Muskuloskeletal

Radiografi konvensional.
Dr. Budiawan Atmadja. SpRad.




Prinsip dasar
Posisi penyinaran / ekspose
harus orthogonal (AP & Lat
/ 90
0
satu sama lain )
Minimal 2 posisi (AP dan
Lat)
Monteggia Fx
Galleazzi Fx
Prinsip dasar
Pada tulang yang
berpasangan harus
terlihat kedua sendi

Definisi
Fraktur adanya
diskontinuitas kortek
Komplit
Inkomplit

Dislokasi tidak adanya
kontak antar tulang
dalam sendi
Karena robekan total sendi

Subluxation tidak
adanya sebagian kontak
antar tulang dalam sendi
Robekan sebagian sendi

Fraktur inkomplit
Greenstick
fraktur satu sisi
kortex



Torus buckling of
the cortex (stress
fracture)
Greenstick Fractures
Buckle Fractures
Arah Garis fraktur
Hubungan antar fragment fraktur
Jumlah fragment fraktur
Adanya hubungan dgn udara bebas

Diagnosis fraktur
Diagnosis fraktur
Arah garis fraktur
Transversal
Diagonal or oblique
Longitudinal
Spiral
Hubungan antar fragment fraktur
Displacement
Angulasi
Shortening
Rotasi
Avulsi / amputasi
Sering fraktur memperlihatkan > 1
abnormaliltas
Diagnosis fraktur
Diagnosis fraktur
Jumlah fragment
fraktur
Simple - 2 fragment
Comminuted - > 2
fragments
Simple Comminuted
1
2
1
2
3
4
Adanya hubungan
fragment fraktur
dgn udara bebas
Closed
Open or compound
Diagnosis fraktur
Salter-Harris Fractures
Fraktur mengenai
epifiseal plate atau
kombinasi dgn
metafise atau epifise
Penting Nilai
prognostik
Tipe I dan II baik
Tipe IV dan V fusi
dan pemendekan tulang
Eponim fraktur
Colles fracture
Smiths fracture
Jones fracture
Boxers fracture
Common Fracture Eponyms
Colles
fracture
Fraktur
distal
radius dgn
angulasi
dorsal

R3
Common Fracture Eponyms
Smiths fracture
Fraktur distal
radius dgn
angulasi palmar
R3
Common Fracture Eponyms
Jones fracture fraktur basal metatarsal
V
Common Fracture Eponyms
Boxers fracture
Fraktur caput
metakarpal V dgn
angulasi palmar

R3
Fraktur Pelvis
Stable and Unstable
Stable fracture
Fraktur tunggal cincin atau perifer
(66%)
moderate trauma : jatuh dll
Unstable fracture
Fraktur multipel lengkung anterior
dan posterior (33%)
Trauma berat : tertabrak dll
Fraktur Pelvis (unstable)
Straddle Fx
Fx bilateral cincin
obturator
Bucket-handle Fx
Fx cincin obturator
Fx atau robekan
sacroiliac joint
kontralateral
Fraktur Pelvis (unstable)
Dislokasi sacroiliac
joint

Fraktur Pelvis (unstable)
1. Fase Inflamasi
Hematoma
Jaringan granulasi
2. Fase Reparasi
Callus fibrocartilageneous
Callus tulang
3. Fase Remodelling

Fracture Healing
Series of images shows indistinctness of fracture line with bony callous
formation and, finally, obliteration of the fracture line. There are metallic rods
transfixing the fracture.
R3
Osteomyelitis
Komplikasi fraktur
Malunion
Sembuh tapi tidak
anatomi
Delayed union
> 16-18 minggu
Disunion / Non union
Penyembuhan gagal >
24 minggu ( 6 bulan)
Infeksi (osteomyelitis)

Osteomyelitis
Tipe berdasarkan klinis
1. Akut
2. Sub akut
3. Kronis
Osteomyelitis kronis
Osteomyelitis sub akut
Onset cepat, perkembangan lambat
Osteomyelitis sub akut, bentuk khusus :
Abses Brodie
Osteomyelitis Garre
Osteomyelitis Salmonella
Osteomyelitis TBC
Paru-paru lesi primer < 50%
terlihat kelainan paru diduga di
lokasi lain
Hematogen
Lesi granulomatosa sub akut dan
kronis
Vertebrae 50% dan proksimal tulang
apendikular



Osteomyelitis TBC
Osteomyelitis TBC
Gambaran lesi
- Destruksi tulang
- Reaksi periosteal
- Matriks tumor
- Ekspansi lesi
- Keterlibatan jaringan lunak

