Brodie's abscess following percutaneous fixation of distal radius fracture in a child.

Karthig Rajakulendran,Rami Hussein,Ibraheim El-Daly,Natasha E Picardo

doi:10.1007/s11751-016-0249-3

Abstract

We report the case of a Brodie’s abscess presenting five and a half years following closed reduction and percutaneous pinning of a distal radius fracture. The index surgery was complicated by a pin site infection that was treated successfully with antibiotics. The patient represented with forearm pain years later, and radiological investigations revealed a Brodie’s abscess in the distal radius at the site of the previous Kirschner wires. The Brodie’s abscess was managed through surgical curettage and antibiotics. Staphylococcus aureus and diphtheroid organisms were cultured from the intraoperative specimens. A Brodie’s abscess is a form of localised subacute osteomyelitis, which usually occurs in the metaphysis of long bones and can mimic malignancy. Previous trauma or surgery has been implicated as predisposing factors. We have only identified one previously reported case of Brodie’s abscess following percutaneous pinning. Ours is the first reported case in an adolescent. The aim of this paper is to raise awareness of this rare complication and review the current literature.

Highlights

Percutaneous pinning using Kirschner wires (K-wires) is a common method used to manage unstable distal radius fractures
We report the case of a Brodie’s abscess presenting five and a half years following closed reduction and percutaneous pinning of a distal radius fracture
The fracture was managed at the time of injury with closed reduction and stabilisation using two percutaneous K-wires (Fig. 1), and one dose of antibiotics was given on induction

Summary

Introduction

Percutaneous pinning using Kirschner wires (K-wires) is a common method used to manage unstable distal radius fractures. There was no significant trauma, and the patient denied any systemic symptoms He had sustained a closed fracture of the left distal radius five and a half years previously, whilst playing rugby. The cavities were curetted until healthy bleeding bone was exposed and irrigated with chlorhexidine and hydrogen peroxide They were packed with a Betadinesoaked wick, and the wound was left open. At the 3-month follow-up, the patient reported no postoperative complications and only minor discomfort on performing strenuous activity. He demonstrated a full painless range of movement in the left arm, and inflammatory markers were normal. Radiographs and an MRI scan were repeated (Figs. 5, 6)

Discussion

Compliance with ethical standards