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Talar dome subchondral lucency
78%
786/1008
Talar dome subchondral sclerosis
14%
142/1008
Diffuse osteopenia
1%
6/1008
Associated medial malleolus fracture
3%
34/1008
Talar lateral process fracture
35/1008
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Figure A demonstrates a talar neck fracture. A subchondral talar lucency at approximately 6 weeks postoperatively indicates revascularization of the talus and is a good prognostic factor for this injury (aka Hawkins' Sign and is exhibited by the arrows in Illustration A). The talar neck blood supply is tenuous and is susceptible to avascular necrosis. The reference by Hawkins classified talar neck fractures and correlated the incidence of avascular necrosis with the degree of displacement and severity of the fracture: Type I = Nondisplaced vertical fractures (AVN 10%). Type II = Displaced with subtalar dislocation/subluxation (AVN > 40%). Type III = Displaced with talar body dislocation (AVN >90%). Type IV = Displaced with talar head subluxation and body extrusion (AVN 100%). The reference by Canale et al reviewed long term outcomes after ORIF of talar neck fractures, and they found that good or excellent results were seen in only 59%. Salvage procedures such as triple arthrodesis, tibiocalcaneal fusion, and dorsal beak resection of the talar neck all resulted in a high percentage of satisfactory results, but talectomy did not.
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