Calcaneal Brodie’s Abscess: A Rare Case Presentation of 52 Years Duration

With Prior Failed Multiple Treatments Avoiding Major Amputation

Introduction Discussion
Brodie’s abscess or sub-acute osteomyelitis is a rare
presentation accounting for 2% of all osteomyelitis cases. Although Brodie’s abscess in the calcaneus has been treated
it usually presents in the first or second decade of life, we present a successfully using a one-stage approach of aggressive
rare case in a 69-year-old white male. He was seen by an infectious debridement and curettage with antibiotic beads/calcium sulfate
disease specialist and referred to a Podiatric (Foot and Ankle) packing as Olasinde demonstrated (2). Currently, the standard
Surgeon. A team approach was coordinated and the patient was Figure 2. Presentation on 09/18/2015, arrows point to abscess, MRI on right treatment of osteomyelitis includes debridement of infected tissues,
treated by the Podiatric Surgery and Infectious Diseases teams and dead space management, and 4 to 6 weeks of parenteral antibiotics
culture specific antibiotics afterwards. With aggressive surgical as indicated in a recent review by Gomes (6). It is paramount that a
intervention using an offloading device (external fixator) to prevent load bearing bone such as the calcaneus be protected from the
post-operative fracture along with culture specific systemic destructive weight bearing to prevent collapse, especially when
antibiotics the patient recovered and was functioning well in a aggressive curettage and drilling is performed in revisional cases
normal shoe. He remains ulceration and cellulitis free at eleven such as this one. Another key component of this case is culture
months post-op. a b
specific systemic antibiotic therapy as well as local delivery of
Figure 3. Operation on 10/21/2015, a. aggressive drilling of the sclerotic antibiotics through the use of well documented antibiotics beads. At
calcaneal bone to promote bleeding and osteogenesis; b. packing with 11 months follow-up, the patient was ambulating pain free in a
Case Report calcium sulfate and vancomycin. normal shoe.
A 69-year-old white male had a history of surgery on his left
heel in 1964 for a bone cyst. His post-operative course was
complicated by infection. Unfortunately, for the last 52 years his
quality of life has been affected by the painful heel abscess with
draining fistula in spite of numerous attempts at surgical correction
and multiple courses of oral and IV antibiotics. Major amputation
Conclusions
was considered. MRI on 9/18/2015 (Figure 1) demonstrated a Brodie’s abscess or sub-acute osteomyelitis occurs in about
a b
calcaneal Brodie's abscess measuring approximately 4.1 x 2.7 x 3.0 2% of all osteomyelitis cases. We recommend that with bone
cm which contained dependent fluid and gas. Figure 4a. Immediate post operative X-ray. b. Sidekick Stealth External reactivity and difficult chronic cases, as well as cases with multiple
Fixator device prior surgeries, be treated utilizing an aggressive team approach
with inter-physician communication to alter appropriate required
Figure 5. External fixator removed and delayed
treatments.
primary closure of lateral wound delayed until 5
weeks post initial procedure. The patient was Pearls from this case include
Figure 1a. Figure 1b. allowed protected weight bearing in CAM boot • a team approach to limb salvage
at 5 weeks and returned to normal shoe at 2
months post-operatively. • aggressive surgical therapy
The patient was successfully treated utilizing a team approach by
the Providence Hospital Podiatric Surgery and Infectious Disease • appropriate bio-mechanical offloading
Departments. Surgical approach (Figure 2) consisted of a very
aggressive debridement including curettage and drilling of the
hypertrophied sclerotic cortical calcaneal walls due to prior surgical
attempts and the chronicity of the abscess. The void was filled with References
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