{"version":"1.0.0","segments":[{"speaker":"Charles Goldfarb","startTime":10.8,"endTime":13.38,"body":"Welcome to the"},{"speaker":"Charles Goldfarb","startTime":10.8,"endTime":13.38,"body":"upper hand, where Chuck and"},{"speaker":"Charles Goldfarb","startTime":13.38,"endTime":14.49,"body":"Chris talk hand surgery."},{"speaker":"Chris Dy","startTime":14.82,"endTime":16.56,"body":"We are two hand"},{"speaker":"Chris Dy","startTime":14.82,"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":24.36,"body":"Thank you for"},{"speaker":"Charles Goldfarb","startTime":22.05,"endTime":24.36,"body":"subscribing wherever you get"},{"speaker":"Charles Goldfarb","startTime":24.36,"endTime":25.26,"body":"your podcasts."},{"speaker":"Chris Dy","startTime":25.47,"endTime":27.66,"body":"And be sure to leave a"},{"speaker":"Chris Dy","startTime":25.47,"endTime":27.66,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":27.66,"endTime":28.23,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":29.1,"endTime":30.9,"body":"All right,"},{"speaker":"Charles Goldfarb","startTime":29.1,"endTime":30.9,"body":"Chris, Chuck, how"},{"speaker":"Chris Dy","startTime":30.9,"endTime":31.32,"body":"are you?"},{"speaker":"Charles Goldfarb","startTime":31.739,"endTime":33.809,"body":"I'm really,"},{"speaker":"Charles Goldfarb","startTime":31.739,"endTime":33.809,"body":"really well, how are you?"},{"speaker":"Chris Dy","startTime":34.23,"endTime":38.13,"body":"I am fine. I am just"},{"speaker":"Chris Dy","startTime":34.23,"endTime":38.13,"body":"hoping that our audio is better"},{"speaker":"Chris Dy","startTime":38.13,"endTime":41.55,"body":"than I know, I have been bad in"},{"speaker":"Chris Dy","startTime":38.13,"endTime":41.55,"body":"the last few weeks. And I'm"},{"speaker":"Chris Dy","startTime":41.55,"endTime":46.11,"body":"trying to get better. We did a"},{"speaker":"Chris Dy","startTime":41.55,"endTime":46.11,"body":"little interview for the"},{"speaker":"Chris Dy","startTime":46.11,"endTime":51.33,"body":"plastics fellow for his for his"},{"speaker":"Chris Dy","startTime":46.11,"endTime":51.33,"body":"website. And I did mention that"},{"speaker":"Chris Dy","startTime":51.33,"endTime":55.2,"body":"I've tried three different mics"},{"speaker":"Chris Dy","startTime":51.33,"endTime":55.2,"body":"in three different laptops. I"},{"speaker":"Chris Dy","startTime":55.2,"endTime":56.37,"body":"can't figure it out."},{"speaker":"Charles Goldfarb","startTime":56.97,"endTime":59.49,"body":"Well, you"},{"speaker":"Charles Goldfarb","startTime":56.97,"endTime":59.49,"body":"sound good today. And I know"},{"speaker":"Charles Goldfarb","startTime":59.49,"endTime":62.61,"body":"it's really frustrating. I must"},{"speaker":"Charles Goldfarb","startTime":59.49,"endTime":62.61,"body":"have gotten lucky because it"},{"speaker":"Charles Goldfarb","startTime":62.61,"endTime":65.07,"body":"seems to have worked out well"},{"speaker":"Charles Goldfarb","startTime":62.61,"endTime":65.07,"body":"with a really old pair of"},{"speaker":"Charles Goldfarb","startTime":65.25,"endTime":69.03,"body":"quality but old headphones and"},{"speaker":"Charles Goldfarb","startTime":65.25,"endTime":69.03,"body":"my Mac Pro."},{"speaker":"Chris Dy","startTime":69.51,"endTime":71.58,"body":"Well, you know, that's"},{"speaker":"Chris Dy","startTime":69.51,"endTime":71.58,"body":"how I would describe you Chuck,"},{"speaker":"Chris Dy","startTime":71.7,"endTime":76.35,"body":"quality, but old. But no shout"},{"speaker":"Chris Dy","startTime":71.7,"endTime":76.35,"body":"out to shout out to Eric Zhu,"},{"speaker":"Chris Dy","startTime":76.47,"endTime":79.71,"body":"our podcast intern who has stuck"},{"speaker":"Chris Dy","startTime":76.47,"endTime":79.71,"body":"with us for so long. And"},{"speaker":"Chris Dy","startTime":79.77,"endTime":82.89,"body":"hopefully, you know, he's able"},{"speaker":"Chris Dy","startTime":79.77,"endTime":82.89,"body":"to make me sound a little bit"},{"speaker":"Chris Dy","startTime":82.89,"endTime":83.28,"body":"better."},{"speaker":"Charles Goldfarb","startTime":83.97,"endTime":86.1,"body":"Well, yeah,"},{"speaker":"Charles Goldfarb","startTime":83.97,"endTime":86.1,"body":"it's hard work. And so Eric, you"},{"speaker":"Charles Goldfarb","startTime":86.1,"endTime":88.5,"body":"got your work cut out for you."},{"speaker":"Charles Goldfarb","startTime":86.1,"endTime":88.5,"body":"But we appreciate all your"},{"speaker":"Charles Goldfarb","startTime":88.5,"endTime":89.16,"body":"efforts."},{"speaker":"Chris Dy","startTime":89.78,"endTime":94.13,"body":"So Chuck, I have a"},{"speaker":"Chris Dy","startTime":89.78,"endTime":94.13,"body":"nice little piece of feedback to"},{"speaker":"Chris Dy","startTime":94.13,"endTime":99.29,"body":"get I got an email from Dr."},{"speaker":"Chris Dy","startTime":94.13,"endTime":99.29,"body":"Matthew Brown over he is a"},{"speaker":"Chris Dy","startTime":99.29,"endTime":103.31,"body":"fellow in hand and wrist surgery"},{"speaker":"Chris Dy","startTime":99.29,"endTime":103.31,"body":"in Wrightington in the UK. And"},{"speaker":"Chris Dy","startTime":103.31,"endTime":108.14,"body":"he was kind enough to send me an"},{"speaker":"Chris Dy","startTime":103.31,"endTime":108.14,"body":"email. And he mentioned that as"},{"speaker":"Chris Dy","startTime":108.14,"endTime":110.39,"body":"an orthopedic trained hand"},{"speaker":"Chris Dy","startTime":108.14,"endTime":110.39,"body":"surgeon with a record of"},{"speaker":"Chris Dy","startTime":110.39,"endTime":114.2,"body":"multidisciplinary education, I"},{"speaker":"Chris Dy","startTime":110.39,"endTime":114.2,"body":"would be most grateful for your"},{"speaker":"Chris Dy","startTime":114.2,"endTime":118.52,"body":"participation, he invited me to"},{"speaker":"Chris Dy","startTime":114.2,"endTime":118.52,"body":"help with a talk at the IFSSH"},{"speaker":"Chris Dy","startTime":118.55,"endTime":121.61,"body":"meeting. He said he's a big fan"},{"speaker":"Chris Dy","startTime":118.55,"endTime":121.61,"body":"of the excellent upper hand"},{"speaker":"Chris Dy","startTime":121.61,"endTime":124.4,"body":"podcast, which has"},{"speaker":"Chris Dy","startTime":121.61,"endTime":124.4,"body":"simultaneously supported his"},{"speaker":"Chris Dy","startTime":124.4,"endTime":127.91,"body":"recent hand diploma revision and"},{"speaker":"Chris Dy","startTime":124.4,"endTime":127.91,"body":"made his weekly four hour"},{"speaker":"Chris Dy","startTime":127.91,"endTime":130.46,"body":"fellowship commutes between"},{"speaker":"Chris Dy","startTime":127.91,"endTime":130.46,"body":"Edinburgh and Wrightington more"},{"speaker":"Chris Dy","startTime":130.46,"endTime":134.12,"body":"enjoyable, he has highly"},{"speaker":"Chris Dy","startTime":130.46,"endTime":134.12,"body":"recommended it to his UK"},{"speaker":"Chris Dy","startTime":134.12,"endTime":137.87,"body":"colleagues. So another example"},{"speaker":"Chris Dy","startTime":134.12,"endTime":137.87,"body":"of how we love our podcast"},{"speaker":"Chris Dy","startTime":137.87,"endTime":140.84,"body":"community. And clearly, you"},{"speaker":"Chris Dy","startTime":137.87,"endTime":140.84,"body":"know, I'm flattered and honored"},{"speaker":"Chris Dy","startTime":140.84,"endTime":143.87,"body":"at the opportunity to come speak"},{"speaker":"Chris Dy","startTime":140.84,"endTime":143.87,"body":"next June. And I'm sure we'll be"},{"speaker":"Chris Dy","startTime":143.87,"endTime":145.82,"body":"plugging that meeting as things"},{"speaker":"Chris Dy","startTime":143.87,"endTime":145.82,"body":"come along too."},{"speaker":"Charles Goldfarb","startTime":146.4,"endTime":148.23,"body":"Oh, we will"},{"speaker":"Charles Goldfarb","startTime":146.4,"endTime":148.23,"body":"for sure it is going to be a"},{"speaker":"Charles Goldfarb","startTime":148.23,"endTime":152.22,"body":"great meeting. And I've had a"},{"speaker":"Charles Goldfarb","startTime":148.23,"endTime":152.22,"body":"little insight, especially on to"},{"speaker":"Charles Goldfarb","startTime":152.22,"endTime":154.95,"body":"the pediatric and congenital"},{"speaker":"Charles Goldfarb","startTime":152.22,"endTime":154.95,"body":"side of the program is going to"},{"speaker":"Charles Goldfarb","startTime":154.95,"endTime":158.43,"body":"be strong. I wonder if I'm going"},{"speaker":"Charles Goldfarb","startTime":154.95,"endTime":158.43,"body":"to get an invite to try to make"},{"speaker":"Charles Goldfarb","startTime":158.43,"endTime":160.5,"body":"you sound better at this"},{"speaker":"Charles Goldfarb","startTime":158.43,"endTime":160.5,"body":"meeting, too. I mean, I don't"},{"speaker":"Charles Goldfarb","startTime":160.5,"endTime":161.55,"body":"know how you're gonna do it"},{"speaker":"Charles Goldfarb","startTime":160.5,"endTime":161.55,"body":"without me."},{"speaker":"Chris Dy","startTime":161.93,"endTime":164.9,"body":"You know, Chuck, uh,"},{"speaker":"Chris Dy","startTime":161.93,"endTime":164.9,"body":"you know, the, you can keep"},{"speaker":"Chris Dy","startTime":164.9,"endTime":167.09,"body":"following along on the"},{"speaker":"Chris Dy","startTime":164.9,"endTime":167.09,"body":"bootstraps here. I mean, you"},{"speaker":"Chris Dy","startTime":167.09,"endTime":168.11,"body":"know, I'll pull you along."},{"speaker":"Charles Goldfarb","startTime":168.11,"endTime":168.41,"body":"I'll take it."},{"speaker":"Chris Dy","startTime":169.7,"endTime":174.17,"body":"Well, thank you. Thank"},{"speaker":"Chris Dy","startTime":169.7,"endTime":174.17,"body":"you to Matt, for the email, and"},{"speaker":"Chris Dy","startTime":174.17,"endTime":176.51,"body":"you know, your kind words and"},{"speaker":"Chris Dy","startTime":174.17,"endTime":176.51,"body":"for telling everybody about the"},{"speaker":"Chris Dy","startTime":176.51,"endTime":180.26,"body":"podcast, we're really excited"},{"speaker":"Chris Dy","startTime":176.51,"endTime":180.26,"body":"that it seems to really be"},{"speaker":"Chris Dy","startTime":180.65,"endTime":181.85,"body":"having a foothold."},{"speaker":"Charles Goldfarb","startTime":182.4,"endTime":184.71,"body":"Yeah, we are"},{"speaker":"Charles Goldfarb","startTime":182.4,"endTime":184.71,"body":"grateful for all comments. And"},{"speaker":"Charles Goldfarb","startTime":184.71,"endTime":187.95,"body":"we've said this before, and"},{"speaker":"Charles Goldfarb","startTime":184.71,"endTime":187.95,"body":"we'll say it again, the emails"},{"speaker":"Charles Goldfarb","startTime":187.95,"endTime":191.61,"body":"and the questions, and the nice"},{"speaker":"Charles Goldfarb","startTime":187.95,"endTime":191.61,"body":"reviews really do provide fuel"},{"speaker":"Charles Goldfarb","startTime":191.61,"endTime":195.27,"body":"for us. Because while this is a"},{"speaker":"Charles Goldfarb","startTime":191.61,"endTime":195.27,"body":"labor of love, it is first a"},{"speaker":"Charles Goldfarb","startTime":195.27,"endTime":198.93,"body":"labor. And it does require us"},{"speaker":"Charles Goldfarb","startTime":195.27,"endTime":198.93,"body":"finding the time to do this,"},{"speaker":"Charles Goldfarb","startTime":198.93,"endTime":201.96,"body":"even though we always have fun"},{"speaker":"Charles Goldfarb","startTime":198.93,"endTime":201.96,"body":"doing it, just trying to carve"},{"speaker":"Charles Goldfarb","startTime":201.96,"endTime":203.7,"body":"out that little bit of time. So"},{"speaker":"Charles Goldfarb","startTime":201.96,"endTime":203.7,"body":"thank you."},{"speaker":"Chris Dy","startTime":204.29,"endTime":207.65,"body":"Yes. And that actually"},{"speaker":"Chris Dy","startTime":204.29,"endTime":207.65,"body":"brings us to our next segment on"},{"speaker":"Chris Dy","startTime":207.65,"endTime":211.13,"body":"the show. We're gonna do a"},{"speaker":"Chris Dy","startTime":207.65,"endTime":211.13,"body":"detail episode today. And I got"},{"speaker":"Chris Dy","startTime":211.13,"endTime":214.31,"body":"an email on the"},{"speaker":"Chris Dy","startTime":211.13,"endTime":214.31,"body":"handpodcast@gmail.com account"},{"speaker":"Chris Dy","startTime":214.4,"endTime":218.33,"body":"from Dr. Colin Kennedy, who"},{"speaker":"Chris Dy","startTime":214.4,"endTime":218.33,"body":"kindly wrote us saying that he"},{"speaker":"Chris Dy","startTime":218.33,"endTime":221.6,"body":"is a hand surgeon in Las Vegas"},{"speaker":"Chris Dy","startTime":218.33,"endTime":221.6,"body":"and wanted to let us both know"},{"speaker":"Chris Dy","startTime":221.6,"endTime":225.5,"body":"how much he enjoys the deep dive"},{"speaker":"Chris Dy","startTime":221.6,"endTime":225.5,"body":"episodes, found it educational"},{"speaker":"Chris Dy","startTime":225.5,"endTime":228.08,"body":"hear us go through Common"},{"speaker":"Chris Dy","startTime":225.5,"endTime":228.08,"body":"Procedure step by step and to"},{"speaker":"Chris Dy","startTime":228.08,"endTime":231.35,"body":"discuss the nuances to the case"},{"speaker":"Chris Dy","startTime":228.08,"endTime":231.35,"body":"and the techniques. It's a"},{"speaker":"Chris Dy","startTime":231.35,"endTime":234.38,"body":"refreshing reminder to pay close"},{"speaker":"Chris Dy","startTime":231.35,"endTime":234.38,"body":"attention to certain steps of"},{"speaker":"Chris Dy","startTime":234.38,"endTime":238.19,"body":"the case that we may gloss over."},{"speaker":"Chris Dy","startTime":234.38,"endTime":238.19,"body":"And certainly this is something"},{"speaker":"Chris Dy","startTime":238.19,"endTime":241.19,"body":"where we have certain things"},{"speaker":"Chris Dy","startTime":238.19,"endTime":241.19,"body":"that we pay attention to. And"},{"speaker":"Chris Dy","startTime":241.19,"endTime":243.56,"body":"these are the things that matter"},{"speaker":"Chris Dy","startTime":241.19,"endTime":243.56,"body":"to us. And if you guys are"},{"speaker":"Chris Dy","startTime":243.56,"endTime":246.71,"body":"listening to this episode or any"},{"speaker":"Chris Dy","startTime":243.56,"endTime":246.71,"body":"of the other detail episodes and"},{"speaker":"Chris Dy","startTime":246.71,"endTime":249.41,"body":"have techniques and pointers"},{"speaker":"Chris Dy","startTime":246.71,"endTime":249.41,"body":"that you want to share with us,"},{"speaker":"Chris Dy","startTime":249.41,"endTime":253.04,"body":"please please email us and let"},{"speaker":"Chris Dy","startTime":249.41,"endTime":253.04,"body":"us know. And Colin, thank you"},{"speaker":"Chris Dy","startTime":253.04,"endTime":256.91,"body":"for that fantastic email. And I"},{"speaker":"Chris Dy","startTime":253.04,"endTime":256.91,"body":"did respond asking if there were"},{"speaker":"Chris Dy","startTime":256.91,"endTime":260.75,"body":"any particular types of topics"},{"speaker":"Chris Dy","startTime":256.91,"endTime":260.75,"body":"you wanted for deep dive. And he"},{"speaker":"Chris Dy","startTime":260.75,"endTime":265.4,"body":"requested one of two topics,"},{"speaker":"Chris Dy","startTime":260.75,"endTime":265.4,"body":"acute SL repairs or drainage of"},{"speaker":"Chris Dy","startTime":265.4,"endTime":269.99,"body":"flexor tenosynovitis. And I've"},{"speaker":"Chris Dy","startTime":265.4,"endTime":269.99,"body":"heard I actually encountered"},{"speaker":"Chris Dy","startTime":269.99,"endTime":272.69,"body":"this drainage of flexor"},{"speaker":"Chris Dy","startTime":269.99,"endTime":272.69,"body":"tenosynovitis on my most recent"},{"speaker":"Chris Dy","startTime":272.69,"endTime":276.08,"body":"call and a little birdie, Dr."},{"speaker":"Chris Dy","startTime":272.69,"endTime":276.08,"body":"Elizabeth Wall mentioned that"},{"speaker":"Chris Dy","startTime":276.08,"endTime":279.92,"body":"you also encountered flexor teno"},{"speaker":"Chris Dy","startTime":276.08,"endTime":279.92,"body":"on a recent call so maybe we'll"},{"speaker":"Chris Dy","startTime":279.92,"endTime":283.25,"body":"table that one is that memory"},{"speaker":"Chris Dy","startTime":279.92,"endTime":283.25,"body":"may be a little too raw for now."},{"speaker":"Chris Dy","startTime":283.67,"endTime":286.43,"body":"And we'll talk about acute SL"},{"speaker":"Chris Dy","startTime":283.67,"endTime":286.43,"body":"repairs but here I am"},{"speaker":"Chris Dy","startTime":286.43,"endTime":289.76,"body":"voluntarily presenting a sports"},{"speaker":"Chris Dy","startTime":286.43,"endTime":289.76,"body":"topic to you Chuck."},{"speaker":"Charles Goldfarb","startTime":290.21,"endTime":293.54,"body":"Well, listen I"},{"speaker":"Charles Goldfarb","startTime":290.21,"endTime":293.54,"body":"while both are interesting, we"},{"speaker":"Charles Goldfarb","startTime":293.54,"endTime":296.27,"body":"should pick the more exciting"},{"speaker":"Charles Goldfarb","startTime":293.54,"endTime":296.27,"body":"topic which is SL and let's"},{"speaker":"Charles Goldfarb","startTime":296.27,"endTime":300.59,"body":"discuss that today. I do think"},{"speaker":"Charles Goldfarb","startTime":296.27,"endTime":300.59,"body":"there are some pearls about The"},{"speaker":"Charles Goldfarb","startTime":301.01,"endTime":305.15,"body":"flexor tenosynovitis drainage"},{"speaker":"Charles Goldfarb","startTime":301.01,"endTime":305.15,"body":"that I was, you know, it's just"},{"speaker":"Charles Goldfarb","startTime":305.18,"endTime":308.87,"body":"it for me it was an example of"},{"speaker":"Charles Goldfarb","startTime":305.18,"endTime":308.87,"body":"why it is important for the"},{"speaker":"Charles Goldfarb","startTime":308.87,"endTime":313.94,"body":"attending to be in the OR in the"},{"speaker":"Charles Goldfarb","startTime":308.87,"endTime":313.94,"body":"middle of the night in cases"},{"speaker":"Charles Goldfarb","startTime":313.94,"endTime":316.79,"body":"like this, because hopefully,"},{"speaker":"Charles Goldfarb","startTime":313.94,"endTime":316.79,"body":"and presumably, there's always"},{"speaker":"Charles Goldfarb","startTime":316.79,"endTime":321.35,"body":"something we can teach. And so"},{"speaker":"Charles Goldfarb","startTime":316.79,"endTime":321.35,"body":"those opportunities are"},{"speaker":"Charles Goldfarb","startTime":321.35,"endTime":325.4,"body":"important, but not the most"},{"speaker":"Charles Goldfarb","startTime":321.35,"endTime":325.4,"body":"glamorous of topics. Let's be"},{"speaker":"Chris Dy","startTime":325.0,"endTime":331.03,"body":"Yes, I remember as a"},{"speaker":"Chris Dy","startTime":325.0,"endTime":331.03,"body":"fellow here, Ryan Calfee, who is"},{"speaker":"Chris Dy","startTime":325.4,"endTime":325.97,"body":"honest."