The Hand Society, Elbow Deformity and Drake

Chuck and Chris discuss the Hand Society meeting in Toronto including the highlights for each of them.  They also discuss a pediatric elbow case including dome osteotomy treatment.  And, if you listen to the end, you will learn more about the Drake show in Toronto!

Subscribe to our newsletter:  https://bit.ly/3iHGFpD

See www.practicelink.com/theupperhand for more information from our partner on job search and career opportunities.

See https://checkpointsurgical.com or www.nervemaster.com for information about the company and its products as well as good general information about nerve pathology.

 
Please complete our Survey: bit.ly/3X0Gq89

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.

Complete podcast catalog at theupperhandpodcast.wustl.edu.  

Transcript

Charles Goldfarb: 0:03

Welcome to the upper hand podcast where Chuck and Chris talk Hand Surgery.

Chris Dy: 0:07

We are two hand surgeons at Washington University in St. Louis here to talk about all things hand surgery related from technical to personal.

Charles Goldfarb: 0:15

Please subscribe, wherever you get your podcasts.

Chris Dy: 0:18

And thank you in advance for leaving a review and leaving a rating wherever you get your podcasts.

Charles Goldfarb: 0:24

Oh, hey, Chris.

Chris Dy: 0:25

Hey, Chuck, how are you?

Charles Goldfarb: 0:27

I'm great. Just back from the Great North, Canada.

Chris Dy: 0:31

Yes, it was a busy busy week for the WashU hand service, you included. Congratulations on being elected to council for the hand society as a treasurer. That's a huge deal.

Charles Goldfarb: 0:43

Thank you very much. Yeah, I it'd be fun to reengage with the hand society. And I have to say my first couple of encounters are were really pretty amazing. There's great people on council. They're always great people, but great people on council good conversations and doing some really good stuff. Steve Moran is president. Jennifer Wolf is outgoing president or now she's ex president or whatever it's called. And

Chris Dy: 1:08

yeah, I think it's an immediate past president is a technical term.

Charles Goldfarb: 1:12

Maybe you should be on council. Yes. Immediate Past President. But Steve ran the meeting on Saturday evening and has some really good stuff planned. And it's gonna be fun. It's gonna be exciting.

Chris Dy: 1:23

It's a lot of wash you on the council? I mean, I know Dan was say, just stepped out as a Member at Large under eight. He's a former WashU faculty and alum from the fellowship. And there's you and Ryan Calfee. And is Marty still on council technically, because he's now phased out.

Charles Goldfarb: 1:39

He is phased out. But he did have a nice talk at the meeting which we should get to as we sort of rehash will, you know, the meeting and all that goes with it?

Chris Dy: 1:51

Well, absolutely. I can't wait to talk about it. We I mean, I was there for a very brief period of time, not technically at the main meeting, actually got away with that register. Because I was mainly at the I was only at the young surgeons boot camp and the hand fellowship directors, then we can talk about that for sure. But first of all read down in his case, let's let's thank one of our sponsors. So the upper hand is sponsored by practice link magazine, the physician job search and career advancement resource.

Charles Goldfarb: 2:17

Becoming a physician is hard finding the right job doesn't have to be joined practice link for free today at www.practice.link.com. So you held down the fort a bit. So you flew in early, and now it's our new policy that one of us is going to stay back. And yes,

Chris Dy: 2:34

yes. That was not the policy when I was a fellow. It wasn't for until recently. But yes, I think Herb is big enough now where as much as all of us are pretty heavily involved. At the meeting, I had to say no to my friends. And when I was asked to do stuff, because I took off it was fun. Emily's oldest and I are fantastic fellow held down the fort and we had a good time.

Charles Goldfarb: 2:56

Excellent. Yeah, it's weird. I missed a meeting for some reason. I don't remember what your excuse is kind of just like a hole in you know, and it makes me more excited to go back next year. But you were missed. No doubt you were missed.

Chris Dy: 3:10

I would I would like to hope so. But I know certainly sounds like everything was was great. At the meeting on a Paige Fox and Megan Conti, Mica ran a wonderful meeting. From what I hear in what I've seen on social media. I think everybody loved the format changes that they made. Many think that next year's program chairs have big shoes to fill.

