Prognostic reliability of the Hawkins sign in fractures of the talus.

Abstract:

OBJECTIVE:To determine the prognostic reliability, sensitivity, and specificity of the Hawkins sign. The Hawkins sign is a subchondral radiolucent band in the talar dome that is indicative of viability at 6 to 8 weeks after a talus fracture. It is visible in the anterior-posterior view, but seldom appears on lateral radiographs. DESIGN:Retrospective study. SETTING:University hospital. PATIENTS AND METHODS:Between January 1995 and December 2000, a total of 41 patients (13 female, 28 male) with displaced talar fractures were operated on in our hospital. Thirty-four patients with a mean age of 35 years (range 12-60) were followed for more than 36 months (range 36-52). The prognostic reliability of the Hawkins sign was studied in 31 of these patients using a two-by-two table. The Ankle-Hindfoot scale of the American Orthopaedic Foot and Ankle Society (AOFAS) was used as an outcome measure. RESULTS:No Hawkins sign was found in the five patients who developed avascular necrosis (AVN) of the talus. In the remaining 26 patients who did not develop AVN, a positive (full) Hawkins sign was observed 11 times, a partially positive Hawkins sign 4 times, and a negative Hawkins sign 11 times. The Hawkins sign thus showed a sensitivity of 100% and a specificity of 57.7%. The Hawkins sign (if present) appeared between the 6th and the 9th week after trauma. Mean [range] AOFAS scores were: Pain, 31 [10-40] out of 40; Function, 39 [14-50] out of 50; and Alignment, 7 [0-10] out of 10. The clinical results were satisfactory. CONCLUSION:The Hawkins sign is a good indicator of talus vascularity following fracture. If a full or partial positive Hawkins sign is detected, it is unlikely that AVN will develop at a later stage after injury.

journal_name

J Orthop Trauma

authors

Tezval M,Dumont C,Stürmer KM

doi

10.1097/BOT.0b013e318148c665

subject

Has Abstract

pub_date

2007-09-01 00:00:00

pages

538-43

issue

8

eissn

0890-5339

issn

1531-2291

pii

00005131-200709000-00004

journal_volume

21

pub_type

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