Adnan Çakar

Avascular necrosis of the femoral head (AVN) is a progressive disorder that may lead to femoral head deformity and total hip arthroplasty (THA). Bone marrow aspirate concentrate (BMAC) and hyperbaric oxygen therapy (HBOT) are used as adjuncts to core decompression (CD), but comparative evidence is limited. In this retrospective cohort study, 87 patients with Ficat–Arlet IIA–IIB AVN underwent CD + BMAC (n = 42, Group A) or CD + HBOT (n = 45, Group B) between 2012 and 2023. Inclusion required MRI-confirmed AVN, Tönnis grade 0–1, and a minimum follow-up of 24 months. Clinical outcomes were assessed using the Harris Hip Score (HHS), and radiological progression using the Tönnis classification. Most baseline characteristics were similar between groups, except for affected side (right-sided involvement: 45.2% versus 66.7%, P = 0.044) and bilaterality (50.0% versus 24.4%, P = 0.014). Among patients who did not undergo THA (n = 66; Group A, n = 31; Group B, n = 35), mean HHS did not differ between groups (83.68 ± 10.34 versus 82.69 ± 11.22, P = 0.711). Tönnis grade distribution (P = 0.361) and THA conversion rates (26.2% versus 22.2%, P = 0.803) also did not differ significantly between groups. Stage IIB patients showed worse outcomes, with shorter THA-free survival (log-rank P = 0.036). Two-way analysis of variance (ANOVA) revealed no treatment × stage interaction (P = 0.193). On multivariable analysis, the combined necrotic angle was the only independent predictor of both radiological progression and THA conversion, whereas Ficat stage was not independently associated with either outcome. The combined necrotic angle showed acceptable discrimination for THA conversion (AUC = 0.773). In this cohort, no significant difference in clinical or radiological outcomes was detected between CD + BMAC and CD + HBOT in early-stage femoral head AVN; however, the study was not powered to establish equivalence. Necrotic lesion extent was the strongest prognostic factor identified in this cohort. Level of Evidence: Therapeutic Level III, retrospective comparative study.

Background Although synovial fluid culture is the diagnostic gold standard for septic arthritis, culture negativity is common and reported rates range widely, from approximately 20% to 60%, depending on diagnostic criteria, prior antibiotic exposure, and culture methodology. Existing prediction scores focus on differentiating septic from aseptic arthritis but do not predict culture positivity in patients with established septic arthritis. We developed and internally evaluated the Istanbul Septic Arthritis Score (ISAS) to predict synovial fluid culture positivity in native adult knee septic arthritis. Methods This retrospective cohort study included 198 adult patients (≥ 18 years) treated for native knee septic arthritis at a tertiary referral center between January 2006 and December 2025. Septic arthritis was diagnosed using the Newman classification criteria (Grade A: culture-positive; Grade C: culture-negative with intraoperative purulence and clinical findings). Demographic, clinical, serum laboratory, and synovial fluid parameters were analyzed. Multivariable logistic regression identified independent predictors of culture positivity, which were used to develop a simplified clinical scoring system. Results Of 198 patients, 60 (30.3%) had culture-positive and 138 (69.7%) had culture-negative septic arthritis. Three independent predictors of culture positivity were identified: serum C-reactive protein (OR = 1.006 per mg/L, p < 0.001), synovial fluid leukocyte count (OR = 1.041 per 10,000/mm³, p = 0.010), and younger age (OR = 0.980 per year, p = 0.021). The ISAS score (range 0–7 points) demonstrated moderate discriminative ability (AUC = 0.713, 95% CI: 0.631–0.795, p < 0.001), equivalent to the full multivariable model. Using a cut-point of ≥ 5, two risk groups showed clear separation in culture positivity: a lower-risk group (0–4 points, 19.5%) and a higher-risk group (5–7 points, 52.3%) (p < 0.001). Conclusion ISAS is a simple, preliminary tool that may help estimate synovial fluid culture positivity in native adult knee septic arthritis and is intended to support, not replace, clinical judgement. In higher-risk patients (ISAS ≥ 5), broader empiric antimicrobial coverage, extended culture incubation, and molecular diagnostic methods may warrant consideration alongside clinical judgement and local microbiological protocols. As this score was derived from a single-center retrospective cohort, external validation in multicenter prospective settings is essential before routine clinical use. Clinical trial registration Not applicable.

Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.

Purpose Titanium elastic nail (TEN) is a good option for femoral shaft fractures in school-age children, whereas a spica cast is favored for younger patients. We aimed to compare these treatment modalities in a group of children aged three to six years. Methods 34 patients aged 3–6 years with an isolated closed femoral shaft fracture treated with TEN or one-leg spica cast immobilization were retrospectively assessed. Age, gender, weight, mechanism of injury, hospital stay time, bone union time, radiographic shortening, malunion, and complications were compared between the treatment groups. Results 16 (47.1%) patients who were treated with TEN (Group T) and 18 (52.9%) patients with spica casting (Group S) were included with a mean of 51 (24–94) months follow-up. The mean age was 4.98 years and statistically similar between both groups (mean, 5.2 vs. 4.8 years; p = 0.234). The patients in Group T were heavier (mean, 19.3 vs. 17.2 kg; p < 0.001) and were more likely to have a higher-energy mechanism of injury (p = 0.006). The mean late femoral shortening of Group S patient’s was 6.5 ± 3.5 mm and significantly higher than Group T, which was 2.0 ± 2.9 (p = 0.050). However, effective late femoral shortening rates were not statistically different between groups (p = 0.347). Malunion was seen in six (33.3%) patients in Group S, whereas none of the patients in Group T had malunion at the last follow-up examination and were statistically different (p = 0.011). Conclusion Our study identified radiographic evidence favoring TEN over spica cast immobilization in treating preschool-age children with an isolated femoral shaft fracture in terms of malunion.