Radiologi Dasar Ortopedia

Tujuan
• Review secara sistematik pendekatan
interpretasi X-ray ortopedia
• Rencana keperawatan sesuai dengan temuan x-
ray
Mengapa Perawat Perlu Belajar X-Ray?
• Menurunkan risiko cedera atau perburukan
kondisi
• Merencanakan pemenuhan kebutuhan dasar
• Merencanakan pentingnya kebutuhan
kolaborasi
• Meningkatkan komunikasi tim
 Pendekatan ABCs

Pendekatan ABCs dapat diterapkan pada semua

film x-ray
 ABCs APPROACH
A
◦ Adequacy, Alignment
B
◦ Bones (tulang): Bentuk, densitas, fraktur, destruksi,
osteofit
C
◦ Cartilage (Kartilago): sela sendi/ celah diskus
intervertebralis
S
◦ Soft Tissues (jaringan lunak): massa, kalsifikasi
 ADEQUACY
• All x-rays should have an adequate number of
views.
– Minimum of 2 views—AP and lateral
– 3 views preferred
– Some bones require 4 views

• All x-rays should have adequate penetration

 ALIGNMENT (Kesegarisan)
• Alignment: hubungan anatomi antar tulang

• Normal x-rays should have normal alignment

• Kondisi fraktur atau dislokasi akan berdampak

pada kesegarisan gambaran x-ray
 BONES
• Kaji garis fraktur atau distorsi pada tulang

• Kaji keseluruhan panjang tulang

• Adakah fraktur?
 CARTILAGE
• Kaji jarak sendi tulang rawan (cartilage on x-
rays, may can not be seen)
• Jarak sendi yang lebar mengindikasikan injuri
ligamen atau fraktur
 SOFT TISSUES
• Identifikasi jaringan lunak yang bengkak dan
efusi sendi
• These can be signs of occult fractures
 REVIEW: ABCs
A
◦ Assess adequacy of x-ray which includes proper
number of views and penetration
◦ Assess alignment of x-rays
B
◦ Examine bones throughout their entire length for
fracture lines and/or distortions
C
◦ Examine cartilages (joint spaces) for widening
S
◦ Assess soft tissues for swelling/effusions

Masfuri, FIK 2013

 REVIEW: ABCs
A
◦ Assess adequacy of x-ray which includes proper
number of views and penetration
◦ Assess alignment of x-rays
B
◦ Examine bones throughout their entire length for
fracture lines and/or distortions
C
◦ Examine cartilages (joint spaces) for widening
S
◦ Assess soft tissues for swelling/effusions
 ANATOMI TULANG
Kata Kunci:
• Deskripsikan lokasi abnormalitas tulang dgn
proses pertumbuhan tulang: Diaphysis,
metaphysis or epiphysis
 Bone anatomy
1

3
 Struktur tulang
• Bagian medula tulang lebih gelap
dibandingkan bagian korteks tulang
 Anatomi sendi
• Persendian umumnya ada cairan sinovial,
bandingkan 2 garis tulang dengan jaringan
kartilago dan kapsul cairan sinovial

1
 Descriptive terms
General terms can be used to describe the
location of an abnormality

1
2

4
 Systematic approach
• Patient and image data
• Bone and joint alignment
• Joint spacing
• Cortical outline
• Bone texture
• Soft tissues

Masfuri, FIK 2013

Systematic approache

Masfuri, FIK 2013

 Celah Sendi
• Joint spacing may be narrowed due to
cartilage loss or widened due to
dislocation/dissociation
• X-Ray example: Osteoarthritis of the 1st
metatarsophalangeal joint
 Cortical outline
Careful scrutiny of the bone cortex:
• Check the cortical outline (white lines) of ALL
bones visible on every X-ray available
• Check for any breach in this outline (red line ! )
Boxer fracture

Masfuri, FIK 2013

 Bone texture
Example: Proximal femur
• Well defined trabecular pattern visible
forming the femoral neck architecture
• Distortion of this trabecular pattern may make
an abnormality
Proximal femur

Masfuri, FIK 2013

 Soft tissues
• Abnormality example: Joint effusion
containing fat and blood (lipohaemarthrosis)
that has 'leaked' from bone following trauma
• Visible fracture line

Masfuri, FIK 2013

Masfuri, FIK 2013
 Viewing principles
• Confidence in assessing musculoskeletal system
X-rays comes from experience and a knowledge
of normal appearances. All patients are different,
so being sure of the distinction between normal
and abnormal is often difficult.

• Key points:
– 2 views are better than 1
– Check all available images
– Compare with the other side (if imaged)
– If available ALWAYS compare with old X-rays

Masfuri, FIK 2013

 2 views

Masfuri, FIK 2013

Masfuri, FIK 2013
FRACTURE LINES
 FRACTURE LINES
• A is a transverse fracture

• B is an oblique fracture

• C is a spiral fracture

• D is a comminuted fracture
WHAT TYPE OF FRACTURE
LINE IS THIS???
ANS: TRANSVERSE FRACTURE
• Fraktur transversal terjadi tegak lurus
terhadap sumbu panjang tulang
• To fully describe the fracture, this is a closed
midshaft transverse humerus fracture.
ANOTHER EXAMPLE OF FRACTURE
LINE…

Masfuri, FIK 2013

 ANS: SPIRAL FRACTURE
• Fraktur spiral terjadi secara spiral di sepanjang
sumbu panjang tulang
• They are usually caused by a rotational force
 ANS: COMMINUTED
FRACTURE
• Comminuted fractures are those with 2 or
more bone fragments are present

• Sometimes difficult to appreciate on x-ray but

will clearly show on CT scan
 LANGUAUGE OF FRACTURES
• To review, when seeing a patient with a
fracture and the x-ray, describe the following:
– Open vs closed fracture
– Anatomic location of fracture (distal, mid,
proximal) and if fracture is intra-articular
– Fracture line (transverse, oblique, spiral,
comminuted)
– Relationship of fracture fragments (angulation,
displacement, dislocation, etc)
– Neurovascular status
TERIMAKASIH