Cervical Spine Traction With Gardner-Wells Tongs

Overview

1.

Cervical spine traction is accomplished with placement of calipers or tongs to the skull and attachment to a pulley system secured to a bed.
2.

Although a wide variety of tongs exist, Gardner-Wells tongs are the most frequently used and the most frequently available. Gardner-Wells tongs consist of a hoop attached to two 30-degree angled pins.

Indications for Use

1.

Subaxial cervical fractures that are misaligned
2.

Subaxial cervical facet dislocations
3.

Selected odontoid fractures, hangman’s fractures, and C1-C2 rotatory subluxation

Precautions

1.

Before application of cervical spine traction, consultation with the treating spine surgeon is paramount. Typically, unconscious or uncooperative patients require a magnetic resonance imaging (MRI) scan prior to reduction to rule out an associated disc herniation. Some controversy exists with regard to obtaining a prereduction MRI scan in patients who are awake and cooperative.
2.

Repeat cervical spine radiography is essential. Use of a C-arm machine allows repeated radiography to evaluate the reduction as weights are added.
3.

Careful pin placement is paramount to avoid iatrogenic injury.
4.

The pin site entry is 1 cm above the pinna (earlobe) in line with the external auditory meatus.
5.

Ensure that the pressure-sensitive spring-loaded indicator on the pin protrudes by 1–2 mm to indicate 30 in./pounds of pressure.
6.

The pins should be simultaneously tightened.
7.

Traction weights need to be added cautiously and sequentially.
- a.
  
  Start with 10 lb and add 5 lb per level. For example, a C5-C6 injury should have 35 lb of traction weight.
8.

Gardner-Wells tongs need to be retightened after 24 h. However, they can only be retightened once.
9.

The following complications can occur with application of Gardner-Wells tongs:
- a.
  
  Skull perforation
- b.
  
  Injury to the temporalis muscle or temporal artery
- c.
  
  Pin migration or pullout
- d.
  
  Infection
10.

No absolute maximum weight for traction exists, but some authors suggest a limit of 70 lb. Be aware that MRI-compatible tongs are made of graphite and titanium, resulting in lower failure loads. Avoid using these tongs if more than 50 lb are to be used.

Pearls

1.

Prior to application, ensure that a complete neurological examination is documented.
2.

If an MRI scan is planned, then ensure that the Gardner-Wells tongs are made of an MRI-compatible graphite tong and titanium pin system.
3.

Place the bed into a slight reverse Trendelenburg position if the patient’s weight is light and if he or she slides to the top of the bed as weights are being applied.
4.

Facet dislocations without associated fractures can be “unlocked” by raising the height of the pulley, thus resulting in a flexion movement and aiding in reduction.
5.

Unilateral facet dislocations typically require more weight than do bilateral dislocations.