­­Patient position 

Cervical Spine Reduction-019

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)


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)


  1. Manual traction is added to tongs by senior clinician, greatest on side of un-reduced facet
  2. Gentle rotation to 45 degrees is applied towards side of unreduced facet whilst maintaining additional traction


Patient position

Singhal Bed



Shoulder strap placement

Screen Shot 2016-05-19 at 19.15.23


Load cell tensioner handle

Screen Shot 2016-05-19 at 19.14.46


Mast tensioner handle

Screen Shot 2016-05-19 at 19.14.38


­­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