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7/24/2019 KULIAH Muskuloskeletal UKI.ppt
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MuskuloskeletalMuskuloskeletal
Radiografi konvensional.Radiografi konvensional.Dr. Budiawan Atmadja. SpRad.Dr. Budiawan Atmadja. SpRad.
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Prinsip dasarPrinsip dasar
Posisi penyinaran / eksposePosisi penyinaran / ekspose
harus orthogonal (AP & Latharus orthogonal (AP & Lat
/ 90/ 9000satu sama lain )satu sama lain )
Minimal 2 posisi (AP danMinimal 2 posisi (AP danLat)Lat)
Monteggia Fx
allea!!i Fx
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Prinsip dasarPrinsip dasar
Pada tulang yangPada tulang yang
"erpasangan harus"erpasangan harus
terlihat kedua senditerlihat kedua sendi
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DefinisiDefinisi FrakturFraktur adanyaadanya
diskontinuitas kortekdiskontinuitas kortek
KomplitKomplit
InkomplitInkomplit
DislokasiDislokasi tidak adanyatidak adanya
kontak antar tulang dalamkontak antar tulang dalam
sendisendi
Karena robekan total sendiKarena robekan total sendi
SubluxationSubluxation tidak adanyatidak adanya
sebagian kontak antar tulangsebagian kontak antar tulang
dalam sendidalam sendi
Robekan sebagian sendiRobekan sebagian sendi
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Fraktur inkomplitFraktur inkomplit
Greenstik frakturGreenstik fraktur
satu sisi kortexsatu sisi kortex
!orus bukling of!orus bukling oft"e ortex #stresst"e ortex #stress
frature$frature$
Greenstick Fractures
Buckle Fractures
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%ra" Garis fraktur%ra" Garis fraktur
&ubungan antar fragment fraktur&ubungan antar fragment fraktur
'umla" fragment fraktur'umla" fragment fraktur
%danya "ubungan dgn udara bebas%danya "ubungan dgn udara bebas
Diagnosis frakturDiagnosis fraktur
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Diagnosis frakturDiagnosis fraktur
%ra" garis fraktur%ra" garis fraktur
!ransversal!ransversal
Diagonal or obli(ueDiagonal or obli(ue
)ongitudinal)ongitudinal SpiralSpiral
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&ubungan antar fragment fraktur&ubungan antar fragment fraktur
DisplaementDisplaement
%ngulasi%ngulasi
S"orteningS"ortening
RotasiRotasi
%vulsi * amputasi%vulsi * amputasiSering fraktur memperli"atkan + ,Sering fraktur memperli"atkan + ,
abnormaliltasabnormaliltas
Diagnosis frakturDiagnosis fraktur
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Diagnosis frakturDiagnosis fraktur
'umla" fragment'umla" fragment
frakturfraktur
Simple -Simple - fragment fragment
/omminuted/omminuted -- + +
fragmentsfragments
Simple Comminuted
1
2
1
2
3
4
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%danya "ubungan%danya "ubungan
fragment frakturfragment fraktur
dgn udara bebasdgn udara bebas/losed/losed
0pen or ompound0pen or ompound
Diagnosis frakturDiagnosis fraktur
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Salter-&arris FraturesSalter-&arris Fratures
Fraktur mengenaiFraktur mengenai
epifiseal plate atauepifiseal plate atau
kombinasi dgnkombinasi dgn
metafise atau epifisemetafise atau epifise1enting1enting 2ilai2ilai
prognostikprognostik !ipe I dan II baik!ipe I dan II baik
