Brodie’s abscess is a type of osteomyelitis with a chronic course and the formation of a limited abscess in the spongy substance of the bone. It is characterized by a sluggish flow. There are recurrent exudative synovitis, soreness during palpation, weather changes, after physical exertion. Some patients develop periodic exacerbations with increased pain. The diagnosis is made based on the results of a clinical examination, radiography, CT. At the initial stages, immobilization, antibiotic therapy is carried out, followed by autopsy, scraping, if necessary, with filling the cavity with bone chips or special implants.
ICD 10
86.8 Other osteomyelitis (Brodie’s abscess)
General information
Brodie’s abscess is a rare form of osteomyelitis with an atypical favorable course. It is usually diagnosed in adolescents and young people, mainly male. In 80% of cases, it is localized in the metaphyses of the tibia, the proximal part of the segment suffers more often. It can affect the femur and humerus, less often – other tubular bones. Spongy bones are rarely involved. A significant duration of the disease is typical (up to several decades), symptoms simulating joint damage, a variable X-ray picture.
Causes
Brodie’s abscess is caused by various low-virulent strains of staphylococci. Most often, the causative agent is Staphylococcus aureus. Infection occurs hematogenically from distant endogenous foci (carious teeth, inflamed tonsils in chronic tonsillitis, etc.). Previous acute viral infections, minor injuries, and immune disorders are considered as predisposing factors. Pathology usually develops in adolescence, before ossification of the epiphyseal plate.
Pathogenesis
After the penetration of pathogenic microorganisms into the bones, a single focus of a teardrop-shaped or oblong shape with a diameter of 1.5-2 cm is formed, often located superficially in the subcostal layer. With a prolonged course, the size of the abscess can increase to 4-5 cm. Pronounced osteosclerosis is formed around the focus. The thickening of the periosteum is determined. The contents of the abscess are represented by granulation growths, serous or purulent fluid. The appearance of fistulas and bone deformities is uncharacteristic.
Symptoms
Pathology manifests itself by an increase in body temperature to febrile figures, general weakness, weakness, symptoms of intoxication. The listed manifestations persist for 2-3 days. Immediately after that, or after a few days, local aching pains occur in the periarticular area. Subsequently, Brodie’s proceeds chronically. Patients complain about the appearance of painful sensations when weather conditions change, after loading on the limb.
It is possible to increase pain at night. Some patients have periodic exacerbations, during which there is an increase in the duration and intensity of the pain syndrome without worsening the general condition. Articular symptoms often prevail in the clinical picture. Recurrent synovitis is detected. There may be some restriction of movements due to reactive aseptic inflammation of the articular cavity.
Complications
Brodie’s abscess is characterized by a favorable course. Complications rarely develop. Sequestration usually does not form. Individual cases of the formation of external fistulas and the breakthrough of the contents of the abscess into the joint cavity with the appearance of purulent arthritis are described.
Diagnostics
The establishment of the etiology of the disease is carried out by traumatologists. Diagnosis is often difficult due to the peculiarities of symptoms and variability of the X-ray picture of pathology. The following diagnostic measures are carried out:
- Physical examination. An external examination reveals minor edema, mild local hyperthermia, and increased vascular network. During the period of synovitis recurrence, fluctuation is detected. Signs of inflammation in the blood are poorly expressed, so laboratory tests are not informative.
- Radiography. In typical cases, the images show a single isolated rounded bone cavity of the correct shape, the length of which coincides with the length of the bone. The cavity is surrounded by a strip of osteosclerosis. The metaphysis is somewhat thickened due to periosteal layers.
- Computed tomography. Confirms the presence of an intraosseous cystic formation surrounded by an ossification zone, a bright periosteal reaction with sclerotic transformation.
Differential diagnosis
Brodie’s abscess is differentiated with ordinary chronic osteomyelitis, osteoarticular tuberculosis, bone cyst, gumma, osteoid osteoma, eosinophilic granuloma. Normal osteomyelitis is characterized by sequestration, the formation of rough periosteal growths, alternating areas of osteosclerosis and osteoporosis. The bone cyst is larger, with a multicameral structure.
With bone tuberculosis, the focus is smaller, irregularly shaped, with a spongy sequester, prone to a rapid breakthrough to the surface of the skin or into the joint cavity. Gummas in the vast majority of cases are multiple, have less smooth contours. In eosinophilic granulomas, cardboard-like contours and a less pronounced rim of sclerosis are visible in the images. Osteoid osteomas are manifested by gradually increasing pains.
Treatment
Treatment is carried out in a hospital setting. Depending on the stage of the disease, conservative or surgical tactics may be indicated. Conservative measures are carried out at early stages, including:
- the application of a plaster cast for a period of 3-4 weeks;
- antibiotic therapy taking into account the sensitivity of microflora;
- physical therapy (UHF).
If the above measures are ineffective, the admission of a patient with a long-term Brody abscess shows excision of the pathological focus within the unchanged tissues. Small cavities are scraped, washed, drained, large ones are filled with bone chips after removal of the affected tissues to improve healing. In the postoperative period, bandages are performed, antibiotics are prescribed intramuscularly.
In recent years, biocompatible composite implants in the form of rods, plates and pins have been used to fight infection and stimulate osteogenesis. Antibiotics, orotic acid and calcium gluconate are applied to the surface of the implants. The drugs have antimicrobial and osteotropic effects, the structure gradually resolves over a period of 8 months to 3 years as normal bone is formed.
Forecast
The forecast is quite favorable. With an early start of treatment, the elimination of a purulent focus is possible, although in practice such cases are observed infrequently due to the late admission of patients and other factors. Despite the tendency to a long course, Brodie’s abscess rarely causes the development of serious complications. The ability to work is preserved. The outcome of surgical interventions is good.
Prevention
Preventive measures involve timely treatment of foci of chronic infection, correction of immune disorders, adequate therapy of viral infections. An important role in the early detection of the disease and the prevention of its long-term course is played by a full-fledged examination, including radiography of the joint with the capture of the metaphysical zone.
