Thurstan Holland sign

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The Thurstan Holland sign [1] or fragment, also known as the shiny corner sign, [2] is the small metaphyseal triangular portion of bone carried with the physis in type II and IV Salter–Harris fractures. The sign was named after the Liverpool pioneer in Radiology, Dr Charles Thurstan Holland (1863–1941). [3]


The metaphysis is the narrow portion of a long bone between the epiphysis and the diaphysis. It contains the growth plate, the part of the bone that grows during childhood, and as it grows it ossifies near the diaphysis and the epiphyses.

Physis is a Greek theological, philosophical, and scientific term usually translated into English as "nature".

Salter–Harris fracture fracture that involves the epiphyseal plate or growth plate of a bone

A Salter–Harris fracture or growth plate fracture is a fracture that involves the epiphyseal plate or growth plate of a bone. It is thus a form of child bone fracture. It is a common injury found in children, occurring in 15% of childhood long bone fractures. This type of fracture and its classification system is named for Robert B. Salter and William H. Harris, who created and published this classification system in the Journal of Bone and Joint Surgery in 1963.

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Epiphyseal plate part of a long bone where growth takes place

The epiphyseal plate is a hyaline cartilage plate in the metaphysis at each end of a long bone. It is the part of a long bone where new bone growth takes place; that is, the whole bone is alive, with maintenance remodeling throughout its existing bone tissue, but the growth plate is the place where the long bone grows longer.

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Charles Thurstan Holland British physician and pioneer radiologist

Charles Thurstan Holland (1863–1941) was a general practitioner in Liverpool who was best known by his pioneering research in the field of Radiology. The Thurstan Holland sign is named after him.

Triplane fracture is a fracture at the epiphyseal plate of the tibia in early adolescence with involvement of the epiphysis and metaphysis of the tibia. The link presents two types of imaging. The first four images are radiographic images while the last 3 are CT scans of the left distal tibia and fibula. The first radiographic image is an anterior-posterior view of the distal third of the left tibia and fibula. The image presents a fracture of the distal epiphyseal plate of the tibia and fibula. The primary imaging (radiograph) identifies the abnormality in the anatomy of subject’s left distal tibia and fibula. However, it is difficult to view the extent of the fracture and classify the fracture based on radiographic image. Figure four is a CT scan of the posterior aspect of the left distal tibia and fibula. Note that in this image the extent of the fracture is more visible extending to the epiphysis and metaphysis. The type of fracture is a Salter-Harris type IV. The CT scan was an appropriate choice of advance imaging which helps clinicians determine the extent of the fracture and enable us to address the problem appropriately.


  1. Note: Thurstan is often misspelled as "Thurston": Charles Thurstan Holland: a genealogical note
  2. Essentials of Orthopaedics - CHAPTER 15: Fractures in Children, p.289: Thurston Holland Sign (Shiny Corner Sign)
  3. RadioGraphics 1995: Vol 15, pp. 481-488 Radiologic History Exhibit "[Holland] also described the bony fragment seen with epiphyseal fractures; it was later realized that this triangular, metaphyseal fragment, known as the corner sign or Holland fragment, was the hallmark of the Salter-Harris type II epiphyseal fracture."