Purpose: To evaluate the diagnostic parameters for detection of pelvic bone infections and to present the results of conservative and operative treatment.

Materials-methods: 17 children with acute osteomyelitis of the pelvis or septic sacroiliitis were treated from 1992 to 2000. They were followed-up for 1,5 to 8 years.

10 patients presented with leukocytosis. In 15 patients ESR exceeded 40 mm and in 10 patients CRP exceeded 20 mg%. Blood cultures yielded Staphylococcus aureus in 6 cases and Streptococcus in one. In only 2 cases were plain X-Rays suggestive of infection. Every patient had a positive Tc99m MDP bone scan (increased absorption), which permitted localization of the infection. Furthermore, MRI was performed on 12 patients, yielding abnormal findings in all cases.

All patients received antistaphylococcal antibiotics intravenously for 10–14 days, followed by a further 3–8 week course per os, depending upon the response to treatment. Treatment started with considerable delay for 3 patients; they all were submitted to surgical drainage and debridement.

Results: All patients were normal at clinical follow-up by the end of treatment. By the end of follow-up no signs of osteomyelitis or residual deformity appeared.

Conclusions: The usual laboratory and radiological investigations can be misleading. Tc99m MDP bone scan and MRI permit prompt diagnosis and localization of the infection. With the appropriate antibiotics the clinical results are usually excellent, provided that the disease is diagnosed without delay. Surgical drainage and debridement is necessary in cases of delayed or missed diagnosis.