{"speaker":"Charles Goldfarb","startTime":59.91,"endTime":63.6,"body":"shared some thoughts on Twitter"},{"speaker":"Charles Goldfarb","startTime":63.6,"endTime":67.08,"body":"and Instagram. And I shared some"},{"speaker":"Charles Goldfarb","startTime":63.6,"endTime":67.08,"body":"thoughts on the podcast. And it"},{"speaker":"Charles Goldfarb","startTime":67.08,"endTime":69.36,"body":"was interesting that some people"},{"speaker":"Charles Goldfarb","startTime":67.08,"endTime":69.36,"body":"had heard of the podcast some"},{"speaker":"Charles Goldfarb","startTime":69.36,"endTime":72.57,"body":"people hadn't. A few of the"},{"speaker":"Charles Goldfarb","startTime":69.36,"endTime":72.57,"body":"people who had not heard the"},{"speaker":"Charles Goldfarb","startTime":72.57,"endTime":76.77,"body":"podcast since have logged on and"},{"speaker":"Charles Goldfarb","startTime":72.57,"endTime":76.77,"body":"listened in. So this is from one"},{"speaker":"Charles Goldfarb","startTime":76.77,"endTime":81.03,"body":"of my former co fellows. This is"},{"speaker":"Charles Goldfarb","startTime":76.77,"endTime":81.03,"body":"from Mike Dedonna, who was a"},{"speaker":"Charles Goldfarb","startTime":81.03,"endTime":86.13,"body":"year behind me. And he gave me"},{"speaker":"Charles Goldfarb","startTime":81.03,"endTime":86.13,"body":"permission to share his review."},{"speaker":"Charles Goldfarb","startTime":86.79,"endTime":89.28,"body":"Chuck, it was so great to see"},{"speaker":"Charles Goldfarb","startTime":86.79,"endTime":89.28,"body":"you in Jackson Hole I've just"},{"speaker":"Charles Goldfarb","startTime":89.28,"endTime":92.82,"body":"completed a deep dive binge"},{"speaker":"Charles Goldfarb","startTime":89.28,"endTime":92.82,"body":"listen to the podcast. And"},{"speaker":"Charles Goldfarb","startTime":92.82,"endTime":96.87,"body":"here's the feedback I promised."},{"speaker":"Charles Goldfarb","startTime":92.82,"endTime":96.87,"body":"The podcast is in all caps."},{"speaker":"Charles Goldfarb","startTime":97.05,"endTime":101.22,"body":"Absolutely outstanding. You and"},{"speaker":"Charles Goldfarb","startTime":97.05,"endTime":101.22,"body":"Chris are fantastic. I love"},{"speaker":"Charles Goldfarb","startTime":101.22,"endTime":104.67,"body":"this. The two of you are"},{"speaker":"Charles Goldfarb","startTime":101.22,"endTime":104.67,"body":"unbelievably engaging,"},{"speaker":"Charles Goldfarb","startTime":104.67,"endTime":107.16,"body":"entertaining, authentic, honest,"},{"speaker":"Charles Goldfarb","startTime":104.67,"endTime":107.16,"body":"funny, and of course, extremely"},{"speaker":"Charles Goldfarb","startTime":107.16,"endTime":110.19,"body":"knowledgeable. I love the"},{"speaker":"Charles Goldfarb","startTime":107.16,"endTime":110.19,"body":"breadth of topics as well as the"},{"speaker":"Charles Goldfarb","startTime":110.19,"endTime":113.07,"body":"depth and clarity you provide on"},{"speaker":"Charles Goldfarb","startTime":110.19,"endTime":113.07,"body":"everything from patient"},{"speaker":"Charles Goldfarb","startTime":113.07,"endTime":115.95,"body":"presentation and indications to"},{"speaker":"Charles Goldfarb","startTime":113.07,"endTime":115.95,"body":"surgical techniques with great"},{"speaker":"Charles Goldfarb","startTime":115.95,"endTime":119.97,"body":"detail and specifics down to the"},{"speaker":"Charles Goldfarb","startTime":115.95,"endTime":119.97,"body":"number of sutures you use to"},{"speaker":"Charles Goldfarb","startTime":119.97,"endTime":124.29,"body":"close the carpal tunnel and love"},{"speaker":"Charles Goldfarb","startTime":119.97,"endTime":124.29,"body":"the kiefhaber box, which is what"},{"speaker":"Charles Goldfarb","startTime":124.29,"endTime":128.19,"body":"we call the retractor placement"},{"speaker":"Charles Goldfarb","startTime":124.29,"endTime":128.19,"body":"for the carpal tunnel, as well"},{"speaker":"Charles Goldfarb","startTime":128.19,"endTime":130.59,"body":"as discussion of complications"},{"speaker":"Charles Goldfarb","startTime":128.19,"endTime":130.59,"body":"therapy and everything in"},{"speaker":"Charles Goldfarb","startTime":130.59,"endTime":134.19,"body":"between. I've gotten my whole"},{"speaker":"Charles Goldfarb","startTime":130.59,"endTime":134.19,"body":"team to listen, with one caveat."},{"speaker":"Charles Goldfarb","startTime":134.22,"endTime":137.79,"body":"They can't move to St. Louis, to"},{"speaker":"Charles Goldfarb","startTime":134.22,"endTime":137.79,"body":"join you guys. You're that good."},{"speaker":"Charles Goldfarb","startTime":137.79,"endTime":141.33,"body":"Congrats to you. And Chris,"},{"speaker":"Charles Goldfarb","startTime":137.79,"endTime":141.33,"body":"thank you very much. And so Wow,"},{"speaker":"Charles Goldfarb","startTime":141.33,"endTime":144.69,"body":"Mike, that is really, really"},{"speaker":"Charles Goldfarb","startTime":141.33,"endTime":144.69,"body":"nice. We appreciate the kind"},{"speaker":"Charles Goldfarb","startTime":144.69,"endTime":145.11,"body":"words."},{"speaker":"Chris Dy","startTime":145.81,"endTime":147.61,"body":"That's, that's"},{"speaker":"Chris Dy","startTime":145.81,"endTime":147.61,"body":"awesome. And you have now"},{"speaker":"Chris Dy","startTime":147.61,"endTime":151.66,"body":"managed to mention that you did"},{"speaker":"Chris Dy","startTime":147.61,"endTime":151.66,"body":"the Stern fellowship at least"},{"speaker":"Chris Dy","startTime":151.66,"endTime":155.59,"body":"four times in the last four"},{"speaker":"Chris Dy","startTime":151.66,"endTime":155.59,"body":"episodes. That is fantastic,"},{"speaker":"Chris Dy","startTime":155.62,"endTime":158.65,"body":"great fellowship. We're very"},{"speaker":"Chris Dy","startTime":155.62,"endTime":158.65,"body":"thankful to Dr. Stern for"},{"speaker":"Chris Dy","startTime":158.65,"endTime":162.46,"body":"training. An incredible number"},{"speaker":"Chris Dy","startTime":158.65,"endTime":162.46,"body":"of amazing hand surgeons. Well"},{"speaker":"Chris Dy","startTime":162.46,"endTime":162.97,"body":"included."},{"speaker":"Charles Goldfarb","startTime":164.159,"endTime":165.959,"body":"It's"},{"speaker":"Charles Goldfarb","startTime":164.159,"endTime":165.959,"body":"interesting it I'm trying to"},{"speaker":"Charles Goldfarb","startTime":165.959,"endTime":169.679,"body":"feel young by harking, you know,"},{"speaker":"Charles Goldfarb","startTime":165.959,"endTime":169.679,"body":"back to those days, but it is"},{"speaker":"Charles Goldfarb","startTime":169.679,"endTime":173.849,"body":"amazing. You know, when you"},{"speaker":"Charles Goldfarb","startTime":169.679,"endTime":173.849,"body":"think about your legacy, what"},{"speaker":"Charles Goldfarb","startTime":173.849,"endTime":176.849,"body":"does that look like? Is it the"},{"speaker":"Charles Goldfarb","startTime":173.849,"endTime":176.849,"body":"patients you treated? Is it the"},{"speaker":"Charles Goldfarb","startTime":176.849,"endTime":181.679,"body":"articles you wrote? Or is it the"},{"speaker":"Charles Goldfarb","startTime":176.849,"endTime":181.679,"body":"people you touched and educated?"},{"speaker":"Charles Goldfarb","startTime":181.679,"endTime":185.549,"body":"And I think the older I get, the"},{"speaker":"Charles Goldfarb","startTime":181.679,"endTime":185.549,"body":"more realize I realize how"},{"speaker":"Charles Goldfarb","startTime":185.549,"endTime":190.109,"body":"impactful that process is."},{"speaker":"Charles Goldfarb","startTime":185.549,"endTime":190.109,"body":"Looking in that room with all of"},{"speaker":"Charles Goldfarb","startTime":190.109,"endTime":192.569,"body":"those former fellows, it was"},{"speaker":"Charles Goldfarb","startTime":190.109,"endTime":192.569,"body":"really meaningful."},{"speaker":"Chris Dy","startTime":193.08,"endTime":195.06,"body":"Well, that's, that's"},{"speaker":"Chris Dy","startTime":193.08,"endTime":195.06,"body":"great. And you know, perhaps we"},{"speaker":"Chris Dy","startTime":195.06,"endTime":198.27,"body":"should get Dr. Stern on at some"},{"speaker":"Chris Dy","startTime":195.06,"endTime":198.27,"body":"point just to talk about that"},{"speaker":"Chris Dy","startTime":198.39,"endTime":199.08,"body":"topic."},{"speaker":"Charles Goldfarb","startTime":199.45,"endTime":202.21,"body":"I would love"},{"speaker":"Charles Goldfarb","startTime":199.45,"endTime":202.21,"body":"that. And he would love that I"},{"speaker":"Charles Goldfarb","startTime":202.21,"endTime":204.7,"body":"feel confident you would know"},{"speaker":"Charles Goldfarb","startTime":202.21,"endTime":204.7,"body":"better than I given your close"},{"speaker":"Charles Goldfarb","startTime":205.27,"endTime":207.25,"body":"podcasting relationship with"},{"speaker":"Charles Goldfarb","startTime":205.27,"endTime":207.25,"body":"him."},{"speaker":"Chris Dy","startTime":207.28,"endTime":210.19,"body":"Yeah, he's he's part"},{"speaker":"Chris Dy","startTime":207.28,"endTime":210.19,"body":"of the side gig, the side gig's"},{"speaker":"Chris Dy","startTime":210.19,"endTime":213.19,"body":"actually resuming again in"},{"speaker":"Chris Dy","startTime":210.19,"endTime":213.19,"body":"October. So First Hand is coming"},{"speaker":"Chris Dy","startTime":213.19,"endTime":215.62,"body":"back in October. We hope it's"},{"speaker":"Chris Dy","startTime":213.19,"endTime":215.62,"body":"been long enough that you've"},{"speaker":"Chris Dy","startTime":215.62,"endTime":218.35,"body":"missed us. And we're excited"},{"speaker":"Chris Dy","startTime":215.62,"endTime":218.35,"body":"about that."