The internal fixation of fractures is associated with a risk of infection. Open fractures in particular are susceptible to such infection. Treatment is difficult and patients can develop a chronic osteomyelitis. We present the case of a patient who developed chronic osteomyelitis with a persistent discharging sinus following internal fixation of an open fracture of tibia. At presentation, the sinus tract had undergone malignant transformation causing massive soft tissue and bony destruction. This patient died from carcinomatosis after metastasis of his cancer. This catastrophic complication of chronic osteomyelitis is now uncommon; however, this case reminds us that the long-term follow-up of all such patients is mandatory.