Investigating long-term quality of life and depressive symptoms following fracture-related infection: a systematic review with meta-analysis of heterogeneous evidence

Abstract

Background : Fracture-related infection (FRI) is associated with prolonged treatment courses and functional impairment. However, the long-term effects of FRI on quality of life (QoL) and psychological outcomes remain unclear. Methods : A PRISMA-compliant systematic review of PubMed, Web of Science, and Google Scholar for studies published from 2010 to August 2025 was performed. Methodological quality and bias were assessed with Methodological Index for Non-Randomised Studies (MINORS) and ROBINS-I. Where appropriate, data were synthesized using random-effects models and interpreted cautiously due to substantial heterogeneity. Results : Fifteen studies met the inclusion criteria. The evidence base is dominated by retrospective cohorts: mean MINORS attainment 66.4 % and mean loss to follow-up 19.5 %. Meta-analysis of three studies ( n =125) showed non-significant mean changes at 12 months or more in SF-36 and SF-12 physical component score (PCS) of 5.81 (SD 6.54, p =0.124) and 3.86, (9.12, p =0.463) in the mental component (MCS). Pooled long-term estimates from seven studies ( n =262) were 38.9 (2.18) for PCS and 51.2 (4.11) for MCS. Compared with US population norms, PCS was reduced, whereas differences in mental QoL were not significant. Three studies ( n =118) assessing psychological symptoms using the ISR reported elevated depressive symptom and total ISR scores exceeding established caseness thresholds. Discussion : Current evidence suggests persistent physical and psychological burden after FRI treatment. However, heterogeneity, limited study quality, evolving FRI definitions, and a lack of appropriate comparison groups prevent definitive conclusions. Prospective studies using standardized outcome measures are required.