Revmar2013 Wr2 Ys1e Tulangfraktur Vf

8/19/2019 Revmar2013 Wr2 Ys1e Tulangfraktur Vf

1/41

MENGENALI FRAKTURTULANG

Penyegaran dan Pendalamn Radiologi17-18 Maret 21!


2/41

"e#inition$

Fra%t&re

"i$lo%ation

'&(l&)ation


3/41

Fra%t&re

A di$r&*tion in all

or *art o# t+e

%orte) o# a (one

All , %om*lete

Part , in%om*lete ,%+ildren

om*lete #ra%t&re o# t+e $&rgi%al

ne%. o# t+e +&mer&$


4/41

"i$lo%ation

T+e (ony

%om*onent$ o# a /oint

no longer are in

%onta%t 0it+ ea%+

ot+er

T+ere i$ %om*lete

di$r&*tion o# t+e /ointR!

"i$lo%ation o# t+e meta%ar*al-

*+alyngeal /oint o# t+e t+&m(


5/41

'&(l&)ation

T+e (ony

%om*onent$ o# a

/oint are *artially in%onta%t 0it+ ea%+

ot+er

T+ere i$ *artialdi$r&*tion o# t+e

/oint

R!


6/41

In%om*lete Fra%t&re$

Green$ti%.

#ra%t&re

t+ro&g+ one

%orte)

Tor&$

(&%.ling o#t+e %orte)

Al$o %alled 3&%.le #)4

Green$ti%. Fra%t&re$ 3&%.le Fra%t&re$


7/41

3y t+e dire%tion o# t+e #ra%t&re line

3y t+e relation$+i* o# t+e #ragment$

3y t+e n&m(er o# #ragment$

3y %omm&ni%ation 0it+ t+e atmo$*+ere

5o0 Fra%t&re$ Are "e$%ri(ed


8/41


3y t+e dire%tion o# t+e #ra%t&re line

Tran$6er$e

"iagonal or o(li&e

Longit&dinal

'*iral


9/41


3y t+e dire%tion o#

t+e #ra%t&re line Tran$6er$e

*er*endi%&lar to t+e

long a)i$ o# t+e (one

a&$ed (y a #or%e

*er*endi%&lar to $+a#t


10/41


3y t+e dire%tion o# t+e

#ra%t&re line

"iagonal or o(li&e

%a&$ed (y a #or%e

&$&ally a**lied in t+e

$ame dire%tion a$ t+elong a)i$ o# t+e (one


11/41



#ra%t&re line Longit&dinal along t+e

long a)i$ o# t+e (one

R!


12/41



#ra%t&re line

'*iral a t0i$ting

#ra%t&re %a&$ed (y a

tor&e in/&ry $&%+ a$

*lanting t+e #oot in a+ole 0+ile r&nning


13/41


3y t+e relation$+i* o# one #ra%t&re

#ragment to anot+er "i$*la%ement

Ang&lation

'+ortening

Rotation

Mo$t #ra%t&re$ di$*lay more t+an one o#

t+e$e a(normalitie$ o# *o$ition


14/41


3y %on6ention a(normalitie$ o# *o$itionde$%ri(e t+e relation$+i* o# t+e di$tal

#ra%t&re #ragment relati6e to t+e *ro)imal

#ragment


15/41

"i$*la%ement

T+e amo&nt o# o##-$et o#

t+e di$tal #ra%t&re

#ragment relati6e to t+e

*ro)imal

T+ere i$ lateral

di$*la%ement o# t+edi$tal #emoral #ra%t&re

#ragment in t+i$ %a$eLateral Medial


16/41

Ang&lation

T+e angle a0ay #rom t+e

normal t+at t+e di$tal

#ragment ma.e$ 0it+ t+e

*ro)imal

In t+i$ %a$e t+e di$tal

#ragment i$ ang&lated

medially #rom t+e

*o$ition it 0o&ld +a6e

0ere it not #ra%t&redLateralMedial


17/41


18/41

Rotation

Almo$t al0ay$ in6ol6e$

long (one$ :+&mer&$

and #em&r;

Knee /oint i$ in AP

*o$ition :*oint$

#or0ard; (&t an.le*oint$ lateral in t+i$

%a$e Lateral atan.le

Antero*o$terior

at .nee


19/41


3y t+e n&m(er o#

#ra%t&re

#ragment$

T0o #ragment$ -

'im*le

More t+an t0o#ragment$ -

ommin&ted

'im*le ommin&ted

1

2

1

2

!

