Christof Radler

Orthopädisches Spital Speising Wien · Department of Pediatric Orthopaedics and Foot Surgery

The history and development of circular fixation is closely aligned with the history of limb lengthening. Gavriil A. Ilizarov not only developed his circular fixator, but he also was the first to research and publish on distraction osteogenesis. Progress and dissemination of the method was initially based on individual pioneers; a standardized nome...

Zusammenfassung Die X-chromosomale Hypophosphatämie (XLH, OMIM 307800) ist eine seltene Knochenerkrankung, die durch Mutationen in PHEX (PHEX phosphate regulating endopeptidase X-linked) verursacht wird. Rachitis, Osteomalazie, Kleinwuchs und komplexe Beindeformitäten gehören zu den wichtigsten skelettalen Veränderungen dieser Erkrankung. Die konse...

Background and purpose: We report results and complications of gradual bone lengthening for post-traumatic lower-limb length discrepancy (LLD) with Precice intramedullary lengthening nails in 34 adults. Patients and methods: Inclusion criteria were lower-limb lengthening using the Precice nail, posttraumatic etiology, age older than 18 years, an...

X-linked hypophosphatemia is a rare disorder of bone metabolism caused by inactivating mutations in the PHEX. Conservative therapies such as treatment with phosphate salts or FGF23-inhibiting antibodies can improve symptoms, the latter being superior to the healing of rickets. Recent studies show a high burden of disease of children and adults with...

Background Gait deviations, lower limb pain and joint stiffness represent key symptoms in patients with X-linked hypophosphatemia (XLH, OMIM 307800), a rare disorder of mineral homeostasis. While the pathomechanism for rickets is well understood, the direct role of PHEX (Phosphate-regulating neutral endopeptidase) deficiency in non-rachitic feature...

Background: The Precice intramedullary bone lengthening nail has been used in our department since 2013. We sought to determine the efficacy and safety of intramedullary limb lengthening with Precice nails in children and adolescents. Methods: We retrospectively investigated patients 18 years and younger who underwent lower-limb lengthening usin...

Background: X-linked hypophosphatemia (XLH) is a rare genetic disorder characterized by lower limb deformity, gait and joint problems, and pain. Hence, quality of life is substantially impaired. This study aimed to assess lower limb deformity, specific radiographic changes, and gait deviations among adolescents and adults with XLH. Design: Data on...

The Ponseti method for treatment of congenital clubfoot is well established and has been introduced in most pediatric orthopedic centers worldwide. However, reported rates of recurrence are largely variable and open joint surgery is still performed frequently, even in the age group younger than 6 years of age. Preventing recurrence and residual def...

Background: We aimed to evaluate the effect of tibialis anterior tendon transfer (TATT) on foot motion in children with clubfoot recurrence after initial Ponseti treatment. Methods: Children with dynamic clubfoot recurrence after initial Ponseti treatment who underwent TATT between 2014 and 2017 were considered for inclusion. Exclusion criteria...

Background Fractures in childhood can result in malalignment and/or leg shortening due to insufficient reduction, malunion or injury to the growth plate. Objective Different types of posttraumatic deformities around the knee as well as the diagnostic approach and correction are discussed. Material and methods While deformities without shortening...

Purpose: Instability of the knee is a common finding in patients with congenital limb deficiency. The instability can be attributed to soft tissue abnormalities, frontal, sagittal or rotational deformity of the lower limb and bony dysplasia of the patella or of the femoral condyles. In most of the cases, these pathomorphologic changes stay asympto...

Die Ponseti-Methode hat sich in den letzten 10 Jahren beinahe weltweit als Goldstandard zur initialen Klumpfußtherapie durchgesetzt. Dennoch gibt es nach wie vor große Schwankungen in Bezug auf Authentizität und Qualität in der Anwendung der Ponseti-Methode. Besonders die Bemühungen bezüglich Schienencompliance und folglich die Rezidivhäufigkeit ze...

Background: Despite the popularity of tension band plating (TBP) current literature lacks clinical data concerning recurrence ("rebound") of frontal plane malalignment. This study investigated the rebound phenomenon after TBP in idiopathic genu varum/valgum deformities. We analyzed factors that may contribute to the development of rebound after re...

