Application of Gardner-Wells Tongs, Mayfield Head Holder, and Halo

Ehsan Saadat

John M. Rhee

Gardner-Wells Tongs

General indications for Gardner-Wells tongs (Figure 30-1):
- To reduce fractures/dislocations of the cervical spine
- Occasionally when intraoperative traction is desired during anterior cervical diskectomy and fusion or corpectomy
- For preoperative traction of cervical deformity
  
  Figure 30-1 ▪ Gardner-Wells tongs.
The optimal location for pins is 1 cm above the pinna of the ear, in line with external auditory meatus and below the equator of the skull (Figure 30-2).
- A pin that is too anterior will place the temporalis muscle and the superficial temporal artery and vein at risk.
- Pins proximal to the equator of the skull can pull out with traction.
  
  Figure 30-2 ▪ A-B, Proper pin location for Gardner-Wells tongs.
Prep the area with povidone iodine solution or alcohol. If patient is awake during application of the tongs, infiltrate the skin down to the skull with several milliliters of 0.5% Marcaine with epinephrine.
Tighten the pins sequentially, going from side to side to evenly tension them, until the spring-loaded indicator protrudes 1 mm above surface, equal to about 30 lb of force.
An anterior pin applies a flexion moment to the cervical spine.
A posterior pin applies an extension moment to the cervical spine.
Rope is tied to the S hook and passed over a fulcrum at the top of the bed. Weight is tied to the other end of the rope hanging from the bed as needed.
- An average head weighs around 10-13 lbs. Therefore, this is a reasonable amount of weight to initiate traction.
- Weight is gradually added as needed, carefully assessing neurologic status and taking x-rays to verify position.