<


20/41


3y t+e relation$+i*

o# t+e #ra%t&re to t+e

atmo$*+ere lo$ed

9*en or %om*o&nd

3e$t e6al&ated%lini%ally

9*en or %om*o&nd #ra%t&re o# t+e ti(ia

%omm&ni%ate$ 0it+ o&t$ide air


21/41

'alter-5arri$ Fra%t&re$

Fra%t&re$ t+at in6ol6e t+e e*i*+y$eal

*late alone or in %om(ination 0it+ an

ad/a%ent *art o# t+e (one

=+y i$ t+e %la$$i#i%ation im*ortant>

Progno$ti% 6al&e

Ty*e I?$ and II?$ do 0ell

Ty*e I@?$ and @?$ %an de6elo* early #&$ion o#

e*i*+y$i$ and $+ortening o# t+at (one


22/41

'alter-5arri$ la$$i#i%ation

Ty*e I E*i*+y$eal *late alone

Ty*e II E*i*+y$eal *late and meta*+y$i$ Ty*e III E*i*+y$eal *late and e*i*+y$i$

Ty*e I@ E*i*+y$eal *late meta*+y$i$

and e*i*+y$i$

Ty*e @ %r&$+ #ra%t&re o# e*i*+y$eal *late


23/41


Ty*e I

Fra%t&re t+ro&g+

t+e e*i*+y$eal*late alone

9#ten di##i%&lt to

dete%t 0it+o&tot+er $ide #or

%om*ari$on

R!


24/41


Ty*e II #ra%t&re o# t+e

meta*+y$i$ and t+e

e*i*+y$eal *late

Mo$t %ommon ty*e o#

'alter #ra%t&re

orner-$ign4 $mallmeta*+y$eal #ragment

R!


25/41


Ty*e III Fra%t&re

o# t+e e*i*+y$eal

*late and t+e

e*i*+y$i$

R!


26/41


Ty*e I@ Fra%t&re

t+ro&g+ t+e

meta*+y$i$

e*i*+y$eal *late and

t+e e*i*+y$i$

Poorer *rogno$i$

ie *remat&re %lo$&re

o# e*i*+y$i$

R!


27/41

ommon Fra%t&re E*onym$

olle?$ #ra%t&re 'mit+?$ #ra%t&re

Bone$? #ra%t&re

3o)er?$ #ra%t&re


28/41


olle?$

#ra%t&re

#ra%t&re o#

t+e di$tal

radi&$ 0it+

dor$alang&lation

R!


29/41


'mit+?$ #ra%t&re

#ra%t&re o# t+e

di$tal radi&$ 0it+

*almar

ang&lation

Fall on a #le)ed

+and

R!


30/41


Bone$? #ra%t&re #) (a$e Ct+ metatar$al


31/41


3o)er?$ #ra%t&re #)

+ead Ct+ meta%ar*al

0it+ *almarang&lation

Mo$t o#ten t+e

re$&lt o# *&n%+ing a*er$on or 0all

R!


32/41

Ea$ily Mi$$ed Fra%t&re$

'%a*+oid #ra%t&re$

3&%.le #ra%t&re$ o# radi&$D&lna Radial +ead #ra%t&re

'&*ra%ondylar #ra%t&re$ in %+ildren

Po$terior di$lo%ation o# t+e $+o&lder

5i* #ra%t&re$


33/41


'%a*+oid #ra%t&re$

%ommon

Pain in anatomi%al

$n# (o)

Fall on

o&t$tret%+ed +and an lead to

a6a$%&lar ne%ro$i$R!


34/41

3&%.le #ra%t&re$ o#

radi&$D&lna +ildren

Loo. #or ang&lation

o# %orte) 5eal &i%.ly

R!



35/41

Radial +ead

#ra%t&re ommon

May re&ire

m&lti*le 6ie0$to $ee it



36/41

'&*ra%ondyla

r #ra%t&re$ in%+ildren


R!'&*ra%ondylar #ra%t&re$ %an (e di##i%&lt

e$*e%ially in %+ildren :t+i$ i$ an ad<


37/41

Po$terior

di$lo%ation o# t+e

$+o&lder

5&meral +ead

loo.$ li.e

lig+t(&l(4

U$&ally need

anot+er 6ie0 li.e

a)illary or 6ie0


R!


38/41

5i* #ra%t&re$

May (e 6ery $&(tleand re&ire (one$%an or MRI #ordiagno$i$

In t+i$ %a$e 0+ite

one o# $%lero$i$i$ an im*a%ted$&(%a*ital #ra%t&re


R!


39/41


40/41

Fracture Healing

Indistinctness of fracture line

Bony callous production

Bridging of fracture

Obliteration of fracture line

Remodeling of bone


41/41

'erie$ o# image$ $+o0$ indi$tin%tne$$ o# #ra%t&re line 0it+ (ony %allo&$

#ormation and #inally o(literation o# t+e #ra%t&re line T+ere are metalli% rod$

tran$#i)ing t+e #ra%t&re

R!

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Revmar2013 Wr2 Ys1e Tulangfraktur Vf