Cadmore media player playing video Live: Rheumatoid Arthritis Patient Undergoes Silicone Joint Arthroplasty of the MP Joints (Knuckles)
Video Player
Accessibility
Using forms mode, you can utilize keyboard shortcuts to make usability more efficient.
Space bar will play and pause the video. Pressing escape will close all displays and pressing it again will jump to the end of the player.
You can press A to open the Keyboard Shortcut Dialog which also provides an audio description of the player and all of its features.
Language
1x
Play Speed
Adjust Volume
Transcript
Search
Result Count
of
Click to jump to result
Search
Re-center
Segments
Result Count
of
Click to jump to result
Search
Name:
Live: Rheumatoid Arthritis Patient Undergoes Silicone Joint Arthroplasty of the MP Joints (Knuckles)
Description:
Live: Rheumatoid Arthritis Patient Undergoes Silicone Joint Arthroplasty of the MP Joints (Knuckles)
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/1611ffbf-d2f0-447d-9875-5b2bd67bdef4/videoscrubberimages/Scrubber_1.jpg
Duration:
T01H31M26S
Embed URL:
https://stream.cadmore.media/player/1611ffbf-d2f0-447d-9875-5b2bd67bdef4
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/1611ffbf-d2f0-447d-9875-5b2bd67bdef4/LIVE_ Rheumatoid Arthritis patient undergoes silicone joint .mp4?sv=2019-02-02&sr=c&sig=4RhxtdBmEjNb7mn0PyNVqDksZQPKICsQq%2B0YAHWq%2FxQ%3D&st=2024-11-21T17%3A23%3A08Z&se=2024-11-21T19%3A28%3A08Z&sp=r
Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
ALEJANDRO BADIA: Looking knife please. [INAUDIBLE].
ALEJANDRO BADIA: Because tenotomy.
ASSISTANT: Hi, everyone. Welcome to live surgery Tuesday. Here we
ALEJANDRO BADIA: are starting it's a patient with as I mentioned in the preamble that this patient, she's a little chunky as you can see, a lot of fatty tissue so that is not typical of our rheumatoid patients so this will make it a little bit challenging.
ALEJANDRO BADIA: I may have to extend the incision, but what I do different than most of my colleagues is I make the uh, the uh Indeed whatever you try. So I um, a young lady. So I make my incisions longitudinally because when you make a fist, you're not pulling on the incision.
ALEJANDRO BADIA: So most people do it this way. To begin with, we live in Miami, so looks matter, right? So it's very ugly, kind of like a Frankenstein hands whereas this incision very steady. A little more work for me, but honestly, it's better for the patient and the hand therapist because they're not pulling against the scars. So, so.
ALEJANDRO BADIA: So we are going to make the primary incision will be on the radial side so again, this is the difficulty because I'm going to reef up the radial side in order to. Proximally, I might have to make these incisions here.
ALEJANDRO BADIA: All right. So I'm going to open the sagittal hood on this side, on the radial side. And we are recording this for hopefully they will edit a lot of it and we'll put it on VuMedi, which is kind of like a YouTube for surgeons, right?
ALEJANDRO BADIA: So in terms of rheumatoid handling this, I don't do nearly as much as I used to because a rheumatology colleagues really, really get patients a lot better with the DMAs disease, disease modifying agents. So the Merra and Remicade and all these very strong medicines,
ALEJANDRO BADIA: but there's a rheumatoid tissue. So this, this is what ends up really destroying the joint so it's really a disease, more of the soft tissue of the capsule and of the synovium autoimmune and secondarily, through [INAUDIBLE] it starts destroying the joint. Now, her joints are not that far gone so I would not have operated on her if it wasn't for the pain she was having.
ALEJANDRO BADIA: She actually came to the office several times kind of pleading with me to do it and finally I realized she was in a lot of pain. I said, OK, well, we'll do it. Her deformity is not terrible, so that's good so in a way, she'll have maybe a better result because she's not so far gone.
ALEJANDRO BADIA: Let me have an Army Navy, it's unusual to use that, but boys use this is the problem, folks. When you have you know, you have a lot of fat. I mean, it makes everything harder. It's just a little. Huh? Two, three, four, five. Yes. Well, I'm starting with that and then we're going to release the intrinsics on the ulnar side only.
ALEJANDRO BADIA: I need extra rowels, please.
ASSISTANT: Dr. Badia, can you explain the difference between arthritis and rheumatoid arthritis?
ALEJANDRO BADIA: Yes. So osteoarthritis is uncommon at this joint. This is involving at a carpometacarpal phalangeal joint is very typical of rheumatoid disease, which is an autoimmune disease, very different from osteoarthritis, which we still don't know the cause.
ALEJANDRO BADIA: Rongeur please. We have Susannah from Sterling Moon Designs who says, I wish our grandmother had a surgeon like you. Well, she kind of did. The problem is, Bob Colwell was, you know, my grandfather was a hand surgeon. He trained Joe Imbrigiglio, and I went when I was eight years old to discuss this surgery, which a guy named Al Swanson, a legend amongst hand surgeons, is really the person who started doing using silicone implants.
ALEJANDRO BADIA: But for what reasons that you know, obviously, I don't know as an eight-year-old what the reason was, but she did not have the surgery she really needed. Her hands were much worse than this, by the way. I mean, much worse. So it is the arthritic joint, there is still some cartilage, but the edges of it are very arthritic
ALEJANDRO BADIA: so, let's go. Let's actually do the intrinsic release on the ulnar side. As I said, this can be a little more challenging for me just because of the amount of fat so. You have a soft retainer. OK, so I'll release the intrinsic so that you are more better but you can see here's the extensors and we'll bring this refit up on the radial side and then that will correct her,
ALEJANDRO BADIA: her ulnar drift. Now I'm going to use, yeah, that one. OK that's great, I'll work to use that later. Let's go, let's go to the middle finger now. The US decided to issue.
ALEJANDRO BADIA: It's a big vein, I don't want to move back because it helps drain it. So we track one over here.
ASSISTANT: Are there any correlations to the diagnosis of rheumatoid arthritis? Is it age related or is it genetics? What is it mostly leaning towards?
ALEJANDRO BADIA: You know, there is some tendency in families, I think it's called HDA4 gene. There's a few genes that it's been associated with, but nobody, nobody understands, just like other autoimmune diseases, nobody, you know, lupus, nobody knows exactly why. A lot of things we don't understand in science. I'll say it again.
ALEJANDRO BADIA: We spend more money, I think on the cosmetics industry than on basic medical research. So it's a matter of priorities in our society. Let's release. You know what I'm going to have to release first on the ulnar side just because she really is deviating. So the reality is she is going to benefit a lot from us. She's really, she's really deviating.
ALEJANDRO BADIA: Now, so I want to always leave an edge for my colleagues. I'm going to leave an edge of the sagittal hood for later repair. The other thing I'm going to do, which is a newer thing, is to minimize scarring and also reduce inflammation in post op inflammation and improve healing. I'm going to lay a sheet of tissue, a company called BioTissue, and they happen to be based very near us
ALEJANDRO BADIA: so their laboratories. So we're going to be laying that at the end of the surgery when you lay in that between the extensor. Now there are other tissue products I use like this for scarring, but this one has a biologic component so, so it really depends on the indication. All right. So this one looks
ALEJANDRO BADIA: much more predictable speed. In the first place. Yeah right after that, there's one. OK so here's the, here's the capsule. Yeah, I'll take it pretty much. OK so I'm going to remove this.
ALEJANDRO BADIA: There's sort of this very senolitic thickening between capsule. One of the challenges we have, and I'd love to collaborate more with my rheumatology colleagues, they often refer to these patients very late, if at all so we need to, and I think as it happens, I think surgeons maybe think that our results are better than it perhaps are in many cases
ALEJANDRO BADIA: and rheumatologists is the opposite. They think that this surgery I don't know won't work well, so this is one of the other problems in health care. There's just not enough discussion between specialties. We don't keep up with our advances. That's something that you know needs to change. OK. [VOICEOVER IN SPANISH] [VOICEOVER IN SPANISH] Peru. To heal many years.
ALEJANDRO BADIA: And yet we must remember that. [AUDIO IN SPANISH] [AUDIO IN SPANISH] [AUDIO IN SPANISH] next two fingers. So, again, the difference is I don't make the incision across this way. Yeah this is more work, but there's a lot of advantages, as I mentioned earlier.
ALEJANDRO BADIA: So you got a big vein here. I'm going to try to avoid that vein because again that will drain.
ASSISTANT: If you have any questions, please comment below and let us know where you are watching us from. Dr. Badia [AUDIO IN SPANISH] [AUDIO IN SPANISH] [AUDIO IN SPANISH]
ASSISTANT: Patients are, viewers are asking.
ALEJANDRO BADIA: Yes. You're going to see that in a moment. So now I'm going to the ring finger. OK and you can, I'll show you in a moment. Actually, this is all there is. So I'm using a big retractor. I normally don't have to, but this patient just has a lot of fatty tissue. So the tendon is deviating to the ulnar side, to the pinky side.
ALEJANDRO BADIA: So now I'm going to.
ASSISTANT: There's the Colombia saludo.
ALEJANDRO BADIA: OK so now I have to release the. The ulnar sagittal, but I'm going to ream the radial side.
ASSISTANT: I think it's a good idea to speak in Spanish. We have another person commenting. I'll have to do a combination. Combination soy medical drama story clinic.
ASSISTANT: That is Bogota. [AUDIO IN SPANISH] Bienvenidos. OK.
ALEJANDRO BADIA: Can OK. So many. [AUDIO IN SPANISH] [AUDIO IN SPANISH] I'd like to use this opportunity as I can to dynamic what we're doing here.
