Management of Chronic Long-Bone Osteomyelitis Using Antibiotic Cement–Coated Nails in Libya: A Cross-Sectional Survey Across Public Hospitals in the Eastern, Central, and Western

Abstract

Chronic long-bone osteomyelitis remains a persistent challenge for orthopaedic services, particularly in settings where diagnostic capacity and surgical resources vary between hospitals. This cross-sectional survey was conducted across five Libyan public hospitals in the Eastern, Central, and Western regions to estimate chronic osteomyelitis caseload patterns and to examine how structural capacity and surgeon decision-making processes were associated with utilisation of antibiotic cement–coated intramedullary nails. A purposive–convenience sampling approach was used to recruit 500 orthopaedic clinicians, with questionnaire administration supervised on-site to support completeness and standardised procedures. Data were analysed using SPSS (Version 29) through descriptive statistics, bivariate tests aligned with the hypotheses, and multivariable regression modelling with p < .05 and 95% confidence intervals. The sample comprised 380 males (76.0%) and 120 females (24.0%), with 64.0% reporting prior use of coated nails and 72.0% reporting annual chronic osteomyelitis caseloads of ten or more cases. Hypothesis testing demonstrated significant regional differences in caseload (H1: F(2, 497) = 6.84, p = .001). Structural capacity showed a positive association with utilisation (H2: r = .41, p < .001; β = 0.38, 95% CI [0.29, 0.47], p < .001). Surgeon capability independently predicted utilisation (H3: β = 0.31, 95% CI [0.22, 0.40], p < .001). Diagnostic and microbiology capacity and stronger orientation towards local antibiotic delivery independently predicted higher utilisation (H4: β = 0.24, 95% CI [0.15, 0.33], p < .001; β = 0.29, 95% CI [0.20, 0.38], p < .001).  Overall, utilisation patterns were shaped by regional context, service infrastructure, and surgeon-level processes rather than clinical preference alone, indicating that strengthening diagnostics, resource availability, and targeted training may support more consistent management across Libyan public hospitals.

resource availability, and targeted training may support more consistent management across

Libyan public hospitals.