Innovative Management of Brodie's Abscess: Continuous Local Antibiotic Perfusion in a 14-Year-Old Patient.

Abstract

BACKGROUND Brodie's abscess is a rare form of subacute osteomyelitis that primarily affects the metaphyseal regions of long bones. Conventional treatment involves thorough curettage and systemic antibiotic therapy for ≥6 weeks, with bone grafting required for abscess sizes >3 cm. Continuous local antibiotic perfusion (CLAP) delivers high concentrations of antibiotics directly to the infection site and facilitates preservation of biologically active bone tissue. Here, we report a case of an extensive Brodie's abscess that was successfully treated with CLAP, highlighting its potential as an alternative to conventional treatment. CASE REPORT A 14-year-old boy was diagnosed with a 15-cm Brodie's abscess in the medial cortical bone of the left femur, with a primary infection in the intracortical pseudocavity. The patient underwent treatment with CLAP and intramedullary antibiotic perfusion pins were placed in the pseudocavity. Given the preservation of bone bioactivity, we anticipated spontaneous bone remodeling after infection control and therefore decided against bone grafting. The infection site received direct gentamicin infusions for 18 days, and systemic antibiotic therapy continued for 1 month. Postoperatively, the signs of inflammation rapidly subsided, and thereafter, no recurrence of infection was observed, while bone remodeling was achieved at the site of the bone defect. CONCLUSIONS In cases of cortical bone abscess, systemically administered antibiotics have limited penetration, whereas CLAP allows direct administration of high-concentration antibiotics to the lesion, which may provide an advantage in infection control. The findings of this case suggest that CLAP may serve as a viable treatment option for Brodie's abscess, particularly in cases with limited systemic antibiotic penetration.