Current RMA Instruments:

Changes from Previous Instruments:

SOP Bulletin 111

ICD Coding:

• ICD-9-CM Codes: 756.4
• ICD-10-AM Codes: Q78.6

This is a genetic disorder of the bone manifesting in multiple benign cartilage topped bone tumours arising from the growth plates.

Is specific diagnostic evidence required to apply the SOP? – Yes.

This diagnosis is based on imaging of the bone with MRI [magnetic resonance imaging], CT [computerised axial tomogram], or plain x-rays, with opinion from a specialist orthopaedic surgeon.

Are there sub-factors that require specific information? – No.

The only factor is for clinical worsening from inability to obtain appropriate clinical management.  It is difficult to ascertain a clinical worsening given the progressive nature of the disorder.  See notes below.

Additional diagnoses covered by SOP

• Nil

Conditions excluded from SOP

• Single osteochondroma
• Synovial osteochondromatosis
• Enchondromatosis

Unconfirmed diagnosis

If, after applying the above information, you are unable to confirm the diagnosis, you should then seek medical officer advice about further investigation.

Notes on appropriate clinical management

Worsening beyond the normal progression of the disease needs to be evident before a clinical worsening factor can be considered.

Treatment is surgical excision if the osteochondroma becomes large enough to cause pain or disfigurement.

An osteochondroma is usually symptomless unless it is palpable. Nerve or artery compression caused by an enlarging osteochondroma may incite symptoms.  Lesions appear to grow away from the physeal line and usually increase in size during growth spurts at puberty.  Chondrosarcoma may arise from the cartilage cap.  This rare complication is estimated to occur in 1-2% of cases.

Neumann, R. 1995, ‘Bone Tumours’, in Orthopaedic Secrets, eds D.E. Brown & R.D. Neumann, Hanley & Belfus, Inc., Philadelphia, p. 73