Stressed or fractured: MRI differentiating indicators of physeal injury

To identify MRI findings that can indicate chronic physeal stress injury and differentiate it from acute Salter-Harris (SH) fracture of the pediatric knee or wrist. IRB-approved retrospective study of consecutively selected knee and wrist MRIs from 32 athletes with chronic physeal stress injury and 30 children with acute SH fracture. MRI characteristics (physeal patency, physeal thickening, physeal signal intensity (SI), continuity of the zone of provisional calcification (ZPC), integrity of the periosteum and/or perichondrium, pattern of periphyseal and soft tissue edema signal, and joint effusion) were compared. Forty-eight chronic physeal stress injuries (mean age 13.1 years [8.2–17.5 years]) and 35 SH fractures (mean age 13.3 years [5.1–16.0 years]) were included. Any physeal thickening was more common with chronic stress injury (98