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Hawkins Type I Talar Fractures

- Discussion:
    - type I fractures represent non displaced fractures;
    - fracture line entering the subtalar joint between the middle and posterior facets;
    - only those frxs in which there is no displacement of frx line and no incongruity of subtalar joint are designated as type I frx;

- Radiographic Evaluation:
    - consider CT scan if there is any question of displacement;

- Treatment:
    - important challenge in this injury is ensuring that anatomic reduction is obtained with no varus rotation;
    - most agree that this type of frx should be treated by below knee cast for 8-12 weeks, until clinical & x-ray signs of frx healing occur;
    - foot may be placed in slight equinus for proper reduction;
    - leg is kept non-wt bearing for 4 weeks, & then wt bearing is allowed in cast for another 8 weeks or until healing is evident by x-rays as evidenced by trabeculations across the fracture site;
            - at times, tomograms in the lateral projection will be needed to demonstrate union across the fracture site;

- Complications:
    - AVN: 10%
    - varus angulation may occur converting fracture to a Type II Talar Frx;
         - occurs due to medial comminution;
         - the main effect of this is to eliminate subtalar motion