ALEJANDRO BADIA: So OK, so here's the. Someone asked me, I don't know who, the patient about removing the capsule. So this is the, the capsule would. Below it, I can see the rheumatoid sinovium which is the cells that line the capsule and secrete the synovial fluid right? [AUDIO IN SPANISH] [AUDIO IN SPANISH]
ALEJANDRO BADIA: Thank you, Randy. Well, in Mexico. Let's move on. [AUDIO IN SPANISH] [AUDIO IN SPANISH] They are treating rheumatoid as so important.
ALEJANDRO BADIA: But we actually thought actually need to cure a tendency had a tendency to connect a lot of tenderness. Salud de La Florida Politico. It's tough.
ASSISTANT: [AUDIO IN SPANISH] because they say potentially that in vivo permettant [AUDIO IN SPANISH] Please do not report our medical content. If you do not wish to watch it, you can,
ASSISTANT: to watch it, you can tune out of the live.
ALEJANDRO BADIA: You can watch things like shootings and things like that in the news every day, unfortunately, yet people report us. That's amazing. All right. So here's the small finger.
ALEJANDRO BADIA: I'm going to release the ulnar side to the ulnar shaft to the hood. Then we'll release the intrinsic later. OK so now the tendon comes over.
ALEJANDRO BADIA: We remove this capsule. A new capsule, of course, will form. Here's a rheumatoid. The reams of those joint again. Not terrible but here's the, here's a rheumatoid.
ALEJANDRO BADIA: So once we get rid of the joint, there's no more pain because there's no more jerking, no more synovial.
ASSISTANT: [AUDIO IN SPANISH] [AUDIO IN SPANISH] [AUDIO IN SPANISH]
ALEJANDRO BADIA: [AUDIO IN SPANISH] [AUDIO IN SPANISH] [AUDIO IN SPANISH] [AUDIO IN SPANISH]
ASSISTANT: [AUDIO IN SPANISH] [AUDIO IN SPANISH]
ALEJANDRO BADIA: Please, Thomas. So we have to find the capsule. [AUDIO IN SPANISH] So keep trying to get that.
ALEJANDRO BADIA: OK so here, here's more capsule. All right. So let's go back. So, so you have to release the intrinsic so the sagittal band to this finger doesn't want to come over.
ALEJANDRO BADIA: So you saw the picture of before so later you'll see the after. So we'll have, we'll start with the sagittal saw in a moment. OK, Kate, I've got to get much more exposure here. Yeah three, two, five
ALEJANDRO BADIA: Oh yes.
ASSISTANT: So yes. We will be uploading the recording later. OK actually, immediately after surgery, we will share the recording. We'll also upload that recording to our YouTube channel, which is www.youtube.com/c/drbadia.
ASSISTANT: Or you can simply search for Alejandro Badia on the YouTube search bar and you'll find our channel.
ALEJANDRO BADIA: I'll be able to do all four because. Yes I'm going to do all four. So let me really see intrinsics here so suction. [INAUDIBLE]
ALEJANDRO BADIA: Do we have that opportunity? I have a question, Dr. Badia whenever you're ready, let me know.
ASSISTANT: Yeah go ahead. OK so the extensor tendon for the fifth finger, is it split or retracted? Same question for the second practice.
ALEJANDRO BADIA: It's retracted really to both sides.
ALEJANDRO BADIA: But I'm going to basically take the radial side of the hood and move it over and repair it over rest and I have to release the ulnar side. So right now what I'm doing in the index is I'm going to the intrinsics which are here, OK you see this is holding this up. So when I'm, all I'm going to do is without coming in and I'm going to basically free up.
ASSISTANT: Could you bring the whole thing closer towards me and then angle it down.
ALEJANDRO BADIA: Let's see. So now that allowed the finger to come this way. So let's have.
ASSISTANT: I don't think we need to be missing out for a minute. We're trying to adjust the boom camera. Can you swing out for a minute so I can swing out?
ALEJANDRO BADIA: Do you want to just move the hand.
ASSISTANT: No, it's that your head,
ASSISTANT: your head is covering it up. How about you? No can you bring it up? Thank you.
ALEJANDRO BADIA: Now, if you attach the radial collateral on this, the um. I'm from both sides, but this is the one that I'm going to reattach later on. There it is so. We'll make a, once we got the cuts about to put the implants in, we'll make a drill hole and then we'll reattach. Is her right hand as severe as her left?
ALEJANDRO BADIA: No. Osteotome about that width and then.
ALEJANDRO BADIA: Tom. This is everybody's favorite part in orthopedic surgery. Oh, yeah so she's, you know, she's she's pretty arthritic. I mean, it's not so. Rongeur
ASSISTANT: This joint that you just removed, was it supposed to be covered in cartilage? Yeah all right, everybody, take a look. No cartilage.
ALEJANDRO BADIA: But what's important is that the rheumatoid, the tissue eventually is going to erode it so there's more cartilage here on the base. All right.
ALEJANDRO BADIA: Let's start broaching.
ASSISTANT: You're going to come out here. Where is that coming from?
ALEJANDRO BADIA: Could you get my phone out of my leg? Now we're doing the serial
ALEJANDRO BADIA: broaching but these are silicone implants. It's one of the few places we still use silicone other than in South Beach.
ASSISTANT: Dr. Badia, one of your viewers said, this is always very, very impressive. Thank you very much for letting us be here.
ALEJANDRO BADIA: The pleasures. We have nothing without education. I am going to try. No, that's going to be too tight. OK, that's the size. At least three feet. He didn't do that.
ALEJANDRO BADIA: He didn't. He didn't do the three. OK, so it's a two. At some point, you're all here. So let's get up here. Stuff the way.
ASSISTANT: Doctor, can you specify on that question? You said what kind of preparation does he do? Are you referring to pre-op or what exactly so that I can ask accurately.
ALEJANDRO BADIA: I'm sorry, what's the question?
ASSISTANT: One of the doctors wrote that he would like to know what kind of preparation you do. I just want him to specify what he means.
ALEJANDRO BADIA: Well, when I released the intrinsics, I'm going to, particularly on the ulnar side, the collateral ligament, and I'm going to reattach the radial one and you have the all clear, Kate. Come out? Yeah, you come out. Come out of.
ASSISTANT: Another question is, does the rheumatoid arthritis, is it cured or does it decline after this or what happens?
ALEJANDRO BADIA: Well, no, nothing changes. That's for our, that's for the medications. So what I'm doing here is taking joints that are, can you burr that. This is a little bit more. Once there's not a joint, then there is not pain in that joint
ALEJANDRO BADIA: right that's?
ASSISTANT: In short, they would like to know the patient then has to continue to take her medication.
ALEJANDRO BADIA: Yes, absolutely. Yeah this is just, you know this is, my job as a hand surgeon is to fix a hand. I count on my medical colleagues to stabilize the disease
ALEJANDRO BADIA: and that's why the collaboration is so important. One great thing I've studied a lot is in Japan, they have actually arthritis clinics, rheumatoid arthritis clinics, specifically where the mycologist, the mycologist is, the primary care doctor, the orthopedic surgeon, the hand surgeon perhaps, the hand therapist and the social worker to help organize all this. They all meet
ALEJANDRO BADIA: and uh work together to help the patient. So our medical system has you know, needs a lot of work. Anyone who knows me well knows that I feel that way. The money is definitely in the system. It just has to be allocated correctly.
ASSISTANT: And if you want to hear more about that, Thursday, we'll go live for fixing health care from the trenches. [INAUDIBLE] important finger.
ASSISTANT: Yeah, that's.
ALEJANDRO BADIA: Right? Two. I got to go up one more? You can go down the line or you could still go up two. You were two here. And two and two. Two and two? Yes. All right.
ALEJANDRO BADIA: Yeah we're going to stay with that. If you've got decent bones, this is not again, this in many ways, this is not a typical know, while we're at it, let's. Like before we put in, let's go to the next joint.
ALEJANDRO BADIA: New at the moment. The, she's got on this side.
ALEJANDRO BADIA: The people. The regular pick me up. They're right up on the break. So here's the ulnar intrinsic and way down there, I'm going to divide it right here.
ALEJANDRO BADIA: OK good. Tonight, the collateral is holding us back.
ASSISTANT: Will the patient have to wear a splint post-op to correct deviation as well.
ALEJANDRO BADIA: Yes. I'm not crazy about this so mediation freer.
ALEJANDRO BADIA: Here can you show me that guidewire, please?
ALEJANDRO BADIA: He still wants to go and to. Pullman please.
ASSISTANT: For those of you who are at work or can't watch the entire live surgery right now, we will be uploading the recording and it'll be on YouTube as well.
ALEJANDRO BADIA: For hand surgeons it'll be on VuMedi at some point, right, Kate?
ASSISTANT: Here's our setup. I mean, it won't be as fast as hill, though, pushing a button to make something, of course, at some point. The patient has rheumatoid arthritis. How soon after surgery will therapy begin?
ALEJANDRO BADIA: I mean real therapy, about three weeks because I approach this a little bit different and we'll talk about that a little later.
ASSISTANT: So Dr. Badia is removing the arthritic joints and then it will be replaced with a silicone implant.
ASSISTANT: If you want to see the before pictures of what the patients hand looked like, we did share that on our story. Right now, he's removing the joint and creating space for the new implant.
ASSISTANT: For the Fellows who are watching this, you can also visit; physicians.drbadia.com. For more surgical content and you can also learn how you can come to our center and shadow Dr. Badia as part of our observership program. Oh here is the other joint.
