The American Academy of Orthopaedic Surgeons (AAOS) released a 2025 update to their clinical practice guideline, Management of Acute Compartment Syndrome. Every five years the AAOS reviews this guideline, examines the latest evidence, and releases any relevant findings in an update. This most recent update received minor adjustments, primarily in the form of a single updated recommendation and the addition of supporting evidence, as outlined below.

According to the AAOS, the newly available evidence reviewed for this update did not warrant changing the guideline scope and so it was approved for updating via the AAOS Rapid Update Methodology. The following spotlights the singular recommendation update, along with the latest supportive evidence now included in the guideline.

Key Elements of the 2025 Update:

Updated recommendation – Associated Fracture: AAOS changed the recommendation level from Consensus (one star) to Limited (two stars).

  • 2025: "Limited evidence supports that operative fixation (external or internal) be performed for initial stabilization of long bone fractures with concomitant acute compartment syndrome requiring fasciotomy."
  • 2018: "In the absence of reliable evidence, it is the opinion of the work group that operative fixation (external or internal) should be performed for initial stabilization of long bone fractures with concomitant acute compartment syndrome requiring fasciotomy."

The AAOS also added in new, supportive evidence:

  • The Impacts of Internal Versus External Fixation For Tibial Fractures with Simultaneous Acute Compartment Syndrome (European Journal of Orthopaedic Surgery & Traumatologie, 2019)
  • Comparison of Single and Double Incision Leg Fasciotomy in Disaster Settings—Experience from 2023 Turkiye Earthquakes (Injury, 2024)
  • Regional Anesthesia Reduces Inpatient and Outpatient Perioperative Opioid Demand in Periarticular Elbow Surgery (Journal of Shoulder and Elbow Surgery, 2022)
  • Regional Anesthesia Associated with Decreased Inpatient and Outpatient Opioid Demand in Tibial Plateau Fracture Surgery (Anesthesia & Analgesia, 2022)
  • Evaluation of Clinical and Venous Blood Parameters as Surrogate Indicators in Assessing the Need For Fasciotomy in Lower Limb Compartment Syndrome (International Journal of Lower Extremity Wounds, 2021)
  • Single-Incision Fasciotomy Decreases Infection Risk Compared with Dual-Incision Fasciotomy in Treatment of Tibial Plateau Fractures with Acute Compartment Syndrome (Journal of Orthopaedic Trauma, 2023)
  • Is The Timing of Fixation Association with Fracture-Related Infection Among Tibial Plateau Fracture Patients with Compartment Syndrome? A Multicenter Retrospective Cohort Study of 729 Patients (Injury, 2022)
  • Early Versus Delayed Definitive Fixation Relative to Fasciotomy Closure in High-Energy Tibial Plateau Fractures with Compartment Syndrome (Journal of Orthopaedic Trauma, 2024)
  • Periarticular Multimodal Analgesia in Decreasing Perioperative Pain in Tibial Plateau (Injury, 2022)
  • Comparison of Dermatotraction and Negative Pressure Wound Therapy For Closure of Cruris Fasciotomy After 2023 (Joint Disease and Related Surgery, 2023)
  • A Dual-Sensor Ultrasound Based Method For Detecting Elevated Muscle Compartment Pressures: A Prospective Clinical Pilot Study (Injury, 2021)
  • Perfusion Pressure Lacks Diagnostic Specificity For the Diagnosis of Acute Compartment Syndrome (Journal of Orthopaedic Trauma, 2020)
  • Differences Between Primary and Secondary Definitive Osteosynthesis For Fractures of the Lower Leg with Concomitant Acute Compartment Syndrome (European Journal of Trauma & Emergency Surgery, 2020)

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