Charles Goldfarb: 3:31

For sure. There's a little upper hand love. I think people tend to share love with you maybe a little more than me. But I would say, you know, maybe 10 People had upper hand comment, you know, people I didn't know, which was super fun. And one of the sessions. So I came up to me and said it was a smaller session on PRP fracture dislocations. And they said that my voice made them think that they were in the vodcast like living the podcast, which I thought was pretty funny. Yeah,

Chris Dy: 4:01

they're I mean, I think that just by virtue of me being a little closer to most trainees age, I think it probably approached a bit more. When I was at the young surgeons bootcamp and at the fellowship directors meet and greet a lot of love. And it was great to hear I let everybody know, thank you for, for listening and for coming up and saying something, and it is what keeps us going. And I did ask for some suggestions about what else we could do maybe and a lot of requests for more, more deep dives on technique. So we've got to get back to the back to the lab and start thinking of what what to do next. But if you're listening, and you want a specific technique, even if we've already done it, you want to see maybe how things have changed in the last few years. Please, you know, send send us an email Han podcast@gmail.com or leave a comment in your five star review.

Charles Goldfarb: 4:50

Love that. So before we jump in the meeting, and I want to hear about the bootcamp and the fellowship directors meeting and I can share some of my experiences. Let's do a quick case. What do you think?

Chris Dy: 5:01

Yeah, that'd be great. Let's, let's do something that combines things that you love. So maybe something in the pediatric adolescent room and then some album.

Charles Goldfarb: 5:08

Yeah, so I'll share case I have a young seven year old little girl who had two previous fractures over elbow, he old uneventfully, and came to the office with really remarkable deformity about 35 to 40 degrees of elbow Varus. So for those of you on the younger side, listening, so essentially, you know, in the younger age groups even more so but you know, elbows are in valgus. And I like to think of it as the ability to carry a bucket without banging your knee, and this situation can happen, where for whatever reason, one of those fractures lead to avascular necrosis to the medial elbow, and you your elbows just swings into major Varus. And it can just be an aesthetic issue, but it can be a functional issue to

Chris Dy: 6:01

what led to the delay in presentation. And oftentimes we ask patients, well, what what took so long for you to come in? What was the deal there?

Charles Goldfarb: 6:10

I think it was likely a couple of things. First of all, she healed uneventfully from her fractures, her pain went away. And the deformity is a gradual progression, the lateral elbow keeps, keeps growing, the medial elbow does not. And so it just gets worse and worse. And then you start to do funny things with the elbow, it wasn't majorly painful for her, but you sort of have to do a weird thing to get the elbow straight. And so I think it's just it is usually a progressive, or it's always a progressive phenomenon. And at some point, family notices the child notices, and they come.

Chris Dy: 6:46

Okay, so how long ago was the fracture prior to this patient seeing?

Charles Goldfarb: 6:49

Yeah, the first fracture was, as I recall, four years ago, and maybe the second fracture was two years ago. And so I don't even know which fracture truly and the X rays were all outside radiographs, unfortunately, that I could not get my hands on. But in the end, it was what we see, which is the medial elbow, that is the medial condylar area doesn't develop normally, the trochlea doesn't develop normally. You know, I don't routinely get MRI. So I don't see the cartilage development, which certainly will be more impressive than the bony lack of development. But for a lot of reasons, you know, surgery is one of the options discussed, especially in the growing child.

Chris Dy: 7:33

Now, do you at this point, how much obviously, seven year old, young woman so you're looking at, you know, solid amount of time for growth, skeletal growth to continue probably at least another five, six years? Right? So how do you time this out? Like, how do you figure out what what to do? Well, we can talk about what to do, but also how to figure out when to do it.

Charles Goldfarb: 7:50

Yeah, I mean, people have talked about firesteel arrest on the lateral side. And I think that's potentially an option. But in an older child, I wouldn't do that in this age group. And so intentionally

Chris Dy: 8:02

closing down the lateral side, so that, you know, essentially, whatever you do, the medial side can catch up, or at least stopping it from getting worse,

Charles Goldfarb: 8:09

stopping it from getting worse. Yeah. And some people will use staples for that. But that didn't make a ton of sense to me, unless you expect some type of rebound growth immediately. And then, we talked about osteotomy. So I think your question of timing is a really good one. And the principle here was, it's hard to get that much correction in one surgery. And so we're going to maximize our correction now see what happens with continued growth, and potentially do a second surgery, you know, in a number of years, knock on wood, I've never had to do that second surgery. So we'll kind of see, you know, how she grows and what happens over time.

