Tibial osteomyelitis is the most prevalent type of all osteomyelitis. Because of its anatomical characteristics, little soft tissue coverage and a single blood supply, it is one of the preferred sites for osteomyelitis. Here we show a case of postoperative infection of an open tibial fracture that developed into osteomyelitis and finally healed by two surgeries (first surgery: tibial internal fixation removal + removal of infected lesion + external fixation frame fixation; second surgery, iliac bone graft extraction + external fixation adjustment). Figure 1: The patient’s right tibiofibular open fracture was infected 6 months after surgery, the fracture end did not heal, and the skin of the lower leg broke down and flowed pus. Figure 2: After admission, “right tibiofibular osteomyelitis lesion removal + internal fixation + external fixation bracket fixation” was performed, and the internal fixation was removed, the foci of infection were removed, the external fixation bracket was fixed, and the skin was tension-free sutured. Figure 3: Six months after the debridement, the infection was well controlled, and the patient was admitted to the hospital for “right tibial osteomyelitis with iliac bone grafting”, in which cancellous bone from the anterior superior iliac spine was taken and implanted in the bone defect to assist the healing of the fracture end. Figure 4: 6 weeks after the bone grafting, the fracture end showed obvious bone scab growth and blurred fracture line. Figure 5: At 3 months after the bone grafting, the fracture end can be seen to be basically bony healed. Figure 6: 2 months after bone grafting, the external fixation frame is in place and the skin is healing well. Figure 7: 3 months after bone grafting, the fracture is healed, the external fixation frame is removed, and the skin is healing well. The difficulty in healing tibial osteomyelitis lies in the poor blood supply to the fracture end and the limited skin coverage conditions. The problem of bone nonunion remaining after the lesion is cleared also needs to be treated with care. How to achieve complete healing with the shortest time and the least number of operations is the subject of osteomyelitis treatment. Our department has successfully treated more than 600 cases of tibial osteomyelitis. We have accumulated a lot of experience. Patients facing osteomyelitis problems should contact us as soon as possible, the time point of treatment is very important.