Cervical Spine Traction With Gardner-Wells Tongs


  • 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


  • 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.


  • 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.


  • 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.


Aug 22, 2023 | Posted by in ORTHOPEDIC | Comments Off on Cervical Spine Traction With Gardner-Wells Tongs

Full access? Get Clinical Tree

Get Clinical Tree app for offline access