!ipe I3 dan 3!ipe I3 dan 3 fusifusidan pemendekan tulangdan pemendekan tulang
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4ponim fraktur4ponim fraktur
/olle5s frature/olle5s frature
Smit"5s fratureSmit"5s frature
'ones5 frature'ones5 frature
6oxer5s frature6oxer5s frature
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/ommon Frature 4ponyms/ommon Frature 4ponyms
/olle5s/olle5s
fraturefrature
FrakturFraktur
distaldistal
radius dgnradius dgn
angulasiangulasidorsaldorsal
R3
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/ommon Frature 4ponyms/ommon Frature 4ponyms
Smit"5s fratureSmit"5s frature
Fraktur distalFraktur distalradius dgnradius dgn
angulasi palmarangulasi palmar
R3
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/ommon Frature 4ponyms/ommon Frature 4ponyms
'ones5 frature'ones5 frature fraktur basal metatarsal 3 fraktur basal metatarsal 3
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/ommon Frature 4ponyms/ommon Frature 4ponyms
6oxer5s frature6oxer5s frature
Fraktur aputFraktur aput
metakarpal 3 dgnmetakarpal 3 dgnangulasi palmarangulasi palmar
R3
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Fraktur 1elvisFraktur 1elvis
StableStable andandUnstableUnstableStable fractureStable fracture
Fraktur tunggal cincin atau perifer (66!Fraktur tunggal cincin atau perifer (66!m"derate trauma # jatu$ dllm"derate trauma # jatu$ dll
Unstable fractureUnstable fracture
Fraktur multipel lengkung anteri"r danFraktur multipel lengkung anteri"r dan
p"steri"r (%%!p"steri"r (%%!&rauma berat # tertabrak dll&rauma berat # tertabrak dll
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Fraktur 1elvis #unstable$Fraktur 1elvis #unstable$
Straddle F'Straddle F'
F' bilateral cincinF' bilateral cincin
"bturat"r"bturat"r
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Bucket$andle F'Bucket$andle F'
F' cincin "bturat"rF' cincin "bturat"r
F' atau r"bekanF' atau r"bekan
sacr"iliac j"intsacr"iliac j"intk"ntralateralk"ntralateral
Fraktur 1elvis #unstable$Fraktur 1elvis #unstable$
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Disl"kasi sacr"iliacDisl"kasi sacr"iliac
j"intj"int
Fraktur 1elvis #unstable$Fraktur 1elvis #unstable$
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1.1. FaseFaseInflamasiInflamasi
HematomaHematoma
Jaringan granulasiJaringan granulasi
2.2. FaseFaseReparasiReparasi
Callus fibrocartilageneousCallus fibrocartilageneous
Callus tulangCallus tulang
3.3. FaseFaseRemodellingRemodelling
Frature &ealingFrature &ealing
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Series of images shows indistinctness of fracture line with bon callous
formation and! finall! obliteration of the fracture line" #here are metallic rods
transfi$ing the fracture"
R3
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0steomyelitis0steomyelitis
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Komplikasi frakturKomplikasi fraktur
)aluni"n)aluni"n
Sembu$ tapi tidakSembu$ tapi tidak
anat"mianat"mi
Dela*ed uni"nDela*ed uni"n
+ ,6,- minggu+ ,6,- minggu
Disuni"n /"n uni"nDisuni"n /"n uni"n
0en*embu$an gagal +0en*embu$an gagal +
12 minggu ( 6 bulan!12 minggu ( 6 bulan!
3nfeksi ("ste"m*elitis!3nfeksi ("ste"m*elitis!
