The Hawkins sign describes subchondral lucency of the talar dome seen in AP view that occurs secondary to subchondral atrophy 6-8 weeks after a talar neck fracture 1.
This indicates that there is sufficient vascularity in the talus, and is therefore unlikely to develop avascular necrosis of the talar dome later 2,3.
Disruption of the blood supply to all or a portion of the talar dome results in absence of the Hawkins sign (seen as subchondral sclerosis), which usually indicates underlying avascular necrosis 4.
History and etymology
The sign is named after Leland G Hawkins (1933-1991) 5, an American orthopedic surgeon. He also established the Hawkins classification of talar neck fractures which helps in risk assessment of avascular necrosis of the talar dome.
- 1. Hawkins LG. Fractures of the neck of the talus. J Bone Joint Surg Am. 1970;52 (5): 991-1002. J Bone Joint Surg Am (link) - Pubmed citation
- 2. Tezval M, Dumont C, Stürmer KM. Prognostic reliability of the Hawkins sign in fractures of the talus. J Orthop Trauma. 2007;21 (8): 538-43. doi:10.1097/BOT.0b013e318148c665 - Pubmed citation
- 3. Pearce DH, Mongiardi CN, Fornasier VL et-al. Avascular necrosis of the talus: a pictorial essay. Radiographics. 2005;25 (2): 399-410. Radiographics (full text) - doi:10.1148/rg.252045709 - Pubmed citation
- 4. Tehranzadeh J, Stuffman E, Ross SD. Partial Hawkins sign in fractures of the talus: a report of three cases. AJR Am J Roentgenol. 2003;181 (6): 1559-63. doi:10.2214/ajr.181.6.1811559 - Pubmed citation
- 5. Day MA, Compton JT, Buckwalter JA. Leland G. Hawkins, MD-His Life and Orthopaedic Legacy: Talus Fractures and the Hawkins Classification. (2018) The Iowa orthopaedic journal. 38: 1-8. Pubmed