Chris Dy: 8:46

So this is avascular necrosis of the medial condyle.

Charles Goldfarb: 8:50

Avscular necrosis is more than the medial lateral condyle. It's the entire medial elbow,

Chris Dy: 8:54

the entire medial elbow. So what are your options surgically at this point? So I mean, you know, is this something where you actually have a chance to bring this medial aspect of the elbow back to life in terms of vascularity? Or is it what what can you do now?

Charles Goldfarb: 9:09

Yeah, to my knowledge, no one has ever accomplished that goal. And so it's really about minimizing the deformity, unloading some of the force. So with the Varus positioning, you get increased force load on the medial elbow, which is certainly not helpful for anything. And so some type of osteotomy of the distal humerus to realign it is is the goal. And there's different ways to do that. The literature to overly simplify a closing wedge osteotomy, which is perfectly reasonable, not my first choice for a couple of reasons, which I can share a dome osteotomy which is my first choice for a couple of reasons, and some people do some Step Cut osteotomies and different things. I'm sure people have tried external fixer length dinners and things like that, but I really liked the dome osteotomy

Chris Dy: 10:00

So why do you like to dome over a closing wedge, and maybe explain what a dome is for those that are less familiar?

Charles Goldfarb: 10:07

Yeah, so the closing wedge is obviously based laterally so you take away bone from the lateral side and close the wedge that shortens the humerus a bit. And what it also does because of a size mismatches, it creates a step off. So where you take bone out is no longer a smoother arc. It's clinically notable. not a reason not to do that if that's your preferred choice, but the dome osteotomy satisfies all my goals. It doesn't shorten, it creates a huge amount of cancellous bone for healing, so healings typically pretty rapid, it maintains length, and it's just seems like it's a bit of a more gentle correction. In older kids. I'll use a small plate posted early on the posterior lateral humerus. In this age group. I use K wires and immobilize and they heal pretty fast and it doesn't normalize the elbow, but it's a big step in the right direction.

Chris Dy: 10:57

So is the dome what it sounds like you're shaping a dome?

Charles Goldfarb: 11:01

Yeah, so I use the dome for Madelungs distally. And I don't know if we've ever talked about Madelungs, that'd be a good conversation. I think that touches more hand surgeons than a lot of this stuff I do. A dome can be two dimensional, which is this one was so just a medial lateral dome. And literally, I use K wires to perforate the cortex and then an osteotome. And to cut in a curvilinear fashion. It can also be a three dimensional dome, which is sort of what we do, especially for matalon. Sometimes the distal humerus, where it's both a medial lateral dome and an anterior posterior dome, which can you know, allow a three dimensional correction, but I really liked the surgery.

Chris Dy: 11:38

Yes, obviously, very technically challenging in carpentry in terms of the need to be precise. Is this something where you are, you know, doing this, obviously, very carefully in surgery, you know, as you're looking at the humerus? Or is it something where you're doing kind of your fancier, you know, preoperative planning with models and stuff that you do for other cases.

Charles Goldfarb: 12:01

Yeah, it This to me is just a technically, that's a moderately demanding, not the most demanding that we use clinical alignment, and radiographic alignment in the or to assess correction. And if I get these elbows back to a neutral alignment, I'm happy. So it's a posterior incision, we work on either side of the triceps, we keep the owner safe, we identify the owner of and keep it safe, we don't truly transpose it, we keep it safe. And as long as it's not scarred in I think that's fine. laterally we don't specifically identify the vagal nerve because we're pretty distal the osteotomy is just proximal to the electron fossa. And so we just stay out of the realm of the radial nerve so fun exposure fun surgery guy get it right technically, but I think it's a good case.

Chris Dy: 12:50

That sounds great. And then down the line you said you know this shouldn't have many issues with regards to maintaining length and then you said you're not trying to restore kind of the normal value, you know, slight carrying out angle of you know, some slight values so you shouldn't be neutral here.

