What causes Hawkins Sign in the ankle on frontal radiograph?
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Answer:
Hawkins Sign is a subchondral lucent band on the talar dome visible 6-8 weeks after talar neck or talar body fracture, indicating preserved vascularity through disuse osteopenia and predicting low risk of avascular necrosis (AVN) with good prognosis.
Why is it called so?
Named after American orthopedic surgeon Leland G. Hawkins, who described it in his seminal 1970 paper “Fractures of the Neck of the Talus” as subchondral talar dome osteopenia on ankle radiographs 6-8 weeks post-talar fracture to assess vascular integrity.
Pathophysiology:
Post-fracture immobilization causes disuse osteopenia via bone resorption in vascularized subchondral bone, manifesting as lucency beneath the talar dome; intact vascularity allows osteoclast-mediated resorption, while avascular bone remains sclerotic without lucency.
Alternative names: None
Other associated named signs: Partial Hawkins sign (incomplete subchondral lucency, indicating partial vascular preservation with intermediate AVN risk)
References
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