As surgical management of carpal tunnel release (CTR) becomes ever more common, extensive research has emerged to optimize the contextualization of this procedure. In particular, CTR under the wide-awake, local-anesthesia, no-tourniquet (WALANT) technique has emerged as a cost-effective, safe, and straightforward option for the millions who undergo this procedure worldwide. CTR under WALANT is associated with considerable cost savings and workflow efficiencies; it can be safely and effectively executed in an outpatient clinic under field sterility with less use of resources and production of waste, and it has consistently demonstrated standard or better post-operative pain control and satisfaction among patients. In this review of the literature, we describe the current findings on CTR using the WALANT technique.

➢ Advanced care planning most commonly refers to the act of planning and preparing for decisions with regard to end-of-life care and/or serious illness based on a patient’s personal values, life goals, and preferences. ➢ Over time, advanced care planning and its formalization through advanced directives have demonstrated substantial benefits to patients, their families and caregivers, and the larger health-care system. ➢ Despite these benefits, advanced care planning and advanced directives remain underutilized. ➢ Orthopaedic surgeons interact with patients during sentinel events, such as fragility hip fractures, that indicate a decline in the overall health trajectory. ➢ Orthopaedic surgeons must familiarize themselves with the concepts and medicolegal aspects of advanced care planning so that care can be optimized for patients during sentinel health events.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had a significant impact on hospitals, including the occupational health departments in charge of handling healthcare worker (HCW) staffing during high rates of exposure and infection of HCWs. HCWs who were exposed to a patient or community member infected with SARS-CoV-2 were required to isolate from work for a minimum of 14 days from the date of exposure. Aims: This study was aimed to assess the relative risk of SARS-CoV-2 infection following different types of workplace and community exposures. Methods: We analyzed the details of workplace and community exposures of HCWs to SARS-CoV-2 at Montefiore Medical Center in New York between 22 June 2020 and 22 November 2020. Results: Of 562 HCW SARS-CoV-2 exposures analyzed, 218 were from the community and 345 were from the workplace. Twenty-nine per cent of community exposures resulted in infection, which was significantly greater than workplace exposure infection (2%). Household community exposures resulted in a larger frequency of infection than non-household community exposures. Of the seven infections after workplace exposures, five had qualifying exposures to a co-worker and two were exposed to an infected patient during a non-aerosolized procedure. Conclusions: HCW exposure to SARS-CoV-2 continues to present staffing challenges to healthcare systems. Even with deviations from standard personal protective equipment protocol, workplace exposures resulted in low frequencies of infection. In our study, the primary source of HCW infection was exposure in the community. Our findings support investing in efforts to educate around continued masking and social distancing in the community in addition to interventions targeted at addressing vaccine hesitancy.

In this study, we compared the risk of coronavirus disease 2019 (COVID-19) between clinical and nonclinical healthcare workers (HCWs) while adjusting for home ZIP codes. Clinical HCWs did not have a higher risk of COVID-19, but living in higher-risk ZIP codes was associated with increased infection rates. However, environmental services workers showed increased risk of COVID-19.

Introduction: Private equity (PE) has had an increasing influence in health care, including procedural subspecialties such as orthopaedic surgery. No studies yet have characterized the orthopaedic practices that are acquired by PE firms. Methods: This cross-sectional study analyzed PE acquisitions of orthopaedic practices in the United States between January 1, 2016, and December 31, 2023. A combination of PitchBook and manual web searches was used to identify PE acquisitions. The Medicare Data on Provider Practice and Specialty were used to identify Tax Identification Numbers of practices and the unique providers of each practice at time of affiliation. Results: Eighty-nine orthopaedic practices were identified from 2016 to 2023, accounting for 4.8% of orthopaedists by 2023. More than three-quarters of acquisitions took place from 2021 to 2023 (77.5%). Nearly half of acquisitions were in the South (47.2%). At time of acquisition, 36.6% of providers in the practices were surgeons, 10.0% were nonsurgical physicians, and 53.4% were ancillary providers, such as advanced practice providers and therapists. The most represented subspecialties included sports (24.8%) and arthroplasty (18.2%), and the least represented were pediatrics (0.7%) and tumor (0.3%). Conclusion: PE involvement in orthopaedics skyrocketed in 2021. Practices targeted by PE firms typically included a multidisciplinary mix of providers, more than half of whom were nonphysician adjuncts, with a geographic predilection for the South. Orthopaedic subspecialties with historically higher reimbursements and outpatient volumes were overrepresented in PE-acquired practices. Future work should examine the resulting influence of PE in orthopaedics, including provider turnover, practice patterns, and clinical outcomes. Level of Evidence: Level III . See Instructions for Authors for a complete description of levels of evidence.