Establishing signs for acute and healing phases of distal tibial classic metaphyseal lesions.

The lack of thin bucket handle fractures on any follow-up skeletal surveys suggests this sign represents an acute phase of injury. The next phases of healing appear to be thick bucket handle fracture followed by bucket handle fracture with endochondral bone filling the gap. It is important to note that normalization of the metaphysis at 2-week follow-up does not exclude CML because this was seen in about one-fifth of cases.