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

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

Answer: (B)

Thurstan-Holland sign reflects a small metaphyseal fragment seen on X-ray that results when the fracture line goes through the growth plate and involves the metaphysis. This metaphyseal fragment, sometimes called the Thurston-Holland fragment, is classically described with Salter-Harris type II injuries, where the fracture passes through the physis and metaphysis and leaves a piece of metaphysis that can be displaced but remains connected to the epiphysis by the periosteum. The sign can also appear in Type IV injuries, where the line traverses metaphysis, physis, and epiphysis, producing a similar metaphyseal fragment on radiographs. That’s why the Thurston-Holland sign is associated with both II and IV fractures. Types I and III involve the physis with no separate metaphyseal fragment, and Type V is a crush injury to the physis without a discrete fragment, so the sign is not typically seen with them.