},{"speaker":"Charles Goldfarb","startTime":218.55,"endTime":220.86,"body":"You've been"},{"speaker":"Charles Goldfarb","startTime":218.55,"endTime":220.86,"body":"renewed congratulations."},{"speaker":"Chris Dy","startTime":220.9,"endTime":225.16,"body":"It was it was a"},{"speaker":"Chris Dy","startTime":220.9,"endTime":225.16,"body":"competitive process. So So here"},{"speaker":"Chris Dy","startTime":225.16,"endTime":228.73,"body":"is our new segment. It's called"},{"speaker":"Chris Dy","startTime":225.16,"endTime":228.73,"body":"we'll have hand surgery. So it"},{"speaker":"Chris Dy","startTime":228.73,"endTime":231.52,"body":"speaking of engaging our"},{"speaker":"Chris Dy","startTime":228.73,"endTime":231.52,"body":"listener community the topics"},{"speaker":"Chris Dy","startTime":231.52,"endTime":234.37,"body":"for this we'll have hand surgery"},{"speaker":"Chris Dy","startTime":231.52,"endTime":234.37,"body":"have been submitted by the"},{"speaker":"Chris Dy","startTime":234.37,"endTime":237.91,"body":"current medical student on my"},{"speaker":"Chris Dy","startTime":234.37,"endTime":237.91,"body":"rotation Ruba Socrab, who's"},{"speaker":"Chris Dy","startTime":237.91,"endTime":240.37,"body":"going to be doing her away"},{"speaker":"Chris Dy","startTime":237.91,"endTime":240.37,"body":"rotation at the University of"},{"speaker":"Chris Dy","startTime":240.37,"endTime":242.98,"body":"Michigan shortly so anybody up"},{"speaker":"Chris Dy","startTime":240.37,"endTime":242.98,"body":"in Ann Arbor look out for her."},{"speaker":"Chris Dy","startTime":242.98,"endTime":248.5,"body":"She's fantastic. Noel Palumbo"},{"speaker":"Chris Dy","startTime":242.98,"endTime":248.5,"body":"current pgy three resident in"},{"speaker":"Chris Dy","startTime":248.5,"endTime":254.08,"body":"orthopedics here at Wash U and"},{"speaker":"Chris Dy","startTime":248.5,"endTime":254.08,"body":"Lauren Wessel current outgoing"},{"speaker":"Chris Dy","startTime":254.08,"endTime":258.07,"body":"hand fellow here at Wash U so"},{"speaker":"Chris Dy","startTime":254.08,"endTime":258.07,"body":"Chuck, six topics on the wheel"},{"speaker":"Chris Dy","startTime":258.07,"endTime":262.99,"body":"of hand surgery, very high tech,"},{"speaker":"Chris Dy","startTime":258.07,"endTime":262.99,"body":"six posts in a circle. Okay, so"},{"speaker":"Chris Dy","startTime":262.99,"endTime":265.42,"body":"what I'm going to do is I'm"},{"speaker":"Chris Dy","startTime":262.99,"endTime":265.42,"body":"going to spin a pin and whatever"},{"speaker":"Chris Dy","startTime":265.42,"endTime":268.6,"body":"side whatever topic we fall on,"},{"speaker":"Chris Dy","startTime":265.42,"endTime":268.6,"body":"we're going to talk about for 15"},{"speaker":"Chris Dy","startTime":268.6,"endTime":269.14,"body":"minutes."},{"speaker":"Charles Goldfarb","startTime":269.65,"endTime":271.72,"body":"Perfect. I"},{"speaker":"Charles Goldfarb","startTime":269.65,"endTime":271.72,"body":"love that. While you're about to"},{"speaker":"Charles Goldfarb","startTime":271.72,"endTime":275.56,"body":"do that, I do want to say that I"},{"speaker":"Charles Goldfarb","startTime":271.72,"endTime":275.56,"body":"looked at our reviews online and"},{"speaker":"Charles Goldfarb","startTime":275.56,"endTime":278.68,"body":"we don't we don't this is"},{"speaker":"Charles Goldfarb","startTime":275.56,"endTime":278.68,"body":"totally totally side gab I'm not"},{"speaker":"Charles Goldfarb","startTime":278.68,"endTime":283.48,"body":"just demeaning your wheel of"},{"speaker":"Charles Goldfarb","startTime":278.68,"endTime":283.48,"body":"hand surgery, but I do. I do"},{"speaker":"Charles Goldfarb","startTime":283.48,"endTime":289.78,"body":"want to say that I was reviewing"},{"speaker":"Charles Goldfarb","startTime":283.48,"endTime":289.78,"body":"the the questionnaire we asked"},{"speaker":"Charles Goldfarb","startTime":289.81,"endTime":292.18,"body":"listeners to fill out if you"},{"speaker":"Charles Goldfarb","startTime":289.81,"endTime":292.18,"body":"haven't done that, please do it."},{"speaker":"Charles Goldfarb","startTime":292.36,"endTime":295.51,"body":"And they they were very clear"},{"speaker":"Charles Goldfarb","startTime":292.36,"endTime":295.51,"body":"that they liked the nerve talk."},{"speaker":"Charles Goldfarb","startTime":295.51,"endTime":298.33,"body":"They want more sports, they want"},{"speaker":"Charles Goldfarb","startTime":295.51,"endTime":298.33,"body":"more technical, so we're going"},{"speaker":"Charles Goldfarb","startTime":298.33,"endTime":301.99,"body":"to do that but I also wanted"},{"speaker":"Charles Goldfarb","startTime":298.33,"endTime":301.99,"body":"emphasise that the mugs are"},{"speaker":"Charles Goldfarb","startTime":301.99,"endTime":304.72,"body":"coveted and there are people"},{"speaker":"Charles Goldfarb","startTime":301.99,"endTime":304.72,"body":"that really want our mugs. So"},{"speaker":"Charles Goldfarb","startTime":304.72,"endTime":308.11,"body":"we're going to send a mug to"},{"speaker":"Charles Goldfarb","startTime":304.72,"endTime":308.11,"body":"people who send in questions"},{"speaker":"Charles Goldfarb","startTime":308.11,"endTime":311.65,"body":"that we answer on air. And I'm"},{"speaker":"Charles Goldfarb","startTime":308.11,"endTime":311.65,"body":"going to send Mike a mug for his"},{"speaker":"Charles Goldfarb","startTime":311.68,"endTime":315.25,"body":"generous review. So sorry,"},{"speaker":"Charles Goldfarb","startTime":311.68,"endTime":315.25,"body":"Chris, I had to get that out."},{"speaker":"Charles Goldfarb","startTime":315.28,"endTime":317.59,"body":"You know, I'm old. I forget"},{"speaker":"Charles Goldfarb","startTime":315.28,"endTime":317.59,"body":"things. I have to say it when it"},{"speaker":"Charles Goldfarb","startTime":317.59,"endTime":318.37,"body":"comes to mind."},{"speaker":"Chris Dy","startTime":318.54,"endTime":321.84,"body":"And I did want to say,"},{"speaker":"Chris Dy","startTime":318.54,"endTime":321.84,"body":"Shohbit you're not getting a mug"},{"speaker":"Chris Dy","startTime":321.84,"endTime":326.16,"body":"until your papers published."},{"speaker":"Chris Dy","startTime":321.84,"endTime":326.16,"body":"There's that current fellow"},{"speaker":"Chris Dy","startTime":326.16,"endTime":329.52,"body":"class is dying to get mugs. And"},{"speaker":"Chris Dy","startTime":326.16,"endTime":329.52,"body":"you know, Jeff Stepan you're"},{"speaker":"Chris Dy","startTime":329.52,"endTime":332.82,"body":"finally getting your mug and we"},{"speaker":"Chris Dy","startTime":329.52,"endTime":332.82,"body":"can't wait to have you back. So"},{"speaker":"Chris Dy","startTime":332.85,"endTime":336.87,"body":"um, and oh, Micah Sinclair, we"},{"speaker":"Chris Dy","startTime":332.85,"endTime":336.87,"body":"should get you a mug too."},{"speaker":"Chris Dy","startTime":337.32,"endTime":339.54,"body":"Anyway, so on the wheel of hand"},{"speaker":"Chris Dy","startTime":337.32,"endTime":339.54,"body":"surgery."},{"speaker":"Charles Goldfarb","startTime":339.57,"endTime":341.1,"body":"Chris is being"},{"speaker":"Charles Goldfarb","startTime":339.57,"endTime":341.1,"body":"generous today."},{"speaker":"Chris Dy","startTime":341.49,"endTime":344.19,"body":"Micah listens every"},{"speaker":"Chris Dy","startTime":341.49,"endTime":344.19,"body":"week, and we co chair the"},{"speaker":"Chris Dy","startTime":344.19,"endTime":347.46,"body":"Government Affairs Committee for"},{"speaker":"Chris Dy","startTime":344.19,"endTime":347.46,"body":"the for the hand society. She"},{"speaker":"Chris Dy","startTime":347.46,"endTime":350.73,"body":"does great work. So I think"},{"speaker":"Chris Dy","startTime":347.46,"endTime":350.73,"body":"she's earned what she has to"},{"speaker":"Chris Dy","startTime":350.73,"endTime":351.81,"body":"work with me on a committee. So"},{"speaker":"Charles Goldfarb","startTime":352.65,"endTime":354.03,"body":"Amen. Thank"},{"speaker":"Charles Goldfarb","startTime":352.65,"endTime":354.03,"body":"you Micah."},{"speaker":"Chris Dy","startTime":354.0,"endTime":358.74,"body":"The inclusion criteria"},{"speaker":"Chris Dy","startTime":354.0,"endTime":358.74,"body":"are expanding. So let's see here"},{"speaker":"topics are","startTime":358.77,"endTime":362.07,"body":"favorite instruments"},{"speaker":"topics are","startTime":358.77,"endTime":362.07,"body":"slash preference cards,"},{"speaker":"topics are","startTime":362.46,"endTime":366.96,"body":"preparing for new or unfamiliar"},{"speaker":"topics are","startTime":362.46,"endTime":366.96,"body":"cases. Didn't see that coming."},{"speaker":"topics are","startTime":367.02,"endTime":371.91,"body":"And I'll elaborate more as that"},{"speaker":"topics are","startTime":367.02,"endTime":371.91,"body":"comes up. SLAC wrist. Never have"},{"speaker":"topics are","startTime":371.91,"endTime":377.37,"body":"I ever, and networking. So I'm"},{"speaker":"topics are","startTime":371.91,"endTime":377.37,"body":"going to spin this and I just"},{"speaker":"topics are","startTime":377.37,"endTime":381.15,"body":"want to know before I spin it,"},{"speaker":"topics are","startTime":377.37,"endTime":381.15,"body":"which topic Do you least want?"},{"speaker":"Charles Goldfarb","startTime":383.46,"endTime":385.68,"body":"I think"},{"speaker":"Charles Goldfarb","startTime":383.46,"endTime":385.68,"body":"they're all fine. I'm willing to"},{"speaker":"Charles Goldfarb","startTime":385.68,"endTime":386.55,"body":"tackle any of them."