Pediatric Rotational Deformities (Miserable Malalignement Syndrome): An Introduction

Pediatric rotational deformities is important because it gives insight into the significance of the often ignored rotational deformities. Whereas angular deformities of the lower limbs, particularly those in the coronal plane (valgus/varus of more than 10–15°), have been shown to have detrimental effects on adjacent joints and alter the biomechanics of the lower limbs, there is little evidence to show that rotational deformities of similar magnitude can cause unwanted effects. As a result of this, rotational deformities have generally received less attention than angular deformities and are frequently underestimated, and a “benign neglect approach” is often the default plan. In addition, it is often easy for the patient to compensate for and hide rotational deformities, while angular deformities are usually more obvious. Furthermore, unlike angular deformities, it may be difficult to accurately measure and quantify rotational deformities with clinical examination or plain x-rays. CT scan rotational profile is required to accurately quantify the deformity.