Which statement correctly describes Thurston-Holland sign?

• A. It is a radiographic sign for a triangular metaphyseal fragment in Salter-Harris type II fractures
• B. It is a sign of tibial plateau fracture
• C. It is a sign of avascular necrosis
• D. It is a sign of osteoporosis

Answer: (A)

Thurston-Holland sign is a radiographic clue seen in pediatric growth-plate injuries, specifically Salter-Harris Type II fractures. In this injury, the fracture runs through the physis with a piece of metaphysis displaced as a triangular fragment, which becomes visible on X-ray as the Thurston-Holland fragment. This triangular metaphyseal fragment is characteristic of SH type II fractures and helps distinguish this pattern from other injuries. While the sign is most commonly described in the distal tibia, the principle applies to SH II injuries in other physes as well. The other listed conditions do not produce this radiographic feature: tibial plateau fractures show articular involvement with different fracture lines, avascular necrosis is a vascular complication rather than a specific radiographic clue, and osteoporosis involves generalized bone density loss rather than a distinct metaphyseal fragment.