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Hello to all!

I need advice on a Hawkins 2, talar neck fracture I suffered while out cycling 10 weeks ago. As all of us are probably aware the disruption of the fragile talar vascular structure is the main barrier to healing, with avascular necrosis of all or part of the talus being a significant factor in all talar fractures. In my case, three screws were used to stabilize/ align the talus and I was plaster casted for 6 weeks (3 months non-weight bearing).

At my six week caste removal and review, xrays were inconclusive for bone changes. I’m currently waiting a MRI scan and follow up review with the orthopod to establish if avascular necrosis has occurred, thus requiring further intervention.

Now being the patient, I’ve realized that my limited experience with Hawkins fractures is with patients who are seeking treatment for the chronic after effects of talar fractures and nothing to do with the surgical approach. Having done a lot of refreshing up on Hawkins fractures, I have struggled to find specific information on the decision process for the various methods of vascular repair.

Obviously, if avascular necrosis is present, the choice of treatment will be governed to a large extent by the presentation of the MRI findings and possibly the surgeons preference, but if a choice is available I’m keen to place myself in a better position to discuss and engage in the decision process.

I’m hoping some colleagues with direct experience in Talar fractures can help me with information on current / best practice options for non union issues.

Especially in regard to:

Core Decompression
Muscle flap
Free vascularized bone graft
Shock wave therapy
Bone stimulators

Many thanks
Barrie