Charles Goldfarb: 13:05

I'd love to get you know 7-10 degrees of valgus but then you're going from 35 to 40 degree correction to you know more it's just hard it's a lot of correction and and people like you worry about the the nerve on the inside of the elbow. I mean, I guess if we're gonna get that much correction, we might consider transposing it but as I said, I just get a sense of the nerve and make sure it's not tethered and make sure it's not taught with a correction is not which it typically is not I leave it

Chris Dy: 13:32

sounds like a great case. Yeah, that's fine. Let's

Charles Goldfarb: 13:35

talk here society.

Chris Dy: 13:36

Yeah, let's talk but before we do that, why don't we thank our one of our other sponsors. So the upper hand is sponsored by checkpoint surgical, a provider of innovative solutions for peripheral nerve surgery. As a hand surgeon, you know that nerves matter. It's why checkpoint surgical is singularly focused on elevating the clinical practice of peripheral nerve surgery with innovative technologies that help improve patient

Charles Goldfarb: 13:57

outcomes. Checkpoint surgicals portfolio includes a range of handheld intraoperative nerve stimulators, nerve cutting instruments, and biomaterials To learn more visit www dot checkpoint surgical.com Checkpoint surgical driving innovation and nerve surgery.

Chris Dy: 14:16

I will say I disclosed my podcast sponsorship in my disclosure slide for the young surgeon bootcamp and I didn't know I was like, this is kind of a weird thing to disclose but put it up there and just said you decide whether this is relevant or not.

Charles Goldfarb: 14:31

You know, I I'm glad you said that. I need to start doing that it. It obviously doesn't affect I'm not a neurosurgeon and not looking for a job. So I don't know that. It is important to disclose everything so I will in the future, but I didn't think to do with this meeting.

Chris Dy: 14:45

Yet. The every year I go to the clinician scientist program in here, Tim Wright give his talk about conflicts of interest and disclosure. And he has these pet peeves and I've probably talked about it on the air before but you know he one of his pet peeves is when people Just quickly flash your disclosures and then say none of these are relevant. So I've made it I've been intentional about saying, here are my disclosures, I will let you decide whether they are relevant or not. And then, you know, it was actually led to a pretty good discussion at the last clinician scientist program about, you know, when to get involved with industry and kind of those relationships. So maybe some of you want to pack on a future episode.

Charles Goldfarb: 15:22

Yeah, absolutely. I think we've touched on it before, but it's a, you know, I think it's a really important thing to touch on. And I will say that I tend to disclose anything and everything, this this excluded for this past meeting, because a lot of people do just say not relevant to this talk. That's hard. That's hard. And that's not that shouldn't be necessarily their judgment, even though I'm sure they're honest with that. But that's probably not my approach.

Chris Dy: 15:45

Yeah, the ASSH didn't have a box for podcast sponsorship. So I can see why you might have overlooked this when you were frantically filling out your forms the many forms that we need to fill out. So Toronto was great. You know, it's my second year that was doing the young surgeon bootcamp, it's kind of a cool format, where you have I was in the, you know, the skeletal or bone room, and there's a separate soft tissue room. But, you know, three different manufacturers set up some pretty, pretty comprehensive, cad-, you know, cadaver specimen stations with their, with their technologies and their implants. And, you know, this, I was working with diffusivities, and talked about metacarpal and proximal failings, fractures, gave a lecture and then was a table instructor essentially, for the entire day was exhausting.

Charles Goldfarb: 16:33

That is very tiring. I've been there numbered for this particular one, but I'm sure you're exhausted and that, but the teaching must have been amazing for that.

Chris Dy: 16:40

Yeah, and it was good to see people's you know, different, you know, different levels of interest and expertise, something you have, ranging from junior and mid level residents, to senior residents and fellows and some practicing surgeons. So, seeing what they each wants to know. And what they each want to learn is always interesting. And I learned to so you know, the, the other instructors I was with that the diffuse and these table, were teaching me some stuff. And then I did wander over to the medartis table and into skeletal dynamics table and learn some tricks.

Charles Goldfarb: 17:09

That's great. No, I mean, that goes without saying, but it needs to be stated. We always learn at these sessions, whether whenever we're teaching, I mean, if you're giving a podium presentation, hopefully you learn from CO presenters if it's a symposium, but if you're in a small group session, I can talk about what I did. I always learned in those situations. So that's one of the reasons I like doing it.

