Fractures of talus in children are extremely rare injuries and account for only 0. Dec 25, 2016 hawkins type 2 displaced fracture of the talar neck with subtalar dislocation or subluxation. A a type i fracture is a talar neck fracture, b type ii is a talar neck fracture with subtalar dislocation, c type iii is a talar neck fracture with subtalar. This type of fracture often occurs during a highenergy event, such as a car collision or a fall from a significant height. Karges definition fractures of the talus are severe injuries affecting ankle and hindfoot joint function. In the present study, we report a surgical treatment of hawkins type iii talar neck fracture through the approach of medial malleolar osteotomy and miniplate for fixation and discuss the therapeutic effects after longterm followup. Hawkins sign is a good indicator of talus vascularity following talus fracture. Jan 11, 2020 there are three major complications that commonly occur with talus fractures. Subsequently, treatment has been determined according to the described fracture type and. A talus fracture is a break in one of the bones that forms the ankle. Talar fracture repair and rehabilitation amazon s3. The presence of this sign after a talar fracture implies that avascular necrosis avn of the talus has not occurred. Talus ankle fracture diagnostics, treatment, surgery, postop, therapyrehab and activity as seen through the eyes of a patient and nurse. The original hawkins classification includes three fracture types.
Lateral process fractures are most commonly classified into three types, according to the hawkins criteria. Simple two level ring fixator was applied for all patients, reduction was achieved and assessed by image intensifier then fixation was. A hawkins type ii fracture is a displaced vertical talar neck fracture with a subluxation or dislocation of the subtalartalocalcaneal joint. Avascular necrosis and salvage of talus fractures discussion. Talar neck fracture reduced and stabilized with an.
Displaced fracture with body of talus dislocated from both subtalar and ankle joint canale and kelly 2 described a rare type 4 category which in addition to features described for type 3 there is dislocation or subluxation of the head of the talus at the talonavicular joint. The hawkins system is the most widely accepted classification system for talar neck fractures and includes three classifications based on initial fracture displacement. Type i, the most common, consists of a large fragment with a single fracture line extending from the talofibular articular surface to the subtalar joint fig 16. C, anteroposterior radiograph obtained 7 weeks after injury shows partial hawkins sign arrowheads on lateral dome and ischemic changes and cancellous screws on medial side. Godoysantos, 20 talus fracture may also be associated with fractures of the distal tibia. A 51year old smoker male without relevant medical history. A method of open reduction of an irreducible hawkins type iii. Pins or screws may be needed, as well as treatment of the damaged muscles and other tissue.
Fractures of the neck of talus in adults are associated with fractures of medial malleolus in 16%, but this association is mainly with hawkins group iii fractures of neck of talus. Talus fracture causes, types, symptoms, complications. Article fracture of the lateral process of the talus. By determining how much soft tissue injury and the extent of talar fracture, external fixation can be more superior to internal fixation. They typically occur following highenergy trauma, such as a. The hawkins sign indicates subchondral talar dome osteopenia and signifies intact vascularity. However, these fractures are extremely rare in children. The literature describes only individual cases of such injuries. Feb 27, 2020 a hawkins type iii fracture is a displaced fracture extending through the talar neck with dislocation at both the subtalar and tibiotalar joints. These problems are ankle arthritis, fracture malunion, and osteonecrosis. Talar neck fractures hawkins type 2 and 3 treated with anatomical reduction and near anatomical reduction having satisfactory clinical and functional outcome, where as hawkins type 4 having fair to poor outcome with complication like avn, arthritis and malunion due to poor initial reduction. Eight years after hawkins description of talar neck fractures, canale and kelly 20 reported a type iv fracture a displaced talar neck fracture with either dislocation or subluxation of all.
After fracture union the avascular body of the talus is protected by using a patellartendon bearing brace. The purpose of this paper is to report a grade 3 tscherne, isolated and displaced hawkins type iii talar neck fracture that was specifically treated with open reduction and external fixation. Contrary to the prior literature, the most common type of talar fracture in our study population was an isolated body fracture. Open reduction and internal fixation of the talus david e. Figure 7a hawkinscanale type iii talar neck fracture. Talus fracture hawkins 3 displaced fracture explained. Talus fracture other than neck trauma orthobullets.
Hawkins type iii talar neck fractures indicate injuries to the tibiotalar and subtalar joints 8. Treatment consisted of open reduction followed by an external fixator to maintain. Fracture of the lateral process of the talus is a common, yet frequently missed, injury. Talar neck fracture with subtalar and tibiotalar and talonavicular dislocation commonest type of talus fracture. Clinical outcome and concomitant injuries in operatively. Hawkins type iii talar fractures wheeless textbook of orthopaedics. Surgical management of hawkins type iii talar neck fracture. Master woolfbrand of duisburg, a man strong and fleshy, in jumping from a bank three feet high so twisted and broke his right foot that the whole of the os tali was not only displaced but. Jan 14, 2015 fractures of the neck of the talus based on the modified hawkins classification are shown. A simple technique for reduction of nearly extruded talar. We present a pediatric lowenergy hawkins type iii fracture dislocation that had excessive displacement accompanied by neurovascular and tendon entrapment. Hawkins type iii fracture talar neck may sometimes be a nightmare for surgeons to reduce, even intraoperatively. Mechanism talar body injuries often result from high energy trauma, with the hindfoot either in supination or pronation. Talar neck fracture reduced and stabilized with an ilizarov.
