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Rios JJP, Bernáldez GIL, Oropeza EO, Aguilar OJM, Olvera MD. Closed reduction of fracture-dislocation of the sub-axial cervical spine with Gardner-Wells tongs. Technical note. Trauma Case Rep 2023; 48:100948. [PMID: 37781163 PMCID: PMC10540047 DOI: 10.1016/j.tcr.2023.100948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/22/2023] [Indexed: 10/03/2023] Open
Abstract
Study design Technical note. Purpose To provide a technical description of the placement of Gardner-Wells tongs and the performance of awake cranio-cervical traction to reduce AO type C injuries of the sub-axial cervical spine with Gardner-Wells tongs. Methods In this technical note, the authors present the indications, the contraindications, the pull-out of the pins, a detailed description of the technique for its proper placement, traction reduction technique, reduction maneuvers, complications and post-reduction care. Results Awake reduction of AO type C injuries of the sub-axial cervical spine can be successfully performed using Gardner-Wells tongs. Conclusions There is sufficient evidence to recommend the use of cranio-cervical traction in these vertebral injuries; however, we lack a detailed technical note to guide its proper placement.
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Affiliation(s)
- Jeasson Javier Pérez Rios
- National Autonomous University of Mexico, Ciudad de México, Mexico
- Mexico City Spine Clinic, “Dr. Manuel Dufoo Olvera”, Mexico City, Mexico
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Lee D, Kawano K, Ishida S, Yamaguchi Y, Kuroki T, Nagai T, Higa K, Kurogi S, Hamanaka H, Ochiai H, Chosa E. The impact of helicopter emergency medical services and craniocervical traction on the early reduction of cervical spine dislocation in a rural area of Japan. J Orthop Sci 2022; 27:606-613. [PMID: 33933327 DOI: 10.1016/j.jos.2021.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/29/2021] [Accepted: 03/15/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Several studies have shown an association between achieving decompression of the spinal cord within a few hours and neurological recovery, even in patients with complete paralysis due to cervical spine dislocation. This study aimed to clarify the impact of helicopter emergency medical services (HEMSs) and craniocervical traction on the rapid reduction of lower cervical spine dislocation in rural Japan. METHODS The success rate of and factors inhibiting closed reduction, the time from injury to reduction and the functional prognosis of lower cervical spine dislocations treated between July 2012 and February 2020 were retrospectively analysed. RESULTS Fourteen patients were transported by HEMS (group H), seven by ambulance (group A) and two by themselves. Although the average traveled distance and injury severity score were significantly higher in group H (64.5 km, 28.0) than in group A (24.7 km, 18.6), there was no significant difference in the average time to admission or the time to initiation of craniocervical traction after admission between groups H (159.4 min, 52.2 min) and A (163.6 min, 53.2 min). The success rate of closed reduction was 95%, and neurological deterioration was not observed in any cases. The average traction time and weight for reduction were 30.3 min and 16.3 kg, respectively. Body size and fracture-dislocation type did not significantly affect the traction time or weight. The rate of reduction within 4 h after injury was higher in group H (79%) than in group A (33%). Inner fixations were treated an average of 5.7 days after admission. After treatment, three of nine AIS A patients recovered the ability to walk, and all three patients underwent successful closed reduction within 4 h after injury. CONCLUSION HEMS and highly successful closed reduction contributed to the early reduction of cervical spine dislocation and can potentially improve complete paralysis.
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Affiliation(s)
- Deokcheol Lee
- The Department of Orthopaedic Surgery, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan; Emergency Medicine, Acute Critical Care Center, University of Miyazaki Hospital, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
| | - Keisuke Kawano
- The Department of Orthopaedic Surgery, Miyazaki Prefectural Nobeoka Hospital, 2-1-10 Shinkouji, Nobeoka, 882-0835, Japan
| | - Shotaro Ishida
- The Department of Orthopaedic Surgery, Miyazaki Prefectural Nichinan Hospital, 1-9-5 Kiyama, Nichinan, 887-0013, Japan
| | - Yoichiro Yamaguchi
- The Department of Orthopaedic Surgery, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan; Emergency Medicine, Acute Critical Care Center, University of Miyazaki Hospital, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Tomofumi Kuroki
- The Department of Orthopaedic Surgery, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Takuya Nagai
- The Department of Orthopaedic Surgery, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Kiyoshi Higa
- The Department of Orthopaedic Surgery, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Syuji Kurogi
- The Department of Orthopaedic Surgery, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Hideaki Hamanaka
- The Department of Orthopaedic Surgery, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Hidenobu Ochiai
- Emergency Medicine, Acute Critical Care Center, University of Miyazaki Hospital, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Etsuo Chosa
- The Department of Orthopaedic Surgery, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
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