Interpretation of 2025 American Academy of Orthopaedic Surgeons (AAOS) on Management of Acute Compartment Syndrome Evidence-Based Clinical Practice Guideline_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YE Yi , LU Bing , XIAO Chengwei , LAN Fei , LI Xiaoxue ,  ZHANG Kun

Department of Orthopedics, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Affiliated Hospital of University of Electronic Science and Technology of China, Chengdu Sichuan, 610072, P. R. China;

Corresponding?author：

ZHANG Kun, Email: 18880442561@163.com

Keywords：

Acute compartment syndrome; American Academy of Orthopaedic Surgeons (AAOS); clinical practice guideline; guideline interpretation

DOI：

10.7507/1002-1892.202603087

Video：

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In November 2025, the American Academy of Orthopaedic Surgeons (AAOS) released the updated Clinical Practice Guideline for the Management of Acute Compartment Syndrome (ACS). This guideline addresses key issues including early diagnostic strategies, surgical decision-making, and perioperative management, presenting 8 recommendations and 7 consensus statements. A systematic interpretation highlights the core recommendations regarding the diagnostic value of biomarkers, the important role of compartment pressure monitoring, surgical decision-making, and wound management. A major update is the upgrade of the recommendation for early fixation of long bone fractures in ACS patients with associated fractures from expert consensus to a limited recommendation. Compared with the Chinese Guideline for Early Diagnosis and Treatment of Acute Compartment Syndrome (2020 edition), there were three key similarities and differences. Diagnostic strategy: both guidelines value compartment pressure monitoring, but the Chinese guideline emphasizes its diagnostic role, whereas the AAOS guideline focuses on its utility in dynamic monitoring to help rule out ACS. Biomarkers: Chinese guidelines suggests that serum lactate, serum cardiac troponin, and myoglobinuria may serve as indicators of traumatic ACS; the AAOS guideline only recognizes myoglobinuria, serum troponin, and, in specific contexts, femoral venous lactate as having adjunctive value, and explicitly states that serum biomarkers should not be used as the basis for fasciotomy decision-making in late or missed ACS. Treatment: both guidelines emphasize that once the diagnosis is confirmed, early fasciotomy should be performed. The AAOS guideline provides a reference for Chinese clinicians to improve early recognition and standardized management of ACS.

Citation： YE Yi, LU Bing, XIAO Chengwei, LAN Fei, LI Xiaoxue, ZHANG Kun. Interpretation of 2025 American Academy of Orthopaedic Surgeons (AAOS) on Management of Acute Compartment Syndrome Evidence-Based Clinical Practice Guideline. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(9): 1346-1350. doi: 10.7507/1002-1892.202603087 Copy