ASSISTANT: But we have two now, right? So this is supposed to be covered in cartilage. Look at what it looks like. OK all. In your opinion, Dr. Badia do you prefer silicone prostheses or sometimes do you choose metal?
ASSISTANT: One of the questions. Not for rheumatoid arthritis.
ALEJANDRO BADIA: I've used metal, but it's a rare osteoarthritic
ASSISTANT: We use the BioPro metal prosthesis in the thumb in the CMC joints.
ALEJANDRO BADIA: I'm sorry. We haven't seen one or no. You'll do the big reveal. What size is this one? Two. I have one.
ASSISTANT: We'll show you what the silicone prosthesis looks like shortly.
ALEJANDRO BADIA: Ok, mallet. Top one.
ALEJANDRO BADIA: OK all right. We'll be back in a moment.
ASSISTANT: We do have a lot of videos on the CMC joint arthroplasty that Doctor Badia does with Biopro. They're on our website and on YouTube.
ALEJANDRO BADIA: Right to me first and then your freer.
ALEJANDRO BADIA: Can somebody adjust my camera head so its it's just loving on my hands. You want it tightened? No, no, just, just sort of just lift it up and just lift it where? There? OK.
ASSISTANT: OK, so here's our rep from BioPro showing us what it looks like in photo. You'll see it live in just a minute. Yes, let me show you what the X-ray looks like. Yes, I'll cover it. Hey, here's a pre-op X-ray.
ASSISTANT: AP and here is a lateral.
ALEJANDRO BADIA: Good quality bone in this patient, which will help.
ALEJANDRO BADIA: Remember this? The idea that silicone implants attract more spacers and then the soft tissue will reform that capsule but without the. So, so you'll see when it's in there. So it's not really a, it's not a joint replacement in the same sort as even the days of joint or knee replacement.
ALEJANDRO BADIA: These are a silicone spacers.
ASSISTANT: Will she lose strength in her hand.
ALEJANDRO BADIA: Will she lose strength? Well, depends. You know, strength doesn't come from a surgery and injection or strength comes from using the hand and doing the exercises so that'll be up to our hand therapy colleagues to work on a strengthening program that she'll continue to do on her own.
ALEJANDRO BADIA: You want to move over here? Let's move away from them all at once. OK tenotomy. Is our final joint?
ASSISTANT: Two more. Patients want to know about our post-op pain control after this surgery. Are we giving narcotics?
ALEJANDRO BADIA: I will let her.
ASSISTANT: We do in general, for pretty much all of our procedures. As long as the patient is able to take anti-inflammatories, we do a combination of Tylenol arthritis every eight hours and Aleve, which is Naproxen Sodium every 12 hours together. Right combined, correct. Do you think both are on the clock for at least the first two days until the block has worn off? I mean, there's misery in front of me.
ASSISTANT: And most patients do well enough that they don't need any narcotics after that. But the procedures that we're anticipating, you know, a little bit stronger pain, we will give a prescription for a small amount of a narcotic. But, you know, sometimes, you know, just kind of as just in case for most patients do really well and only take the. We have patients largely
ALEJANDRO BADIA: our anesthesia colleagues with blocks that they do so we have patients that have had shoulder replacements and never took a narcotic.
ALEJANDRO BADIA: Dr. Sigman would be proud. Yup so Scott Sigman, shout out to Scott Sigman, who is one of the original opioid sparing surgeons who does knee replacements and arthroscopy and rotator cuff repairs and he's been a big proponent of this. As many of you know, we continue to be in an opioid crisis, now it's mostly fentanyl, and we have young people dying because of this.
ALEJANDRO BADIA: So this is something. The medications are what our politicians, unfortunately. Just gone too well for me with most. Ironically, except the physicians which is a total of 14, I think, between the Senate and Congress.
ALEJANDRO BADIA: So that's not enough to really move the needle.
ASSISTANT: And both medications that Kate stated are part of our pain protocol are over the counter.
ASSISTANT: One more joint. So all. OK so so far we have three. A little bit smaller. I would want to keep them as, like, keepsake old joints.
ASSISTANT: This is Dr. Badia's toolbox.
ALEJANDRO BADIA: The one is the one here. That's probably the one. Now you make sure you. Each one of the.
ALEJANDRO BADIA: You can't see. Mike, please remove that toxic.
ALEJANDRO BADIA: Make sure we release the intrinsic here. I'm not. Tenotomy. Thank you guys for staying with us till the end. OK so there you are, I just did an intrinsic release. So if you look at the difference so in Kate.
ALEJANDRO BADIA: Traction. Knife.
ALEJANDRO BADIA: OK now freer. Like that. I'm constantly, constantly doing releases. So, you know, keep in mind always, my knee arthroplasty replacement.
ALEJANDRO BADIA: So a lot of the art in it isn't what people think of, it's a soft tissue balancing. If you don't release the soft tissues in the appropriate place, you're not going to get the right result. So this is much more accurate, as you can see. OK we all please.
ASSISTANT: Dr. Badia is now checking sizes for the implant.
ALEJANDRO BADIA: Not surprising. The ulnar side to me is a little worse so that's the number one. That's the zero. That's the one that I just gave you. And I had a one for the proximal right? Yeah. OK, that's good. Let's go to the last one. Small finger, open it up.
ALEJANDRO BADIA: The most difficult one. These are the ones that have really given me a headache in the past, because especially when the finger is so deviated, you can't release this. This is why I try to speak into rheumatologist and refer the patients early. We can get a much better result.
ASSISTANT: For those of you who just tuned in, this is a rheumatoid arthritis patient
ASSISTANT: and Dr. Badia is going to be replacing the joints in her knuckle with a silicone implant from BioPro.
ALEJANDRO BADIA: If you are here and you touch on the collateral, which on the ulnar side they typically don't need to repair, not everyone does, not every one repairs so it depends. I, I actually have rheumatoid training with two very good hand surgeons that both did a lot of hand surgery.
ALEJANDRO BADIA: Charlie Malone in New York and NYU and then later on my primary mentor, John Imbruglia, who I just watched watch. What team was there recently for the Super Bowl and before that. It was something I don't know. Was it soccer? I think it was a playoff game.
ALEJANDRO BADIA: Yeah Yeah. Oh, the Eagles. I'm sorry. I'm honestly not a huge football fan. I played rugby, so no pads.
ASSISTANT: Dr. B, I think is a good time for you to mention that you're going to be in New York [OK, go for it] again. Coming Thursday, Dr. Badia will be in New York.
ALEJANDRO BADIA: I'm doing my first base joint replacement there with the BioPro implant in Manhattan, outpatient of course, and you know, it's not a big, not really procedure done up there so I'm looking forward to kind of giving patients at least that option as opposed to simply removing the trapezium, which is what the. So it's funny, this joint is not as nearly as arthritic, but.
ALEJANDRO BADIA: OK all right.
ASSISTANT: Is that our last one?
ASSISTANT: Yes. All right. Take a look, guys. One, two, three, four.
ALEJANDRO BADIA: This is the one. That's the one.
ASSISTANT: And Dr. Badia is checking sizes for the implant.
ALEJANDRO BADIA: Now, sometimes, paradoxically, the small finger is actually a little bit bigger. The metacarpal tends to be bigger than the ring finger, hence my theory as to why ring finger for two. Ring finger, trigger fingers are the most common.
ALEJANDRO BADIA: Nope, can't do that. Can't do that. And it is. That's I can't do that.
ASSISTANT: No, it's. I can't touch this.
ALEJANDRO BADIA: I'll stick to my day job. I used to say my day and night.
ALEJANDRO BADIA: Thank God it's not nights anymore much but. All right? Yeah, definitely. So you. As expected keep the intrinsic release on the ulnar side is very important so don't worry about that flashing the knife, please.
ASSISTANT: So if you wanted to know how to get in touch with Dr. Badia, our website www.drbadia.com, you can press contact me or ask me a question and Dr. Badia will respond to you directly.
ASSISTANT: Yes, he gets those, he gets those to his email. And now we have two locations available, Miami and New York.
ALEJANDRO BADIA: OK so there's our surgeons here. Here's our radial collateral ligament so see that it's a joint DVT. When when I reattach it, see, the finger won't do that now. Right, right there, Ok, so very important. OK, let's get the all.
ASSISTANT: [VIDEO AUDIO IN SPANISH]
ASSISTANT: [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH]
ASSISTANT: [VIDEO AUDIO IN SPANISH] Both the system.
ALEJANDRO BADIA: That's all. OK that's wonderful. All right. Let's have now the recovery.
ALEJANDRO BADIA: We're going to need four of the nylon sutures. I'm going to do that drill now. Drilling in a foreign island. You want to drill on k-wire? Yep this is just to make a little hole. Later on, we'll use this same wire to.
ASSISTANT: So while Dr. Badia does that, I'll show you guys the pre-op X-ray one more time. [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH]
ASSISTANT: [VIDEO AUDIO IN SPANISH]
ALEJANDRO BADIA: Yes, ma'am, please. Just to reattach the collateral.
ALEJANDRO BADIA: All right, let's have one Hohmann inside the file with one. One we won't need this one. OK which one? One, one, one, one. There you go. The practices. Yep suppose like that now.
ALEJANDRO BADIA: She got pretty good. They can go in with the shoulder that you have. In fact. Yes. It's the same song.
ALEJANDRO BADIA: Yeah. Yeah. Want to do a two? No, no. Because the other one is a one, and I only have one. Here, start opening. Makes I think that this.
ASSISTANT: There's the unveiling. That's the final. Dr. Badia is working with the trial. [Hohmann over here.
