[Prognostic factors for avascular necrosis following talar fractures].
OBJECTIVE
We performed an investigation of factors for avascular necroses after talus fracture and on the reliability of the Hawkins Sign.


METHODS
From 1984 until 1997 a total of 98 patients with 99 talus fractures were surgically treated. Of these, 79 patients with 80 fractures were examined clinically and radiologically. The average postoperative interval was 6 years and 2 months.


RESULTS
With respect to the 65 central fractures, the rate of necrosis amounted to 14 %, that of collum fractures to 17 %. Necroses arose solely in dislocated central fractures of the talus, type III and IV according to Marti/Weber fracture classification. The rate of necrosis rose with the degree of dislocation of the fractures. In 24 patients the Hawkins Sign could be retrospectively investigated. It proved to be a relatively reliable sign for vitality since only 1 out of 12 patients with positive or partial positive Hawkins Sign developed avascular necrosis. Neither a short interval between accident and operation, the age at the time of the accident, nor the ipsilateral fracture of the medial malleolus showed a necrosis preventive influence. In 5 out of 9 talus necroses the patients were very or mostly satisfied with the result of their treatment.


CONCLUSIONS
The Hawkins Sign proved to be a relatively reliable sign for vitality of the talus after fracture. Risk for avascular necrosis increases according to the degree of fracture dislocation.
Chirurgische Universitätsklinik und Poliklinik, Ruhr-Universität Bochum, Berufsgenossenschaftliche Kliniken Bergmannsheil, Bochum. Schulzenhaus@web.de
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Schulze
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Richter
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Russe
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Ingelfinger
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Muhr
D000293:Adolescent; D000328:Adult; D016512:Ankle Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000000981:diagnostic imaging*; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011379:Prognosis; D011859:Radiography; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013628:Talus / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery