This retrospective study of 41 operatively treated displaced talar fractures evaluates whether the Hawkins sign reliably predicts or excludes avascular necrosis of the talus. The core question: can you trust a positive Hawkins sign to rule out AVN, and does a negative sign predict it?
Every talar fracture patient you follow deserves a dedicated AP radiograph at 6–9 weeks specifically to look for the Hawkins sign. This is not a routine check-in film — it is the only plain-radiograph window to assess talar viability before AVN becomes diagnosable at 6–8 months.
When you see a positive or partially positive Hawkins sign, you can confidently reassure the patient: AVN is not coming. The 100% negative predictive value means a positive sign is a true rule-out.
When the sign is absent at week 9, do not conclude AVN is inevitable. Obtain MRI only if the patient is symptomatic or radiographs suggest structural change. Do not image early, because the sign may still be developing before week 9.
The Hawkins sign is a board classic: it was first described in the same 1970 paper that introduced the Hawkins classification of talar neck fractures. Knowing both. The classification (Types I–IV by dislocation pattern) and the sign (subchondral radiolucency = viability). From the same landmark paper is high-yield for the OITE.
This retrospective study of 41 operatively treated displaced talar fractures evaluates whether the Hawkins sign reliably predicts or excludes avascular necrosis of the talus. The core question: can you trust a positive Hawkins sign to rule out AVN, and does a negative sign predict it?
Every talar fracture patient you follow deserves a dedicated AP radiograph at 6–9 weeks specifically to look for the Hawkins sign. This is not a routine check-in film — it is the only plain-radiograph window to assess talar viability before AVN becomes diagnosable at 6–8 months.
When you see a positive or partially positive Hawkins sign, you can confidently reassure the patient: AVN is not coming. The 100% negative predictive value means a positive sign is a true rule-out.
When the sign is absent at week 9, do not conclude AVN is inevitable. Obtain MRI only if the patient is symptomatic or radiographs suggest structural change. Do not image early, because the sign may still be developing before week 9.
The Hawkins sign is a board classic: it was first described in the same 1970 paper that introduced the Hawkins classification of talar neck fractures. Knowing both. The classification (Types I–IV by dislocation pattern) and the sign (subchondral radiolucency = viability). From the same landmark paper is high-yield for the OITE.