Understanding the pathoanatomy of severe recurrent clubfoot and its implication on treatment options is important for the successful treatment. A comprehensive clinical evaluation of the different components helps in selecting procedures. Individual needs and social and psychological factors influencing treatment and the impact of treatment on the...

Where Are We Now?The introduction and wide availability of CT enables us to directly measure femoral anteversion and tibial torsion. However, there is ongoing controversy regarding what to measure, where to measure, and even why to measure.The terminology regarding the torsional profile of the femur can be confusing – some authors tend to use femor...

Objectives Routine ultrasonography can detect congenital femoral deficiency (CFD) and fibular hemimelia (FH), but prenatal detection rate and its relation to deformity severity have never been reported. Whether mothers prefer prenatal diagnosis is also unknown. We aimed to determine whether mothers prefer prenatal diagnosis, to report detection rat...

Background: The aim of the study was to evaluate how clubfeet treated with the Ponseti method compare with control feet in gait analysis and whether additional information can be provided by the Oxford foot model. Methods: All patients with a minimum age of three years in our prospective database of clubfeet treated with the Ponseti method were...

Diagnosis and early treatment of developmental dysplasia of the hip (DDH) continue to be issues of discussion. In 1992, a nationwide general ultrasound screening program using Graf technique was introduced to detect DDH in Austria. We investigated the effects of this program on the rates of operative and conservative interventions and the influence...

Cleidocranial dysplasia is an autosomal dominant disorder characterized by defective ossification of the intramembraneous ossification (primarily the clavicles, cranium, and pelvis), and it is caused by mutations in the RUNX2 gene that is responsible for osteoblast differentiation. Spine deformities were of progressive nature and considered to be t...

The Ponseti method has become the gold standard of care for the treatment of congenital club foot. Despite numerous articles in MEDLINE reporting results from around the globe there are still crucial details of the Ponseti method which seem to be less commonly known or considered. The Ponseti method is not only a detailed method of manipulation and...

The Ponseti method has become the gold standard for clubfoot treatment. Although promising short-term results have been published, only a few studies report results at the end of the bracing period. We aimed to evaluate the functional midterm results, rate of recurrence and need for subsequent surgery. Patients from our prospective database of club...

Anterior tibial tendon transfer is a common procedure for treatment of clubfoot recurrence. Fixation of the tendon usually includes passing the tendon through the lateral cuneiform. Drilling the bone and passing sutures through the plantar aspect of the foot may cause neurovascular damage. Anterior tibial tendon transfer was performed through the l...

The treatment of neglected or relapsed clubfoot is still a challenge. Extensive open surgeries may lead to postoperative scarring and various complications.Gradual distraction using circular fixators for treatment of these cases was described by many researchers in the last decades. Different techniques were used with and without open surgeries. Re...

To examine maternal attitudes towards prenatal diagnosis of idiopathic clubfoot and to determine the incidence of false-negative ultrasound examinations. Surveys were mailed to mothers of patients with clubfoot born between 2000 and 2007 who were treated at either Sinai Hospital of Baltimore or Orthopaedic Hospital Speising. Exclusion criteria were...

Recurrent genu valgum deformity complicates treatment of congenital femoral deficiencies (CFD) and fibular hemimelia (FH). We analysed factors influencing recurrence. Patients who underwent limb lengthening or deformity correction for CFD and/or FH were reviewed. Radiographs after surgery and after a minimum of a further six months were analysed. C...

Congenital femoral deficiency (CFD) is a rare and complex deformity. The results and complications of surgical correction of this deformity using ring fixators (Ilizarov/Taylor Spatial Frame) have been evaluated. We retrospectively reviewed a consecutive series of 30 patients with CFD, between the ages of 3.3 and 17 years (mean, 9.3 years), with 35...

Radiographs have traditionally been used to describe and quantify foot deformities in infants and children. We hypothesized that the interobserver reliability of measurements obtained from radiographs of pediatric feet would be low, especially with regard to the infant foot, and that normal ranges and standard deviations would decrease in associati...

Measurements of femoral and tibial torsion obtained from radiographs or computed tomographic scans have been used to describe rotational malalignment of the lower extremities and to clarify indications for surgery. A weak relationship between anatomic torsion deformity and the resulting transverse plane gait pattern in patients with cerebral palsy...

Most congenital lower limb deficiencies present with shortening of the leg and deformities of the bones and joints. Regardless of severity, a limb deformity is always a handicap for the child with a negative functional and psychological impact. The goal of treatment is to achieve a well-­functioning leg with normal alignment and stability, and a no...

