Salter-Harris Type II Fracture MCQ — NEET PG Practice Question | NEETPGAI
Salter-Harris Type II Fracture
medium
bone Orthopedics
A 9-year-old boy presents to the emergency department with left wrist pain and swelling following a fall onto an outstretched hand. Radiographs of the distal radius show a fracture through the physis with a triangular fragment of metaphyseal bone. The structure marked **B** in the diagram is the Thurston-Holland fragment. Which of the following statements best characterizes this finding?
A. This is a Salter-Harris Type III fracture, which extends through the epiphysis and requires open reduction for anatomic alignment
B. This is a Salter-Harris Type V crush injury, which is the most common type but often missed initially and carries the worst prognosis
C. This is a Salter-Harris Type IV fracture, which passes vertically through the epiphysis, physis, and metaphysis with high risk of growth arrest
D. This is a Salter-Harris Type II fracture, which is the most common physeal fracture and carries an excellent prognosis for normal growth
Explanation
Why option 1 is correct
The Thurston-Holland fragment is a pathognomonic triangular metaphyseal fragment that defines a Salter-Harris Type II fracture. Type II fractures account for 75% of all physeal injuries and occur when the fracture line passes through the physis and extends into the metaphysis, creating this characteristic fragment. Type II fractures have an excellent prognosis for normal growth because the germinal layer of the physis is typically preserved, and the fracture is usually amenable to closed reduction and cast immobilization. The distal radius is the most common location for Type II injuries, especially after a fall onto an outstretched hand (FOOSH) mechanism in children.
Why each distractor is wrong
Option 2 (Type III): Type III fractures extend through the physis AND epiphysis (intra-articular), producing an epiphyseal fragment, not a metaphyseal fragment. The Thurston-Holland fragment is metaphyseal, not epiphyseal, so this cannot be Type III.
Option 3 (Type IV): Type IV fractures pass vertically through the epiphysis, physis, AND metaphysis. While they do involve the metaphysis, they are distinguished by intra-articular involvement of the epiphysis and carry a much higher risk of growth arrest and articular incongruity. The presence of a metaphyseal fragment alone (without epiphyseal involvement) indicates Type II, not Type IV.
Option 4 (Type V): Type V is a crush injury to the physis itself, which does not produce a discrete metaphyseal fragment. It is the rarest type (not the most common), is often missed initially, and carries the worst prognosis. The presence of a clear Thurston-Holland fragment rules out Type V.
High-YieldNEET PG
Thurston-Holland fragment = Salter-Harris Type II = metaphyseal fragment + physis fracture = 75% of physeal injuries = excellent prognosis.
Harrison's 21e; Rockwood and Wilkins Fractures in Children 9e
Practice similar questions
Sign up free to access AI-powered MCQ practice with detailed explanations and adaptive learning.
