Hawkins classification

Description

Hawkins classification: Classification system for talar neck fractures. Hawkins originally described Types I-III in 1970 with Canale and Kelly adding Type IV in 1978

  • Hawkins Type I: Nondisplaced talar neck fracture
  • Hawkins Type II: Talar neck fracture with subtalar dislocation
  • Hawkins Type III: Talar neck fracture with subtalar and tibiotalar dislocation
  • Hawkins Type IV: Talar neck fracture with subtalar and tibiotalar and talonavicular dislocation

Commonest type of talus fracture. High energy injury usually associated with forced dorsiflexion and axial load. Associated with risk of avascular necrosis (AVN)

Classification Talus fracture dislcoations astralgus

History of talus fracture classification

1608Wilhelm Fabry first description of talus fracture in a report quoted in Opera quae extant omnia (1646). Observation 67:140.

…the Rev. Master Woolfbrand of Duisburg, a man strong and fleshy, in jumping from a bank three feet high so twisted and broke his right foot that the whole of the os tali was not only displaced but the ligaments by which it is bound to the other bones, being broken, it burst through the skin and hung out.

1818Astley Cooper wrote at length on fractures and dislocations of the astragalus (talus) in his treatise on dislocations and on fractures of the joints (1824)

1919 – Anderson HG was consulting surgeon to the Royal Flying Corps in the war of 1914-1918. He described eighteen cases of fracture and dislocation of the talus. He noted the association of injuries of the talus with the aircraft crash and named them collectively ‘Aviator’s Astragalus.’

…falls from a height on to the foot are common in civilian occupations but the calcaneum [os calcis] is usually broken, On the other hand, the aviator usually falls with his machine and strikes the ground at an angle. The sole of the foot rests on the rudder bar and with the impact the latter gets pressed into the instep just in front of the heel. There the astragalus takes most of the force and becomes the seat of fracture. Before the actual fracture occurs, the foot may be in a position of acute dorsiflexion, plantar flexion, or may be inverted.

1939 – Various attempts made to create a classification system such as Miller and Baker in the Southern Medical Journal in 1939.

1952 – Coltart reported on 228 talus injuries treated by surgeons in the British Royal Air Force in an attempt to describe the variety of injuries that occur to the talus and surrounding joints. He described various talus fracture patterns, fracture-dislocation combinations, and isolated peritalar dislocations

1970Leland G Hawkins described injury patterns and avascular necrosis (AVN) rates in a series of 57 vertical talar neck fractures in 55 patients from three different institutions. All 55 patients sustained forced dorsiflexion injuries, similar to the mechanism described as Aviator’s Astragalus by  Anderson in 1919. Originally classified into three types (Types I-III)

1978 – Canale and Kelly presented a series of 71 fractures with an average 13-year followup (range, 2.5–32 years) and an AVN rate of 52%. They added Type IV to Hawkins original classification. Fracture of the talar neck with dislocation of the body from the ankle or subtalar joint and additional dislocation/subluxation of the head of the talus from the talonavicular joint


Associated Persons


Alternative names

  • Aviator’s astragalus
  • Astragalus fractures

References


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Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and informatics. Asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | vocortex |

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