Postoperative Foot and Ankle Axis Parameters and Their Relationship to Functional Outcomes After Tibial Pilon Fracture Surgery.

Background: Tibial pilon fractures are challenging intra-articular distal tibial fractures that compromise foot-ankle biomechanics. Restoration of anatomical radiological axis parameters has been reported as a predictor of clinical outcomes.

Purpose: To investigate the relationship between postoperative foot and ankle axis parameters and functional outcomes.

Study design: Retrospective cohort study.

Methods: This single-center retrospective study included 60 surgically managed tibial pilon fractures between February 2021 and June 2023. Postoperative radiological parameters (ADTA, LDTA, MAD, MDA, plantigrade angle) were measured. AOFAS, FADI, VAS, and SF-36 were used to determine functional outcomes. Correlation and multiple regression analyses were performed.

Results: Mean age was 40.3 ± 8.6 years, and 61.7% of patients were male. Anatomical reduction was achieved in 78.3% of patients. Those with anatomical reduction had significantly higher AOFAS, FADI, and SF-36 scores (p < 0.05). Plantigrade angle correlated positively with AOFAS and FADI and negatively with VAS. Greater MDA was associated with poorer functional outcomes.

Conclusion: Postoperative radiological axis parameters, particularly the plantigrade angle and metatarsal declination angle, showed significant correlation with early functional outcomes after tibial pilon fracture surgery. Precise radiological measurements are essential for predicting recovery and guiding treatment strategies.

Level of evidence: Level III, retrospective cohort study.