Spine and musculoskeletal

Fraktur Colles

Diskontinuitas tulang pada

tulang radius 1/3 distal di
sertai angulasi ke arah
dorsal.
Fraktur Colles

Diskontinuitas tulang pada

tulang radius 1/3 distal di
sertai angulasi ke arah
dorsal.
 Fraktur
Colles

Diskontinuitas tulang pada

tulang radius 1/3 distal di
sertai angulasi ke arah
dorsal.
 Fraktur Colles

Diskontinuitas tulang pada

tulang radius 1/3 distal di
sertai angulasi ke arah
dorsal.
 Fraktur Colles

Diskontinuitas tulang pada

tulang radius 1/3 distal di
sertai angulasi ke arah
dorsal.
Fraktur Smith
 Fraktur
Smith

Diskontinuitas tulang pada

tulang radius 1/3 distal di
sertai angulasi ke arah
anterior.
 Fraktur
Smith

Diskontinuitas tulang pada

tulang radius 1/3 distal di
sertai angulasi ke arah
anterior.
 Fraktur
Smith

Diskontinuitas tulang pada

tulang radius 1/3 distal di
sertai angulasi ke arah
anterior.
 Fraktur
Smith

Diskontinuitas tulang pada

tulang radius 1/3 distal di
sertai angulasi ke arah
anterior.
 Fraktur
Smith

Diskontinuitas tulang pada

tulang radius 1/3 distal di
sertai angulasi ke arah
anterior.
Galeazzi
 Galeazzi

Diskontinuitas pada tulang

radius 1/3 distal disertai
dislokasi ulna
 Galeazzi
Diskontinuitas pada tulang
radius 1/3 distal disertai
dislokasi ulna
 Galeazzi

Diskontinuitas pada tulang

radius 1/3 distal disertai
dislokasi ulna
 Galeazzi

Diskontinuitas pada tulang

radius 1/3 distal disertai
dislokasi ulna
 Galeazzi

Diskontinuitas pada tulang

radius 1/3 distal disertai
dislokasi ulna
Monteggia
Monteggia

Diskontinuitas pada tulang

ulna 1/3 proximal disertai
dislokasi radius
Monteggia

Diskontinuitas pada tulang

ulna 1/3 proximal disertai
dislokasi radius
Monteggia

Diskontinuitas pada tulang

ulna 1/3 proximal disertai
dislokasi radius
Monteggia

Diskontinuit
as pada
tulang ulna
1/3
proximal
disertai
dislokasi
radius
Fraktur Boxer
 Boxer