},{"speaker":"Chris Dy","startTime":331.03,"endTime":335.32,"body":"excellent about coming to every"},{"speaker":"Chris Dy","startTime":331.03,"endTime":335.32,"body":"call case. always saying there's"},{"speaker":"Chris Dy","startTime":335.32,"endTime":338.95,"body":"always something that that we"},{"speaker":"Chris Dy","startTime":335.32,"endTime":338.95,"body":"can teach you. So and he taught"},{"speaker":"Chris Dy","startTime":338.95,"endTime":342.04,"body":"me a lot. So there's certainly"},{"speaker":"Chris Dy","startTime":338.95,"endTime":342.04,"body":"value in that. So we'll save"},{"speaker":"Chris Dy","startTime":342.04,"endTime":345.34,"body":"flexor teno for another day. But"},{"speaker":"Chris Dy","startTime":342.04,"endTime":345.34,"body":"let's do a deep dive a Kobe"},{"speaker":"Chris Dy","startTime":345.34,"endTime":349.09,"body":"style detail episode on"},{"speaker":"Chris Dy","startTime":345.34,"endTime":349.09,"body":"technique for acute SL repair."},{"speaker":"Chris Dy","startTime":349.09,"endTime":352.6,"body":"So let me present a case to you."},{"speaker":"Chris Dy","startTime":349.09,"endTime":352.6,"body":"So you've got a 45 year old"},{"speaker":"Chris Dy","startTime":352.6,"endTime":356.56,"body":"gentleman who had a fall on to"},{"speaker":"Chris Dy","startTime":352.6,"endTime":356.56,"body":"his wrist about six weeks ago."},{"speaker":"Chris Dy","startTime":358.36,"endTime":361.78,"body":"And he was seen by somebody else"},{"speaker":"Chris Dy","startTime":358.36,"endTime":361.78,"body":"was diagnosed with a wrist"},{"speaker":"Chris Dy","startTime":361.78,"endTime":365.26,"body":"sprain. He comes in complaining"},{"speaker":"Chris Dy","startTime":361.78,"endTime":365.26,"body":"of pain over the dorsal aspect"},{"speaker":"Chris Dy","startTime":365.26,"endTime":370.24,"body":"of his wrist. His Watson test"},{"speaker":"Chris Dy","startTime":365.26,"endTime":370.24,"body":"doesn't have any instability, or"},{"speaker":"Chris Dy","startTime":370.24,"endTime":373.99,"body":"clunking. But it certainly hurts"},{"speaker":"Chris Dy","startTime":370.24,"endTime":373.99,"body":"when you do it. There's no"},{"speaker":"Chris Dy","startTime":373.99,"endTime":376.63,"body":"tenderness over his scaphoid"},{"speaker":"Chris Dy","startTime":373.99,"endTime":376.63,"body":"proper, and there's no"},{"speaker":"Chris Dy","startTime":376.63,"endTime":380.35,"body":"tenderness over here, his distal"},{"speaker":"Chris Dy","startTime":376.63,"endTime":380.35,"body":"radius. His radiographs don't"},{"speaker":"Chris Dy","startTime":380.35,"endTime":384.19,"body":"show any frank widening of the"},{"speaker":"Chris Dy","startTime":380.35,"endTime":384.19,"body":"SL interval, they do show a"},{"speaker":"Chris Dy","startTime":384.19,"endTime":387.04,"body":"little bit of DISI a little bit"},{"speaker":"Chris Dy","startTime":384.19,"endTime":387.04,"body":"of extension at the lunate but"},{"speaker":"Chris Dy","startTime":387.04,"endTime":391.09,"body":"no crazy, you know, deformity,"},{"speaker":"Chris Dy","startTime":387.04,"endTime":391.09,"body":"you know, large increase in the"},{"speaker":"Chris Dy","startTime":391.09,"endTime":395.83,"body":"SL angle. So how do you approach"},{"speaker":"Chris Dy","startTime":391.09,"endTime":395.83,"body":"that patient in terms of"},{"speaker":"Chris Dy","startTime":396.43,"endTime":400.09,"body":"imaging? And then let's talk a"},{"speaker":"Chris Dy","startTime":396.43,"endTime":400.09,"body":"little bit about a lot about"},{"speaker":"Chris Dy","startTime":400.12,"endTime":400.72,"body":"technique."},{"speaker":"Charles Goldfarb","startTime":401.5,"endTime":403.33,"body":"Yeah, start,"},{"speaker":"Charles Goldfarb","startTime":401.5,"endTime":403.33,"body":"I'm gonna start and I'm gonna"},{"speaker":"Charles Goldfarb","startTime":403.33,"endTime":405.79,"body":"hit on a couple of points that"},{"speaker":"Charles Goldfarb","startTime":403.33,"endTime":405.79,"body":"you made, which I think are"},{"speaker":"Charles Goldfarb","startTime":405.79,"endTime":410.14,"body":"really important. The first is"},{"speaker":"Charles Goldfarb","startTime":405.79,"endTime":410.14,"body":"the concept of pain, where it is"},{"speaker":"Charles Goldfarb","startTime":410.17,"endTime":413.89,"body":"how long I may last after an"},{"speaker":"Charles Goldfarb","startTime":410.17,"endTime":413.89,"body":"injury like this, and, and how"},{"speaker":"Charles Goldfarb","startTime":413.89,"endTime":417.79,"body":"to use just your physical exam"},{"speaker":"Charles Goldfarb","startTime":413.89,"endTime":417.79,"body":"to differentiate possible"},{"speaker":"Charles Goldfarb","startTime":417.79,"endTime":423.01,"body":"etiology. So for me, I use"},{"speaker":"Charles Goldfarb","startTime":417.79,"endTime":423.01,"body":"listers tubercle, to start every"},{"speaker":"Charles Goldfarb","startTime":423.01,"endTime":426.28,"body":"examination of the wrist, and I"},{"speaker":"Charles Goldfarb","startTime":423.01,"endTime":426.28,"body":"go about a centimeter distal to"},{"speaker":"Charles Goldfarb","startTime":426.28,"endTime":429.25,"body":"listers on the dorsal side of"},{"speaker":"Charles Goldfarb","startTime":426.28,"endTime":429.25,"body":"the wrist, and you theoretically"},{"speaker":"Charles Goldfarb","startTime":429.25,"endTime":432.94,"body":"fall into a little valley. And"},{"speaker":"Charles Goldfarb","startTime":429.25,"endTime":432.94,"body":"that valley is the SL. And it is"},{"speaker":"Charles Goldfarb","startTime":432.94,"endTime":436.99,"body":"remarkable to me that outside of"},{"speaker":"Charles Goldfarb","startTime":432.94,"endTime":436.99,"body":"the initial trauma, a couple of"},{"speaker":"Charles Goldfarb","startTime":436.99,"endTime":441.28,"body":"days, people will really"},{"speaker":"Charles Goldfarb","startTime":436.99,"endTime":441.28,"body":"localize to the SL area to the"},{"speaker":"Charles Goldfarb","startTime":441.28,"endTime":444.73,"body":"waist of the scaphoid to the"},{"speaker":"Charles Goldfarb","startTime":441.28,"endTime":444.73,"body":"lunate itself, but you can"},{"speaker":"Charles Goldfarb","startTime":444.73,"endTime":446.86,"body":"pretty quickly figure out where"},{"speaker":"Charles Goldfarb","startTime":444.73,"endTime":446.86,"body":"the pain is coming from. So"},{"speaker":"Charles Goldfarb","startTime":446.86,"endTime":449.71,"body":"that's the first thing. And I"},{"speaker":"Charles Goldfarb","startTime":446.86,"endTime":449.71,"body":"don't know if you think about"},{"speaker":"Charles Goldfarb","startTime":449.71,"endTime":452.8,"body":"the same way, but I start with"},{"speaker":"Charles Goldfarb","startTime":449.71,"endTime":452.8,"body":"just trying to really localize"},{"speaker":"Charles Goldfarb","startTime":452.8,"endTime":456.82,"body":"the area of pain, just distal to"},{"speaker":"Charles Goldfarb","startTime":452.8,"endTime":456.82,"body":"Lister's. Although let's be"},{"speaker":"Charles Goldfarb","startTime":456.82,"endTime":460.66,"body":"honest, it's six weeks, not"},{"speaker":"Charles Goldfarb","startTime":456.82,"endTime":460.66,"body":"everyone has pain. But in this"},{"speaker":"Charles Goldfarb","startTime":460.66,"endTime":463.54,"body":"patient still with pain. So do"},{"speaker":"Charles Goldfarb","startTime":460.66,"endTime":463.54,"body":"you think about it the same way"},{"speaker":"Charles Goldfarb","startTime":463.54,"endTime":465.07,"body":"as far as your exam goes?"},{"speaker":"Chris Dy","startTime":465.16,"endTime":468.52,"body":"I do. But we were told"},{"speaker":"Chris Dy","startTime":465.16,"endTime":468.52,"body":"the very beginning that we"},{"speaker":"Chris Dy","startTime":468.52,"endTime":471.04,"body":"didn't disagree enough. I"},{"speaker":"Chris Dy","startTime":468.52,"endTime":471.04,"body":"actually go to the the area"},{"speaker":"Chris Dy","startTime":471.04,"endTime":474.97,"body":"where I think it's going to be"},{"speaker":"Chris Dy","startTime":471.04,"endTime":474.97,"body":"most painful last, because once"},{"speaker":"Chris Dy","startTime":474.97,"endTime":478.36,"body":"I've pushed on that area, I tend"},{"speaker":"Chris Dy","startTime":474.97,"endTime":478.36,"body":"to lose some sensitivity of"},{"speaker":"Chris Dy","startTime":478.39,"endTime":481.81,"body":"other portions of my"},{"speaker":"Chris Dy","startTime":478.39,"endTime":481.81,"body":"examination. So I wouldn't start"},{"speaker":"Chris Dy","startTime":481.81,"endTime":485.02,"body":"there. I would probably go there"},{"speaker":"Chris Dy","startTime":481.81,"endTime":485.02,"body":"last but I agree 100% otherwise."},{"speaker":"Charles Goldfarb","startTime":485.47,"endTime":487.96,"body":"Yeah, very"},{"speaker":"Charles Goldfarb","startTime":485.47,"endTime":487.96,"body":"true. And then the second thing-"},{"speaker":"Chris Dy","startTime":487.96,"endTime":489.67,"body":"You're, you're just"},{"speaker":"Chris Dy","startTime":487.96,"endTime":489.67,"body":"you're just mean and you just"},{"speaker":"Chris Dy","startTime":489.67,"endTime":492.22,"body":"want to jam on people and cause"},{"speaker":"Chris Dy","startTime":489.67,"endTime":492.22,"body":"them pain. So that's fine."},{"speaker":"Charles Goldfarb","startTime":492.33,"endTime":495.87,"body":"Get their"},{"speaker":"Charles Goldfarb","startTime":492.33,"endTime":495.87,"body":"respect early. The second thing"},{"speaker":"Charles Goldfarb","startTime":495.87,"endTime":500.49,"body":"is the shift test. And I do it"},{"speaker":"Charles Goldfarb","startTime":495.87,"endTime":500.49,"body":"every time described by Kirk"},{"speaker":"Charles Goldfarb","startTime":500.49,"endTime":503.61,"body":"Watson. There's different ways"},{"speaker":"Charles Goldfarb","startTime":500.49,"endTime":503.61,"body":"to do it. But I do it a classic,"},{"speaker":"Charles Goldfarb","startTime":503.64,"endTime":507.6,"body":"classic way. And I don't know"},{"speaker":"Charles Goldfarb","startTime":503.64,"endTime":507.6,"body":"how good it is, you know,"},{"speaker":"Charles Goldfarb","startTime":507.63,"endTime":510.78,"body":"certainly there are times when"},{"speaker":"Charles Goldfarb","startTime":507.63,"endTime":510.78,"body":"the patient responds with"},{"speaker":"Charles Goldfarb","startTime":510.78,"endTime":514.2,"body":"discomfort if they're not"},{"speaker":"Charles Goldfarb","startTime":510.78,"endTime":514.2,"body":"guarding. And it can make me"},{"speaker":"Charles Goldfarb","startTime":514.2,"endTime":517.83,"body":"feel better. Other times I do"},{"speaker":"Charles Goldfarb","startTime":514.2,"endTime":517.83,"body":"it, I don't get much feedback,"},{"speaker":"Charles Goldfarb","startTime":517.83,"endTime":521.01,"body":"maybe because the patient is"},{"speaker":"Charles Goldfarb","startTime":517.83,"endTime":521.01,"body":"guarding. But for me, that's not"},{"speaker":"Charles Goldfarb","startTime":521.01,"endTime":524.7,"body":"a be all and end all test. How"},{"speaker":"Charles Goldfarb","startTime":521.01,"endTime":524.7,"body":"do you think about the Watson's"},{"speaker":"Charles Goldfarb","startTime":524.7,"endTime":525.72,"body":"scaphoid shift test?"},{"speaker":"Chris Dy","startTime":526.29,"endTime":529.26,"body":"Um, you know, I think"},{"speaker":"Chris Dy","startTime":526.29,"endTime":529.26,"body":"that it's a useful test, I"},{"speaker":"Chris Dy","startTime":529.26,"endTime":534.69,"body":"always do it. I I think you very"},{"speaker":"Chris Dy","startTime":529.26,"endTime":534.69,"body":"rarely see the findings that"},{"speaker":"Chris Dy","startTime":534.69,"endTime":537.66,"body":"Watson described in its classic,"},{"speaker":"Chris Dy","startTime":534.69,"endTime":537.66,"body":"you know, you're going to feel"},{"speaker":"Chris Dy","startTime":538.2,"endTime":542.52,"body":"an actual shift or clunk as the"},{"speaker":"Chris Dy","startTime":538.2,"endTime":542.52,"body":"scaphoid reduces back as you let"},{"speaker":"Chris Dy","startTime":542.52,"endTime":545.91,"body":"go of your thumb. Because when"},{"speaker":"Chris Dy","startTime":542.52,"endTime":545.91,"body":"you're what, you know for that"},{"speaker":"Chris Dy","startTime":545.91,"endTime":548.52,"body":"maneuver, it's very hard to"},{"speaker":"Chris Dy","startTime":545.91,"endTime":548.52,"body":"demonstrate to talk through the"},{"speaker":"Chris Dy","startTime":548.52,"endTime":553.89,"body":"maneuver. But you know, with"},{"speaker":"Chris Dy","startTime":548.52,"endTime":553.89,"body":"your thumb being on the distal"},{"speaker":"Chris Dy","startTime":553.89,"endTime":558.51,"body":"pole, kind of on the palmar"},{"speaker":"Chris Dy","startTime":553.89,"endTime":558.51,"body":"surface of the of the wrist. As"},{"speaker":"Chris Dy","startTime":558.51,"endTime":561.9,"body":"you go from ulnar deviation"},{"speaker":"Chris Dy","startTime":558.51,"endTime":561.9,"body":"extension into flexion, and"},{"speaker":"Chris Dy","startTime":561.9,"endTime":567.18,"body":"radial deviation, what you're"},{"speaker":"Chris Dy","startTime":561.9,"endTime":567.18,"body":"trying to do is subluxate that,"},{"speaker":"Chris Dy","startTime":569.04,"endTime":572.55,"body":"subluxate that proximal pole of"},{"speaker":"Chris Dy","startTime":569.04,"endTime":572.55,"body":"the scaphoid out of the scaphoid"},{"speaker":"Chris Dy","startTime":572.55,"endTime":576.96,"body":"fossa. And as you let go of your"},{"speaker":"Chris Dy","startTime":572.55,"endTime":576.96,"body":"thumb, in the setting of"},{"speaker":"Chris Dy","startTime":577.29,"endTime":581.88,"body":"complete SL tear, in which the"},{"speaker":"Chris Dy","startTime":577.29,"endTime":581.88,"body":"scaphoid is adopting a flexed"},{"speaker":"Chris Dy","startTime":581.88,"endTime":587.07,"body":"posture. That scaphoid should"},{"speaker":"Chris Dy","startTime":581.88,"endTime":587.07,"body":"clunk back in to the scaphoid"},{"speaker":"Chris Dy","startTime":587.07,"endTime":591.93,"body":"fossa. And I very rarely will"},{"speaker":"Chris Dy","startTime":587.07,"endTime":591.93,"body":"see that but I find it to be"},{"speaker":"Chris Dy","startTime":591.93,"endTime":594.78,"body":"helpful because there's a little"},{"speaker":"Chris Dy","startTime":591.93,"endTime":594.78,"body":"bit of a shift it moves a little"},{"speaker":"Chris Dy","startTime":594.78,"endTime":596.34,"body":"bit or causes a lot of pain."},{"speaker":"Charles Goldfarb","startTime":597.27,"endTime":599.64,"body":"Yeah, again,"},{"speaker":"Charles Goldfarb","startTime":597.27,"endTime":599.64,"body":"hard to do over a podcast when"},{"speaker":"Charles Goldfarb","startTime":599.64,"endTime":603.87,"body":"we have points to that. So the"},{"speaker":"Charles Goldfarb","startTime":599.64,"endTime":603.87,"body":"first is that you are pushing on"},{"speaker":"Charles Goldfarb","startTime":603.87,"endTime":607.95,"body":"the scaphoid tuberosity at the"},{"speaker":"Charles Goldfarb","startTime":603.87,"endTime":607.95,"body":"base of the thumb. And if the"},{"speaker":"Charles Goldfarb","startTime":607.95,"endTime":611.04,"body":"patient has pain there, that's"},{"speaker":"Charles Goldfarb","startTime":607.95,"endTime":611.04,"body":"not a positive test, you are"},{"speaker":"Charles Goldfarb","startTime":611.04,"endTime":614.61,"body":"looking for pain and"},{"speaker":"Charles Goldfarb","startTime":611.04,"endTime":614.61,"body":"theoretically a clunk dorsally"},{"speaker":"Charles Goldfarb","startTime":614.61,"endTime":617.64,"body":"over the SL. And as you said,"},{"speaker":"Charles Goldfarb","startTime":614.61,"endTime":617.64,"body":"when you go from ulnar"},{"speaker":"Charles Goldfarb","startTime":617.64,"endTime":620.79,"body":"deviation, where the scaphoid"},{"speaker":"Charles Goldfarb","startTime":617.64,"endTime":620.79,"body":"should be extended to radial"},{"speaker":"Charles Goldfarb","startTime":620.79,"endTime":623.73,"body":"deviation, where the scaphoid"},{"speaker":"Charles Goldfarb","startTime":620.79,"endTime":623.73,"body":"should be flexed. Initially,"},{"speaker":"Charles Goldfarb","startTime":623.73,"endTime":628.2,"body":"your thumb is preventing the"},{"speaker":"Charles Goldfarb","startTime":623.73,"endTime":628.2,"body":"scaphoid from flexing and maybe"},{"speaker":"Charles Goldfarb","startTime":628.2,"endTime":631.38,"body":"pushing it out over the back."},{"speaker":"Charles Goldfarb","startTime":628.2,"endTime":631.38,"body":"And the so you may get a clunk"},{"speaker":"Charles Goldfarb","startTime":631.38,"endTime":635.43,"body":"there, you may get a clunk when"},{"speaker":"Charles Goldfarb","startTime":631.38,"endTime":635.43,"body":"you let go. But I think it's a"},{"speaker":"Charles Goldfarb","startTime":635.43,"endTime":638.76,"body":"helpful test. It's just not all"},{"speaker":"Charles Goldfarb","startTime":635.43,"endTime":638.76,"body":"that reliable for me."