ALEJANDRO BADIA: I think we might need that here to help him here. OK, let's slide the table back this way. She retracted. Flex it to show me the base. Just like.
ASSISTANT: So here in the OR, we have Dr. Rossio visiting from Spain.
ASSISTANT: How's your experience been so far?
DR ROSSIO: It's been very interesting. Very, very nice cases.
ASSISTANT: Which one's been your favorite?
DR ROSSIO: I think this one, I haven't seen this surgery before and it's been very, very nice.
ASSISTANT: You've been with us for one month. Two months? How long?
DR ROSSIO: One month. I'm staying here two months.
ASSISTANT: If you're interested in joining our observership program, you can visit our website: physicians. drbadia.com
ALEJANDRO BADIA: Yeah that's a little tight. That's what's happening OK, limits indicate.
ASSISTANT: So we will be announcing our next podcast guest tonight. I think you guys will really enjoy this episode.
ALEJANDRO BADIA: They'll laugh.
ASSISTANT: We'll give you a hint in our stories. We've been sharing a few of his posts. But he is an orthopedic surgeon, a spine surgeon, and our podcast will be live on YouTube, Twitter, Facebook and LinkedIn.
ASSISTANT: We don't have the option to go live on Instagram yet, but we will post a short recap of the episode. We'll share the link on our stories the night prior to the podcast and the morning of so that you guys can leave Instagram and join us on Facebook, YouTube, or any of the other platforms.
ASSISTANT: For those of you who are joining us now, we've been live for about an hour. Doctor Badia removed the arthritic joints. Here they are. And he's going to be replacing them with silicone implants. So right now, he is testing out the trials and we're getting ready for the finals.
ALEJANDRO BADIA: This is fresh. It's the one before I knew the first word.
ASSISTANT: Dr. Badia, I have a question for you. [Yes]. One of our viewers wants to know how long before the patient can resume regular light activities. Well, I think she meant regular life [she's going to be splendid in four weeks].
ALEJANDRO BADIA: So she's know, she's going to have some
ALEJANDRO BADIA: inconveniences for the next four to six weeks.
ASSISTANT: After that, I'm sure she's going to be very happy with her results.
ALEJANDRO BADIA: Well, I'm going to play this kind of highly. It's on its volar plate. Jersey in triquetrum did not do a great job releasing that prior so that's why we're struggling.
ALEJANDRO BADIA: They're not a new. I think it's here on. OK quick service. Another psychic.
ALEJANDRO BADIA: My name will be drawn. But we see this and it's just so hard to see in her, you know? Yeah. OK, so now we're good. OK, let's put the trial in again. Not that it was easy. Anyone would do it. It was easy. We have a beer right now, so.
ASSISTANT: You can have one tonight. Oh, Happy Valentine's Day. No, I don't have beer on Valentine's Day OK? [Is it wine tonight?] Men out there, no beer tonight OK? We'll be around at nine. OK can you.
ASSISTANT: Looks. I think that's OK. All right. Let's open that two, let's have the one, one. OK. Let's have that in a minute. Yes let's have drill and suture.
ALEJANDRO BADIA: You OK? OK OK. I want to get up to speed. Just got to see the radial side.
ASSISTANT: [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH]
ASSISTANT: If you're just joining us and you missed the introduction, the live recording will be up this afternoon.
ALEJANDRO BADIA: Was it two? It's nice. To tell.
ALEJANDRO BADIA: OK. You see the other four?
ALEJANDRO BADIA: I mean, now I can do more. Is that more for. There's only one left open right? And good else.
ALEJANDRO BADIA: Extensible go that way. Another two two.. Need irrigation.
ASSISTANT: This is the part where you channel your grandmother.
ALEJANDRO BADIA: OK let's start with the, let's start with the, we're just starting with the radial side irrigation. We're going to suture. Yes and why's that? They don't give you a lot of last minute removing little crappy things so I need a, I need a knife available.
ASSISTANT: [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH]
ALEJANDRO BADIA: [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH]
ALEJANDRO BADIA: [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH]
ALEJANDRO BADIA: [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH]
ASSISTANT: [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH]
ALEJANDRO BADIA: So now we want to come back, mainly because she's so difficult to get exposure to.
ASSISTANT: So Dr. Badia, Dr. Rossia is trying to get a picture of the implant.
ASSISTANT: [VIDEO AUDIO IN SPANISH] That's good to hear. Dusting the piece.
ASSISTANT:
ALEJANDRO BADIA: And you guys just visualization here. So hard. So I don't want anybody. How's our? How's our side? Because all of a sudden, the Hand's way over. Told you, Kate? Yeah it looks perfect.
ALEJANDRO BADIA: OK so now is. Alright, this is the part where they're. Can we find out we're going to be using this bio tissue material here. [INAUDIBLE]
ASSISTANT: can you talk a little bit about the product? Yeah so it's a little cordiotic membrane.
ASSISTANT: It's a cryopreserved tissue that comes from the umbilical cord and the outer layer, which is considered the amniotic membrane. It's cryo research so we assemble the structural integrity and biology of the natural tissue itself and there's a unique matrix that lives in the umbilical cord. It's HCA three, which stands for heavy chain hyaluronic acid contracts in three.
ASSISTANT: And we started this product in VI and then it's now it's used in surgical, it's used in wound care and in pain management. And what we've seen with all the studies that we've done over the last 37 years consecutively, all through grants provided by the NIH, is that there's this unique matrix that is responsible for modulating inflammation, some regulating scarring, and then recruiting the patient's own hemostasis on site.
ASSISTANT: So that is what Dr. Badia is using in the surgery today. Thank you so much for that explanation.
ALEJANDRO BADIA: You guys started all this section here. I came to 1995, right?
ASSISTANT: Yes. Yes. And it started in the eye to heal chemical eye burns and regenerate corneas. [But even knows a little bit
ALEJANDRO BADIA: about the eye, which I would not include myself.
ALEJANDRO BADIA: But I know corneal injuries can be very, very complicated. How do you hear your [INAUDIBLE] has revolutionized and now we're using it in other. Get one more in here.
ASSISTANT: And for the layperson who isn't part of the medical field, this is part of the regenerative medicine.
ALEJANDRO BADIA: Correct. Be very careful. There is a lot of political.
ASSISTANT: Here's the box, guys. It's not stem cells.
ALEJANDRO BADIA: Yeah please, please, folks, be careful. You know, understand this field before you go. I had also thought that yours quite intellectually told me once somewhere up to Boca for injection of stem cells, they said.
ALEJANDRO BADIA: What was the problem? You couldn't even tell me what the diagnosis was. So, you know, you've got to understand. You've got to. What are these injecting substances in your body? Please educate yourself. What would you do? This is important.
ALEJANDRO BADIA: The soft tissue balancing. So Kate's keeping my index finger in a good position. We're repairing.
ASSISTANT: Now what would you say is the main difference between PRP and this product that we're going to be using? For the layperson who believes that PRP is the Holy Grail or the gold standard of regenerative medicine.
ASSISTANT: Yeah so it's just another product but what we claim with this product is that resembles the structural integrity from the natural tissue itself, which with over 37 years of consecutive research, we have shown to regenerate and modulate that inflammation and regulate the scarring. So PRP comes from the patient's own blood and it's spin and it could work very well with a younger person, but with an older patient that has several comorbidities, it could be at times inconclusive.
ASSISTANT: Thank you. [AUDIO IN SPANISH]
ALEJANDRO BADIA: It is ulnar, ulnar drift always for because the corpus does just there's a z deformity right in rheumatoid based upon because of the pull of the extensors et cetera.
ALEJANDRO BADIA: And so what I want to do is give a little more stability to the radial sides and even the finger tends to deviate that way. So. Yeah. Maybe this one. Very you know what she index finger could be the damage that a.
ALEJANDRO BADIA:
ALEJANDRO BADIA: Show it to me and show me how to adjust to the tractors. In case.
ALEJANDRO BADIA: This time. I'm going to do pants over this repair. Now we're reefing the sagittal hood to eliminate some of the redundancy.
ALEJANDRO BADIA: Need a roll of.
ALEJANDRO BADIA: Roll of four by four, we get a sterile cast padding. And in the world.
ASSISTANT: We are finishing up for those of you that have been watching us live since the beginning. If you have any final questions,
ASSISTANT: start writing them down now, please. [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH]
ALEJANDRO BADIA: OK you already see the index and middle finger in position and the hands so much better, look at the ring and the poly. So you know what, before we put those implants in, Kate, let's release this capsule and then we're going to pin those PIP's. Knife, please.
ALEJANDRO BADIA: Any time now when we factor. The best.
ASSISTANT: Is this stiff capsule also a consequence of rheumatoid arthritis Dr. Badia?
ALEJANDRO BADIA: So she has a, basically a swan neck so she has a hyperextension
ALEJANDRO BADIA: so we're going to close it up, release the.
ALEJANDRO BADIA: Give me a little capsule.
ALEJANDRO BADIA: In the 45 wire frame. Yep. Do you want me to turn it on the other side? Sure, sure.
ASSISTANT: I don't know. Yeah. Cut him. Are you going to want a pressure on here? No.
ALEJANDRO BADIA: You need a. Give me a. Kate and I will close together, so we both will,
ALEJANDRO BADIA: both will each need a repeat. [VIDEO ENDS]
Segment:0 .
ALEJANDRO BADIA: Looking knife please. [INAUDIBLE].
ALEJANDRO BADIA: Because tenotomy.
ASSISTANT: Hi, everyone. Welcome to live surgery Tuesday. Here we
ALEJANDRO BADIA: are starting it's a patient with as I mentioned in the preamble that this patient, she's a little chunky as you can see, a lot of fatty tissue so that is not typical of our rheumatoid patients so this will make it a little bit challenging.
