Undiagnosed Brodie abscess in a gymnast after surgical fixation of a tibial fracture

Abstract 

Objective

This study presents a case of a posttraumatic subacute osteomyelitis in a child with leg pain.

Clinical Features

A 10-year-old female gymnast with leg pain presented to a chiropractic clinic after having been treated over the previous year for a leg fracture. The patient had leg pain associated with prolonged use of her right leg, restlessness at night, and tenderness over the right tibia. The history did not suggest a mechanical cause of the patient's pain. All available radiographs were reviewed by the chiropractor; a diffuse lytic lesion with bone thickening and sclerosis was clearly visible in the area of the patient's chief complaint, representing a Brodie abscess.

Intervention and Outcome

The doctor of chiropractic sent the patient back to the hospital. She was treated first with oral antibiotics, which were not successful. She underwent surgery and recovered well.

Conclusion

Subacute osteomyelitis may have a diagnostic delay; thus, it is possible for a chiropractor to see this condition in the office. A good case history, examination, and radiographs are important for the diagnosis and to make a proper referral.

Key indexing terms: Osteomyelitis, Child, Abscess, Diagnosis, Chiropractic