Bone biopsies were performed in spinal cord injured patients with pressure ulcers in whom osteomyelitis was suspected. Roentogenograms and bone and gallium scans were also evaluated to determine their usefulness in diagnosing osteomyelitis. Infected bone underlying pressure ulcers revealed only mild focal inflammatory changes which did not correlate well with x-ray and nuclear scan abnormalities. Negative scans, however, essentially ruled out osteomyelitis. There was no clear association of delayed healing or recurrence of pressure sore with osteomyelitis. Antibiotic therapy of greater than three weeks' duration did not significantly affect the outcome of the disease.