What is Rotational Deformity?
An improper angulation of a bone around its longitudinal axis, resulting in malalignment of a joint, is known as rotational deformity. It is commonly seen in the long bones of the lower extremities in children. The orientation of the hip, knee, and ankle in relation to each other is altered by the rotational deformity.
Types of Rotational Deformity
The various types of rotational deformity include:
- Internal Tibial Torsion (ITT): The most frequent rotational deformity is internal tibial torsion, which is an inner twisting of the shinbone. It results in in-toeing and is commonly detected at birth or in the first few months of life.
- External Tibial Torsion (ETT): Outward twisting of the shinbone or external tibial torsion is usually seen if the top of the foot is pressed on the shin of the same leg when the infant is in the uterus. The foot is externally (outwardly) turned as a result of this.
- Internal Femoral Torsion (IFT): After the age of three, internal femoral torsion or internal twisting of the thighbone is the most common cause of in-toeing. The in-toeing may be significantly worse if the tibia and femur are both internally rotated.
- External Femoral Torsion (EFT): External femoral torsion is a rare occurrence because the femur usually rotates internally rather than outwardly in the uterus. Out-toeing can also be caused by external femoral torsion.
What are the Causes of Rotational Deformity?
The most common cause of a rotational deformity is improper position and excess pressure on the bones while in utero. In some instances, it can occur as part of the normal growth process and resolve spontaneously. Rotational deformities can also be caused by pathologic conditions such as clubfoot, skew foot, hip disorders, and neuromuscular diseases.
What are the Symptoms of Rotational Deformity?
The majority of rotational abnormalities are painless. They can sometimes produce pain in the lower back, hips, and legs, as well as cause extreme difficulty in twisting the body in a specific direction.
Diagnosis of a Rotational Deformity
Your doctor will review your medical history and symptoms and conduct a physical examination including assessing joint range of motion and observing the joint in different positions and while walking. An X-ray may also be ordered to detect malpositioned bones. A CT scan or MRI is sometimes ordered to look for soft-tissue abnormalities.
Treatment for a Rotational Deformity
A rotational deformity can be treated surgically as well as non-surgically. Treatment depends on the type and severity of the deformity, as well as previous treatments that may have been performed. For severe rotational deformities causing pain and loss of function, the following osteotomy (bone-cutting) procedures may be recommended:
Derotational Proximal Femoral Osteotomy
A derotational proximal femoral osteotomy is performed to realign the femur for anatomic alignment of the limb below the osteotomy, which includes the patella, leg, ankle, and foot. The femoral groove (which articulates with the patella) will usually be placed precisely beneath the patella. People with deformities and accompanying lower-extremity disorders such as patella femoral discomfort and recurring subluxation or dislocations are typical candidates for a proximal femoral osteotomy.
Proximal and Distal Tibial Osteotomy
The Proximal Tibial Osteotomy has also proven to be a successful and safe treatment. A proximal tibial osteotomy is commonly performed on younger patients who have a deformity and other lower-extremity issues such as patella femoral discomfort and recurring subluxation or dislocation.
Osteotomy of the Tibial Tubercle
An osteotomy of the tibial tubercle is performed in conjunction with other treatments to treat patellar instability and patellofemoral discomfort. The tibial tubercle (bump on the front of the shin bone) is realigned to ensure patellar (knee cap) stability. The tibial tubercle may be moved distally or medially, towards the inside section of the leg, to correct patellar tracking. This takes the weight off the troublesome areas of the kneecap.
Some of the risks and complications of an osteotomy include:
- Blood clots
- Injuries to vessels and nerves
- Failure of the osteotomy to heal