Biomechanical Implications of Asymmetric Gardner-Wells Tong Placement During Cervical Spine Traction

In cases of cervical facet dislocations, traction is typically delivered in the acute setting with tongs attached to the skull via two pins. Although the pins are recommended to be inserted symmetrically in a neutral loading position, erroneous asymmetric pin placement has been documented in case reports, but its biomechanical implications are unknown. The current study utilized a human surrogate to evaluate the influence of asymmetrically placed pins in the axial or frontal planes. In addition, asymmetry of the cable that delivers the traction force to the tongs was also investigated. In the majority of the pin configuration experiments, pin asymmetry did not significantly affect cervical spine loading. One exception was if one pin was placed 1 cm anterior to neutral and the contralateral was in the neutral position. This configuration resulted in a significant increase in the cervical extension moment, which should typically be avoided because it can hinder reduction. (Journal of Surgical Orthopaedic Advances 33(4):233-239, 2024).