Clinical outcome of closed reduction of cervical spine injuries in a cohort of Nigerians

Abstract

Study design A prospective observational study. Objectives To evaluate the effectiveness of closed reduction of cervical spine injuries (CSIs) using cervical traction and identify probable complications. Setting Methods Consecutive CSIs managed by closed reduction using Gardener-Well's Tongs traction were prospectively analysed. The data included imaging and neurological examinations findings, Frankel grading, and extent of reduction. Reduction of 95% or more was deemed satisfactory. The primary outcome measures were extent/degree of reduction and neurologic status classified as improved, same, or worse. Other complications were taken as secondary outcome measures. Result Seventy-four patients, 49 males, mean age 35.2 years (SD 9.7) were included. In all, 78.4% presented within 72 hours of injury. In total, 85.1% had road traffic crashes. Anterior subluxation was seen in 86.5%. The degree of displacement was <25% in 36/74 (48.6%), 25-50% in 19/74 (25.7%), 50-75% in 8/74 (10.8%), and >75% in 11/74 (14.9%). Traction reduction was done after 7 days of injury in 52.7% and same day of injury in 1.4%. Reduction weight ranged from 2 kg to 60 kg. Reduction was satisfactory in 67.6% and failed in 32.4%. In all, 81.1% of patients remained neurologically the same, while 18.9% improved. Causes of failed reduction were facet lock (15), old injury (8), new-onset/worsening pain (3), and over-distraction (2). Complications of closed reduction were over-distraction (5), tong pull-out (2), new-onset/worsening pain (2), and skull perforation (1). Conclusions Satisfactory closed reduction is feasible in patients with CSI and significant malalignment. The method is associated with few complications.

Fracture Dislocation at the Level of C6-C7: A Case Report and Literature Review

“…In addition, the complications of reduction in a closed manner were over-distraction most commonly, tong pull-out, new-onset or worsening pain, and finally skull perforation. However, they concluded that satisfactory reduction can be achieved in patients with cervical spine injuries and significant malalignment [17].…”

Traumatic Cervical Facet Fractures and Dislocations

“…There is no accepted upper limit to the weight that can be used to reduce these injuries; however, weights up to 140 lb (63.5 kg) have been reported as tolerated for reduction of facet dislocations 31,32 . On average, for unilateral facet dislocations, 10 lb (4.5 kg) per level above the jumped facets will be required in order to reduce the dislocation (i.e., the more caudal the dislocation, the more weight is necessary for reduction).…”