Thurston-Holland sign is typically seen with which Salter-Harris fracture types?

Thurston-Holland sign is typically seen with which Salter-Harris fracture types?

• A. II or IV
• B. I or III
• C. I or II
• D. III or IV

Answer: (A)

The Thurston-Holland sign comes from a small metaphyseal fragment that is pulled away by the fracture line when the growth plate is involved with a metaphyseal component. This creates a visible triangular or chip-like fragment near the physis on radiographs—the Thurston-Holland fragment. It is classic for Salter-Harris type II fractures, where the line runs through the physis and metaphysis, producing that metaphyseal piece. It can also appear in more complex injuries that involve both metaphysis and epiphysis, namely Salter-Harris type IV fractures, where a similar metaphyseal fragment may be seen adjacent to the growth plate. In physeal-only injuries (type I) or in injuries that spare the metaphysis (type III) there isn’t a metaphyseal fragment, so this sign isn’t typical. Hence, the sign is most typical in type II and can be seen in type IV.

The Thurston-Holland sign comes from a small metaphyseal fragment that is pulled away by the fracture line when the growth plate is involved with a metaphyseal component. This creates a visible triangular or chip-like fragment near the physis on radiographs—the Thurston-Holland fragment. It is classic for Salter-Harris type II fractures, where the line runs through the physis and metaphysis, producing that metaphyseal piece. It can also appear in more complex injuries that involve both metaphysis and epiphysis, namely Salter-Harris type IV fractures, where a similar metaphyseal fragment may be seen adjacent to the growth plate. In physeal-only injuries (type I) or in injuries that spare the metaphysis (type III) there isn’t a metaphyseal fragment, so this sign isn’t typical. Hence, the sign is most typical in type II and can be seen in type IV.