[Diagnosis and treatment of Brodie's abcess in adults: about twenty cases].
BACKGROUND
Brodie's abscess is a bone abscess described as a localized primary purulent collection with sclerotic wall. Since the first report of Sir Benjamin Brodie in 1832, many papers described different clinical and treatment aspects. Pathogeny and therapy still remain not clearly elucidated.


OBJECTIVE
The aim of our study is to describe clinical aspect and to study the result of treatment including surgery and antibiotics.


METHODS
Our study is retrospective including 20 patients admitted to the author's institution for isolated bone abscess. The mean age of these patients is 30 years old (14 up to 46 years) with male predominance. Symptoms were chronic including localized pain with no systemic illness. The erythrocyte sedimentation rate was elevated in 2/3 of the cases. Roentegenogram was typical in 18 cases showing metaphysic cyst with sclerotic wall. Tibia was the most involved bone, 14 among 20 cases. Bacteriological study of the abscess pus isolated staphylococcus in 12 cases and pseudomonas in two cases. No organism was identified in the six remaining cases. Histopathological study showed chronic osteomyelitis with granulation including lymphocytes and plasma cells in all cases. Surgery and antibiotics were adequate for treatment in all cases. Our approach consisted in curettage without primary skin closure, cast immobilisation and antibiotics.


RESULTS
Our patients were followed up over a median period of six years (8 months to 10 years). Overall, the results of treatment were good and in the long-term the abscess disappeared in all cases without recurrence. The erythrocyte sedimentation rate was normalized in 10 weeks and roentegenologically, the abscess disappeared progressively without osteomyelitis complication.


CONCLUSIONS
According to our study, we believe that surgical treatment based on total excision of the bone collection and the sclerotic wall is the best method of therapy. As a matter of fact, healing was obtained without grafting in all cases and in the long-term follow up, abscess disappeared without recurrence and fistulisation.
Kanoun
Mohamed Lassaad
ML
Service des urgences traumatologiques, Hôpital Aziza Othmana, Tunisie.
Khorbi
Adel
A
Khmiri
Chekib
C
Tebourbi
Anis
A
Hadded
Naoufel
N
Boughzala
Walid
W
Ben Maitig
Mahmoud
M
Chebil
Mounir
M
Hachem
Abdelhamid
A
Essadem
Hamza
H
D000038:Abscess / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001845:Bone Cysts / Q000175:diagnosis; D002370:Casts, Surgical; D003475:Curettage; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008214:Lymphocytes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D010026:Osteosclerosis / Q000175:diagnosis; D010950:Plasma Cells / Q000473:pathology; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000628:therapy; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000628:therapy; D013977:Tibia / Q000382:microbiology / Q000473:pathology
D000900:Anti-Bacterial Agents