A 28-year-old man sustains a displaced talar neck fracture treated with open reduction and internal fixation. At 8 weeks postoperatively, the subchondral bone at the talar dome shows subchondral radiolucency (atrophy) on the mortise view. This finding indicates:

• A Progressive avascular necrosis of the talus
• B Infection at the fracture site
• C Post-traumatic arthritis of the ankle joint
• D A favourable prognosis because the talar body has preserved blood supply ✓

Explanation

The Hawkins sign is subchondral atrophy (radiolucent band) beneath the talar dome seen 6 to 8 weeks after talar neck fracture. It indicates active resorption by living osteocytes, proving the body of the talus retains its blood supply and will not develop avascular necrosis. Absence of the Hawkins sign suggests loss of vascularity but does not confirm AVN. Infection and arthritis are unrelated to this specific radiographic pattern.

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

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Written and medically reviewed by the StethoPrep medical team.