title: Intra-epiphyseal stress injury of the proximal tibial epiphysis: preliminary experience of magnetic resonance imaging findings.
abstract: Stress induced injuries affecting the physeal plate or cortical bone in children and adolescents, especially young athletes, have been well described. However, there are no reports in the current English language literature of stress injury affecting the incompletely ossified epiphyseal cartilage. We present four cases of stress related change to the proximal tibial epiphysis (PTE) along with their respective magnetic resonance imaging (MRI) appearances ranging from subtle oedema signal to a pseudo-tumour like appearance within the epiphyseal cartilage. The site and pattern of intra-epiphyseal injury is determined by the type of tissue that is affected, the maturity of the skeleton and the type of forces that are transmitted through the tissue. We demonstrate how an awareness of the morphological spectrum of MRI appearances in intra-epiphyseal stress injury and the ability to identify concomitant signs of stress in other nearby structures can help reduce misdiagnosis, avoid invasive diagnostic procedures like bone biopsy and reassure patients and their families.
authors.affiliation: Stafford General Hospital, Weston Road, Stafford, Staffordshire ST16 3SA, UK. Electronic address: drgtony@gmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Tony
authors.affiliation: Hillingdon Hospital, Pield Heath Rd, Uxbridge, Middlesex UB8 3NN, UK. Electronic address: amandacharran@yahoo.com.
authors.forename: A
authors.initials: A
authors.lastname: Charran
authors.affiliation: Department of Diagnostic Imaging, Robert Jones and Agnes Hunt, Orthopaedic Hospital, Oswestry, Shropshire SY10 7 AG, UK. Electronic address: bernhard.tins@rjah.nhs.uk.
authors.forename: B
authors.initials: B
authors.lastname: Tins
authors.affiliation: Department of Diagnostic Imaging, Robert Jones and Agnes Hunt, Orthopaedic Hospital, Oswestry, Shropshire SY10 7 AG, UK. Electronic address: radhesh.lalam@rjah.nhs.uk.
authors.forename: R
authors.initials: R
authors.lastname: Lalam
authors.affiliation: Department of Diagnostic Imaging, Robert Jones and Agnes Hunt, Orthopaedic Hospital, Oswestry, Shropshire SY10 7 AG, UK. Electronic address: prudencia.tyrrell@rjah.nhs.uk.
authors.forename: P N M
authors.initials: PN
authors.lastname: Tyrrell
authors.affiliation: Department of Diagnostic Imaging, Robert Jones and Agnes Hunt, Orthopaedic Hospital, Oswestry, Shropshire SY10 7 AG, UK. Electronic address: jaspreet.singh@rjah.nhs.uk.
authors.forename: J
authors.initials: J
authors.lastname: Singh
authors.affiliation: Orthopaedic Oncology, Robert Jones and Agnes Hunt, Orthopaedic Hospital, Oswestry, Shropshire SY10 7 AG, UK. Electronic address: paul.cool@rjah.nhs.uk.
authors.forename: P
authors.initials: P
authors.lastname: Cool
authors.affiliation: Paediatric Orthopaedics, Robert Jones and Agnes Hunt, Orthopaedic Hospital, Oswestry, Shropshire SY10 7 AG, UK. Electronic address: nigel.kiely@rjah.nhs.uk.
authors.forename: N
authors.initials: N
authors.lastname: Kiely
authors.affiliation: Department of Diagnostic Imaging, Robert Jones and Agnes Hunt, Orthopaedic Hospital, Oswestry, Shropshire SY10 7 AG, UK. Electronic address: Victor.Pullicino@rjah.nhs.uk.
authors.forename: V N
authors.initials: VN
authors.lastname: Cassar-Pullicino
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries / Q000473:pathology*; D002648:Child; D004838:Epiphyses / Q000293:injuries / Q000473:pathology*; D005593:Fracture Fixation, Internal / Q000379:methods*; D006132:Growth Plate / Q000098:blood supply / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D000072042:Salter-Harris Fractures; D013978:Tibial Fractures / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome
keywords: MRI; Proximal tibial epiphysis; Stress injury