title: Subacute physeal abscess: case report to illustrate treatment with a minimally invasive incision and drainage technique.
abstract: BACKGROUND
  Brodie's abscess is a form of subacute osteomyelitis characterised by a low grade pyogenic abscess found most commonly in the metaphysis. One rare form found in children crosses the physeal growth plate and into the epiphysis. Due to the rarity of this subtype and  apprehension associated with treatment of the transphyseal abscess, no clear guidance exists on its management.
  
  
  METHODS
  We present a case of delayed diagnosis of Brodie's abscess crossing the physis in a 14-year-old boy. He gave a one-year history of pain in the right knee  and early x-rays had shown lucent areas in the tibia. However, these were only noted to be significant at presentation one year later. We also describe an improvised minimally invasive and atraumatic technique of modifying a laminar suction catheter for accessing and draining the abscess.
  
  
  CONCLUSIONS
  From our experience and reports in the literature it is clear that antibiotic treatment is generally advocated with varying degrees of surgical intervention. Outcomes are largely favourable. Nevertheless, initial drainage allows samples to be sent for microbiological and histological assessment  to aid subsequent management and may prevent subsequent leg length discrepancy from failed conservative treatment. We believe that management of a transphyseal abscess must include early drainage and a prolonged course of antibiotics. The antibiotic choice and duration will be governed by  culture results and local policy but is commonly given for up to six weeks in the literature and must include one antistaphylococcal drug.
authors.affiliation: Princess Alexandra Hospital NHS Trust, UK. taimur.shah@doctors.org.uk
authors.forename: T T
authors.initials: TT
authors.lastname: Shah
authors.forename: K F
authors.initials: KF
authors.lastname: Chin
authors.forename: A
authors.initials: A
authors.lastname: Noorani
authors.forename: D
authors.initials: D
authors.lastname: Nairn
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002404:Catheterization / Q000295:instrumentation / Q000379:methods*; D003646:Debridement / Q000379:methods; D004867:Equipment Design; D006132:Growth Plate; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010019:Osteomyelitis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011859:Radiography; D013396:Suction / Q000379:methods; D013977:Tibia