Tampak diskontinuitas pada

distal metakarpal 5
 Boxer

Tampak diskontinuitas pada

distal metakarpal 5
 Boxer

Tampak diskontinuitas pada

distal metakarpal 5
 Boxer

Tampak diskontinuitas
pada distal
metakarpal 5
 Boxer

Tampak diskontinuitas pada

distal metakarpal 5
Fracture ankle
 Three views of the ankle demonstrate a horizontal fracture through the lateral
malleolus, below the level of the ankle joint, consistent with a Weber A fracture.
 Oblique distal
fibular fracture
with lateral
displacement of
the distal fracture
fragment.
This distal fibular
fracture can be
classified as a
Weber B fracture.
 Bimalleoral
ankle frakture
Posterior dislocation of
the talus in comparison
to the tibia. Distal
fibular fracture with
posterior
angulation/displaceme
nt. Posterior malleolus
fracture is not well
seen.
Ankle dislocation
with complex,
comminuted
fractures of the
medial and
lateral malleoli,
which are
severely
displaced. There
are further
fractures, most
likely involving
the posterior
malleolus, that
are not well
visualized on
plain x-ray along
with apparent
malalignment of
the subtalar joint
Fraktur metatarsal
• Fracture of the shaft of
the 5th metatarsal.
• Toe ring 2nd digit.
Fractures through the necks of the right third and fourth metatarsals
are observed. Plantar displacement of the right third metatarsal head
relative to the diaphyseal shaft. There is complex fracturing at the base
of the right second metatarsal. The fracture lines breach the plantar
surface. The fracture courses through the medial corner although there
is no frank widening of the Lisfranc space.
• Undisplaced fracture
of the distal third
metatarsal
• Transverse fracture of
the shafts of the left
2nd and 3rd
metatarsal with
minimal displacement
of the distal fracture
fragments.
• The fracture of the
2nd metatarsal only
seen on the oblique
view.
• Oblique fracture of the distal 5th
metatarsal diaphysis with some
periosteal reaction and early callus
formation.
Fraktur metacarpal
• Comminuted
fractures are
seen at the base
of the 2nd, 3rd,
4th metacarpals
with mild
displacement
especially at the
2nd and 3rd
metacarpal
level. OA
changes are
seen at the 1st
MP joint.
Oblique
fracture of
mid shaft of
3rd
metacarpal.
• Oblique
fracture of
the 4th
metacarpal
shaft. The
fracture is
impossible
to see on the
AP view, and
challenging
to see on the
lateral. The
oblique view
gives the
best view of
the fracture.
• Frontal projection:
• subtle oblique
sclerotic line in the
right 4th metacarpal
mid-shaft
• carpal bones are
normal
• visualized radius and
ulnar bone are
normal
• the other metacarpal
and phylangeal
bones are normal
• Oblique projection:
• comminuted
fracture of the right
4th metacarpal
without extension
into the articular
surface
• Minimally
displaced
fracture at
the base /
metaphysis
of the left
fifth
metacarpal.
Fraktur elbow
• There is medial
dislocation of
proximal end of
radius - ulna along
with fracture of
medial epicondyle.
• Elbow dislocation with posterolateral displacement of the proximal
radius and ulna. Intra-articular radial head fracture. Bone chip projects
inferiorly to the distal humerus - unclear origin. Large joint effusion.
• The elbow
joint is
dislocated.
Radial head
fracture.
• Superiorly displaced lateral supracondylar fracture
with undisplaced medial epicondylar fracture.
• No elbow joint dislocation.
• Small volume joint effusion seen.
• Moderate periarticular soft tissue thickening seen.
• X-ray demonstrates
a completely
displaced supracon
dylar fracture. No
dislocation or
forearm fracture
identified.
Fraktur genue
• There is a comminuted patella fracture, with associated
proximal retraction of the proximal fragment.
• There is complete fracture at the distal (metadiaphysis) femur with overriding and posteromedial displacement of
the distal fracture segment. Small laterally displaced osseous fragment is also observed. The fracture margins are
irregular. There are ill-defined lucencies reflective of lytic changes involving the distal shaft, metaphysis and
epiphysis of the femur. Interrupted periosteal reaction (Codman triangle) is demonstrated at the distal femoral
shaft above the fracture site. Lobulated soft tissue mass density is seen surrounding the fracture and effacing the
adjacent fat planes. Red arrow highlights the Codman triangle.
• Fibular head fracture, undisplaced.
• Bone fragment
above the fibula
head and lateral to
the tibia
• This injury is known
as a Segond
fracture, which is a
relatively
common avulsion
fracture of the
knee, and is often
associated with
anterior cruciate
ligament tears.
• Severe comminute
d fracture of the
proximal tibial
diaphysis,
metaphysis and
epiphysis
with lipohemarthr
osis and
a butterfly
fragment.
Posterior
displacement of
the distal
fragment. Avulsion
fracture of the
fibular head and
oblique fracture of
the proximal
fibular diaphysis.
Spondylolisthesis
• Pergeseran
L4 ke
anterior
terhadap L5,
Anterolisthe
sis Grade II

• lordosis
lumbal
Spondilolistesis
korpus vertebra
L5 pada jarak
sekitar
seperempat dari
panjangnya
(grade 1-2),
mungkin sebagai
akibat dari
spondilolisis
bilateral.
• CT
menunjukkan
pergeseran
anterior
korpus
vertebra L5
pada S1.

