• Usia : 30 tahun • Alamat : DSN POLOSIRI • Jenis Kelamin : Laki-laki Anamnesis • KU : Nyeri pada tungkai kiri dan kanan • Riwayat Penyakit Sekarang : Nyeri pada tungkai kiri dan kanan dirasakan sejak 2 hari yang lalu setelah pasien jatuh dari ketinggian sekitar 5 meter saat pasien bekerja. Posisi terjatuh dalam posisi berdiri. Tidak ada nyeri kepala, muntah dan pingsan. Tidak ada riwayat hipertensi dan diabetes. Pemeriksaan Fisik • Compos mentis GCS 15 • TD : 120/80 • Pernafasan : 20x/m • Nadi : 80x/m • Suhu : 36.7 c • NPRS : 4 Foto Cruris Bilateral posisi AP/Lateral • Alignment genu joint dan ankle joint bilateral baik, tidak tampak dislokasi • Tampak fraktur komunitif pada 1/3 distal os tibia sinistra • Densitas tulang baik • Celah sendi yang tervisualisasi kesan baik • Jaringan lunak sekitar kesan baik Kesan : Fraktur Komunitif 1/3 distal os tibia sinistra Foto Ankle Joint Bilateral AP/Lateral/Mortise View • Alignment Ankle Joint bilateral berubah • Tampak fraktur pada aspek anteroinferior et posteroinferior os calcaneus dextra • Tampak fraktur komunitis pada 1/3 distal os tibia sinistra • Tibiofibular overlap 1cm, medial clear space 0.1cm, total clear space 0.2 pedis dextra • Tibiofibular overlap 1cm, medial clear space 0.3 cm, total clear space 0.3 pedis • Densitas tulang baik • Jaringan lunak disekitar kesan swelling Kesan : • Fraktur pada aspek anteroinferior et posteroinferior os calcanesius dextra • Fraktur komunitis pada 1/3 distal os tibia sinistra • Tibiofibular overlap 1cm, medial clear space 0.1cm, total clear space 0.2cm pedis dextra • Tibiofibular overlap 1cm, medial clear space 0.3 cm, total clear space 0.3cm pedis sinistra Pembahasan When imaging the ankle obtain 3 views to appropriately evaluate the joint: AP, Lateral and the Mortise study. sumber : https://www2.aofoundation.org Radiographic Evaluation • Begin with the AP and Lateral views. Trace the entire length of the tibia and fibula. • the mortise view. evaluate for joint space (clear space). The ring structure of the ankle is made up of three bones (tibia, fibula and talus) and three ligaments (medial and lateral collateral ligaments and interosseous ligament) if there is one break in the ring, look for a second.
To evaluate the integrity of the syndesmosis
use the following measurements: •Tibiofibular overlap < 1mm •Increased medial clear space: less than or equal to 4 mm •Increased Tibiofibular clear space: < 6 mm • The medial clear space should not exceed 4 mm and is usually equal to the distance between the tibial plafond and the talus. Widening of the medial joint space requires disruption of the medial collateral ligament • The lateral clear space is measured from the medial border of the fibula to the lateral border of the posterior tibia 1cm above the tibial plafond. • Tibiofibular overlap should be at least 6 mm on an AP image and usually at least 1 mm on a mortise view. Reduced overlap is a sign of syndesmotic widening/injury Pembahasan • A fracture is described as a disruption in the continuity of all or part of the cortex of a bone. Radiologic features of acute fractures • Abrupt disruption of all or part of the cortex • Acute changes in the smooth contour of a normal bone • Fracture lines are black and linear • Fracture fragments are jagged and rough How fractures are describe