ALEJANDRO BADIA: I may have to extend the incision, but what I do different than most of my colleagues is I make the uh, the uh Indeed whatever you try. So I um, a young lady. So I make my incisions longitudinally because when you make a fist, you're not pulling on the incision.
ALEJANDRO BADIA: So most people do it this way. To begin with, we live in Miami, so looks matter, right? So it's very ugly, kind of like a Frankenstein hands whereas this incision very steady. A little more work for me, but honestly, it's better for the patient and the hand therapist because they're not pulling against the scars. So, so.
ALEJANDRO BADIA: So we are going to make the primary incision will be on the radial side so again, this is the difficulty because I'm going to reef up the radial side in order to. Proximally, I might have to make these incisions here.
ALEJANDRO BADIA: All right. So I'm going to open the sagittal hood on this side, on the radial side. And we are recording this for hopefully they will edit a lot of it and we'll put it on VuMedi, which is kind of like a YouTube for surgeons, right?
ALEJANDRO BADIA: So in terms of rheumatoid handling this, I don't do nearly as much as I used to because a rheumatology colleagues really, really get patients a lot better with the DMAs disease, disease modifying agents. So the Merra and Remicade and all these very strong medicines,
ALEJANDRO BADIA: but there's a rheumatoid tissue. So this, this is what ends up really destroying the joint so it's really a disease, more of the soft tissue of the capsule and of the synovium autoimmune and secondarily, through [INAUDIBLE] it starts destroying the joint. Now, her joints are not that far gone so I would not have operated on her if it wasn't for the pain she was having.
ALEJANDRO BADIA: She actually came to the office several times kind of pleading with me to do it and finally I realized she was in a lot of pain. I said, OK, well, we'll do it. Her deformity is not terrible, so that's good so in a way, she'll have maybe a better result because she's not so far gone.
ALEJANDRO BADIA: Let me have an Army Navy, it's unusual to use that, but boys use this is the problem, folks. When you have you know, you have a lot of fat. I mean, it makes everything harder. It's just a little. Huh? Two, three, four, five. Yes. Well, I'm starting with that and then we're going to release the intrinsics on the ulnar side only.
ALEJANDRO BADIA: I need extra rowels, please.
ASSISTANT: Dr. Badia, can you explain the difference between arthritis and rheumatoid arthritis?
ALEJANDRO BADIA: Yes. So osteoarthritis is uncommon at this joint. This is involving at a carpometacarpal phalangeal joint is very typical of rheumatoid disease, which is an autoimmune disease, very different from osteoarthritis, which we still don't know the cause.
ALEJANDRO BADIA: Rongeur please. We have Susannah from Sterling Moon Designs who says, I wish our grandmother had a surgeon like you. Well, she kind of did. The problem is, Bob Colwell was, you know, my grandfather was a hand surgeon. He trained Joe Imbrigiglio, and I went when I was eight years old to discuss this surgery, which a guy named Al Swanson, a legend amongst hand surgeons, is really the person who started doing using silicone implants.
ALEJANDRO BADIA: But for what reasons that you know, obviously, I don't know as an eight-year-old what the reason was, but she did not have the surgery she really needed. Her hands were much worse than this, by the way. I mean, much worse. So it is the arthritic joint, there is still some cartilage, but the edges of it are very arthritic
ALEJANDRO BADIA: so, let's go. Let's actually do the intrinsic release on the ulnar side. As I said, this can be a little more challenging for me just because of the amount of fat so. You have a soft retainer. OK, so I'll release the intrinsic so that you are more better but you can see here's the extensors and we'll bring this refit up on the radial side and then that will correct her,
ALEJANDRO BADIA: her ulnar drift. Now I'm going to use, yeah, that one. OK that's great, I'll work to use that later. Let's go, let's go to the middle finger now. The US decided to issue.
ALEJANDRO BADIA: It's a big vein, I don't want to move back because it helps drain it. So we track one over here.
ASSISTANT: Are there any correlations to the diagnosis of rheumatoid arthritis? Is it age related or is it genetics? What is it mostly leaning towards?
ALEJANDRO BADIA: You know, there is some tendency in families, I think it's called HDA4 gene. There's a few genes that it's been associated with, but nobody, nobody understands, just like other autoimmune diseases, nobody, you know, lupus, nobody knows exactly why. A lot of things we don't understand in science. I'll say it again.
ALEJANDRO BADIA: We spend more money, I think on the cosmetics industry than on basic medical research. So it's a matter of priorities in our society. Let's release. You know what I'm going to have to release first on the ulnar side just because she really is deviating. So the reality is she is going to benefit a lot from us. She's really, she's really deviating.
ALEJANDRO BADIA: Now, so I want to always leave an edge for my colleagues. I'm going to leave an edge of the sagittal hood for later repair. The other thing I'm going to do, which is a newer thing, is to minimize scarring and also reduce inflammation in post op inflammation and improve healing. I'm going to lay a sheet of tissue, a company called BioTissue, and they happen to be based very near us
ALEJANDRO BADIA: so their laboratories. So we're going to be laying that at the end of the surgery when you lay in that between the extensor. Now there are other tissue products I use like this for scarring, but this one has a biologic component so, so it really depends on the indication. All right. So this one looks
ALEJANDRO BADIA: much more predictable speed. In the first place. Yeah right after that, there's one. OK so here's the, here's the capsule. Yeah, I'll take it pretty much. OK so I'm going to remove this.
ALEJANDRO BADIA: There's sort of this very senolitic thickening between capsule. One of the challenges we have, and I'd love to collaborate more with my rheumatology colleagues, they often refer to these patients very late, if at all so we need to, and I think as it happens, I think surgeons maybe think that our results are better than it perhaps are in many cases
ALEJANDRO BADIA: and rheumatologists is the opposite. They think that this surgery I don't know won't work well, so this is one of the other problems in health care. There's just not enough discussion between specialties. We don't keep up with our advances. That's something that you know needs to change. OK. [VOICEOVER IN SPANISH] [VOICEOVER IN SPANISH] Peru. To heal many years.
ALEJANDRO BADIA: And yet we must remember that. [AUDIO IN SPANISH] [AUDIO IN SPANISH] [AUDIO IN SPANISH] next two fingers. So, again, the difference is I don't make the incision across this way. Yeah this is more work, but there's a lot of advantages, as I mentioned earlier.
ALEJANDRO BADIA: So you got a big vein here. I'm going to try to avoid that vein because again that will drain.
ASSISTANT: If you have any questions, please comment below and let us know where you are watching us from. Dr. Badia [AUDIO IN SPANISH] [AUDIO IN SPANISH] [AUDIO IN SPANISH]
ASSISTANT: Patients are, viewers are asking.
ALEJANDRO BADIA: Yes. You're going to see that in a moment. So now I'm going to the ring finger. OK and you can, I'll show you in a moment. Actually, this is all there is. So I'm using a big retractor. I normally don't have to, but this patient just has a lot of fatty tissue. So the tendon is deviating to the ulnar side, to the pinky side.
ALEJANDRO BADIA: So now I'm going to.
ASSISTANT: There's the Colombia saludo.
ALEJANDRO BADIA: OK so now I have to release the. The ulnar sagittal, but I'm going to ream the radial side.
ASSISTANT: I think it's a good idea to speak in Spanish. We have another person commenting. I'll have to do a combination. Combination soy medical drama story clinic.
ASSISTANT: That is Bogota. [AUDIO IN SPANISH] Bienvenidos. OK.
ALEJANDRO BADIA: Can OK. So many. [AUDIO IN SPANISH] [AUDIO IN SPANISH] I'd like to use this opportunity as I can to dynamic what we're doing here.
ALEJANDRO BADIA: So OK, so here's the. Someone asked me, I don't know who, the patient about removing the capsule. So this is the, the capsule would. Below it, I can see the rheumatoid sinovium which is the cells that line the capsule and secrete the synovial fluid right? [AUDIO IN SPANISH] [AUDIO IN SPANISH]
ALEJANDRO BADIA: Thank you, Randy. Well, in Mexico. Let's move on. [AUDIO IN SPANISH] [AUDIO IN SPANISH] They are treating rheumatoid as so important.
ALEJANDRO BADIA: But we actually thought actually need to cure a tendency had a tendency to connect a lot of tenderness. Salud de La Florida Politico. It's tough.
ASSISTANT: [AUDIO IN SPANISH] because they say potentially that in vivo permettant [AUDIO IN SPANISH] Please do not report our medical content. If you do not wish to watch it, you can,
ASSISTANT: to watch it, you can tune out of the live.
ALEJANDRO BADIA: You can watch things like shootings and things like that in the news every day, unfortunately, yet people report us. That's amazing. All right. So here's the small finger.
ALEJANDRO BADIA: I'm going to release the ulnar side to the ulnar shaft to the hood. Then we'll release the intrinsic later. OK so now the tendon comes over.
ALEJANDRO BADIA: We remove this capsule. A new capsule, of course, will form. Here's a rheumatoid. The reams of those joint again. Not terrible but here's the, here's a rheumatoid.
ALEJANDRO BADIA: So once we get rid of the joint, there's no more pain because there's no more jerking, no more synovial.
ASSISTANT: [AUDIO IN SPANISH] [AUDIO IN SPANISH] [AUDIO IN SPANISH]
ALEJANDRO BADIA: [AUDIO IN SPANISH] [AUDIO IN SPANISH] [AUDIO IN SPANISH] [AUDIO IN SPANISH]
ASSISTANT: [AUDIO IN SPANISH] [AUDIO IN SPANISH]
ALEJANDRO BADIA: Please, Thomas. So we have to find the capsule. [AUDIO IN SPANISH] So keep trying to get that.
