[Effectiveness analysis of percutaneous parallel screw fixation via posterolateral "safe zone" for Hawkins type â - â ¢ talar neck fractures].

Objective: To explore the effectiveness of the percutaneous parallel screw fixation via the posterolateral "safe zone" for Hawkins type Ⅰ-Ⅲ talar neck fractures. Methods: A retrospective analysis was conducted on the clinical data from 35 patients who met the selection criteria of talar neck fractures between January 2019 and June 2021. According to the surgical method, they were divided into a study group (14 cases, using percutaneous posterolateral "safe zone" parallel screw fixation) and a control group (21 cases, using traditional open reduction and anterior cross screw internal fixation). There was no significant difference in gender, age, affected side, Hawkins classification, and time from injury to operation between the two groups ( P>0.05). The operation time, bone healing time, complications, and Hawkins sign were recorded, and the improvement of pain and ankle-foot function were evaluated by visual analogue scale (VAS) score and American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score at last follow-up. The overall quality of life was assessed by the short form of 12-item health survey (SF-12), which was divided into physical and psychological scores; and the satisfaction of patients was evaluated by the 5-point Likert scale. Results: The operation time in the study group was significantly shorter than that in the control group ( P<0.05). All patients werefollowed up 13-35 months, with an average of 20.6 months; there was no significant difference in the follow-up time between the two groups ( P>0.05). The time of bone healing in the study group was shorter than that in the control group, and the positive rate of Hawkins sign (83.33%) was higher than that in the control group (33.33%), and the differences were significant ( P<0.05). In the control group, there were 2 cases of incision delayed healing, 7 cases of avascular necrosis of bone, 3 cases of joint degeneration, 1 case of bone nonunion, and 3 cases of internal fixation irritation; while in the study group, there were only 2 cases of joint degeneration, and there was a significant difference in the incidence of complications between the two groups ( P<0.05). At last follow-up, there was no significant difference in VAS score between the two groups ( P>0.05), but the SF-12 physical and psychological scores, AOFAS ankle and hindfoot scores, and patients' satisfaction in the study group were significantly better than those in the control group ( P<0.05). Conclusion: The treatment of Hawkins type Ⅰ-Ⅲ talar neck fractures with percutaneous parallel screw fixation via the posterolateral "safe zone" can achieve better effectiveness than traditional open surgery, with the advantages of less trauma, fewer complications, faster recovery, and higher patient satisfaction.

Effectiveness analysis of percutaneous parallel screw fixation via posterolateral "safe zone" for Hawkins type Ⅰ- Ⅲ talar neck fractures / 中国修复重建外科杂志

OBJECTIVE@#To explore the effectiveness of the percutaneous parallel screw fixation via the posterolateral "safe zone" for Hawkins type Ⅰ-Ⅲ talar neck fractures.@*METHODS@#A retrospective analysis was conducted on the clinical data from 35 patients who met the selection criteria of talar neck fractures between January 2019 and June 2021. According to the surgical method, they were divided into a study group (14 cases, using percutaneous posterolateral "safe zone" parallel screw fixation) and a control group (21 cases, using traditional open reduction and anterior cross screw internal fixation). There was no significant difference in gender, age, affected side, Hawkins classification, and time from injury to operation between the two groups ( P>0.05). The operation time, bone healing time, complications, and Hawkins sign were recorded, and the improvement of pain and ankle-foot function were evaluated by visual analogue scale (VAS) score and American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score at last follow-up. The overall quality of life was assessed by the short form of 12-item health survey (SF-12), which was divided into physical and psychological scores; and the satisfaction of patients was evaluated by the 5-point Likert scale.@*RESULTS@#The operation time in the study group was significantly shorter than that in the control group ( P<0.05). All patients werefollowed up 13-35 months, with an average of 20.6 months; there was no significant difference in the follow-up time between the two groups ( P>0.05). The time of bone healing in the study group was shorter than that in the control group, and the positive rate of Hawkins sign (83.33%) was higher than that in the control group (33.33%), and the differences were significant ( P<0.05). In the control group, there were 2 cases of incision delayed healing, 7 cases of avascular necrosis of bone, 3 cases of joint degeneration, 1 case of bone nonunion, and 3 cases of internal fixation irritation; while in the study group, there were only 2 cases of joint degeneration, and there was a significant difference in the incidence of complications between the two groups ( P<0.05). At last follow-up, there was no significant difference in VAS score between the two groups ( P>0.05), but the SF-12 physical and psychological scores, AOFAS ankle and hindfoot scores, and patients' satisfaction in the study group were significantly better than those in the control group ( P<0.05).@*CONCLUSION@#The treatment of Hawkins type Ⅰ-Ⅲ talar neck fractures with percutaneous parallel screw fixation via the posterolateral "safe zone" can achieve better effectiveness than traditional open surgery, with the advantages of less trauma, fewer complications, faster recovery, and higher patient satisfaction.

