Workshop Membaca Foto Konvensioinal MSK_REVIEW_Paulus Rahardjo
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Transcript of Workshop Membaca Foto Konvensioinal MSK_REVIEW_Paulus Rahardjo
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PR
Workshop Radiologi MuskuloskeletalPra-Dik Dokter Muda FK. UNAIR
Disusun oleh:Paulus Rahardjo – Divisi Muskuloskeletal – Dept Radiologi
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PRPRREVIEW
• SISTEMATIKA MEMBACA FOTO KONVENTIONAL MSK
• FRAKTUR• ARTHRITIS• OSTEOMYELITIS
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PRPRABCS
• Sistematika membaca foto:
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PRPR
Systematic EvaluationAlignment
Bone
Cartilage (joint space)
Soft tissue
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PRPRAlignment
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PRPRAlignment
• Contoh kelainan Alignment: Dislokasi/ Subluksasi
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PRPRAlignment• Contoh kelainan Alignment: Dislokasi/ Subluksasi
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PRPRFracture displacement (“dislocation”)
• The term 'displacement' is often used as a specific term to describe loss of bone alignment along its long axis.
• Types of fracture displacement include - angulation, rotation, change of bone length, and loss of alignment.
• The severity and nature of displacement are key factors when considering fracture management.
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PRPRDisplacement and shortening
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PRPRAngulation and Rotation
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PRPRDistraction and impaction
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PRPRBone
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PRPRBone
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PRPRBone: periksa cortical outline + medulla
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PRPRBone• Fracture dan tumor
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PRPRFracture types
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PRPRFracture types
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PRPRFracture types
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PRPR
Fracture in children
INCOMPLET FX• Buckling of the
cortex• Green stick• BowingSYMPHYSIOLYSIS• Salter – Harris
Class
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PRPR
Fracture of the growth plate: Epiphysiolysis
S A L T R
slipped above lower through ruined
Salter & Harris Classification
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PR
Epiphysiolysis : Contralateral view for comparison
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PRSkull Frature
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PRSkull Frature
• Normal Skull• Sutures bergerigi
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PRSkull Frature; Linear + impressi
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PRPRCartilage
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PRPRCartilage >> Joint >>Arthritis
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PRPRArthritis
osteopenia
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PR
Joint space narrowing
RA- symetric OA- Asymetric
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PRPROsteoarthritis:”
• Joint narrowing + osteophyte / “lipping”
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PRPR
Rheumatoid Arthritis
• Joint space narrowing + Marginal erosion
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PRPRMarginal erosion
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PRPR
KASUS>>>>>>>>>>>>>
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PRPRKasus 1
• Pasien laki-laki, 34 tahun dibawa ke UGD RS swasta klas B, pada jam 10 malam oleh ambulans polisi setelah tertabrak oleh mobil dengan kecepatan tinggi di suatu perempatan.
• Selain luka-luka di berberapa bagian tubuh, dia merasakan nyeri hebat dan pembengkakan di bagian paha kiri dan tungkai tersebut memendek.
• Bagian inilah yang menjadi fokus pemeriksaan dokter UGD.• Pengobatan pasien dibayar oleh asuransi kesehatan (biaya tidak
masalah), • Bila saudara adalah doketer UGDnya, apakah modalitas pemeriksaan
radilogi yang terbaik yang saudara pilihkan untuk pasien ini?
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PRPRKasus 1
• Foto sinar-x konvenstional• Mengapa doker UGD memilih modalitas ini?
Diskusikan!
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PRPRKasus 1
• Ini adalah foto femur pasien.
• Dokter radiologi baru saja pulang, dan saudara harus segera melaporkannya kepada dokter jaga spesialis orthopedi
• Bagaimana saudara mendiskripsikan hasil foto ini?
• Apakah diagnosis atau kesimpulan saudara?
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PRPRKasus 1, post op
• Post operasi dengan alat fiksasi internal dilakukan foto lagi.
• Apakah hasil “open reduction”nya sudah baik?
• Apa kriteria “baik” di atas?
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PRPRKasus 2
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PRPRKasus 2
• Seorang perempuan 65 tahun datang kepada saudara- seorang dokter praktek umum- dengan keluhan nyeri lutut kanan dan kiri.
• Di pagi hari terasa kaku, menjelang siang keluhan kaku berkurang, tetapi mulai terasa nyeri terutama di sisi dalam dari masing-masing sendi lutut.
• Foto apakah yang saudar minta? Dan sebutkan “proyeksi dasar” dari foto yang saudara minta tersebut?
• Bagaimanakah posisi tubuh pasien sewaktu dilakukan foto?
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PRPRKasus 2
• Diskripsikan kelainan yang saudara temukan?
• Apakah diagnosis saudara?
• Apakah ada tanda lain yang menjadi tanda radiologis untuk diagnosis itu yang tidak tampak pada foto ini?
Berdiri
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PRPRKasus 2
• Diskripsikan kelainan yang saudara temukan?
• Apakah diagnosis saudara?
• Apakah ada tanda lain yang menjadi tanda radiologis untuk diagnosis itu yang tidak tampak pada foto ini?
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PRPRKasus 3
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PRPRKasus 3
• Seorang anak perempuan dibawa oleh keluarganya dengan rujukan dokter umum untuk dilakuka foto
• Anak tersebut jatuh kemarin sore, dan setelah ditunggu 24 jam kemudian masih mengeluh nyeri di lengan bawahnya.
• Dari luar tidak tampak kelainan bermakna.• Foto konvensionalnya adalah sebagai berikut
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PRPRKasus 3
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PRPRKasus 3
• Dokter radiologi mendiagnosis kasus ini sebagai “Fraktur”.• Apakah saudara menemukan garis frakturnya?• Apakah foto ini normal?• Jelaskan pendapat anda!
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PRPRKasus 3
• Bowing fraktur – salah satu contoh dari incomplete fracture pada anak-anak
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PRPRKasus 4
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PRPRKasus 4
• Seorang perempuan mengalami nyeri punggung bawah setelah jatuh terduduk seminggu sebelumnya..
• Tidak ada deformitas, hanya nyeri tekan di level lumbal bagian atas
• Dilakukan foto vertebra lumbal untuk mencari penyebabnya
• Foto lumbal tersebut hasilnya seperti ini (Next slide)
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PRPRKasus 4
• Next slide untuk membesaran gambar
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PRPR
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PRPRKasus 4
• Diskripsikan temuan saudara menggunakan metode
ABCs
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PRPR
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PRPRMal-alignment dan Kelainan Bone
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PRPRKasus 4
• Apa bedanya kasus sebelumnya dengan kasus ini
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PRPRKasus 4
• Apa bedanya kasus sebelumnya dengan kasus ini
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PRPRKasus 5
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PRPRDo you see the fracture?
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PRPR
Surgical Indication?• Depresi fragment fraktur lebih dari 1 tebal tulang
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PRPRKasus 6-10 QUICK READING
• Kasus-kasus trauma• Diskripsikan dengan cepat dan buat diagnosis dengan
tepat!
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PRPRKasus 6
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PRPRKasus 7
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PRPRKasus 8• Diskripsikan kelainan yang ditemukan pada foto ini
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PRPRKasus 9
• Post trauma dengan nyeri dada kiri bawah
• Next Slide (gambar diperbesar)
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PRPRKasus 9
• Sudah dapatkan kelainannya?
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PRPRKasus 10
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PRPRFx healing