Osteomyelitis A048

Current RMA Instruments

Changes from previous Instruments

ICD Coding

• ICD-10-AM Codes: M46.2, M86, M90.2, K10.2

Brief description

This condition involves inflammation of bone caused by infection. The infection is usually from a bacterium, a mycobacterium or a fungi and may be acute or chronic. Osteomyelitis can occur as a result of direct infection of the bone via blood borne spread from another bodily source of infection or via a deep wound or open fracture that exposes bone to infection. Additionally, infection can spread from nearby infected tissue or joint. Osteomyeltiis can affect all bones including the jaw, bones of the inner ear and vertebrae. 

Confirming the diagnosis

Diagnosis is generally established via a combination of clinical history, examination findings, imaging tests (X-rays, MRI or CT scans), blood tests (checking for infection markers) and microbiological testing and biopsy of the involved bone. The diagnosis will sometimes be made in the absence of positive bone or blood cultures if the clinical picture and other investigative findings are indicative.

The appropriate medical specialist is an Infectious Diseases Physician, General Medicine Physician or Othropaedic Surgeon.

Additional diagnoses covered by SOP

• Brodie abscess
• Infectious osteitis

Conditions excluded from SOP

• Chondritis #
• Discitis #
• Isolated septic arthritis^#
• Myelitis^#
• Osteomalacia^#
• Osteonecrosis^#
• Osteopaenia, declared not a disease by RMA - NIF
• Osteoporosis *

* another SOP applies - the SOP has the same name unless otherwise specified

^# non-SOP condition

Clinical onset

The condition may present in a variety of ways depending on the underlying cause, associated conditions and whether the condition is acute or chronic. There may be a history of a preceding trauma or a non-healing skin ulcer. Symptoms may include pain at the site along with tenderness, redness and swelling. Individuals may experience fever and feeling generally unwell. Chronic osteomyelitis may also present as a non-healing fracture.  

Clinical worsening

The course of the condition is variable. Generally good outcomes occur with acute osteomyelitis, but less favourable outcomes may occur with chronic disease. Surgical debridement and antibiotic therapy (both intravenous and oral) is generally required and some patients may go on to need amputations. Any consideration for worsening will require expert specialist opinion.