1.	中華醫學會骨科學分會外固定與肢體重建學組, 中國醫師協會創傷外科醫師分會創傷感染專業委員會, 中國醫師協會骨科醫師分會創傷專家工作委員會. 中國急性骨筋膜室綜合征早期診斷與治療指南(2020版)[J]. 中華創傷骨科雜志, 2020, 22(8): 645-654.
2.	von Keudell AG, Weaver MJ, Appleton PT, et al. Diagnosis and treatment of acute extremity compartment syndrome[J]. Lancet, 2015, 386(10000): 1299-1310.
3.	Bouklouch Y, Miclau T, Harvey E. Diagnosis of acute compartment syndrome: current diagnostic parameters. Injury, 2025, 56 Suppl 1: 112773. doi: 10.1016/j.injury.2025.112773.
4.	游靖宇, 劉少云, 張茂. 急性骨筋膜室綜合征的診治研究進展[J]. 創傷外科雜志, 2020, 22(6): 470-473.
5.	American Academy of Orthopaedic Surgeons. Management of acute compartment syndrome evidence-based clinical practice guideline[EB/OL]. (2025-11-18) [2026-03-01]. https://www.aaos.org/quality/quality-programs/acute-compartment-syndrome/?tab=all_guidelines.
6.	Cunningham DJ, LaRose MA, Zhang GX, et al. Regional anesthesia reduces inpatient and outpatient perioperative opioid demand in periarticular elbow surgery[J]. J Shoulder Elbow Surg, 2022, 31(2): e48-e57.
7.	Dasgupta R, Ekka NMP, Das A, et al. Evaluation of clinical and venous blood parameters as surrogate indicators in assessing the need for fasciotomy in lower limb compartment syndrome[J]. Int J Low Extrem Wounds, 2024, 23(3): 403-411.
8.	DeKeyser G, Bunzel E, O’Neill D, et al. Single-incision fasciotomy decreases infection risk compared with dual-incision fasciotomy in treatment of tibial plateau fractures with acute compartment syndrome[J]. J Orthop Trauma, 2023, 37(10): 519-524.
9.	Dubina AG, Morcos G, O’Hara NN, et al. Is the timing of fixation associated with fracture-related infection among tibial plateau fracture patients with compartment syndrome? A multicenter retrospective cohort study of 729 patients[J]. Injury, 2022, 53(11): 3814-3819.
10.	Flagstad I, Albright P, Pedri T, et al. Early versus delayed definitive fixation relative to fasciotomy closure in high-energy tibial plateau fractures with compartment syndrome[J]. J Orthop Trauma, 2024, 38(6): 195-200.
11.	Kellam PJ, Dekeyser GJ, Marchand LS, et al. Periarticular multimodal analgesia in decreasing perioperative pain in tibial plateau fractures: A double blind randomized controlled pilot study[J]. Injury, 2022, 53(12): 4123-4128.
12.	K?l??arslan K, Erdo?an Y, Karaman Y, et al. Comparison of dermatotraction and negative pressure wound therapy for closure of cruris fasciotomy after 2023 Kahramanmaras earthquake[J]. Jt Dis Relat Surg, 2023, 34(2): 497-502.
13.	Marmor MT, Barker JP, Matz J, et al. A dual-sensor ultrasound based method for detecting elevated muscle compartment pressures: A prospective clinical pilot study[J]. Injury, 2021, 52(8): 2166-2172.
14.	Schmidt AH, Di J, Zipunnikov V, et al. Perfusion pressure lacks diagnostic specificity for the diagnosis of acute compartment syndrome[J]. J Orthop Trauma, 2020, 34(6): 287-293.
15.	Ull C, Jansen O, Seybold D, et al. Differences between primary and secondary definitive osteosynthesis for fractures of the lower leg with concomitant acute compartment syndrome[J]. Eur J Trauma Emerg Surg, 2020, 46(5): 1167-1173.
16.	Cunningham DJ, LaRose M, Zhang G, et al. Regional anesthesia associated with decreased inpatient and outpatient opioid demand in tibial plateau fracture surgery[J]. Anesth Analg, 2022, 134(5): 1072-1081.
17.	Akbari Aghdam H, Sheikhbahaei E, Hajihashemi H, et al. The impacts of internal versus external fixation for tibial fractures with simultaneous acute compartment syndrome[J]. Eur J Orthop Surg Traumatol, 2019, 29(1): 183-187.
18.	Bar?a F, Atilla HA, Demir EB, et al. Comparison of single and double incision leg fasciotomy in disaster settings—Experience from 2023 Türkiye earthquakes[J]. Injury, 2024, 55(6): 111582. doi: 10.1016/j.injury.2024.111582.
19.	Alamshah SM, Jahanshahi A, Minaee H, et al. Investigating correlation of lower extremity muscle compartment syndrome with muscle related serum enzyme tests: Is any reliable biomarker? Biomed Pharmacol J, 2016, 9(3): 1183-1188.
20.	Mitas P, Vejrazka M, Hruby J, et al. Prediction of compartment syndrome based on analysis of biochemical parameters[J]. Ann Vasc Surg, 2014, 28(1): 170-177.
21.	Cancio LC, Jimenez-Reyna JF, Barillo DJ, et al. One hundred ninety-five cases of high-voltage electric injury[J]. J Burn Care Rehabil, 2005, 26(4): 331-340.
22.	Janzing HM, Broos PL. Routine monitoring of compartment pressure in patients with tibial fractures: Beware of overtreatment! Injury, 2001, 32(5): 415-421.
23.	Kim TH, Chung JY, Kim KS, et al. Is external fixation needed for the treatment of tibial fractures with acute compartment syndrome? Injury, 2018, 49(2): 376-381.
24.	Mittal N, Bohat R, Virk JS, et al. Dermotaxis v/s loop suture technique for closure of fasciotomy wounds: a study of 50 cases[J]. Strategies Trauma Limb Reconstr, 2018, 13(1): 35-41.