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0steomyelitis0steomyelitis
&ipe berdasarkan klinis&ipe berdasarkan klinis
,.,. AkutAkut
1.1. Sub akutSub akut
%.%. 4r"nis4r"nis
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0steomyelitis kronis0steomyelitis kronis
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0steomyelitis sub akut0steomyelitis sub akut
5nset cepat perkembangan lambat5nset cepat perkembangan lambat
5ste"m*elitis sub akut bentuk k$usus #5ste"m*elitis sub akut bentuk k$usus #Abses Br"dieAbses Br"die
5ste"m*elitis 7arre5ste"m*elitis 7arre5ste"m*elitis Salm"nella5ste"m*elitis Salm"nella
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0steomyelitis !6/0steomyelitis !6/
0aruparu lesi primer0aruparu lesi primer 8 9:8 9:
terli$at kelainan paruterli$at kelainan paru diduga dididuga di
l"kasi lainl"kasi lain
;emat"gen;emat"gen
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0steomyelitis !6/0steomyelitis !6/
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0steomyelitis !6/0steomyelitis !6/
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Gambaran lesi
-%estruksi tulang
-Reaksi periosteal
-&atriks tumor
-'kspansi lesi
-(eterlibatan )aringan lunak
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!ipe destruksi!ipe destruksi
Geograp"iGeograp"i
Mot"-eatenMot"-eaten
1ermeative1ermeative *on+ossifing fibromaGeograp"i &ultiple &elomaMot"-eaten
)eukemia * permeative
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!ipe Destruksi!ipe Destruksi
Geographic &oth+eaten ,ermeati-e
.ess malignant &ore malignant
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Reaksi periostealReaksi periosteal
6enign6enign
2one2one
SolidSolid
KeganasanKeganasan
)amellated or onion-skin)amellated or onion-skin
SunburstSunburst
/odman5s triangle/odman5s triangle
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#ipe Reaksi periosteal
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*on+ossifing fibroma
6enign6enign
2one2one
SolidSolid
%ggressive*malignant%ggressive*malignant
0nion-skinning0nion-skinning
SunburstSunburst
/odman5s triangle/odman5s triangle
#ipe Reaksi periosteal
# R78 999
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Chronic osteomelitis
6enign6enign
2one2one
SolidSolid
%ggressive*malignant%ggressive*malignant
0nion-skinning0nion-skinning
SunburstSunburst
/odman5s triangle/odman5s triangle# R78 999
#ipe Reaksi periosteal
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6enign6enign
2one2one
SolidSolid
%ggressive*malignant%ggressive*malignant
0nion-skinning0nion-skinning
SunburstSunburst
/odman5s triangle/odman5s triangle
'wing/s sarcoma
# Greenspan8 999
#ipe Reaksi periosteal
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0steosarcoma
6enign6enign
2one2one
SolidSolid
%ggressive*malignant%ggressive*malignant
0nion-skinning0nion-skinning
SunburstSunburst
/odman5s triangle/odman5s triangle# Greenspan8 999
#ipe Reaksi periosteal
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'wing/s+Codman/s
triangle
6enign6enign
2one2one
SolidSolid
%ggressive*malignant%ggressive*malignant
0nion-skinning0nion-skinning
SunburstSunburst
/odman5s triangle/odman5s triangle# R78 999
#ipe Reaksi periosteal
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Reaksi periostealReaksi periosteal
Solid .amellated Codman/sSunburst
.ess malignant &ore malignant
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0steoblasti0steoblasti
/artilaginous/artilaginous
#umor matri$
&etastasis Ca ,rostat
# R78 999
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&ultiple &eloma
#ipe '$pansif
&ultiple meloma
&ets
neursmal bone cstFibrous dsplasia
Brown tumor
'nchondroma
.mphoma
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Renal Cell Carcinoma
&ultiple meloma
&etastasis
neursmal bone cstFibrous dsplasia
Brown tumor
'nchondroma
.mphoma
#ipe '$pansif
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neursmal Bone Cst
&ultiple meloma
&ets
neursmal bone cstFibrous dsplasia
Brown tumor
'nchondroma
.mphoma
#ipe '$pansif
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Fibrous %splasia
&ultiple meloma
&ets
neursmal bone cstFibrous dsplasia
Brown tumor
'nchondroma
.mphoma
#ipe '$pansif
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Brown #umor
&ultiple meloma
&ets
neursmal bone cstFibrous dsplasia
Brown tumor
'nchondroma
.mphoma # R78 999
#ipe '$pansif
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'nchondroma
