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7/23/2019 09. Dr. Budiawan - KULIAH Radiologi Muskuloskeletal UKI.2008 1.
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MuskuloskeletalMuskuloskeletal
Radiografi konvensional.Radiografi konvensional.Dr. Budiawan Atmadja. SpRad.Dr. Budiawan Atmadja. SpRad.
7/23/2019 09. Dr. Budiawan - KULIAH Radiologi Muskuloskeletal UKI.2008 1.
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7/23/2019 09. Dr. Budiawan - KULIAH Radiologi Muskuloskeletal UKI.2008 1.
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Prinsip dasar Prinsip dasar
Posisi penyinaran / eksposePosisi penyinaran / ekspose
harus orthogonal (AP & Latharus orthogonal (AP & Lat
/ 90/ 9000 satu 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 dasar Prinsip 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
7/23/2019 09. Dr. Budiawan - KULIAH Radiologi Muskuloskeletal UKI.2008 1.
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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 fraktur Diagnosis fraktur
7/23/2019 09. Dr. Budiawan - KULIAH Radiologi Muskuloskeletal UKI.2008 1.
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Diagnosis fraktur Diagnosis 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 fraktur Diagnosis fraktur
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Diagnosis fraktur Diagnosis fraktur
'umla" fragment'umla" fragment
fraktur fraktur
–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 fraktur Diagnosis 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 fraktur 4ponim 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 palmar angulasi 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 palmar angulasi palmar
R3
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Fraktur vertebraeFraktur vertebrae
Fraktur kompresi dan bursting fracture
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SpondilolistesisSpondilolistesis
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Fraktur 1elvisFraktur 1elvis
StableStable andand UnstableUnstableStable 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"int j"int
Fraktur 1elvis #unstable$Fraktur 1elvis #unstable$
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1.1. FaseFase InflamasiInflamasi
– HematomaHematoma
– Jaringan granulasiJaringan granulasi
2.2. FaseFase ReparasiReparasi
– Callus fibrocartilageneousCallus fibrocartilageneous
– Callus tulangCallus tulang
3.3. FaseFase RemodellingRemodelling
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$ing the fracture"
R3
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0steomyelitis0steomyelitis
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Komplikasi fraktur Komplikasi fraktur
)aluni"n)aluni"n
– Sembu$ 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
<esi granul"mat"sa<esi granul"mat"sa sub akut dansub akut dan
kr"niskr"nis
=ertebrae 9: dan pr"ksimal tulang=ertebrae 9: dan pr"ksimal tulang
apendikularapendikular
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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 fibroma
Geograp"i&ultiple &eloma
Mot"-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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0steoblasti0steoblasti
/artilaginous/artilaginous
#umor matri$
Chondrosarcoma
# R78 999
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&ultiple &eloma
#ipe '$pansif
&ultiple meloma
&ets
neursmal bone cst Fibrous dsplasia
Brown tumor
'nchondroma
.mphoma
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Renal Cell Carcinoma
&ultiple meloma
&etastasis
neursmal bone cst Fibrous dsplasia
Brown tumor
'nchondroma
.mphoma
#ipe '$pansif
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neursmal Bone Cst
&ultiple meloma
&ets
neursmal bone cst Fibrous dsplasia
Brown tumor
'nchondroma
.mphoma
#ipe '$pansif
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Fibrous %splasia
&ultiple meloma
&ets
neursmal bone cst Fibrous dsplasia
Brown tumor
'nchondroma
.mphoma
#ipe '$pansif
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Brown #umor
&ultiple meloma
&ets
neursmal bone cst Fibrous dsplasia
Brown tumor
'nchondroma
.mphoma # R78 999
#ipe '$pansif
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'nchondroma
&ultiple meloma
&ets
neursmal bone cst Fibrous dsplasia
Brown tumor
'nchondroma
.mphoma# R78 999
#ipe '$pansif
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.mphoma
&ultiple meloma
&ets
neursmal bone cst Fibrous dsplasia
Brown tumor
'nchondroma
.mphoma# R78 999
#ipe '$pansif
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6enign vs. Malignant6enign vs. Malignant
: Greenspan8 )ippinott8 999
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'inak dan Ganas'inak dan Ganas
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0steosarkoma0steosarkoma
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Saroma 4;ingSaroma 4;ing
<amelar dan sun ra* appearance
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Sarkoma 4;ingSarkoma 4;ing
>"dman triangle dan sun ra* appearance
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0steokondroma0steokondroma
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Myeloma multipleMyeloma multiple
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G/! #Giant /ell !umour$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 formation
–Subchondral cstsSubchondral csts
%rt"ritis Degeneratif %rt"ritis Degeneratif
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%egeneratif arthritis
%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"eumatoid %rt"ritisR"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
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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 monoartikuler simetris 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
S
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%nkylosing Spondylitis %nkylosing Spondylitis
HLA!2" positi#eHLA!2" positi#e
Corpus #ertebrae persegiCorpus #ertebrae persegi!amboospine from!amboospine 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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