},{"speaker":"Chris Dy","startTime":639.45,"endTime":643.08,"body":"Yeah, I agree. I think"},{"speaker":"Chris Dy","startTime":639.45,"endTime":643.08,"body":"it's useful to go through with"},{"speaker":"Chris Dy","startTime":643.08,"endTime":646.92,"body":"the trainees the theory, you"},{"speaker":"Chris Dy","startTime":643.08,"endTime":646.92,"body":"know, the theory and the"},{"speaker":"Chris Dy","startTime":646.92,"endTime":649.89,"body":"kinematics behind it as to why"},{"speaker":"Chris Dy","startTime":646.92,"endTime":649.89,"body":"it should theoretically be"},{"speaker":"Chris Dy","startTime":649.89,"endTime":652.62,"body":"positive, because that"},{"speaker":"Chris Dy","startTime":649.89,"endTime":652.62,"body":"reinforces this concept of the"},{"speaker":"Chris Dy","startTime":652.65,"endTime":657.24,"body":"in the setting of an SL tear of"},{"speaker":"Chris Dy","startTime":652.65,"endTime":657.24,"body":"the scaphoid wanting to flex."},{"speaker":"Charles Goldfarb","startTime":658.02,"endTime":659.73,"body":"And then your"},{"speaker":"Charles Goldfarb","startTime":658.02,"endTime":659.73,"body":"next question is around imaging."},{"speaker":"Charles Goldfarb","startTime":659.73,"endTime":664.89,"body":"And so for me, a scapholunate"},{"speaker":"Charles Goldfarb","startTime":659.73,"endTime":664.89,"body":"series is a little different"},{"speaker":"Charles Goldfarb","startTime":664.89,"endTime":667.29,"body":"radiographically than a scaphoid"},{"speaker":"Charles Goldfarb","startTime":664.89,"endTime":667.29,"body":"series. But a scapholunate"},{"speaker":"Charles Goldfarb","startTime":667.29,"endTime":671.61,"body":"series is a PA radiograph, a"},{"speaker":"Charles Goldfarb","startTime":667.29,"endTime":671.61,"body":"lateral radiograph, an ulnar"},{"speaker":"Charles Goldfarb","startTime":671.61,"endTime":676.65,"body":"deviation radiograph, and a"},{"speaker":"Charles Goldfarb","startTime":671.61,"endTime":676.65,"body":"supinated grip view. And those"},{"speaker":"Charles Goldfarb","startTime":676.65,"endTime":679.86,"body":"hopefully give me information."},{"speaker":"Charles Goldfarb","startTime":676.65,"endTime":679.86,"body":"And the supinated grip, we"},{"speaker":"Charles Goldfarb","startTime":679.86,"endTime":683.28,"body":"usually do bilaterally on the"},{"speaker":"Charles Goldfarb","startTime":679.86,"endTime":683.28,"body":"same X ray plate to compare the"},{"speaker":"Charles Goldfarb","startTime":683.28,"endTime":686.31,"body":"gap. And sometimes we'll do a"},{"speaker":"Charles Goldfarb","startTime":683.28,"endTime":686.31,"body":"live C-arm, which can be helpful"},{"speaker":"Charles Goldfarb","startTime":686.31,"endTime":689.07,"body":"as well. It sounds like in this"},{"speaker":"Charles Goldfarb","startTime":686.31,"endTime":689.07,"body":"case, there wasn't major"},{"speaker":"Charles Goldfarb","startTime":689.07,"endTime":693.0,"body":"widening of the SL, which often"},{"speaker":"Charles Goldfarb","startTime":689.07,"endTime":693.0,"body":"is present, but that we can get"},{"speaker":"Charles Goldfarb","startTime":693.0,"endTime":695.85,"body":"to the secondary stabiliser"},{"speaker":"Charles Goldfarb","startTime":693.0,"endTime":695.85,"body":"issue but but even if there's a"},{"speaker":"Charles Goldfarb","startTime":695.85,"endTime":698.73,"body":"complete SL tear, you don't"},{"speaker":"Charles Goldfarb","startTime":695.85,"endTime":698.73,"body":"always have immediate widening."},{"speaker":"Chris Dy","startTime":699.45,"endTime":703.38,"body":"So do you use the"},{"speaker":"Chris Dy","startTime":699.45,"endTime":703.38,"body":"ulnar deviation view to help you"},{"speaker":"Chris Dy","startTime":703.38,"endTime":707.43,"body":"understand the correctability of"},{"speaker":"Chris Dy","startTime":703.38,"endTime":707.43,"body":"the scaphoid? Say that it is you"},{"speaker":"Chris Dy","startTime":707.43,"endTime":709.41,"body":"know, say, not in this"},{"speaker":"Chris Dy","startTime":707.43,"endTime":709.41,"body":"particular case, but you have a"},{"speaker":"Chris Dy","startTime":709.41,"endTime":713.67,"body":"flexed down scaphoid. Do you use"},{"speaker":"Chris Dy","startTime":709.41,"endTime":713.67,"body":"that ulnar deviation view to say"},{"speaker":"Chris Dy","startTime":713.67,"endTime":717.03,"body":"okay, I think I can get this one"},{"speaker":"Chris Dy","startTime":713.67,"endTime":717.03,"body":"back. Or if it doesn't budge on"},{"speaker":"Chris Dy","startTime":717.03,"endTime":719.43,"body":"an ulnar deviation view do you"},{"speaker":"Chris Dy","startTime":717.03,"endTime":719.43,"body":"say there's no way we're going"},{"speaker":"Chris Dy","startTime":719.43,"endTime":722.13,"body":"to get this scaphoid to sit up"},{"speaker":"Chris Dy","startTime":719.43,"endTime":722.13,"body":"into a neutral posture?"},{"speaker":"Charles Goldfarb","startTime":722.9,"endTime":726.56,"body":"I do use it"},{"speaker":"Charles Goldfarb","startTime":722.9,"endTime":726.56,"body":"for that reason. And I do use it"},{"speaker":"Charles Goldfarb","startTime":726.56,"endTime":728.6,"body":"gives a great view of the"},{"speaker":"Charles Goldfarb","startTime":726.56,"endTime":728.6,"body":"scaphoid itself, obviously"},{"speaker":"Charles Goldfarb","startTime":728.6,"endTime":731.75,"body":"because it's extended. But if it"},{"speaker":"Charles Goldfarb","startTime":728.6,"endTime":731.75,"body":"doesn't extend as much as you"},{"speaker":"Charles Goldfarb","startTime":731.75,"endTime":735.5,"body":"might want, that's a secondary"},{"speaker":"Charles Goldfarb","startTime":731.75,"endTime":735.5,"body":"signal of a problem. Because it"},{"speaker":"Charles Goldfarb","startTime":735.5,"endTime":738.5,"body":"really is that lunate and"},{"speaker":"Charles Goldfarb","startTime":735.5,"endTime":738.5,"body":"triquetrum, which bring it into"},{"speaker":"Charles Goldfarb","startTime":738.5,"endTime":742.01,"body":"extension, so the complete tear"},{"speaker":"Charles Goldfarb","startTime":738.5,"endTime":742.01,"body":"may not extend as much. And"},{"speaker":"Charles Goldfarb","startTime":742.01,"endTime":746.24,"body":"yeah, I mean, if it doesn't want"},{"speaker":"Charles Goldfarb","startTime":742.01,"endTime":746.24,"body":"to extend, it does raise alarm"},{"speaker":"Charles Goldfarb","startTime":746.24,"endTime":748.88,"body":"bells, although usually I think"},{"speaker":"Charles Goldfarb","startTime":746.24,"endTime":748.88,"body":"you can get it back into"},{"speaker":"Charles Goldfarb","startTime":748.88,"endTime":752.06,"body":"position. But at six weeks, as"},{"speaker":"Charles Goldfarb","startTime":748.88,"endTime":752.06,"body":"you mentioned, we're not"},{"speaker":"Charles Goldfarb","startTime":752.06,"endTime":755.57,"body":"terribly worried about our"},{"speaker":"Charles Goldfarb","startTime":752.06,"endTime":755.57,"body":"ability to correct this. If we"},{"speaker":"Charles Goldfarb","startTime":755.57,"endTime":757.85,"body":"end up going to the operating"},{"speaker":"Charles Goldfarb","startTime":755.57,"endTime":757.85,"body":"room for a scapholunate ligament"},{"speaker":"Charles Goldfarb","startTime":757.85,"endTime":758.21,"body":"injury."},{"speaker":"Chris Dy","startTime":758.69,"endTime":761.06,"body":"So I want to spend the"},{"speaker":"Chris Dy","startTime":758.69,"endTime":761.06,"body":"majority of our time on the"},{"speaker":"Chris Dy","startTime":761.06,"endTime":764.24,"body":"technique parts of it. But just"},{"speaker":"Chris Dy","startTime":761.06,"endTime":764.24,"body":"a brief word about imaging,"},{"speaker":"Chris Dy","startTime":764.3,"endTime":766.13,"body":"always an arthrogram for you in"},{"speaker":"Chris Dy","startTime":764.3,"endTime":766.13,"body":"this setting?"},{"speaker":"Charles Goldfarb","startTime":767.14,"endTime":770.32,"body":"I'm changing a"},{"speaker":"Charles Goldfarb","startTime":767.14,"endTime":770.32,"body":"little bit. Yes, I think an"},{"speaker":"Charles Goldfarb","startTime":770.32,"endTime":773.29,"body":"arthrogram for most of us is the"},{"speaker":"Charles Goldfarb","startTime":770.32,"endTime":773.29,"body":"right way to go even though"},{"speaker":"Charles Goldfarb","startTime":773.29,"endTime":777.16,"body":"patients don't love it. Because"},{"speaker":"Charles Goldfarb","startTime":773.29,"endTime":777.16,"body":"it's just so good when you have"},{"speaker":"Charles Goldfarb","startTime":777.16,"endTime":781.0,"body":"a potential ligament injury to"},{"speaker":"Charles Goldfarb","startTime":777.16,"endTime":781.0,"body":"see that contrast flow from the"},{"speaker":"Charles Goldfarb","startTime":781.0,"endTime":784.72,"body":"radiocarpal joint to the mid"},{"speaker":"Charles Goldfarb","startTime":781.0,"endTime":784.72,"body":"carpal joint. But a really good"},{"speaker":"Charles Goldfarb","startTime":784.72,"endTime":788.2,"body":"MRI, you know, like a three"},{"speaker":"Charles Goldfarb","startTime":784.72,"endTime":788.2,"body":"Tesla machine with good"},{"speaker":"Charles Goldfarb","startTime":788.2,"endTime":791.8,"body":"radiologist. Often you don't"},{"speaker":"Charles Goldfarb","startTime":788.2,"endTime":791.8,"body":"need it, but I think it's safer"},{"speaker":"Charles Goldfarb","startTime":791.8,"endTime":794.62,"body":"still in 2021 for most of us to"},{"speaker":"Charles Goldfarb","startTime":791.8,"endTime":794.62,"body":"order the arthrogram."},{"speaker":"Chris Dy","startTime":795.49,"endTime":798.4,"body":"Yeah, I was fortunate"},{"speaker":"Chris Dy","startTime":795.49,"endTime":798.4,"body":"enough in residency to have"},{"speaker":"Chris Dy","startTime":798.4,"endTime":802.21,"body":"trained in place that did"},{"speaker":"Chris Dy","startTime":798.4,"endTime":802.21,"body":"beautiful wrist MRIs. And I"},{"speaker":"Chris Dy","startTime":802.21,"endTime":805.0,"body":"remember coming here and"},{"speaker":"Chris Dy","startTime":802.21,"endTime":805.0,"body":"fellowship being Oh, do we need"},{"speaker":"Chris Dy","startTime":805.0,"endTime":807.22,"body":"an arthrogram? And you're like,"},{"speaker":"Chris Dy","startTime":805.0,"endTime":807.22,"body":"of course you need an arthrogram"},{"speaker":"Chris Dy","startTime":807.22,"endTime":811.69,"body":"like, Oh, sorry. Sorry, sorry."},{"speaker":"Chris Dy","startTime":807.22,"endTime":811.69,"body":"Sorry, sir. I will never"},{"speaker":"Chris Dy","startTime":811.69,"endTime":814.0,"body":"question you again on the need"},{"speaker":"Chris Dy","startTime":811.69,"endTime":814.0,"body":"for an arthrogram."},{"speaker":"Charles Goldfarb","startTime":814.81,"endTime":816.49,"body":"Yeah, but it's"},{"speaker":"Charles Goldfarb","startTime":814.81,"endTime":816.49,"body":"fair. I mean, it really does"},{"speaker":"Charles Goldfarb","startTime":816.49,"endTime":819.85,"body":"depend on your imaging"},{"speaker":"Charles Goldfarb","startTime":816.49,"endTime":819.85,"body":"capabilities. And we know we're"},{"speaker":"Charles Goldfarb","startTime":819.85,"endTime":822.79,"body":"very fortunate at Wash U. I"},{"speaker":"Charles Goldfarb","startTime":819.85,"endTime":822.79,"body":"don't know there's a huge"},{"speaker":"Charles Goldfarb","startTime":822.79,"endTime":826.72,"body":"difference between the imaging"},{"speaker":"Charles Goldfarb","startTime":822.79,"endTime":826.72,"body":"quality here versus your Mecca."},{"speaker":"Charles Goldfarb","startTime":826.93,"endTime":830.53,"body":"But you know, there's nothing"},{"speaker":"Charles Goldfarb","startTime":826.93,"endTime":830.53,"body":"wrong with ordering an"},{"speaker":"Charles Goldfarb","startTime":830.53,"endTime":831.01,"body":"arthrogram."},{"speaker":"Chris Dy","startTime":830.55,"endTime":834.84,"body":"Indeed, so I will say"},{"speaker":"Chris Dy","startTime":830.55,"endTime":834.84,"body":"now at this point, say we've"},{"speaker":"Chris Dy","startTime":834.84,"endTime":838.29,"body":"decided that we're going to go"},{"speaker":"Chris Dy","startTime":834.84,"endTime":838.29,"body":"to the operating room. So this"},{"speaker":"Chris Dy","startTime":837.72,"endTime":851.61,"body":"Very young, very young."},{"speaker":"Chris Dy","startTime":838.29,"endTime":843.27,"body":"patient's MR arthrogram came bac"},{"speaker":"Chris Dy","startTime":838.29,"endTime":843.27,"body":"with a full thickness SL tea"},{"speaker":"Chris Dy","startTime":843.27,"endTime":848.07,"body":". And he's a young person, he'"},{"speaker":"Chris Dy","startTime":843.27,"endTime":848.07,"body":"45. So even younger than you"},{"speaker":"Chris Dy","startTime":848.07,"endTime":848.61,"body":"Chuck an"},{"speaker":"Chris Dy","startTime":851.85,"endTime":857.43,"body":"Now the timeframe gives me pause"},{"speaker":"Chris Dy","startTime":851.85,"endTime":857.43,"body":"and I intentionally made it six"},{"speaker":"Chris Dy","startTime":857.43,"endTime":861.66,"body":"weeks. So what do you think Can"},{"speaker":"Chris Dy","startTime":857.43,"endTime":861.66,"body":"you repair a ligament at six"},{"speaker":"Chris Dy","startTime":861.66,"endTime":864.09,"body":"weeks? Can you repair ligament a"},{"speaker":"Chris Dy","startTime":861.66,"endTime":864.09,"body":"three months when can you no"},{"speaker":"Chris Dy","startTime":864.09,"endTime":865.62,"body":"longer repair an SL ligament?"},{"speaker":"Charles Goldfarb","startTime":866.5,"endTime":868.9,"body":"So first of"},{"speaker":"Charles Goldfarb","startTime":866.5,"endTime":868.9,"body":"all, for those still learning"},{"speaker":"Charles Goldfarb","startTime":868.9,"endTime":872.11,"body":"about the scapholunate ligament,"},{"speaker":"Charles Goldfarb","startTime":868.9,"endTime":872.11,"body":"you know it's a C shaped"},{"speaker":"Charles Goldfarb","startTime":872.11,"endTime":877.57,"body":"ligament dorsal proximal and"},{"speaker":"Charles Goldfarb","startTime":872.11,"endTime":877.57,"body":"volar. There's nothing distally."},{"speaker":"Charles Goldfarb","startTime":877.96,"endTime":881.11,"body":"And we always talk about the"},{"speaker":"Charles Goldfarb","startTime":877.96,"endTime":881.11,"body":"dorsal scapholunate ligament"},{"speaker":"Charles Goldfarb","startTime":881.11,"endTime":886.06,"body":"being the key portion. And when"},{"speaker":"Charles Goldfarb","startTime":881.11,"endTime":886.06,"body":"I think about it, you know if"},{"speaker":"Charles Goldfarb","startTime":886.06,"endTime":890.47,"body":"we're like in the lab or if"},{"speaker":"Charles Goldfarb","startTime":886.06,"endTime":890.47,"body":"we're excising an injured"},{"speaker":"Charles Goldfarb","startTime":890.47,"endTime":893.47,"body":"scaphoid to do a four bone"},{"speaker":"Charles Goldfarb","startTime":890.47,"endTime":893.47,"body":"fusion or whatever. If you're"},{"speaker":"Charles Goldfarb","startTime":893.47,"endTime":895.87,"body":"trying to cut through that"},{"speaker":"Charles Goldfarb","startTime":893.47,"endTime":895.87,"body":"scaphoid ligament, especially"},{"speaker":"Charles Goldfarb","startTime":895.87,"endTime":899.86,"body":"dorsal it's not easy. It's a"},{"speaker":"Charles Goldfarb","startTime":895.87,"endTime":899.86,"body":"stout ligament, especially"},{"speaker":"Charles Goldfarb","startTime":899.86,"endTime":903.04,"body":"dorsally, where you really need"},{"speaker":"Charles Goldfarb","startTime":899.86,"endTime":903.04,"body":"a sharp knife to get through it."},{"speaker":"Charles Goldfarb","startTime":903.7,"endTime":909.31,"body":"However, if you are repairing"},{"speaker":"Charles Goldfarb","startTime":903.7,"endTime":909.31,"body":"it, it seems ridiculously"},{"speaker":"Charles Goldfarb","startTime":909.76,"endTime":913.54,"body":"difficult to do that it seems"},{"speaker":"Charles Goldfarb","startTime":909.76,"endTime":913.54,"body":"thin, it's unimpressive. And"},{"speaker":"Charles Goldfarb","startTime":913.54,"endTime":916.63,"body":"trying to stitch that ligament"},{"speaker":"Charles Goldfarb","startTime":913.54,"endTime":916.63,"body":"back together is tough. So"},{"speaker":"Charles Goldfarb","startTime":916.63,"endTime":918.94,"body":"that's what I'll start with, I"},{"speaker":"Charles Goldfarb","startTime":916.63,"endTime":918.94,"body":"want to say one more thing. And"},{"speaker":"Charles Goldfarb","startTime":918.94,"endTime":922.78,"body":"that is six weeks is really"},{"speaker":"Charles Goldfarb","startTime":918.94,"endTime":922.78,"body":"important. And I know you didn't"},{"speaker":"Charles Goldfarb","startTime":922.78,"endTime":928.54,"body":"pick that number arbitrarily."},{"speaker":"Charles Goldfarb","startTime":922.78,"endTime":928.54,"body":"Historically speaking, we would"},{"speaker":"Charles Goldfarb","startTime":928.54,"endTime":932.98,"body":"either say, you have three weeks"},{"speaker":"Charles Goldfarb","startTime":928.54,"endTime":932.98,"body":"to repair an SL ligament, or"},{"speaker":"Charles Goldfarb","startTime":932.98,"endTime":937.06,"body":"else forget about it, or you"},{"speaker":"Charles Goldfarb","startTime":932.98,"endTime":937.06,"body":"have six weeks to repair an SL"},{"speaker":"Charles Goldfarb","startTime":937.06,"endTime":942.01,"body":"ligament. And after that, you're"},{"speaker":"Charles Goldfarb","startTime":937.06,"endTime":942.01,"body":"not getting it. And so forget"},{"speaker":"Charles Goldfarb","startTime":942.01,"endTime":945.01,"body":"about it proceed to a salvage"},{"speaker":"Charles Goldfarb","startTime":942.01,"endTime":945.01,"body":"procedure, like literally,"},{"speaker":"Charles Goldfarb","startTime":945.28,"endTime":947.68,"body":"that's what we would say. So"},{"speaker":"Charles Goldfarb","startTime":945.28,"endTime":947.68,"body":"proceed to a scaphoid excision"},{"speaker":"Charles Goldfarb","startTime":947.68,"endTime":951.13,"body":"four bone fusion. In 2021, I"},{"speaker":"Charles Goldfarb","startTime":947.68,"endTime":951.13,"body":"think most of us would not"},{"speaker":"Charles Goldfarb","startTime":951.13,"endTime":954.46,"body":"proceed to a salvage procedure,"},{"speaker":"Charles Goldfarb","startTime":951.13,"endTime":954.46,"body":"we would think about a repair or"},{"speaker":"Charles Goldfarb","startTime":954.46,"endTime":955.75,"body":"repair plus."