Chris Dy: 17:29

Yeah, it was fun. And obviously, there was a lot of banter about about the podcast, which was fun to hear. So I didn't I did ask people for, for what they wanted, what they want to hear. And you know, what is oftentimes the question of how the podcast got started. So I tell my version of that story. And, you know, I don't know how accurate it is, but it's the one I'm sticking with.

Charles Goldfarb: 17:48

I don't know if I know what our various versions are. You are struck by lightning one day and said, Oh, my God, I have a game changer. I gotta get Chuck involved.

Chris Dy: 17:57

Now, you probably don't remember. But there was a time where, I think, a full year and a half or two years before we actually started thinking of doing the podcast I approached, you said we should do a podcast, you know. First you and Ryan, and said I think we should Ryan Calfee because I think we should do a podcast or do something based on our you know, the conversations if you haven't conference and you're like, No, it's not good idea. And then all of a sudden you had an idea to do a podcast. That's a great idea, Chuck, I think it'd be really fun.

Charles Goldfarb: 18:28

I think to listeners, this is what age discrimination looks like he he assumed I am old and forgot all the conversation. He happens to be right.

Chris Dy: 18:38

Here we go with our ageism.

Charles Goldfarb: 18:41

What else did you do? And in Toronto?

Chris Dy: 18:44

Well, I did have some really good meals. But we want to talk about that. So one interesting thing that that came up that a couple people brought up is that they were like, I feel like we really know you and like know a lot about your life. What did you cook last week, funny stories. But now after right after the boot camp, we had our annual hand fellowship Directors Association meeting and I got some feedback about kind of what applicants are looking for in hand fellowship. You know, that was some work that the group up at Beth Israel did. Carl Harper led that survey. And so that was interesting to hear kind of what people are looking for to fellowship, at least what they say in a survey. And then also we talked about, obviously, interview formats. I think there are going to be most programs are going to try to offer interviews on the same day, which I think always helps you in terms of giving the invites released on the same day. And then I think most programs are going to be in person but I think there are still a handful of programs, not a handful, a decent number of programs that are going to be virtual, either because their institution is requiring that or because that is their preference.

Charles Goldfarb: 19:51

It's tough. I mean, I see the pros and cons of both approaches. It's nothing like an in person interview, but it's a lot to ask. Certainly the applicants get it better sense of who we are what our institution is. But there's, you know, there's a monetary cost, which is not insignificant. A full day of zoom interviews though, it's kind of like your cadaver day. It's it's exhausting, not that in persons, you know, always joyous, but it's much more enjoyable than zoom all day.

Chris Dy: 20:21

Yeah, no, I think there is something to that. But I think there like you said the practicalities and the financial aspects of it, at least for most applicants should probably be a combination of in person and virtual, which will, you know, be easier for scheduling you know, getting time off of their busy residency schedules and and also financially, so, we will be in person here at WashU this year. So just if you're listening, you know, start saving, saving up for a nice trip to the summer week.

Charles Goldfarb: 20:46

Love it, love it. I can briefly recap my take on the meeting. I've been to Toronto a handful of times and it's always a nice time I don't ever get out enough unfortunately to see the city but you know, nice people. It's easy and the location of the meeting kind of in the central part of downtown was fortuitous. can share our cultural experiences there.

Chris Dy: 21:10

But how was he how's the language barrier was really hard on you.

Charles Goldfarb: 21:14

It's a valid the only place I can survive other than the United States. Yeah, I heard a little French I took some French in high school and, you know, get your order to

Chris Dy: 21:25

Quebec, though, you're in Ontario.

Charles Goldfarb: 21:26

I guess. I guess. There's a Quebecians come over to Toronto.

Chris Dy: 21:32

So I was funny. Before we go on I on Monday night, I arrived pretty late. And of course, I was like, I'm not gonna waste night in Toronto. So I went and ate a meal on my own at like, some absurd time. And so I was falling asleep in and I had the TV on and I found a buffalo TV station. And it was great. Because, you know, all the temperatures were in Fahrenheit, I understood what was going on. Didn't have to do a whole lot of math. And, you know, the other thing that I noticed is that given the strength of the US Dollar versus the Canadian dollar, it felt like, you know, it was like, Oh, that's really expensive. Oh, wait, it's not