Twenty-five post-traumatic leg length discrepancies combined with axial deviation in 22 patients were treated with the Taylor spatial frame. We retrospectively analysed the accuracy of correction, the complication rate and the clinical outcome including the duration of treatment. The cases were divided into three sub-groups according to the level o...

Congenital talipes equinovarus is the most common deformity of the lower limb. The adequate treatment of clubfeet is still a challenge for orthopaedic surgeons and requires well-founded knowledge of pathoanatomy and established therapeutical options. This refresher, in addition to pathoanatomical fundamentals, provides an update on diagnostic and t...

Intoduction Advanced bone maturation is a radiographic feature that might be encountered in a number of different forms of skeletal dysplasias such as Desbuquois dyspalsia, Larsen syndrome, the Reunion Island form of Larsen syndrome, diastrophic dysplasia, acrodysostosis, Catel-Manzke syndrome, a variant of metatropic dysplasia and Maroteaux-lamy s...

X-linked hereditary hypophosphatemic rickets can induce various multiplanar deformities of the lower limb. We evaluated our ability to correct these deformities and assessed complications and recurrence rates in 10 children (eight girls and a pair of twin boys) followed from early childhood to skeletal maturity. We performed 37 corrective operation...

The Ponseti method for treatment of idiopathic clubfeet involves the use of serial casts, percutaneous Achilles tenotomy in most cases, and bracing with an abduction orthosis to prevent relapse. Although Ponseti recommended evaluation of the infant clubfoot strictly by palpation, many orthopaedic surgeons still rely on radiographs for decision-maki...

Circular external fixators have several advantages over other surgical options in the treatment of limb length discrepancy and axial deformity. The innovative Taylor Spatial Frame (TSF) combines a rigid hexapod fixation system with the support of a web-based software program, and thus offers the possibility of simultaneous corrections of multidirec...

Aseptische Knochennekrosen können im Kindes- und Jugendalter während der Wachstumsperiode und bei exzessiver physischer Belastung an ver- schiedenen Stellen des Skelettes auftreten. Als Ursache wird eine passagere intraossäre Durchblutungsstörung durch embolische Gefäßverschlüsse, blande Infektionen, Traumen, Gefäßspasmen, vegetative Dysregulatione...

A 45-year-old homeless male patient did not return for follow-up for routine removal 72 days after an external fixator had been placed for a grade II open fracture of the proximal tibia. Ten years later, he was accidentally referred to our institution for newly incurred fractures of the femoral neck on the same side and also for an opposite-side me...

Unlabelled: The knee has various pathologic appearances in patients with congenital longitudinal deformities of the lower extremities. Radiographs from 39 patients with unilateral longitudinal congenital deficiencies of the lower extremities were analyzed to describe epiphyseal and metaphyseal configurations and position of the epiphyseal plate. W...

The Ponseti method for the treatment of congenital clubfeet has been propagated due to the sometimes disappointing functional results after surgical treatment. The aim of our study was to evaluate our early results and experiences with the Ponseti method. Between December 2002 and December 2004 a total of 87 clubfeet in 59 patients were treated usi...

A common pathologic finding in the knee associated with congenital longitudinal deformity is aplasia of one or both cruciate ligaments. We performed a radiographic analysis to assess the changes in the femoral intercondylar notch and the tibial eminence in relation to the status of the cruciate ligaments. Thirty-four knees in thirty-one patients wi...

We present the long-term outcome of nine cases of proximal scaphoid non-union treated by the modified Russe II procedure including excision of the avascular proximal scaphoid pole, placement of a shaped iliac crest bone graft and internal fixation. The patients were re-examined after a mean follow-up of 16.7 years (ranging from 3.5 to 28 years) and...

Cases of developmental dislocation of the hip occur after walking age because of late or missed diagnosis and failed conservative or operative treatment. Although a general consensus exists for the treatment in infants up to the age of 18 months, the recommendations for the treatment of developmental dislocation of the hip in older children range f...

Unlabelled: The aim of our study was to evaluate Iloprost, a prostacyclin analog, for treatment of reflex sympathetic dystrophy in children not responsive to conservative treatment. Seven female patients with a mean age of 9 years (range, 6-11 years) diagnosed with reflex sympathetic dystrophy Stage II were treated with infusions of Iloprost given...

