Short Bone

Irregular Bones
Sesamoid
Bone
Patella
3
4
5
Osteolytic /osteodestruksi
Osteosklerosis.
Artefak.
Multipel Myeloma
Sclerotic (or blastic)
bony
metastases can
arise
neuroblastoma.
11
12
Diagram
perubahan
morfologi tulang
Clothing artifact simulating perhaps
calcification (arrow)
Adhesive tape artifact. White liner
artifact extending beyond the skin
(arrows)
Tulang
Normal
Abnormal
(Patologis)
1. Trauma.
2. Infeksi.
3. Inflamatory Desiases.
4. Proses Degeneratif.
5. Osteonecrosis.
6. Tumor.
7. Gangguan Metabolic & Endokrin.
8. Anomali/Congenital.
Fraktur : cortex tulang terputus sebagian
(incompleta) atau total (completa).
Dislokasi.
Injury Soft Tissue.
Kedudukan anatomis dan perluasan Fractur :
Pars tertia proximal, media, distal.
Supracondylar.
Intraarticular.
Jenis Fractur :
Incomplete Fractur (Terutama pada anak).
Complete Fractur.
Arah garis Fractur :
Transversal.
Obliq.
Spiral.
Longitudinal.
Aligment Fragman Fractur :
Medial displacement.
Lateral displacepment.
Medial angulation.
Lateral angulation.
Internal rotation.
External rotation.
Bayonet apposition.
Distraction.
Special feature fracture (gambaran khusus)
Impaction.
Depression.
Compression.
Special types fracture (fractur jenis khusus) :
Fractur patologis dan faktor aktifitas.
Fatique (tulang normal, abnormal stres atau aktifitas
berlebihan, mis: olah raga berat).
Insufficiency (Tulang abnormal, misalnya :
osteoporosis, aktifitas normal, misalnya berjalan).
Keadaan sekunder akibat penyakit tulang lain
(biasanya tumor).
Complete Fractur
Fraktur
Transversal
Fraktur Obliq
Fraktur Spiral Fraktur
Longitudinal
Dibandingkan dg
yg normal.
impacted fracture - fracture in
which one broken end is wedged
into the other broken end fracture.
Longitudinale fractur
Greenstick fracture, a 5-year-old
child
The results of radiography in patients
with early-stage tibial stress fractures
typically are normal. One type of tibial
stress fracture (arrow).
Incompleta fractur
This finding could have been misinterpreted as a neoplasm or infectious
process without the radiographs and proper patient history. The
fracture completely healed with rest.
Distraction, displacement, angulation,
or shortening (overriding) may occur.
Distraction is separation in the
longitudinal axis. Displacement is the
degree to which the fractured ends
are out of alignment with each other; it
is described in millimeters or bone
width percentage. Angulation is the
angle of the distal fragment measured
from the proximal fragment.
Displacement and angulation may
occur in the ventral-dorsal plane,
lateral-medial plane, or both.
The AP view (A) -- depicting a Salter Harris type III injury (arrow) -- often
underappreciates the true severity of the injury. CT scans (B) demonstrate the 3
fracture planes: coronal (c), transverse (t), and sagittal (s). Minimal displacement
(< 2 mm) of the articular surface can be tolerated in these injuries but operative
treatment is often necessary for good outcomes.
A pathologic fracture is a broken bone caused by disease leading to
weakness of the bone.
CT scan
cranium :
depress fractur
cranium
Depress fractur
cranium
Fractur linier
cranium
Burst Fracture
Fractur kompressi
VTh12
A magnetic resonance imaging (MRI) scan of a fracture-
dislocation in the thoracic spine. Note the disruption of the
spinal cord.
Considerable
bleeding occurs at
the fracture. The
blood lies between
the bone ends and
under the
periosteum.
In a few days a
blood clot forms.
Soon the clot is
invaded by
osteoblasts from
the nearby bone
and from the
periosteum.
The osteoblasts
lay down new
bone which fills
the gap between
the fragments
and bulges out
at the sides. This is
the callus.
Over a period of
many months
the callus is
absorbed by the
osteoclasts, and
they make more
new bone
exactly like the
original one.
Callus
Atrophic Non Union Fractur, ada
celah antar fragmen, ujung
fragmen tumpul. Gambar ini
tampak malunion fractur fibbula.
Hypertrophic non union fractur
pada os tibia et fibula, tampak
flarring ujung fragmen, sclerosis,
celah antar fragmen.
Trauma sendi
Perdarahan intra-articular dlm knee : Fat fluid level.
Posterior Dislokasi Shoulder Joint
AP Y-View
Y-View
AP Y-View
Anterior Dislokasi Shoulder Joint
Dislokasi Hip Joint Dextra
Vertebrae Lumbales Vertebrae Cervical
Scoty Dog
Terlihat
pada
proyeksi
oblique
Diperlukan radiography 2 proyeksi,
dengan sudut 90 derajat pada
masing-masing proyeksi.
Diusahakan 2 sendi langsung terlihat .
Kedudukan anatomis dan perluasan fractur.
Jenis fractur.
Arah garis fractur.
Aligment fragmen fractur.
Adanya impaction, depression, atau
compression.
Adanya hubungan abnormalitas yang telah ada .