Hawkins sign of the knee: Imaging appearance and clinical implication of an unusual pattern of disuse osteopenia.

Disuse osteopenia (DO) is a disorder due to reduced weight-bearing often following immobilization injuries. It is most commonly observed in the ankles and knees and is believed to be due primarily to increased bone reabsorption associated with disuse. Both traditional radiography and magnetic resonance (MR) imaging are useful in identifying abnormalities associated with DO. Specifically, linear subchondral osteopenia has been given the term "Hawkins sign" when seen in the talus, but this finding may also be seen elsewhere. When present, it not only is an indication of DO but also indicates the presence of sufficient vascular flow, and the unlikely development of avascular necrosis. We report a case of Hawkins sign of the knee demonstrated on radiography and MR and demonstrate the clinical importance of recognizing this sign, outside its usual setting, in assessing the prognosis of a healing fracture.

Prevention of Avascular Necrosis with Fractures of the Talar Neck.

Displaced talar neck fractures no longer constitute a surgical emergency; timing of definitive surgery has no bearing on the risk of osteonecrosis. Amount of initial fracture displacement is best predictor of osteonecrosis. Grossly displaced fractures or fracture-dislocations should be provisionally reduced, with or without temporary external fixation. Periosteal stripping should be limited to only that necessary to obtain anatomic reduction. Dissection within the sinus tarsi or tarsal canal should be avoided. Rigid internal fixation with solid cortical screws countersunk within the talar head and placed below the "equator" of the talar head is imperative for optimum stability.

The prognostic value of the hawkins sign and diagnostic value of MRI after talar neck fractures.

BACKGROUND: The early diagnosis of avascular necrosis of the talus (AVN) and prediction of ankle function for talar fractures are important. The Hawkins sign, as a radiographic predictor, could exclude the possibility of developing ischemic bone necrosis after talar neck fractures, but its relationship with ankle function remains unclear. The purpose of this study was to illustrate the prognostic effect of the Hawkins sign on ankle function after talar neck fractures and to study the value of early MRI in detecting the AVN changes after talus fractures. METHODS: Cases of talar neck fractures between November 2008 and November 2013 were evaluated. The occurrences of the Hawkins sign and AVN were studied. X-ray imaging was performed at multiple time points from the 4th to the 12th week after the fractures, and MRI examinations were used in the Hawkins sign negative group, with the time span ranging from 1.5 to 12 months. AOFAS scores of the Hawkins sign positive and negative groups were compared during the follow-up. Forty-four cases (48 feet) were evaluated. RESULTS: The occurrence of positive Hawkins sign was 50%, 30%, and 33.3%, the incidence of AVN was 0%, 10%, and 50%, respectively, in type I, type II, and type III and IV talus fractures, respectively. The AOFAS scores showed no statistically significant difference between Hawkins sign positive group and negative group in type I and II fractures. The Hawkins sign positive group had better AOFAS scores than the negative group in type III and IV fractures. However, there was no statistically significant difference between Hawkins sign positive and negative groups when AVN cases were excluded in type III and IV fractures. CONCLUSION: The Hawkins sign was a reliable predictor excluding the possibility of AVN. It did not have predictive value on the ankle function in low-energy fractures and may predict better ankle function in high-energy fractures. MRI can diagnose AVN during an earlier period, and we believe Hawkins sign negative patients should undergo MRI examinations 12 weeks after the fractures, especially in high-energy traumatic cases. LEVEL OF EVIDENCE: Level III, comparative case series.