Kasus ini
menunjukkan
spondilolistesis
yang khas.
Radiografi menunjukkan
spondilolisis dengan
spondilolistesis derajat I
Spondylolisthesis
pada L4-L5 (grade
II) dengan defek
pars
interarticularis
bilateral
Tuberculous spondylitis
• shows disk space
destruction, lucency
and compression of
adjacent vertebral
bodies, and
development of
severe kyphosis
Lateral view
showing TB
involvemnt of
two adjacent
vertebrae
 Total destruction of
the L4/ L5 disk, with
partial destruction of
adjacent vertebral
bodies. There are
also paraspinal
masses and central
canal narrowing.

Pott disease is the eponymous name given to

tuberculosis spondylitis.
 Thoracic spine radiographes
showed a destructive
processes involving T11
associated with kyphosis of
the spine which was
confirmed on thoracic spine
CT.

Pathologically proven Mycobacterium

tuberculosis infection of the thoracic spine (aka
Pott disease)
 Destructive process
involves the left side
of the L5 vertebral
body. The discs are
relatively spared,
compared to the
degree of bony
destruction.

DIAGNOSIS:
Spinal lesion: Necrotizing granulomatous
inflammation with acid fast bacilli, in keeping
with mycobacterial infection.
Burst fracture
Burst fracture

Burst fraktur
dengan
retropulsed
fragment, yang
mempersempit
kanal sentral.
Tidak terdapat
tanda spinal cord
yang abnormal
Loss of L1 vertebral
body height,
particularly
anteriorly, focal
kyphosis,
retropulsion of the
posterior vertebral
body margin
and widening of the
pedicle spacing on
the AP image
consistent with a
burst type fracture.
• Burst fracture
with
retopulsion
into the spinal
canal,
compressing
the thecal sac.

Case Discussion
• A case of
unstable
burstfracture.
Any spinal
fracture is
considered to
be stable as
long as the
middle
column
remains
intact.
 Fraktur burst dari vertebra L2
ditandai oleh beberapa fragmentasi,
kehilangan tinggi vertebra secara
difus, retropulsi fragmen di kanal
tulang belakang (stenosis sekitar
50%).

Garis fraktur kecil juga diamati di

lengkung posterior L2 dan dalam
proses transversa kanan L3.

Terdapat spondilolisis L5 yang terkait

dengan spondlyolistesis ringan
(grade I).

Diskusi Kasus
Ini adalah kasus khas burst fraktur setelah
riwayat jatuh dari ketinggian. Terdapat
spondylolysis L5 yang terkait dengan
spondylolisthesis ringan (grade I).
• Compression
fracture of L1 is
noted with
approximately 30%
loss of height
anteriorly. Mild
narrowing of the
central canal at this
level.
Chance Fracture
(flexion-distraction injury)
 Chance Fracture
• There is a subtle
horizontal lucency
through the left pedicle.
In lateral projection of the
lumbar spine there is a
minor compression
fracture of the body of
T11.

• Case Discussion
• The Chance fracture
represents a spinal lesion
caused by a flexion-
distraction injury pattern.
On the AP film
the posterior
elements of T12
are poorly seen
and the distance
between the
T11 and T12
spinous
processes
appears
markedly
increased.
Chance fracture of T12 with
complete tear of the T11-12
ligamentum flavuum and
supraspinus ligament,
Chance fracture L2
extending through the
vertebral body,
pedicles, laminae, left
transverse process and
spinous process, with
widening of the
posterior fracture
lines.
a flexion-distraction
injury (seatbelt
injury)
• L3 chance
fracture
Hangman Fracture
 Hangman
Fracture
Bilateral fracture
through the pedicles
of C2 is
demonstrated,
alignment is similar
to previous cross-
sectional imaging
with approximately
10° of forward tilt
and 3 mm of
anterior subluxation.
Case Discussion
• Typical features
of a hangman's
fracture with
associated
ligamentous
injuries.
X-ray of the
cervical spine
with a
Hangman's
fracture. Left
without, right
with
annotation.
Clearly can be
seen that C2
(red outline) is
moved
forward with
respect to C3
(blue outline).
Lateral cervical x-ray shows a fracture involving
the pars interarticularis of C2 with a 5 mm
diastasis and anterolistesis of C2 on C3. This
patient also has metallic instrumentation in
the lower cervical spine. This is highly
suggestive of Hangman's fracture. CT-scan is
recommended to further evaluate the extent
of the cervical spine injuries.