Adanya fractur jenis khusus.
Keterlibatan growth plate (misalnya : Salter Haris
Classification).
Adanya soft tissue swelling.
Obliterasi atau pergeseran garis lemak.
Periosteal atau endosteal reaction.
Joint effusion.
Intracapsular fat-fluid level.
Double cortex line.
Buckling (tekukan) cortex.
Irregularitas dari metaphyseal corner.
Ketika fractur gagal "healing"
(non union) harus dibedakan :
Reactive (hypertrophic dan
oligotrophic).
Non reactive (atrophic).
Infected.
Ketika pasien mempunyai riwayat
trauma skeletal, harus diperhatikan
kemungkinan adanya komplikasi :
Sudecks atrophy.
Volkmanns ischemic contracture.
Postraumatic myocitis ossificans.
Osteonecrosis.
Cedera pembuluh darah.
Gangguan pertumbuhan.
Post traumatic arthritis.
Ketika ada cedera yang
berhubungan dengan soft tissue,
perlu dibuat radiography dengan
alat tambahan atau perlakuan
khusus, misalnya :
Stress radiography.
Arthrography.
Myelography.
CT scan.
MRI.
Osteomyelitis :
Aktif.
Inactive
Periosteal
Reaction
Osteomyelitis is inflammation of the
bone caused by an infecting
organism.
Gout Arthritis
Infeksi dalam membrane synovial dekat tendo.
Osteoarthritis (OA) :
OA Primer.
OA Sekunder (Post trauma, slip capital
femoral epiphysis, Congenital hip dislokasi,
Inflamatory arthritis, Osteonecrosis, Pagets
desiases, dll).
Tempat paling sering : Vertebrae, Hip
joint, Knee joint, serta interphalangeal
joint.
Gambaran umum OA : Osteofit,
penyempitan ruang sendi, subchondral
cyst, subchondral sclerosis.
- Penyempitan celah sendi.
- Sub chondral sclerotik.
- Osteofit/spur formation.
- Sub chondral cyst
formation
Perthes disease,
terjadi pada anak
usia 0 s/d 15 th
Nyeri lutut tanpa trauma, Area radiolusen dg tepi sklerosis.
Dapat :
1.Sekunder (bone metastasis)
2.Primer
Osteolytic bone metastasis
Osteoblastic bone metastasis
Bone scan
Bentuk lesi Tumor tulang
Benigna & maligna.
"sun ray" periosteal reaction
Sclerotic lesion terlihat
meluas hingga epifise
Codman triangle
Diaphysis atau metaphysis
mottled, osteolytic lesion with poorly marginated edges
sunburst periosteal reaction
lamellated periosteal reaction.
Fibrous dysplasia is an abnormal bone growth where normal bone is
replaced with fibrous bone tissue.
Fibrous dysplasia may be monostotic or polyostotic
intramedullary diaphyseal
lesion that blends w/ thinned,
bulged cortex;
hazy or ground glass lesion
which may occur w/ angular
deformity;
angular deformity in bone is
often present at the level of
lesion;
active lesion may progress in
size and deformity;
Di regio metafisis, eccentric lesion, batas tegas, tidak ada
atau minimal sclerotik, endosteal scalloping.
Intracortical, osteolitik , biasanya dikelilingi osteosclerosis.
Rhabdomyosarcoma is a type of cancer that begins in a
type of muscle called striated muscle.
(Soft Tissue Sarcoma)
Gambaran pada
pemeriksaan radiologi
tidak khas. Diagnosis
ditegakkan dengan biopsi.
Proliferasi fibroblast yang
tumbuh secara infiltratif. Tidak
dapat bermetastasis.
Biasanya berusia 15 s/d 39 th
Area lusen,
membulat/oval, penipisan
cortex, terlihat ekstensi
tumor ke jaringan lunak.
Terlihat :
lobulasi
trabekulasi irregular
penipisan cortex
osteolytic dengan bubble
soap appearace
Osteoporosis.
Normal
- Pelebaran epiphyseal plate.
- Metaphyseal cupping dengan tepi
tidak jelas.
- Tulang panjang bowing
(melengkung).
- Scoliosis.
- Slipped femoral head epiphysis.
Loosers
zone.
Rickets
- Penurunan densitas tulang secara umum.
- Trabekulasi tulang mengabur.
- Tulang panjang bowing (melengkung).
Wanita 55
th
, kurang sinar
matahari, fraktur pubis dan
tuberositas ischii.
Loosers zone.
Dapat terjadi berupa :
Underdevelopment tulang atau
extremitas.
Overdevelopment tulang.
Maldevelopment (Regional atau
general)
Dorsoplantar (DP) view Lateral view
Bayi 5 bulan
DP View : Talo-calcaneal angle <15
(normal 15 s/d 40),
Lateral view : <25 (Normal 25 s/d 45)
CTEV
Normal
Osteopetrosisis a rare genetic disorder in which BONE remodeling is
defective. Though the body builds new bone (osteoblastic activity), it
does not adequately clear away old bone (osteoclastic activity).
Achondroplasia is the most common cause of short limb dwarfism.
Tidak memiliki tulang rawan
imperfect bone formation
Bones that break easily, often from mild trauma or with no apparent cause.
Multiple fractures are common.