},{"speaker":"Chris Dy","startTime":386.63,"endTime":392.87,"body":"Alright, here we go."},{"speaker":"Chris Dy","startTime":386.63,"endTime":392.87,"body":"Spinning. SLAC wrist, of course,"},{"speaker":"Chris Dy","startTime":392.87,"endTime":395.63,"body":"the only clinical topic, but we"},{"speaker":"Chris Dy","startTime":392.87,"endTime":395.63,"body":"can get into some technical"},{"speaker":"Chris Dy","startTime":395.63,"endTime":399.92,"body":"stuff. So on this wheel of hand"},{"speaker":"Chris Dy","startTime":395.63,"endTime":399.92,"body":"surgery, slack wrist is being"},{"speaker":"Chris Dy","startTime":399.92,"endTime":403.73,"body":"removed, and shall be replaced"},{"speaker":"Chris Dy","startTime":399.92,"endTime":403.73,"body":"by a new topic. It will be"},{"speaker":"Chris Dy","startTime":403.73,"endTime":405.65,"body":"sports, I promise for next time."},{"speaker":"Charles Goldfarb","startTime":406.28,"endTime":408.44,"body":"Perfect. Well,"},{"speaker":"Charles Goldfarb","startTime":406.28,"endTime":408.44,"body":"this is great. Because those of"},{"speaker":"Charles Goldfarb","startTime":408.44,"endTime":411.65,"body":"you who can't really envision"},{"speaker":"Charles Goldfarb","startTime":408.44,"endTime":411.65,"body":"what this beautiful wheel looks"},{"speaker":"Charles Goldfarb","startTime":411.65,"endTime":415.19,"body":"like, just join us on YouTube,"},{"speaker":"Charles Goldfarb","startTime":411.65,"endTime":415.19,"body":"you can actually see it on our"},{"speaker":"Charles Goldfarb","startTime":415.19,"endTime":416.57,"body":"zoom podcast."},{"speaker":"Chris Dy","startTime":416.63,"endTime":419.51,"body":"We've been slacking on"},{"speaker":"Chris Dy","startTime":416.63,"endTime":419.51,"body":"the social meaning I have been"},{"speaker":"Chris Dy","startTime":419.51,"endTime":423.2,"body":"slacking on the social, I will"},{"speaker":"Chris Dy","startTime":419.51,"endTime":423.2,"body":"post a picture of this amazing"},{"speaker":"Chris Dy","startTime":423.2,"endTime":427.64,"body":"we'll have posted. But so this"},{"speaker":"Chris Dy","startTime":423.2,"endTime":427.64,"body":"is what happens when you don't"},{"speaker":"Chris Dy","startTime":427.64,"endTime":430.94,"body":"get your sports surgery on and,"},{"speaker":"Chris Dy","startTime":427.64,"endTime":430.94,"body":"you end up with a slack wrist."},{"speaker":"Chris Dy","startTime":430.94,"endTime":436.94,"body":"So, Chuck, so let's talk about"},{"speaker":"Chris Dy","startTime":430.94,"endTime":436.94,"body":"SLAC wrist. So how often does"},{"speaker":"Chris Dy","startTime":436.94,"endTime":440.36,"body":"this actually come up? And"},{"speaker":"Chris Dy","startTime":436.94,"endTime":440.36,"body":"what's the classic story? For a"},{"speaker":"Chris Dy","startTime":440.36,"endTime":442.25,"body":"presentation of a patient with a"},{"speaker":"Chris Dy","startTime":440.36,"endTime":442.25,"body":"SLAC wrist?"},{"speaker":"Charles Goldfarb","startTime":443.03,"endTime":445.19,"body":"I guess I"},{"speaker":"Charles Goldfarb","startTime":443.03,"endTime":445.19,"body":"would, I would say it's a bi"},{"speaker":"Charles Goldfarb","startTime":445.19,"endTime":448.73,"body":"modal age distribution. And I"},{"speaker":"Charles Goldfarb","startTime":445.19,"endTime":448.73,"body":"use that term just because I"},{"speaker":"Charles Goldfarb","startTime":448.73,"endTime":452.48,"body":"wanted to work that into a"},{"speaker":"Charles Goldfarb","startTime":448.73,"endTime":452.48,"body":"sentence. There's there's the"},{"speaker":"Charles Goldfarb","startTime":452.48,"endTime":453.17,"body":"youngest-"},{"speaker":"Chris Dy","startTime":453.56,"endTime":456.56,"body":"There's the Chris"},{"speaker":"Chris Dy","startTime":453.56,"endTime":456.56,"body":"injury and the Chuck injury."},{"speaker":"Charles Goldfarb","startTime":459.32,"endTime":461.93,"body":"Fair enough,"},{"speaker":"Charles Goldfarb","startTime":459.32,"endTime":461.93,"body":"although I might spread us apart"},{"speaker":"Charles Goldfarb","startTime":461.93,"endTime":462.53,"body":"a little further."},{"speaker":"Chris Dy","startTime":462.68,"endTime":464.09,"body":"I will probably Yeah."},{"speaker":"Chris Dy","startTime":462.68,"endTime":464.09,"body":"Okay."},{"speaker":"Charles Goldfarb","startTime":464.15,"endTime":467.33,"body":"So maybe"},{"speaker":"Charles Goldfarb","startTime":464.15,"endTime":467.33,"body":"there's someone my age who fell"},{"speaker":"Charles Goldfarb","startTime":467.42,"endTime":470.24,"body":"a year and a half ago, had some"},{"speaker":"Charles Goldfarb","startTime":467.42,"endTime":470.24,"body":"wrist pain and went away. And"},{"speaker":"Charles Goldfarb","startTime":470.24,"endTime":472.88,"body":"now that wrist pain has come"},{"speaker":"Charles Goldfarb","startTime":470.24,"endTime":472.88,"body":"back with a vengeance. And then"},{"speaker":"Charles Goldfarb","startTime":472.88,"endTime":478.4,"body":"there's the patient who's 65 or"},{"speaker":"Charles Goldfarb","startTime":472.88,"endTime":478.4,"body":"70, who comes in with wrist"},{"speaker":"Charles Goldfarb","startTime":478.4,"endTime":482.75,"body":"pain. And to me, it's super"},{"speaker":"Charles Goldfarb","startTime":478.4,"endTime":482.75,"body":"interesting, because you don't"},{"speaker":"Charles Goldfarb","startTime":482.75,"endTime":487.7,"body":"need an X ray on that 65 year"},{"speaker":"Charles Goldfarb","startTime":482.75,"endTime":487.7,"body":"old. You can look at that wrist"},{"speaker":"Charles Goldfarb","startTime":487.73,"endTime":490.7,"body":"and know what the diagnosis is."},{"speaker":"Charles Goldfarb","startTime":487.73,"endTime":490.7,"body":"But I think for me, there really"},{"speaker":"Charles Goldfarb","startTime":490.7,"endTime":491.75,"body":"are two populations."},{"speaker":"Chris Dy","startTime":492.32,"endTime":494.9,"body":"So I think I know what"},{"speaker":"Chris Dy","startTime":492.32,"endTime":494.9,"body":"you're talking about in terms of"},{"speaker":"Chris Dy","startTime":494.9,"endTime":497.27,"body":"what that wrist looks like. And"},{"speaker":"Chris Dy","startTime":494.9,"endTime":497.27,"body":"it's always that wrist that's"},{"speaker":"Chris Dy","startTime":497.27,"endTime":500.42,"body":"just like a little swollen in"},{"speaker":"Chris Dy","startTime":497.27,"endTime":500.42,"body":"the right spot. And it hurts,"},{"speaker":"Chris Dy","startTime":500.45,"endTime":503.09,"body":"obviously, I mean, looking just"},{"speaker":"Chris Dy","startTime":500.45,"endTime":503.09,"body":"looking at it, you can tell but"},{"speaker":"Chris Dy","startTime":503.09,"endTime":507.08,"body":"you know where it's gonna hurt."},{"speaker":"Chris Dy","startTime":503.09,"endTime":507.08,"body":"You know, how do you do you ask"},{"speaker":"Chris Dy","startTime":507.08,"endTime":510.59,"body":"them if they had any trauma in"},{"speaker":"Chris Dy","startTime":507.08,"endTime":510.59,"body":"the past? Do you? Do you buy the"},{"speaker":"Chris Dy","startTime":510.59,"endTime":512.66,"body":"story? Do you? I mean, do you"},{"speaker":"Chris Dy","startTime":510.59,"endTime":512.66,"body":"believe them? Because most"},{"speaker":"Chris Dy","startTime":512.66,"endTime":513.53,"body":"people don't know?"},{"speaker":"Charles Goldfarb","startTime":514.25,"endTime":516.17,"body":"Yeah. So"},{"speaker":"Charles Goldfarb","startTime":514.25,"endTime":516.17,"body":"again, just just to make sure we"},{"speaker":"Charles Goldfarb","startTime":516.17,"endTime":520.07,"body":"are crystal clear. We don't want"},{"speaker":"Charles Goldfarb","startTime":516.17,"endTime":520.07,"body":"to be obtuse, but dorsal radial"},{"speaker":"Charles Goldfarb","startTime":520.07,"endTime":524.9,"body":"swelling at the radioscaphoid"},{"speaker":"Charles Goldfarb","startTime":520.07,"endTime":524.9,"body":"joint and point tenderness there"},{"speaker":"Charles Goldfarb","startTime":524.93,"endTime":527.9,"body":"is the tip off. But again, you"},{"speaker":"Charles Goldfarb","startTime":524.93,"endTime":527.9,"body":"can see it just by looking at"},{"speaker":"Charles Goldfarb","startTime":527.9,"endTime":533.15,"body":"the wrist. I always ask, I don't"},{"speaker":"Charles Goldfarb","startTime":527.9,"endTime":533.15,"body":"know if it matters, I guess it's"},{"speaker":"Charles Goldfarb","startTime":533.15,"endTime":536.93,"body":"just part of the discussion. But"},{"speaker":"Charles Goldfarb","startTime":533.15,"endTime":536.93,"body":"I always ask, do you?"