RADIOGRAPHY TECHNIQUE OF OSSA MANUS WITH SUSPECTED FRACTURE OF PROXIMAL PHALANG DIGITI 4 AND 5 SINISTRA IN RADIOLOGY INSTALLATION OF EFARINA HOSPITAL

Radiographs of the human bones are the bones consisting of the carpal bones, the metacarpal bones and the phalanges. Fractures are broken bones, usually caused by trauma or physical exertion, the force and angle of the force, the condition of the bone itself, and the soft tissue around the bone will determine whether the fracture is complete or incomplete. A complete fracture occurs when the entire bone is broken, whereas an incomplete fracture does not involve the entire thickness of the bone. The occurrence of fractures caused by traffic accidents. The purpose of this study was to determine the procedures for carrying out radiography of the human oss with suspected fracture at Efarina Pangkalan Kerinci Hospital. The type of research used was descriptive with data collection techniques by means of observation, documentation and interviews. The results of the examination of the human oss in fracture cases at Efarina Pangkala Kerinci Hospital are generally using postero-anterior and oblique projections. The ideal x-ray machine for ossa manus radiography is a portable x-ray unit or a mobile x-ray unit with relatively low capabilities. The x-ray film used is a high speed type combined with a fast screen intensifying (IS) where this type of film and intensifying screen (IS) can produce images with good detail and sharpness. Thus the radiation dose can also be reduced for the patient and the operator himself. The x-ray film washing process used should preferably use automatic processing. It is hoped that it can be used as a reference for radiographic results, especially in fracture cases. The ideal x-ray machine for ossa manus radiography is a portable x-ray unit or a mobile x-ray unit with relatively low capabilities. The x-ray film used is a high speed type combined with a fast screen intensifying (IS) where this type of film and intensifying screen (IS) can produce images with good detail and sharpness. Thus the radiation dose can also be reduced for the patient and the operator himself. The x-ray film washing process used should preferably use automatic processing.


INTRODUCTION A.
Background According to Evelin C. Pearce, Radiological examination is an examination that can be used to determine the anatomy and physiology of a person so that Pathological and Traumatic disorders can assist in determining the diagnosis. (Evelin C. Pearce) Ossa Manus is a bone consisting of Ossa Carpalia, Ossa Metacarpalia and Phalanx.
Fractures are broken bones, usually caused by trauma or physical exertion, the force and angle of the force, the condition of the bone itself, and the soft tissue around the bone will determine whether the fracture is complete or incomplete. A complete fracture occurs when the entire bone is broken, whereas an incomplete fracture does not involve the entire thickness of the bone. There are several terms used to describe the type of fracture, namely: transverse fracture, longitudinal fracture, segmental fracture, compression fracture, and avulsion fracture (price, 2005) Radiological examination is a very precise examination used to determine the anatomy and physiology of an organ so that pathological and traumatic abnormalities can assist in making a diagnosis. The examination used in the Ossa Manus photo shoot is the PA (Postero-Anterior) projection and the Oblique projection. With the description above, the author will explain and make it into a scientific paper with the title: "Radiographic Examination Technique of Ossa Manus in Proximal Digiti 4 and 5 Left Phalanx Fracture Cases at the Radiology Installation of Pangkalan Kerinci Hospital in 2021" B.
Scope of Writing At this writing the author chose the projection used is the PA (Postero-Anterior) and Oblique projections. The ideal X-Ray device for Ossa Manus Radiography is a Portable X-Ray unit or Mobile X-Ray unit with relatively low capabilities. The x-ray film used is a high speed type combined with an intensifying screen (IS) which can produce images with good detail and sharpness. Thus the radiation dose can also be reduced for the patient and the operator himself. The x-ray film washing process used should use Automatic Processing.

C.
Formulation of the problem In making this paper, the author will formulate the problems that arise in the examinations carried out, these problems can be formulated: chapter discussed are as follows:

LITERATURE REVIEWS A.
Anatomy and Physiology According to Pearce, Anatomy is the study of the composition of the body and the relationship of its parts to one another (Pearce, 2009).
According to Ethel slone Physiology is the science that studies the functions of living bodies such as the science of anatomy and physiology also includes special fields of function of certain organ systems (Ethel slone, 2003

B. Pathology
According to Price Pathology is the science or study of disease. In its broadest meaning, pathology literally means abnormal biology, the study of inappropriate biological processes or the study of sick or disturbed individuals (Price, 2005).
Fractures are broken bones, usually caused by trauma or physical exertion, the force and angle of the force, the condition of the bone itself, and the soft tissue around the bone will determine whether the fracture is complete or incomplete. A complete fracture occurs when the entire bone is broken, whereas an incomplete fracture does not involve the entire thickness of the bone (Price, 2005) There are several terms used to describe the type of fracture. -Greenstick fracture Greenstick fractures are incomplete fractures and are common in children. The cortex is partially intact, as is the periosteum. These fractures will quickly heal and quickly undergo re-modelling to normal form and function -Avulsion Fracture An avulsion fracture is the separation of a bone fragment at the insertion site of a tendon or ligament. Here explained the problem of fracture. For example caused by a collision or trauma and caused by KLL (traffic accident). The symptoms caused by these fractures are often encountered, namely: pain, broken tissue, broken bone, inflammation, red or blue discoloration and rupture.

