Symmetry of the left and right tibial plafond; a comparison of 75 distal tibia pairs

Purpose: Tibia plafond or pilon fractures present a high level of complexity, making their surgical management challenging. Three-Dimensional Virtual Planning (3DVP) can assist in preoperative planning to achieve optimal fracture reduction. This study aimed to assess the symmetry of the left and right tibial plafond and whether left–right mirroring can reliably be used. Methods: Bilateral CT scans of the lower limbs of 75 patients without ankle problems or prior fractures of the lower limb were included. The CT images were segmented to create 3D surface models of the tibia. Subsequently, the left tibial models were mirrored and superimposed onto the right tibia models using a Coherent Point Drift surface matching algorithm. The tibias were then cut to create bone models of the distal tibia with a height of 30 mm, and correspondence points were established. The Euclidean distance was calculated between correspondence points and visualized in a boxplot and heatmaps. The articulating surface was selected as a region of interest. Results: The median left–right difference was 0.57 mm (IQR, 0.38 – 0.85 mm) of the entire tibial plafond and 0.53 mm (IQR, 0.37 – 0.76 mm) of the articulating surface. The area with the greatest left–right differences were the medial malleoli and the anterior tubercle of the tibial plafond. Conclusion: The tibial plafond exhibits a high degree of bilateral symmetry. Therefore, the mirrored unfractured tibial plafond may be used as a template to optimize preoperative surgical reduction using 3DVP techniques in patients with pilon fractures.