},{"speaker":"Chris Dy","startTime":956.86,"endTime":961.33,"body":"Yeah so, you know, I"},{"speaker":"Chris Dy","startTime":956.86,"endTime":961.33,"body":"think that the repair plus is"},{"speaker":"Chris Dy","startTime":961.33,"endTime":963.82,"body":"the interesting part. And we've"},{"speaker":"Chris Dy","startTime":961.33,"endTime":963.82,"body":"talked a little bit about on the"},{"speaker":"Chris Dy","startTime":963.82,"endTime":966.76,"body":"Never have I ever episode about"},{"speaker":"Chris Dy","startTime":963.82,"endTime":966.76,"body":"procedures that are published,"},{"speaker":"Chris Dy","startTime":966.76,"endTime":969.94,"body":"but we probably wouldn't do. And"},{"speaker":"Chris Dy","startTime":966.76,"endTime":969.94,"body":"one of those was the three LT,"},{"speaker":"Chris Dy","startTime":969.94,"endTime":972.55,"body":"the three ligament tenodysis."},{"speaker":"Chris Dy","startTime":969.94,"endTime":972.55,"body":"But that is a reconstruction"},{"speaker":"Chris Dy","startTime":972.55,"endTime":976.6,"body":"procedure, that stops shy of the"},{"speaker":"Chris Dy","startTime":972.55,"endTime":976.6,"body":"salvages, the four corners, the"},{"speaker":"Chris Dy","startTime":976.6,"endTime":980.11,"body":"PRCs, that kind of thing."},{"speaker":"Chris Dy","startTime":976.6,"endTime":980.11,"body":"Because we're assuming in this"},{"speaker":"Chris Dy","startTime":980.11,"endTime":982.78,"body":"case, when I'm telling you since"},{"speaker":"Chris Dy","startTime":980.11,"endTime":982.78,"body":"it's the case I'm presenting, no"},{"speaker":"Chris Dy","startTime":982.78,"endTime":987.97,"body":"arthritis. And we're trying to"},{"speaker":"Chris Dy","startTime":982.78,"endTime":987.97,"body":"prevent that formation of SLAC"},{"speaker":"Chris Dy","startTime":987.97,"endTime":991.51,"body":"wrist, you know, the predictable"},{"speaker":"Chris Dy","startTime":987.97,"endTime":991.51,"body":"pattern of arthritis that occurs"},{"speaker":"Chris Dy","startTime":991.51,"endTime":995.23,"body":"with SL incompetence. Now, I"},{"speaker":"Chris Dy","startTime":991.51,"endTime":995.23,"body":"will say nobody knows, and"},{"speaker":"Chris Dy","startTime":995.23,"endTime":998.71,"body":"correct me if I'm wrong, because"},{"speaker":"Chris Dy","startTime":995.23,"endTime":998.71,"body":"you are in this world, much more"},{"speaker":"Chris Dy","startTime":998.71,"endTime":1002.34,"body":"than I am. But nobody really"},{"speaker":"Chris Dy","startTime":998.71,"endTime":1002.34,"body":"knows the timeframe, how long it"},{"speaker":"Chris Dy","startTime":1002.34,"endTime":1005.28,"body":"takes to get a SLAC wrist after"},{"speaker":"Chris Dy","startTime":1002.34,"endTime":1005.28,"body":"an SL tear, but we know that it"},{"speaker":"Chris Dy","startTime":1005.28,"endTime":1006.45,"body":"eventually occurs."},{"speaker":"Charles Goldfarb","startTime":1007.29,"endTime":1010.32,"body":"Yeah, what we"},{"speaker":"Charles Goldfarb","startTime":1007.29,"endTime":1010.32,"body":"know is that the flexed position"},{"speaker":"Charles Goldfarb","startTime":1010.32,"endTime":1015.09,"body":"of the scaphoid eventually leads"},{"speaker":"Charles Goldfarb","startTime":1010.32,"endTime":1015.09,"body":"to arthritis of undetermined"},{"speaker":"Charles Goldfarb","startTime":1015.09,"endTime":1020.28,"body":"time. And that likely is in my"},{"speaker":"Charles Goldfarb","startTime":1015.09,"endTime":1020.28,"body":"humble opinion, that likely is"},{"speaker":"Charles Goldfarb","startTime":1020.28,"endTime":1024.75,"body":"related to the exact injury"},{"speaker":"Charles Goldfarb","startTime":1020.28,"endTime":1024.75,"body":"experienced and so do is the"},{"speaker":"Charles Goldfarb","startTime":1024.75,"endTime":1029.4,"body":"tear only of the SL proper, or"},{"speaker":"Charles Goldfarb","startTime":1024.75,"endTime":1029.4,"body":"are the accessory ligaments"},{"speaker":"Charles Goldfarb","startTime":1029.43,"endTime":1033.03,"body":"injured because essentially, if"},{"speaker":"Charles Goldfarb","startTime":1029.43,"endTime":1033.03,"body":"the accessory ligaments are not"},{"speaker":"Charles Goldfarb","startTime":1033.03,"endTime":1035.82,"body":"injured, eventually they will"},{"speaker":"Charles Goldfarb","startTime":1033.03,"endTime":1035.82,"body":"fail over time and that scaphoid"},{"speaker":"Charles Goldfarb","startTime":1035.82,"endTime":1038.94,"body":"will truly flex and you get"},{"speaker":"Charles Goldfarb","startTime":1035.82,"endTime":1038.94,"body":"arthritis. And so I think it can"},{"speaker":"Charles Goldfarb","startTime":1038.94,"endTime":1040.8,"body":"be five years, it could be 20"},{"speaker":"Charles Goldfarb","startTime":1038.94,"endTime":1040.8,"body":"years. So it's really"},{"speaker":"Charles Goldfarb","startTime":1040.8,"endTime":1044.31,"body":"unpredictable. But we've all"},{"speaker":"Charles Goldfarb","startTime":1040.8,"endTime":1044.31,"body":"seen. Well, you and I have seen"},{"speaker":"Charles Goldfarb","startTime":1044.88,"endTime":1048.33,"body":"that patient who comes in with"},{"speaker":"Charles Goldfarb","startTime":1044.88,"endTime":1048.33,"body":"no recollection of injury, that"},{"speaker":"Charles Goldfarb","startTime":1048.33,"endTime":1051.84,"body":"dorsal radial swelling, and you"},{"speaker":"Charles Goldfarb","startTime":1048.33,"endTime":1051.84,"body":"know the diagnosis before you"},{"speaker":"Charles Goldfarb","startTime":1051.84,"endTime":1056.61,"body":"get the x ray, which is a SLAC"},{"speaker":"Charles Goldfarb","startTime":1051.84,"endTime":1056.61,"body":"wrist. So yeah, it's an"},{"speaker":"Charles Goldfarb","startTime":1056.61,"endTime":1060.66,"body":"interesting thing. We don't have"},{"speaker":"Charles Goldfarb","startTime":1056.61,"endTime":1060.66,"body":"all the answers and that that"},{"speaker":"Charles Goldfarb","startTime":1060.69,"endTime":1063.57,"body":"that Brunelli type"},{"speaker":"Charles Goldfarb","startTime":1060.69,"endTime":1063.57,"body":"reconstruction is certainly the"},{"speaker":"Charles Goldfarb","startTime":1063.57,"endTime":1066.84,"body":"choice of many. And this patient"},{"speaker":"Charles Goldfarb","startTime":1063.57,"endTime":1066.84,"body":"would be a candidate for that,"},{"speaker":"Charles Goldfarb","startTime":1066.84,"endTime":1071.79,"body":"honestly, because repair is just"},{"speaker":"Charles Goldfarb","startTime":1066.84,"endTime":1071.79,"body":"so so unsatisfying."},{"speaker":"Chris Dy","startTime":1072.18,"endTime":1074.85,"body":"So let's change one"},{"speaker":"Chris Dy","startTime":1072.18,"endTime":1074.85,"body":"important caveat here say it's"},{"speaker":"Chris Dy","startTime":1074.85,"endTime":1079.05,"body":"two weeks. Patient has come to"},{"speaker":"Chris Dy","startTime":1074.85,"endTime":1079.05,"body":"you for the original injury and"},{"speaker":"Chris Dy","startTime":1079.08,"endTime":1082.74,"body":"original assessment. You're in"},{"speaker":"Chris Dy","startTime":1079.08,"endTime":1082.74,"body":"the OR do you find that that"},{"speaker":"Chris Dy","startTime":1082.74,"endTime":1085.77,"body":"ligament is often ruptured mid"},{"speaker":"Chris Dy","startTime":1082.74,"endTime":1085.77,"body":"substance between the scaphoid"},{"speaker":"Chris Dy","startTime":1085.77,"endTime":1088.29,"body":"and lunate? Do you find that it"},{"speaker":"Chris Dy","startTime":1085.77,"endTime":1088.29,"body":"is often come off of the"},{"speaker":"Chris Dy","startTime":1088.29,"endTime":1091.47,"body":"scaphoid more or come off the"},{"speaker":"Chris Dy","startTime":1088.29,"endTime":1091.47,"body":"lunate? And then how do you talk"},{"speaker":"Chris Dy","startTime":1091.47,"endTime":1094.26,"body":"me through how you would"},{"speaker":"Chris Dy","startTime":1091.47,"endTime":1094.26,"body":"technically do this repair?"},{"speaker":"Charles Goldfarb","startTime":1096.04,"endTime":1100.72,"body":"Yes, so I"},{"speaker":"Charles Goldfarb","startTime":1096.04,"endTime":1100.72,"body":"think it can be either my most"},{"speaker":"Charles Goldfarb","startTime":1100.72,"endTime":1103.87,"body":"recent event was a perilunate"},{"speaker":"Charles Goldfarb","startTime":1100.72,"endTime":1103.87,"body":"that I repaired a couple of days"},{"speaker":"Charles Goldfarb","startTime":1103.87,"endTime":1109.42,"body":"later on my elective day. And in"},{"speaker":"Charles Goldfarb","startTime":1103.87,"endTime":1109.42,"body":"that case, the ligament is most"},{"speaker":"Charles Goldfarb","startTime":1109.42,"endTime":1111.79,"body":"commonly torn off the lunate."},{"speaker":"Charles Goldfarb","startTime":1109.42,"endTime":1111.79,"body":"Certainly that was my experience"},{"speaker":"Charles Goldfarb","startTime":1111.79,"endTime":1115.81,"body":"a couple of days ago. I think"},{"speaker":"Charles Goldfarb","startTime":1111.79,"endTime":1115.81,"body":"however, often the ligament"},{"speaker":"Charles Goldfarb","startTime":1115.81,"endTime":1119.95,"body":"remains on the lunate and is"},{"speaker":"Charles Goldfarb","startTime":1115.81,"endTime":1119.95,"body":"torn off the scaphoid especially"},{"speaker":"Charles Goldfarb","startTime":1119.95,"endTime":1129.25,"body":"in an isolated SL. So my goal is"},{"speaker":"Charles Goldfarb","startTime":1119.95,"endTime":1129.25,"body":"an anatomical reduction of the"},{"speaker":"Charles Goldfarb","startTime":1129.25,"endTime":1132.43,"body":"carpus. More than the SL but"},{"speaker":"Charles Goldfarb","startTime":1129.25,"endTime":1132.43,"body":"it's an anatomic reduction of"},{"speaker":"Charles Goldfarb","startTime":1132.43,"endTime":1135.55,"body":"the scaphoid and the lunate with"},{"speaker":"Charles Goldfarb","startTime":1132.43,"endTime":1135.55,"body":"considerations for the capitate."},{"speaker":"Charles Goldfarb","startTime":1136.03,"endTime":1139.45,"body":"And I would say traditionally,"},{"speaker":"Charles Goldfarb","startTime":1136.03,"endTime":1139.45,"body":"I've done that with K-wire"},{"speaker":"Charles Goldfarb","startTime":1139.45,"endTime":1143.02,"body":"fixation. And then as good a"},{"speaker":"Charles Goldfarb","startTime":1139.45,"endTime":1143.02,"body":"repair as I can do with the"},{"speaker":"Charles Goldfarb","startTime":1143.02,"endTime":1146.23,"body":"dorsal SL and this is where I"},{"speaker":"Charles Goldfarb","startTime":1143.02,"endTime":1146.23,"body":"get to my disappointment. And"},{"speaker":"Charles Goldfarb","startTime":1146.23,"endTime":1150.01,"body":"this is this is why I think"},{"speaker":"Charles Goldfarb","startTime":1146.23,"endTime":1150.01,"body":"these fail is that you know we"},{"speaker":"Charles Goldfarb","startTime":1150.01,"endTime":1154.27,"body":"are hoping that we can get an"},{"speaker":"Charles Goldfarb","startTime":1150.01,"endTime":1154.27,"body":"intra articular ligament bathed"},{"speaker":"Charles Goldfarb","startTime":1154.27,"endTime":1157.84,"body":"in synovial fluid to heal with a"},{"speaker":"Charles Goldfarb","startTime":1154.27,"endTime":1157.84,"body":"suture anchor and a little"},{"speaker":"Charles Goldfarb","startTime":1157.84,"endTime":1161.8,"body":"horizontal mattress suture. It's"},{"speaker":"Charles Goldfarb","startTime":1157.84,"endTime":1161.8,"body":"just not a ligament that is"},{"speaker":"Charles Goldfarb","startTime":1161.8,"endTime":1166.12,"body":"amenable to a good repair. And I"},{"speaker":"Charles Goldfarb","startTime":1161.8,"endTime":1166.12,"body":"don't think to healing but"},{"speaker":"Charles Goldfarb","startTime":1166.12,"endTime":1168.52,"body":"hopefully enough scar tissue"},{"speaker":"Charles Goldfarb","startTime":1166.12,"endTime":1168.52,"body":"forms to prevent problems down"},{"speaker":"Charles Goldfarb","startTime":1168.52,"endTime":1170.95,"body":"the road. That's honestly how I"},{"speaker":"Charles Goldfarb","startTime":1168.52,"endTime":1170.95,"body":"think about it. Whether it's two"},{"speaker":"Charles Goldfarb","startTime":1170.95,"endTime":1173.71,"body":"weeks or six weeks, or whether"},{"speaker":"Charles Goldfarb","startTime":1170.95,"endTime":1173.71,"body":"it's an immediate repair with a"},{"speaker":"Charles Goldfarb","startTime":1173.74,"endTime":1177.52,"body":"perilunate, I just don't think"},{"speaker":"Charles Goldfarb","startTime":1173.74,"endTime":1177.52,"body":"that ligament lends itself to"},{"speaker":"Charles Goldfarb","startTime":1177.52,"endTime":1178.0,"body":"repair."},{"speaker":"Chris Dy","startTime":1178.99,"endTime":1181.21,"body":"So let's you made a"},{"speaker":"Chris Dy","startTime":1178.99,"endTime":1181.21,"body":"couple of really interesting"},{"speaker":"Chris Dy","startTime":1181.21,"endTime":1183.31,"body":"points I think we should"},{"speaker":"Chris Dy","startTime":1181.21,"endTime":1183.31,"body":"elaborate on given that this is"},{"speaker":"Chris Dy","startTime":1183.31,"endTime":1186.04,"body":"a detail episode. So you"},{"speaker":"Chris Dy","startTime":1183.31,"endTime":1186.04,"body":"mentioned getting anatomical"},{"speaker":"Chris Dy","startTime":1186.04,"endTime":1190.0,"body":"reduction. How do you do that? I"},{"speaker":"Chris Dy","startTime":1186.04,"endTime":1190.0,"body":"know that you're you know if"},{"speaker":"Chris Dy","startTime":1190.0,"endTime":1192.64,"body":"you're going to talk about"},{"speaker":"Chris Dy","startTime":1190.0,"endTime":1192.64,"body":"joysticks, and you know K-wire"},{"speaker":"Chris Dy","startTime":1192.64,"endTime":1196.09,"body":"fixation. What size K-wires do"},{"speaker":"Chris Dy","startTime":1192.64,"endTime":1196.09,"body":"you use for the joysticks, what"},{"speaker":"Chris Dy","startTime":1196.09,"endTime":1200.11,"body":"size K-wires Do you use for the"},{"speaker":"Chris Dy","startTime":1196.09,"endTime":1200.11,"body":"fixation, are they percutaneous,"},{"speaker":"Chris Dy","startTime":1200.17,"endTime":1202.72,"body":"are you leaving them out? Are"},{"speaker":"Chris Dy","startTime":1200.17,"endTime":1202.72,"body":"you leave cutting them and"},{"speaker":"Chris Dy","startTime":1202.72,"endTime":1205.69,"body":"burying them underneath the"},{"speaker":"Chris Dy","startTime":1202.72,"endTime":1205.69,"body":"skin? Where are the wires going?"},{"speaker":"Charles Goldfarb","startTime":1206.68,"endTime":1208.72,"body":"So the first"},{"speaker":"Charles Goldfarb","startTime":1206.68,"endTime":1208.72,"body":"question is, if we are going to"},{"speaker":"Charles Goldfarb","startTime":1208.72,"endTime":1215.59,"body":"use K-wires for fixation and try"},{"speaker":"Charles Goldfarb","startTime":1208.72,"endTime":1215.59,"body":"to do a repair, then."},{"speaker":"Chris Dy","startTime":1216.04,"endTime":1218.56,"body":"So, so joysticks. So-"},{"speaker":"Charles Goldfarb","startTime":1218.56,"endTime":1220.9,"body":"Yeah, well, if"},{"speaker":"Charles Goldfarb","startTime":1218.56,"endTime":1220.9,"body":"we're going to use K-wires for"},{"speaker":"Charles Goldfarb","startTime":1220.9,"endTime":1225.19,"body":"fixation, and not something like"},{"speaker":"Charles Goldfarb","startTime":1220.9,"endTime":1225.19,"body":"an internal brace, which we can"},{"speaker":"Charles Goldfarb","startTime":1225.19,"endTime":1232.69,"body":"talk about, which may have a"},{"speaker":"Charles Goldfarb","startTime":1225.19,"endTime":1232.69,"body":"role here, then we are going for"},{"speaker":"Charles Goldfarb","startTime":1232.75,"endTime":1237.67,"body":"the anatomical reduction as"},{"speaker":"Charles Goldfarb","startTime":1232.75,"endTime":1237.67,"body":"judged by direct visualization"},{"speaker":"Charles Goldfarb","startTime":1237.73,"endTime":1241.63,"body":"of the scapholunate interval and"},{"speaker":"Charles Goldfarb","startTime":1237.73,"endTime":1241.63,"body":"you know, X ray in the operating"},{"speaker":"Charles Goldfarb","startTime":1241.63,"endTime":1246.61,"body":"room. And so I use 6-2 K-wires"},{"speaker":"Charles Goldfarb","startTime":1241.63,"endTime":1246.61,"body":"as joysticks. And so typically,"},{"speaker":"Charles Goldfarb","startTime":1246.61,"endTime":1250.3,"body":"you're taking the lunate out of"},{"speaker":"Charles Goldfarb","startTime":1246.61,"endTime":1250.3,"body":"extension into flexion, bringing"},{"speaker":"Charles Goldfarb","startTime":1250.3,"endTime":1254.62,"body":"the scaphoid out of flexion into"},{"speaker":"Charles Goldfarb","startTime":1250.3,"endTime":1254.62,"body":"extension, and often over"},{"speaker":"Charles Goldfarb","startTime":1254.62,"endTime":1259.39,"body":"extending it slightly to make"},{"speaker":"Charles Goldfarb","startTime":1254.62,"endTime":1259.39,"body":"your SL angle 30 degrees, 35-40"},{"speaker":"Charles Goldfarb","startTime":1259.39,"endTime":1263.38,"body":"degrees, something like that."},{"speaker":"Charles Goldfarb","startTime":1259.39,"endTime":1263.38,"body":"And then on my first K-wire, so"},{"speaker":"Charles Goldfarb","startTime":1263.44,"endTime":1268.18,"body":"my first K-wire will be from the"},{"speaker":"Charles Goldfarb","startTime":1263.44,"endTime":1268.18,"body":"distal scaphoid to the capitate."},{"speaker":"Charles Goldfarb","startTime":1268.45,"endTime":1271.78,"body":"To hold the scaphoid in general"},{"speaker":"Charles Goldfarb","startTime":1268.45,"endTime":1271.78,"body":"where I want and then I use the"},{"speaker":"Charles Goldfarb","startTime":1272.23,"endTime":1275.14,"body":"after having used the joysticks"},{"speaker":"Charles Goldfarb","startTime":1272.23,"endTime":1275.14,"body":"to hold things generally"},{"speaker":"Charles Goldfarb","startTime":1275.14,"endTime":1277.6,"body":"together, the second K-wires"},{"speaker":"Charles Goldfarb","startTime":1275.14,"endTime":1277.6,"body":"from the scaphoid to the lunate."