DASAR-DASAR RADIOLOGI

MUSKULOSKELETAL
Cara membaca foto MS

A = Alignment
B = Bone
C = Celah sendi
S = Soft tissue
ANATOMY TULANG DAN SENDI

Pelajari anatomi tulang mulai dari skull sampai

phalanx distal kaki
 4.

3.
2.
1.
1. Articular cartilage
2. Subarticular of
epiphyse
5.
3. Epiphysis
4. Epiphyseal line
6.
5. Metaphysis
6. Diaphysis
KELAINAN TULANG DAN SENDI
1. ANOMALI PERKEMBANGAN/KONGENITAL

2. INFEKSI

3. TRAUMA & FRAKTUR

4. PENYAKIT DEFISIENSI TULANG

5. PENYAKIT DISPLASIA TULANG

6. TUMOR TULANG

7. AVASCULAR NEKROSIS/ASEPTIK NEKROSIS

8. PENYAKIT DEGENERATIF SENDI/METABOLIK

 FRAKTUR
4.1 Classification of fractures and dislocations
4.1.1 General classifications
• a fracture is either a complete break in the continuity of a bone or an incomplete break or crack.
• fractures are subdivided according to their cause:
1. acute traumatic fractures
2. stress fractures
3. pathological fractures
• acute traumatic fractures are classified as:
complete — discontinuity between two or more bone fragments
incomplete — portion of cortex remains intact
displaced — space between margins of fracture causing deformity
undisplaced — bone fragments closely apposed with minimal deformity
closed/simple — no communication between fracture and skin surface
open/compound — wound extends from skin surface to fracture
• an open/compound fracture is liable to be contaminated and has a high risk of infection.
• descriptive terms used to indicate the shape or pattern of an acute fracture in the adult are
(fig 4.1):
1. transverse fractures
2. oblique fractures
3. spiral fractures
4. comminuted fractures (2 or more fragments)
5. compression/crush fractures
 6. depressed (in skull)
Figure 4.1
Common fracture patterns. (modified from Adams & Hamblen, Outline of
Fractures, 10th ed, Churchill Livingstone 1992, with permission)
4.1.2 Dislocations

• a joint is dislocated (luxated) when its articular

surfaces are wholly displaced one from the other,
so that apposition between them is lost (fig 4.2).
• subluxation exists when the articular surfaces are
partly displaced but retain some contact with
each other.
• dislocation may occur in isolation or with a fracture
(so-called fracture-dislocation) (fig 4.3).
Figure 4.2
Fifth finger showing dorsal
dislocation of the proximal
interphalangeal joint.

Figure 4.3
AP ankle showing a fracture-dislocation.
There is a spiral fracture of the
distal fibula and medial subluxation of the
distal tibia with respect to the
top of the talus.
4.1.3 Fractures in children

• the pattern of bony injuries in the child are somewhat different to

the adult as the skeleton is more
elastic and less brittle.
• fractures in children are classified as (fig 4.4);
— complete
— greenstick fracture
— torus (buckle) fracture
— pipe fracture
— bowing injury
— infant’s (toddler’s) fracture
— epiphyseal/metaphyseal fractures
— avulsion injuries
Figure 4.4
Typical fracture patterns in children.
(modified from Lee Rogers Radiology of
Skeletal Trauma 2nd Ed, Churchill
Livingstone 1992)
Figure 4.5
Child with a greenstick
fracture of the radius.
4.3 Complications of fractures

• complications of fractures may be classified into intrinsic (related to the fracture

itself ) and extrinsic
(the result of associated injury).
• intrinsic complications include;
— delayed union and non-union
— malunion and shortening
— avascular necrosis
— infection
— degenerative joint disease
• extrinsic complications include;
— injury to adjacent vessels, nerves and tendons
— injury to viscera
— fat embolism (release of marrow fat to the lungs)
— reflex sympathetic dystrophy (Sudeck’s atrophy)
GAMBARAN RADIOLOGI
Osteomyelitis

Osteoporosis diperlihatkan 10-14 hr dari

timbulnya gejala
Infant dan Anak-anak ------metafise, soft tissue
sweeling, involucrum timbul setelah tiga
minggu
Dewasa------ epifise, bone often remains sclerotic
and irregular in outline
CT Scan-----Terlihat local bone destruction
pada fragmentasi dari densitas tulang
Osteomyelitis

Plain radiographic findings in

acute or subacute osteomyelitis are
deep soft-tissue swelling,
a periosteal reaction, cortical
irregularity, and demineralization.
The chronic phase of the disease is
characterized by thick, irregular,
sclerotic bone interspersed with
radiolucencies, an elevated
periosteum, and chronic draining
sinuses.
 Osteomyelitis Kronik

Sclerosing osteomyelitis of the lower tibia. Sequestrum of the lower tibia

Chronic osteomyelitis of the calcaneum. Cortex of the proximal phalanx
Air in the soft tissues. of the hallux is irregular
Fraktur radius bagian distal
a.Fraktur Colles
fr.radius bagian distal (sampai 1 mm
dibagian distal) dengan angulasi ke
posterior, dislokasi ke posterior dan deviasi
fragmen distal ke radial
b. Fraktur Smith
Fr.radius bagian distal dengan angulasi atau
dislokasi fragmen distal ke volar
Colles’ fracture
Foto PA: Foto Lateral:
 Fraktur radius bagian Displacement ke arah dorsal dan
distal disertai fraktur angulasi radius bagian distal ke
prosesus stiloid ulna arah proksimal
Smith’s type fracture
Fraktur radius dan ulna
a. Fr.Monteggia

fr.ulna bagian proximal dengan dislokasi

kaput radii

b. Fr.Galeazzi
fr.radius bagian distal dengan dislokasi
ulna bagian distal
Fr. Galeazzi
Fr. Monteggia
Fr. Galeazzi
Fr. Monteggia