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

Area of Science:

• Orthopedics
• Infectious Diseases
• Pharmacology

Background:

• Brodie's abscess is a rare subacute osteomyelitis affecting long bones.
• Conventional treatment includes curettage, long-term antibiotics, and potentially bone grafting for large abscesses.
• Systemic antibiotics have limited penetration in cortical bone abscesses.

Purpose of the Study:

• To report a case of extensive Brodie's abscess treated with Continuous Local Antibiotic Perfusion (CLAP).
• To highlight CLAP as a potential alternative to conventional treatments.
• To evaluate the efficacy of CLAP in infection control and bone preservation.

Main Methods:

• A 14-year-old boy with a 15-cm femoral Brodie's abscess was treated with CLAP.
• Intramedullary antibiotic perfusion pins were used for direct gentamicin delivery (18 days).
• Systemic antibiotics were administered for 1 month; bone grafting was avoided.

Main Results:

• Rapid subsidence of inflammatory signs post-treatment.
• No recurrence of infection observed.
• Successful bone remodeling achieved at the defect site without grafting.

Conclusions:

• CLAP enables direct, high-concentration antibiotic delivery to bone abscesses, overcoming limitations of systemic therapy.
• CLAP is a viable treatment option for Brodie's abscess, especially when systemic penetration is poor.
• Preservation of bone bioactivity with CLAP may facilitate spontaneous bone remodeling.