ALEJANDRO BADIA: OK so here, here's more capsule. All right. So let's go back. So, so you have to release the intrinsic so the sagittal band to this finger doesn't want to come over.
ALEJANDRO BADIA: So you saw the picture of before so later you'll see the after. So we'll have, we'll start with the sagittal saw in a moment. OK, Kate, I've got to get much more exposure here. Yeah three, two, five
ALEJANDRO BADIA: Oh yes.
ASSISTANT: So yes. We will be uploading the recording later. OK actually, immediately after surgery, we will share the recording. We'll also upload that recording to our YouTube channel, which is www.youtube.com/c/drbadia.
ASSISTANT: Or you can simply search for Alejandro Badia on the YouTube search bar and you'll find our channel.
ALEJANDRO BADIA: I'll be able to do all four because. Yes I'm going to do all four. So let me really see intrinsics here so suction. [INAUDIBLE]
ALEJANDRO BADIA: Do we have that opportunity? I have a question, Dr. Badia whenever you're ready, let me know.
ASSISTANT: Yeah go ahead. OK so the extensor tendon for the fifth finger, is it split or retracted? Same question for the second practice.
ALEJANDRO BADIA: It's retracted really to both sides.
ALEJANDRO BADIA: But I'm going to basically take the radial side of the hood and move it over and repair it over rest and I have to release the ulnar side. So right now what I'm doing in the index is I'm going to the intrinsics which are here, OK you see this is holding this up. So when I'm, all I'm going to do is without coming in and I'm going to basically free up.
ASSISTANT: Could you bring the whole thing closer towards me and then angle it down.
ALEJANDRO BADIA: Let's see. So now that allowed the finger to come this way. So let's have.
ASSISTANT: I don't think we need to be missing out for a minute. We're trying to adjust the boom camera. Can you swing out for a minute so I can swing out?
ALEJANDRO BADIA: Do you want to just move the hand.
ASSISTANT: No, it's that your head,
ASSISTANT: your head is covering it up. How about you? No can you bring it up? Thank you.
ALEJANDRO BADIA: Now, if you attach the radial collateral on this, the um. I'm from both sides, but this is the one that I'm going to reattach later on. There it is so. We'll make a, once we got the cuts about to put the implants in, we'll make a drill hole and then we'll reattach. Is her right hand as severe as her left?
ALEJANDRO BADIA: No. Osteotome about that width and then.
ALEJANDRO BADIA: Tom. This is everybody's favorite part in orthopedic surgery. Oh, yeah so she's, you know, she's she's pretty arthritic. I mean, it's not so. Rongeur
ASSISTANT: This joint that you just removed, was it supposed to be covered in cartilage? Yeah all right, everybody, take a look. No cartilage.
ALEJANDRO BADIA: But what's important is that the rheumatoid, the tissue eventually is going to erode it so there's more cartilage here on the base. All right.
ALEJANDRO BADIA: Let's start broaching.
ASSISTANT: You're going to come out here. Where is that coming from?
ALEJANDRO BADIA: Could you get my phone out of my leg? Now we're doing the serial
ALEJANDRO BADIA: broaching but these are silicone implants. It's one of the few places we still use silicone other than in South Beach.
ASSISTANT: Dr. Badia, one of your viewers said, this is always very, very impressive. Thank you very much for letting us be here.
ALEJANDRO BADIA: The pleasures. We have nothing without education. I am going to try. No, that's going to be too tight. OK, that's the size. At least three feet. He didn't do that.
ALEJANDRO BADIA: He didn't. He didn't do the three. OK, so it's a two. At some point, you're all here. So let's get up here. Stuff the way.
ASSISTANT: Doctor, can you specify on that question? You said what kind of preparation does he do? Are you referring to pre-op or what exactly so that I can ask accurately.
ALEJANDRO BADIA: I'm sorry, what's the question?
ASSISTANT: One of the doctors wrote that he would like to know what kind of preparation you do. I just want him to specify what he means.
ALEJANDRO BADIA: Well, when I released the intrinsics, I'm going to, particularly on the ulnar side, the collateral ligament, and I'm going to reattach the radial one and you have the all clear, Kate. Come out? Yeah, you come out. Come out of.
ASSISTANT: Another question is, does the rheumatoid arthritis, is it cured or does it decline after this or what happens?
ALEJANDRO BADIA: Well, no, nothing changes. That's for our, that's for the medications. So what I'm doing here is taking joints that are, can you burr that. This is a little bit more. Once there's not a joint, then there is not pain in that joint
ALEJANDRO BADIA: right that's?
ASSISTANT: In short, they would like to know the patient then has to continue to take her medication.
ALEJANDRO BADIA: Yes, absolutely. Yeah this is just, you know this is, my job as a hand surgeon is to fix a hand. I count on my medical colleagues to stabilize the disease
ALEJANDRO BADIA: and that's why the collaboration is so important. One great thing I've studied a lot is in Japan, they have actually arthritis clinics, rheumatoid arthritis clinics, specifically where the mycologist, the mycologist is, the primary care doctor, the orthopedic surgeon, the hand surgeon perhaps, the hand therapist and the social worker to help organize all this. They all meet
ALEJANDRO BADIA: and uh work together to help the patient. So our medical system has you know, needs a lot of work. Anyone who knows me well knows that I feel that way. The money is definitely in the system. It just has to be allocated correctly.
ASSISTANT: And if you want to hear more about that, Thursday, we'll go live for fixing health care from the trenches. [INAUDIBLE] important finger.
ASSISTANT: Yeah, that's.
ALEJANDRO BADIA: Right? Two. I got to go up one more? You can go down the line or you could still go up two. You were two here. And two and two. Two and two? Yes. All right.
ALEJANDRO BADIA: Yeah we're going to stay with that. If you've got decent bones, this is not again, this in many ways, this is not a typical know, while we're at it, let's. Like before we put in, let's go to the next joint.
ALEJANDRO BADIA: New at the moment. The, she's got on this side.
ALEJANDRO BADIA: The people. The regular pick me up. They're right up on the break. So here's the ulnar intrinsic and way down there, I'm going to divide it right here.
ALEJANDRO BADIA: OK good. Tonight, the collateral is holding us back.
ASSISTANT: Will the patient have to wear a splint post-op to correct deviation as well.
ALEJANDRO BADIA: Yes. I'm not crazy about this so mediation freer.
ALEJANDRO BADIA: Here can you show me that guidewire, please?
ALEJANDRO BADIA: He still wants to go and to. Pullman please.
ASSISTANT: For those of you who are at work or can't watch the entire live surgery right now, we will be uploading the recording and it'll be on YouTube as well.
ALEJANDRO BADIA: For hand surgeons it'll be on VuMedi at some point, right, Kate?
ASSISTANT: Here's our setup. I mean, it won't be as fast as hill, though, pushing a button to make something, of course, at some point. The patient has rheumatoid arthritis. How soon after surgery will therapy begin?
ALEJANDRO BADIA: I mean real therapy, about three weeks because I approach this a little bit different and we'll talk about that a little later.
ASSISTANT: So Dr. Badia is removing the arthritic joints and then it will be replaced with a silicone implant.
ASSISTANT: If you want to see the before pictures of what the patients hand looked like, we did share that on our story. Right now, he's removing the joint and creating space for the new implant.
ASSISTANT: For the Fellows who are watching this, you can also visit; physicians.drbadia.com. For more surgical content and you can also learn how you can come to our center and shadow Dr. Badia as part of our observership program. Oh here is the other joint.
ASSISTANT: But we have two now, right? So this is supposed to be covered in cartilage. Look at what it looks like. OK all. In your opinion, Dr. Badia do you prefer silicone prostheses or sometimes do you choose metal?
ASSISTANT: One of the questions. Not for rheumatoid arthritis.
ALEJANDRO BADIA: I've used metal, but it's a rare osteoarthritic
ASSISTANT: We use the BioPro metal prosthesis in the thumb in the CMC joints.
ALEJANDRO BADIA: I'm sorry. We haven't seen one or no. You'll do the big reveal. What size is this one? Two. I have one.
ASSISTANT: We'll show you what the silicone prosthesis looks like shortly.
ALEJANDRO BADIA: Ok, mallet. Top one.
ALEJANDRO BADIA: OK all right. We'll be back in a moment.
ASSISTANT: We do have a lot of videos on the CMC joint arthroplasty that Doctor Badia does with Biopro. They're on our website and on YouTube.
ALEJANDRO BADIA: Right to me first and then your freer.
ALEJANDRO BADIA: Can somebody adjust my camera head so its it's just loving on my hands. You want it tightened? No, no, just, just sort of just lift it up and just lift it where? There? OK.
ASSISTANT: OK, so here's our rep from BioPro showing us what it looks like in photo. You'll see it live in just a minute. Yes, let me show you what the X-ray looks like. Yes, I'll cover it. Hey, here's a pre-op X-ray.
ASSISTANT: AP and here is a lateral.
ALEJANDRO BADIA: Good quality bone in this patient, which will help.
ALEJANDRO BADIA: Remember this? The idea that silicone implants attract more spacers and then the soft tissue will reform that capsule but without the. So, so you'll see when it's in there. So it's not really a, it's not a joint replacement in the same sort as even the days of joint or knee replacement.
ALEJANDRO BADIA: These are a silicone spacers.
ASSISTANT: Will she lose strength in her hand.
ALEJANDRO BADIA: Will she lose strength? Well, depends. You know, strength doesn't come from a surgery and injection or strength comes from using the hand and doing the exercises so that'll be up to our hand therapy colleagues to work on a strengthening program that she'll continue to do on her own.