Charles Goldfarb: 22:05

quite so bad. Not quite so bad. Yeah. All true. All true. Yeah, I mean, Paige, and Megan, Paige Fox and Megan Conti Mica did a great job with the meeting. Everyone always innovates a little bit. And then it's interesting to see what sticks and what people want. It was a good meeting. The they were wonderful symposia instructional course lectures. The the guest speakers were excellent. So one of the one of the highlights of the meeting is what's called the founders lecture. That is on Friday. And Marty Boyer was Jennifer Wolf, President Jennifer Wolf's founders lecture and Morty loves to talk about his 10 or 12 rules and and surgery that he shares with the fellows here in St. Louis. And he expounded upon that, and it was excellent. And the funny The funniest part about it, I have to say there were some funny parts. But the funniest part about it was one of Marty's points is, you know, always take the later flight, you know, to be with your family or early flight home. Well, originally it was, I think it was like the later flight out. And I think he added to that take the early flight home. So which is funny haha, in that on Saturday, in the afternoon, we were doing a symposium. And everyone was like mad at Marty, because he told everybody take their flight home and no one was there.

Chris Dy: 23:31

Oh, it's funny. Well, I was a, I was checking out of my hotel very early on Wednesday morning. And I saw a fellow member of the hand society and somebody that's pretty well known. And they were checking out early or trying to arrange an early checkout, because their baseball team is in the playoffs and their kids are coming home. And they're like, I'm getting home. I was like, Oh, the boy rules? Yes.

Charles Goldfarb: 23:54

Yes. Anyway, it was it was great. He did a great job with it. And it was it was very well received. We did some good talks. There was a pre course on the distal radius. And I gave a talk at that pre course about arthroscopic versus open treatment of concomitant TFCC tears talked about the initial assessment and and why we tend to hopefully stabilize patients who are unstable, we stabilize them with supination rather than pens, and then talked about what happens a year later if they're painful and how you handle that. So that was a fun talk. It was a good pre course.

Chris Dy: 24:26

What's um, what were the big take home some of that pre course in terms of you know, how you and other risk gurus approach stabilizing, you know, the drnj through TFCC repair.

Charles Goldfarb: 24:40

Yeah, I think generally the school of thought is that first of all, there's higher risks with certain distal radius fracture patterns, such as the fracture pattern when the distal fracture fragments translated for radially.

Chris Dy: 24:55

And you know, the so called coronal shift, the coronal

Charles Goldfarb: 24:58

shifts. Thank you I highly comminuted fractures and higher energy injuries. And I think everyone has the same approach that if you can find a position that creates stability, no matter what the distal ulna looks like, typically that position is supination, then supinate, the wrist sugar tongs splint, and then monster cast and let them heal without cross spinning or opening to fix the ulnar styloid. It there's been an evolution in our understanding of what happens. And it used to be, you know, when I was younger, we talked about whether it was a hip fracture, or a base of the styloid fracture. And now the fracture pattern is sort of ignored as long as you can obtain stability in the operating room. What I have learned in my short career is that even when you have a base of the illness, Stallard fracture, and you fix it, it doesn't necessarily mean that you've created stability. And so that's yet another reason why don't rush to fix those and really, really hope and thankfully, almost always is the case. Supination create stability.

Chris Dy: 26:01

I think that's a good point. And one thing that, you know, we try, there are little things that you as the primary surgeon or the faculty surgeon are doing, you know, that you don't always verbalize. And usually when we're going in and bringing the mini CRM in for the final X rays, that's when I'm checking my dear EJ, and I try to make a point to the trainees that this is what I'm doing right now. Because oftentimes, you can sneak in that assessment. And you know, if they don't learn to do that, you're they're obviously missing a big part of the, you know, big part of the overall case,

Charles Goldfarb: 26:32

it's a really good point, because we can do things on the fly and satisfy ourselves, I try to do the same thing, I try to make a point of what I'm doing. Just like when I do a TFCC repair, I want to gently assess whether we've lost any passive range of motion in the form. And I tried to make a big deal about that, because I think it's important that we do it every single time.

Chris Dy: 26:52

So one change that Paige and Megan put in this year was they limited the number of presentations that one could give, which obviously, probably made the meeting much calmer and saner for, for somebody like us being asked to do a bunch of things, but I know that I talked to our friend anymore. And she was saying that it was great because she wasn't running around and leaving one pre chorus to jump to the next pre chorus or ICL, the ICL. So you probably had a little bit of a throttle on what you limit on what you presented. So were there any other talks or that you gave?

