Thurstan Holland sign

Thurstan Holland sign is a radiological sign associated with certain types of fractures, particularly those involving the ankle and the growth plate in children. It is named after Thurstan Holland, a radiologist who first described this feature. The sign is indicative of a Salter-Harris fracture, which is a classification of fractures involving the growth plate (physis) of a bone. The Thurstan Holland sign is characterized by the presence of a small fragment of bone that is displaced and attached to the epiphyseal plate, visible on X-ray images.

Characteristics

The Thurstan Holland sign is primarily observed in Salter-Harris Type II fractures, which occur through the growth plate and extend into the metaphysis, causing a small corner of the metaphysis to become detached. This detached fragment remains attached to the displaced epiphyseal segment, creating the appearance that is characteristic of the Thurstan Holland sign. The presence of this sign is significant because it helps in diagnosing the specific type of growth plate fracture, which is crucial for appropriate treatment and prognosis.

Clinical Significance

The identification of the Thurstan Holland sign on radiographic images is important in the clinical setting for several reasons:

• It aids in the accurate diagnosis of the type of Salter-Harris fracture, which is essential for determining the appropriate treatment plan.
• Understanding the type of fracture is crucial for predicting potential complications, such as growth disturbances or joint incongruity, which could result from improper alignment or healing.
• Early and accurate diagnosis facilitated by recognizing this sign can lead to better outcomes for the patient, as appropriate management strategies can be implemented promptly.

Treatment

Treatment of fractures exhibiting the Thurstan Holland sign typically involves:

• Reduction of the fracture, which may be done manually (closed reduction) or surgically (open reduction), depending on the severity and displacement of the fracture.
• Immobilization of the affected limb to ensure proper healing, often using a cast or splint.
• Close monitoring of the healing process, with follow-up X-rays to ensure that the bone is aligning and healing correctly.
• In some cases, especially if the growth plate is damaged, further interventions may be necessary to address potential complications, such as growth disturbances.

Conclusion

The Thurstan Holland sign is a valuable diagnostic feature that aids in the identification and management of certain types of growth plate fractures. Recognizing this sign on radiographic images can significantly impact the treatment and prognosis of affected individuals, highlighting the importance of radiological expertise in the diagnosis and management of pediatric fractures.