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Subacute Osteomyelitis (Brodie Abscess): Follow-up

Author: Khalid Khoshhal, MBBS, FRCS Ed, ABOS, Vice Dean, College of Medicine; Assistant Professor, Pediatric Orthopedic Surgery, Department of Orthopedics, Taibah University, Saudi Arabia
Coauthor(s): Robert Mervyn Letts, MD, FRCS(C), FACS, Former Chief, Department of Surgery, Division of Pediatric Orthopedics, Children's Hospital of Eastern Ontario, University of Ottawa; Consultant Pediatric Orthopedic Surgeon, Sheikh Khalifa Medical City, UAE
Contributor Information and Disclosures

Updated: Jul 18, 2008

Outcome and Prognosis

Subacute osteomyelitis is difficult to diagnose, but, once diagnosed, it is a curable disease with a 100% cure rate. Hamdy et al reported their results in treating 44 patients24 of which 24 were treated with antibiotics only, and 20 had surgical debridement followed by antibiotics. With the exception of 1 patient who received inadequate antibiotic therapy, all patients responded well, regardless of whether treatment was conservative or surgical. At an average follow-up of 18 months, no recurrences and no damage to the physis were reported.24

No good outcome studies have been reported as of yet, but from the available literature (apart from the previously mentioned rare complications), the outcome of subacute osteomyelitis is excellent, and full recovery is the rule in most cases.

Future and Controversies

Subacute osteomyelitis treatment remains controversial. Some investigators agree that a conservative course of antibiotic therapy is preferred. In lesions with an aggressive character in which a tumor cannot be excluded, surgery is indicated to establish the diagnosis. Diagnostic experience and awareness of the condition significantly reduce the indications for surgery from an approach in which biopsies are taken of all lesions, to an approach in which biopsies are taken of only selected lesions.

Development of molecular assays for the direct detection of microorganisms has been an actively growing specialty. Amplification techniques such as those using polymerase chain reaction (PCR) should provide increased sensitivity because of the extensive amplification of target nucleic acid to identify the RNA or DNA of viruses, bacteria, and other microorganisms in patients' blood. At present, however, these techniques are not widely available.

 


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References
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Further Reading

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Keywords

subacute osteomyelitis, subacute osteomyelitis prognosis, subacute osteomyelitis diagnosis, subacute osteomyelitis treatment, Brodie abscess, Brodie abscess prognosis, Brodie abscess diagnosis, Brodie abscess treatment, Brodie's abscess, osteogenic sarcoma, osteosarcoma, bone infection, bone inflammation, primary subacute osteomyelitis, chronic osteomyelitis, hematogenous osteomyelitis, Ewing sarcoma, multifocal subacute osteomyelitis, punched-out radiolucency, punched-out lesion, serpentine sign, penumbra sign

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Contributor Information and Disclosures

Author

Khalid Khoshhal, MBBS, FRCS Ed, ABOS, Vice Dean, College of Medicine; Assistant Professor, Pediatric Orthopedic Surgery, Department of Orthopedics, Taibah University, Saudi Arabia
Disclosure: Nothing to disclose.

Coauthor(s)

Robert Mervyn Letts, MD, FRCS(C), FACS, Former Chief, Department of Surgery, Division of Pediatric Orthopedics, Children's Hospital of Eastern Ontario, University of Ottawa; Consultant Pediatric Orthopedic Surgeon, Sheikh Khalifa Medical City, UAE
Disclosure: Nothing to disclose.

Medical Editor

Charles T Mehlman, DO, MPH, Director, Musculoskeletal Outcomes Research, Associate Professor, Division of Pediatric Orthopedic Surgery, Cincinnati Children's Hospital Medical Center
Charles T Mehlman, DO, MPH is a member of the following medical societies: American Academy of Pediatrics, American Fracture Association, American Medical Association, American Orthopaedic Foot and Ankle Society, American Osteopathic Association, Arthroscopy Association of North America, North American Spine Society, Ohio State Medical Association, Pediatric Orthopaedic Society of North America, and Scoliosis Research Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Thomas M DeBerardino, MD, Associate Professor of Orthopaedic Surgery, University of Connecticut Health Center
Thomas M DeBerardino, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, and American Orthopaedic Society for Sports Medicine
Disclosure: Arthrex, Inc. Grant/research funds Other; Arthrex, Inc. Honoraria Speaking and teaching; Genzyme Biosurgery. Inc. Grant/research funds Other; Musculoskeletal Transplant Foundation Grant/research funds Other; Histogenics Grant/research funds None; Arthrex, Inc. Consulting fee Speaking and teaching

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Carlos J Lavernia, MD, FAAOS, Adjunct Clinical Professor, Department of Orthopedic Surgery, University of Miami School of Medicine; Medical Director, Orthopedic Institute at Mercy Hospital
Carlos J Lavernia, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Hip and Knee Surgeons, Arthritis Foundation, Biomedical Engineering Society, Florida Orthopaedic Society, and Orthopaedic Research Society
Disclosure: Zimmer Stock Implant Designer

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