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IIN PARANNUAN
KONSULEN :
PROF. CHAIRUDDIN RASJAD, MD, Ph.D Sp.B, Sp.OT
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PENDAHULUAN
X-Ray adalah pancaran sinarradiasi yang dihasilkan dari
tabung x-ray selama prosespemaparan.
Radiographrepresentasi
struktur 2 dimensi atau 3dimensi
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RADIOGRAPHIC VIEW
ANTERIOPOSTERIOR VIEW (AP)
POSTEROANTERIOR VIEW (PA)
OBLIQUE VIEW
LATERAL VIEW
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DENSITY
Hiper
radiolucent
Radiolucent Intermediete Radiopaque Hiper
radiopaqueUDARA BEBAS UDARA DALAM
RONGGA TUBUH
OTOT, JANTUNG ,
JARINGAN IKATTULANG, BINTIKKALSIFIKASI
LOGAM
PEMBULUHDARAH
KALSIFIKASIDINDING PEM.DARAH
KONTRAS MEDIA
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CERVICAL SPINE
Normal C-spine X-rays do not
exclude significant injury Clinical considerations are of
particular importance when assessingappearances of C-spine X-rays
Look at all views available in asystematic manner
KEYPOINTS
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STANDARD VIEWS
LATERAL VIEW AP VIEWODNTOID PEG
VIEW/OPEN MOUTH
VIEW
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ADDITIONAL VIEW
SWIMMERSVIEW
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LATERAL VIEW
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C - S P I N E S Y S T E M A T I C A P P R OA C H -N O R M A L L A T E R A L1
Coverage - All vertebrae are visible from the skullbase to the top of T2 (T1 is considered adequate)
- If T1 is not visible then a repeat image with thepatient's shoulders lowered or a 'swimmer's' viewmay be necessary
Alignment - Check the Anterior line (the line of theanterior longitudinal ligament), the Posterior line(the line of the posterior longitudinal ligament), andthe Spinolaminar line (the line formed by theanterior edge of the spinous processes - extendsfrom inner edge of skull).
- GREEN = Anterior line
- ORANGE = Posterior line
- RED = Spinolaminar line
Bone - Trace the cortical outline of all the bones tocheck for fractures
Note: The spinal cord (not visible) lies between theposterior and spinolaminar lines
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C-SPINE SYSTEMATICA P P ROAC H - N O R M A L L AT E R A L 2
Disc spaces - The vertebral bodies are spaced apart by theintervertebral discs - not directly visible with X-rays. Thesespaces should be approximately equal in height
Prevertebral soft tissue - Some fractures cause widening of the
prevertebral soft tissue due to prevertebral haematoma- Normal prevertebral soft tissue (asterisks) - narrow down toC4 and wider below
-Above C4 1/3rd vertebral body width
- Below C4 100% vertebral body width
Note: Not all C-spine fractures are accompanied byprevertebral haematoma - lack of prevertebral soft tissuethickening should NOT be taken as reassuring
Edge of image - Check other visible structures
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C - S P I N E N O R M A L A N A T O M Y -
L A T E R A L ( D E T A I L )
Bone - The cortical outline is not always welldefined but forcing your eye around the edgeof all the bones will help you identify fractures
C2 Bone Ring - At C2 (Axis) the lateral massesviewed side on form a ring of corticated bone(red ring )
This ring is not complete in all subjects andmay appear as a double ring
A fracture is sometimes seen as a step in thering outline
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AP VIEW
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C - S P I N E S Y S T E M A T I C A P P R OA C H -
N O R M A L A P
Coverage - The AP view should cover thewhole C-spine and the upper thoracic spine
Alignment - The lateral edges of the C-spineare aligned (red lines )
Bone - Fractures are often less clearly visibleon this view than on the lateral
Spacing - The spinous processes (orange) arein a straight line and spaced approximatelyevenly
Soft tissues - Check for surgical emphysema
Edges of image - Check for injury to theupper ribs and the lung apices forpneumothorax
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OPEN MOUTH VIEW
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C - S P I N E N O R M A L A N A T O M Y - O P E NM O U T H V I E W
C-spine normal anatomy - Open mouth view
This view is considered adequate if it shows
the alignment of the lateral processes of C1and C2 (red circles)
The distance between the peg and the lateralmasses of C1 (asterisks) should be equal oneach side
Note: In this image the odontoid peg is fullyvisible which is not often achievable in the
context of trauma due to difficulty in patientpositioning
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SWIMMERS VIEW
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COMMON C-SPINEFRACTURES
C1 'Jefferson' fracture - Openmouth view
The space between the odontoid peg of C2 and the lateralmasses of C1 is widened on both sides (arrows)
The lateral masses of C1 are both laterally displaced and nolonger align with the lateral masses of C2 (red rings)
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C2 odontoid peg fracture - Lateral view
The C2 bone 'ring' is incomplete due to a
fractureThe odontoid peg is displaced posteriorly
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C2 'hangman' fracture - Lateral view
Loss of alignment at C2/C3 with anteriordisplacement of C2 (large arrow)
Following the cortical outline of C2 (white line)reveals discontinuity due to a fracture
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'Extension teardrop' fracture -
Lateral view
A fracture fragment is seen at the
anterior/inferior corner of C2resembling a 'teardrop'
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Flexion teardrop' fracture - Lateral view
'Following the outline of the vertebral bodies shows ananterior - inferior C6 vertebral corner 'teardrop' fracture
fragmentThe facet joint of C6/C7 is widened - compare with level
above
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LONG BONES
Key points
When describing the location of a boneabnormality within a growing bone you can refer toits position in the diaphysis, metaphysis or epiphysis
It is also correct to use simple descriptive termssuch as - shaft - proximal/distal end - cortical -
medullary - articular surface
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BONE STRUCTURE
Cortex vs Medulla
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C O M M O N L O N G B O N E S F R A C T U R E
Transversal fracture Oblique fracture
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Spiral fracture Sagital fracture
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COMMINUTED FRACTURE
Comminuted fracture Butterfly fracture Segmental fracture
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PELVIC BONES
Key points
If there is one pelvic
fracture - look for anotherfracture, or disruption ofthe pubic symphysis or
sacroiliac joints
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The 2 hemi-pelvisbones and the
sacrum form a bonering boundposteriorly by thesacroiliac joints andanteriorly by thepubic symphysis
Each obturator
foramen is alsoformed by a ring ofbone
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Pelvis diastasis
Both the pubic symphysis andthe right sacroiliac joint are
widenedThere is complete separation of
the right hemi-pelvis from theaxial skeleton
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Acetabular frakture
A tiny step in the cortical edgeof the pelvic ring reveals a
fracture which passes into the
acetabulumThe fracture passes to theobturator ring and then
through the inferior pubicramus
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