Patient position
Patient is positioned supine on Howard Wright bed. Traction frame set up as shown
Ensure the following:
- Poles are perpendicular and parallel. Rope and pulley in midline
- Cage joins are tight
- There is adequate distance from the weight spike to the floor
- Knots are secured and ends taped
Pin placement
Black dotted line – skull equator
Red line – Temporal artery (palpated)
Green line – Pin insertion line, 1cm superior to pinna
Depending on injury pattern, flexion, extension or neutral neck position may be required during traction. This is achieved using the following pin placements. The on-call spinal specialist (OCSS) will recommend pin placement 1-2 cm anterior or posterior to a point directly superior to the pinna (neutral)
Depending on injury pattern, flexion, extension or neutral neck position may be required during traction. This is achieved using the following pin placements. The on-call spinal specialist (OCSS) will recommend pin placement 1-2 cm anterior or posterior to a point directly superior to the pinna (neutral)
Posterior placement causes the neck to flex with traction
Anterior placement causes the neck to extend with traction
Gardner-Wells tongs assembly
Depending on tong and S hook size, it may be necessary to remove a pin to place S hook
Ensure pin nuts are outside of tongs prior to pin placement
Tension indicatior
One pin will be spring loaded so that it indicates optimal tension, check it is working correctly prior to tightening
Once optimal tension reached, the pin will protrude 1mm from pin so that it is flush with the exterior margin. Do not over tighten
Shoulder traction
Shoulder traction may be required to obtain images of the lower cervical spine
Manipulation of locked facet (left)
- Manual traction is added to tongs by senior clinician, greatest on side of un-reduced facet
- Gentle rotation to 45 degrees is applied towards side of unreduced facet whilst maintaining additional traction
Patient position
Singhal Bed
Shoulder strap placement
Load cell tensioner handle
Mast tensioner handle
Traction application
ASIA assessment
Medical Research Council (MRC) grading
| MRC Grade | Objective Power |
| Grade 5 | Normal power |
| Grade 4 | Active movement against gravity and resistance |
| Grade 3 | Active movement against gravity only |
| Grade 2 | Active movement with gravity eliminated |
| Grade 1 | Only a trace or flicker of movement |
| Grade 0 | No movement |