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Injection of bone cement into the talus to prevent further avascular necrosis
2%
27/1619
Ankle fusion
1%
17/1619
Subtalar fusion
26/1619
Ankle arthroscopy to address this osteochondral lesion
4%
68/1619
Continued observation as the vascularity to the talus is intact
91%
1470/1619
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A subchondral radiolucency of the talar dome after a talar neck fracture is known as the "Hawkins sign" and is a well-described radiographic indication of viability of the talar body. Rockwood and Green state "by the 6th-8th week, if the patient has been non-weight-bearing, diffuse atrophy is evident by radiographs. An AP radiograph of the ankle reveals the presence or absence of subchondral atrophy in the dome of the talus. Subchondral atrophy excludes the diagnosis of avascular necrosis." Tezval et al in a retrospective review showed that a subchondral lucency seen on the AP radiograph was a good indicator of talus vascularity following fracture. They state it is unlikely that AVN will develop at a later stage after injury if a Hawkins sign was present. Illustration A shows the characteristic appearance of a Hawkins sign and subchondral sclerosis.
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