},{"speaker":"Chris Dy","startTime":1277.6,"endTime":1281.32,"body":"I found this to be"},{"speaker":"Chris Dy","startTime":1277.6,"endTime":1281.32,"body":"much more gratifying to correct"},{"speaker":"Chris Dy","startTime":1281.32,"endTime":1285.76,"body":"the SL angle, as opposed to"},{"speaker":"Chris Dy","startTime":1281.32,"endTime":1285.76,"body":"correcting the actual gap. Does"},{"speaker":"Chris Dy","startTime":1285.76,"endTime":1286.93,"body":"the gap matter?"},{"speaker":"Charles Goldfarb","startTime":1288.07,"endTime":1292.96,"body":"I think the"},{"speaker":"Charles Goldfarb","startTime":1288.07,"endTime":1292.96,"body":"gap does matter. For the"},{"speaker":"Charles Goldfarb","startTime":1292.96,"endTime":1298.57,"body":"theoretical ability to repair"},{"speaker":"Charles Goldfarb","startTime":1292.96,"endTime":1298.57,"body":"the ligament, because you need"},{"speaker":"Charles Goldfarb","startTime":1298.57,"endTime":1303.64,"body":"it in close apposition, if not"},{"speaker":"Charles Goldfarb","startTime":1298.57,"endTime":1303.64,"body":"over reduced slightly to have"},{"speaker":"Charles Goldfarb","startTime":1303.64,"endTime":1306.22,"body":"any chance of getting that"},{"speaker":"Charles Goldfarb","startTime":1303.64,"endTime":1306.22,"body":"ligament to heal."},{"speaker":"Chris Dy","startTime":1306.0,"endTime":1310.2,"body":"So how, technically,"},{"speaker":"Chris Dy","startTime":1306.0,"endTime":1310.2,"body":"how do you manage the gap? I've"},{"speaker":"Chris Dy","startTime":1310.2,"endTime":1314.16,"body":"seen people kind of take those"},{"speaker":"Chris Dy","startTime":1310.2,"endTime":1314.16,"body":"joysticks and cross them almost"},{"speaker":"Chris Dy","startTime":1314.16,"endTime":1316.8,"body":"to hold it together and maybe"},{"speaker":"Chris Dy","startTime":1314.16,"endTime":1316.8,"body":"use a big kocher something like"},{"speaker":"Chris Dy","startTime":1316.8,"endTime":1319.44,"body":"that to keep it held depending"},{"speaker":"Chris Dy","startTime":1316.8,"endTime":1319.44,"body":"on you know number of people you"},{"speaker":"Chris Dy","startTime":1319.44,"endTime":1320.67,"body":"have assisting you etc."},{"speaker":"Charles Goldfarb","startTime":1321.45,"endTime":1324.78,"body":"Yeah, I like I"},{"speaker":"Charles Goldfarb","startTime":1321.45,"endTime":1324.78,"body":"like that concept. So I'll tell"},{"speaker":"Charles Goldfarb","startTime":1324.78,"endTime":1327.72,"body":"you what I haven't been overly"},{"speaker":"Charles Goldfarb","startTime":1324.78,"endTime":1327.72,"body":"successful with is trying to use"},{"speaker":"Charles Goldfarb","startTime":1327.72,"endTime":1331.95,"body":"like towel clips to apply a"},{"speaker":"Charles Goldfarb","startTime":1327.72,"endTime":1331.95,"body":"compression force. For me, I've"},{"speaker":"Charles Goldfarb","startTime":1331.95,"endTime":1334.74,"body":"been really happy with 6-2"},{"speaker":"Charles Goldfarb","startTime":1331.95,"endTime":1334.74,"body":"K-wires, and you have to be"},{"speaker":"Charles Goldfarb","startTime":1334.74,"endTime":1338.01,"body":"careful how you place your 6-2"},{"speaker":"Charles Goldfarb","startTime":1334.74,"endTime":1338.01,"body":"K-wires because they can get in"},{"speaker":"Charles Goldfarb","startTime":1338.01,"endTime":1340.95,"body":"the way of other things like"},{"speaker":"Charles Goldfarb","startTime":1338.01,"endTime":1340.95,"body":"your suture anchor. And some"},{"speaker":"Charles Goldfarb","startTime":1340.95,"endTime":1343.86,"body":"people will put their suture"},{"speaker":"Charles Goldfarb","startTime":1340.95,"endTime":1343.86,"body":"anchor in first and then put the"},{"speaker":"Charles Goldfarb","startTime":1343.86,"endTime":1347.97,"body":"6-2 K-wire in. So you want that"},{"speaker":"Charles Goldfarb","startTime":1343.86,"endTime":1347.97,"body":"anchor placed appropriately. But"},{"speaker":"Charles Goldfarb","startTime":1347.97,"endTime":1351.78,"body":"if you have your K-wire"},{"speaker":"Charles Goldfarb","startTime":1347.97,"endTime":1351.78,"body":"joysticks in place, and you do"},{"speaker":"Charles Goldfarb","startTime":1351.78,"endTime":1355.05,"body":"the reduction mover from a"},{"speaker":"Charles Goldfarb","startTime":1351.78,"endTime":1355.05,"body":"dorsal volar standpoint, and"},{"speaker":"Charles Goldfarb","startTime":1355.05,"endTime":1359.31,"body":"then you cross your hands, for a"},{"speaker":"Charles Goldfarb","startTime":1355.05,"endTime":1359.31,"body":"mobile scaphoid, it's really"},{"speaker":"Charles Goldfarb","startTime":1359.31,"endTime":1362.46,"body":"effective in reducing or like I"},{"speaker":"Charles Goldfarb","startTime":1359.31,"endTime":1362.46,"body":"said even over reducing the"},{"speaker":"Charles Goldfarb","startTime":1362.46,"endTime":1364.56,"body":"interval slightly. Is that how"},{"speaker":"Charles Goldfarb","startTime":1362.46,"endTime":1364.56,"body":"you do it?"},{"speaker":"Chris Dy","startTime":1365.22,"endTime":1367.95,"body":"Yeah, and I think that"},{"speaker":"Chris Dy","startTime":1365.22,"endTime":1367.95,"body":"the joystick placement is super"},{"speaker":"Chris Dy","startTime":1367.95,"endTime":1371.1,"body":"important. So you mentioned"},{"speaker":"Chris Dy","startTime":1367.95,"endTime":1371.1,"body":"oftentimes that you're you need"},{"speaker":"Chris Dy","startTime":1371.1,"endTime":1373.26,"body":"the joysticks to be out of the"},{"speaker":"Chris Dy","startTime":1371.1,"endTime":1373.26,"body":"way of other things like your"},{"speaker":"Chris Dy","startTime":1373.29,"endTime":1376.8,"body":"fixation, K-wires and your"},{"speaker":"Chris Dy","startTime":1373.29,"endTime":1376.8,"body":"anchors. So it's important to"},{"speaker":"Chris Dy","startTime":1376.8,"endTime":1379.35,"body":"think about where you're going"},{"speaker":"Chris Dy","startTime":1376.8,"endTime":1379.35,"body":"to put those things. And then"},{"speaker":"Chris Dy","startTime":1379.38,"endTime":1382.89,"body":"you're correcting the lunate"},{"speaker":"Chris Dy","startTime":1379.38,"endTime":1382.89,"body":"from being in extension. So you"},{"speaker":"Chris Dy","startTime":1382.89,"endTime":1386.85,"body":"want to make sure that when you"},{"speaker":"Chris Dy","startTime":1382.89,"endTime":1386.85,"body":"put in your wire, you're a"},{"speaker":"Chris Dy","startTime":1386.85,"endTime":1391.53,"body":"little more proximal on the"},{"speaker":"Chris Dy","startTime":1386.85,"endTime":1391.53,"body":"lunate so that you have room to"},{"speaker":"Chris Dy","startTime":1391.56,"endTime":1394.71,"body":"correct the extension and flex"},{"speaker":"Chris Dy","startTime":1391.56,"endTime":1394.71,"body":"the linear speed Yeah, correct"},{"speaker":"Chris Dy","startTime":1394.71,"endTime":1398.88,"body":"it and flex it into anatomic"},{"speaker":"Chris Dy","startTime":1394.71,"endTime":1398.88,"body":"neutral position. And then vice"},{"speaker":"Chris Dy","startTime":1398.88,"endTime":1401.34,"body":"versa for the scaphoid so that"},{"speaker":"Chris Dy","startTime":1398.88,"endTime":1401.34,"body":"you have room to extend the"},{"speaker":"Chris Dy","startTime":1401.34,"endTime":1403.44,"body":"skateboard. So you're almost"},{"speaker":"Chris Dy","startTime":1401.34,"endTime":1403.44,"body":"dropping those wires in at"},{"speaker":"Chris Dy","startTime":1403.44,"endTime":1405.9,"body":"different angles to correct them"},{"speaker":"Chris Dy","startTime":1403.44,"endTime":1405.9,"body":"so that they sit next to each"},{"speaker":"Chris Dy","startTime":1405.9,"endTime":1408.15,"body":"other and then you can bring"},{"speaker":"Chris Dy","startTime":1405.9,"endTime":1408.15,"body":"your hands across like you"},{"speaker":"Chris Dy","startTime":1408.15,"endTime":1411.72,"body":"mentioned. So I think about the"},{"speaker":"Chris Dy","startTime":1408.15,"endTime":1411.72,"body":"same way do you use 6-2 wires"},{"speaker":"Chris Dy","startTime":1411.72,"endTime":1413.46,"body":"and 4-5s for the joysticks?"},{"speaker":"Charles Goldfarb","startTime":1413.99,"endTime":1417.11,"body":"For the"},{"speaker":"Charles Goldfarb","startTime":1413.99,"endTime":1417.11,"body":"joysticks, I use 6-2. For the"},{"speaker":"Charles Goldfarb","startTime":1417.14,"endTime":1423.8,"body":"pins that I put in, I use 0.045"},{"speaker":"Charles Goldfarb","startTime":1417.14,"endTime":1423.8,"body":"K-wires and I do tend to bury"},{"speaker":"Charles Goldfarb","startTime":1423.8,"endTime":1427.43,"body":"those. If I use them. I will be"},{"speaker":"Charles Goldfarb","startTime":1423.8,"endTime":1427.43,"body":"honest that at the six week"},{"speaker":"Charles Goldfarb","startTime":1427.43,"endTime":1430.22,"body":"interval, I'm probably thinking"},{"speaker":"Charles Goldfarb","startTime":1427.43,"endTime":1430.22,"body":"about an internal brace and no"},{"speaker":"Charles Goldfarb","startTime":1430.22,"endTime":1434.51,"body":"K-wires whatsoever. But if I'm"},{"speaker":"Charles Goldfarb","startTime":1430.22,"endTime":1434.51,"body":"going to put in K-wires, I use"},{"speaker":"Charles Goldfarb","startTime":1434.54,"endTime":1437.0,"body":"4-5s and I bury them, what do"},{"speaker":"Charles Goldfarb","startTime":1434.54,"endTime":1437.0,"body":"you do?"},{"speaker":"Chris Dy","startTime":1437.75,"endTime":1442.22,"body":"Um, I will use 6-2s"},{"speaker":"Chris Dy","startTime":1437.75,"endTime":1442.22,"body":"for all of it. And I typically"},{"speaker":"Chris Dy","startTime":1442.22,"endTime":1445.55,"body":"will bury them if I am using"},{"speaker":"Chris Dy","startTime":1442.22,"endTime":1445.55,"body":"K-wires. And I probably have a"},{"speaker":"Chris Dy","startTime":1446.09,"endTime":1449.36,"body":"lower threshold to use K-wires"},{"speaker":"Chris Dy","startTime":1446.09,"endTime":1449.36,"body":"than you since I probably do"},{"speaker":"Chris Dy","startTime":1449.36,"endTime":1451.94,"body":"less sports surgery and I've"},{"speaker":"Chris Dy","startTime":1449.36,"endTime":1451.94,"body":"less familiarity with kind of"},{"speaker":"Chris Dy","startTime":1452.27,"endTime":1455.87,"body":"the comfort levels of you know"},{"speaker":"Chris Dy","startTime":1452.27,"endTime":1455.87,"body":"when to let people move things"},{"speaker":"Chris Dy","startTime":1455.87,"endTime":1460.64,"body":"than than you are. Now you"},{"speaker":"Chris Dy","startTime":1455.87,"endTime":1460.64,"body":"mentioned one thing that the"},{"speaker":"Chris Dy","startTime":1460.64,"endTime":1463.76,"body":"scaphoid that you can get the"},{"speaker":"Chris Dy","startTime":1460.64,"endTime":1463.76,"body":"reduction. What do you do if you"},{"speaker":"Chris Dy","startTime":1463.76,"endTime":1464.93,"body":"can't extend the scaphoid?"},{"speaker":"Charles Goldfarb","startTime":1465.89,"endTime":1467.96,"body":"If you really"},{"speaker":"Charles Goldfarb","startTime":1465.89,"endTime":1467.96,"body":"can't extend the scaphoid"},{"speaker":"Charles Goldfarb","startTime":1467.96,"endTime":1470.6,"body":"because of scar tissue again,"},{"speaker":"Charles Goldfarb","startTime":1467.96,"endTime":1470.6,"body":"that would be a longer interval"},{"speaker":"Charles Goldfarb","startTime":1470.6,"endTime":1475.52,"body":"than six weeks, then I think you"},{"speaker":"Charles Goldfarb","startTime":1470.6,"endTime":1475.52,"body":"either have to do a sharp"},{"speaker":"Charles Goldfarb","startTime":1475.55,"endTime":1480.47,"body":"release of scar tissue typically"},{"speaker":"Charles Goldfarb","startTime":1475.55,"endTime":1480.47,"body":"at the volar distal aspect of"},{"speaker":"Charles Goldfarb","startTime":1480.47,"endTime":1488.03,"body":"the scaphoid or at the ST joint,"},{"speaker":"Charles Goldfarb","startTime":1480.47,"endTime":1488.03,"body":"scaphotrapezial joint. But in my"},{"speaker":"Charles Goldfarb","startTime":1488.03,"endTime":1490.76,"body":"experience has just been really"},{"speaker":"Charles Goldfarb","startTime":1488.03,"endTime":1490.76,"body":"rare that that is required, but"},{"speaker":"Charles Goldfarb","startTime":1490.76,"endTime":1494.57,"body":"I think you have to be prepared."},{"speaker":"Charles Goldfarb","startTime":1490.76,"endTime":1494.57,"body":"Likewise, you know, most of the"},{"speaker":"Charles Goldfarb","startTime":1494.57,"endTime":1496.79,"body":"time you have to be prepared to"},{"speaker":"Charles Goldfarb","startTime":1494.57,"endTime":1496.79,"body":"do a salvage procedure. If"},{"speaker":"Charles Goldfarb","startTime":1496.79,"endTime":1499.46,"body":"you're doing something at six,"},{"speaker":"Charles Goldfarb","startTime":1496.79,"endTime":1499.46,"body":"you know three months or six"},{"speaker":"Charles Goldfarb","startTime":1499.46,"endTime":1502.46,"body":"months Don't think it's foolish"},{"speaker":"Charles Goldfarb","startTime":1499.46,"endTime":1502.46,"body":"to just tell the patient and go"},{"speaker":"Charles Goldfarb","startTime":1502.46,"endTime":1505.28,"body":"to escape when they repair,"},{"speaker":"Charles Goldfarb","startTime":1502.46,"endTime":1505.28,"body":"because it may not be possible."},{"speaker":"Charles Goldfarb","startTime":1505.49,"endTime":1507.56,"body":"And so this is one of the"},{"speaker":"Charles Goldfarb","startTime":1505.49,"endTime":1507.56,"body":"situations where preparation"},{"speaker":"Charles Goldfarb","startTime":1507.56,"endTime":1508.49,"body":"really matters."},{"speaker":"Chris Dy","startTime":1509.02,"endTime":1511.81,"body":"That was to say the I"},{"speaker":"Chris Dy","startTime":1509.02,"endTime":1511.81,"body":"like using in the office and"},{"speaker":"Chris Dy","startTime":1512.32,"endTime":1517.72,"body":"using the live fluoro to get the"},{"speaker":"Chris Dy","startTime":1512.32,"endTime":1517.72,"body":"the ulnar deviation view so that"},{"speaker":"Chris Dy","startTime":1517.72,"endTime":1520.78,"body":"I can prepare myself and prepare"},{"speaker":"Chris Dy","startTime":1517.72,"endTime":1520.78,"body":"the patient for what we are"},{"speaker":"Chris Dy","startTime":1520.78,"endTime":1525.37,"body":"likely to encounter. And then I"},{"speaker":"Chris Dy","startTime":1520.78,"endTime":1525.37,"body":"know we're going to save SL"},{"speaker":"Chris Dy","startTime":1525.37,"endTime":1530.23,"body":"reconstruction for a different"},{"speaker":"Chris Dy","startTime":1525.37,"endTime":1530.23,"body":"detail episode. So I will ask"},{"speaker":"Chris Dy","startTime":1530.23,"endTime":1534.22,"body":"you, you know, what kinds of"},{"speaker":"Chris Dy","startTime":1530.23,"endTime":1534.22,"body":"anchors, are you using relative"},{"speaker":"Chris Dy","startTime":1534.22,"endTime":1537.43,"body":"size and manufacturer? If you"},{"speaker":"Chris Dy","startTime":1534.22,"endTime":1537.43,"body":"want to say, and what kind of"},{"speaker":"Chris Dy","startTime":1537.43,"endTime":1539.74,"body":"sutures are loaded in those"},{"speaker":"Chris Dy","startTime":1537.43,"endTime":1539.74,"body":"anchors? How many anchors are"},{"speaker":"Chris Dy","startTime":1539.74,"endTime":1541.03,"body":"using and where are you placing"},{"speaker":"Chris Dy","startTime":1539.74,"endTime":1541.03,"body":"them?"},{"speaker":"Charles Goldfarb","startTime":1541.9,"endTime":1543.76,"body":"Yeah, again,"},{"speaker":"Charles Goldfarb","startTime":1541.9,"endTime":1543.76,"body":"it gets to the point of what are"},{"speaker":"Charles Goldfarb","startTime":1543.76,"endTime":1548.68,"body":"you really accomplishing with"},{"speaker":"Charles Goldfarb","startTime":1543.76,"endTime":1548.68,"body":"these anchors and with the, with"},{"speaker":"Charles Goldfarb","startTime":1548.68,"endTime":1552.91,"body":"the suture, because it's not a"},{"speaker":"Charles Goldfarb","startTime":1548.68,"endTime":1552.91,"body":"strength repair. Your, the goal"},{"speaker":"Charles Goldfarb","startTime":1552.91,"endTime":1556.51,"body":"here is simply to get a close"},{"speaker":"Charles Goldfarb","startTime":1552.91,"endTime":1556.51,"body":"re-approximation of the anatomy"},{"speaker":"Charles Goldfarb","startTime":1556.66,"endTime":1560.05,"body":"and have that ligament laying"},{"speaker":"Charles Goldfarb","startTime":1556.66,"endTime":1560.05,"body":"back in place, put back in"},{"speaker":"Charles Goldfarb","startTime":1560.05,"endTime":1566.41,"body":"place. And I use a typically a"},{"speaker":"Charles Goldfarb","startTime":1560.05,"endTime":1566.41,"body":"two seven corkscrew anchor with"},{"speaker":"Charles Goldfarb","startTime":1566.41,"endTime":1572.02,"body":"a 2-0 FiberWire ethibond type"},{"speaker":"Charles Goldfarb","startTime":1566.41,"endTime":1572.02,"body":"suture, I happen to use Arthrex."},{"speaker":"Charles Goldfarb","startTime":1572.05,"endTime":1574.36,"body":"As we all know, it doesn't"},{"speaker":"Charles Goldfarb","startTime":1572.05,"endTime":1574.36,"body":"matter what anchor you're using,"},{"speaker":"Charles Goldfarb","startTime":1574.36,"endTime":1579.61,"body":"I'm not conflicted. So that is"},{"speaker":"Charles Goldfarb","startTime":1574.36,"endTime":1579.61,"body":"that's my approach. And I put"},{"speaker":"Charles Goldfarb","startTime":1579.61,"endTime":1583.6,"body":"one anchor in and I try to do a"},{"speaker":"Charles Goldfarb","startTime":1579.61,"endTime":1583.6,"body":"little horizontal mattress, I've"},{"speaker":"Charles Goldfarb","startTime":1583.6,"endTime":1587.14,"body":"tried to do a little Krackow"},{"speaker":"Charles Goldfarb","startTime":1583.6,"endTime":1587.14,"body":"type suture, it doesn't work. To"},{"speaker":"Charles Goldfarb","startTime":1587.14,"endTime":1590.68,"body":"get that to get that, again, the"},{"speaker":"Charles Goldfarb","startTime":1587.14,"endTime":1590.68,"body":"ligament to lay nicely back in"},{"speaker":"Charles Goldfarb","startTime":1590.68,"endTime":1592.18,"body":"place to give it the chance to"},{"speaker":"Charles Goldfarb","startTime":1590.68,"endTime":1592.18,"body":"heal."