The diagnosis chronic exertional compartment syndrome is traditionally linked to elevated intracompartmental pressures, although uncertainty regarding this diagnostic instrument is increasing. The aim of current review was to evaluate literature for alternative diagnostic tests. A search in line with PRISMA criteria was conducted. Studies evaluating diagnostic tests for chronic exertional compartment syndrome other than intracompartmental pressure measurements were included. Bias and quality of studies were evaluated using the Oxford Levels of Evidence and the QUADAS-2 instrument. A total of 28 studies met study criteria (MRI n=8, SPECT n=6, NIRS n=4, MRI and NIRS together n=1, miscellaneous modalities n=9). Promising results were reported for MRI (n = 4), NIRS (n = 4) and SPECT (n = 3). These imaging techniques rely on detecting changes of signal intensity in manually selected regions of interest in the muscle compartments of the leg. Yet, diagnostic tools and protocols were diverse. Moreover, five studies explored alternative modalities serving as an adjunct, rather than replacing pressure measurements. Future research is warranted as clinical and methodological heterogeneity were present and high quality validation studies were absent. Further optimization of specific key criteria based on a patient’s history, physical examination and symptom provocation may potentially render intracompartmental pressure measurement redundant.

A 44-year-old man with a 9-day-old left displaced midshaft clavicle fracture was initially treated conservatively. The patient experienced an increase of pain with tickling and cold sensation in the left upper extremity. CT angiography showed left subclavian artery occlusion over 3 cm at the level of the fracture. At surgical repair, a subclavian-brachial bypass was constructed and fracture fixation was done with an eight-hole locking compression plate. Follow-up at 6 months showed full range of motion of the left shoulder, an open bypass and fracture consolidation.

Background Vascular access is a prerequisite for Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) placement. Training such skills to emergency physicians (EPs) could contribute to better outcomes in non-compressible truncal hemorrhage patients. This study aimed to determine whether a concise training program could train EPs to recognize anatomical structures and correctly visualize and identify the puncture site for percutaneous placement of a REBOA catheter. Methods Eleven EPs participated in our training program, including basic anatomy and training in access materials for REBOA. Participants underwent expert-guided practice on each other and were then tested on key skills to include: identification of anatomical structures, anatomical knowledge, technical skills for vascular access imaging with a handheld ultrasound, and time to identify adequate puncture site of the Common Femoral Artery (CFA) with ultrasound. Consultant vascular surgeons functioned as expert controls. Results EPs had a median overall technical skills score of 32.5 [27.0-35.0]. All EPs were able to identify the correct CFA puncture site with a median time of 52.9 seconds [35.6-63.7] at the first attempt and 34.0 seconds [21.2-44.7] at the post-test (Z=-2.756, p=0.006). Consultant vascular surgeons were significantly faster (p=0.000). Conclusions EPs are capable of visualizing the femoral artery and vein within one minute. The speed of correct visualisation improved rapidly after repetition. Our concise theoretical and practical training program proved useful regardless of prior endovascular experience and training. This program, as a component of an expanded Endovascular Resuscitation and Trauma Management curriculum, in combination with realistic task training models (simulator, perfused cadaver, or live tissue) has the potential to provide effective training of the skills required to competently perform REBOA.