Introduction

Chronic osteomyelitis remains a major therapeutic challenge. • Disease duration is often assumed to reflect increasing severity. • Unclear whether long-standing infection means more complex surgical management.

Aim: compare microbiology, surgical strategy, and outcomes between long- and short-duration chronic osteomyelitis.

Methods

Retrospective study — patients surgically treated for chronic osteomyelitis. • Two groups by disease duration: o Group 1: >10 years; o Group 2: <10 years. • Data collected: o Microbiology; o Classification — Cierny–Mader & BACH; o Surgical strategy — single-stage vs two-stage; o Bone resection; o Fixation; o Soft-tissue coverage; o Clinical outcome — resolution vs recurrence.

Results

Study population & disease duration

Group 1 (n=12) Mean 29.6 years

Group 1 (n=11) Mean 3.6 years

23 patients total

Surgical strategy & outcomes: Two-stage surgery; Segmental bone resection; Flap coverage; Recurrence

Microbiology, host profile (BACH) & fixation

Group 1 • Monomicrobial: 66.7% (mainly S. aureus) • BACH: favourable host, less agressive pathogens • Adequate sot-tissue coverage • Fixation: rarely need Group 2 • Greater diversity: Gram-negative + fungal organisms • BACH: higher resistant pathogens • Poorer soft tissue, greater host compromisse • Fixation required: 63.6%

Conclusions

Long-standing osteomyelitis was not associated with increased surgical complexity. By contrast, shorter-duration cases required more aggressive surgical management, likely reflecting higher biological activity, greater microbiological diversity, and greater host compromise. Chronic, long-standing infections may evolve into more contained and stable disease states. These findings challenge the assumption that longer disease duration implies greater severity and highlight the importance of multidimensional assessment in guiding surgical strategy.