Muskuloskeletal

Radiografi konvensional.
Dr. Budiawan Atmadja. SpRad.

Prinsip dasar

Posisi penyinaran / ekspose

harus orthogonal (AP & Lat
/ 900 satu sama lain )
Minimal 2 posisi (AP dan
Lat)

Galleazzi Fx

Monteggia 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

Greenstick Fractures

Torus

buckling of
the cortex (stress
fracture)
Buckle Fractures

Diagnosis fraktur
Arah

Garis fraktur
Hubungan antar fragment fraktur
Jumlah fragment fraktur
Adanya hubungan dgn udara bebas

Diagnosis fraktur
Arah

garis fraktur

Transversal
Diagonal or oblique
Longitudinal
Spiral

Diagnosis fraktur
Hubungan

antar fragment fraktur

Displacement
Angulasi
Shortening
Rotasi
Avulsi / amputasi
Sering

fraktur memperlihatkan > 1

abnormaliltas

Diagnosis fraktur
Jumlah

fragment

fraktur
Simple - 2 fragment
Comminuted - > 2
fragments

2
1

4
2

Simple

Comminuted

Diagnosis fraktur
Adanya

hubungan
fragment fraktur
dgn udara bebas
Closed
Open or compound

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

Fraktur Pelvis (unstable)

Bucket-handle

Fx

Fx cincin obturator
Fx atau robekan
sacroiliac joint
kontralateral

Fraktur Pelvis (unstable)

Dislokasi

joint

sacroiliac

Fracture Healing
1.

Fase Inflamasi
Hematoma
Jaringan granulasi

2.

Fase Reparasi
Callus fibrocartilageneous
Callus tulang

3.

Fase Remodelling

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.
2.
3.

Akut
Sub akut
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

Leukemia / permeative

Multiple Myeloma

Moth-eaten

Tipe Destruksi

Geographic
Less malignant

Moth-eaten

Permeative
More malignant

Reaksi periosteal
Benign

None
Solid
Keganasan

Lamellated or onion-skin
Sunburst
Codmans triangle

Tipe Reaksi periosteal

Tipe Reaksi periosteal

Benign

None
Solid
Aggressive/malignant

Onion-skinning
Sunburst
Codmans triangle
R3, 2000

Non-ossifying fibroma

Tipe Reaksi periosteal

Benign

None
Solid
Aggressive/malignant

Onion-skinning
Sunburst
Codmans triangle
R3, 2000

Chronic osteomyelitis

Tipe Reaksi periosteal

Benign

None
Solid
Aggressive/malignant

Onion-skinning
Sunburst
Codmans triangle
Greenspan, 2000

Ewings sarcoma

Tipe Reaksi periosteal

Benign

None
Solid
Aggressive/malignant

Onion-skinning
Sunburst
Codmans triangle

Greenspan, 2000

Osteosarcoma

Tipe Reaksi periosteal

Benign

None
Solid
Aggressive/malignant

Onion-skinning
Sunburst
Codmans triangle

R3, 2000

Ewings-Codmans
triangle

Reaksi periosteal

Solid
Less malignant

Lamellated

Sunburst

Codmans
More malignant

Tumor matrix
Osteoblastic
Cartilaginous

R3, 2000

Metastasis Ca Prostat

Tumor matrix
Osteoblastic
Cartilaginous

R3, 2000

Chondrosarcoma

Tipe Expansif

Multiple myeloma

Mets

Aneurysmal bone cyst

Fibrous dysplasia

Brown tumor

Enchondroma

Lymphoma
Multiple Myeloma

Tipe Expansif

Multiple myeloma

Metastasis

Aneurysmal bone cyst

Fibrous dysplasia

Brown tumor

Enchondroma

Lymphoma
Renal Cell Carcinoma

Tipe Expansif

Multiple myeloma

Mets

Aneurysmal bone cyst

Fibrous dysplasia

Brown tumor

Enchondroma

Lymphoma
Aneurysmal Bone Cyst

Tipe Expansif

Multiple myeloma

Mets

Aneurysmal bone cyst

Fibrous dysplasia

Brown tumor

Enchondroma

Lymphoma
Fibrous Dysplasia

Tipe Expansif

Multiple myeloma

Mets

Aneurysmal bone cyst

Fibrous dysplasia

Brown tumor

Enchondroma

Lymphoma

R3, 2000

Brown Tumor

Tipe Expansif

Multiple myeloma

Mets

Aneurysmal bone cyst

Fibrous dysplasia

Brown tumor

Enchondroma

Lymphoma

R3, 2000

Enchondroma

Tipe Expansif

Multiple myeloma

Mets

Aneurysmal bone cyst

Fibrous dysplasia

Brown tumor

Enchondroma

R3, 2000

Lymphoma
Lymphoma

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

Erosive

of articular cortex

arthritis

Vital sign
Erosions

Arthritis Degeneratif

Foto

polos

Penyempitan ruang sendi

Subchondral sclerosis
Marginal osteophyte formation
Subchondral cysts

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 1st and 2nd
Sendi besar biasa tak terlihat erosi

RA

RA usually
involves 5th
MT-P joint
first

RA of Foot

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