Hawkins reviewed 57 vertical talar neck fractures in 55 patients to propose a radiographic classification and define AVN risk by fracture type. The study also described the Hawkins sign as a prognostic tool and evaluated outcomes across treatment methods.
Before this paper, AVN incidence after talar neck fracture was poorly defined and contested, with no framework linking injury pattern to complication risk. The Hawkins classification made fracture type a direct predictor of AVN probability — a correlation that remains the foundation for surgical decision-making and patient counseling worldwide.
When you see a talar neck fracture, classify it immediately on the initial X-ray: Group I can be treated closed with near-zero AVN risk, Group II requires anatomic reduction (closed or open) with counseling that AVN risk is 42%, and Group III demands open reduction with the expectation that AVN will occur in approximately 9 of 10 patients.
At 6–8 weeks post-injury, obtain an AP ankle X-ray out of cast: subchondral atrophy of the talar dome (Hawkins sign) is reassuring evidence of intact vascularity. Its absence warrants close monitoring but does not confirm AVN. Canale and Kelly later added a Type IV (associated talonavicular dislocation), cementing Hawkins' framework as the template for all subsequent talar neck fracture research.
Hawkins reviewed 57 vertical talar neck fractures in 55 patients to propose a radiographic classification and define AVN risk by fracture type. The study also described the Hawkins sign as a prognostic tool and evaluated outcomes across treatment methods.
Before this paper, AVN incidence after talar neck fracture was poorly defined and contested, with no framework linking injury pattern to complication risk. The Hawkins classification made fracture type a direct predictor of AVN probability — a correlation that remains the foundation for surgical decision-making and patient counseling worldwide.
When you see a talar neck fracture, classify it immediately on the initial X-ray: Group I can be treated closed with near-zero AVN risk, Group II requires anatomic reduction (closed or open) with counseling that AVN risk is 42%, and Group III demands open reduction with the expectation that AVN will occur in approximately 9 of 10 patients.
At 6–8 weeks post-injury, obtain an AP ankle X-ray out of cast: subchondral atrophy of the talar dome (Hawkins sign) is reassuring evidence of intact vascularity. Its absence warrants close monitoring but does not confirm AVN. Canale and Kelly later added a Type IV (associated talonavicular dislocation), cementing Hawkins' framework as the template for all subsequent talar neck fracture research.