Tipe destruksi
Geographic
Moth-eaten
Permeative
Non-ossifying fibroma
Geographic
Multiple Myeloma
Moth-eaten
Leukemia / permeative
Tipe Destruksi
Geographic Moth-eaten Permeative
Less malignant More malignant
Reaksi periosteal
Benign
None
Solid
Keganasan
Lamellated or onion-skin
Sunburst
Codmans triangle
Tipe Reaksi periosteal
Non-ossifying fibroma
Benign
None
Solid
Aggressive/malignant
Onion-skinning
Sunburst
Codmans triangle
Tipe Reaksi periosteal
R
3
, 2000
Chronic osteomyelitis
Benign
None
Solid
Aggressive/malignant
Onion-skinning
Sunburst
Codmans triangle
R
3
, 2000
Tipe Reaksi periosteal
Benign
None
Solid
Aggressive/malignant
Onion-skinning
Sunburst
Codmans triangle
Ewings sarcoma
Greenspan, 2000
Tipe Reaksi periosteal
Osteosarcoma
Benign
None
Solid
Aggressive/malignant
Onion-skinning
Sunburst
Codmans triangle
Greenspan, 2000
Tipe Reaksi periosteal
Ewings-Codmans
triangle
Benign
None
Solid
Aggressive/malignant
Onion-skinning
Sunburst
Codmans triangle
R
3
, 2000
Tipe Reaksi periosteal
Reaksi periosteal
Solid Lamellated Codmans Sunburst
Less malignant More malignant
Osteoblastic
Cartilaginous

Tumor matrix
Metastasis Ca Prostat
R
3
, 2000
Osteoblastic
Cartilaginous

Tumor matrix
Chondrosarcoma
R
3
, 2000
Multiple Myeloma
Tipe Expansif
Multiple myeloma
Mets
Aneurysmal bone cyst
Fibrous dysplasia
Brown tumor
Enchondroma
Lymphoma

Renal Cell Carcinoma
Multiple myeloma
Metastasis
Aneurysmal bone cyst
Fibrous dysplasia
Brown tumor
Enchondroma
Lymphoma

Tipe Expansif
Aneurysmal Bone Cyst
Multiple myeloma
Mets
Aneurysmal bone cyst
Fibrous dysplasia
Brown tumor
Enchondroma
Lymphoma

Tipe Expansif
Fibrous Dysplasia
Multiple myeloma
Mets
Aneurysmal bone cyst
Fibrous dysplasia
Brown tumor
Enchondroma
Lymphoma

Tipe Expansif
Brown Tumor
Multiple myeloma
Mets
Aneurysmal bone cyst
Fibrous dysplasia
Brown tumor
Enchondroma
Lymphoma

R
3
, 2000
Tipe Expansif
Enchondroma
Multiple myeloma
Mets
Aneurysmal bone cyst
Fibrous dysplasia
Brown tumor
Enchondroma
Lymphoma

R
3
, 2000
Tipe Expansif
Lymphoma
Multiple myeloma
Mets
Aneurysmal bone cyst
Fibrous dysplasia
Brown tumor
Enchondroma
Lymphoma

R
3
, 2000
Tipe Expansif
Benign vs. Malignant
Greenspan, Lippincott, 2000
Jinak dan Ganas
Osteosarkoma
Osteokondroma
Myeloma multiple
GCT (Giant Cell Tumour)
ABC (Aneurysmal Bone Cyst)
Definisi
Kelainan tulang dalam ruang sendi
dan adanya penyempitan ruang
sendi
Klasifikasi
Hypertrophic arthritis
Vital sign
Bone production
Sclerosis
Infectious arthritis
Vital sign
Destruction of articular cortex
Erosive arthritis
Vital sign
Erosions
Foto polos
Penyempitan ruang sendi
Subchondral sclerosis
Marginal osteophyte formation
Subchondral cysts
Arthritis Degeneratif
Degeneratif arthritis
Charcots Knees-Diabetes
Arthritis Infeksi
Penyebab
Biasa staphylococcus
Progesif
TBC
Hematogen
Lebih lamban
Anak-anak vertebrae
Dewasa lutut
Osteoporosis berat
Sembuh sering
ankylosis
Septic arthritis
Erosive Arthritis
Tipe
Rheumatoid arthritis
Gout
Hemophilia
Erosive osteoarthritis
Rheumatoid variants
Psoriatic arthritis
Reiter's
Ankylosing spondylitis
Inflammatory bowel disease
Rheumatoid Arthritis

Simetris bilateral
Perubahan paling awal : MCP, PIP,
ulnar styloid
Radiocarpal joint paling sering
menyempit
Periarticular demineralization
Mulai sendi MCP 1
st
and 2
nd

Sendi besar biasa tak terlihat erosi
RA
RA of Foot
RA usually
involves 5
th

MT-P joint
first
Gout

Interval lama antara gejala dgn
adanya perubahan pada tulang
Asimetris dan monoartikuler
Pria lebih sering
Paling sering sendi MT- P
pertama
Tophus jarang membentuk
kalsifikasi
Olecranon bursitis umum
Gout
Ankylosing Spondylitis


HLA-B27 positive
Corpus vertebrae persegi
Bamboo-spine from
continuous syndesmophytes
Peripheral large joint erosive
arthritis
Ankylosing Spondylitis