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

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.