Multicentre comparative study of Z-shape elevating-pulling reduction and skull traction reduction for treatment of lower cervical locked facets

Awake Early Manual Reduction Is Highly Effective for Subaxial Cervical Spine Dislocation

Introduction

Guidelines published in 2013 recommend early closed reduction for cervical spine dislocation. There are two types of closed reduction: manual reduction and traction. Manual reduction can be performed early. In addition, it can correct rotation and requires a short time for complete reduction. We perform manual reduction for cervical spine dislocation. This study aimed to evaluate early manual reduction's success rate and safety for cervical dislocation. We also examined the relationship between time to reduction and improvement in paralysis.

Methods

This retrospective cohort study included 361 patients with cervical spine injuries treated at our hospital between July 2010 and December 2021. We assigned patients to the early group if the time from injury to reduction was ≤6 hours and to the late group if >6 hours. We performed awake manual reduction on the patients. Furthermore, we compared reduction's success rate and safety, including neurological outcomes.

Results

Overall, 46 patients were included in the study: 31 and 15 in the early and late groups, respectively. The success rate of reduction was 93%, and no neurological complications from reduction were observed. The neurological outcomes and reduction success rates were significantly superior in the early group than in the late group.

Conclusions

Neurological outcomes were significantly superior when reduction was performed within 6 hours than after 6 hours. Manual reduction can be performed early, safely, and easily. It is effective for cervical spine dislocation requiring early reduction for an excellent neurologic prognosis.

Clinical Efficacy and Safety of Ibuprofen plus Traction, Reposition, and Hip Spica Cast in the Treatment of Developmental Dysplasia of the Hip

Objective. To assess the clinical efficacy and safety of ibuprofen plus traction, reposition, and hip spica cast in the treatment of developmental dysplasia of the hip (DDH). Methods. Between January 2019 and July 2020, 60 children with DDH treaded in department of orthopedics of our institution were assessed for eligibility and recruited. They were assigned at a ratio of 1 : 1 to receive either traction + reposition + hip spica cast plus analgesia pump (observation group) or traction + reposition + hip spica cast plus analgesia pump and oral ibuprofen (control group). The outcome measures included clinical efficacy, pain scores, unexpected pain calls, the dosage of analgesia pump, and adverse events. Results. The two groups had similar clinical efficacy ( $P>0.05$ ). The patients given oral ibuprofen were associated with significantly lower pain scores at 24 h and 72 h postoperatively versus those without oral ibuprofen ( $P<0.05$ ). Analgesics with oral ibuprofen resulted in fewer unexpected pain calls versus analgesics without oral ibuprofen within 72 h postoperatively ( $P<0.05$ ). The application of oral ibuprofen in the analgesia pump showed great improvement in lowering the dosage of analgesia pump versus the absence of ibuprofen ( $P<0.05$ ). The incidence of adverse events was similar between the two groups of patients ( $P>0.05$ ). Conclusion. Traction + reposition + hip spica cast plus analgesia pump and oral ibuprofen effectively mitigated postoperative pain in children with DDH and reduces analgesic drug dosage with a high safety profile.

Early Management of Cervical Spine Trauma: WFNS Spine Committee Recommendations

Epidemiology, prevention, early management of cervical spine trauma and it's reduction are the objectives of this review paper. A PubMed and MEDLINE search between 2009 and 2019 were conducted using keywords. Case reports, experimental studies, papers other than English language and and unrelated studies were excluded. Up-to-date information on epidemiology of spine trauma, prevention, early emergency management, transportation, and closed reduction were reviewed and statements were produced to reach a consensus in 2 separate consensus meeting of World Federation of Neurosurgical Societies (WFNS) Spine Committee. The statements were voted and reached a positive or negative consensus using Delphi method. Global incidence of traumatic spinal injury is higher in low- and middle-income countries. The most frequent reasons are road traffic accidents and falls. The incidence from low falls in the elderly are increasing in high-income countries due to ageing populations. Prevention needs legislative, engineering, educational, and social efforts that need common efforts of all society. Emergency care of the trauma patient, transportation, and in-hospital acute management should be planned by implementing detailed protocols to prevent further damage to the spinal cord. This review summarizes the WFNS Spine Committee recommendations on epidemiology, prevention, and early management of cervical spine injuries.