Volume fusion of CT images to measure femoral symmetricity

PURPOSE: Pre-operative planning is widely used in orthopaedic surgery. In case of trauma with fracture or previous injury with malunion, the contralateral extremity is used as a surrogate for planning with an assumption of symmetry between sides. The aim of this study was to investigate femoral symmetricity in human adults. METHODS: Ten randomly selected lower extremity computerized tomography (CT) images were analyzed for femur symmetry using 3D Trauma and CT motion analysis (CTMA). Mirrored images of the left femur were created using the right as a template. The 3D images from each side were merged, and translational and rotational differences reported. RESULTS: There were no statistically significant differences between mirrored images of the left and right femurs. Differences in rotation and translation of bony segmentation showed a greater variation in internal and external rotation of the distal femur (CI − 0.7° to 4.9°) compared to varus/valgus (CI − 1.3° to 0.8°) or flexion/extension (CI − 0.5° to 0.6°), though none of these differences were significant. CONCLUSION: The left and right femurs of healthy adults are symmetrical. Pre-operative templating relying on the contralateral healthy femur is encouraged.