Prognostische Faktoren für die avaskuläre Nekrose nach Talusfrakturen

Schulze, W; Richter, J.; Russe, O; Ingelfinger, Patrick; Muhr, G.

doi:10.1055/s-2002-33401

Cited by 17 publications

(5 citation statements)

References 11 publications

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“…To understand the prognostic significance of Hawkins sign, all the articles were thoroughly reviewed; we identified eight articles of which six were of our interest, as they had mentioned the prognostic value of Hawkins sign. 34 35 36 37 38 39 …”

Section: Methodsmentioning

confidence: 99%

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Management Options in Avascular Necrosis of Talus

Dhillon

Rana

Panda

et al. 2018

IJOO

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Avascular necrosis (AVN) of the talus can be a cause of significant disability and is a difficult problem to treat. The most common cause is a fracture of the talus. We have done a systematic review of the literature with the following aims: (1) identify and summarize the available evidence in literature for the treatment of talar AVN, (2) define the usefulness of radiological Hawkins sign and magnetic resonance imaging in early diagnosis, and (3) provide patient management guidelines. We searched MEDLINE and PUBMED using keywords and MESH terminology. The articles' abstracts were read by two of the authors. Forty-one studies met the inclusion criteria of the 335 abstracts screened. The interventions of interest included hindfoot fusion, conservative measures, bone grafting, vascularized bone graft, core decompression, and talar replacement. All studies were of Level IV evidence. We looked to identify the study quality, imprecise and sparse data, reporting bias, and the quality of evidence. Based on the analysis of available literature, we make certain recommendations for managing patients of AVN talus depending on identified disease factors such as early or late presentation, extent of bone involvement, bone collapse, and presence or absence of arthritis. Early talar AVN seems best treated with protected weight bearing and possibly in combination with extracorporeal shock wave therapy. If that fails, core decompression can be considered. Arthrodesis should be saved as a salvage procedure in late cases with arthritis and collapse, and a tibiotalocalcaneal fusion with bone grafting may be needed in cases of significant bone loss. Role of vascularized bone grafting is still not defined clearly and needs further investigation. Future prospective, randomized studies are necessary to guide the conservative and surgical management of talar AVN.

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Section: Methodsmentioning

confidence: 99%

“…in their followup of 65 fractures could evaluate the Hawkins sign in 24 of their patients and concluded the Hawkins sign to be a relatively reliable sign for vitality of the talus after fracture. 36 Lutz et al . and Schwarz et al .…”

Section: Prognostic Significance Of Hawkins Signmentioning

confidence: 99%

Management Options in Avascular Necrosis of Talus

Dhillon

Rana

Panda

et al. 2018

IJOO

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“…A positive Hawkins sign is prognostically favorable and is considered to be a negative predictor of the development of talar osteonecrosis 15 . Subsequent research supports the prognostic importance of a positive Hawkins sign, with the majority of the literature showing it to be strongly associated with the lack of development of osteonecrosis 3,8,20-29 .…”

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confidence: 90%

The Hawkins Sign of the Talus

Griffin,

Landy,

Mechas

et al. 2024

Journal of Bone and Joint Surgery

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Background: Osteonecrosis is a complication of talar neck fractures associated with chronic pain and poor functional outcomes. The Hawkins sign, the radiographic presence of subchondral lucency seen in the talar dome 6 to 8 weeks after trauma, is a strong predictor of preserved talar vascularity. This study sought to assess the accuracy of the Hawkins sign in a contemporary cohort and assess factors associated with inaccuracy. Methods: A retrospective review of talar neck fractures at a level-I trauma center from 2008 to 2016 was conducted. Both the Hawkins sign and osteonecrosis were evaluated on radiographs. The Hawkins sign was determined on the basis of radiographs taken approximately 6 to 8 weeks after injury, whereas osteonecrosis was determined based on radiographs taken throughout follow-up. The Hawkins sign accuracy was assessed using proportions with 95% confidence intervals (CIs), and associations were examined with Fisher exact testing. Results: In total, 105 talar neck fractures were identified. The Hawkins sign was observed in 21 tali, 3 (14% [95% CI, 3% to 36%]) of which later developed osteonecrosis. In the remaining 84 tali without a Hawkins sign, 32 (38% [95% CI, 28% to 49%]) developed osteonecrosis. Of the 3 tali that developed osteonecrosis following observation of the Hawkins sign, all were in patients who smoked. Conclusions: A positive Hawkins sign may not be a reliable predictor of preserved talar vascularity in all patients. We identified 3 patients with a positive Hawkins sign who developed osteonecrosis, all of whom were smokers. Factors impairing the restoration of microvascular blood supply to the talus may lead to osteonecrosis despite the presence of preserved macrovascular blood flow and an observed Hawkins sign. Further research is needed to understand the factors limiting Hawkins sign accuracy. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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“…The Hawkins sign describes subchondral lucency of the talar dome that occurs secondary to subchondral atrophy due to inactivity six to eight weeks after a talar neck fracture. It indicates that there is sufficient vascularity in the talus and it is unlikely to develop an avascular necrosis later [8] , [9] . In case of combined non-union of the fracture and persisting pain diagnostics should be performed to confirm avascular necrosis.…”

Section: Introductionmentioning

confidence: 99%