interprertasi x-ray on pelvic and long bone.pptx

8/14/2019 interprertasi x-ray on pelvic and long bone.pptx

1/40

IIN PARANNUAN

KONSULEN :

PROF. CHAIRUDDIN RASJAD, MD, Ph.D Sp.B, Sp.OT


2/40

PENDAHULUAN

X-Ray adalah pancaran sinarradiasi yang dihasilkan dari

tabung x-ray selama prosespemaparan.

Radiographrepresentasi

struktur 2 dimensi atau 3dimensi


3/40

RADIOGRAPHIC VIEW

ANTERIOPOSTERIOR VIEW (AP)

POSTEROANTERIOR VIEW (PA)

OBLIQUE VIEW

LATERAL VIEW


4/40

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


5/40

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
http://localhost/var/www/apps/conversion/tmp/scratch_10//localhost/Users/iinparanuan/Desktop/Screen%20Shot%202013-10-11%20at%208.05.36%20PM.pnghttp://localhost/var/www/apps/conversion/tmp/scratch_10//localhost/Users/iinparanuan/Desktop/Screen%20Shot%202013-10-11%20at%208.05.36%20PM.pnghttp://localhost/var/www/apps/conversion/tmp/scratch_10//localhost/Users/iinparanuan/Desktop/Screen%20Shot%202013-10-11%20at%208.05.36%20PM.pnghttp://localhost/var/www/apps/conversion/tmp/scratch_10//localhost/Users/iinparanuan/Desktop/Screen%20Shot%202013-10-11%20at%208.05.36%20PM.png


6/40


7/40

STANDARD VIEWS

LATERAL VIEW AP VIEWODNTOID PEG

VIEW/OPEN MOUTH

VIEW


8/40

ADDITIONAL VIEW

SWIMMERSVIEW


9/40

LATERAL VIEW


10/40

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


11/40

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


12/40

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


13/40

AP VIEW


14/40

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


15/40

OPEN MOUTH VIEW


16/40

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


17/40

SWIMMERS VIEW


18/40


19/40

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)


20/40

C2 odontoid peg fracture - Lateral view

The C2 bone 'ring' is incomplete due to a

fractureThe odontoid peg is displaced posteriorly


21/40

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


22/40

'Extension teardrop' fracture -

Lateral view

A fracture fragment is seen at the

anterior/inferior corner of C2resembling a 'teardrop'


23/40

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


24/40


25/40


26/40

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


27/40


28/40


29/40

BONE STRUCTURE

Cortex vs Medulla


30/40

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


31/40

Spiral fracture Sagital fracture


32/40

COMMINUTED FRACTURE

Comminuted fracture Butterfly fracture Segmental fracture


33/40

PELVIC BONES

Key points

If there is one pelvic

fracture - look for anotherfracture, or disruption ofthe pubic symphysis or

sacroiliac joints


34/40


35/40

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


36/40

Pelvis diastasis

Both the pubic symphysis andthe right sacroiliac joint are

widenedThere is complete separation of

the right hemi-pelvis from theaxial skeleton


37/40

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


38/40


39/40


40/40

interprertasi x-ray on pelvic and long bone.pptx

Documents