During the massive manufactures and installations of fixed offshore wind turbines in China, initial imperfections were often found in the inspection. As more and more attentions and efforts of the wind energy sector have been devoted to deep waters with fixed and floating wind turbines (FWTs), the impact of such initial imperfections on fatigue assessment is paramount to the reliable design and safe operation, which warrant rigorous study. This paper presents a comprehensive review of three different initial imperfections and their impacts on the fatigue lifetime of FWTs’ tower flange connections. A brief introduction on FWTs and flange connections is provided at first. This is followed by a detailed discussion of the environmental loadings and fatigue assessment on the flange bolted connections. Finally, a comprehensive review of the state-of-art research on three common initial imperfections, including flatness divergence, bolt loosening and tower inclination, are presented. Their impact on fatigue assessment is further discussed.