Derotational Osteotomies of the Femur and Tibia for Tetratorsional Malalignment

Torsional malalignment of the lower extremities can cause hip, knee, and ankle pain as well as patellofemoral symptoms, gait abnormalities, and difficulty running. The term miserable malalignment has been used historically to describe the combination of excessive femoral anteversion and external tibial torsion. We propose tetratorsional malalignment as a more accurate and descriptive term for this bilateral combination of torsional abnormalities. We present a case of tetratorsional malalignment treated with staged bilateral femur and tibia derotational osteotomies and intramedullary nail fixation, which resulted in resolution of her joint symptoms and overall improvement in lower extremity function.