Hawkins Type III Talar Fractures
- See: Avascular Necrosis and Salvage of Talus Fractures
- displaced frx of talar neck with dislocation of body of talus from both subtalar joint and ankle joint;
- when body dislocates, it is usually found on posterior medial aspect adjacent to the Achilles tendon;
- body fragment rotates around intact deltoid ligament fibers to lie in soft tissues w/ frx surface pointing laterally and cephalad;
- in this location, there can be compression of the neurovascular structures, and care must be taken when approaching by open
means dislocated body of talus;
- talocalcaneal ligament is ruptured when there is dorsal displacement of the distal fragment;
- after rupture of this ligament, it is difficult to control distal talar neck fracture by closed means;
- Radiographic Evaluation: Hawkins Sign
- surgical approaches:
- usually there is posteromedial displacement with the deltoid ligament intact (which means that the deltoid brach artery
is left intact)
- medial malleolar osteotomy;
- associated frxs of medial malleolus facilitates reduction because malleolus & attached deltoid ligament can be retracted distally,
& ankle mortise can be opened to allow reduction of talus;
- frequently deep fibers of deltoid lig remain attached to talar body;
- these fibers is not be released surgically because they may carry only remaining arterial supply to the body;
- it is preferable to osteotomize the medial malleolus and reflect it distally to facilitate reduction rather than cutting
intact deltoid ligament;
- Reduction of irreducible Hawkins III talar neck fracture by means of a medial malleolar osteotomy: a report of three cases with a 4-year mean follow-up.
- Open Reduction for AO/OTA 81-B3 (Hawkins 3) Talar Neck Fractures: The Natural Delivery Method.
- anterior capsule at medial axilla is exposed;
- posterior tibial tendon sheath is incised posteriorly, exposing the posterior tibial tendon (retract the tendon posteriorly);
- drill two holes into the medial malleolus inorder to accomodate post osteotomy screw placement;
- care is taken to avoid trauma to the deltoid ligament;
- 1 cm proximal to the joint line, a saggital saw is used to make a transverse cut thru the tibial cortex, parallel to the plafond;
- this cut extends to the level of the axilla;
- osteotome is then used to complete the ostetomy (from the axilla to the transverse cut), in an anterior to posterior direction;
- facilitated, w/ insertion of calcaneal traction pin;
- inorder to reduce talar body into the mortise, foot is dorsiflexed w/ heel translated anteriorly;
- the foot is then everted, and talar body translated medially, and finally is plantar flexed;
- ref: Open Reduction for AO/OTA 81-B3 (Hawkins 3) Talar Neck Fractures: The Natural Delivery Method.
- retrograde K wires are placed through frx & out posterior lateral aspect;
- cannulated screws are used through posterior-lateral aspect using wires;
- ref: Treatment of Comminuted Talar Neck Fractures with Use of Minifragment Plating.
- vast majority of these patients will have a poor result (infection, AVN, DJD);
- avascular necrosis and salvage of talus fractures
- AVN: may occur in up to 90 % of patients
Original Text by Clifford R. Wheeless, III, MD.
Last updated by Data Trace Staff on Wednesday, May 18, 2016 10:02 am