},{"speaker":"Chris Dy","startTime":1592.66,"endTime":1595.48,"body":"Now that's a mini size"},{"speaker":"Chris Dy","startTime":1592.66,"endTime":1595.48,"body":"type basically, anchor?"},{"speaker":"Charles Goldfarb","startTime":1595.57,"endTime":1597.82,"body":"Yeah, mini"},{"speaker":"Charles Goldfarb","startTime":1595.57,"endTime":1597.82,"body":"mini mini anchor of some sort."},{"speaker":"Charles Goldfarb","startTime":1597.85,"endTime":1598.09,"body":"Yep."},{"speaker":"Chris Dy","startTime":1598.09,"endTime":1598.42,"body":"Got it."},{"speaker":"Charles Goldfarb","startTime":1598.6,"endTime":1600.46,"body":"And and"},{"speaker":"Charles Goldfarb","startTime":1598.6,"endTime":1600.46,"body":"carefully positioned to keep it"},{"speaker":"Charles Goldfarb","startTime":1600.46,"endTime":1602.92,"body":"out of the joint, whether that"},{"speaker":"Charles Goldfarb","startTime":1600.46,"endTime":1602.92,"body":"be the mid carpal joint or the"},{"speaker":"Charles Goldfarb","startTime":1602.92,"endTime":1606.04,"body":"SL joint right at the edge of"},{"speaker":"Charles Goldfarb","startTime":1602.92,"endTime":1606.04,"body":"the articular cartilage."},{"speaker":"Chris Dy","startTime":1607.04,"endTime":1609.32,"body":"Well, so I mean,"},{"speaker":"Chris Dy","startTime":1607.04,"endTime":1609.32,"body":"taking other orthopedic lessons"},{"speaker":"Chris Dy","startTime":1609.32,"endTime":1613.22,"body":"of repairing ligaments back down"},{"speaker":"Chris Dy","startTime":1609.32,"endTime":1613.22,"body":"to bone. What do you think about"},{"speaker":"Chris Dy","startTime":1613.22,"endTime":1615.62,"body":"like a double row? Like why not"},{"speaker":"Chris Dy","startTime":1613.22,"endTime":1615.62,"body":"another anchor?"},{"speaker":"Charles Goldfarb","startTime":1616.77,"endTime":1618.6,"body":"Cuz I don't"},{"speaker":"Charles Goldfarb","startTime":1616.77,"endTime":1618.6,"body":"think it adds anything. I think"},{"speaker":"Charles Goldfarb","startTime":1618.6,"endTime":1621.03,"body":"all you're adding is the"},{"speaker":"Charles Goldfarb","startTime":1618.6,"endTime":1621.03,"body":"strength of the suture, which"},{"speaker":"Charles Goldfarb","startTime":1621.03,"endTime":1623.52,"body":"gets to the reconstructive"},{"speaker":"Charles Goldfarb","startTime":1621.03,"endTime":1623.52,"body":"concepts and gets to the"},{"speaker":"Charles Goldfarb","startTime":1623.7,"endTime":1625.92,"body":"internal brace. I think one of"},{"speaker":"Charles Goldfarb","startTime":1623.7,"endTime":1625.92,"body":"the interesting things that I"},{"speaker":"Charles Goldfarb","startTime":1625.92,"endTime":1630.0,"body":"struggle with that I'm certainly"},{"speaker":"Charles Goldfarb","startTime":1625.92,"endTime":1630.0,"body":"far and away, not the first, is"},{"speaker":"Charles Goldfarb","startTime":1630.0,"endTime":1634.23,"body":"that okay, so let's say you do"},{"speaker":"Charles Goldfarb","startTime":1630.0,"endTime":1634.23,"body":"have that isolated SL injury, as"},{"speaker":"Charles Goldfarb","startTime":1634.23,"endTime":1638.7,"body":"we do an open approach to the"},{"speaker":"Charles Goldfarb","startTime":1634.23,"endTime":1638.7,"body":"scapholunate ligament. We are"},{"speaker":"Charles Goldfarb","startTime":1638.7,"endTime":1641.22,"body":"cutting secondary stabilizers,"},{"speaker":"Charles Goldfarb","startTime":1638.7,"endTime":1641.22,"body":"assuming they hadn't been"},{"speaker":"Charles Goldfarb","startTime":1641.22,"endTime":1644.79,"body":"injured with the injury. And so"},{"speaker":"Charles Goldfarb","startTime":1641.22,"endTime":1644.79,"body":"that's why the ligament sparing"},{"speaker":"Charles Goldfarb","startTime":1644.79,"endTime":1647.4,"body":"approach, for example, was"},{"speaker":"Charles Goldfarb","startTime":1644.79,"endTime":1647.4,"body":"developed. I think it was"},{"speaker":"Charles Goldfarb","startTime":1647.4,"endTime":1651.24,"body":"developed at Mayo, but certainly"},{"speaker":"Charles Goldfarb","startTime":1647.4,"endTime":1651.24,"body":"the Mayo guys use it. And so"},{"speaker":"Charles Goldfarb","startTime":1651.24,"endTime":1653.76,"body":"that's, that's fundamentally"},{"speaker":"Charles Goldfarb","startTime":1651.24,"endTime":1653.76,"body":"problematic. And that's why"},{"speaker":"Charles Goldfarb","startTime":1653.76,"endTime":1657.81,"body":"people like PC Ho, who does"},{"speaker":"Charles Goldfarb","startTime":1653.76,"endTime":1657.81,"body":"really great work."},{"speaker":"Charles Goldfarb","startTime":1657.81,"endTime":1661.23,"body":"arthroscopically have described"},{"speaker":"Charles Goldfarb","startTime":1657.81,"endTime":1661.23,"body":"arthroscopic repair techniques,"},{"speaker":"Charles Goldfarb","startTime":1661.44,"endTime":1665.4,"body":"not in an attempt to have"},{"speaker":"Charles Goldfarb","startTime":1661.44,"endTime":1665.4,"body":"technology triumph over reason."},{"speaker":"Charles Goldfarb","startTime":1665.55,"endTime":1669.0,"body":"But really to preserve those"},{"speaker":"Charles Goldfarb","startTime":1665.55,"endTime":1669.0,"body":"secondary stabilizers, which"},{"speaker":"Charles Goldfarb","startTime":1669.0,"endTime":1673.17,"body":"makes a lot of sense, I'm just"},{"speaker":"Charles Goldfarb","startTime":1669.0,"endTime":1673.17,"body":"not yet convinced that I can"},{"speaker":"Charles Goldfarb","startTime":1673.2,"endTime":1676.77,"body":"effectively perform an"},{"speaker":"Charles Goldfarb","startTime":1673.2,"endTime":1676.77,"body":"arthroscopic repair, much less a"},{"speaker":"Charles Goldfarb","startTime":1676.77,"endTime":1679.8,"body":"reconstruction of the SL"},{"speaker":"Charles Goldfarb","startTime":1676.77,"endTime":1679.8,"body":"interval. And so I typically do"},{"speaker":"Charles Goldfarb","startTime":1679.8,"endTime":1683.01,"body":"an open approach, I will"},{"speaker":"Charles Goldfarb","startTime":1679.8,"endTime":1683.01,"body":"consider a ligament sparing"},{"speaker":"Charles Goldfarb","startTime":1683.01,"endTime":1685.92,"body":"approach. And if I'm not able to"},{"speaker":"Charles Goldfarb","startTime":1683.01,"endTime":1685.92,"body":"do a ligament sparing approach"},{"speaker":"Charles Goldfarb","startTime":1685.92,"endTime":1690.33,"body":"because of access, then I just"},{"speaker":"Charles Goldfarb","startTime":1685.92,"endTime":1690.33,"body":"make sure I do a really as good"},{"speaker":"Charles Goldfarb","startTime":1690.33,"endTime":1693.33,"body":"as possible repair of the dorsal"},{"speaker":"Charles Goldfarb","startTime":1690.33,"endTime":1693.33,"body":"capsule when I close."},{"speaker":"Chris Dy","startTime":1693.87,"endTime":1696.21,"body":"So when you do your"},{"speaker":"Chris Dy","startTime":1693.87,"endTime":1696.21,"body":"approach, when you don't do a"},{"speaker":"Chris Dy","startTime":1696.21,"endTime":1698.46,"body":"ligament sparing approach, are"},{"speaker":"Chris Dy","startTime":1696.21,"endTime":1698.46,"body":"you doing the standard kind of"},{"speaker":"Chris Dy","startTime":1698.46,"endTime":1701.49,"body":"inverted T dorsal capsulotomy?"},{"speaker":"Charles Goldfarb","startTime":1702.35,"endTime":1704.12,"body":"I am I"},{"speaker":"Charles Goldfarb","startTime":1702.35,"endTime":1704.12,"body":"actually just make a straight"},{"speaker":"Charles Goldfarb","startTime":1704.12,"endTime":1708.77,"body":"line capsulotomy. So just for"},{"speaker":"Charles Goldfarb","startTime":1704.12,"endTime":1708.77,"body":"all of those dorsal incision,"},{"speaker":"Charles Goldfarb","startTime":1709.79,"endTime":1712.4,"body":"thankfully, you know, you're not"},{"speaker":"Charles Goldfarb","startTime":1709.79,"endTime":1712.4,"body":"really encompassing any any"},{"speaker":"Charles Goldfarb","startTime":1712.4,"endTime":1715.04,"body":"nerves typically in this in the"},{"speaker":"Charles Goldfarb","startTime":1712.4,"endTime":1715.04,"body":"midline right over the third"},{"speaker":"Charles Goldfarb","startTime":1715.04,"endTime":1718.01,"body":"compartment. Open the third"},{"speaker":"Charles Goldfarb","startTime":1715.04,"endTime":1718.01,"body":"compartment, I go ahead and"},{"speaker":"Charles Goldfarb","startTime":1718.01,"endTime":1722.78,"body":"transpose the EPL. I leave the"},{"speaker":"Charles Goldfarb","startTime":1718.01,"endTime":1722.78,"body":"EPL transposed when I close and"},{"speaker":"Charles Goldfarb","startTime":1722.78,"endTime":1725.93,"body":"I close the retinaculum beneath"},{"speaker":"Charles Goldfarb","startTime":1722.78,"endTime":1725.93,"body":"it. And then I'm working between"},{"speaker":"Charles Goldfarb","startTime":1725.93,"endTime":1728.6,"body":"the second and fourth"},{"speaker":"Charles Goldfarb","startTime":1725.93,"endTime":1728.6,"body":"compartments. So I incise the"},{"speaker":"Charles Goldfarb","startTime":1728.81,"endTime":1731.72,"body":"capsule longitudinally, if"},{"speaker":"Charles Goldfarb","startTime":1728.81,"endTime":1731.72,"body":"that's my approach for the day,"},{"speaker":"Charles Goldfarb","startTime":1732.41,"endTime":1736.16,"body":"and I as minimally as possible,"},{"speaker":"Charles Goldfarb","startTime":1732.41,"endTime":1736.16,"body":"take the capsule off the radius,"},{"speaker":"Charles Goldfarb","startTime":1736.37,"endTime":1738.86,"body":"and then you have great"},{"speaker":"Charles Goldfarb","startTime":1736.37,"endTime":1738.86,"body":"exposure, it does simplify your"},{"speaker":"Charles Goldfarb","startTime":1738.86,"endTime":1742.52,"body":"repair, there is no doubt I am"},{"speaker":"Charles Goldfarb","startTime":1738.86,"endTime":1742.52,"body":"not one, ok we'll work a little"},{"speaker":"Charles Goldfarb","startTime":1742.52,"endTime":1745.28,"body":"nerve into this. I'm not one who"},{"speaker":"Charles Goldfarb","startTime":1742.52,"endTime":1745.28,"body":"routinely performs a post"},{"speaker":"Charles Goldfarb","startTime":1745.28,"endTime":1749.57,"body":"interosseous nerve neurectomy. I"},{"speaker":"Charles Goldfarb","startTime":1745.28,"endTime":1749.57,"body":"want to hear if you do and then"},{"speaker":"Charles Goldfarb","startTime":1749.6,"endTime":1752.45,"body":"do the repair, I close well, and"},{"speaker":"Charles Goldfarb","startTime":1749.6,"endTime":1752.45,"body":"I'm done. What do you what do"},{"speaker":"Charles Goldfarb","startTime":1752.45,"endTime":1754.13,"body":"you think about that post"},{"speaker":"Charles Goldfarb","startTime":1752.45,"endTime":1754.13,"body":"interosseous nerve?"},{"speaker":"Chris Dy","startTime":1754.72,"endTime":1757.12,"body":"I don't do the"},{"speaker":"Chris Dy","startTime":1754.72,"endTime":1757.12,"body":"neurectomy. Although I see the"},{"speaker":"Chris Dy","startTime":1757.12,"endTime":1759.94,"body":"argument. I know that Dr. Rob"},{"speaker":"Chris Dy","startTime":1757.12,"endTime":1759.94,"body":"Gray is going to tell me that I"},{"speaker":"Chris Dy","startTime":1759.94,"endTime":1765.73,"body":"should be doing it every time."},{"speaker":"Chris Dy","startTime":1759.94,"endTime":1765.73,"body":"Thanks, Rob. I don't I guess I"},{"speaker":"Chris Dy","startTime":1765.73,"endTime":1768.13,"body":"could be convinced, but I feel"},{"speaker":"Chris Dy","startTime":1765.73,"endTime":1768.13,"body":"like there is enough literature"},{"speaker":"Chris Dy","startTime":1768.13,"endTime":1770.59,"body":"out there suggesting that that"},{"speaker":"Chris Dy","startTime":1768.13,"endTime":1770.59,"body":"has appropriate deceptive"},{"speaker":"Chris Dy","startTime":1770.59,"endTime":1774.79,"body":"function. And we're trying to"},{"speaker":"Chris Dy","startTime":1770.59,"endTime":1774.79,"body":"preserve the native or restore"},{"speaker":"Chris Dy","startTime":1774.79,"endTime":1777.79,"body":"the native anatomy. And I think"},{"speaker":"Chris Dy","startTime":1774.79,"endTime":1777.79,"body":"there's probably more sense in"},{"speaker":"Chris Dy","startTime":1777.79,"endTime":1780.94,"body":"keeping it in this particular"},{"speaker":"Chris Dy","startTime":1777.79,"endTime":1780.94,"body":"case. And I feel differently if"},{"speaker":"Chris Dy","startTime":1780.94,"endTime":1785.26,"body":"we were doing obviously some"},{"speaker":"Chris Dy","startTime":1780.94,"endTime":1785.26,"body":"kind of salvage procedure. And I"},{"speaker":"Chris Dy","startTime":1785.26,"endTime":1787.51,"body":"guess you know, the question I"},{"speaker":"Chris Dy","startTime":1785.26,"endTime":1787.51,"body":"have for you just a little"},{"speaker":"Chris Dy","startTime":1787.51,"endTime":1790.33,"body":"technical things. How much"},{"speaker":"Chris Dy","startTime":1787.51,"endTime":1790.33,"body":"extensor retinaculum do you feel"},{"speaker":"Chris Dy","startTime":1790.33,"endTime":1794.86,"body":"like you have to divide in order"},{"speaker":"Chris Dy","startTime":1790.33,"endTime":1794.86,"body":"to get your access to the depth"},{"speaker":"Chris Dy","startTime":1794.86,"endTime":1796.63,"body":"you need between the second and"},{"speaker":"Chris Dy","startTime":1794.86,"endTime":1796.63,"body":"fourth compartments? You"},{"speaker":"Chris Dy","startTime":1796.63,"endTime":1799.78,"body":"mentioned opening up a portion"},{"speaker":"Chris Dy","startTime":1796.63,"endTime":1799.78,"body":"of it to transpose the EPL out."},{"speaker":"Chris Dy","startTime":1799.81,"endTime":1802.45,"body":"Are you taking down all the"},{"speaker":"Chris Dy","startTime":1799.81,"endTime":1802.45,"body":"extensor retinaculum, you know,"},{"speaker":"Chris Dy","startTime":1802.45,"endTime":1805.18,"body":"just a distal quarter, third,"},{"speaker":"Chris Dy","startTime":1802.45,"endTime":1805.18,"body":"something like that."},{"speaker":"Charles Goldfarb","startTime":1806.08,"endTime":1808.03,"body":"I think you"},{"speaker":"Charles Goldfarb","startTime":1806.08,"endTime":1808.03,"body":"could do it either way, I tend"},{"speaker":"Charles Goldfarb","startTime":1808.03,"endTime":1810.28,"body":"to just open the third"},{"speaker":"Charles Goldfarb","startTime":1808.03,"endTime":1810.28,"body":"compartment and transpose the"},{"speaker":"Charles Goldfarb","startTime":1810.28,"endTime":1814.51,"body":"EPL. I think he could also leave"},{"speaker":"Charles Goldfarb","startTime":1810.28,"endTime":1814.51,"body":"the EPL where it sits, not"},{"speaker":"Charles Goldfarb","startTime":1814.51,"endTime":1818.02,"body":"transpose it and work distal to"},{"speaker":"Charles Goldfarb","startTime":1814.51,"endTime":1818.02,"body":"it. I just think it'd be it can"},{"speaker":"Charles Goldfarb","startTime":1818.02,"endTime":1820.96,"body":"be a little more of a flux"},{"speaker":"Charles Goldfarb","startTime":1818.02,"endTime":1820.96,"body":"factor. And I think if you're if"},{"speaker":"Charles Goldfarb","startTime":1820.96,"endTime":1824.41,"body":"you're going for a big exposure"},{"speaker":"Charles Goldfarb","startTime":1820.96,"endTime":1824.41,"body":"go for the big exposure. I think"},{"speaker":"Charles Goldfarb","startTime":1824.41,"endTime":1827.38,"body":"there are some reasons like an"},{"speaker":"Charles Goldfarb","startTime":1824.41,"endTime":1827.38,"body":"arthritis procedure, were taking"},{"speaker":"Charles Goldfarb","startTime":1827.38,"endTime":1829.9,"body":"out the post interosseous nerve"},{"speaker":"Charles Goldfarb","startTime":1827.38,"endTime":1829.9,"body":"makes all the sense in the"},{"speaker":"Charles Goldfarb","startTime":1829.9,"endTime":1832.93,"body":"world, because I don't think it"},{"speaker":"Charles Goldfarb","startTime":1829.9,"endTime":1832.93,"body":"really matters for the future. I"},{"speaker":"Charles Goldfarb","startTime":1832.93,"endTime":1837.52,"body":"do think there's a component of"},{"speaker":"Charles Goldfarb","startTime":1832.93,"endTime":1837.52,"body":"dynamic stability provided by"},{"speaker":"Charles Goldfarb","startTime":1837.58,"endTime":1840.52,"body":"some would say the FCR"},{"speaker":"Charles Goldfarb","startTime":1837.58,"endTime":1840.52,"body":"especially or, or the radial"},{"speaker":"Charles Goldfarb","startTime":1840.52,"endTime":1843.58,"body":"wrist extensors. And so to me,"},{"speaker":"Charles Goldfarb","startTime":1840.52,"endTime":1843.58,"body":"even though I don't think it's"},{"speaker":"Charles Goldfarb","startTime":1843.58,"endTime":1847.21,"body":"been proven conclusively, I"},{"speaker":"Charles Goldfarb","startTime":1843.58,"endTime":1847.21,"body":"think that post interosseous"},{"speaker":"Charles Goldfarb","startTime":1847.21,"endTime":1850.48,"body":"nerve innervating the capsule"},{"speaker":"Charles Goldfarb","startTime":1847.21,"endTime":1850.48,"body":"does provide some of that"},{"speaker":"Charles Goldfarb","startTime":1850.48,"endTime":1852.58,"body":"potential, which is why I don't"},{"speaker":"Charles Goldfarb","startTime":1850.48,"endTime":1852.58,"body":"take it out."