Charles Goldfarb: 27:23

Yeah, it was interesting. They shared the data at the council meeting after the meeting, there were 7% increase, there was an increase of 7% of the number of speakers. I actually thought it would have been higher than that. Yeah, me too. But it did make I think one of the points was it was sort of offensive if you were to paid pre course. And you had speakers coming and going and rushing in and rushing out. And I think it's also just about there are really talented people in this society. And there's plenty of people who can give a good talk. Now, some talks are better than others. But it was a little nice. I found myself busier than I thought I was going to be I went to Toronto thinking it would be, I'd be able to fit into a lot of things I ended up running around a little bit. Gave the symposium I mentioned was Don Milan's great panel tomorrow, Rosen tall. Jim Chang's got Kosan, we were talking about things I say and don't say to patients, and we could we could build off that and have a good podcast on that. And that sort of is what Boyer was alluding to. I think that'd be a fun conversation for us to have. So maybe I'll save the I won't spoil it.

Chris Dy: 28:29

Yeah, maybe pull in one of those other panelists as the guests I think that'd be a really fun thing to to explore.

Charles Goldfarb: 28:34

Yeah, that'd be great. And what else did I do? I did we, you know, what was fun was mentioning my love of elbow, Don Bae, and I hosted a, an ICL, we've talked about it for literally 10 years, we asked Doug Hutchinson from Utah to join us. And so we did an ICL on the adolescent elbow. And I noticed one of those deals where I wasn't sure if it'd be the three of us in a room, or more, and I'm sure that was packed, there was probably 60 people. Awesome, which is great, which is great. We talked about OCDs. We talked about intra articular radial head fractures in the adolescent, which gets conflated with radial neck fractures too often, and they're very, very different. And then we talked about instability has some good cases. It was a it was very fun.

Chris Dy: 29:20

Man, you were just giving us so much fodder for future podcast topics, maybe we shouldn't honestly, we should unpack some of the stuff that you presented on and I could give a talk on, you know, using different ways of fixing metacarpal and phalanx fractures. And you know, everybody's all about these headless compression screws now, so I shared kind of my experience, good and bad. With that, with that approach. So I think we've, you know, laid out of course, for some future episodes,

Charles Goldfarb: 29:44

for sure. So I'll tell you what I liked about the meeting just in general, and I'll be curious to hear what you missed about the meeting. What I liked about it was it felt I don't know why it felt really good. I mean, obviously, we both know a ton of people. It is It felt great to see a lot of people haven't seen in a while to catch up. Had a really, really good time and already looking forward to next year. And I don't know that I've always said that in the past. So I don't know if it's something about me this changing if it's post COVID I don't know. But I really did enjoy it and connected with people in a really positive way.

Chris Dy: 30:20

That's great. Yeah, I mean, I missed, you know, seeing people that you know, normally I would see at the meeting every year and then I'll see him next year and other meetings and you know, so I missed seeing some of the big addresses I wanted to see Marty give his talk. I wanted to see Elizabeth Hoggart give her international great lecture, which from what I hear was fantastic. And she's somebody that I spent some time with when she was still in Stockholm. I missed our WashU fellowship reception, which from what I understand was, was great. And Ryan really put together a nice group of people and the energy there and just seeing all the what all the people have done who have been trained either residency or fellowship at our program. So I know that I think it's Minneapolis next year, right,

Charles Goldfarb: 30:58

Minneapolis, which will be a great town for this meeting for sure. Let let me let me talk a little about Friday night, perhaps as we bring this to a close. So is that okay, good. Yeah,

Chris Dy: 31:09

absolutely. Please talk about our fellowship. It's fantastic. And this is not an advertisement.

Charles Goldfarb: 31:15

Definitely not. So we do a little bit on the earlier side. So people want to go out to dinner and then go out to dinner, we meet at six o'clock. And we had a wonderful showing, once again, it certainly is a large number of previous fellows. There's a there's a really good number of Washington University orthopedic residents who go into hand a lot of them join our international traveling fellows. There was, may have been all of them, I think at least five of the six were there. And so as you know, we know we get together, we have a drink. There's some appetizers which were delicious. And then my favorite thing is to go around the room and just hear everyone talk about themselves and Boyer resist that. But he loves it too.

