Hematogenous osteomyelitis predominantly affects the metaphyseal regions of long bones due to their rich blood supply and slow blood flow, which facilitates bacterial seeding. Among long bones, the femur is most commonly involved because of its size, vascularity, and frequent exposure to minor trauma, making it more susceptible to infection. Early recognition and surgical debridement are crucial to prevent chronic infection and deformity. The femur’s anatomy with extensive metaphyseal blood supply explains its predisposition over other long bones like the tibia, humerus, or radius.

Reference: Campbell's Operative Orthopaedics, 13th Edition.