Lower leg symmetry: a Q3D-CT analysis

Purpose: In fracture and realignment surgery, the contralateral unaffected side is often used as a model or template for the injured bone even though clinically valuable quantitative data of bilateral symmetry are often unavailable. Therefore, the objective of the present study was to quantify and present the bilateral symmetry of the tibia and fibula. Methods: Twenty bilateral lower-leg CT scans were acquired in healthy volunteers. The left and right tibia and fibula were segmented resulting in three-dimensional polygons for geometrical analyses (volume, surface and length). The distal and proximal segment of the right tibia of each individual was subsequently matched to the left tibia to quantify alignment differences (translation and rotation). Bone symmetry on group level was assessed using the Student’s t test and intra-individual differences were assessed using mixed-models analyses. Results: Intra-individuals differences were found for tibia volume (5.2 ± 3.3 cm3), tibia surface (5.2 ± 3.3 cm2), translations in the lateral (X-axis; 9.3 ± 8.9 mm) and anterior direction (Y-axis; 7.1 ± 7.0 mm), for tibia length (translation along Z-axis: 3.1 ± 2.4 mm), varus/valgus (φz: 1.7o ± 1.4°), and endotorsion/exotorsion (φz: 4.0o ± 2.7°). Conclusion: This study shows intra-individual tibia asymmetry in both geometric and alignment parameters of which the surgeon needs to be aware in pre-operative planning. The high correlation between tibia and fibula length allows the ipsilateral fibula to aid in estimating the original tibia length post-injury. Future studies need to establish whether the found asymmetry is clinically relevant when the contralateral side is used as reference in corrective surgery. Level of evidence: III cohort study.