The "Gull Sign": a harbinger of failure for internal fixation of geriatric acetabular fractures.

OBJECTIVES

To identify factors affecting the outcomes of surgery for acetabular fracture in patients over the age of 60 years.

DESIGN

Retrospective review of records and radiographs; current examination, radiographs and outcome surveys when possible.

SETTING

Academic, Level 1 trauma center.

PATIENTS/

PARTICIPANTS

Forty-eight patients over age 60 with displaced acetabulum fractures.

INTERVENTION: Surgical reduction and fixation.

MAIN OUTCOME MEASUREMENTS: Clinical ratings and radiographic evaluations, Short Musculoskeletal Functional Assessment survey (SMFA), SF-36, and hip-specific questions. Radiographs were evaluated using the criteria of Matta.

RESULTS

Ten patients died since surgery. Four were lost to follow-up. Seven had >12 months of follow-up information in the chart. Twenty-seven had current evaluations for the study. Average follow-up was 37 months, range 1-114 months. The average age at surgery was 71.6 years (range 61-88). No perioperative deaths occurred. Initial reductions achieved: 61% anatomic, 34% imperfect, and 5% poor. A specific radiographic finding (superomedial dome impaction) predictive of failure was identified. This was designated the "Gull Sign." These patients had inadequate reduction, early fixation failure, or medial/superior joint narrowing and subluxation. Functional outcomes in patients with current examination were similar to age-matched controls. Radiographic outcomes: 30% excellent, 30% good, 9% fair, 23% poor, and 7% arthroplasty. Anatomic reduction was closely related to good or excellent radiographic result.

CONCLUSIONS

While some patients over sixty years of age can have satisfactory functional outcomes after acetabular fracture fixation, a significant number will have failure of the procedure. Osteopenic patients with superomedial dome impaction (the Gull Sign) did not benefit from attempted open reduction and internal fixation in this series.