Hawkins Sign

The Hawkins sign is a subchondral radiolucent band along the dome of the talus. It is a good prognostic sign that is best seen on frontal radiographs of the ankle 6–8 weeks after a vertical fracture of the neck of the talus. The radiolucent band reflects osteoclast activity following disuse or immobilization that results in bone reabsorption and indicates a preserved blood supply. An absent Hawkins sign indicates a high risk of avascular necrosis.

Absence of the Hawkins sign has been shown to be 100% sensitive and 57.7% specific for avascular necrosis in patients with displaced talar fractures.

References

• Donnelly EF. The Hawkins sign. Radiology. 1999 Jan;210(1):195-6.
• Tezval M, Dumont C, Stürmer KM. Prognostic reliability of the Hawkins sign in fractures of the talus. J Orthop Trauma. 2007 Sep;21(8):538-43.