We present a case of delayed osteonecrosis of the ilium. After receiving embolization and multiple orthopaedic procedures following a complex pelvic crush injury, the patient subsequently developed posterior pelvic pain and tenderness over the posterior superior iliac spine, along with pain on sacroiliac joint compression. Magnetic resonance imaging of the pelvis demonstrated a bone infarction in the left ilium adjacent to the sacroiliac joint.Conclusion:
The symptoms from osteonecrosis of the ilium may simulate sacroiliitis or other conditions. It is important to keep the differential diagnosis in mind when considering additional management for posterior pelvic pain in the setting of prior trauma and preexisting hardware.