Rasmus Thorkildsen

Oslo University Hospital, Kristiania (historical), Oslo County, Norway

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Publications (8)8.96 Total impact

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    ABSTRACT: Trapezium components from two uncemented total joint replacements were compared in a three-dimensional finite element model. A 100 N axial and angular load was applied in a normal and an osteoporotic bone model. The axial deformation and maximum periprosthetic stress are greater for the Elektra(TM) than the Motec CMC(®) cup. The Motec CMC(®) design is less sensitive to changing bone quality. The Elektra(TM) cup transmits more stress to the cortical bone rim in all load conditions, but under angular loading the proportionate increase in stress is lower. The Motec CMC(®) design distributes the stress and contact pressure more evenly, whereas the Elektra(TM) transfers most of the load to the cortical bone rim and the screw hole base. The design features that are believed to be of greatest significance for the differences are the raised centre of rotation of the Motec CMC(®) cup and the collar acting as a lever arm.
    Hand Surgery 01/2013; 18(2):221-8.
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    ABSTRACT: The Motec cementless modular metal-on-metal ball-and-socket wrist arthroplasty was implanted in 16 wrists with scaphoid nonunion advanced collapse (SNAC; grades 3 or 4) and 14 wrists with scapholunate advanced collapse (SLAC) in 30 patients (20 men) with severe (grades 3 or 4) post-traumatic osteoarthritis of the wrist. The mean age of the patients was 52 years (31 to 71). All prostheses integrated well radiologically. At a mean follow-up of 3.2 years (1.1 to 6.1) no luxation or implant breakage occurred. Two wrists were converted to an arthrodesis for persistent pain. Loosening occurred in one further wrist at five years post-operatively. The remainder demonstrated close bone-implant contact. The clinical results were good, with markedly decreased Disabilities of the Arm Shoulder and Hand (DASH) and pain scores, and increased movement and grip strength. No patient used analgesics and most had returned to work. Good short-term function was achieved using this wrist arthroplasty in a high-demand group of patients with post-traumatic osteoarthritis.
    Journal of Bone and Joint Surgery - British Volume 11/2012; 94(11):1540-5. · 2.69 Impact Factor
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    ABSTRACT: OBJECTIVES:: Scaphoid non-union is relatively rare in children and adolescents, and no long-term follow-up has been reported. DESIGN:: retrospective follow-up study. PATIENTS:: Eleven patients (10 boys), mean 15.2 (13.9-15.9) years of age with scaphoid non-union and open growth plates were operated with bone grafting, Kirchner-wire fixation and 12 weeks of cast immobilisation. MAIN OUTCOME MEASUREMENTS:: Bony union, degenerative wrist changes and restoration of the carpal architecture was assessed with CT and radiographs. Clinical parameters included active ROM, grip strength, key pinch strength and subjective outcome scores (QDASH, VAS). RESULTS:: the patients were followed up after mean 6.9 (3.1-15.1) years, all attended. Radiographs and CT confirmed healing of all non-unions, the carpal anatomy was restored and the wrists were rated SNAC 0, without degenerative changes. The clinical result was excellent with VAS at rest = 1, at activity = 6 and QDASH score =3.3. Active ROM and grip strength were insignificantly reduced (14° and 2 kgs), the key pinch strength remained similar. CONCLUSION:: Healing of a scaphoid non-union can be expected in adolescents after open reduction, K-wire fixation, bone grafting and plaster immobilisation, resulting in pain relief and excellent wrist function without degenerative changes after longer term follow-up. LEVEL OF EVIDENCE:: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
    Journal of orthopaedic trauma 08/2012; · 1.78 Impact Factor
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    ABSTRACT: Scaphoid injury and subsequent non-union is a well documented and researched subject. This article gives an overview of the epidemiology and results of the patients we have treated for scaphoid non-union at a University Hospital. 283 scaphoid non-unions in 268 patients (83% men) were operated upon, 230 as a primary and 47 as a secondary. The median age at time of surgery was 27 years. One-third of the non-unions were located in the proximal part of the scaphoid and the remaining two-thirds in the middle part. Of the 146 patients (55%) who contacted a doctor at the time of injury, 53 fractures where diagnosed (20%). Fourteen (5%) were operated primarily while 39 (15%) (seven dislocated) were immobilized in plaster casts. Thirty-two (12%) were under the age of 16 at the time of injury. The average time from the injury to the initial non-union surgery was 1.5 years with 2.8 years to the second procedure. The risk of osteoarthritis increased time from injury to surgery (both primary and secondary procedures). The greatest potential for the reduction of scaphoid non-union is an increased awareness amongst younger men. There is also potential for improved accuracy in the diagnosis of scaphoid fractures (better clinical tests, the use of radiographs, CTs and MRIs) in order to identify the fracture and evaluate dislocation at the initial injury. Early diagnosis and treatment of fractures and non-unions will reduce the development of degenerative wrist changes.
    Hand Surgery 01/2012; 17(3):331-5.
