The American Academy of Orthopaedic Surgeons guideline on acute compartment syndrome, released in November 2025, has now been interpreted in detail against the 2020 Chinese guideline. It carries eight recommendations and seven consensus statements covering diagnosis, surgical decision-making and perioperative care.

Three points separate it from earlier practice. On compartment pressure, both guidelines value monitoring, but the AAOS emphasis is on dynamic monitoring to help rule the diagnosis out, rather than on a single pressure reading to rule it in. On biomarkers, it accepts only myoglobinuria, serum troponin and, in specific contexts, femoral venous lactate as adjuncts - and states explicitly that serum biomarkers must not form the basis of a fasciotomy decision in late or missed compartment syndrome. On associated fractures, early fixation of long bones moves from expert consensus to a limited recommendation.

The biomarker statement is the one to carry into the trauma room. A normal creatine kinase or lactate in a limb you are worried about is not reassurance, and a raised one in a limb you are not worried about is not an indication. The diagnosis remains clinical and serial - pain out of proportion, pain on passive stretch, a tense compartment, a patient who needs re-examining rather than a repeat blood test. Once it is made, decompress.

Re-examine serially and document each examination; a single assessment cannot exclude the diagnosis
Use compartment pressure monitoring to help exclude, not as the sole trigger to operate
Do not delay or withhold fasciotomy on the basis of a normal serum biomarker
Check for myoglobinuria and troponin as adjuncts, knowing they do not decide the operation
Plan early fixation of an associated long bone fracture rather than deferring it by default

Why it matters

Biomarkers have been creeping into a decision they cannot support, and a normal one is exactly how a missed compartment syndrome gets justified afterwards.

Don't overread it

This is an interpretation of a guideline issued in November 2025, not new trial evidence, and the fracture-fixation recommendation is graded as limited.