this condition is no longer rare, and in some countries the incidence is equal to

that of acute
osteomyelitis. Its relative mildness is presumably due
to the organism being less virulent or the patient
more resistant (or both). It is more variable in skeletal distribution than acute
osteomyelitis, but the distal
femur and the proximal and distal tibia are the
favourite sites. The anatomical classification suggested
by Roberts et al. (1982) is useful in comparing features in various reported series
of cases.
Pathology
Typically there is a well-defined cavity in cancellous
bone usually in the tibial metaphysis containing
glairy seropurulent fluid (rarely pus). The cavity is
lined by granulation tissue containing a mixture of
acute and chronic inflammatory cells. The surrounding bone trabeculae are often
thickened. The lesion
sometimes encroaches on and erodes the bony cortex.
Occasionally it appears in the epiphysis and, in adults,
in one of the vertebral bodies.
Clinical features
The patient is usually a child or adolescent who has
had pain near one of the larger joints for several weeks
or even months. He or she may have a limp and often
there is slight swelling, muscle wasting and local tenderness. The temperature is
usually normal and there
is little to suggest an infection.
The WBC count and blood cultures usually show
no abnormality but the ESR is sometimes elevated. Imaging
The typical radiographic lesion is a circumscribed,

round or oval radiolucent cavity 12 cm in diameter.

Most often it is seen in the tibial or femoral metaphysis, but it may occur in the
epiphysis or in one of the
cuboidal bones (e.g. the calcaneum). Sometimes the
cavity is surrounded by a halo of sclerosis (the classic Brodies abscess);
occasionally it is less well defined,
extending into the diaphysis.
Metaphyseal lesions cause little or no periosteal
reaction; diaphyseal lesions may be associated with
periosteal new bone formation and marked cortical
thickening. If the cortex is eroded the lesion may be
mistaken for a malignant tumour.
The radioisotope scan shows markedly increased
activity.
Diagnosis
The clinical and x-ray appearances may resemble those
of cystic tuberculosis, eosinophilic granuloma or
osteoid osteoma; occasionally they mimic a malignant
bone tumour like Ewings sarcoma. Epiphyseal lesions
are easily mistaken for chondroblastoma. The diagnosis often remains in doubt
until a biopsy is performed.
If fluid is encountered, it should be sent for bacteriological culture; this is positive
in about half the
cases and the organism is almost always Staphylococcus
aureus