&ultiple meloma
&ets
neursmal bone cstFibrous dsplasia
Brown tumor
'nchondroma
.mphoma# R78 999
#ipe '$pansif
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.mphoma
&ultiple meloma
&ets
neursmal bone cstFibrous dsplasia
Brown tumor
'nchondroma
.mphoma# R78 999
#ipe '$pansif
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6enign vs. Malignant6enign vs. Malignant
: Greenspan8 )ippinott8 999
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'inak dan Ganas'inak dan Ganas
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0steosarkoma0steosarkoma
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0steokondroma0steokondroma
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Myeloma multipleMyeloma multiple
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G/! #Giant /ell !umour$G/! #Giant /ell !umour$
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%6/ #%neurysmal 6one /yst$%6/ #%neurysmal 6one /yst$
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DefinisiDefinisi
(elainan tulang dalam ruang sendi(elainan tulang dalam ruang sendidan adana penempitan ruangdan adana penempitan ruang
sendisendi
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KlasifikasiKlasifikasi
pertrophic arthritispertrophic arthritis ital signital sign
Bone productionBone production
SclerosisSclerosis
nfectious arthritisnfectious arthritis ital signital sign
%estruction of articular corte$%estruction of articular corte$
'rosi-e arthritis'rosi-e arthritis ital signital sign
'rosions'rosions
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Foto polosFoto polos,enempitan ruang sendi,enempitan ruang sendi
Subchondral sclerosisSubchondral sclerosis
&arginal osteophte formation&arginal osteophte formationSubchondral cstsSubchondral csts
%rt"ritis Degeneratif%rt"ritis Degeneratif
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%egeneratif arthritis
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Charcot/s (nees+%iabetes
%rt"ritis Infeksi%rt"ritis Infeksi
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%rt"ritis Infeksi%rt"ritis Infeksi1enyebab1enyebab
Biasa staphlococcusBiasa staphlococcus
,rogesif,rogesif
#BC#BC
ematogenematogen .ebih lamban.ebih lamban
nak+anaknak+anak -ertebrae-ertebrae
%ewasa%ewasa lututlutut
0steoporosis berat0steoporosis beratSembuhSembuh sering anklosissering anklosis
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Septic arthritis
4rosive %rt"ritis4rosive %rt"ritis
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4rosive %rt"ritis4rosive %rt"ritis!ipe!ipe
Rheumatoid arthritisRheumatoid arthritis
GoutGout
emophiliaemophilia
'rosi-e osteoarthritis'rosi-e osteoarthritis
Rheumatoid -ariantsRheumatoid -ariants
,soriatic arthritis,soriatic arthritis Reiter5sReiter5s
nklosing spondlitisnklosing spondlitis
nflammator bowel diseasenflammator bowel disease
R" t id % t" itiR"eumatoid %rt"ritis
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R"eumatoid %rt"ritisR"eumatoid %rt"ritis
Simetris bilateralSimetris bilateral ,erubahan paling awal 6 &C,! ,,!,erubahan paling awal 6 &C,! ,,!ulnar stloidulnar stloid
Radiocarpal )oint paling seringRadiocarpal )oint paling sering
menempitmenempit
,eriarticular deminerali7ation,eriarticular deminerali7ation
&ulai sendi &C, 1&ulai sendi &C, 1stst
and 2and 2ndnd
Sendi besar biasa tak terlihat erosiSendi besar biasa tak terlihat erosi
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R of Foot
R usuall
in-ol-es 8th
+, )oint
first
GoutGout
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GoutGout nter-al lama antara ge)ala dgnnter-al lama antara ge)ala dgn
adana perubahan pada tulangadana perubahan pada tulangsimetris dan monoartikulersimetris dan monoartikuler
,ria lebih sering,ria lebih sering
,aling sering sendi + ,,aling sering sendi + ,
pertamapertama
#ophus )arang membentuk#ophus )arang membentuk
kalsifikasikalsifikasi
0lecranon bursitis0lecranon bursitis umumumum
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Gout
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%nkylosing Spondylitis%nkylosing Spondylitis
HLA-2! positi"eHLA-2! positi"e
Corpus "ertebrae persegiCorpus "ertebrae persegiamboo-spine fromamboo-spine from
continuous s#ndesmop$#tescontinuous s#ndesmop$#tes
%erip$eral large &oint erosi"e%erip$eral large &oint erosi"eart$ritisart$ritis
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nklosing Spondlitis
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