ALEJANDRO BADIA: You want to move over here? Let's move away from them all at once. OK tenotomy. Is our final joint?
ASSISTANT: Two more. Patients want to know about our post-op pain control after this surgery. Are we giving narcotics?
ALEJANDRO BADIA: I will let her.
ASSISTANT: We do in general, for pretty much all of our procedures. As long as the patient is able to take anti-inflammatories, we do a combination of Tylenol arthritis every eight hours and Aleve, which is Naproxen Sodium every 12 hours together. Right combined, correct. Do you think both are on the clock for at least the first two days until the block has worn off? I mean, there's misery in front of me.
ASSISTANT: And most patients do well enough that they don't need any narcotics after that. But the procedures that we're anticipating, you know, a little bit stronger pain, we will give a prescription for a small amount of a narcotic. But, you know, sometimes, you know, just kind of as just in case for most patients do really well and only take the. We have patients largely
ALEJANDRO BADIA: our anesthesia colleagues with blocks that they do so we have patients that have had shoulder replacements and never took a narcotic.
ALEJANDRO BADIA: Dr. Sigman would be proud. Yup so Scott Sigman, shout out to Scott Sigman, who is one of the original opioid sparing surgeons who does knee replacements and arthroscopy and rotator cuff repairs and he's been a big proponent of this. As many of you know, we continue to be in an opioid crisis, now it's mostly fentanyl, and we have young people dying because of this.
ALEJANDRO BADIA: So this is something. The medications are what our politicians, unfortunately. Just gone too well for me with most. Ironically, except the physicians which is a total of 14, I think, between the Senate and Congress.
ALEJANDRO BADIA: So that's not enough to really move the needle.
ASSISTANT: And both medications that Kate stated are part of our pain protocol are over the counter.
ASSISTANT: One more joint. So all. OK so so far we have three. A little bit smaller. I would want to keep them as, like, keepsake old joints.
ASSISTANT: This is Dr. Badia's toolbox.
ALEJANDRO BADIA: The one is the one here. That's probably the one. Now you make sure you. Each one of the.
ALEJANDRO BADIA: You can't see. Mike, please remove that toxic.
ALEJANDRO BADIA: Make sure we release the intrinsic here. I'm not. Tenotomy. Thank you guys for staying with us till the end. OK so there you are, I just did an intrinsic release. So if you look at the difference so in Kate.
ALEJANDRO BADIA: Traction. Knife.
ALEJANDRO BADIA: OK now freer. Like that. I'm constantly, constantly doing releases. So, you know, keep in mind always, my knee arthroplasty replacement.
ALEJANDRO BADIA: So a lot of the art in it isn't what people think of, it's a soft tissue balancing. If you don't release the soft tissues in the appropriate place, you're not going to get the right result. So this is much more accurate, as you can see. OK we all please.
ASSISTANT: Dr. Badia is now checking sizes for the implant.
ALEJANDRO BADIA: Not surprising. The ulnar side to me is a little worse so that's the number one. That's the zero. That's the one that I just gave you. And I had a one for the proximal right? Yeah. OK, that's good. Let's go to the last one. Small finger, open it up.
ALEJANDRO BADIA: The most difficult one. These are the ones that have really given me a headache in the past, because especially when the finger is so deviated, you can't release this. This is why I try to speak into rheumatologist and refer the patients early. We can get a much better result.
ASSISTANT: For those of you who just tuned in, this is a rheumatoid arthritis patient
ASSISTANT: and Dr. Badia is going to be replacing the joints in her knuckle with a silicone implant from BioPro.
ALEJANDRO BADIA: If you are here and you touch on the collateral, which on the ulnar side they typically don't need to repair, not everyone does, not every one repairs so it depends. I, I actually have rheumatoid training with two very good hand surgeons that both did a lot of hand surgery.
ALEJANDRO BADIA: Charlie Malone in New York and NYU and then later on my primary mentor, John Imbruglia, who I just watched watch. What team was there recently for the Super Bowl and before that. It was something I don't know. Was it soccer? I think it was a playoff game.
ALEJANDRO BADIA: Yeah Yeah. Oh, the Eagles. I'm sorry. I'm honestly not a huge football fan. I played rugby, so no pads.
ASSISTANT: Dr. B, I think is a good time for you to mention that you're going to be in New York [OK, go for it] again. Coming Thursday, Dr. Badia will be in New York.
ALEJANDRO BADIA: I'm doing my first base joint replacement there with the BioPro implant in Manhattan, outpatient of course, and you know, it's not a big, not really procedure done up there so I'm looking forward to kind of giving patients at least that option as opposed to simply removing the trapezium, which is what the. So it's funny, this joint is not as nearly as arthritic, but.
ALEJANDRO BADIA: OK all right.
ASSISTANT: Is that our last one?
ASSISTANT: Yes. All right. Take a look, guys. One, two, three, four.
ALEJANDRO BADIA: This is the one. That's the one.
ASSISTANT: And Dr. Badia is checking sizes for the implant.
ALEJANDRO BADIA: Now, sometimes, paradoxically, the small finger is actually a little bit bigger. The metacarpal tends to be bigger than the ring finger, hence my theory as to why ring finger for two. Ring finger, trigger fingers are the most common.
ALEJANDRO BADIA: Nope, can't do that. Can't do that. And it is. That's I can't do that.
ASSISTANT: No, it's. I can't touch this.
ALEJANDRO BADIA: I'll stick to my day job. I used to say my day and night.
ALEJANDRO BADIA: Thank God it's not nights anymore much but. All right? Yeah, definitely. So you. As expected keep the intrinsic release on the ulnar side is very important so don't worry about that flashing the knife, please.
ASSISTANT: So if you wanted to know how to get in touch with Dr. Badia, our website www.drbadia.com, you can press contact me or ask me a question and Dr. Badia will respond to you directly.
ASSISTANT: Yes, he gets those, he gets those to his email. And now we have two locations available, Miami and New York.
ALEJANDRO BADIA: OK so there's our surgeons here. Here's our radial collateral ligament so see that it's a joint DVT. When when I reattach it, see, the finger won't do that now. Right, right there, Ok, so very important. OK, let's get the all.
ASSISTANT: [VIDEO AUDIO IN SPANISH]
ASSISTANT: [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH]
ASSISTANT: [VIDEO AUDIO IN SPANISH] Both the system.
ALEJANDRO BADIA: That's all. OK that's wonderful. All right. Let's have now the recovery.
ALEJANDRO BADIA: We're going to need four of the nylon sutures. I'm going to do that drill now. Drilling in a foreign island. You want to drill on k-wire? Yep this is just to make a little hole. Later on, we'll use this same wire to.
ASSISTANT: So while Dr. Badia does that, I'll show you guys the pre-op X-ray one more time. [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH]
ASSISTANT: [VIDEO AUDIO IN SPANISH]
ALEJANDRO BADIA: Yes, ma'am, please. Just to reattach the collateral.
ALEJANDRO BADIA: All right, let's have one Hohmann inside the file with one. One we won't need this one. OK which one? One, one, one, one. There you go. The practices. Yep suppose like that now.
ALEJANDRO BADIA: She got pretty good. They can go in with the shoulder that you have. In fact. Yes. It's the same song.
ALEJANDRO BADIA: Yeah. Yeah. Want to do a two? No, no. Because the other one is a one, and I only have one. Here, start opening. Makes I think that this.
ASSISTANT: There's the unveiling. That's the final. Dr. Badia is working with the trial. [Hohmann over here.
ALEJANDRO BADIA: I think we might need that here to help him here. OK, let's slide the table back this way. She retracted. Flex it to show me the base. Just like.
ASSISTANT: So here in the OR, we have Dr. Rossio visiting from Spain.
ASSISTANT: How's your experience been so far?
DR ROSSIO: It's been very interesting. Very, very nice cases.
ASSISTANT: Which one's been your favorite?
DR ROSSIO: I think this one, I haven't seen this surgery before and it's been very, very nice.
ASSISTANT: You've been with us for one month. Two months? How long?
DR ROSSIO: One month. I'm staying here two months.
ASSISTANT: If you're interested in joining our observership program, you can visit our website: physicians. drbadia.com
ALEJANDRO BADIA: Yeah that's a little tight. That's what's happening OK, limits indicate.
ASSISTANT: So we will be announcing our next podcast guest tonight. I think you guys will really enjoy this episode.
ALEJANDRO BADIA: They'll laugh.
ASSISTANT: We'll give you a hint in our stories. We've been sharing a few of his posts. But he is an orthopedic surgeon, a spine surgeon, and our podcast will be live on YouTube, Twitter, Facebook and LinkedIn.
ASSISTANT: We don't have the option to go live on Instagram yet, but we will post a short recap of the episode. We'll share the link on our stories the night prior to the podcast and the morning of so that you guys can leave Instagram and join us on Facebook, YouTube, or any of the other platforms.
ASSISTANT: For those of you who are joining us now, we've been live for about an hour. Doctor Badia removed the arthritic joints. Here they are. And he's going to be replacing them with silicone implants. So right now, he is testing out the trials and we're getting ready for the finals.
ALEJANDRO BADIA: This is fresh. It's the one before I knew the first word.
ASSISTANT: Dr. Badia, I have a question for you. [Yes]. One of our viewers wants to know how long before the patient can resume regular light activities. Well, I think she meant regular life [she's going to be splendid in four weeks].
ALEJANDRO BADIA: So she's know, she's going to have some
ALEJANDRO BADIA: inconveniences for the next four to six weeks.
