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The Jones-Powell Classification of open pelvic fractures: a multicenter study evaluating mortality rates
Lisa K Cannada1, Ryan M Taylor, Robert Reddix
1Department of Orthopaedic Surgery, Saint Louis University, St Louis, Missouri 63110, USA. Lcannada@slu.edu
Insights
Open pelvic fractures have a high mortality rate, with Jones-Powell Class 3 injuries showing a 38% mortality. Rectal lacerations indicate increased injury severity and mortality risk in these patients.
Area of Science:
- Trauma Surgery
- Orthopedic Surgery
- Emergency Medicine
Background:
- Open pelvic fractures historically carry a high mortality rate.
- The Jones-Powell Classification system aids in predicting outcomes.
- Advances in early treatment may impact survival rates.
Purpose of the Study:
- To apply the Jones-Powell Classification to open pelvic fracture mortality.
- To evaluate the impact of modern interventions (pelvic binder, diverting colostomy, emergent angiography) on mortality.
Main Methods:
- Retrospective review of open pelvic fracture patients from six Level I trauma centers (2000-2006).
- Epidemiologic study, Level IV evidence.
Main Results:
- Overall mortality rate was 23% (15/64 patients).
- All deaths occurred in patients with unstable fractures and/or rectal lacerations.
- Jones-Powell Class 3 injuries had a 38% mortality rate.
Conclusions:
- A Jones-Powell Class 3 open pelvic fracture is associated with significantly increased mortality.
- Rectal laceration may be a marker for severe injury and higher mortality risk.
- Further research into acute interventions' impact on mortality is warranted.
Background:
Historically, open pelvic fractures have a high mortality rate. The Jones-Powell Classification system was developed to assist with morbidity and mortality prediction.The purposes of our study were twofold: 1. Apply the Jones-Powell Classification to mortality rates of open pelvic fractures; 2. Because the original article published on the Jones-Powell Classification was from 1997, there have been advances in the early treatment of pelvic fractures to include the use of the pelvic binder, early diverting colostomies, and emergent angiography. We wanted to examine if any of those acute interventions affected mortality rate.
Methods:
This is a retrospective review of all patients presenting with open pelvic fractures at six Level I trauma centers between 2000 and 2006.
Results:
There were 64 patients with an average age of 34 years (range, 17-57 years). Fourteen had stable pelvic fracture patterns, and 50 had unstable fracture patterns. The overall mortality rate in our study was 15 patients (23%). All patients who died had an unstable pelvic fracture and/or rectal laceration. Sixteen patients had diverting colostomies within 48 hours of injury. There were four patients with rectal lacerations and no patients with diverting colostomies who died.
Discussion:
In our population group, there was an overall mortality rate of 23%. A Jones-Powell Class 3 injury had a 38% mortality rate. The presence of a rectal laceration may serve as a marker for the severity of the patient's injuries and increased risk of mortality.
Level Of Evidence:
Epidemiologic study, level IV.
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