Brodie's abscess is a sub-acute form of osteomyelitis, presenting as a collection of pus in bone, often with an insidious onset. It's first description in the medical literature was in 1832 by sir Benjamin Brodie during a lecture held for the Medical and Surgical Society. The first case he described, a 24-year old male, had suffered half his life with bouts of severe pain originating from a bony swelling above the right ankle. Since no other treatment was successful they decided to amputate the affected limb. Examination of the amputated specimen showed a walnut sized collection of pus. This is when Brodie hypothesized that limb sparing surgery by means of trephination and thus drainage of the abscess should be the cornerstone of treatment. In this pre-antibiotic era this was the only treatment option available. There are several etiologies concerning bone infections: Fracture related bone infection after (open) trauma, exposed bone in diabetic wounds or haematogenous osteomyelitis. The primary site of bacterial spread is often unknown. It is hypothesized that susceptibility of bone is increased after bone bruising resulting from minor prior trauma without open wounds or a fracture. Brodie's abscess is a contained infection in the myelum, surrounded by a sclerotic wall. Thus leading to little systematic inflammatory response.
Other diseases can present similarly to Brodie's abscess and warrant further investigations, such as osteoid osteoma, Langerhans cell histiocytosis, chondrasarcoma, eosinphilic granuloma or tuberculosis.
Treatment of a Brodie's abscess is based on the preference of the health care professional, as no publications other than case reports and series are available. The aims of this article are description of the clinical characteristics, surgical treatment, outcome and consequence of Brodie's abscess based on the case-reports described in the medical literature up to now.