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MUSCULOSKELETAL

RADIOLOGY-OVERVIEW
Elysanti Dwi Martadiani
Interpretation of skeletal radiograph
A - Adequacy
Alignment
B - Bone density
C- Cartilage
- Sub-Chondral bone
- Celah sendi
Soft tissue
Metaphysis

Epiphysis
Cartilage joint space

Subchondral bone layer

Cortex Soft tissue

Medulla
Diaphysis
Bone density

Increased density Normal density Decreased density


(Osteopenia)
Rules of two
1 . Two views: one view is too few / no view
2 . Two joints: image the joint above and below a long bone
3 . Two sides: compare the other side (difficult cases only)
4 . Two abnormalities: look for a second abnormality
5 . Two occasions: compare current films with old films (especially for
fracture )
6 . Two visits: repeat the film after a procedure or after an interval
7 . Two opinions: ask colleague for opinion for doubtful cases
8 . Two records: write down clinical and radiographic findings
9 . Two specialists: also get a formal radiological report
10 . Two examinations: do not forget other tests such as ultrasonography,
computed tomography, magnetic resonance imaging, or isotope bone
scanning for complex cases.
TRAUMA
Fracture and dislocation
Fracture : a break of the structural continuity
of bone or periosteum cortical
discontinuity

A dislocation : when the joint surfaces become


completely disengaged
Complete Incomplete
fracture fracture
Comminuted fracture : > 2 segments
Non displaced Displaced
fracture fracture
Rotation Angulation
Associated with joint subluxation or
dislocation

Dislocation of
radial head

Fracture of
Ulna
Joint dislocation
Fracture Healing
Essential event : creation of bony bridge
between fracture fragments

Bony callus begins 3-4 weeks after injury, and


continues until firm union is formed 2-3
month later

Malunion, delayed union, non union


Callus dan Malunion

Malunion
Callus
OSTEOMYELITIS
Acute
Cortex destruction/ Osteomyelitis
rarefaction (focal
osteolytic)
Periosteal Reaction

rarefaction

Periosteal
reaction
Acute Stage Osteomyelitis

Cortex destruction rarefaction Periosteal Reaction


Non aggressive ~callus
Involucrum ~ wrap
Sequestrum ~ death bone, set apart
Cloaca ~ track, opening

involucrum

Chronic
Osteomyelitis
sequestrum

Cloaca
Chronic Stage
Involucrum Sequestrum Cloaca : opening /track
BONE TUMOR
AGE
SITE
Epifisis Flat bone Medullary
Metafisis Tubular bone Cortical
Diafisis Juxtacortical

Central
Eccentric
MORFOLOGI LESI
1. BORDER : Sharp, ill-define
Zone of transition : narrow, wide
Morfologi
Type of bone destruction : geographic
moth-eaten
permeative
PERIOSTEAL REACTION

ONION SKIN SUNBURST/ CODMAN


SUNRAY TRIANGLE
ONION SKIN SUNBURST CODMANS
TRIANGLE
Morfologi : MATRIX MINERALIZATION
Stippled opacity
Flocculent opacity
Ring and arch opacity
Cotton-like opacity
Morfologi : MATRIX
Solid opacity
Cloud-like opacity
Ivory-like opacity
Morfologi : SOFT TISSUE MASS
SINGLE / MULTIPLE
Single : primary bone tumor / metastatis
Multiple : metabolic , hematologic, metastasis
OSTEOSARCOMA
EWING SARCOMA
ill-defined osteolytic Presentation with pain,
lesion in the diaphysis mass, fever, anemia and
of a long bone in a child leukocytosis.
with a large soft tissue
mass. Most common location:
Onion-skin periosteal femur, iliac bone, fibula,
reaction, aggressive rib, tibia.
periosteal reaction
,sometimes sunburst-
type
Ewing Sarcoma

Bone destruction

Onion skin periosteal


reaction
DEGENERATIVE
Osteoarthritis
Degenerative joint
disease
Osteophytes
Joint space
narrowing
Sclerotic of
subchondral bone
Soft tissue
swelling due to
joint effusion
SELAMAT BELAJAR