A study of 135 adult patients with suspected bone infections at Union Hospital (October 2023-January 2025) compared metagenomic next-generation sequencing (mNGS) with traditional microbial cultures. Out of 101 patients with a confirmed infection (osteomyelitis, post-traumatic limb infections, diabetic foot), 74.81% of all patients had an infection. mNGS achieved higher sensitivity (94.06%) versus culture (47.52%, p=0.000) with similar specificity (85.29% vs. 76.47%, p=0.549). Age had a trend affecting mNGS positivity (p=0.092). Patients with a positive mNGS (n=95) tended to have longer hospitalization compared to negative ones (n=6, p=0.098). mNGS increases the diagnostic yield especially in polymicrobial infections, low pathogen occurrences or negative cultures. A negative mNGS was associated with shorter hospitalization and lower rehospitalization.