},{"speaker":"Chris Dy","startTime":537.5,"endTime":541.88,"body":"I do just to see what"},{"speaker":"Chris Dy","startTime":537.5,"endTime":541.88,"body":"happens. I don't believe them. I"},{"speaker":"Chris Dy","startTime":541.88,"endTime":545.18,"body":"actually, you know, this patient"},{"speaker":"Chris Dy","startTime":541.88,"endTime":545.18,"body":"came in to see me recently one"},{"speaker":"Chris Dy","startTime":545.18,"endTime":549.05,"body":"of my recent clinics. And you"},{"speaker":"Chris Dy","startTime":545.18,"endTime":549.05,"body":"know, I immediately knew what"},{"speaker":"Chris Dy","startTime":549.05,"endTime":551.99,"body":"was going on and was very"},{"speaker":"Chris Dy","startTime":549.05,"endTime":551.99,"body":"curious to see what the X ray"},{"speaker":"Chris Dy","startTime":551.99,"endTime":555.35,"body":"was going to look like. And lo"},{"speaker":"Chris Dy","startTime":551.99,"endTime":555.35,"body":"and behold, it was a, you know,"},{"speaker":"Chris Dy","startTime":555.53,"endTime":559.52,"body":"already a SLAC wrist. So for the"},{"speaker":"Chris Dy","startTime":555.53,"endTime":559.52,"body":"listeners who are earlier on in"},{"speaker":"Chris Dy","startTime":559.52,"endTime":564.17,"body":"training, let's talk through the"},{"speaker":"Chris Dy","startTime":559.52,"endTime":564.17,"body":"progression of a SLAC wrist. So"},{"speaker":"Chris Dy","startTime":564.17,"endTime":566.93,"body":"you have an injury to the SL"},{"speaker":"Chris Dy","startTime":564.17,"endTime":566.93,"body":"ligament which leads to some"},{"speaker":"Chris Dy","startTime":566.93,"endTime":570.23,"body":"element of instability. And"},{"speaker":"Chris Dy","startTime":566.93,"endTime":570.23,"body":"eventually because that link"},{"speaker":"Chris Dy","startTime":570.23,"endTime":573.65,"body":"between the scaphoid and lunate"},{"speaker":"Chris Dy","startTime":570.23,"endTime":573.65,"body":"is no longer intact. The"},{"speaker":"Chris Dy","startTime":573.65,"endTime":578.03,"body":"scaphoid will flex. So what"},{"speaker":"Chris Dy","startTime":573.65,"endTime":578.03,"body":"happens there, Chuck in terms of"},{"speaker":"Chris Dy","startTime":578.03,"endTime":580.28,"body":"you know, the contact pressure"},{"speaker":"Chris Dy","startTime":578.03,"endTime":580.28,"body":"is yada yada yada?"},{"speaker":"Charles Goldfarb","startTime":581.84,"endTime":583.91,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":581.84,"endTime":583.91,"body":"we could go deep we could go"},{"speaker":"Charles Goldfarb","startTime":583.91,"endTime":589.16,"body":"deep dive into the biomechanics"},{"speaker":"Charles Goldfarb","startTime":583.91,"endTime":589.16,"body":"of how the carpus works, but I"},{"speaker":"Charles Goldfarb","startTime":589.16,"endTime":591.89,"body":"think you said it really well."},{"speaker":"Charles Goldfarb","startTime":589.16,"endTime":591.89,"body":"Without that scapholunate"},{"speaker":"Charles Goldfarb","startTime":591.89,"endTime":595.7,"body":"ligament the scaphoid is going"},{"speaker":"Charles Goldfarb","startTime":591.89,"endTime":595.7,"body":"to flex. When the scahpoid"},{"speaker":"Charles Goldfarb","startTime":595.7,"endTime":601.19,"body":"flexes the pressure between"},{"speaker":"Charles Goldfarb","startTime":595.7,"endTime":601.19,"body":"initially this styloid of the"},{"speaker":"Charles Goldfarb","startTime":601.19,"endTime":605.0,"body":"distal radius and the scaphoid"},{"speaker":"Charles Goldfarb","startTime":601.19,"endTime":605.0,"body":"waist, and subsequently, the"},{"speaker":"Charles Goldfarb","startTime":605.0,"endTime":608.54,"body":"proximal, more proximal distal"},{"speaker":"Charles Goldfarb","startTime":605.0,"endTime":608.54,"body":"radius and the more proximal"},{"speaker":"Charles Goldfarb","startTime":608.54,"endTime":612.95,"body":"scaphoid, the contact forces"},{"speaker":"Charles Goldfarb","startTime":608.54,"endTime":612.95,"body":"increase. And because that's not"},{"speaker":"Charles Goldfarb","startTime":612.95,"endTime":616.37,"body":"the regular load bearing"},{"speaker":"Charles Goldfarb","startTime":612.95,"endTime":616.37,"body":"pattern, and you get arthritis"},{"speaker":"Charles Goldfarb","startTime":616.37,"endTime":616.79,"body":"there."},{"speaker":"Chris Dy","startTime":617.54,"endTime":620.0,"body":"So maybe just for"},{"speaker":"Chris Dy","startTime":617.54,"endTime":620.0,"body":"completeness sake, when we"},{"speaker":"Chris Dy","startTime":620.03,"endTime":623.33,"body":"replace this on the wheel, we'll"},{"speaker":"Chris Dy","startTime":620.03,"endTime":623.33,"body":"put scapholunate ligament"},{"speaker":"Chris Dy","startTime":623.33,"endTime":625.91,"body":"treatment and go a little more"},{"speaker":"Chris Dy","startTime":623.33,"endTime":625.91,"body":"into that. But let's say that"},{"speaker":"Chris Dy","startTime":625.91,"endTime":628.94,"body":"ship has sailed. It's an"},{"speaker":"Chris Dy","startTime":625.91,"endTime":628.94,"body":"irreparable ligament and you've"},{"speaker":"Chris Dy","startTime":628.94,"endTime":632.09,"body":"already developed arthritic"},{"speaker":"Chris Dy","startTime":628.94,"endTime":632.09,"body":"changes. How do you what do you"},{"speaker":"Chris Dy","startTime":632.09,"endTime":634.46,"body":"tell that patient? You know, I"},{"speaker":"Chris Dy","startTime":632.09,"endTime":634.46,"body":"tend to kind of give them you"},{"speaker":"Chris Dy","startTime":634.46,"endTime":637.61,"body":"know, hey, this process has"},{"speaker":"Chris Dy","startTime":634.46,"endTime":637.61,"body":"already started. We can't cure"},{"speaker":"Chris Dy","startTime":637.61,"endTime":641.6,"body":"it, we can treat it but we can't"},{"speaker":"Chris Dy","startTime":637.61,"endTime":641.6,"body":"cure it. I typically will start"},{"speaker":"Chris Dy","startTime":641.6,"endTime":644.18,"body":"them with a brace and a steroid"},{"speaker":"Chris Dy","startTime":641.6,"endTime":644.18,"body":"shot and a steroid shot if their"},{"speaker":"Chris Dy","startTime":644.18,"endTime":647.57,"body":"pain is real bad at that point."},{"speaker":"Chris Dy","startTime":644.18,"endTime":647.57,"body":"Do you offer anything different"},{"speaker":"Chris Dy","startTime":647.57,"endTime":648.35,"body":"than that right away?"},{"speaker":"Charles Goldfarb","startTime":648.87,"endTime":651.15,"body":"No, I think"},{"speaker":"Charles Goldfarb","startTime":648.87,"endTime":651.15,"body":"that's exactly right. Because"},{"speaker":"Charles Goldfarb","startTime":651.15,"endTime":654.51,"body":"you can make a patient"},{"speaker":"Charles Goldfarb","startTime":651.15,"endTime":654.51,"body":"dramatically better I, I will"},{"speaker":"Charles Goldfarb","startTime":654.51,"endTime":658.41,"body":"say, I'm not one to give steroid"},{"speaker":"Charles Goldfarb","startTime":654.51,"endTime":658.41,"body":"injection after steroid"},{"speaker":"Charles Goldfarb","startTime":658.41,"endTime":661.29,"body":"injection after steroid"},{"speaker":"Charles Goldfarb","startTime":658.41,"endTime":661.29,"body":"injection, because I do believe"},{"speaker":"Charles Goldfarb","startTime":661.29,"endTime":664.17,"body":"there are negative consequences"},{"speaker":"Charles Goldfarb","startTime":661.29,"endTime":664.17,"body":"when you are potentially"},{"speaker":"Charles Goldfarb","startTime":664.17,"endTime":667.62,"body":"salvaging some of the"},{"speaker":"Charles Goldfarb","startTime":664.17,"endTime":667.62,"body":"articulations of the wrist. And"},{"speaker":"Charles Goldfarb","startTime":667.62,"endTime":670.86,"body":"so I think a single injection"},{"speaker":"Charles Goldfarb","startTime":667.62,"endTime":670.86,"body":"with the offer of a split works"},{"speaker":"Charles Goldfarb","startTime":670.86,"endTime":673.71,"body":"great, and give the patient a"},{"speaker":"Charles Goldfarb","startTime":670.86,"endTime":673.71,"body":"chance to see if they like it if"},{"speaker":"Charles Goldfarb","startTime":673.71,"endTime":676.41,"body":"they can work with the splint,"},{"speaker":"Charles Goldfarb","startTime":673.71,"endTime":676.41,"body":"and it solves their problem,"},{"speaker":"Charles Goldfarb","startTime":676.47,"endTime":681.72,"body":"either temporarily, or more long"},{"speaker":"Charles Goldfarb","startTime":676.47,"endTime":681.72,"body":"term. And if they fail that,"},{"speaker":"Charles Goldfarb","startTime":681.96,"endTime":684.3,"body":"then we have options. We have"},{"speaker":"Charles Goldfarb","startTime":681.96,"endTime":684.3,"body":"good surgical options."},{"speaker":"Chris Dy","startTime":684.63,"endTime":687.69,"body":"So but what do you you"},{"speaker":"Chris Dy","startTime":684.63,"endTime":687.69,"body":"know, if you're putting in"},{"speaker":"Chris Dy","startTime":687.72,"endTime":691.86,"body":"steroids, and you say you're"},{"speaker":"Chris Dy","startTime":687.72,"endTime":691.86,"body":"doing some surgery down the line"},{"speaker":"Chris Dy","startTime":691.86,"endTime":695.61,"body":"that preserves some elements of"},{"speaker":"Chris Dy","startTime":691.86,"endTime":695.61,"body":"wrist motion? What are you"},{"speaker":"Chris Dy","startTime":695.64,"endTime":698.1,"body":"trying to save? Really? Because"},{"speaker":"Chris Dy","startTime":695.64,"endTime":698.1,"body":"I mean, if you're assuming your"},{"speaker":"Chris Dy","startTime":698.1,"endTime":700.35,"body":"steroids in the right place,"},{"speaker":"Chris Dy","startTime":698.1,"endTime":700.35,"body":"you're not really affecting the"},{"speaker":"Chris Dy","startTime":700.35,"endTime":704.61,"body":"mid carpal joint. You know, so"},{"speaker":"Chris Dy","startTime":700.35,"endTime":704.61,"body":"are you saying it's, it's the"},{"speaker":"Chris Dy","startTime":704.64,"endTime":707.01,"body":"impact on the radius cartilage"},{"speaker":"Chris Dy","startTime":704.64,"endTime":707.01,"body":"itself?"