Congenital unilateral anterolateral tibial bowing in combination with a bifid ipsilateral great toe is a very rare deformity which resembles the anterolateral tibial bowing that occurs in association with congenital pseudarthrosis of the tibia. However, spontaneous resolution of the deformity without operative treatment and with a continuously stra...

Aseptic osteonecrosis (AON) in children can progress during ossification of cartilage in periods of increased growth or excessive physical stain and may occur in various locations in the skeleton. Disturbance of blood supply to the bone has been suggested as the main pathological mechanism involved in AON, which is characterised by the death of bon...

Aseptische Knochennekrosen treten bei Kindern im Rahmen von Knorpelverknöcherungsstörungen während vermehrten körperlichen Wachstums, oder während vermehrter körperlicher Belastung an unterschiedlichen Skelettlokalisationen auf. Als Ursache wird eine passagere intraossäre Durchblutungsstörung diskutiert, in deren Folge es zum Auftreten einer Knoche...

Serial casting is successful in avoiding extensive posteromedial release (PMR) in only 11% to 58% of patients with idiopathic congenital clubfoot. Extensive open surgery is commonly associated with long-term stiffness and weakness. Ponseti claims to avoid PMR in 89% of cases by using his specific technique of manipulation, casting, and limited surg...

Complications associated with fixation of artificial ligaments in augmented repair of the anterior cruciate ligament (ACL) have been reported throughout the literature. However, fractures following ligament augmentation device (LAD) fixation appear to be rare. We report the case of a 43-year-old woman, injured in a road accident, who sustained a de...

Zusammenfassung Grundlagen: Die Behandlungsergebnisse, die mit dem Ilizarov System und Hybrid-Fixateuren erzielt werden, ermutigen zum breiten Einsatz bei der Versorgung von kniegelenksnahen Frakturen. Wir berichten von den ersten zehn Fällen mit zum Teil multiplen Frakturen, in denen eine Ringfixation im Bereich des Kniegelenkes angewendet wurde....

Zusammenfassung Grundlagen: Die Komplikationen nach Kreuzbandrekonstruktionen sind in der Literatur ausführlich beschrieben. Frakturen im Zusammenhang mit diesem Eingriff sind ausgesprochen selten. Wir beschreiben den ersten Fall einer distalen Femurfraktur mit der Frakturlinie durch das Schraubenloch einer LAD-(ligament augmentation device)-Fixat...

Zusammenfassung Grundlagen: Zu den beschriebenen Komplikationen der retrograden Oberschenkelnagelung zählen unter anderen Einschränkung der Beweglichkeit, Knorpelschädigung der Gelenksfläche und Degeneration des Femoropatellargelenks. Diese können durch eine exakte präoperative Planung und durch exaktes Einbringen des Nagels minimiert werden. Dies...

Zusammenfassung Grundlagen: Die Entwicklung eines intramedullären Nagels zur Stabilisierung distaler Femurfrakturen in retrograder Technik war ein wesentlicher Beitrag in der Behandlung dieser sehr schwierig zu versorgenden Knochenbrüche. Der SCN (Supracondylar Nail) ist eine Modifizierung bisher bekannter retrograd anzuwendender Implantate, wie e...

Background: Complications associated with retrograde nailing include decreased range of motion and impingement or degeneration of the femoropatellar joint. These complications can be minimized by intensive preoperative planning and precise nail placement. The purpose of this study was to find landmarks which make correct nail insertion easier. The...

Background: The development of the intramedullary nail in stabilisation of very distal femur fractures through retrograde technique has become an essential form of treatment of these difficult fractures. The Supracondylar Nail (SCN) is a modified form of the implants applied until now, such as the Green-Seligson-Henry Nail (GSH). The locking and co...

Background: The results of external circular fixation devices in the treatment of fractures are encouraging and led to a broad use in orthopedic trauma surgery. We report ten cases of lower limb fractures, including two multiple fractures, that were treated by external circular fixation. Methods: The indications for the application of the Ilizarov...

Background: Complications associated with the graft fixation in the repair of the anterior cruciate ligament have been reported throughout the literature. However fractures following a LAD (ligament augmentation device) fixation appear to be rare. We report the first of a distal femoral fracture with the fracture line extending through the screw ho...