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    ABSTRACT: Untreated scaphoid nonunions are a hazard to the wrist, resulting in deteriorating function and radiologic degenerative changes with increasing time. Long-term results after surgery of scaphoid nonunion reporting clinical, radiologic, and subjective outcomes are scarce. Retrospective follow-up study. From 1990 to 1998, 53 patients were operated on for persistent scaphoid nonunion; three patients were excluded from the follow-up (one expelled foreigner, another died of an unrelated cause, one never appeared after surgery), leaving 50 patients eligible for follow-up. All patients were operated on with open reduction and internal fixation; the majority also received a bone graft. Radiology and computed tomography verified union, degenerative wrist changes, and final salvage treatment. Range of motion, grip strength, key pinch, and subjective outcome (QuickDASH, visual analog scale). Fifty patients were followed up after a mean of 12.2 years (standard deviation [SD], 3.0), 47 by clinical and radiologic examination; three were interviewed by telephone and completed QuickDASH and visual analog scale forms. Union was achieved in 45 of 50 scaphoids and an additional two after a second attempt. Five patients (one persistent and four healed nonunions) underwent salvage procedures. Grip strength (41 vs 45 kg, P = nonsignificant), key pinch (11.5 vs 12.4, P = nonsignificant), and active range of motion (186° vs 214°, P < 0.001) were slightly reduced compared with the uninjured side. The subjective outcome was good (mean visual analog scale = 7, mean QuickDASH = 9.1). Minor degenerative changes were seen in nine wrists at surgery and 22 at follow-up. Healing of a scaphoid nonunion provides long-term pain relief, excellent wrist function, and halts degenerative changes in the majority of patients. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
    Journal of orthopaedic trauma 09/2011; 26(4):241-5. · 1.78 Impact Factor
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    ABSTRACT: Neurovascular injuries in children with dislocated supracondylar humeral fractures are not uncommon. Closed reduction and pin fixation usually will restore the circulation. In some patients, there is still compromised circulation and a neurologic deficit, and they are treated with open exploration and microvascular reconstruction. We have investigated the clinical and functional outcome more than 1 year after the injury in this most serious group of patients. Retrospective follow-up study. During 2001 to 2007, five patients were referred to our department with a pale, pulseless hand and circulatory impairment with absent or slow capillary refill after primary treatment with closed reduction and cross pinning at their local hospital for Gartland Type III supracondylar fractures. Two of the patients also had clinical signs of nerve injury. All were reoperated on with open exploration and release of the entrapped brachial artery. Vascular reconstruction was performed in four patients (vasodilating agent was sufficient in one patient) and release of the median nerve from the fracture in two. One of these two also had a Kirschner wire pierced through the ulnar nerve. All fractures were rereduced and cross-pinned. No intra- or postoperative complications were seen. OUTCOME/RESULTS: At follow-up more than 1 year after the injury, all patients exhibited normal and symmetric function in their upper extremities, including circulation, neurologic status, range of motion, grip strength, and key pinch strength. Clinical and radiologic appearance was normal. Pulseless arms after repositioning of dislocated supracondylar humeral fractures are a medical emergency. After open release and, if necessary, microvascular reconstruction of vessels and nerves, fracture reduction, and fixation, excellent clinical long-term outcome can be expected. The procedure can be carried out with a low rate of complications.
    Journal of orthopaedic trauma 11/2010; 25(1):26-30. · 1.78 Impact Factor
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    ABSTRACT: Untreated ununited scaphoid fractures are a hazard to the wrist because of increasing degenerative changes with time. We have treated 81 consecutive ununited scaphoid fractures by open reposition, autologous bone transplantation, and Kirschner wire fixation, 2.7 years after the primary injury. Sixty-nine were men and the mean age at operation was 29 (range 15-71) years. Anatomy of the wrist was restored and radiological healing confirmed in 72/81 patients. There were two deep infections, and the fractures did not heal. Patients with moderate preoperative arthritic wrist changes (scaphoid non-union advanced collapse (SNAC) stage 2) or ununited fractures of the proximal 1/6 of the scaphoid had worse healing than the remainder. Two of nine scaphoids that did not heal were reoperated on with autologous bone grafting and fixation with screws or pins, both of which healed successfully. Three salvage procedures (two wrist arthrodeses and one four corner fusion) were done and the remaining four declined further treatment. Our overall results are comparable to results published where alternative fixation methods have been used. We find that our standard method using Kirschner (K) wires and bone grafting is reliable and inexpensive for most scaphoid pseudarthroses and our results are comparable to published results when alternative fixation methods have been used.
    Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery 02/2010; 44(2):106-11. · 0.94 Impact Factor
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    ABSTRACT: Eighteen patients who underwent revision non-vascularized bone grafting and internal fixation after failed surgery for scaphoid nonunion were reviewed after a minimum of 8.2 years. Eleven of the nonunions were located in the middle and seven in the proximal third of the scaphoid. The mean interval between injury and the revision procedure was 6 years. Sixteen of the 18 nonunions healed, two after a third attempt. Three patients with healed nonunions and one patient with persistent nonunion required salvage procedures for progressive radiocarpal arthrosis. In the remaining 14 cases, the mean loss of wrist flexion/extension arc compared to the contralateral wrist was 36 degrees . Mean reduction of grip strength and key pinch was 9.3 kg and 0.9 kg respectively. The QuickDASH score was 18 and a visual analogue pain score was 21/100 at follow-up. Wrist degeneration increased in all but one case during the observation period. Thirteen of 16 patients with union and one patient with a persisting nonunion experienced moderate symptoms.
    The Journal of hand surgery, European volume. 09/2009; 34(6):772-7.