},{"speaker":"Charles Goldfarb","startTime":707.33,"endTime":709.16,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":707.33,"endTime":709.16,"body":"they're, I mean, again, I don't"},{"speaker":"Charles Goldfarb","startTime":709.16,"endTime":712.76,"body":"know the science like some"},{"speaker":"Charles Goldfarb","startTime":709.16,"endTime":712.76,"body":"listeners probably do. And some"},{"speaker":"Charles Goldfarb","startTime":712.76,"endTime":715.58,"body":"scientists probably do. But I"},{"speaker":"Charles Goldfarb","startTime":712.76,"endTime":715.58,"body":"think it's pretty clear that"},{"speaker":"Charles Goldfarb","startTime":715.64,"endTime":719.27,"body":"repetitive steroid injections"},{"speaker":"Charles Goldfarb","startTime":715.64,"endTime":719.27,"body":"have a negative impact on the"},{"speaker":"Charles Goldfarb","startTime":719.27,"endTime":721.28,"body":"cartilage. And so the"},{"speaker":"Charles Goldfarb","startTime":719.27,"endTime":721.28,"body":"radiolunate joint, if you're"},{"speaker":"Charles Goldfarb","startTime":721.28,"endTime":724.76,"body":"going to consider, you know,"},{"speaker":"Charles Goldfarb","startTime":721.28,"endTime":724.76,"body":"scaphoid excision and four bone"},{"speaker":"Charles Goldfarb","startTime":724.76,"endTime":727.82,"body":"fusion, or we know that this"},{"speaker":"Charles Goldfarb","startTime":724.76,"endTime":727.82,"body":"gave when the ligaments intact"},{"speaker":"Charles Goldfarb","startTime":727.82,"endTime":730.61,"body":"and so the the steroids will"},{"speaker":"Charles Goldfarb","startTime":727.82,"endTime":730.61,"body":"migrate to the mid carpal joint"},{"speaker":"Charles Goldfarb","startTime":730.61,"endTime":731.09,"body":"as well."},{"speaker":"Chris Dy","startTime":731.93,"endTime":735.38,"body":"So what's what's your"},{"speaker":"Chris Dy","startTime":731.93,"endTime":735.38,"body":"current thought process on"},{"speaker":"Chris Dy","startTime":735.47,"endTime":740.06,"body":"procedures other than a four"},{"speaker":"Chris Dy","startTime":735.47,"endTime":740.06,"body":"corner or? Or PRC? Do you see"},{"speaker":"Chris Dy","startTime":740.06,"endTime":743.06,"body":"any role for like radial"},{"speaker":"Chris Dy","startTime":740.06,"endTime":743.06,"body":"styloidectomy at all? Like, how"},{"speaker":"Chris Dy","startTime":743.06,"endTime":745.49,"body":"does that or even arthroscopy"},{"speaker":"Chris Dy","startTime":743.06,"endTime":745.49,"body":"some might argue?"},{"speaker":"Charles Goldfarb","startTime":746.42,"endTime":748.43,"body":"Yeah, I mean,"},{"speaker":"Charles Goldfarb","startTime":746.42,"endTime":748.43,"body":"I guess it depends a little bit"},{"speaker":"Charles Goldfarb","startTime":748.43,"endTime":750.89,"body":"on the severity of the"},{"speaker":"Charles Goldfarb","startTime":748.43,"endTime":750.89,"body":"arthrosis. I mean, if you catch"},{"speaker":"Charles Goldfarb","startTime":750.89,"endTime":754.46,"body":"something really early, a scope"},{"speaker":"Charles Goldfarb","startTime":750.89,"endTime":754.46,"body":"in my mind has a role for"},{"speaker":"Charles Goldfarb","startTime":754.73,"endTime":758.18,"body":"confirming the diagnosis maybe."},{"speaker":"Charles Goldfarb","startTime":754.73,"endTime":758.18,"body":"And I don't really believe in"},{"speaker":"Charles Goldfarb","startTime":758.18,"endTime":760.88,"body":"the whole cleanup procedure in"},{"speaker":"Charles Goldfarb","startTime":758.18,"endTime":760.88,"body":"this situation, although some"},{"speaker":"Charles Goldfarb","startTime":760.88,"endTime":765.71,"body":"might advocate for that as"},{"speaker":"Charles Goldfarb","startTime":760.88,"endTime":765.71,"body":"buying time. I don't do a lot of"},{"speaker":"Charles Goldfarb","startTime":765.71,"endTime":767.84,"body":"radial styloidectomies, you"},{"speaker":"Charles Goldfarb","startTime":765.71,"endTime":767.84,"body":"know, those can be done"},{"speaker":"Charles Goldfarb","startTime":767.84,"endTime":770.45,"body":"arthroscopically or open. I"},{"speaker":"Charles Goldfarb","startTime":767.84,"endTime":770.45,"body":"think they're pretty"},{"speaker":"Charles Goldfarb","startTime":770.45,"endTime":773.69,"body":"straightforward. There was a ton"},{"speaker":"Charles Goldfarb","startTime":770.45,"endTime":773.69,"body":"of research done in years past,"},{"speaker":"Charles Goldfarb","startTime":773.69,"endTime":777.5,"body":"especially after government"},{"speaker":"Charles Goldfarb","startTime":773.69,"endTime":777.5,"body":"quantifying what type of"},{"speaker":"Charles Goldfarb","startTime":777.5,"endTime":781.31,"body":"osteotomy made sense what angle"},{"speaker":"Charles Goldfarb","startTime":777.5,"endTime":781.31,"body":"the osteotomy was to protect the"},{"speaker":"Charles Goldfarb","startTime":781.31,"endTime":784.94,"body":"ligaments? I just don't do many"},{"speaker":"Charles Goldfarb","startTime":781.31,"endTime":784.94,"body":"in 2021. Do you?"},{"speaker":"Chris Dy","startTime":785.39,"endTime":792.41,"body":"I don't thank you for"},{"speaker":"Chris Dy","startTime":785.39,"endTime":792.41,"body":"triggering me. Just the insert"},{"speaker":"Chris Dy","startTime":792.41,"endTime":797.45,"body":"the origin of the radius gave a"},{"speaker":"Chris Dy","startTime":792.41,"endTime":797.45,"body":"cavity ligament so okay. Well, I"},{"speaker":"Chris Dy","startTime":797.45,"endTime":800.03,"body":"guess in the short time that we"},{"speaker":"Chris Dy","startTime":797.45,"endTime":800.03,"body":"have left in terms of the"},{"speaker":"Chris Dy","startTime":800.03,"endTime":804.26,"body":"technical aspects, you know, how"},{"speaker":"Chris Dy","startTime":800.03,"endTime":804.26,"body":"do you decide between whether"},{"speaker":"Chris Dy","startTime":804.26,"endTime":807.02,"body":"you're going to offer a PRC or"},{"speaker":"Chris Dy","startTime":804.26,"endTime":807.02,"body":"four corner fusion?"},{"speaker":"Charles Goldfarb","startTime":807.08,"endTime":808.97,"body":"Thank I do it."},{"speaker":"Charles Goldfarb","startTime":807.08,"endTime":808.97,"body":"Well, first of all, the"},{"speaker":"Charles Goldfarb","startTime":808.97,"endTime":812.3,"body":"literature has become more"},{"speaker":"Charles Goldfarb","startTime":808.97,"endTime":812.3,"body":"clear, right? the PRC is better,"},{"speaker":"Charles Goldfarb","startTime":812.63,"endTime":816.68,"body":"it's less revised, it's less"},{"speaker":"Charles Goldfarb","startTime":812.63,"endTime":816.68,"body":"expensive, patients are equally"},{"speaker":"Charles Goldfarb","startTime":816.68,"endTime":822.86,"body":"happy. And most of us like the"},{"speaker":"Charles Goldfarb","startTime":816.68,"endTime":822.86,"body":"PRC, I probably do more four"},{"speaker":"Charles Goldfarb","startTime":822.86,"endTime":826.67,"body":"bone fusions than I do PRCs."},{"speaker":"Charles Goldfarb","startTime":822.86,"endTime":826.67,"body":"Having Having said that, of"},{"speaker":"Charles Goldfarb","startTime":826.67,"endTime":829.4,"body":"course, you know, everyone's"},{"speaker":"Charles Goldfarb","startTime":826.67,"endTime":829.4,"body":"like, what the heck is he"},{"speaker":"Charles Goldfarb","startTime":829.4,"endTime":832.73,"body":"talking about? I think they're"},{"speaker":"Charles Goldfarb","startTime":829.4,"endTime":832.73,"body":"both good options. I really do."},{"speaker":"Chris Dy","startTime":833.66,"endTime":836.57,"body":"So an interesting"},{"speaker":"Chris Dy","startTime":833.66,"endTime":836.57,"body":"thing, I saw a patient as a"},{"speaker":"Chris Dy","startTime":836.57,"endTime":840.71,"body":"second opinion very recently,"},{"speaker":"Chris Dy","startTime":836.57,"endTime":840.71,"body":"who had a very straightforward"},{"speaker":"Chris Dy","startTime":840.71,"endTime":845.45,"body":"issue, and was recommended to"},{"speaker":"Chris Dy","startTime":840.71,"endTime":845.45,"body":"have a PRC by somebody else, and"},{"speaker":"Chris Dy","startTime":845.45,"endTime":849.53,"body":"came in and was like, That just"},{"speaker":"Chris Dy","startTime":845.45,"endTime":849.53,"body":"sounds ridiculous. So how do you"},{"speaker":"Chris Dy","startTime":849.53,"endTime":852.32,"body":"explain this procedure to the"},{"speaker":"Chris Dy","startTime":849.53,"endTime":852.32,"body":"patient of we're going to treat"},{"speaker":"Chris Dy","startTime":852.32,"endTime":855.5,"body":"your arthritis by removing an"},{"speaker":"Chris Dy","startTime":852.32,"endTime":855.5,"body":"entire row of bones. I mean,"},{"speaker":"Chris Dy","startTime":855.5,"endTime":858.56,"body":"clearly, we have to have that"},{"speaker":"Chris Dy","startTime":855.5,"endTime":858.56,"body":"conversation for thumb CMC"},{"speaker":"Chris Dy","startTime":858.56,"endTime":860.6,"body":"surgery, but just seems weird."},{"speaker":"Charles Goldfarb","startTime":861.11,"endTime":863.33,"body":"It's a hard"},{"speaker":"Charles Goldfarb","startTime":861.11,"endTime":863.33,"body":"sell. So my hearing my"},{"speaker":"Charles Goldfarb","startTime":863.33,"endTime":868.64,"body":"conversation goes like this. If"},{"speaker":"Charles Goldfarb","startTime":863.33,"endTime":868.64,"body":"I'm selling a PRC, so you have"},{"speaker":"Charles Goldfarb","startTime":868.64,"endTime":871.52,"body":"this significant arthritis, we"},{"speaker":"Charles Goldfarb","startTime":868.64,"endTime":871.52,"body":"have to get rid of this"},{"speaker":"Charles Goldfarb","startTime":871.52,"endTime":877.7,"body":"arthritic bone. And thankfully,"},{"speaker":"Charles Goldfarb","startTime":871.52,"endTime":877.7,"body":"we can use other bones to"},{"speaker":"Charles Goldfarb","startTime":877.7,"endTime":881.72,"body":"support your wrist. There's an"},{"speaker":"Charles Goldfarb","startTime":877.7,"endTime":881.72,"body":"operation that's been around for"},{"speaker":"Charles Goldfarb","startTime":881.75,"endTime":885.44,"body":"100 years, anything that's been"},{"speaker":"Charles Goldfarb","startTime":881.75,"endTime":885.44,"body":"around this long has got to"},{"speaker":"Charles Goldfarb","startTime":885.44,"endTime":890.96,"body":"work. And, and I draw a little"},{"speaker":"Charles Goldfarb","startTime":885.44,"endTime":890.96,"body":"picture, a terrible picture, we"},{"speaker":"Charles Goldfarb","startTime":890.96,"endTime":893.48,"body":"laugh at my art, and then I"},{"speaker":"Charles Goldfarb","startTime":890.96,"endTime":893.48,"body":"explain what we're going to do"},{"speaker":"Charles Goldfarb","startTime":893.48,"endTime":896.09,"body":"and I explained that I trust"},{"speaker":"Charles Goldfarb","startTime":893.48,"endTime":896.09,"body":"this procedure and usually that"},{"speaker":"Charles Goldfarb","startTime":896.12,"endTime":898.55,"body":"that convinces them. Are you"},{"speaker":"Charles Goldfarb","startTime":896.12,"endTime":898.55,"body":"sold?"