C. Etiology
Etiology is the determination of disease and factors that cause certain diseases (Price, 2005) The etiology of Ossa Manus Fractures includes blows that result in broken bones, collisions, traffic accidents, falls with the arms extended so that a fracture of the wrist can occur, fractures when the bone itself is brittle. D.

Radiography Technique
According to Hariaty, radiographic technique is a science that studies the procedures for photographing objects examined using x-rays to obtain radiographic images, so as to be able to establish a precise and accurate diagnosis (Hariaty, 2012 -At the time of exposure, try to turn the patient to the side that is not being photographed or away from the light.

Research Locations
The location of this research was carried out at the Radiology Installation of Efarina Hospital, Pangkalan Kerinci, Pelalawan Regency.

Data Checking Techniques
The data inspection technique is secondary data. The method used in writing this scientific paper uses a descriptive method, while the approach used is a case with a technique; 1. Observation and physical examination by direct observation of the client on matters relating to the client's problems. 2. Documentation studies are carried out by seeking sources of information obtained from the patient's status and matters relating to the patient's problems. Literature study, namely by studying books, papers and other sources to obtain scientific basis related to the fracture of the human os in the 4th and 5th digit proximal phalanges so that the theory can be compared with the implementation in cases in hospitals. In this study, the study observed the implementation of Ossa Manus Radiography starting from the initial examination of the manus with cases of proximal phalangeal fractures to completion.

b). History of disease
The patient who was a victim of a traffic accident on April 23, 2021, around 13.00 felt dizzy and had pain in the left hand. With a diagnosis of suspected fracture of the left Manus. On April 23, 2021 the patient was taken to the Radiology room to take a left manus X-ray of the patient.

Examination Execution 1). Photo request letter
The patient brings a letter requesting a photo of the human ossa with clinical post KLL, then the patient is taken to the examination room and the cover letter is read by the officer (radiographer) and carries out an examination according to the examination procedure. 2). Tools preparation a. X-ray machine used X-ray plane Name/Brand : EST 5000 S/F601 HF HIGE Tube serial number : 640191713 kv Maximum : 500 kV Tube type : Double Focus 3). Accessories 1. The radiographic equipment required for examination of the human oss is: 2. The tape and film used are 24 x 30 cm in size, 1 sheet without grid 3. The film used is Blue sensitive with High speed 4. Markers are used as signs or codes for patient identification, namely anatomical position marks (L) 5. The intensifying screen used is Blue emitting with High Speed.

4). Inspection Techniques
The radiographic techniques performed to show fracture abnormalities in the human oss are:

Evaluation of Photo Results
After carrying out a radiographic examination of the human ossa with a suspected fracture, starting from the radiography and the chemical film washing process, the resulting X-rays can be evaluated as follows: Evaluation of PA projection examination results 1. An anatomical picture of the human oss is visible from the Postero-Anterior position without superposition 2. Film size 24 cm x 30 cm 3. Image sharpness is sufficient 4. The radiographic image density is sufficient 5. Radiographic image details are sufficient 6. Radiographic image contrast is sufficient Evaluation of the results of the lateral projection examination 1. Anatomical view of the human ossa from the lateral view. A picture of the fracture in the manus is seen 2. Film size 24 cm x 30 cm 3. Image sharpness is sufficient 4. The radiographic image density is sufficient 5. Radiographic image details are sufficient 6. Radiographic image contrast is sufficient 6.Film processing Film processing carried out at the Radiology installation at Efarina Hospital Pangkalan Kerinci is automatic processing.

B. DISCUSSION
Based on the radiographs that have been obtained regarding the examination of the left left ossa fracture at the Radiology Installation of Efarina Hospital Pangkalan Kerinci, in general the examination of the left ossa fracture uses the PA and Lateral projections because with this projection it can already reveal the suspected abnormality in this case a fracture in the 4th digit manus bone and 5. In my opinion, from a theoretical point of view, the projection that provides a clearer radiograph regarding the examination of an ossa fracture is a lateral projection because this projection can provide information about the suspected abnormality and in the radiographic appearance there is no superposition between the phalanges digiti 1,2,3, 4, and 5.
The advantage of examining the left ossa fracture is that the patient can clearly know the location of the left ossa fracture based on the anatomy, and besides that the radiation received by the patient is less because the area of the irradiation field is carried out as needed. The disadvantage of this examination is that the patient feels pain due to the hand being moved in order to get a good picture.