lthough sacral osteomyelitis mostly presents as a chronic entity when bone is exposed in a long-standing decubitis ulcer, there are some case reports exist in the literature which designates postoperative complications leading to chronic sacral oteomyelitis. Acute or subacute sacral ostemyelitis is extremely rare.A 2012 English-language search of the medical literature discovered 23 case reports of chronic sacral osteomyelitis other than secondary to decubitis ulcers. These reported cases included 7 cases seen after postoperative A AB BS ST TR RA AC CT T This a unique case report of an otherwise healthy 54 year-old man who was sustained a battle-field injury from high-velocity gun-shots leading to right knee disarticulation and sacral fracture and subsequent sacral osteomyelitis, which are extremely rare. Sacral osteomyelitis and sacral fracture without neurologic injury has not been reported, and, to our knowledge, this is only the first case of sacral osteomyelitis without neurologic compromise due to a foreign body and its management in the English literature. Of 23 reported cases of sacral osteomyelitis (secondary to non biological materials that was used in the index procedure or unknown etiology), there is not one reported case of sacral osteomyelitis secondary to a missile fragment. Our case was described in detail, including the method of osteomyelitis management, and a review of the literature regarding the etiology of the condition also is presented.