Pelvic osteomyelitis is a rare disease that presents like many other common paediatric orthopaedic conditions. The diagnosis and management of the disease is often delayed and as a consequence this may contribute to increased morbidity in affected individuals. In an attempt to improve our diagnostic accuracy, 23 cases of pelvic osteomyelitis presenting to our tertiary referral centre between 1998 and 2006 were reviewed. Case notes were reviewed to examine clinical, pathological and radiological variables attributable to pelvic osteomyelitis, as well as subsequent management of the disease. Pelvic osteomyelitis was diagnosed on the basis of a positive bone and/or magnetic resonance scan. The presentation was associated with a limp and a history of non-weight bearing. The patients presented with an average temperature of 38.4 degrees C and pathology revealed an average erythrocyte sedimentation rate and C-reactive protein of 61.2 and 59.1, respectively. A child with a clinical picture including limping, fevers and raised inflammatory markers should be approached with a high index of suspicion of pelvic osteomyelitis. Seven patients in our series required surgical intervention for debridement and washout. Magnetic resonance imaging performed in the most recent cases was found to be a useful investigation in the diagnosis and management of pelvic osteomyelitis.