1. 中華醫學會骨科學分會外固定與肢體重建學組, 中國醫師協會創傷外科醫師分會創傷感染專業委員會, 中國醫師協會骨科醫師分會創傷專家工作委員會. 中國急性骨筋膜室綜合征早期診斷與治療指南(2020版)[J]. 中華創傷骨科雜志, 2020, 22(8): 645-654.
2. von Keudell AG, Weaver MJ, Appleton PT, et al. Diagnosis and treatment of acute extremity compartment syndrome[J]. Lancet, 2015, 386(10000): 1299-1310.
3. Bouklouch Y, Miclau T, Harvey E. Diagnosis of acute compartment syndrome: current diagnostic parameters. Injury, 2025, 56 Suppl 1: 112773. doi: 10.1016/j.injury.2025.112773.
4. 游靖宇, 劉少云, 張茂. 急性骨筋膜室綜合征的診治研究進展[J]. 創傷外科雜志, 2020, 22(6): 470-473.
5. American Academy of Orthopaedic Surgeons. Management of acute compartment syndrome evidence-based clinical practice guideline[EB/OL]. (2025-11-18) [2026-03-01]. https://www.aaos.org/quality/quality-programs/acute-compartment-syndrome/?tab=all_guidelines.
6. Cunningham DJ, LaRose MA, Zhang GX, et al. Regional anesthesia reduces inpatient and outpatient perioperative opioid demand in periarticular elbow surgery[J]. J Shoulder Elbow Surg, 2022, 31(2): e48-e57.
7. Dasgupta R, Ekka NMP, Das A, et al. Evaluation of clinical and venous blood parameters as surrogate indicators in assessing the need for fasciotomy in lower limb compartment syndrome[J]. Int J Low Extrem Wounds, 2024, 23(3): 403-411.
8. DeKeyser G, Bunzel E, O’Neill D, et al. Single-incision fasciotomy decreases infection risk compared with dual-incision fasciotomy in treatment of tibial plateau fractures with acute compartment syndrome[J]. J Orthop Trauma, 2023, 37(10): 519-524.
9. Dubina AG, Morcos G, O’Hara NN, et al. Is the timing of fixation associated with fracture-related infection among tibial plateau fracture patients with compartment syndrome? A multicenter retrospective cohort study of 729 patients[J]. Injury, 2022, 53(11): 3814-3819.
10. Flagstad I, Albright P, Pedri T, et al. Early versus delayed definitive fixation relative to fasciotomy closure in high-energy tibial plateau fractures with compartment syndrome[J]. J Orthop Trauma, 2024, 38(6): 195-200.
11. Kellam PJ, Dekeyser GJ, Marchand LS, et al. Periarticular multimodal analgesia in decreasing perioperative pain in tibial plateau fractures: A double blind randomized controlled pilot study[J]. Injury, 2022, 53(12): 4123-4128.
12. K?l??arslan K, Erdo?an Y, Karaman Y, et al. Comparison of dermatotraction and negative pressure wound therapy for closure of cruris fasciotomy after 2023 Kahramanmaras earthquake[J]. Jt Dis Relat Surg, 2023, 34(2): 497-502.
13. Marmor MT, Barker JP, Matz J, et al. A dual-sensor ultrasound based method for detecting elevated muscle compartment pressures: A prospective clinical pilot study[J]. Injury, 2021, 52(8): 2166-2172.
14. Schmidt AH, Di J, Zipunnikov V, et al. Perfusion pressure lacks diagnostic specificity for the diagnosis of acute compartment syndrome[J]. J Orthop Trauma, 2020, 34(6): 287-293.
15. Ull C, Jansen O, Seybold D, et al. Differences between primary and secondary definitive osteosynthesis for fractures of the lower leg with concomitant acute compartment syndrome[J]. Eur J Trauma Emerg Surg, 2020, 46(5): 1167-1173.
16. Cunningham DJ, LaRose M, Zhang G, et al. Regional anesthesia associated with decreased inpatient and outpatient opioid demand in tibial plateau fracture surgery[J]. Anesth Analg, 2022, 134(5): 1072-1081.
17. Akbari Aghdam H, Sheikhbahaei E, Hajihashemi H, et al. The impacts of internal versus external fixation for tibial fractures with simultaneous acute compartment syndrome[J]. Eur J Orthop Surg Traumatol, 2019, 29(1): 183-187.
18. Bar?a F, Atilla HA, Demir EB, et al. Comparison of single and double incision leg fasciotomy in disaster settings—Experience from 2023 Türkiye earthquakes[J]. Injury, 2024, 55(6): 111582. doi: 10.1016/j.injury.2024.111582.
19. Alamshah SM, Jahanshahi A, Minaee H, et al. Investigating correlation of lower extremity muscle compartment syndrome with muscle related serum enzyme tests: Is any reliable biomarker? Biomed Pharmacol J, 2016, 9(3): 1183-1188.
20. Mitas P, Vejrazka M, Hruby J, et al. Prediction of compartment syndrome based on analysis of biochemical parameters[J]. Ann Vasc Surg, 2014, 28(1): 170-177.
21. Cancio LC, Jimenez-Reyna JF, Barillo DJ, et al. One hundred ninety-five cases of high-voltage electric injury[J]. J Burn Care Rehabil, 2005, 26(4): 331-340.
22. Janzing HM, Broos PL. Routine monitoring of compartment pressure in patients with tibial fractures: Beware of overtreatment! Injury, 2001, 32(5): 415-421.
23. Kim TH, Chung JY, Kim KS, et al. Is external fixation needed for the treatment of tibial fractures with acute compartment syndrome? Injury, 2018, 49(2): 376-381.
24. Mittal N, Bohat R, Virk JS, et al. Dermotaxis v/s loop suture technique for closure of fasciotomy wounds: a study of 50 cases[J]. Strategies Trauma Limb Reconstr, 2018, 13(1): 35-41.

Chinese Journal of Reparative and Reconstructive Surgery

Interpretation of 2025 American Academy of Orthopaedic Surgeons (AAOS) on Management of Acute Compartment Syndrome Evidence-Based Clinical Practice Guideline

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