• Case Discussion
• Hangman's fracture is an
unstable cervical spine
fracture seen with trauma
in hyperextension.
Fracture through the
pedicles of C2 with
anterolisthesis of C2 on
C3.
Degenerative disk disease

Tampak
gambaran
Degenerative
scoliosis
 Degenerative disk disease

Spondylosis disertai Spinal stenosis

Tampak gambaran
osteophytes pada
diskus intervertebral
pada tulang belakang
disertai penyempitan.
Degenerative disk disease

Tampak gambaran
osteophytes pada C5-
6 disertai
penyempitan diskus
Degenerative disk disease

Disk herniation
Degenerative disk disease

Tampak gambaran cervical lordosis dan mild spondylotic disease pada

C5-C6 dan C6-C7
Fraktur Arkus Zigoma

Tampak gambaran fraktur angulasi pada arkus zigoma kiri

 Fraktur Arkus Zigoma

Tampak pada foto Submento-Vertex terdapat gambaran fraktur

 Fraktur Arkus Zigoma

Tampak gambaran fraktur Tripod ditandai dengan adanya fraktur rim orbital inferior
Fraktur Arkus Zigoma

Tampak gambaran Isolated zygoma arch fracture

 Fraktur Arkus Zigoma

Melalui foto submentovertical view tampak gambaran fraktur depresi

 Fraktur Maksilaris

Tampak gambaran fraktur antrum maksilaris kiri disertai

 Fraktur Maksilaris

Tampak gambaran fraktur pada inferior orbital, inferior orbital rim, dinding
lateral dari sinus maksilaris dan arkus zygoma kiri. Merupakan gambaran dari
 Fraktur Maksilaris

Tampak gambaran fraktur pada sinus maksilaris kiri disertai

haemosinus air-fluid level
 Fraktur Maksilaris

Tampak gambaran fraktur Tripod ditandai dengan adanya fraktur orbital disertai fraktur arkus
zigoma kiri dan maksilaris kiri
Fraktur Sinus Maksilaris

Tampak gambaran fraktur zigoma disertai fraktur dan

 Sinusitis

Tampak perselubungan homogen pada

 Sinusitis

Tampak perselubungan pada sinus maksilaris kiri disertai gambaran air-

fluid level
 Sinusitis

Tampak perselubungan homogeny pada sinus

maksilaris kiri
 Sinusitis

Tampak perselubungan diffuse pada sinus maksilaris kiri

 Sinusitis

Tampak perselubungan pada sinus maksilaris kanan disertai gambaran

penebalan polip mukosa
 Hematosinus

Tampak gambaran fraktur orbita kiri disertai perselubungan pada sinus

maksilaris kiri
 Hematosinus

Tampak gambaran fraktur kompleks zigomatiko-maksilaris kiri disertai

perselubungan pada sinus maksilaris kiri
 Hematosinus

Tampak gambaran fraktur pada sinus maksilaris kiri disertai

haemosinus air-fluid level
 Hematosinus

Tampak gambaran fraktur sinus maksilaris bilateral disertai gambaran air-

fluid level (warna merah)
 Hematosinus

Tampak gambaran fraktur kompleks zigomatiko-maksilaris kiri disertai air-fluid

level pada sinus maksilaris kiri