},{"speaker":"Chris Dy","startTime":1853.32,"endTime":1856.68,"body":"Yeah, Elisabet Hagert"},{"speaker":"Chris Dy","startTime":1853.32,"endTime":1856.68,"body":"in, in Sweden has done a lot of"},{"speaker":"Chris Dy","startTime":1856.68,"endTime":1860.55,"body":"work on this and has convinced"},{"speaker":"Chris Dy","startTime":1856.68,"endTime":1860.55,"body":"me that I think that it's"},{"speaker":"Chris Dy","startTime":1860.55,"endTime":1865.11,"body":"important. So, yeah, I think"},{"speaker":"Chris Dy","startTime":1860.55,"endTime":1865.11,"body":"that's one of the things about,"},{"speaker":"Chris Dy","startTime":1865.2,"endTime":1867.6,"body":"for example, like an ACL"},{"speaker":"Chris Dy","startTime":1865.2,"endTime":1867.6,"body":"reconstruction never feels"},{"speaker":"Chris Dy","startTime":1867.6,"endTime":1869.94,"body":"normal, because you don't have"},{"speaker":"Chris Dy","startTime":1867.6,"endTime":1869.94,"body":"the normal purpose of the fibers"},{"speaker":"Chris Dy","startTime":1869.94,"endTime":1873.93,"body":"of the ACL. But again, I'm kind"},{"speaker":"Chris Dy","startTime":1869.94,"endTime":1873.93,"body":"of, I'm not particularly well"},{"speaker":"Chris Dy","startTime":1873.93,"endTime":1876.09,"body":"versed on this, I don't feel"},{"speaker":"Chris Dy","startTime":1873.93,"endTime":1876.09,"body":"very strongly about it, probably"},{"speaker":"Chris Dy","startTime":1876.09,"endTime":1878.43,"body":"the only thing in nerve that I"},{"speaker":"Chris Dy","startTime":1876.09,"endTime":1878.43,"body":"don't feel strongly about."},{"speaker":"Charles Goldfarb","startTime":1879.03,"endTime":1881.73,"body":"I will second"},{"speaker":"Charles Goldfarb","startTime":1879.03,"endTime":1881.73,"body":"that not that I don't feel"},{"speaker":"Charles Goldfarb","startTime":1881.73,"endTime":1884.67,"body":"strongly about any of them,"},{"speaker":"Charles Goldfarb","startTime":1881.73,"endTime":1884.67,"body":"setting it up for you. So how"},{"speaker":"Charles Goldfarb","startTime":1884.67,"endTime":1888.0,"body":"long do you leave your pins in?"},{"speaker":"Charles Goldfarb","startTime":1884.67,"endTime":1888.0,"body":"And do you bury them or no?"},{"speaker":"Chris Dy","startTime":1888.96,"endTime":1891.9,"body":"So I will leave them"},{"speaker":"Chris Dy","startTime":1888.96,"endTime":1891.9,"body":"in as long as they'll let me"},{"speaker":"Chris Dy","startTime":1891.9,"endTime":1895.8,"body":"stay in. To be very honest with"},{"speaker":"Chris Dy","startTime":1891.9,"endTime":1895.8,"body":"you. I shoot for six weeks,"},{"speaker":"Chris Dy","startTime":1896.76,"endTime":1900.48,"body":"depending on the patient, most"},{"speaker":"Chris Dy","startTime":1896.76,"endTime":1900.48,"body":"patients I leave them, I leave"},{"speaker":"Chris Dy","startTime":1900.48,"endTime":1903.81,"body":"them out of the skin. I don't"},{"speaker":"Chris Dy","startTime":1900.48,"endTime":1903.81,"body":"like coming back to the"},{"speaker":"Chris Dy","startTime":1903.81,"endTime":1906.75,"body":"operating room, I don't have to"},{"speaker":"Chris Dy","startTime":1903.81,"endTime":1906.75,"body":"I know we have partners who will"},{"speaker":"Chris Dy","startTime":1906.75,"endTime":1910.08,"body":"remove buried pins in the"},{"speaker":"Chris Dy","startTime":1906.75,"endTime":1910.08,"body":"office. I'm gained from pretty"},{"speaker":"Chris Dy","startTime":1910.08,"endTime":1914.52,"body":"much anything in the office, but"},{"speaker":"Chris Dy","startTime":1910.08,"endTime":1914.52,"body":"usually not that like it's it's,"},{"speaker":"Chris Dy","startTime":1914.73,"endTime":1916.38,"body":"it's a little bloodier than I"},{"speaker":"Chris Dy","startTime":1914.73,"endTime":1916.38,"body":"like."},{"speaker":"Charles Goldfarb","startTime":1917.28,"endTime":1920.1,"body":"I agree with"},{"speaker":"Charles Goldfarb","startTime":1917.28,"endTime":1920.1,"body":"that I do go a little longer. So"},{"speaker":"Charles Goldfarb","startTime":1920.1,"endTime":1923.91,"body":"for an isolated SL, I will shoot"},{"speaker":"Charles Goldfarb","startTime":1920.1,"endTime":1923.91,"body":"for eight weeks and perhaps 10"},{"speaker":"Charles Goldfarb","startTime":1923.91,"endTime":1927.66,"body":"weeks. And when I get to that"},{"speaker":"Charles Goldfarb","startTime":1923.91,"endTime":1927.66,"body":"duration, I typically do bury"},{"speaker":"Charles Goldfarb","startTime":1927.66,"endTime":1931.98,"body":"them. If I if I do a really good"},{"speaker":"Charles Goldfarb","startTime":1927.66,"endTime":1931.98,"body":"job, then the pins are deep"},{"speaker":"Charles Goldfarb","startTime":1931.98,"endTime":1934.5,"body":"enough not to bother the"},{"speaker":"Charles Goldfarb","startTime":1931.98,"endTime":1934.5,"body":"patient, but easily palpable,"},{"speaker":"Charles Goldfarb","startTime":1934.5,"endTime":1936.87,"body":"and I will consider an office"},{"speaker":"Charles Goldfarb","startTime":1934.5,"endTime":1936.87,"body":"removal if the patient would"},{"speaker":"Charles Goldfarb","startTime":1936.87,"endTime":1940.29,"body":"like. Otherwise, I come back to"},{"speaker":"Charles Goldfarb","startTime":1936.87,"endTime":1940.29,"body":"the OR, which I think is a"},{"speaker":"Charles Goldfarb","startTime":1940.29,"endTime":1941.61,"body":"terrible waste of resources."},{"speaker":"Chris Dy","startTime":1942.24,"endTime":1947.85,"body":"So how long do you"},{"speaker":"Chris Dy","startTime":1942.24,"endTime":1947.85,"body":"think pins exterior to the skin"},{"speaker":"Chris Dy","startTime":1947.97,"endTime":1950.88,"body":"will typically last? Do you"},{"speaker":"Chris Dy","startTime":1947.97,"endTime":1950.88,"body":"think you'll you you mentioned"},{"speaker":"Chris Dy","startTime":1950.88,"endTime":1952.77,"body":"you probably can't get eight to"},{"speaker":"Chris Dy","startTime":1950.88,"endTime":1952.77,"body":"10 weeks out of them? Do you"},{"speaker":"Chris Dy","startTime":1952.77,"endTime":1954.03,"body":"think you'd get six weeks out of"},{"speaker":"Chris Dy","startTime":1952.77,"endTime":1954.03,"body":"them?"},{"speaker":"Charles Goldfarb","startTime":1954.42,"endTime":1956.88,"body":"Yes, I think"},{"speaker":"Charles Goldfarb","startTime":1954.42,"endTime":1956.88,"body":"if I was finally leaving for six"},{"speaker":"Charles Goldfarb","startTime":1956.88,"endTime":1960.24,"body":"weeks, for most patients, I"},{"speaker":"Charles Goldfarb","startTime":1956.88,"endTime":1960.24,"body":"would put them external to the"},{"speaker":"Charles Goldfarb","startTime":1960.24,"endTime":1962.82,"body":"skin. And then you know it's"},{"speaker":"Charles Goldfarb","startTime":1960.24,"endTime":1962.82,"body":"patient dependent. And it's the"},{"speaker":"Charles Goldfarb","startTime":1962.82,"endTime":1965.82,"body":"quality of the cast dependent"},{"speaker":"Charles Goldfarb","startTime":1962.82,"endTime":1965.82,"body":"because I think it's the the"},{"speaker":"Charles Goldfarb","startTime":1965.82,"endTime":1969.12,"body":"wiggling is also the putting the"},{"speaker":"Charles Goldfarb","startTime":1965.82,"endTime":1969.12,"body":"pins without tension on the"},{"speaker":"Charles Goldfarb","startTime":1969.12,"endTime":1973.83,"body":"skin. And so really doing a"},{"speaker":"Charles Goldfarb","startTime":1969.12,"endTime":1973.83,"body":"generous release around the pins"},{"speaker":"Charles Goldfarb","startTime":1974.04,"endTime":1978.39,"body":"can be helpful to mitigate pin"},{"speaker":"Charles Goldfarb","startTime":1974.04,"endTime":1978.39,"body":"sight irritability, which leads"},{"speaker":"Charles Goldfarb","startTime":1978.39,"endTime":1979.41,"body":"to a lot of the problems."},{"speaker":"Chris Dy","startTime":1979.65,"endTime":1982.68,"body":"So when you're burying"},{"speaker":"Chris Dy","startTime":1979.65,"endTime":1982.68,"body":"the pins. Do you make a healthy"},{"speaker":"Chris Dy","startTime":1982.68,"endTime":1986.52,"body":"incision to and given that"},{"speaker":"Chris Dy","startTime":1982.68,"endTime":1986.52,"body":"you're on the radial side of the"},{"speaker":"Chris Dy","startTime":1986.52,"endTime":1988.77,"body":"wrist? Do you find the SRN or"},{"speaker":"Chris Dy","startTime":1986.52,"endTime":1988.77,"body":"anything like that?"},{"speaker":"Charles Goldfarb","startTime":1988.89,"endTime":1991.83,"body":"I do. So"},{"speaker":"Charles Goldfarb","startTime":1988.89,"endTime":1991.83,"body":"little incision, right the level"},{"speaker":"Charles Goldfarb","startTime":1991.83,"endTime":1994.02,"body":"of the styloid. And just distal"},{"speaker":"Charles Goldfarb","startTime":1991.83,"endTime":1994.02,"body":"to it because that's where you"},{"speaker":"Charles Goldfarb","startTime":1994.02,"endTime":1997.26,"body":"want to be whether your pan is"},{"speaker":"Charles Goldfarb","startTime":1994.02,"endTime":1997.26,"body":"going proximal towards the"},{"speaker":"Charles Goldfarb","startTime":1997.26,"endTime":2001.76,"body":"lunate or distal towards the"},{"speaker":"Charles Goldfarb","startTime":1997.26,"endTime":2001.76,"body":"distal capitate. That's where"},{"speaker":"Charles Goldfarb","startTime":2001.76,"endTime":2006.53,"body":"you want to be so incision"},{"speaker":"Charles Goldfarb","startTime":2001.76,"endTime":2006.53,"body":"little Ragnell retractors just"},{"speaker":"Charles Goldfarb","startTime":2006.53,"endTime":2009.23,"body":"to protect the sensory nerve,"},{"speaker":"Charles Goldfarb","startTime":2006.53,"endTime":2009.23,"body":"and then you're down on bone. So"},{"speaker":"Charles Goldfarb","startTime":2009.23,"endTime":2012.44,"body":"it's a nice, it's a small"},{"speaker":"Charles Goldfarb","startTime":2009.23,"endTime":2012.44,"body":"incision, but it's effective and"},{"speaker":"Charles Goldfarb","startTime":2012.44,"endTime":2015.71,"body":"it kind of protects the against"},{"speaker":"Charles Goldfarb","startTime":2012.44,"endTime":2015.71,"body":"tertiary damage."},{"speaker":"Chris Dy","startTime":2015.99,"endTime":2018.51,"body":"Now do you do you make"},{"speaker":"Chris Dy","startTime":2015.99,"endTime":2018.51,"body":"that incision before or after"},{"speaker":"Chris Dy","startTime":2018.51,"endTime":2019.56,"body":"you fire the pins?"},{"speaker":"Charles Goldfarb","startTime":2020.61,"endTime":2023.34,"body":"I actually"},{"speaker":"Charles Goldfarb","startTime":2020.61,"endTime":2023.34,"body":"make the incision and then place"},{"speaker":"Charles Goldfarb","startTime":2023.34,"endTime":2026.79,"body":"my pins. And then I make sure"},{"speaker":"Charles Goldfarb","startTime":2023.34,"endTime":2026.79,"body":"and then I make sure that once"},{"speaker":"Charles Goldfarb","startTime":2026.79,"endTime":2029.43,"body":"we're all said and done that the"},{"speaker":"Charles Goldfarb","startTime":2026.79,"endTime":2029.43,"body":"pins are not with I'm leaving"},{"speaker":"Charles Goldfarb","startTime":2029.43,"endTime":2032.67,"body":"them out, leave them in, I just"},{"speaker":"Charles Goldfarb","startTime":2029.43,"endTime":2032.67,"body":"make sure they're not causing"},{"speaker":"Charles Goldfarb","startTime":2032.67,"endTime":2033.6,"body":"irritation of the skin."},{"speaker":"Chris Dy","startTime":2034.2,"endTime":2036.63,"body":"And just one 6-2"},{"speaker":"Chris Dy","startTime":2034.2,"endTime":2036.63,"body":"across the SL? I've seen you"},{"speaker":"Chris Dy","startTime":2036.63,"endTime":2039.54,"body":"know some people use two, 4-5s"},{"speaker":"Chris Dy","startTime":2036.63,"endTime":2039.54,"body":"across the, or you said one,"},{"speaker":"Chris Dy","startTime":2039.63,"endTime":2042.93,"body":"you're using 4-5s for that"},{"speaker":"Chris Dy","startTime":2039.63,"endTime":2042.93,"body":"fixation. So just one not using"},{"speaker":"Chris Dy","startTime":2042.93,"endTime":2044.43,"body":"two for rotational stability?"},{"speaker":"Charles Goldfarb","startTime":2044.7,"endTime":2047.1,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":2044.7,"endTime":2047.1,"body":"if you have a pin going into the"},{"speaker":"Charles Goldfarb","startTime":2047.1,"endTime":2050.01,"body":"capitate and a pin going from"},{"speaker":"Charles Goldfarb","startTime":2047.1,"endTime":2050.01,"body":"the scaphoid to the lunate, one"},{"speaker":"Charles Goldfarb","startTime":2050.01,"endTime":2053.16,"body":"is sufficient. I'm certainly not"},{"speaker":"Charles Goldfarb","startTime":2050.01,"endTime":2053.16,"body":"against two I just don't think"},{"speaker":"Charles Goldfarb","startTime":2053.16,"endTime":2053.76,"body":"it's necessary."},{"speaker":"Chris Dy","startTime":2055.75,"endTime":2058.36,"body":"And then one other"},{"speaker":"Chris Dy","startTime":2055.75,"endTime":2058.36,"body":"technical thing that, you know,"},{"speaker":"Chris Dy","startTime":2058.78,"endTime":2062.47,"body":"when I before I got here, I had"},{"speaker":"Chris Dy","startTime":2058.78,"endTime":2062.47,"body":"seen these repaired with two"},{"speaker":"Chris Dy","startTime":2062.47,"endTime":2066.25,"body":"anchors and then double loading"},{"speaker":"Chris Dy","startTime":2062.47,"endTime":2066.25,"body":"an extra suture through the"},{"speaker":"Chris Dy","startTime":2066.25,"endTime":2069.25,"body":"anchor. I remember talking to"},{"speaker":"Chris Dy","startTime":2066.25,"endTime":2069.25,"body":"you about that and you just kind"},{"speaker":"Chris Dy","startTime":2069.25,"endTime":2074.2,"body":"of saying that that was not your"},{"speaker":"Chris Dy","startTime":2069.25,"endTime":2074.2,"body":"preference. Probably different,"},{"speaker":"Chris Dy","startTime":2075.07,"endTime":2078.37,"body":"different way. But you because"},{"speaker":"Chris Dy","startTime":2075.07,"endTime":2078.37,"body":"you would believe that that"},{"speaker":"Chris Dy","startTime":2078.37,"endTime":2081.55,"body":"would make a difference and"},{"speaker":"Chris Dy","startTime":2078.37,"endTime":2081.55,"body":"probably is just more foreign"},{"speaker":"Chris Dy","startTime":2081.55,"endTime":2085.18,"body":"material holding things in place"},{"speaker":"Chris Dy","startTime":2081.55,"endTime":2085.18,"body":"as opposed to encouraging"},{"speaker":"Chris Dy","startTime":2085.18,"endTime":2085.87,"body":"biology."},{"speaker":"Charles Goldfarb","startTime":2086.83,"endTime":2089.83,"body":"Yeah, listen,"},{"speaker":"Charles Goldfarb","startTime":2086.83,"endTime":2089.83,"body":"I mean, I think very few people"},{"speaker":"Charles Goldfarb","startTime":2089.83,"endTime":2092.41,"body":"would disagree with the"},{"speaker":"Charles Goldfarb","startTime":2089.83,"endTime":2092.41,"body":"statement that the scapholunate"},{"speaker":"Charles Goldfarb","startTime":2092.41,"endTime":2095.08,"body":"ligament injury remains the"},{"speaker":"Charles Goldfarb","startTime":2092.41,"endTime":2095.08,"body":"biggest unsolved problem in hand"},{"speaker":"Charles Goldfarb","startTime":2095.08,"endTime":2098.38,"body":"surgery. And it's kind of sad to"},{"speaker":"Charles Goldfarb","startTime":2095.08,"endTime":2098.38,"body":"say we've been saying it for 30"},{"speaker":"Charles Goldfarb","startTime":2098.38,"endTime":2102.61,"body":"years and it remains unsolved"},{"speaker":"Charles Goldfarb","startTime":2098.38,"endTime":2102.61,"body":"and there are, you know, there"},{"speaker":"Charles Goldfarb","startTime":2102.61,"endTime":2105.22,"body":"are different ways to get around"},{"speaker":"Charles Goldfarb","startTime":2102.61,"endTime":2105.22,"body":"this problem and maybe get"},{"speaker":"Charles Goldfarb","startTime":2105.22,"endTime":2108.67,"body":"through get through this injury"},{"speaker":"Charles Goldfarb","startTime":2105.22,"endTime":2108.67,"body":"for patients with different"},{"speaker":"Charles Goldfarb","startTime":2108.67,"endTime":2112.09,"body":"techniques. But every single"},{"speaker":"Charles Goldfarb","startTime":2108.67,"endTime":2112.09,"body":"hand surgeon has his or her own"},{"speaker":"Charles Goldfarb","startTime":2112.09,"endTime":2114.52,"body":"philosophy on what they need to"},{"speaker":"Charles Goldfarb","startTime":2112.09,"endTime":2114.52,"body":"do with pin placement with"},{"speaker":"Charles Goldfarb","startTime":2114.52,"endTime":2118.48,"body":"anchor placement with double"},{"speaker":"Charles Goldfarb","startTime":2114.52,"endTime":2118.48,"body":"loading of anchors. It's very"},{"speaker":"Charles Goldfarb","startTime":2118.48,"endTime":2121.03,"body":"frustrating. But when there's"},{"speaker":"Charles Goldfarb","startTime":2118.48,"endTime":2121.03,"body":"100 choices, it's because"},{"speaker":"Charles Goldfarb","startTime":2121.03,"endTime":2122.23,"body":"there's no clear winner."},{"speaker":"Chris Dy","startTime":2122.98,"endTime":2125.53,"body":"So let's say we'll"},{"speaker":"Chris Dy","startTime":2122.98,"endTime":2125.53,"body":"leave the suture tape"},{"speaker":"Chris Dy","startTime":2125.53,"endTime":2129.52,"body":"augmentation for a different"},{"speaker":"Chris Dy","startTime":2125.53,"endTime":2129.52,"body":"day. But let's say that you have"},{"speaker":"Chris Dy","startTime":2129.52,"endTime":2132.04,"body":"these K-wires, you've removed"},{"speaker":"Chris Dy","startTime":2129.52,"endTime":2132.04,"body":"the K-wires, what's your"},{"speaker":"Chris Dy","startTime":2132.04,"endTime":2134.92,"body":"protocol? Just bring us to a"},{"speaker":"Chris Dy","startTime":2132.04,"endTime":2134.92,"body":"close with your protocol for"},{"speaker":"Chris Dy","startTime":2134.92,"endTime":2135.4,"body":"rehab."