- Spine trauma
- Indications
- Cervical spine fractures or dislocations (e.g. subluxation, burst fracture, facet dislocation)
- Pre-operative or emergency closed reduction of unstable cervical injuries
- Temporary cervical immobilisation
- Preparation
- Explain the procedure to the patient if conscious
- Analgesia and sedation as needed (local anaesthetic infiltration at pin sites)
- Position the patient supine with the neck in neutral alignment
- Shave and clean pin insertion sites—usually 1 cm above the pinna at the level of the external auditory meatus, in the parietal bone
- Tongs application
- Infiltrate local anaesthetic at both pin sites
- Ensure tongs are properly assembled and aligned
- Place each pin against the skull on the marked site, ensuring symmetrical positioning
- Gradually tighten each side evenly until the tongs are secure
- Torque pins to manufacturer’s recommended setting (usually ~4–8 in-lb for Gardner-Wells tongs)
- Traction application
- Attach the rope and pulley system to the tongs
- Begin with a small weight (e.g. 2.5–5 kg), and incrementally increase depending on patient weight and response
- Monitor alignment with serial lateral cervical spine X-rays
- Stop increasing weights once reduction is achieved or neurologic deterioration occurs
- Monitoring and care
- Frequent neurovascular assessment of the limbs
- Monitor pin sites for signs of infection or loosening
- Maintain head alignment and traction integrity
- Clean pin sites daily with antiseptic
- Leave tongs in place until definitive surgical fixation or orthotic immobilisation is planned