[Is the Hawkins sign able to predict necrosis in fractures of the neck of the astragalus?]. / ¿Es el signo de Hawkins capaz de predecir la necrosis en las fracturas del cuello astragalino?

OBJECTIVE: To assess if the Hawkins sign can predict whether or not astragalus fractures of the neck will develop avascular necrosis. It is also assessed whether the occurrence of this complication is related to the displacement of the fracture, soft tissue injury, or delay in the reduction or surgery. The results were compared with those found in the literature. MATERIAL AND METHODS: A retrospective study was conducted on 23 talar neck fractures recorded over a a period of thirteen years. The following variables were analysed: displacement of the fracture, soft tissue injury, delay and type of treatment, complications, observation of the Hawkins sign, and functional outcome. RESULTS: There were 7 type I Hawkins fractures, 11 type II, and 4 type III and 1 type IV. Four cases developed avascular necrosis (2 Hawkins type II and 2 type III). Hawkins sign was observed in 12 cases, of which none developed necrosis. Four cases with negative Hawkins sign developed necrosis. No statistically significant differences were found when comparing the development of avascular necrosis with the displacement of the fracture, soft tissue injury, or delay in treatment. Differences were found when comparing the development of avascular necrosis with the Hawkins sign (P=.03). CONCLUSION: A positive Hawkins sign rules out that the fractured talus has developed avascular necrosis, but its absence does not confirm it.

Surgical treatment of talus fractures.

Talus fractures result from high-energy mechanisms and usually occur at the neck. Functional outcome after talar neck fracture worsens with increasing Hawkins grade. The mainstay of treatment for talar neck fractures is anatomic reduction and internal fixation. Prompt reduction of dislocations should be performed. Patients should be taken to the operating room as soon as stabilized. Dual incisions and a combination of minifragment plates and screws should be used. Talar body fractures have a high rate of ankle and subtalar arthritis. Lateral process fractures are frequently missed on radiographs. Complications after talus fractures include osteonecrosis, malunion, post-traumatic arthritis, and infection.

Avascular Necrosis after Operative Treatment for Fracture and Dislocations of the Talar Neck / 대한족부족관절학회지

PURPOSE: To evaluate the incidence of avascular necrosis (AVN), prognostic reliability of the Hawkins sign, and clinical outcomes after operative treatment of fracture and dislocations of the talar neck. MATERIALS AND METHODS: We analysed 16 patients with fracture and dislocations of the talar neck which were treated by open reduction and internal fixation and followed up for more than 2 years. The postoperative radiographs were examined for Hawkins sign and avascular necrosis was confirmed by bone scan. The assessment of clinical results was based on the Hawkins scoring system. RESULTS: AVN was occurred in 2 of 16 cases (12.5%) only in type III. Hawkins sign was found 11 of 16 cases (68.8%), which included 8 cases in type II, 2 cases in type III and 1 case in type IV. The Hawkins sign was not observed in two cases with AVN. In contrast, only 2 of the 5 cases with a negative Hawkins sign developed AVN. According to Hawkins scoring system, 4 patients (25.0%) was in excellent, 7 patients (43.8%) in good, 4 patients (25.0%) in fair and 1 patient (6.3%) in poor. CONCLUSION: Incidence of AVN after operative treatment of fracture and dislocations of the talar neck was lower than that of previous reports. Hawkins sign had a high prognostic reliability, but absence of Hawkins' sign should not be considered a totally reliable indicator of development of avascular necrosis.