If an active pars fatigue fracture is suspected, which radiographic views should be taken?

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When a pars interarticularis fatigue fracture is suspected, the priority is to detect an active injury as early as possible. Plain radiographs, even with multiple views, often look normal in the early stages and may only show a defect after the fracture has progressed. That makes them less reliable for confirming an active injury right away.

MRI stands out because it can reveal bone marrow edema and other signs of a stress reaction in the pars interarticularis before a fracture line becomes visible on X-rays. This allows you to confirm an active injury quickly and start appropriate management, such as rest and graded return to activity, without waiting for radiographic changes. MRI also provides information about surrounding structures and helps rule out other causes of back pain.

If MRI findings are inconclusive but suspicion remains high, further imaging like CT can better delineate a cortical fracture, but MRI is the most sensitive initial test for an active pars fatigue fracture.