Surgical management of hawkins type iii talar neck. Prasad, 20 in higher energy mechanisms with displaced talus fractures, associated sh iv distal tibia fractures have been described. The hawkins sign appears as a line of subchondral lucency, first visible between 6 and 8 weeks after the injury and reflecting disuse osteopenia in vascularized. Displaced fractures of the talus are a surgical challenge to orthopaedic surgeons. Talus fracture, hawkins sign everything you need to. Therefore, the management goal of this fracture is. In hawkins classification, type 1 fractures are not associated with dislocation, type 2 are fractures with subtalar dislocation, and type 3 are fractures associated with both ankle and.
Even in the presence of avascular necrosis the fracture can unite. Treatment and evaluation of talus neck fracture tadvi. These fractures usually result from hyperdorsiflexion. Several soft tissue injuries can accompany talus fractures. They typically occur following highenergy trauma, such as a fall from height or. In 1970, hawkins described a threepart classification system of vertical talar neck fractures as they correlate with the incidence of avascular necrosis. Type i is a simple fracture that extends from the articular surface of.
Surgery to treat an open talus fracture often involves much more than lining up the broken pieces of bone. The hawkins 2 classification is the most widely accepted classification system for talar neck fractures. Case discussion talar neck fractures extend through the thinnest crosssectional portion of the talus, just proximal to the talar head. Use of this brace is continued till revascularization blood supply to the talus body develops again of the talus body occurs. Hawkins originally described types i iii in 1970 with canale and kelly adding type iv in 1978. Eight years after hawkins description of talar neck fractures, canale and kelly 20 reported a type iv fracture a displaced talar neck fracture. The ilizarov technique simplified the surgery by allowing the reduction of the. In our study, we present the case of a displaced lowenergy hawkins type iii talar neck fracture concomitant with tendon and neurovascular entrapment. It is likely avn will develop at a later stage after the injury. Surgical management of hawkins type iii talar neck fracture through. Displaced talar neck and body fractures are rare and challenging for the surgeon. Ii is a talar neck fracture with subtalar dislocation, c type iii is a talar neck. Treatment of bilateral hawkins type ii talar neck fractures.
Aug 04, 2016 talus ankle fracture diagnostics, treatment, surgery, postop, therapyrehab and activity as seen through the eyes of a patient and nurse. The injuries are infrequent and the fracture anatomy is partially concealed by adjacent osseous structures. The incidence of these complications increase by the increase in hawkins type fracture 2, 3. Hawkins group i fracture of neck of talus and salter. It is important to note is that in studies performed from the year 2000 onwards, the overall on rate dropped from 33. Hawkin classification of talar neck fracture hawkins 1970 talar neck fractures into three type canale and kelly added type iv based on displacement of body of talus. The peculiar position of the bone in the foot arch and its sophisticated connection to the different joints complicate the treatment of the fracture.
Useful to perdict long term outcome and development of avn of talar body 39. In type 3 injuries, all medial blood supply to the body is disrupted. High energy injury usually associated with forced dorsiflexion and axial load. Talus taler ankle fracture surgery orif, postop recovery, progression of weightbearing, diagnostic imaging, and physical therapy from the patient and nurse perspective. The results of our study challenge the previously accepted notion that talar neck fractures are the most common type of talar fracture 3, 1416, 18, 19. Talus fractures pediatric orthopaedic society of north. D, lateral radiograph shows fracture of talar waist with avascular necrosis and two cancellous screws on proximal talus. Canale and kelly added an additional type, hawkins type iv, a vertical fracture of the talar neck with subtalar, tibiotalar, and talonavicular joint subluxation or dislocation, which also injures all 3 main vessels, with a nearly 100% rate of osteonecrosis.
A hawkins class iii fracture is a displaced fracture extending through the talar neck with dislocation at both the subtalar and tibiotalar joints and a 69100% risk of avn. We report a case of a displaced fracture of the talar neck with a complete posterior dislocation and rotation of the body of the talus hawkins type iii associated with medial malleolus fracture, treated with the method of urgent open reduction. A hawkins type i fracture is an undisplaced fracture, without any associated subluxation or dislocation component to it. The authors report a case of a grade 3 tscherne, isolated hawkins type iii fracture that was treated with open reduction and external fixation. Hawkin classification ofhawkin classification of talar neck fracturetalar neck fracture hawkins 1970 talar neck fractures into fourhawkins 1970 talar neck fractures into four typestypes canale and kelly added type ivcanale and kelly added type iv based on displacement of body of. Several serious complications can occur after talar neck fractures. The overall incidence of talar osteonecrosis in hawkins type ii and type iii fractures varies from 0 to 50%. There were 33 hawkins type i fractures, 48 type ii fractures, 29 type iii and.
