LONG-TERM QUALITY OF LIFE AND MENTAL HEALTH FOLLOWING FRACTURE-RELATED INFECTION: A SYSTEMATIC REVIEW AND META-ANALYSIS

Introduction and Aim Fracture-related infection (FRI) represents a uniquely challenging clinical entity, through its enduring imprint on both physical function and psychological well-being. While surgical eradication of infection remains the principal therapeutic objective, the broader consequences for patients quality-of-life (QoL) are insufficiently characterized. A nuanced understanding of long-term outcomes that extends beyond mere physical restitution is indispensable for guiding clinical judgment and aligning patient expectations with therapeutic reality. Methods A PRISMA-compliant systematic review of PubMed, Web of Science, and Google Scholar for studies published from 2010 through August 2025 was performed. Study quality and risk of bias were critically evaluated using the MINORS and ROBINS-I instruments. Where methodological and statistical compatibility allowed, outcomes were synthesized using random-effects models, with additional sensitivity analyses undertaken. Results Fifteen studies satisfied inclusion criteria, collectively reflecting a literature still largely reliant on retrospective observational designs. Methodological quality was moderate, with a mean MINORS score of 66.4% and an average attrition rate approaching one-fifth of enrolled participants. Meta-analytic synthesis of three studies (n = 125) revealed non-significant improvement in physical or mental health domains, as measured by SF-36 and SF-12 composite scores, beyond 12 months post-intervention. Specifically, the mean change in physical component score (PCS) was 5.81 (SD 6.54; p = 0.124), while the mental component score (MCS) changed by 3.86 (9.12; p = 0.463). Aggregated long-term estimates from seven studies (n = 262) yielded a PCS of 38.9 and an MCS of 51.2. Notably, physical health remained substantially impaired relative to population norms (z = −4.69; p < 0.001), whereas mental health indices were statistically indistinguishable from normative values (z = −0.63; p = 0.53). Inter-study variability proved pronounced across both domains, with the PCS exhibiting considerable dispersion (τ 2 = 27.3; I 2 ≈ 85.7%), paralleled by an even greater degree of heterogeneity in the MCS (τ 2 = 112.9; I 2 ≈ 97.8%). In contrast, psychological assessment in three studies (n = 118) using the ICD-10 based symptom rating demonstrated lasting psychological impairments. Levels of depressive symptomatology and overall psychological distress were elevated and surpassed established clinical thresholds. Conclusion The long-term course of recovery following FRI remains insufficiently defined. There is a pressing need for rigorously designed prospective studies, adequately powered and grounded in standardized outcome measures, with integrated assessment of psychosocial dimensions.