Chapter 150: Skeletal Traction (Gardner-Wells Tongs) for Cervical Spine Dislocations and Fractures

INTRODUCTION

Traumatic injuries to the cervical spine result from forces acting on the head and neck. The incidence of spinal cord injury in the United States is approximately 5 per 100,000.¹ Approximately 60% to 80% of spinal cord injuries involve the cervical spine. Cervical spine injuries can occur at all ages with predilection for teens and young adults. Emergency Physicians must be aware of cervical spine injuries in the elderly with seemingly minor mechanisms of injury.² Motor vehicle collisions are the most common cause and account for almost half of cervical spine injuries.³ The remaining cervical spine injuries result from falls, sports injuries, violence, penetrating wounds, and miscellaneous causes. Few other injuries have the potential to cause such high levels of morbidity.

The primary aims of therapy with an acute spinal cord injury are to safely extract and transport patients from the scene, to identify injury early, to minimize secondary injury to the spinal cord by preventing hypoxia and hypotension, to realign the spine, to improve neurologic recovery, to maintain spinal stability, and to obtain an early functional recovery. This is achieved by decompression of the spinal cord through restoration of the normal sagittal diameter of the spinal canal using cervical traction and/or removing a compressive lesion surgically. This is particularly important in patients who have sustained an incomplete spinal cord lesion and are found to have a progressing neurologic deficit. Restoring the normal anatomic position provides pain relief.

Consider all cervical spine injuries unstable until proven otherwise. Neurosurgical guidelines recommend the use of a rigid cervical collar with supportive blocks and taping of the patient’s forehead to the backboard to provide for the greatest degree of cervical stabilization.⁴ Operative intervention has become more common in the management of cervical trauma with improved imaging and surgical tools. The use of skeletal traction in the acute spinal cord injury patient remains a safe and straightforward method of reducing fractures and maintaining the spinal canal in anatomical alignment during initial management, as a surgical adjunct, or as definitive therapy.

Fabricius Hildanus utilized forceps in treating fractures or dislocations of the cervical spine as early as 1646. Crutchfield is credited for introducing skeletal tongs in the management of cervical spinal injuries.⁵ Crutchfield developed a pair of self-tightening tongs in 1933 that allowed him to apply traction to the cranium in a patient with a cervical spine fracture.⁵ These tongs were subsequently modified and have essentially been replaced by the Gardner-Wells tongs.⁶ Gardner-Wells tongs were introduced in the early 1970s and utilize the principle of a spring-loaded point for cervical traction.⁶

ANATOMY AND PATHOPHYSIOLOGY

Cervical spinal cord injuries can be divided into upper (i.e., occiput to C3) and lower (i.e., C3 to C7) injuries. Numerous classification systems exist. These are based upon the morphology and the mechanism of injury.⁷ No ...