},{"speaker":"Charles Goldfarb","startTime":2136.15,"endTime":2137.89,"body":"Yeah, so let's"},{"speaker":"Charles Goldfarb","startTime":2136.15,"endTime":2137.89,"body":"say we get to eight weeks. So"},{"speaker":"Charles Goldfarb","startTime":2137.89,"endTime":2140.8,"body":"eight weeks patient comes back,"},{"speaker":"Charles Goldfarb","startTime":2137.89,"endTime":2140.8,"body":"the pens are slightly palpable"},{"speaker":"Charles Goldfarb","startTime":2140.8,"endTime":2143.32,"body":"underneath the skin, we can"},{"speaker":"Charles Goldfarb","startTime":2140.8,"endTime":2143.32,"body":"successfully knick the skin and"},{"speaker":"Charles Goldfarb","startTime":2143.32,"endTime":2147.58,"body":"take out the K-wires. Then we"},{"speaker":"Charles Goldfarb","startTime":2143.32,"endTime":2147.58,"body":"send the patient to therapy for"},{"speaker":"Charles Goldfarb","startTime":2147.58,"endTime":2152.98,"body":"a volar forearm thumb spica"},{"speaker":"Charles Goldfarb","startTime":2147.58,"endTime":2152.98,"body":"splint. And we start with active"},{"speaker":"Charles Goldfarb","startTime":2152.98,"endTime":2158.44,"body":"motion and gentle, passive"},{"speaker":"Charles Goldfarb","startTime":2152.98,"endTime":2158.44,"body":"motion, at two additional weeks,"},{"speaker":"Charles Goldfarb","startTime":2158.44,"endTime":2161.89,"body":"we'll go more aggressively with"},{"speaker":"Charles Goldfarb","startTime":2158.44,"endTime":2161.89,"body":"the passive motion. And at 12"},{"speaker":"Charles Goldfarb","startTime":2161.89,"endTime":2164.41,"body":"weeks I go to strengthening. How"},{"speaker":"Charles Goldfarb","startTime":2161.89,"endTime":2164.41,"body":"do you think about it?"},{"speaker":"Chris Dy","startTime":2165.4,"endTime":2168.16,"body":"Pretty similar, not"},{"speaker":"Chris Dy","startTime":2165.4,"endTime":2168.16,"body":"not anything different. I just"},{"speaker":"Chris Dy","startTime":2168.16,"endTime":2170.95,"body":"know that we have a lot of"},{"speaker":"Chris Dy","startTime":2168.16,"endTime":2170.95,"body":"therapy colleagues, if you have"},{"speaker":"Chris Dy","startTime":2170.95,"endTime":2173.41,"body":"seen very different protocols"},{"speaker":"Chris Dy","startTime":2170.95,"endTime":2173.41,"body":"that you've found to be"},{"speaker":"Chris Dy","startTime":2173.41,"endTime":2177.34,"body":"beneficial, certainly let us"},{"speaker":"Chris Dy","startTime":2173.41,"endTime":2177.34,"body":"know. And we'd love to share it."},{"speaker":"Charles Goldfarb","startTime":2177.82,"endTime":2179.62,"body":"Yeah, we've"},{"speaker":"Charles Goldfarb","startTime":2177.82,"endTime":2179.62,"body":"tried in our group to"},{"speaker":"Charles Goldfarb","startTime":2179.62,"endTime":2182.47,"body":"standardize our therapy"},{"speaker":"Charles Goldfarb","startTime":2179.62,"endTime":2182.47,"body":"protocols. We've talked about it"},{"speaker":"Charles Goldfarb","startTime":2182.47,"endTime":2184.54,"body":"a million times, we have"},{"speaker":"Charles Goldfarb","startTime":2182.47,"endTime":2184.54,"body":"wonderful therapy partners at"},{"speaker":"Charles Goldfarb","startTime":2184.54,"endTime":2187.9,"body":"Milliken hand center. And we are"},{"speaker":"Charles Goldfarb","startTime":2184.54,"endTime":2187.9,"body":"pretty uniform, we're not always"},{"speaker":"Charles Goldfarb","startTime":2187.9,"endTime":2191.2,"body":"exactly the same. But we've"},{"speaker":"Charles Goldfarb","startTime":2187.9,"endTime":2191.2,"body":"tried just to for many reasons,"},{"speaker":"Charles Goldfarb","startTime":2191.2,"endTime":2194.95,"body":"it makes sense. One, it's just"},{"speaker":"Charles Goldfarb","startTime":2191.2,"endTime":2194.95,"body":"more applicable. Two, there's"},{"speaker":"Charles Goldfarb","startTime":2194.95,"endTime":2197.95,"body":"more opportunity for research,"},{"speaker":"Charles Goldfarb","startTime":2194.95,"endTime":2197.95,"body":"if we are standardized with our"},{"speaker":"Charles Goldfarb","startTime":2197.95,"endTime":2201.82,"body":"protocols. And three, it's just"},{"speaker":"Charles Goldfarb","startTime":2197.95,"endTime":2201.82,"body":"easier. So I think we're"},{"speaker":"Charles Goldfarb","startTime":2201.82,"endTime":2204.97,"body":"generally pretty uniform because"},{"speaker":"Charles Goldfarb","startTime":2201.82,"endTime":2204.97,"body":"none of us dig in too much on"},{"speaker":"Charles Goldfarb","startTime":2204.97,"endTime":2207.04,"body":"this. If someone has a strong"},{"speaker":"Charles Goldfarb","startTime":2204.97,"endTime":2207.04,"body":"opinion, we go with it. And we"},{"speaker":"Charles Goldfarb","startTime":2207.04,"endTime":2209.68,"body":"defer to our therapy colleagues"},{"speaker":"Charles Goldfarb","startTime":2207.04,"endTime":2209.68,"body":"who kind of see things in"},{"speaker":"Charles Goldfarb","startTime":2209.68,"endTime":2210.1,"body":"action."},{"speaker":"Chris Dy","startTime":2211.18,"endTime":2213.22,"body":"Yeah, so I'm a little"},{"speaker":"Chris Dy","startTime":2211.18,"endTime":2213.22,"body":"I most of my practices a little"},{"speaker":"Chris Dy","startTime":2213.22,"endTime":2215.29,"body":"bit away from Milliken, I'm"},{"speaker":"Chris Dy","startTime":2213.22,"endTime":2215.29,"body":"fortunate enough to work with"},{"speaker":"Chris Dy","startTime":2215.29,"endTime":2217.75,"body":"the Athletico group a fair bit,"},{"speaker":"Chris Dy","startTime":2215.29,"endTime":2217.75,"body":"and I've tried to adopt those"},{"speaker":"Chris Dy","startTime":2217.75,"endTime":2221.26,"body":"protocols. One thing I like that"},{"speaker":"Chris Dy","startTime":2217.75,"endTime":2221.26,"body":"we haven't mentioned that we"},{"speaker":"Chris Dy","startTime":2221.26,"endTime":2225.52,"body":"should before we finish is dart"},{"speaker":"Chris Dy","startTime":2221.26,"endTime":2225.52,"body":"throwers. So what do you think?"},{"speaker":"Chris Dy","startTime":2225.55,"endTime":2228.67,"body":"Can you initiate earlier motion"},{"speaker":"Chris Dy","startTime":2225.55,"endTime":2228.67,"body":"with dart throwers? Maybe you"},{"speaker":"Chris Dy","startTime":2228.67,"endTime":2232.03,"body":"don't even have pins in but you"},{"speaker":"Chris Dy","startTime":2228.67,"endTime":2232.03,"body":"know, can you start things"},{"speaker":"Chris Dy","startTime":2232.06,"endTime":2233.26,"body":"earlier in that plane?"},{"speaker":"Charles Goldfarb","startTime":2234.11,"endTime":2236.57,"body":"I buy the"},{"speaker":"Charles Goldfarb","startTime":2234.11,"endTime":2236.57,"body":"concept and if you want to"},{"speaker":"Charles Goldfarb","startTime":2236.6,"endTime":2239.18,"body":"describe it, you maybe able to"},{"speaker":"Charles Goldfarb","startTime":2236.6,"endTime":2239.18,"body":"do it better than I simply the"},{"speaker":"Charles Goldfarb","startTime":2239.33,"endTime":2245.42,"body":"dorsal radial to volar ulnar"},{"speaker":"Charles Goldfarb","startTime":2239.33,"endTime":2245.42,"body":"motion, I believe, and it's"},{"speaker":"Charles Goldfarb","startTime":2245.42,"endTime":2249.53,"body":"theoretically putting less"},{"speaker":"Charles Goldfarb","startTime":2245.42,"endTime":2249.53,"body":"stress on the SL interval. But"},{"speaker":"Charles Goldfarb","startTime":2249.53,"endTime":2252.2,"body":"we don't routinely use it."},{"speaker":"Charles Goldfarb","startTime":2249.53,"endTime":2252.2,"body":"There's literature out of New"},{"speaker":"Charles Goldfarb","startTime":2252.2,"endTime":2255.35,"body":"York as you're well aware to"},{"speaker":"Charles Goldfarb","startTime":2252.2,"endTime":2255.35,"body":"support it. It's not been a"},{"speaker":"Charles Goldfarb","startTime":2255.35,"endTime":2258.08,"body":"principal of our rehabilitation"},{"speaker":"Charles Goldfarb","startTime":2255.35,"endTime":2258.08,"body":"protocols."},{"speaker":"Chris Dy","startTime":2258.59,"endTime":2262.31,"body":"Little secret I really"},{"speaker":"Chris Dy","startTime":2258.59,"endTime":2262.31,"body":"like it and I use it. I'm a"},{"speaker":"Chris Dy","startTime":2262.31,"endTime":2265.04,"body":"little further away and I guess"},{"speaker":"Chris Dy","startTime":2262.31,"endTime":2265.04,"body":"I can't be in your your huge"},{"speaker":"Chris Dy","startTime":2265.07,"endTime":2268.67,"body":"Chuck Goldfarb, Lindley Wall,"},{"speaker":"Chris Dy","startTime":2265.07,"endTime":2268.67,"body":"Ryan Calfee, Marty Boyer, Dave"},{"speaker":"Chris Dy","startTime":2268.67,"endTime":2270.59,"body":"Brogan study of SL injuries."},{"speaker":"Charles Goldfarb","startTime":2270.62,"endTime":2271.73,"body":"You are not"},{"speaker":"Charles Goldfarb","startTime":2270.62,"endTime":2271.73,"body":"welcome."},{"speaker":"Chris Dy","startTime":2273.35,"endTime":2275.39,"body":"I like the dart"},{"speaker":"Chris Dy","startTime":2273.35,"endTime":2275.39,"body":"throwers, it makes sense to me."},{"speaker":"Chris Dy","startTime":2275.39,"endTime":2278.36,"body":"I obviously trained with Scott"},{"speaker":"Chris Dy","startTime":2275.39,"endTime":2278.36,"body":"Wolfe, who'd spent a lot of time"},{"speaker":"Chris Dy","startTime":2278.36,"endTime":2282.92,"body":"with with Trey Crisco on that"},{"speaker":"Chris Dy","startTime":2278.36,"endTime":2282.92,"body":"idea. I think it makes absolute"},{"speaker":"Chris Dy","startTime":2282.92,"endTime":2286.25,"body":"sense. It's just a matter of"},{"speaker":"Chris Dy","startTime":2282.92,"endTime":2286.25,"body":"whether it's being implemented"},{"speaker":"Chris Dy","startTime":2286.25,"endTime":2288.71,"body":"appropriately and understood by"},{"speaker":"Chris Dy","startTime":2286.25,"endTime":2288.71,"body":"the patient. And that's where I"},{"speaker":"Chris Dy","startTime":2288.71,"endTime":2291.68,"body":"trust our therapy colleagues to"},{"speaker":"Chris Dy","startTime":2288.71,"endTime":2291.68,"body":"help reinforce that, but I do"},{"speaker":"Chris Dy","startTime":2291.68,"endTime":2295.76,"body":"like dart throwers, I think it"},{"speaker":"Chris Dy","startTime":2291.68,"endTime":2295.76,"body":"It allows me some elements of"},{"speaker":"Chris Dy","startTime":2295.76,"endTime":2299.36,"body":"confidence that might repair or"},{"speaker":"Chris Dy","startTime":2295.76,"endTime":2299.36,"body":"reconstruction in a different"},{"speaker":"Chris Dy","startTime":2299.36,"endTime":2301.88,"body":"case is not going to be"},{"speaker":"Chris Dy","startTime":2299.36,"endTime":2301.88,"body":"excessively stressed. But"},{"speaker":"Chris Dy","startTime":2301.88,"endTime":2304.28,"body":"starting to patient on some"},{"speaker":"Chris Dy","startTime":2301.88,"endTime":2304.28,"body":"rehab a little bit earlier on."},{"speaker":"Charles Goldfarb","startTime":2304.97,"endTime":2306.95,"body":"Look I would"},{"speaker":"Charles Goldfarb","startTime":2304.97,"endTime":2306.95,"body":"never argue against it. I just"},{"speaker":"Charles Goldfarb","startTime":2306.95,"endTime":2310.37,"body":"hadn't chosen to implement it."},{"speaker":"Charles Goldfarb","startTime":2306.95,"endTime":2310.37,"body":"But again, that's where some of"},{"speaker":"Charles Goldfarb","startTime":2310.37,"endTime":2313.28,"body":"the variability comes in, which"},{"speaker":"Charles Goldfarb","startTime":2310.37,"endTime":2313.28,"body":"is the spice of life,"},{"speaker":"Charles Goldfarb","startTime":2313.28,"endTime":2313.94,"body":"unfortunately."},{"speaker":"Chris Dy","startTime":2314.75,"endTime":2316.82,"body":"Well maybe one day we"},{"speaker":"Chris Dy","startTime":2314.75,"endTime":2316.82,"body":"can teach an old dog new tricks,"},{"speaker":"Chris Dy","startTime":2316.82,"endTime":2317.15,"body":"Chuck."},{"speaker":"Charles Goldfarb","startTime":2317.51,"endTime":2319.97,"body":"That's true."},{"speaker":"Charles Goldfarb","startTime":2317.51,"endTime":2319.97,"body":"That's true. I'm always happy to"},{"speaker":"Charles Goldfarb","startTime":2319.97,"endTime":2323.18,"body":"learn a new trick. All right,"},{"speaker":"Charles Goldfarb","startTime":2319.97,"endTime":2323.18,"body":"well, this is good. We do have"},{"speaker":"Charles Goldfarb","startTime":2323.21,"endTime":2325.91,"body":"we can do follow ups on this as"},{"speaker":"Charles Goldfarb","startTime":2323.21,"endTime":2325.91,"body":"well. But we appreciate the the"},{"speaker":"Charles Goldfarb","startTime":2325.91,"endTime":2329.06,"body":"listener requests, and hopefully"},{"speaker":"Charles Goldfarb","startTime":2325.91,"endTime":2329.06,"body":"we've satisfied, we've scratched"},{"speaker":"Charles Goldfarb","startTime":2329.06,"endTime":2333.17,"body":"that itch, and send more send"},{"speaker":"Charles Goldfarb","startTime":2329.06,"endTime":2333.17,"body":"more opportunities our way."},{"speaker":"Chris Dy","startTime":2333.4,"endTime":2335.8,"body":"Yeah, Colin, thank you"},{"speaker":"Chris Dy","startTime":2333.4,"endTime":2335.8,"body":"for that suggestion. Hopefully,"},{"speaker":"Chris Dy","startTime":2335.89,"endTime":2339.34,"body":"this, this helped you out as"},{"speaker":"Chris Dy","startTime":2335.89,"endTime":2339.34,"body":"much as it helped us thinking"},{"speaker":"Chris Dy","startTime":2339.34,"endTime":2342.49,"body":"about it. And then honestly, if"},{"speaker":"Chris Dy","startTime":2339.34,"endTime":2342.49,"body":"anybody has any other topics"},{"speaker":"Chris Dy","startTime":2342.49,"endTime":2345.43,"body":"they want, we've gotten a lot of"},{"speaker":"Chris Dy","startTime":2342.49,"endTime":2345.43,"body":"really good reception for the"},{"speaker":"Chris Dy","startTime":2345.43,"endTime":2348.34,"body":"the detail episodes. So if you"},{"speaker":"Chris Dy","startTime":2345.43,"endTime":2348.34,"body":"want more deep dives, tell us"},{"speaker":"Chris Dy","startTime":2348.34,"endTime":2350.62,"body":"what you want to talk about. And"},{"speaker":"Chris Dy","startTime":2348.34,"endTime":2350.62,"body":"we'll try to work it in."},{"speaker":"Charles Goldfarb","startTime":2351.01,"endTime":2353.71,"body":"Yeah, and I"},{"speaker":"Charles Goldfarb","startTime":2351.01,"endTime":2353.71,"body":"would say most importantly, we"},{"speaker":"Charles Goldfarb","startTime":2353.74,"endTime":2359.26,"body":"love your comments. And on"},{"speaker":"Charles Goldfarb","startTime":2353.74,"endTime":2359.26,"body":"Twitter when Chris tweets about"},{"speaker":"Charles Goldfarb","startTime":2359.26,"endTime":2362.62,"body":"this episode, I am sure that"},{"speaker":"Charles Goldfarb","startTime":2359.26,"endTime":2362.62,"body":"some of you are going to comment"},{"speaker":"Charles Goldfarb","startTime":2362.62,"endTime":2366.88,"body":"on your approach. Please do we"},{"speaker":"Charles Goldfarb","startTime":2362.62,"endTime":2366.88,"body":"don't claim to have the all the"},{"speaker":"Charles Goldfarb","startTime":2366.88,"endTime":2368.74,"body":"answers. We have some of the"},{"speaker":"Charles Goldfarb","startTime":2366.88,"endTime":2368.74,"body":"answers. We don't have all the"},{"speaker":"Charles Goldfarb","startTime":2368.74,"endTime":2370.24,"body":"answers. So comment."},{"speaker":"Chris Dy","startTime":2370.84,"endTime":2373.12,"body":"Well, in the last"},{"speaker":"Chris Dy","startTime":2370.84,"endTime":2373.12,"body":"episode, Chuck bragged about the"},{"speaker":"Chris Dy","startTime":2373.12,"endTime":2375.61,"body":"reach of the podcasts and how"},{"speaker":"Chris Dy","startTime":2373.12,"endTime":2375.61,"body":"nobody else could ever top this"},{"speaker":"Chris Dy","startTime":2375.64,"endTime":2379.06,"body":"podcast so. He thinks he has a"},{"speaker":"Chris Dy","startTime":2375.64,"endTime":2379.06,"body":"lot of the answers, so please"},{"speaker":"Chris Dy","startTime":2379.09,"endTime":2380.14,"body":"prove him wrong. Please."},{"speaker":"Charles Goldfarb","startTime":2380.17,"endTime":2382.3,"body":"Prove me"},{"speaker":"Charles Goldfarb","startTime":2380.17,"endTime":2382.3,"body":"wrong. Prove me wrong. All"},{"speaker":"Charles Goldfarb","startTime":2382.3,"endTime":2383.62,"body":"right. Have a good day."},{"speaker":"Chris Dy","startTime":2383.77,"endTime":2384.88,"body":"All right. Take care."},{"speaker":"Chris Dy","startTime":2383.77,"endTime":2384.88,"body":"Bye."},{"speaker":"Charles Goldfarb","startTime":2386.68,"endTime":2388.66,"body":"Hey, Chris."},{"speaker":"Charles Goldfarb","startTime":2386.68,"endTime":2388.66,"body":"That was fun. Let's do it again"},{"speaker":"Charles Goldfarb","startTime":2388.66,"endTime":2389.17,"body":"real soon."},{"speaker":"Chris Dy","startTime":2389.44,"endTime":2391.96,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":2389.44,"endTime":2391.96,"body":"sure to check us out on Twitter"},{"speaker":"Chris Dy","startTime":2392.17,"endTime":2394.36,"body":"@handpodcast. Hey, Chuck, what's"},{"speaker":"Chris Dy","startTime":2392.17,"endTime":2394.36,"body":"your Twitter handle?"},{"speaker":"Charles Goldfarb","startTime":2394.69,"endTime":2397.57,"body":"Mine is"},{"speaker":"Charles Goldfarb","startTime":2394.69,"endTime":2397.57,"body":"@congenitalhand. What about you?"},{"speaker":"Chris Dy","startTime":2397.72,"endTime":2401.08,"body":"Mine is @ChrisDyMD"},{"speaker":"Chris Dy","startTime":2397.72,"endTime":2401.08,"body":"spelled D Y, and if you'd like"},{"speaker":"Chris Dy","startTime":2401.08,"endTime":2404.38,"body":"to email us, you can reach us at"},{"speaker":"Chris Dy","startTime":2401.08,"endTime":2404.38,"body":"handpodcast@gmail.com"},{"speaker":"Charles Goldfarb","startTime":2405.52,"endTime":2407.65,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":2405.52,"endTime":2407.65,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2407.65,"endTime":2408.7,"body":"get your podcasts"},{"speaker":"Chris Dy","startTime":2408.79,"endTime":2411.01,"body":"and be sure to leave a"},{"speaker":"Chris Dy","startTime":2408.79,"endTime":2411.01,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2411.01,"endTime":2411.4,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":2411.79,"endTime":2414.07,"body":"Special thanks"},{"speaker":"Charles Goldfarb","startTime":2411.79,"endTime":2414.07,"body":"to Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":2414.07,"endTime":2417.97,"body":"music. And remember, keep the"},{"speaker":"Charles Goldfarb","startTime":2414.07,"endTime":2417.97,"body":"upper hand come back next"}]}