},{"speaker":"Chris Dy","startTime":899.75,"endTime":902.03,"body":"I love it. I'm"},{"speaker":"Chris Dy","startTime":899.75,"endTime":902.03,"body":"learning here. This is great. So"},{"speaker":"Chris Dy","startTime":902.03,"endTime":904.88,"body":"then how do you how do you sell"},{"speaker":"Chris Dy","startTime":902.03,"endTime":904.88,"body":"the four corner fusion?"},{"speaker":"Charles Goldfarb","startTime":905.63,"endTime":908.72,"body":"I do tend to"},{"speaker":"Charles Goldfarb","startTime":905.63,"endTime":908.72,"body":"use this stereotype if that's"},{"speaker":"Charles Goldfarb","startTime":908.72,"endTime":912.86,"body":"the right word for four bone"},{"speaker":"Charles Goldfarb","startTime":908.72,"endTime":912.86,"body":"fusions in that I think it does"},{"speaker":"Charles Goldfarb","startTime":912.86,"endTime":916.52,"body":"maintain carporal height, I do"},{"speaker":"Charles Goldfarb","startTime":912.86,"endTime":916.52,"body":"believe it probably has some"},{"speaker":"Charles Goldfarb","startTime":916.52,"endTime":920.15,"body":"advantages from a strength"},{"speaker":"Charles Goldfarb","startTime":916.52,"endTime":920.15,"body":"perspective, and it maintains"},{"speaker":"Charles Goldfarb","startTime":920.15,"endTime":924.62,"body":"more normal anatomy. And so for"},{"speaker":"Charles Goldfarb","startTime":920.15,"endTime":924.62,"body":"the patients that either a are"},{"speaker":"Charles Goldfarb","startTime":924.62,"endTime":928.43,"body":"freaked out by the PRC, or B, or"},{"speaker":"Charles Goldfarb","startTime":924.62,"endTime":928.43,"body":"a little younger and higher"},{"speaker":"Charles Goldfarb","startTime":928.43,"endTime":932.9,"body":"demand, I think the four bone"},{"speaker":"Charles Goldfarb","startTime":928.43,"endTime":932.9,"body":"fusion makes sense. And I do"},{"speaker":"Charles Goldfarb","startTime":933.02,"endTime":935.93,"body":"still perform a four bone"},{"speaker":"Charles Goldfarb","startTime":933.02,"endTime":935.93,"body":"fusion, you know, the concept of"},{"speaker":"Charles Goldfarb","startTime":935.93,"endTime":940.19,"body":"just fusing the the capitolunate"},{"speaker":"Charles Goldfarb","startTime":935.93,"endTime":940.19,"body":"joint has become a little more"},{"speaker":"Charles Goldfarb","startTime":940.19,"endTime":943.61,"body":"in vogue lately. But I like the"},{"speaker":"Charles Goldfarb","startTime":940.19,"endTime":943.61,"body":"four bone fusion and I still do"},{"speaker":"Charles Goldfarb","startTime":943.61,"endTime":943.73,"body":"it."},{"speaker":"Chris Dy","startTime":944.12,"endTime":946.7,"body":"So are you also taking"},{"speaker":"Chris Dy","startTime":944.12,"endTime":946.7,"body":"down, you know, the side to side"},{"speaker":"Chris Dy","startTime":946.7,"endTime":949.91,"body":"articulations? Are you just"},{"speaker":"Chris Dy","startTime":946.7,"endTime":949.91,"body":"doing like a two bicolumnar kind"},{"speaker":"Chris Dy","startTime":949.91,"endTime":950.48,"body":"of fusion?"},{"speaker":"Charles Goldfarb","startTime":950.75,"endTime":952.55,"body":"Yeah, I like-"},{"speaker":"Charles Goldfarb","startTime":950.75,"endTime":952.55,"body":"That's a great question. I like"},{"speaker":"Charles Goldfarb","startTime":952.55,"endTime":957.71,"body":"that, I tend to really address"},{"speaker":"Charles Goldfarb","startTime":952.55,"endTime":957.71,"body":"the two mid carpal joints, so"},{"speaker":"Charles Goldfarb","startTime":957.71,"endTime":960.89,"body":"the capitolunate joint I"},{"speaker":"Charles Goldfarb","startTime":957.71,"endTime":960.89,"body":"decorticate. And I fuse that"},{"speaker":"Charles Goldfarb","startTime":960.89,"endTime":964.82,"body":"one. And I also fuse the joint"},{"speaker":"Charles Goldfarb","startTime":960.89,"endTime":964.82,"body":"between the hamate and the"},{"speaker":"Charles Goldfarb","startTime":964.82,"endTime":969.2,"body":"triquetrum. In a perfect world,"},{"speaker":"Charles Goldfarb","startTime":964.82,"endTime":969.2,"body":"I have two screws, one going"},{"speaker":"Charles Goldfarb","startTime":969.2,"endTime":972.98,"body":"from the lunate into the"},{"speaker":"Charles Goldfarb","startTime":969.2,"endTime":972.98,"body":"capitate and a second going from"},{"speaker":"Charles Goldfarb","startTime":972.98,"endTime":977.21,"body":"the triquetrum into the hamate"},{"speaker":"Charles Goldfarb","startTime":972.98,"endTime":977.21,"body":"into the capitate. And I really"},{"speaker":"Charles Goldfarb","startTime":977.21,"endTime":979.94,"body":"liked that. And I've been very"},{"speaker":"Charles Goldfarb","startTime":977.21,"endTime":979.94,"body":"pleased with the results that I"},{"speaker":"Charles Goldfarb","startTime":979.94,"endTime":980.45,"body":"get from that."},{"speaker":"Chris Dy","startTime":981.11,"endTime":984.47,"body":"So we were on our"},{"speaker":"Chris Dy","startTime":981.11,"endTime":984.47,"body":"travel club meeting via zoom"},{"speaker":"Chris Dy","startTime":984.47,"endTime":988.43,"body":"recently of the the younger"},{"speaker":"Chris Dy","startTime":984.47,"endTime":988.43,"body":"generation of hand surgeons. And"},{"speaker":"Chris Dy","startTime":988.46,"endTime":991.49,"body":"we were discussing this very"},{"speaker":"Chris Dy","startTime":988.46,"endTime":991.49,"body":"topic and you know, I felt like"},{"speaker":"Chris Dy","startTime":991.49,"endTime":993.65,"body":"an outlier. Because there are"},{"speaker":"Chris Dy","startTime":991.49,"endTime":993.65,"body":"some of my colleagues are using"},{"speaker":"Chris Dy","startTime":993.71,"endTime":998.12,"body":"plates more and feeling more"},{"speaker":"Chris Dy","startTime":993.71,"endTime":998.12,"body":"confident in moving them earlier"},{"speaker":"Chris Dy","startTime":998.12,"endTime":1000.82,"body":"on with the plates. And you"},{"speaker":"Chris Dy","startTime":998.12,"endTime":1000.82,"body":"know, saying that, you know,"},{"speaker":"Chris Dy","startTime":1000.82,"endTime":1003.97,"body":"there are some reports of"},{"speaker":"Chris Dy","startTime":1000.82,"endTime":1003.97,"body":"construct failure with the type"},{"speaker":"Chris Dy","startTime":1003.97,"endTime":1006.76,"body":"of construct that you just"},{"speaker":"Chris Dy","startTime":1003.97,"endTime":1006.76,"body":"described that I use regularly"},{"speaker":"Chris Dy","startTime":1006.79,"endTime":1011.71,"body":"with early motion. So, you know,"},{"speaker":"Chris Dy","startTime":1006.79,"endTime":1011.71,"body":"if you could do four corner or"},{"speaker":"Chris Dy","startTime":1011.74,"endTime":1015.34,"body":"four bone bicolumnar kind of"},{"speaker":"Chris Dy","startTime":1011.74,"endTime":1015.34,"body":"fusion and move them early,"},{"speaker":"Chris Dy","startTime":1015.37,"endTime":1017.59,"body":"would they you think that would"},{"speaker":"Chris Dy","startTime":1015.37,"endTime":1017.59,"body":"make a difference in terms of"},{"speaker":"Chris Dy","startTime":1017.59,"endTime":1021.97,"body":"the evolving literature between"},{"speaker":"Chris Dy","startTime":1017.59,"endTime":1021.97,"body":"PRC and four bone fusion?"},{"speaker":"Charles Goldfarb","startTime":1022.65,"endTime":1024.18,"body":"I"},{"speaker":"Charles Goldfarb","startTime":1022.65,"endTime":1024.18,"body":"fundamentally I don't believe"},{"speaker":"Charles Goldfarb","startTime":1024.18,"endTime":1026.46,"body":"that it's going to increase"},{"speaker":"Charles Goldfarb","startTime":1024.18,"endTime":1026.46,"body":"motion dramatically in the long"},{"speaker":"Charles Goldfarb","startTime":1026.46,"endTime":1029.16,"body":"term, it might make life a"},{"speaker":"Charles Goldfarb","startTime":1026.46,"endTime":1029.16,"body":"little easier in the short term."},{"speaker":"Charles Goldfarb","startTime":1030.51,"endTime":1035.76,"body":"I guess the question is, would"},{"speaker":"Charles Goldfarb","startTime":1030.51,"endTime":1035.76,"body":"you trust your plate and screws"},{"speaker":"Charles Goldfarb","startTime":1035.79,"endTime":1038.49,"body":"in the lousy lunate bone? That's"},{"speaker":"Charles Goldfarb","startTime":1035.79,"endTime":1038.49,"body":"that's ultimately to me the"},{"speaker":"Charles Goldfarb","startTime":1038.49,"endTime":1042.84,"body":"riskiest issue, the lunate bone"},{"speaker":"Charles Goldfarb","startTime":1038.49,"endTime":1042.84,"body":"is not healthy, it's small. And"},{"speaker":"Charles Goldfarb","startTime":1042.84,"endTime":1045.99,"body":"we're trying to make sure it"},{"speaker":"Charles Goldfarb","startTime":1042.84,"endTime":1045.99,"body":"fuses because that is the key to"},{"speaker":"Charles Goldfarb","startTime":1045.99,"endTime":1048.99,"body":"the whole operation. So I"},{"speaker":"Charles Goldfarb","startTime":1045.99,"endTime":1048.99,"body":"respect that people are doing"},{"speaker":"Charles Goldfarb","startTime":1048.99,"endTime":1052.59,"body":"this, I don't feel a strong need"},{"speaker":"Charles Goldfarb","startTime":1048.99,"endTime":1052.59,"body":"to investigate it, I guess, is"},{"speaker":"Charles Goldfarb","startTime":1052.59,"endTime":1053.28,"body":"my response."