ASSISTANT: After that, I'm sure she's going to be very happy with her results.
ALEJANDRO BADIA: Well, I'm going to play this kind of highly. It's on its volar plate. Jersey in triquetrum did not do a great job releasing that prior so that's why we're struggling.
ALEJANDRO BADIA: They're not a new. I think it's here on. OK quick service. Another psychic.
ALEJANDRO BADIA: My name will be drawn. But we see this and it's just so hard to see in her, you know? Yeah. OK, so now we're good. OK, let's put the trial in again. Not that it was easy. Anyone would do it. It was easy. We have a beer right now, so.
ASSISTANT: You can have one tonight. Oh, Happy Valentine's Day. No, I don't have beer on Valentine's Day OK? [Is it wine tonight?] Men out there, no beer tonight OK? We'll be around at nine. OK can you.
ASSISTANT: Looks. I think that's OK. All right. Let's open that two, let's have the one, one. OK. Let's have that in a minute. Yes let's have drill and suture.
ALEJANDRO BADIA: You OK? OK OK. I want to get up to speed. Just got to see the radial side.
ASSISTANT: [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH]
ASSISTANT: If you're just joining us and you missed the introduction, the live recording will be up this afternoon.
ALEJANDRO BADIA: Was it two? It's nice. To tell.
ALEJANDRO BADIA: OK. You see the other four?
ALEJANDRO BADIA: I mean, now I can do more. Is that more for. There's only one left open right? And good else.
ALEJANDRO BADIA: Extensible go that way. Another two two.. Need irrigation.
ASSISTANT: This is the part where you channel your grandmother.
ALEJANDRO BADIA: OK let's start with the, let's start with the, we're just starting with the radial side irrigation. We're going to suture. Yes and why's that? They don't give you a lot of last minute removing little crappy things so I need a, I need a knife available.
ASSISTANT: [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH]
ALEJANDRO BADIA: [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH]
ALEJANDRO BADIA: [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH]
ALEJANDRO BADIA: [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH]
ASSISTANT: [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH]
ALEJANDRO BADIA: So now we want to come back, mainly because she's so difficult to get exposure to.
ASSISTANT: So Dr. Badia, Dr. Rossia is trying to get a picture of the implant.
ASSISTANT: [VIDEO AUDIO IN SPANISH] That's good to hear. Dusting the piece.
ASSISTANT:
ALEJANDRO BADIA: And you guys just visualization here. So hard. So I don't want anybody. How's our? How's our side? Because all of a sudden, the Hand's way over. Told you, Kate? Yeah it looks perfect.
ALEJANDRO BADIA: OK so now is. Alright, this is the part where they're. Can we find out we're going to be using this bio tissue material here. [INAUDIBLE]
ASSISTANT: can you talk a little bit about the product? Yeah so it's a little cordiotic membrane.
ASSISTANT: It's a cryopreserved tissue that comes from the umbilical cord and the outer layer, which is considered the amniotic membrane. It's cryo research so we assemble the structural integrity and biology of the natural tissue itself and there's a unique matrix that lives in the umbilical cord. It's HCA three, which stands for heavy chain hyaluronic acid contracts in three.
ASSISTANT: And we started this product in VI and then it's now it's used in surgical, it's used in wound care and in pain management. And what we've seen with all the studies that we've done over the last 37 years consecutively, all through grants provided by the NIH, is that there's this unique matrix that is responsible for modulating inflammation, some regulating scarring, and then recruiting the patient's own hemostasis on site.
ASSISTANT: So that is what Dr. Badia is using in the surgery today. Thank you so much for that explanation.
ALEJANDRO BADIA: You guys started all this section here. I came to 1995, right?
ASSISTANT: Yes. Yes. And it started in the eye to heal chemical eye burns and regenerate corneas. [But even knows a little bit
ALEJANDRO BADIA: about the eye, which I would not include myself.
ALEJANDRO BADIA: But I know corneal injuries can be very, very complicated. How do you hear your [INAUDIBLE] has revolutionized and now we're using it in other. Get one more in here.
ASSISTANT: And for the layperson who isn't part of the medical field, this is part of the regenerative medicine.
ALEJANDRO BADIA: Correct. Be very careful. There is a lot of political.
ASSISTANT: Here's the box, guys. It's not stem cells.
ALEJANDRO BADIA: Yeah please, please, folks, be careful. You know, understand this field before you go. I had also thought that yours quite intellectually told me once somewhere up to Boca for injection of stem cells, they said.
ALEJANDRO BADIA: What was the problem? You couldn't even tell me what the diagnosis was. So, you know, you've got to understand. You've got to. What are these injecting substances in your body? Please educate yourself. What would you do? This is important.
ALEJANDRO BADIA: The soft tissue balancing. So Kate's keeping my index finger in a good position. We're repairing.
ASSISTANT: Now what would you say is the main difference between PRP and this product that we're going to be using? For the layperson who believes that PRP is the Holy Grail or the gold standard of regenerative medicine.
ASSISTANT: Yeah so it's just another product but what we claim with this product is that resembles the structural integrity from the natural tissue itself, which with over 37 years of consecutive research, we have shown to regenerate and modulate that inflammation and regulate the scarring. So PRP comes from the patient's own blood and it's spin and it could work very well with a younger person, but with an older patient that has several comorbidities, it could be at times inconclusive.
ASSISTANT: Thank you. [AUDIO IN SPANISH]
ALEJANDRO BADIA: It is ulnar, ulnar drift always for because the corpus does just there's a z deformity right in rheumatoid based upon because of the pull of the extensors et cetera.
ALEJANDRO BADIA: And so what I want to do is give a little more stability to the radial sides and even the finger tends to deviate that way. So. Yeah. Maybe this one. Very you know what she index finger could be the damage that a.
ALEJANDRO BADIA:
ALEJANDRO BADIA: Show it to me and show me how to adjust to the tractors. In case.
ALEJANDRO BADIA: This time. I'm going to do pants over this repair. Now we're reefing the sagittal hood to eliminate some of the redundancy.
ALEJANDRO BADIA: Need a roll of.
ALEJANDRO BADIA: Roll of four by four, we get a sterile cast padding. And in the world.
ASSISTANT: We are finishing up for those of you that have been watching us live since the beginning. If you have any final questions,
ASSISTANT: start writing them down now, please. [VIDEO AUDIO IN SPANISH] [VIDEO AUDIO IN SPANISH]
ALEJANDRO BADIA: OK you already see the index and middle finger in position and the hands so much better, look at the ring and the poly. So you know what, before we put those implants in, Kate, let's release this capsule and then we're going to pin those PIP's. Knife, please.
ALEJANDRO BADIA: Any time now when we factor. The best.
ASSISTANT: Is this stiff capsule also a consequence of rheumatoid arthritis Dr. Badia?
ALEJANDRO BADIA: So she has a, basically a swan neck so she has a hyperextension
ALEJANDRO BADIA: so we're going to close it up, release the.
ALEJANDRO BADIA: Give me a little capsule.
ALEJANDRO BADIA: In the 45 wire frame. Yep. Do you want me to turn it on the other side? Sure, sure.
ASSISTANT: I don't know. Yeah. Cut him. Are you going to want a pressure on here? No.
ALEJANDRO BADIA: You need a. Give me a. Kate and I will close together, so we both will,
ALEJANDRO BADIA: both will each need a repeat. [VIDEO ENDS]
Form Title Download
Transcript
Form Title Bookmark
Entire Media
Segment(s)
Custom Clip
Start At:
End At:
Form Title Share
Entire Media
Segment(s)
Custom Clip
Start At:
End At:
Form Title Accessibility and Keyboard Shortcuts
The cadmore media player is a professional video and audio player experience designed to deliver media as well as relevant transcript, segmentation, and metadata. On the screen is a traditional html video player with buttons such as play, pause, forward, captioning, language and play speed selection and more. Adjacent to the video player are generally tabs, one of which shows a scrolling transcript of the video and the other shows any segmentation of the media, sometimes referred to as chapters. At the top of the video is a menu bar containing an Explore button and Tools button. The Explore button allows you to dig deeper into the video by opening up an explore dialog which contains tabs for a visual navigation of the video using thumbnails, an about tab which contains rich metadata about the media, a segments tab which contains further information about the video, and a related tab which contains links to other media related to this media. The tools button opens a menu with options for sharing the media on social media, creating bookmarking links, creating embed codes for your website, generating citations, and more.
Keyboard Shortcuts
Keyboard shortcuts only work while you are in forms mode. By entering forms mode, you will be able to quickly access portions of the media player with single key commands.
Spacebar: Play/Pause Toggle
I: Info Menu,
O: Tools Menu
T: Transcript Tab,
S: Segments Tab
F: Forward 15,
R: Rewind 15
L: Languages,
P: Playspeed
M: Mute Toggle,
V: Volume Bar
N: Video Only Toggle,
B: Full Screen Toggle
C: Captions Toggle
Escape: Closes dialogs and menus / Exits Player
Z: Next Transcript Chapter
X: Previous Transcript Chapter
Q: Next Transcript Paragraph
W: Previous Transcript Paragraph
Entire Media
Segment(s)
Custom Clip
Start At:
End At:
Embed Size
-
You Size - Responsive
-
We Size - Responsive
-
Picture Overlay Popup
-
400 x 225
-
512 x 288
-
400 x 700
-
768 x 1024
-
1024 x 512
-
1280 x 608
Form Title Cite
No citation provided.
Info
Segments
Related
Thumbnails
Exit Clip Mode
You have requested to see a portion of the video outside of the clip.
Click OK to switch to the full video or click if you would like to stay inside the clip. You can always go back to the clip with Tools and Clip Mode