Chris Dy: 32:01

I find that hard to know, I'm

Charles Goldfarb: 32:03

telling you. He does. He does so so we had a good time. And everyone kind of said a few words about themselves. It's just nice to especially see younger people kind of understanding who some of the older people were, for example, Jeff Cole is a little bit of a celebrity in this program because Jeff Cole was a fellow I want to say in 9596 with Randy Bindra and, and I did a session with Randy, who's a really smart guy. And he Jeff Cole was meeting some of the younger residents and fellows and they like you could see a little light bulb go off because the call notes on the anatomy sessions or Jeff just wrote those. So very, very cool and very fun.

Chris Dy: 32:42

That is one of the I remember last year even meeting some fellows who predated Dr. Gelberman era at Wash U. So some Manske era fellows, which is it's crazy to think that there's so many people that have trained even in our program after Dr. Gelberman stopped practicing.

Charles Goldfarb: 32:58

Now. That's exactly right. I'm preparing for a little talk, I have to give and I count the number of fellows that have been a part of their education. So 51 fellows I have helped to train in my time. And I think it was 26 Washington University orthopedic residents that have gone into hand surgery. So very cool. Very cool numbers.

Chris Dy: 33:19

Cool, I'm sure I'm sure they have spoken glowingly of their experience working with you. Oh,

Charles Goldfarb: 33:26

oh, you're too kind, I'm sure. Some days it's glowing. And so anyways. So after that Ryan and Lindley and Joyce Wilson and I went over to pay our respects to Dr. Stern and this sense of fellowship where we all train. And as we're walking over there, we see these huge masses of people. And actually Ryan and I stayed at our reception a little longer. And we walked over together huge masses of people. And we're like, What the heck is going on? So we kind of were walking around. And finally we stopped and asked, like, oh, tricks in concert tonight. Like what? And, you know, Drake's had this huge tour, and he finished his tour by coming back to Toronto, his hometown, and giving a concert that night and last night, so I'm sorry. So it was Friday night and Saturday night of the hand study week. And so we walked inside to the stern event, which was essentially in a nice restaurant, sort of in a mall connected by a crosswalk to the hockey stadium where the concert was, and so we decided to just check out what things cost and so the cost was not prohibitive. And so caffeine, caffeine, I went to went to hear Drake, we were dressed in nice clothes, and you know, in Canada, everyone's so nice and all that it was we felt very, very comfortable. We had pretty good seats and they look amazing show

Chris Dy: 34:42

in the moment. As you know, as he says the motto You only live once so good for you. That's great. And that is something that if you listen to the end, you got to know that Calfee and Goldfarb went to a drink at the Hanford Site, so thank you for listening all the way to the end.

Charles Goldfarb: 34:55

You'll like you'll like the last caveat, which is that we saw Jeff step in a number of times, obviously throughout the meeting, but he was at a reception with us last night, which was Saturday night, and we're and he heard he, I guess he didn't, hadn't heard or whatever. And so we were telling him I was showing some pictures. And then about two in the morning, I get a text from him, which was, he went to the concert last night. So limited.

Chris Dy: 35:21

That's what you get from the fellowship. For Life,

Charles Goldfarb: 35:25

let's be clear, not free tickets. Inspiration, the inspiration. Yeah,

Chris Dy: 35:30

thank you for clarifying. But sounds like you had a great meeting. You know, look forward to talking again soon.

Charles Goldfarb: 35:37

All right. Good to see you. Hey, Chris. That was fun. Let's do it again real soon.

Chris Dy: 35:41

Sounds good. Well, be sure to check us out on Twitter@handpodcast. Hey, Chuck, what's your Twitter handle?

Charles Goldfarb: 35:46

Mine is@congenitalhand. What about you?

Chris Dy: 35:49

Mine is @ChrisDyMD spelled d-y. And if you'd like to email us, you can reach us at handpodcast@gmail.com.

Charles Goldfarb: 35:57

And remember, please subscribe wherever you get your podcast

Chris Dy: 36:00

and be sure to leave a review that helps us get the word out.

Charles Goldfarb: 36:03

Special thanks to Peter Martin for the amazing music. And remember, keep the upper hand. Come back next week