Partial Hawkins Sign in Fractures of the Talus: A Report of Three Cases
Jamshid Tehranzadeh1,
Eric Stuffman2 and
Steven D. K. Ross3
1 Department of Radiological Sciences, University of California, Irvine College
of Medicine, 101 The City Dr., S, Rte. 140, Orange, CA 92868-3298.
2 University of California, Irvine College of Medicine, Orange, CA
92868-3298.
3 Department of Orthopedic Surgery, University of California, Irvine, Orange, CA
92868-3298.
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Fig. 1A. —19-year-old man who sustained nondisplaced talar fracture
while jumping on trampoline. Initial oblique lateral radiograph of left ankle
obtained after injury shows oblique fracture at neck of talus
(arrows).
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Fig. 1B. —19-year-old man who sustained nondisplaced talar fracture
while jumping on trampoline. Lateral radiograph of left ankle obtained 1 week
after injury shows bone resorption at fracture site (arrows).
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Fig. 1C. —19-year-old man who sustained nondisplaced talar fracture
while jumping on trampoline. Anteroposterior radiograph of left ankle obtained
1 week after injury shows bone resorption at fracture site
(arrows).
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Fig. 1D. —19-year-old man who sustained nondisplaced talar fracture
while jumping on trampoline. Anteroposterior radiograph obtained 6 weeks after
injury shows partial Hawkins sign (arrowheads) on lateral dome and
ischemic changes and cancellous screws on medial talar dome.
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Fig. 1E. —19-year-old man who sustained nondisplaced talar fracture
while jumping on trampoline. Lateral radiograph shows oblique fracture of
talar waist with avascular necrosis and cancellous screws in proximal
segment.
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Fig. 1F. —19-year-old man who sustained nondisplaced talar fracture
while jumping on trampoline. Coronal spin-echo T1-weighted image (TR/TE,
680/10.5) of ankle shows focal area of low signal with obliteration of cortex
on medial dome of talus, corresponding to ischemic area on radiograph. Note
magnetization artifact from cancellous screws.
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Fig. 1G. —19-year-old man who sustained nondisplaced talar fracture
while jumping on trampoline. Sagittal section on medial talar dome of
T1-weighted image (518/10.5) shows characteristic ischemic changes and
avascular necrosis on medial anterior talar dome. Note magnetization artifact
from cancellous screws.
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Fig. 1H. —19-year-old man who sustained nondisplaced talar fracture
while jumping on trampoline. Coronal fat-saturated T2-weighted image
(3,990/100) of ankle shows early phase of ischemia as bone marrow edema in
medial dome of the talus. Note magnetization artifact from cancellous
screws.
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Fig. 2A. —46-year-old man who fell 15 ft (4.5 m) and sustained
nondisplaced talar fracture. Initial anteroposterior radiograph of left ankle
after injury shows mildly comminuted intraarticular talar body fracture
(arrows).
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Fig. 2B. —46-year-old man who fell 15 ft (4.5 m) and sustained
nondisplaced talar fracture. Initial lateral radiograph of left ankle after
injury shows mildly comminuted intraarticular talar body fracture
(arrows).
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Fig. 2C. —46-year-old man who fell 15 ft (4.5 m) and sustained
nondisplaced talar fracture. Anteroposterior radiograph obtained 7 weeks after
injury shows partial Hawkins sign (arrowheads) on lateral dome and
ischemic changes and cancellous screws on medial side.
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Fig. 2D. —46-year-old man who fell 15 ft (4.5 m) and sustained
nondisplaced talar fracture. Lateral radiograph shows fracture of talar waist
with avascular necrosis and two cancellous screws on proximal talus.
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Fig. 3. —24-year-old man who fell and sustained eversion injury of
ankle with displaced vertical talar dome fracture. Anteroposterior radiograph
obtained 6 weeks after open reduction and internal fixation shows transverse
fracture of medial malleolus transfixed with cancellous screw. Note oblique
distal fibular fracture with plate-and-screw fixation. Note impaction fracture
of lateral tibial plafond and lateral talar dome. Vertical fracture of dome of
talus is transfixed with cancellous screw. Note partial Hawkins sign
(arrowheads) on medial and ischemic changes of talus on lateral talar
dome with osteochondral injury of tibial plafond and talar dome on same side.
Note mild osseous resorption around screw tip.
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Fig. 4. —Schematic drawing showing arterial supply of talus.
Extraosseous blood supply comes from three arteries: posterior tibial artery,
anterior tibial artery, and perforating branch of peroneal artery. Main
arterial supply to talar body is from artery of tarsal canal, which is a
branch of posterior tibial artery and contains deltoid branch. It also
supplies portion of anastomotic ring around talus with help of artery of
tarsal sinus. Each of these arteries produces perforating vessels to supply
specific areas of talar body.
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Copyright © 2003 by the American Roentgen Ray Society.
