A 28-year-old man sustains a talar neck fracture treated with open reduction and internal fixation. At 8 weeks postoperatively, a mortise view of the ankle is taken to assess vascularity of the talus. Which radiographic finding indicates an intact blood supply to the talar body?

• A Subchondral radiolucent line beneath the talar dome
• B Sclerosis and increased density of the talar body
• C Widening of the ankle joint space
• D Subchondral osteopenia of the talus compared with the surrounding bone ✓

Explanation

The Hawkins sign is subchondral osteopenia (atrophy) of the talar dome seen 6 to 8 weeks after injury, indicating active revascularization because disuse demineralization requires an intact blood supply. Its absence raises concern for avascular necrosis. The tempting distractor, sclerosis, represents the opposite process: a dense sclerotic talar body suggests lost vascularity and developing AVN, not preserved perfusion.

Reference: Rockwood and Green's Fractures in Adults, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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