Pediatrics Case 13 Diagnosis

Salter-Harris Type II fracture of the middle phalanx.

The diagnosis is suspected clinically and confirmed with plain films. The distinctive finding on x-ray for Salter-Harris type II fractures is an injury which goes through the metaphysis into the growth plate with no extension into the epiphysis or joint space.  While a nondisplaced fracture line through the metaphysis is not radiographically visible, the bony fracture line or fragment on the metaphyseal side of the growth plate secures the diagnosis.  This often triangular fragment is diagnostic of metaphyseal fracture and is also known as a Thurston Holland sign. The fracture line through the physis will not be visible because both the cartilaginous growth plate and fracture lines are radiolucent