},{"speaker":"Chris Dy","startTime":1053.94,"endTime":1055.71,"body":"And then the other."},{"speaker":"Chris Dy","startTime":1053.94,"endTime":1055.71,"body":"The other thing, I think that"},{"speaker":"Chris Dy","startTime":1055.71,"endTime":1058.77,"body":"it's challenging about these"},{"speaker":"Chris Dy","startTime":1055.71,"endTime":1058.77,"body":"sometimes if if it was getting"},{"speaker":"Chris Dy","startTime":1058.77,"endTime":1061.83,"body":"the lunate correction, and"},{"speaker":"Chris Dy","startTime":1058.77,"endTime":1061.83,"body":"getting the lunate correction,"},{"speaker":"Chris Dy","startTime":1061.83,"endTime":1064.53,"body":"but then also being able to get"},{"speaker":"Chris Dy","startTime":1061.83,"endTime":1064.53,"body":"your screw in the right position"},{"speaker":"Chris Dy","startTime":1064.53,"endTime":1067.11,"body":"in the lunate because"},{"speaker":"Chris Dy","startTime":1064.53,"endTime":1067.11,"body":"essentially, you've you've taken"},{"speaker":"Chris Dy","startTime":1067.11,"endTime":1069.9,"body":"down the mid carpal joint, your"},{"speaker":"Chris Dy","startTime":1067.11,"endTime":1069.9,"body":"capitolunate joint's taken down,"},{"speaker":"Chris Dy","startTime":1070.23,"endTime":1073.53,"body":"you're having to flex down,"},{"speaker":"Chris Dy","startTime":1070.23,"endTime":1073.53,"body":"essentially the wrist to get"},{"speaker":"Chris Dy","startTime":1073.53,"endTime":1078.78,"body":"that lunate in neutral posture."},{"speaker":"Chris Dy","startTime":1073.53,"endTime":1078.78,"body":"But then also get your screw"},{"speaker":"Chris Dy","startTime":1078.78,"endTime":1081.18,"body":"kind of in the center of the"},{"speaker":"Chris Dy","startTime":1078.78,"endTime":1081.18,"body":"lunate, you know, volar to"},{"speaker":"Chris Dy","startTime":1081.18,"endTime":1083.76,"body":"dorsal. Do you have any tricks"},{"speaker":"Chris Dy","startTime":1081.18,"endTime":1083.76,"body":"for that because you know,"},{"speaker":"Chris Dy","startTime":1083.76,"endTime":1085.92,"body":"whatever, you know, I tried to"},{"speaker":"Chris Dy","startTime":1083.76,"endTime":1085.92,"body":"do that it's it's a little more"},{"speaker":"Chris Dy","startTime":1085.92,"endTime":1088.53,"body":"challenging just because you end"},{"speaker":"Chris Dy","startTime":1085.92,"endTime":1088.53,"body":"up flexing your wrist, but then"},{"speaker":"Chris Dy","startTime":1088.53,"endTime":1091.23,"body":"it made carpal joint opens up"},{"speaker":"Chris Dy","startTime":1088.53,"endTime":1091.23,"body":"and I try to keep it close. But"},{"speaker":"Chris Dy","startTime":1091.23,"endTime":1092.64,"body":"it's challenging sometimes."},{"speaker":"Charles Goldfarb","startTime":1093.09,"endTime":1095.28,"body":"Totally agree."},{"speaker":"Charles Goldfarb","startTime":1093.09,"endTime":1095.28,"body":"And it can be really"},{"speaker":"Charles Goldfarb","startTime":1095.28,"endTime":1099.0,"body":"challenging. I would say a"},{"speaker":"Charles Goldfarb","startTime":1095.28,"endTime":1099.0,"body":"couple of things, just to make"},{"speaker":"Charles Goldfarb","startTime":1099.0,"endTime":1101.85,"body":"sure we're following up on the"},{"speaker":"Charles Goldfarb","startTime":1099.0,"endTime":1101.85,"body":"biomechanics, without that"},{"speaker":"Charles Goldfarb","startTime":1101.85,"endTime":1106.2,"body":"scaphoid to tether the lunate,"},{"speaker":"Charles Goldfarb","startTime":1101.85,"endTime":1106.2,"body":"the lunate tends to go into DC."},{"speaker":"Charles Goldfarb","startTime":1106.2,"endTime":1111.03,"body":"So it dorsal flexes. And so our"},{"speaker":"Charles Goldfarb","startTime":1106.2,"endTime":1111.03,"body":"goal with the surgery to create"},{"speaker":"Charles Goldfarb","startTime":1111.03,"endTime":1116.07,"body":"the greatest arc of motion is to"},{"speaker":"Charles Goldfarb","startTime":1111.03,"endTime":1116.07,"body":"get the new lunate neutral at"},{"speaker":"Charles Goldfarb","startTime":1116.07,"endTime":1119.58,"body":"the fusion site with the"},{"speaker":"Charles Goldfarb","startTime":1116.07,"endTime":1119.58,"body":"capitate. And so what I do is I"},{"speaker":"Charles Goldfarb","startTime":1119.58,"endTime":1123.63,"body":"decorticate everything, I flex"},{"speaker":"Charles Goldfarb","startTime":1119.58,"endTime":1123.63,"body":"the wrist, and sometimes I have"},{"speaker":"Charles Goldfarb","startTime":1123.63,"endTime":1128.22,"body":"to release that volar lip of the"},{"speaker":"Charles Goldfarb","startTime":1123.63,"endTime":1128.22,"body":"lunate, but I flex the wrist and"},{"speaker":"Charles Goldfarb","startTime":1128.22,"endTime":1131.85,"body":"to get the capitate and the"},{"speaker":"Charles Goldfarb","startTime":1128.22,"endTime":1131.85,"body":"lunate lined up, I place a six"},{"speaker":"Charles Goldfarb","startTime":1131.85,"endTime":1136.68,"body":"two K wire securing the capitate"},{"speaker":"Charles Goldfarb","startTime":1131.85,"endTime":1136.68,"body":"to the lunate and then I can put"},{"speaker":"Charles Goldfarb","startTime":1136.68,"endTime":1139.53,"body":"the wrist wherever I want to put"},{"speaker":"Charles Goldfarb","startTime":1136.68,"endTime":1139.53,"body":"my screw and I've been really"},{"speaker":"Charles Goldfarb","startTime":1139.53,"endTime":1142.8,"body":"happy with that technique and"},{"speaker":"Charles Goldfarb","startTime":1139.53,"endTime":1142.8,"body":"always start there and then go"},{"speaker":"Charles Goldfarb","startTime":1142.8,"endTime":1146.22,"body":"to the other joint for fusion"},{"speaker":"Charles Goldfarb","startTime":1142.8,"endTime":1146.22,"body":"later. So I like that I think"},{"speaker":"Charles Goldfarb","startTime":1146.22,"endTime":1149.37,"body":"it's probably easier putting a"},{"speaker":"Charles Goldfarb","startTime":1146.22,"endTime":1149.37,"body":"dorsal plate on in some respects"},{"speaker":"Charles Goldfarb","startTime":1149.4,"endTime":1153.09,"body":"for that very reason. But I"},{"speaker":"Charles Goldfarb","startTime":1149.4,"endTime":1153.09,"body":"hadn't been a huge impediment"},{"speaker":"Charles Goldfarb","startTime":1153.42,"endTime":1154.77,"body":"for me with that technique."},{"speaker":"Chris Dy","startTime":1155.37,"endTime":1159.21,"body":"And for your ulnar"},{"speaker":"Chris Dy","startTime":1155.37,"endTime":1159.21,"body":"sided screw separate incision"},{"speaker":"Chris Dy","startTime":1159.24,"endTime":1161.91,"body":"work through the same incision."},{"speaker":"Chris Dy","startTime":1159.24,"endTime":1161.91,"body":"If you're in a separate"},{"speaker":"Chris Dy","startTime":1161.91,"endTime":1165.12,"body":"incision, how do you avoid, you"},{"speaker":"Chris Dy","startTime":1161.91,"endTime":1165.12,"body":"know, the dorsal cutaneous"},{"speaker":"Chris Dy","startTime":1165.12,"endTime":1167.85,"body":"branch of the ulnar nerve as as"},{"speaker":"Chris Dy","startTime":1165.12,"endTime":1167.85,"body":"as it's coming from volar to"},{"speaker":"Chris Dy","startTime":1167.85,"endTime":1168.36,"body":"dorsal?"},{"speaker":"Charles Goldfarb","startTime":1168.87,"endTime":1170.04,"body":"Yeah, I'd be"},{"speaker":"Charles Goldfarb","startTime":1168.87,"endTime":1170.04,"body":"interested to hear what you do."},{"speaker":"Charles Goldfarb","startTime":1170.04,"endTime":1172.89,"body":"I do make a separate incision"},{"speaker":"Charles Goldfarb","startTime":1170.04,"endTime":1172.89,"body":"just distal to  the ulnar"},{"speaker":"Charles Goldfarb","startTime":1172.89,"endTime":1177.93,"body":"styloid I find the nerve or"},{"speaker":"Charles Goldfarb","startTime":1172.89,"endTime":1177.93,"body":"nerve branches and free them and"},{"speaker":"Charles Goldfarb","startTime":1177.93,"endTime":1180.24,"body":"then go right for that"},{"speaker":"Charles Goldfarb","startTime":1177.93,"endTime":1180.24,"body":"triquetrum to place the K wire"},{"speaker":"Charles Goldfarb","startTime":1180.24,"endTime":1182.31,"body":"and then the screw. What about"},{"speaker":"Charles Goldfarb","startTime":1180.24,"endTime":1182.31,"body":"you?"},{"speaker":"Chris Dy","startTime":1183.24,"endTime":1185.88,"body":"I do the same. And"},{"speaker":"Chris Dy","startTime":1183.24,"endTime":1185.88,"body":"it's funny because I did that."},{"speaker":"Chris Dy","startTime":1186.51,"endTime":1189.21,"body":"And that's how I remember"},{"speaker":"Chris Dy","startTime":1186.51,"endTime":1189.21,"body":"learning it from from Ryan"},{"speaker":"Chris Dy","startTime":1189.21,"endTime":1192.48,"body":"Calfee when I was this fellow."