Osteonecrosis is reported in up to half of talar neck fractures, although many of these. In type 2 injuries, the medial blood supply may be preserved. Hawkins classification of talar neck fracture illustration. Jul 01, 2010 hawkins type iv has the highest chance, reaching almost 100% due to the amount of displacement and disruption of the blood supply to the talus. Jul 14, 2017 the hawkins system is the most widely accepted classification system for talar neck fractures and includes three classifications based on initial fracture displacement. Type iii is a displaced vertical talar neck fracture with subluxation or dislocation of the. Jan 14, 2015 in 1978, canale and kelly added a fourth group not previously described by hawkins type iv, in which the fracture of the talar neck was associated with dislocation of the body from the ankle or subtalar joint with additional dislocation or subluxation of the head of the talus from the talonavicular joint. In type 1 injuries, the medial blood supply is still assured.
Fractures of the neck of the talus based on the modified hawkins classification are shown. Failure to diagnose and properly treat a fracture of the lateral process of the talus can result in longterm disability caused by subtalar arthrosis, malunion, or nonunion. The hawkins sign describes subchondral lucency of the talar dome seen in ap view that occurs secondary to subchondral atrophy 68 weeks after a talar neck fracture 1 this indicates that there is sufficient vascularity in the talus, and is therefore unlikely to develop avascular necrosis of the talar dome later 2, 3 disruption of the blood supply to all or a portion of the talar dome. Because the talus is important for ankle movement, a fracture often results in substantial loss of motion and function. Hawkins type iv has the highest chance, reaching almost 100% due to the amount of displacement and disruption of the blood supply to the talus. Fractures of the neck of the talus hawkins classification. Hawkins classification of talar fractures uw emergency. Hawkins type 3 displaced fracture of the talar neck with dislocation or subluxation of the talar body from both the tibiotalar and subtalar joints. Apr 21, 2015 results of blair fusion a type 3 fracture dislocation 2nd xray is immediately after blair fusion 3rd xray is after fusion at 3 months 1. Hawkins classification litfl medical eponym library.
In hawkins classification, type 1 fractures are not associated with dislocation, type 2 are fractures with subtalar dislocation, and type 3 are fractures associated with both ankle and subtalar. In the case of a type 1 talus fracture and a calcaneus fracture requiring operative intervention, we believe that internal fixation of the talus may be beneficial to prevent displacement and. Hawkins type i fractures have also been described in association with salter harris iii fractures of distal tibia. Total talar fracture longterm results of internal fixation of talar.
Restoration of articular and axial alignment is necessary to optimize ankle and hindfoot function. How to conquer talar neck fracture malunions podiatry today. Type iii displaced fracture, dislocation subtalar and tibiotalar joints 69100% type iv displaced fracture and disruption of talonavicular joint high avnavascular necrosis nonoperative vs. This data reflects the paradigm shift in management of talar neck fractures described in this article, where. It is based on displacement and dislocation and therefore correlates with the presumed talar blood supply damage.
Seminar on fracture talus chairperson presented by dr rupa kumar. Displaced neck fracture with subtalar dislocation or subluxation. The type iv category consists of a dislocation of the ankle and subtalar joint, along with a dislocation or subluxation of the head of the talus at the talonavicular joint. Open injuries, tendon rupture, and nerve injuries have been reported, 14, 15. Despite this, posttraumatic arthrosis occurs frequently after talar neck and body fractures, especially with comminution of the talar body. We report a case of a displaced fracture of the talar neck with a complete posterior dislocation and rotation of the body of the talus hawkins type iii associated with medial malleolus fracture, treated with the method of urgent open reduction and internal fixation of the. He was involved in a highenergy motor vehicle accident and suffered from several injuries amongst which a severely dislocated talar fracture type hawkins iv fig. Treatment of type 2, 3, and 4 talar neck fractures fig. Arthritis is common after a talus fracture because so much of the bone is covered with cartilage. The hawkins classification is based upon blood supply to the talus. The hawkins classification was expanded by canale and kelly who added the type iv group. Talar neck fracture with subtalar and tibiotalar dislocation. Diagnosis and treatment of talar dislocation fractures.
Type i nondisplaced talar neck fracture rare to see avn type ii talar neck fracture with mild displacement. The degree of displacement and dislocation is thought to be the primary means of the interruption of blood supply and therefore the risk for the development of avn. Hawkins typeii talar fracture with subtalar dislocation. Talus fracture is less common than most fractures, and bilateral talar neck fracture is extremely rare.