Treatment for Brodie’s abscess of the radius in an adolescent: A case report

Highlights

• •

  Brodie’s abscess occurring in upper extremities is rare.

• •

  Penumbra sign identified on MRI is a useful finding for diagnosis.

• •

  We recommend that bone grafting after curettage of the abscess cavity is not always necessary for upper extremities.

Abstract

Introduction

Brodie’s abscess is an uncommon type subacute osteomyelitis. It is typically localized in the metaphysis of tubular bones, particularly in the lower extremities. We herein report a rare case of the abscess appearing in the upper extremities. Furthermore, we successfully treated the large abscess without autogenous bone grafting.

Presentation of case

14-year-old female presented with pain and swelling on the right forearm. Plain radiograph and CT scan indicated a 10 cm longitudinal cortical bone hypertrophy and a well-defined radiolucent lesion in the diaphysis of the right radius. MRI demonstrated that the lesion was hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging inside as well as outside the bone marrow of the radius. Laboratory data showed no inflammatory response, but Staphylococcus aureus was detected by biopsy. We diagnosed Brodie’s abscess of the radius, and performed definitive surgery. Infected bone marrow was curetted and a bony sequestrum inside the cortical bone was harvested. We did not use autogenous bone grafting, since the upper extremities are areas of unloaded bone. Postoperative administration of antibiotics was subsequently performed. One year after surgery, the patient was asymptomatic and there were no complications or signs of infection recurrence.

Conclusion

We diagnosed and surgically treated a rare case of Brodie’s abscess of the radius in an adolescent. An abscess with large cavity is usually treated by curettage and autogenous cancellous bone grafting. However, since the upper extremities are areas of unloaded bone, we successfully treated the abscess by debridement without bone grafting.