2,6,7 Bone biopsy remains the gold standard method for diagnosis. 5,10 Multiple attempts at bone biopsy may be necessary before a successful diagnosis is obtained. Unsuccessful bone biopsy occurs from sampling error within the bone or inconclusive pathologic findings. The histologic features of pelvic osteomyelitis include reactive bone formation, fibrosis, and plasma cell infiltrates. The pelvic bone does not have the same pathologic appearance as acute osteomyelitis noted in childhood.
Persistence is required to establish a diagnosis.
There can be great difficulty in eradicating pelvic osteomyelitis unless a clinical strategy is carried to a conclusion. Two fundamental principles are required for a successful antibiotic regimen. The first is that repeated debridements of the residual bone sequestrum with rongeur or chisel to eliminate dead bone are required. The second principle recommends closure of the pressure ulcer with application of a growth factor 11 or surgical repair with a flap. A baby boomer turns 50 years old every 7 seconds.