},{"speaker":"Chris Dy","startTime":1189.21,"endTime":1192.48,"body":"And then I was teaching a fellow"},{"speaker":"Chris Dy","startTime":1192.51,"endTime":1195.66,"body":"to do I was like, Oh, this is"},{"speaker":"Chris Dy","startTime":1192.51,"endTime":1195.66,"body":"how Dr. Calfee does it too. And"},{"speaker":"Chris Dy","startTime":1195.66,"endTime":1197.97,"body":"they're like, Oh, no. Dr. Calfee"},{"speaker":"Chris Dy","startTime":1195.66,"endTime":1197.97,"body":"just does it through the dorsal"},{"speaker":"Chris Dy","startTime":1197.97,"endTime":1200.4,"body":"incision and I went for and I'm"},{"speaker":"Chris Dy","startTime":1197.97,"endTime":1200.4,"body":"like, What the hell And he's"},{"speaker":"Chris Dy","startTime":1200.4,"endTime":1201.21,"body":"like, oh, yeah I changed."},{"speaker":"Charles Goldfarb","startTime":1202.86,"endTime":1204.09,"body":"You can't just"},{"speaker":"Charles Goldfarb","startTime":1202.86,"endTime":1204.09,"body":"change."},{"speaker":"Chris Dy","startTime":1204.48,"endTime":1206.19,"body":"I guess, you know, and"},{"speaker":"Chris Dy","startTime":1204.48,"endTime":1206.19,"body":"he's like, it just made more"},{"speaker":"Chris Dy","startTime":1206.19,"endTime":1207.63,"body":"sense to me. So that's good."},{"speaker":"Charles Goldfarb","startTime":1207.96,"endTime":1212.31,"body":"So let's say"},{"speaker":"Charles Goldfarb","startTime":1207.96,"endTime":1212.31,"body":"you have do it. Well, I just put"},{"speaker":"Charles Goldfarb","startTime":1212.31,"endTime":1216.72,"body":"it out. There's a question in a"},{"speaker":"Charles Goldfarb","startTime":1212.31,"endTime":1216.72,"body":"classic SLAC wrist. Do you ever"},{"speaker":"Charles Goldfarb","startTime":1216.72,"endTime":1221.43,"body":"consider a complete wrist"},{"speaker":"Charles Goldfarb","startTime":1216.72,"endTime":1221.43,"body":"fusion? And do you ever consider"},{"speaker":"Charles Goldfarb","startTime":1221.43,"endTime":1222.63,"body":"wrist arthroplasty?"},{"speaker":"Chris Dy","startTime":1224.1,"endTime":1226.62,"body":"I think I have a"},{"speaker":"Chris Dy","startTime":1224.1,"endTime":1226.62,"body":"higher threshold to consider"},{"speaker":"Chris Dy","startTime":1226.62,"endTime":1229.71,"body":"wrist arthroplasty. Just because"},{"speaker":"Chris Dy","startTime":1226.62,"endTime":1229.71,"body":"I am not as well versed in if I"},{"speaker":"Chris Dy","startTime":1229.71,"endTime":1232.05,"body":"have anybody that's interested"},{"speaker":"Chris Dy","startTime":1229.71,"endTime":1232.05,"body":"in it, you know, I have a"},{"speaker":"Chris Dy","startTime":1232.05,"endTime":1234.54,"body":"general sense of appropriate"},{"speaker":"Chris Dy","startTime":1232.05,"endTime":1234.54,"body":"indications and, you know,"},{"speaker":"Chris Dy","startTime":1234.54,"endTime":1238.11,"body":"expected outcomes I'll send them"},{"speaker":"Chris Dy","startTime":1234.54,"endTime":1238.11,"body":"to Marty. Since Marty Boyer, our"},{"speaker":"Chris Dy","startTime":1238.11,"endTime":1241.95,"body":"partner does that for our group."},{"speaker":"Chris Dy","startTime":1238.11,"endTime":1241.95,"body":"Although I admittedly want to"},{"speaker":"Chris Dy","startTime":1241.95,"endTime":1245.94,"body":"learn more about it and then you"},{"speaker":"Chris Dy","startTime":1241.95,"endTime":1245.94,"body":"know, total wrist arthrodesis"},{"speaker":"Chris Dy","startTime":1245.94,"endTime":1249.54,"body":"I've done one for a SLAC wrist"},{"speaker":"Chris Dy","startTime":1245.94,"endTime":1249.54,"body":"because it the wrist honestly"},{"speaker":"Chris Dy","startTime":1249.54,"endTime":1252.06,"body":"looked really beat up on the X"},{"speaker":"Chris Dy","startTime":1249.54,"endTime":1252.06,"body":"rays and I had some concerns"},{"speaker":"Chris Dy","startTime":1252.06,"endTime":1258.45,"body":"about the lunate the radiolunate"},{"speaker":"Chris Dy","startTime":1252.06,"endTime":1258.45,"body":"joint. So I ended up offering"},{"speaker":"Chris Dy","startTime":1258.45,"endTime":1261.66,"body":"him a one and done surgery and"},{"speaker":"Chris Dy","startTime":1258.45,"endTime":1261.66,"body":"we did a wrist arthrodesis and"},{"speaker":"Chris Dy","startTime":1261.66,"endTime":1262.2,"body":"very happy."},{"speaker":"Charles Goldfarb","startTime":1263.31,"endTime":1267.06,"body":"I agree and"},{"speaker":"Charles Goldfarb","startTime":1263.31,"endTime":1267.06,"body":"disagree. I agree that there are"},{"speaker":"Charles Goldfarb","startTime":1267.06,"endTime":1270.57,"body":"certain patients that I think a"},{"speaker":"Charles Goldfarb","startTime":1267.06,"endTime":1270.57,"body":"wrist arthroplasty makes sense"},{"speaker":"Charles Goldfarb","startTime":1270.57,"endTime":1274.86,"body":"for. But for those patients, I"},{"speaker":"Charles Goldfarb","startTime":1270.57,"endTime":1274.86,"body":"have no interest in learning how"},{"speaker":"Charles Goldfarb","startTime":1274.86,"endTime":1277.74,"body":"to do a wrist arthroplasty and"},{"speaker":"Charles Goldfarb","startTime":1274.86,"endTime":1277.74,"body":"I'm happy to send them to Dr."},{"speaker":"Charles Goldfarb","startTime":1277.74,"endTime":1281.94,"body":"Boyer. But it is an older lower"},{"speaker":"Charles Goldfarb","startTime":1277.74,"endTime":1281.94,"body":"demand population. There is"},{"speaker":"Charles Goldfarb","startTime":1281.94,"endTime":1287.73,"body":"another group that has very high"},{"speaker":"Charles Goldfarb","startTime":1281.94,"endTime":1287.73,"body":"demand and very bad arthritis"},{"speaker":"Charles Goldfarb","startTime":1287.76,"endTime":1290.4,"body":"and a formal wrist fusion a"},{"speaker":"Charles Goldfarb","startTime":1287.76,"endTime":1290.4,"body":"complete wrist fusion makes"},{"speaker":"Charles Goldfarb","startTime":1290.4,"endTime":1293.76,"body":"sense. And so I do think those"},{"speaker":"Charles Goldfarb","startTime":1290.4,"endTime":1293.76,"body":"two operations come into play"},{"speaker":"Charles Goldfarb","startTime":1293.76,"endTime":1296.73,"body":"although the vast majority of by"},{"speaker":"Charles Goldfarb","startTime":1293.76,"endTime":1296.73,"body":"SLAC wrist patients are treated"},{"speaker":"Charles Goldfarb","startTime":1296.73,"endTime":1300.15,"body":"successfully with either a PRC"},{"speaker":"Charles Goldfarb","startTime":1296.73,"endTime":1300.15,"body":"or a four bone fusion."},{"speaker":"Chris Dy","startTime":1300.72,"endTime":1303.69,"body":"Fantastic. Thanks for"},{"speaker":"Chris Dy","startTime":1300.72,"endTime":1303.69,"body":"playing Wheel of hand surgery. I"},{"speaker":"Chris Dy","startTime":1303.69,"endTime":1306.9,"body":"will replace SLAC wrist with"},{"speaker":"Chris Dy","startTime":1303.69,"endTime":1306.9,"body":"some other sportsy kind of topic"},{"speaker":"Chris Dy","startTime":1306.96,"endTime":1307.71,"body":"and we'll go from there."},{"speaker":"Charles Goldfarb","startTime":1308.04,"endTime":1310.47,"body":"Alright, so"},{"speaker":"Charles Goldfarb","startTime":1308.04,"endTime":1310.47,"body":"listeners if you like the wheel,"},{"speaker":"Charles Goldfarb","startTime":1310.47,"endTime":1313.23,"body":"let us know if you think it's"},{"speaker":"Charles Goldfarb","startTime":1310.47,"endTime":1313.23,"body":"silly. Let us know. Have a good"},{"speaker":"Charles Goldfarb","startTime":1313.23,"endTime":1313.5,"body":"one."},{"speaker":"Chris Dy","startTime":1313.77,"endTime":1315.36,"body":"All right. You better"},{"speaker":"Chris Dy","startTime":1313.77,"endTime":1315.36,"body":"like it."},{"speaker":"Charles Goldfarb","startTime":1317.4,"endTime":1319.38,"body":"Hey, Chris,"},{"speaker":"Charles Goldfarb","startTime":1317.4,"endTime":1319.38,"body":"that was fun. Let's do it again"},{"speaker":"Charles Goldfarb","startTime":1319.38,"endTime":1319.89,"body":"real soon."},{"speaker":"Chris Dy","startTime":1320.16,"endTime":1322.68,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":1320.16,"endTime":1322.68,"body":"sure to check us out on Twitter"},{"speaker":"Chris Dy","startTime":1323.73,"endTime":1325.11,"body":"@Handpodcast. Hey, Chuck, what's"},{"speaker":"Chris Dy","startTime":1323.73,"endTime":1325.11,"body":"your Twitter handle?"},{"speaker":"Charles Goldfarb","startTime":1325.44,"endTime":1328.29,"body":"Mine is"},{"speaker":"Charles Goldfarb","startTime":1325.44,"endTime":1328.29,"body":"@congenitalhand. What about you?"},{"speaker":"Chris Dy","startTime":1328.45,"endTime":1331.81,"body":"Mine is @ChrisDyMD"},{"speaker":"Chris Dy","startTime":1328.45,"endTime":1331.81,"body":"spelled d y. And if you'd like"},{"speaker":"Chris Dy","startTime":1331.81,"endTime":1335.11,"body":"to email us, you can reach us at"},{"speaker":"Chris Dy","startTime":1331.81,"endTime":1335.11,"body":"handpodcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":1336.25,"endTime":1338.38,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":1336.25,"endTime":1338.38,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":1338.38,"endTime":1339.46,"body":"get your podcasts."},{"speaker":"Chris Dy","startTime":1339.52,"endTime":1341.74,"body":"And be sure to leave a"},{"speaker":"Chris Dy","startTime":1339.52,"endTime":1341.74,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":1341.74,"endTime":1342.13,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":1342.53,"endTime":1344.81,"body":"Special thanks"},{"speaker":"Charles Goldfarb","startTime":1342.53,"endTime":1344.81,"body":"to Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":1344.81,"endTime":1348.8,"body":"music. And remember, keep the"},{"speaker":"Charles Goldfarb","startTime":1344.81,"endTime":1348.8,"body":"upper hand. Come back next time."}]}